The use of health coaching in controlling blood pressure of hypertensive patients in the family:literature review

Background:Family is an essential element in caring for clients with hypertension.Appropriate hypertension management can reduce health risks during the treatment.Health coaching in family is a critical intervention to control and manage hypertension through providing education,information,and skills intervention are needed to support lifestyle improvements,manage chronic conditions,and prevent complications of hypertension.This literature study describes health coaching for controlling blood pressure among clients with hypertension in the family.Methods:Narrative literature review was performed to select the article that relates to health coaching of hypertension in the family using search engines including PubMed,ProQuest,SpringerLink,ScienceDirect,and Google Scholar by using keywords health coaching,family,hypertension,and blood pressure.The analysis of articles was carried out using four stages based on the PRISMA flowchart diagram.Results:The results indicated eight articles that were analyzed in this study.Interactive health coaching interventions based on a healthy lifestyle carried out with patients and families effectively improve medication adherence and reduce systolic and diastolic blood pressure.Meanwhile,health coaching applied regarding the principles including motivation,discussion,interviews and goal setting to influence behavior change and self-management.Conclusions:That health coaching applied for families with clients with hypertension is effect on reducing blood pressure and other changes,including knowledge,self-efficacy,and behavior towards health services for patients with hypertension.Therefore,health coaching for the family could be used as a family intervention for clients with hypertension during home health care.

Changes in Metabolites and Allelopathic Effects of Non-Pigmented and Black-Pigmented Lowland Indica Rice Varieties in Phosphorus Deficiency

Phosphorus(P) levels alter the allelopathic activity of rice seedlings against lettuce seeds. In this study, we investigated the effect of P deficiency on the allelopathic potential of non-pigmented and pigmented rice varieties. Rice seedlings of the white variety Khao Dawk Mali(KDML105, non-pigmented) and the black varieties Jao Hom Nin(JHN, pigmented) and Riceberry(RB, pigmented) were cultivated under high P(HP) and low P(LP) conditions. Morphological and metabolic responses to P deficiency were investigated. P deficiency inhibited shoot growth but promoted root growth of rice seedlings in all three varieties. Moreover, P deficiency led to decreased cytosolic phosphate(Pi) and total P concentrations in both shoot and root tissues. The subsequent reduction in internal P concentration enhanced the accumulation of phenolic compounds in both shoot and root tissues of the seedlings. Subsequently, allelopathy-based inter-and intra-specific interactions were assessed using water extracts from seedlings of the three varieties grown under HP and LP conditions. These extracts were tested on seeds of lettuce, the weed Dactyloctenium aegyptium, and the same rice variety. The shoot and root extracts from P-deficient seedlings reduced the germination of all recipient plants. Specifically, the shoot extract from P-deficient KDML105 seedlings reduced the germination index(GI) of lettuce seeds to 1%, while those from P-deficient RB and JHN seedlings produced GIs of 32% and 42%, respectively. However, when rice seeds were exposed to their own LP shoot and root extracts, their GIs increased up to 4-fold, compared with the HP extracts. Additionally, the shoot extracts from P-deficient plants also stimulated the germination of D. aegyptium by about 2–3-fold, whereas the root extracts did not have this effect. Therefore, P starvation led to the accumulation and exudation of phenolics in the shoots and roots of rice seedlings, altering their allelopathic activities. To adapt to P deficiency, rice seedlings potentially release signaling chemicals to suppress nearby competing species while simultaneously promoting their own germination and growth.

