To introduce systems biology as a conceptual framework for research in family medicine, based on empirical data from a case study on the prediction of influenza vaccination outcomes. This concept is primarily oriented towards planning preventive interventions and includes systematic data recording, a multi-step research protocol and predictive modelling.

Factors known to affect responses to influenza vaccination include older age, past exposure to influenza viruses, and chronic diseases; however, constructing useful prediction models remains a challenge, because of the need to identify health parameters that are appropriate for general use in modelling patients’ responses.

The sample consisted of 93 patients aged 50–89 years (median 69), with multiple medical conditions, who were vaccinated against influenza. Literature searches identified potentially predictive health-related parameters, including age, gender, diagnoses of the main chronic ageing diseases, anthropometric measures, and haematological and biochemical tests. By applying data mining algorithms, patterns were identified in the data set. Candidate health parameters, selected in this way, were then combined with information on past influenza virus exposure to build the prediction model using logistic regression.

A highly significant prediction model was obtained, indicating that by using a systems biology approach it is possible to answer unresolved complex medical uncertainties. Adopting this systems biology approach can be expected to be useful in identifying the most appropriate target groups for other preventive programmes.

Knee pain affects 25% of the population aged over 55 years and is the most common complaint of pain among those consulting for primary care. However, a large proportion do not seek help, with up to 50% of those with the most severe form of pain not consulting. Little is known about why this appears to be happening. Our aim was to examine whether consultations for concurrent comorbid disease had any influence on an individual's likelihood of consulting for knee-related problems in primary care.

This was a case–crossover control study of patients aged over 50 years from three North Staffordshire practices with knee pain followed over a three-year period. All comorbid consultations for the same period were identified. The date of knee consultation cases were identified, and within-subject control days for the same individual were determined for 12 months previously or later where there was no knee consultation. McNemar's test for matched pairs was then carried out to assess whether consultation for either a chronic or acute condition in the preceding three months was associated with knee consultation.

A total of 281 participants were included in the case–crossover analysis. There was a lower frequency of chronic comorbid consultations in the three months preceding knee consultation than in either the previous (OR = 0.30; 95% CI 0.11, 0.74) or later control windows (OR = 0.56; 95% CI 0.27, 1.09). There was no difference in the frequency of acute comorbid consultations.

This study suggests that consultations for knee problems are preceded by a period of relatively fewer consultations for other chronic comorbid conditions. Patients might choose to consult for their knee problem when comorbid issues are not a priority. Future research might investigate whether certain comorbid conditions have a greater effect than others, and whether a proactive approach such as screening for knee disorders might improve prognosis?

To describe the natural history of acute upper respiratory tract infections (AURIs) in primary-school children, by recording their daily symptoms.

AURIs in children are one of the most common reasons for people seeking advice from general practitioners (GPs); however, little is known about the natural history of AURIs in terms of the length and severity of symptoms, because the majority of illnesses are contracted at home.

After an initial pilot study to test the feasibility of parents recording symptoms in a diary based on the Canadian Acute Respiratory Illness and Flu Scale (CARIFS), a random selection of primary schools operating in the region was carried out in order to minimise selection bias. Meetings were arranged at the 20 schools to obtain written consent from parents and to give out diaries with a stamped addressed envelope. The diaries recorded daily symptom severity for one episode of AURI, and the data were analysed using SPSS programmes.

Diaries were returned from 223 children, of whom 146 had had an AURI. The average age was eight years, and there were almost equal numbers of boys and girls. The most frequent symptoms were runny nose, cough, feeling unwell and sore throat. There was a biphasic distribution with systemic symptoms in the first three days characterised by fever, poor sleep, irritability, not playing and headache. By day four, symptoms localising the infection to the upper respiratory tract appeared with runny nose, cough, sore throat and poor appetite; these continued into the second and occasionally third week. Most symptoms lasted for 5–11 days, with a median length for all symptoms of seven days. Symptoms defined by parents tended to be scored less for severity than symptoms defined by children.

The migration process may impose stress on the mental health of immigrants.

To describe the experiences of immigrant men of Kurdish ethnicity during and after migration to Sweden with regard to mental health issues.

Using the grounded theory method, we conducted a focus group interview with four Kurdish men and in-depth individual interviews with 10 other Kurdish men.

A model with two major themes and interlinked categories was developed. The themes were (1) protective factors for good mental health (sense of belonging, creation and re-creation of Kurdish identity, sense of freedom, satisfaction with oneself) and (2) risk factors for poor mental health (worry about current political situation in the home country, yearning, lack of sense of freedom, dissatisfaction with Swedish society).

The study provides insights into the psychological and emotional experiences of immigrant men of Kurdish ethnicity during and after migration to Sweden. It is important for primary health care providers to be aware of the impact that similar migration-related and life experiences have on the health status of immigrants, and also to be aware that groups are comprised of unique individuals with differing experiences and reactions to these experiences. The findings highlight the common themes of the men's experiences and suggest ways to ameliorate mental health issues, including feeling like one is seen as an individual, is a full participant in society, and can contribute to one's own culture.

Enhancing self-efficacy is central to programmes promoting self-care and self-management. However, little is known about older people's self-efficacy in doctor–patient interactions. This paper investigates lifestyle, medical and demographic factors associated with self-efficacy in doctor–patient interactions in older people in general practice.

