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BACKGROUND: Obesity is a major and increasing health problem in the United Kingdom, and, until recently, the government health promotion package for general practice reimbursed general practitioners for documenting obesity. Despite poor evidence for effectiveness of interventions in primary care, documentation of obesity could possibly improve patient awareness and knowledge, or provide public health information. AIM: To assess patient perception of obesity and its health risk, and the accuracy of estimating obesity using patient information. METHOD: Subjects were consecutive attenders to a general practitioner (GP) at a single urban practice in the South and West Region. Outcome measures were 'measured' body mass index (BMI) calculated from measured weight and height, 'estimated' BMI using patient information, and patient perception of obesity and the health risks of obesity. RESULTS: There is good correlation between 'estimated' and 'measured' BMI (intraclass correlation 0.91). Estimated BMI is lower than measured BMI (mean 0.77 lower), and the difference increases with age and level of BMI: for BMIs of or = 30 the mean differences (estimated-measured) were -0.06, -0.46, -0.98 and -1.72 respectively. Estimated obesity (BMI > 30) is reasonably sensitive (70%), specific (99%), and predictive (93% positive predictive value) of measured obesity (kappa 0.78). All obese subjects are aware that they are overweight, and most of them (78%, 95% confidence interval 66-88%) are aware that their weight is a health risk. CONCLUSION: Obese patients attending GPs' surgeries are likely to know if they are overweight, or could easily estimate from their knowledge of height and weight that they were overweight with reasonable accuracy. Obese subjects also know that their weight carries health risks. Thus, measurement of obesity in the general population is not likely to improve risk assessment or patient knowledge significantly. Without evidence for effective intervention or improved ...

Metadata only record ; This paper highlights the indicators which can be used to inform policy makers about development options. It found that management units for development intervention should be small scale and based on existing systems, and that systems could experience heavy stress without resulting in long term degradation. Assumptions such as the inherently destructive nature of pastoralism are rejected in the face of the fact that very little is known about African range management. The study starts with reliability of rainfall and environment on the basis that this influences other factors, such as mobility and diversification of the local economy; mobility in turn affects other development interventions, for example veterinary, institutional and marketing services. Other factors include the degree of dependence on pastoral products, the limitations of grazing ability, diversification of the regional and household economy and institutional capacity. The paper reviews the criticism that development projects have rarely been based on sound ecological and socio-economic understandings of the pastoral system. Thus a project objective may be described as aiming to retard degradation and improving livestock management practices; this requires not a general prescription, but knowledge of the variables of the region, the present grazing patterns and seasonal movements. It is important also to highlight where the stated objectives conflict with the well-being of the herder. Considerable improvement may be achieved on both of these counts by increasing local participation in all stages of the project, and making monitoring integral to the operation. On account of this, pastoral projects must often be experimental in nature. Problems are faced when priorities identified by donor agencies are politically abhorrent to the host government, and pressure may be brought to bear to at least achieve something, even if it is not in inline with donor philosophy. - Blench and Marriage Annotated Bibliography

Informal trade in livestock and livestock products is of special concern because of the risk of spreading animal and human diseases. At the same time, informal trade can contribute to people's livelihoods and food security, especially in lowand middle-income countries. Informal trade may involve legal or illegal products. It may be domestic (or internal) or involve neighbouring countries; it may take place within a region or between distant countries. Entrepôt trade (or 're-exports') is a significant form of informal trade in livestock products. Pastoral mobility often entails movement across boundaries for trade and much of this is also informal. There are important economic, social, political, and environmental drivers for informal trade which make it difficult to eliminate. Informal livestock trade may be largely ignored by the authorities, implicitly encouraged, made less attractive, forcibly suppressed, or actively engaged with, in an attempt to mitigate its risks and enhance its benefits. To identify the optimal management approach, it is crucial to understand the importance and characteristics of informal trade, its benefits and risks, and the feasibility and cost-effectiveness of different strategies to address it. The authors describe a case study from East Africa to explore some of the issues raised by informal trade.

Metadata only record ; Pastoral development in Africa, particularly donor-funded development, tends to go in phases. At present we are in what can be described as the "policy" phase. During the 1990s, and continuing into the present decade, there has been much emphasis put on the effect of poor government policies in hampering economic progress in Africa generally. There has been a corresponding increased emphasis on the impact of such policies on pastoral people, areas and systems and on the extent to which pastoralists themselves can or should participate in identifying and advocating key policy issues. This emphasis has led to clearer identification of the policy issues most seriously affecting pastoralism.