A 10-year review and epidemiology of animal bite cases in Gerash city, south of Iran: A retrospective cross-sectional study

Objective:To determine the temporal trend and epidemiology of animal bite cases in Gerash City,Iran.Methods:This retrospective cross-sectional study analyzed 630 cases of people with animal bites between 2011 and 2021 in Gerash City.The collected data were analyzed using Chi-square test.Results:The mean age of victims was(30.9±17.5)years.80.54%Of victims were male,39.70%were self-employed,and 64.60%were adults(≥18 years).Most cases of bites occurred in 2019(91 cases),2020(74 cases)and 2021(87 cases),and most of the bites were related to the upper limbs(62.70%).Most of the wounds were superficial(78%),most of the biting animals were domestic animals(91.74%),and most of the victims had Iranian nationality(97.62%).Conclusions:Given the increasing trend of animal bites in Gerash City,health authorities should carry out basic measures such as education and awareness among the public,especially at-risk groups such as adult males.Additionally,since most cases of bites are due to dogs,it seems necessary to plan for vaccination of dogs,especially those with owners.

Evaluation of Mandibular Deprogramming Using TENS (Transcutaneous Electrical Nerve Stimulation) in Patients at the Specialty Clinic of the Juarez Autonomous University of Tabasco from 2022 to 2024

Temporomandibular disorders (TMD) negatively affect quality of life, causing pain and restricted jaw movements. This study evaluates the effectiveness of Transcutaneous Electrical Nerve Stimulation (TENS) on TMD patients before orthodontic treatment at the Juarez Autonomous University of Tabasco. A quantitative, quasi-experimental study was conducted with 30 patients who met the inclusion criteria: aged 18 to 65 years, with TMJ pain symptoms, diagnosed with temporomandibular disorders using the Helkimo index, and who had provided informed consent for the study. The range of mandibular movement and the Visual Analog Scale (VAS) were measured to record values before therapy. The electrodes of the TENS therapy were positioned on both sides of the jaw in the preauricular area and the masseter muscle, the therapy was administered for 40 minutes, utilizing a frequency of 2 - 4 Hz and a pulse duration of 300 microseconds. Following this, the range of mandibular movement and the VAS were reassessed to evaluate the outcomes., significantly improved maximum mouth opening (37.7 ± 6.4 mm to 44.6 ± 5.88 mm), right laterality (3.86 ± 1.57 mm to 5.43 ± 1.21 mm), left laterality (3.13 ± 1.63 mm to 4.53 ± 1.61 mm), protrusion (4.01 ± 1.7 mm to 5.36 ± 1.32 mm), and pain perception (4.56 ± 2.045 to 2.03 ± 1.5) (P < 0.01). TENS therapy enhances mandibular movement and reduces pain, making it a well-tolerated, non-invasive complementary treatment for TMD.

Spectrum of COVID-19 induced liver injury:A review report

The coronavirus disease 2019(COVID-19)pandemic has caused changes in the global health system,causing significant setbacks in healthcare systems worldwide.This pandemic has also shown resilience,flexibility,and creativity in reacting to the tragedy.The severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection targets most of the respiratory tract,resulting in a severe sickness called acute respiratory distress syndrome that may be fatal in some individuals.Although the lung is the primary organ targeted by COVID-19 viruses,the clinical aspect of the disease is varied and ranges from asymptomatic to respiratory failure.However,due to an unorganized immune response and several affected mechanisms,the liver may also experience liver cell injury,ischemic liver dysfunction,and drug-induced liver injury,which can result in respiratory failure because of the immune system’s disordered response and other compromised processes that can end in multisystem organ failure.Patients with liver cirrhosis or those who have impaired immune systems may be more likely than other groups to experience worse results from the SARS-CoV-2 infection.We thus intend to examine the pathogenesis,current therapy,and consequences of liver damage concerning COVID-19.

The Development of a Feeding Coparenting Scale for Japanese Parents of Fifth- and Sixth-Grade Elementary School Children