A cross-sectional analysis of data from a randomised controlled trial of older people was conducted in a health risk appraisal study in London. Self-efficacy was measured using the Perceived Efficacy in Patient–Physician Interactions Questionnaire.

Older people with higher self-efficacy were significantly more likely to report having had recent preventive care measures such as recent blood pressure measurement and influenza immunisation. Women were less likely to have higher self-efficacy than men. Older people were significantly less likely to have high self-efficacy if they reported having poor memory, low mood, limited activities due to fear of falling, basic education, difficulties with at least one activity of daily living, reduced physical activity, living alone, or risk of social isolation.

A third of people had low self-efficacy in doctor–patient interactions. They appear to be a vulnerable group. Low self-efficacy in interactions with doctors may be a symptom or a characteristic of older people who experience social isolation and depression. Policies that depend on enhancing self-care and self-management need to consider the large number of older people with low self-efficacy in using medical services, and understanding characteristics in older people associated with lower confidence in doctor–patient interactions may be useful in clinical practice and research.

The aim of this study was to investigate barriers to and supports for implementing a diabetes prevention education programme for community health-care workers (CHCWs) in Chiang Mai province, Thailand. The study also aimed to get preliminary input into the design of a tailored diabetes prevention education programme for CHCWs.

Thailand has faced under-nutrition and yet, paradoxically, the prevalence of diseases of over-nutrition, such as obesity and diabetes, has escalated. As access to diabetes prevention programme is limited in Thailand, especially in rural and semi-urban areas, it becomes critical to develop a health information delivery system that is relevant, cost-effective, and sustainable.

Health-care professionals (n = 12) selected from health centres within one district participated in in-depth interviews. In addition, screened people at risk for diabetes participated in interviews (n = 8) and focus groups (n = 4 groups, 23 participants). Coded transcripts from audio-taped interviews or focus groups were analysed by hand and using NVivo software. Concept mapping illustrated the findings.

Health-care professionals identified potential barriers to programme success as a motivation for regular participation, and lack of health policy support for programme sustainability. Health-care professionals identified opportunities to integrate health promotion and disease prevention into CHCWs’ duties. Health-care professionals recommended small-group workshops, hands-on learning activities, case studies, and video presentations that bring knowledge to practice within their cultural context. CHCWs should receive a credit for continuing study. People at risk for diabetes lacked knowledge of nutrition, diabetes risk factors, and resources to access health information. They desired two-way communication with CHCWs. Formative research supports the need for an effective, sustainable programme to support knowledge translation to CHCWs and at-risk populations in the communities they serve. Ultimately, this should support chronic disease prevention in Thailand.

The aim of this study is to investigate whether individuals diagnosed with chronic diseases associated with the metabolic syndrome (MetS) receive favorable quality of care processes in the primary care setting relative to other individuals with and without chronic diseases.

Data from the 2010 Brazos Valley Health Status Assessment (BVHSA) (n = 3964) were analyzed. Individuals diagnosed with chronic diseases that are collectively associated with a diagnosis of MetS, namely obesity, diabetes, high cholesterol, and hypertension, were characterized as a group (ie, analytic sample, n = 168). Clinical guidelines were utilized to identify indicators representing the quality of care processes received by these individuals during visits with their health-care provider.

Measures of quality of care processes were analyzed relative to a comparator group comprising individuals with no chronic diseases and an alternative test group comprising those diagnosed with other chronic diseases (eg, arthritis, depression, and cancer among others) using multinomial and binary logistic regression.

Physician communication of critical issues such as diet, stress, and weight status was statistically more pronounced in the analytic sample relative to the comparator group. However, differences in physician communication about physical activity were not statistically significant relative to the comparator group (OR = 1.26, P = 0.533). Differences in testing of cholesterol (OR = 0.94, P = 0.743) and blood pressure (OR = 1.16, P = 0.619) were also not statistically significant relative to the comparator group. Individuals who may have MetS generally receive favorable quality of care processes from their health-care provider, but opportunities exist to enhance provider communication about physical activity, and to possibly improve frequency of cholesterol and blood pressure testing.

Leg ulceration presents a significant health-care problem for patients and it is likely to be associated with pain. Poorly managed persistent pain may lead to insomnia, depression and suicidal ideation. To manage leg ulcer pain effectively, it is necessary first to assess pain, but there is little evidence of this activity in the literature. This study aimed to explore community nurses’ knowledge and beliefs about the management of painful leg ulceration.

A feasibility study surveyed the knowledge and views of a sample of community nurses in the North of England, United Kingdom. Data were collected using a postal questionnaire.

A total of 115 completed questionnaires were returned (response rate = 32%). The majority of the respondents were female (n = 102, 91.8%). The nurses in this clinical study claimed to be aware of the pain that patients with leg ulceration may experience. Over 90% of the patients were aware of the key consequences of this pain, including insomnia, depression, social isolation and others. However, over one-third of the nurses reported that they had not received pain management training. Approximately one half reported not assessing pain appropriately. Nurses reported using pain triggers and severity to diagnose aetiology and complications of leg ulceration.

This study suggested inadequate pain management practices despite the fact that there were a significant number of the nurses who were aware of the associated pain and possible outcomes. Pain assessment was lacking, suggesting a lack of formal pain assessment procedures. They described not using effective pain management techniques and were aware of their need for education in this area.