URTI, menopause, universal health coverage, and chocolate cravings

F1.largeAhmed Rashid is an academic clinical fellow in general practice at the University of Cambridge. He writes the regular monthly column “Yonder” in the BJGP: a diverse selection of primary care relevant research stories from beyond the mainstream biomedical literature. Twitter: @Dr_A_Rashid

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Childhood upper respiratory tract infection (URTI). Childhood URTI is one of the commonest reasons for parents to consult in primary care. One would think that this makes it an easy type of consultation for doctors to tackle. However, the age-old antibiotic debate still rears its ugly head and has the potential to lead to much miscommunication and misunderstanding. With antimicrobial resistance high on the public health agenda, these interactions have received particular attention recently. In a study published in Patient Education and Counselling, researchers in Bristol interviewed 30 such parents from a variety of socioeconomic areas.1 They found that parents’ perceptions about the credibility of diagnosis and treatment recommendations were highly influenced by clinician communication. They suggest clinicians should focus on symptoms of particular concern to parents and give more precise safety net advice. Interestingly, they found the term ‘viral’ often trivialised the condition and contradicted the parents’ perception of severity. Although an important part of the antibiotic discussion, this explanation needs to be used sensitively with parents.

[bctt tweet=”BJGP Blog – parents found the term ‘viral’ often trivialised URTIs and needs to be used sensitively.”]

Menopause. Throughout the world, experiences of menopause vary enormously and these are greatly shaped by socioeconomic and cultural influences. Although women’s perspectives about menopause have been investigated extensively, men’s views on the subject have received much less attention. Menopause can cause an array of physical and psychological symptoms that have the potential to dramatically affect quality of life and relationships. In order to understand men’s views about menopause, a group of Turkish researchers interviewed 33 married men from Istanbul who were aged 40–77 years. The study, published in the Journal of Pakistan Medical Association, highlighted a clear lack of basic knowledge and a lack of understanding about the treatment options available.2 Participants varied in their willingness to discuss intimate issues but there were clear concerns about their own sex lives. The authors state that clinicians should remember to involve men when delivering health information to women at this crucial time.

Universal health coverage. The NHS is fantastic and we should be proud of it and celebrate it every day. Despite all the problems and challenges, we must not take for granted the fact that health care in this country is free at the point of use. Across the developing world, the drive to reach universal health coverage relies enormously on primary care infrastructure and many countries look towards the British model as a gold standard. In Sub-Saharan Africa, health reforms have tended to be top-down ignoring the perspective of rural communities. Malawi has adopted an ‘essential health package’ to support universal free health coverage and in a recent BMC Health Services Research article,3 rural community residents highlighted various shortcomings of the system, including geographical inequities, affordability and transport problems, healthcare worker shortages, and poor quality of services. It provides a good example of how rural communities are often overlooked in health reforms and should provide local evidence reflecting context-specific needs.

Chocolate cravings. Chocolate has been around for centuries and remains a popular food type and flavour throughout the world. As well as being incredibly popular, it also elicits strong cravings. It was therefore a good choice for a group of health psychologists wanting to examine two mindfulness techniques. The study published in the British Journal of Health Psychology involved a group of 137 university students wishing to reduce their chocolate consumption.4 Participants were allocated to either a ‘defusion’ or ‘acceptance’ mindfulness strategy, or to a conventional relaxation strategy as a control intervention.

The results indicate that individuals in the ‘defusion’ group successfully resisted chocolate over 5 days, although this was not the case for the ‘acceptance’ group. The study demonstrates that although mindfulness can be useful, determining which strategies are helpful for different situations should help enhance the efficacy and cost-effectiveness of interventions.

[bctt tweet=”BJGP Blog: A ‘defusion’ mindfulness strategy could help you resist chocolate…”]


1. Cabral  CIngram  JHay  ADHorwood  J, TARGET team. {2014‘They just say everything’s a virus’ — parent’s judgment of the credibility of clinician communication in primary care consultations for respiratory tract infections in children: a qualitative studyPatient Educ Couns 95(2):248253

2. Hidiroglu  STanriover  OAy  PKaravus  M. (2014A qualitative study on menopause described from the man’s perspectiveJ Pak Med Assoc 64(9):10311036

3. Abiiro  GMbera  GBDe Allegri  (2014Gaps in universal health coverage in Malawi: a qualitative study in rural communitiesBMC Health Serv Res 22(14):234.

4. Jenkins  KTTapper  (2014Resisting chocolate temptation using a brief mindfulness strategyBr J Health Psychol 19(3):509522.


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