Aim: Recently, the role of feeding coparenting has gained attention in the child eating research field. The Feeding Coparenting Scale (FCS), a measure of how caregivers interact with their partners when feeding their children was developed in the United States in 2019. However, there is no valid and reliable measure to assess feeding coparenting among caregivers of school-aged children in Japan. Therefore, this study aimed to develop a Japanese version of the FCS (FCS-J) questionnaire for caregivers with school-aged children. Methods: This was a web-based cross-sectional survey completed by caregivers of children aged 10-12 years. A preliminary survey using interviews and a web-based survey was conducted and found that the translated items of the FCS into Japanese were understandable to Japanese people. The developed survey was administered to parents of children at an elementary school. The reliability of the survey was assessed using both test-retest reliability and internal consistency analysis. Exploratory factor analysis was used to test construct validity, and known population validity was examined in relation to attributes, marital satisfaction, and feeding tasks. Results: Findings with 135 parents of school-aged children showed good internal reliability and validity of the FCS-J. The mean score for the overall FCS-J score was 46.2 (SD = 6.2), with Cronbach’s α of 0.72. For the subscales, Cronbach’s α ranged from 0.75 to 0.79. In sum, the present study’s results support the three-factor structure of the FCS in Japanese caregivers in Japan. Conclusions: The developed FCS-J was found to have a certain degree of reliability and validity. In this study, a Japanese version of the FCS-J was developed. .

Validity,Reliability,and Measurement Invariance of the Thai Smartphone Application-Based Addiction Scale and Bergen Social Media Addiction Scale

Background:In recent years,there has been increased research interest in both smartphone addiction and social media addiction as well as the development of psychometric instruments to assess these constructs.However,there is a lack of psychometric evaluation for instruments assessing smartphone addiction and social media addiction in Thailand.The present study evaluated the psychometric properties and gender measurement invariance of the Thai version of the Smartphone Application-Based Addiction Scale(SABAS)and Bergen Social Media Addiction Scale(BSMAS).Method:A total of 801 Thai university students participated in an online survey from January 2022 to July 2022 which included demographic information,SABAS,BSMAS,and the Internet Gaming Disorder Scale-Short Form(IGDS9-SF).Results:Confirmatory Factor Analyses(CFAs)found that both the SABAS and BSMAS had a one-factor structure.Findings demonstrated adequate psychometric properties of both instruments and also supported measurement invariance across genders.Moreover,scores on the SABAS and BSMAS were correlated with scores on the IGDS9-SF.Conclusion:The results indicated that the SABAS and BSMAS are useful psychometric instruments for assessing the risk of smartphone addiction and social media addiction among Thai young adults.

Corroborative Activities and Recognition Between Community Comprehensive Care Unit’s Nurses and Care Managers in Supporting Discharge of Elderly from Hospital - A Secondary Publication

Objective: The purpose of this study was to clarify the collaborative activities and mutual recognition between community comprehensive care unit nurses (Ns) and care managers (CM) in supporting the discharge of the elderly from the hospital. Methods: A total of 300 nurses working in community comprehensive care wards and 360 care managers working in B City in A Prefecture were surveyed using an anonymous self-administered questionnaire. Results: The highest percentage of responses regarding necessary collaborative activities with multiple professions in supporting hospital discharge were the same for Ns and CMs. The items regarding practice with the highest percentages were “relationship as a team” for Ns, and “user-centered awareness” for CM. While these professionals were willing to share information about their patients’ lives after discharge, the percentage of those explaining their expertise was low. It is thought that collaborative activities focusing on these aspects would lead to more appropriate discharge support.

A study on service capacity of primary medical and health institutions for cervical cancer screening in urban and rural areas in China

Objective: To provide a decision-making basis for sustainable and effective development of cervical cancer screening.Methods: This cross-sectional study assesses the service capacity to conduct cervical cancer screening with a sample of 310 medical staff, medical institutions and affiliated township health centers from 20 countylevel/district-level areas in 14 Chinese provinces in 2016.Results: The county-level/district-level institutions were the main prescreening institutions for cervical cancer screening. More medical staff have become engaged in screening, with a significantly higher amounts in urban than in rural areas(P<0.05). The number of human papillomavirus(HPV) testers grew the fastest(by 225% in urban and 125% in rural areas) over the course of the project. HPV testing took less time than cytology to complete the same number of screening tasks in both urban and rural areas. The proportion of mid-level professionals was the highest among the medical staff, 40.0% in urban and 44.7% in rural areas(P=0.406), and most medical staff had a Bachelor’s degree, accounting for 76.3% in urban and 52.0% in rural areas(P<0.001). In urban areas, 75.0% were qualified medical staff, compared with 68.0% in rural areas, among which the lowest proportion was observed for rural cytology inspectors(22.7%). The medical equipment for cervical pathology diagnosis in urban areas was better(P<0.001). HPV testing equipment was relatively adequate(typing test equipment was 70% in urban areas, and non-typing testing equipment was 70% in rural areas).Conclusions: The service capacity of cervical cancer screening is insufficient for the health needs of the Chinese population. HPV testing might be an optimal choice to fill the needs of cervical cancer screening given current Chinese medical health service capacity.