While most cases of acute cough are self-limiting, antibiotics are prescribed to over 50%. This proportion is inappropriately high given that benefit from treatment with amoxicillin could only be demonstrated in adults with pneumonia (based on chest radiograph) or combined viral-bacterial infection (based on modern microbiological methodology). As routine use of chest radiographs and microbiological testing is costly, clinical prediction rules could be used to identify these patient subsets. In this secondary analysis of data from a multicentre randomised controlled trial in adults presenting to primary care with acute cough, we used prediction rules for pneumonia or combined infection and assessed the effect of amoxicillin in patients predicted to have pneumonia or combined infection on symptom duration, symptom severity and illness deterioration. In total, 2056 patients that fulfilled all inclusion criteria were randomised, 1035 to amoxicillin, 1021 to placebo. Neither patients with a predicted pneumonia nor patients with a predicted combined infection were significantly more likely to benefit from amoxicillin. While the studied clinical prediction rules may help primary care clinicians to reduce antibiotic prescribing for low-risk patients, they did not identify adult acute cough patients that would benefit from amoxicillin treatment. ; GRACE was funded by the European Commission's Framework Programme 6 (LSHMCT-2005-518226). R.B. is funded as a postdoctoral researcher by FWO Flanders (grant 12I6319N). The work was supported by the Methusalem financing program of the Flemish Government. N.H. acknowledges support from the University of Antwerp scientific chair in Evidence-Based Vaccinology, financed in 2009−2019 by a gift from Pfizer and in 2016–2020 from GSK. We are grateful to key members of the GRACE Project group whose hard work has made this study possible, including Niels Adriaenssens, Jordi Almirall, Zuzana Bielicka, Francesco Blasi, Lidewij Broekhuizen, Pascale Bruno, Slawomir Chlabicz, Jo Coast, Mel Davies, Pim de Jong, An De Sutter, Patricia Fernandez, Maciek Godycki-Cwirko, Iris Hering, Kerenza Hood, Helena Hupkova, Janko Kersnik, Anna Kowalczyk, Christina Lannering, Marieke Lemiengre, Frank Leus, Katherine Loens, Christine Lammens, Bo-Eric Malmvall, Artur Mierzecki, Sigvard Mölstad, Karel Moons, Michael Moore, Magdalena Muras, Nuria Sanchez Romano, Matteu Serra Prat, Tom Schaberg, Richard Smith, Igor Svab, Jackie Swain, Paolo Tarsia, Antoni Torres, Pia Touboul, Saskia van Vugt, Robert Veen, and Tricia Worby, Peter Zuithoff, and all the clinicians and patients who consented to be part of GRACE. Conflicts of Interest: The authors declare no conflict of interest

Objective: We aimed to assess the effects of amoxicillin treatment in adult patients presenting to primary care with a lower respiratory tract infection (LRTI) who were infected with a potential bacterial, viral, or mixed bacterial/viral infection. Methods: This multicentre randomized controlled trial focused on adults with LRTI not suspected for pneumonia. Patients were randomized to receive either antibiotic (amoxicillin 1 g) or placebo three times daily for 7 consecutive days using computer-generated random numbers (follow-up 28 days). In this secondary analysis of the trial, symptom duration (primary outcome), symptom severity (scored 0-6), and illness deterioration (reconsultation with new or worsening symptoms, or hospital admission) were analysed in pre-specified subgroups using regression models. Subgroups of interest were patients with a (strictly) bacterial, (strictly) viral, or combined infection, and patients with elevated values of procalcitonin, C-reactive protein, or blood urea nitrogen. Results: 2058 patients (amoxicillin n = 1036; placebo n = 1022) were randomized. Treatment did not affect symptom duration (n = 1793). Patients from whom a bacterial pathogen only was isolated (n = 207) benefited from amoxicillin in that symptom severity (n = 804) was reduced by 0.26 points (95% CI -0.48 to -0.03). The odds of illness deterioration (n = 2024) was 0.24 (95% CI 0.11 to 0.53) times lower from treatment with amoxicillin when both a bacterial and a viral pathogen were isolated (combined infection; n = 198). Conclusions: Amoxicillin may reduce the risk of illness deterioration in patients with a combined bacterial and viral infection. We found no clinically meaningful benefit from amoxicillin treatment in other subgroups. (C) 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved. ; The authors have no conflicts of interest to declare. GRACE was funded by the European Community's Sixth Framework Programme (grant agreement 518226). Work in the UK was also supported by the National Institute for Health Research, in Barcelona by 2009 SGR 911 Ciber de Enfermedades Respiratorias (Ciberes CB06/06/0028), and in Belgium by the Research Foundationd-Flanders (FWO; G.0274.08N). Financial support from the Methusalem financing program of the Flemish Government is also gratefully acknowledged. NH acknowledges support from the University of Antwerp scientific chair in evidence-based vaccinology, financed in 2009-2017 by a gift from Pfizer and GSK. This publication has been financially supported through the European Science Foundation, in the framework of the Research Networking Program TRACE (www.esf.org/trace). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.