Exercise interventions for older adults: A systematic review of meta-analyses

Background:The evidence concerning which physical exercise characteristics are most effective for older adults is fragmented.We aimed to characterize the extent of this diversity and inconsistency and identify future directions for research by undertaking a systematic review of metaanalyses of exercise interventions in older adults.Methods:We searched the Cochrane Database of Systematic Reviews,PsycInfo,MEDLINE,Embase,CINAHL,AMED,SPORTDiscus,and Web of Science for articles that met the following criteria:(1)meta-analyses that synthesized measures of improvement(e.g.,effect sizes)on any outcome identified in studies of exercise interventions;(2)participants in the studies meta-analyzed were adults aged 65+or had a mean age of 70+;(3)meta-analyses that included studies of any type of exercise,including its duration,frequency,intensity,and mode of delivery;(4)interventions that included multiple components(e.g.,exercise and cognitive stimulation),with effect sizes that were computed separately for the exercise component;and(5)meta-analyses that were published in any year or language.The characteristics of the reviews,of the interventions,and of the parameters improved through exercise were reported through narrative synthesis.Identification of the interventions linked to the largest improvements was carried out by identifying the highest values for improvement recorded across the reviews.The study included 56 meta-analyses that were heterogeneous in relation to population,sample size,settings,outcomes,and intervention characteristics.Results:The largest effect sizes for improvement were found for resistance training,meditative movement interventions,and exercise-based active videogames.Conclusion:The review identified important gaps in research,including a lack of studies investigating the benefits of group interventions,the characteristics of professionals delivering the interventions associated with better outcomes,and the impact of motivational strategies and of significant others(e.g.,carers)on intervention delivery and outcomes.

Occupational Health Risk Assessment of Benzene,Toluene,and Xylene in Shanghai

Objective This study was designed to conduct a retrospective and systematic occupational health risk assessment(OHRA)of enterprises that used benzene,toluene,and xylene(BTX)in Shanghai,China.Methods All data for the study were obtained from 1,705 occupational health examination and evaluation reports from 2013 to 2017,and a semiquantitative model following Chinese OHRA guidelines(GBZ/T 298-2017)was applied for the assessment.Results The selected enterprises using BTX were mainly involved in manufacturing of products.Using the exposure level method,health risk levels associated with exposure to BTX were classified as medium,negligible,or low.However,the risk levels associated with benzene and toluene were significantly different according to job types,with gluers and inkers exhibiting greater health risks.For the same job type,the health risk levels assessed using the comprehensive index method were higher than those using the exposure level method.Conclusion Our OHRA reveals that workers who are exposed to BTX still face excessive health risk.Additionally,the risk level varied depending on job categories and exposure to specific chemicals.Therefore,additional control measures recommended by OHRA guidelines are essential to reduce worker exposure levels.

The effects of an exercise program on health-related quality of life in postpartum mothers: A randomized controlled trial

Background and Objective: There is controversy on the psychological effects of postpartum exercise. The study aimed to evaluate the effectiveness of a postpartum exercise program on health-related quality of life and psychological well-being. Methods: We conducted a randomized controlled trial in Tokyo, Japan. The intervention groups participated in ball-exercise classes (weekly exercise of 90 minutes for four weeks) at three months postpartum. The exercise class included the following: 1) greeting and warm-up;2) aerobic exercise involving bouncing on an exercise ball 55 or 65 cm in diameter;3) rest and self-introduction;4) stretching and cooling down. The primary outcome measure was health-related Quality of Life (QOL) assessed using the MOS Short-Form 36-Item Health Survey (SF-36v2). The secondary outcome measures were Rosenberg Self-Esteem Scale (RSES) and Edinburgh Postnatal Depression Scale (EPDS) scores. The intervention group was compared to the control group at four months postpartum. Results: Of the 120 women screened, 110 women met the study criteria. Nine could not be included and the remaining 101 were allocated randomly into intervention and control groups (50 and 51 participants respectively). Analysis of covariance adjusting for baseline values indicated that the SF36 subscales of physical functioning (p = 0.018) and vitality (p = 0.016) significantly improved in the intervention group compared to the control group, although there were no significant differences between the groups in the SF36 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. The RSES increased in the intervention group (p = 0.020) compared to the control group. No significant group differences were observed in EPDS scores. Conclusions: The postpartum exercise class program provided to healthy postpartum women appears to have contributed to promoting health-related QOL and self-esteem.

The impact of health expenditures on public health in BRICS nations

1.Peculiarity of the BRICS emerging economies Since the late 1980s,accelerated globalization has provided economic growth opportunities in mature and emerging economies.The rapidly developing nations of Brazil,Russia,India,China,and South Africa(BRICS nations)have a combined economic output that makes BRICS countries the world's major emerging economies.

Age- and Sex-Specific Impact of Health Literacy on Healthy Lifestyle Characteristics among Japanese Residents in a Rural Community

The study aimed to examine age- and sex-specific associations between health literacy (HL) and healthy lifestyle characteristics. The cross-sectional study was conducted to examine a total 1348 Japanese participants (613 male and 735 female) who took the health check-up program in April 2013, at Tsumagoi Village, Japan. Information was collected by self-administered questionnaire on three communicative and two critical HL items, and healthy lifestyle characteristics listed in Bres-low’s seven health practices. In multivariate logistic analysis, high HL (≥18) was significantly asso-ciated with healthy lifestyle characteristics in both non-elderly (<65 years old) and elderly (≥65 years old) [Odds ratio (OR) = 1.40, 95% Confidence interval (CI) = 1.13 - 1.75 for non-elderly, OR = 1.34, 95% CI = 1.02 - 1.76 for elderly], as well as female participants (OR = 1.43, 95% CI = 1.06 - 1.94), while the significance was borderline in male participants (OR = 1.34, 95% CI = 0.96 - 1.88). Among 5 HL items, the ability to extract health-related information was significantly associated with healthy lifestyle characteristics (OR = 1.52, 95% CI = 1.11 - 2.07 for non-elderly, OR = 1.55, 95% CI = 1.04 - 2.30 for elderly, OR = 1.95, 95% CI = 1.28 - 2.97 for female participants. HDL-C concentration in the high HL group was significantly higher than that in the low HL group. Among healthy lifestyle characteristics, proportions of smoking behavior (non-smoker), exercise frequency (twice or more per week), and sleep duration (7 - 8 hours) were significantly higher in the high HL group than in the low HL group. The present study revealed a positive association between HL and healthy lifestyle characteristics, which suggests that people are likely to engage in health-promoting behaviours based on access and ability to understand medical information for both age groups and female participants. Significant findings among female participants may be emphasized since it’s important from the entire family's perspective as women are the caretakers of the family. These findings may indicate the importance of comprehensive assessment, including HL, for health promotion in the community.

Realities of Reflective Practice Skill among Public Health Nurses in Japan and Related Learning and Lifestyle Factors

Background: According to the diversification of the health needs and the expansion of health disparities, it is necessary to raise their reflective practice skills so that PHNs present more appropriate activities. The purpose of this study was to elucidate the realities of reflective practice skills among public health nurses in Japan and identify related factors. Methods: This study covered 1725 public health nurses in the Chugoku/Shikoku area. We conducted an anonymous self-completed questionnaire survey. As reflective practice skills (RPS), we adopted the six components of the six cycles of the Gibbs reflective model. We used the 20 criteria of the Scale for Practical Competence (SPC). We set 25 learning history/daily lifestyle items. The study plan was approved by the Ethics Committee of Okayama University. Results: We analyzed the 962 (55.8%) valid responses. Although years of experience as a public health nurse was highly correlated with practical skills as measured by SPC, with a correlation coefficient of 0.627, it was not closely related with RPS, with a correlation coefficient as low as 0.129. A logistic regression analysis of the eight learning history items and six daily lifestyle items associated with RPS, with the introduction of the high/low RPS groups as dependent variables, showed a convergence to five factors (odds ratio of 1.38 - 2.29). Conclusions: Going forward, we will need to consider how to accumulate learning on a daily basis and how to include positive health practice in PHN education, in connection with exploring the curriculum and method of training.

Patient Safety,Adverse Healthcare Events and Near-Misses in Obstetric Care—A Systematic Literature Review

Systematic development of a patient safety culture is necessary because lack of quality care leads to human suffering. The aim of this review was to identify evidence of obstetric adverse events (AEs) and near-misses in the context of patient safety. We conducted a search of the published literature from Europe, Australia and the USA in the following databases: Cinahl, Cochrane, Maternity and Infant Care, Ovid, Pro-quest and PubMed, guided by PRISMA procedures. A total of 427 studies were screened, 15 full papers retrieved and nine studies included in the final thematic analysis. The selected papers address a broad spectrum of adverse patient safety events in obstetric care. The themes that emerged were: type of AEs, near-misses and their consequences, strategies to support and improve Patient Safety (PS) and domains related to the WHO Patient Safety competence outcomes. The findings of the first theme were grouped into the following categories: healthcare professionals’ perspectives on ethical conflicts, attributing blame and responsibility, and patients’ perspectives on lack of trust and involvement, as well as medication errors. The second theme, strategies to support interventions to improve PS, was based on two sub-themes: communicating effectively and gaining competence by learning from adverse events, while the third theme was domains related to the WHO Patient Safety competence outcomes. In conclusion, few studies have examined strategies for managing AEs despite the existence of programmes that target the implementation of changes, such as improved teamwork training. In addition to exploring strategies to make safety a priority for patients and healthcare professionals, it is of the utmost importance to improve communication with patients and between professionals in order to maintain and enhance safety. Efforts by organizations and individuals to continuously develop knowledge about the risk of AEs and the use of best practice guidelines are also essential.

In vitro antioxidant and wound healing activity of Sargassum polycystum hydroethanolic extract in fibroblasts and keratinocytes

Objective:To investigate the in vitro antioxidant and wound healing properties of the hydroethanolic extract of Sargassum polycystum,and elucidate the mechanism of its wound healing activity.Methods:Human dermal fibroblast and HaCaT cells were used to evaluate the proliferation by sulforhodamine B and dsDNA assay after treatment with Sargassum polycystum extracts.Scratch wound healing and phalloidin-rhodamine staining were employed to observe migratory activity and filopodia formation,respectively.Western blot and real-time RT-PCR assays were performed to determine the protein and gene expressions related to wound healing activities.Results:The phytochemical analysis found a higher level of flavonoid than phenolic compound in Sargassum polycystum extracts.In human dermal fibroblast cells,Sargassum polycystum extracts at 50 and 100μg/mL significantly increased fibroblast proliferation and the gene expressions of hyaluronic acid synthase 1(HAS1),HAS2,HAS3,collagen type 1 alpha 1 chain(COL1A1),collagen type 3 alpha 1 chain(COL3A1),and elastin.The phosphorylation of Akt,ERK1/2,and p38 MAPK was also significantly upregulated after treatment with Sargassum polycystum extracts.Additionally,50 and 100μg/mL of the extracts prominently enhanced the proliferation,migration,and filopodia formation of HaCaT cells,as well as the protein levels of pFAK/FAK,pSrc/Src,pAkt/Akt,pERK1/2/ERK1/2,Rac1 and Cdc42.Conclusions:Sargassum polycystum extracts show promising wound healing activities in human dermal fibroblasts and keratinocytes.

Increased Prevalence of Thyroid Nodules Across Nearly 10 Years in Shanghai,China

Objective This study aimed to determine whether the prevalence of thyroid nodules(TNs)increased due to modern lifestyles or other factors,despite the advances in screening and diagnostic tools.Methods This study included 3474 pairs of participants,who were matched by gender and age(±3 years)from two cross-sectional sampling surveys:(1)the program on the iodine nutritional status and related health status of residents in Shanghai in 2009;(2)the thyroid disease screening program for adults in Shanghai between 2017 and 2018.The prevalence of TNs and thyroid diseases in 2009 and 2017–2018 were compared,and the potential risk factors of TNs were detected.Results The prevalence of TNs in 2009 was 28.9%:22.5%in males and 34.5%in females.In 2017,this increased to 43.8%:37.9%in males and 49.1%in females.The prevalence of TNs significantly increased from 2009 to 2017(odds ratio,1.486;95%confidence interval,1.238–1.786).In addition,female gender,thyroid disease history,and age were the main risk factors for TNs after adjusting for confounders in the logistic regression across the time period.Conclusion The prevalence of TNs significantly increased across nearly 10 years in Shanghai.

Comparison of Public Health Nurse’s Lifestyle Counseling Skills for Clients with Different Readiness of Behavior Changes in Primary Care Settings

Purpose: Public health nurses (PHNs) are required to assess the readiness of the clients and provide lifestyle counseling accordingly. The purpose of this study was to compare the lifestyle counseling provided for clients with different levels of readiness based on self-evaluations and independent assessment. Methods: Participants were PHNs with 10 years’ experience or less. Lifestyle counseling skills were measured through a simulated counseling session in a primary setting lasting up to 30 minutes, followed by a review session, where the participant provided self-evaluations, and the simulated client provided others-evaluations, of the session. The simulated clients played the role of clients at either the pre-contemplation or contemplation stage of preparedness as per the stages of behavior change theory. Results: The self-evaluation results showed that the mean scores for five of the six skill categories, are lower in the precontemplation-stage client cases than in the contemplation-stage client cases, and significantly so for two skill categories. The others-evaluations showed significantly lower mean scores for all skill categories in the precontemplation cases than in the contemplation cases. Conclusion: The PHNs and simulated clients agreed that lifestyle counseling skills were inadequate for the precontemplation cases, as compared with the contemplation cases. The lifestyle counseling skills of PHNs with less experience may not be well-adjusted to the readiness of the client, indicating difficulties in supporting less prepared clients.

Going “paperless” in an English National Health Service (NHS) breast cancer screening service: The intriduction of fully digital mammography

Objective: To test the feasibility of a fully paperless system, termed “paperlite” in a UK breast screening service. To demonstrate in NHS practice, how workload and workflow could be improved by moving to a paperless system and discovering what impact this has upon the complexity within the service. Setting: Warwickshire, Solihull and Coventry Breast Screening Service in the West Midlands of England. Methods: Quality improvement methodologies were employed, including value stream mapping, task analysis and a time-and-motion study. Results: The screening centred screened approximately 50,000 women per year. If they were to implement a paperless system, the administrative workload would decrease. The time saving per batch of screens, which could be achieved by moving to the paperless system ranged from 19 to 56 minutes (mean = 36 minutes). When calculated by batch the mean time saving per woman screened by moving to the paperless system was 42 seconds. This equates to 583 hours of administrative work per year in a centre screening 50,000 women. Conclusions: The paperless system has many benefits compared to the original system in terms of reductions in waste, time and cost. The simplification and standardisation of the process resulted in fewer tasks and interfaces where errors could occur, hence inadvertently improving patient safety. The limitation of the work is the heavy reliance on technology, live interfacing with computer databases and software stability is necessary for a paperless system to be used in NHS practice.