Objective: To examine practice nurses' beliefs about obesity and their current practices and the role of the weight management context and their own BMI on these factors. Design: Cross sectional questionnaire. Subjects: Questionnaires concerning beliefs about obesity and current practices were completed by 586 practice nurses. Results: The subjects rated lifestyle as the main cause and cardiovascular problems as the main consequences of obesity, regarded weight loss as bene®cial and reported high con®dence in their ability to give advice to obese patients. However, their expectations of patient compliance and actual weight loss were low indicating that practice nurses rate their advice giving skills as independent to the outcome of this advice. Further, failed weight loss was explained in terms of patient and not professional factors. In addition, the results indicated variability in their beliefs and behaviour according to the location of this advice and the practice nurse's own BMI. In particular, practice nurses who run weight loss clinics reported giving weight loss advice more frequently, spending longer counselling obese patients, reported greater con®dence in giving weight loss advice and more optimism about outcomes. Further, those with low BMIs rated obesity as more preventable, reported being less likely to advise patients to use a calorie controlled diet and more likely to suggest eating less in general. Conclusion: Education programmes for practice nurses should not only include skills training but emphasise both the factors involved in advice giving and self appraisal. Such appraisal should include a role for both the practice nurse's and the patient's behaviour to minimise the`operation was a success but the patient died' approach to obesity management.

OBJECTIVE: To examine the impact of two styles of educational package on practice nurses' management of obesity. SUBJECTS AND MEASURES: A questionnaire was completed by 66 practice nurses concerning their obesity related beliefs and the content and style of their weight related practices before and one month after being randomly allocated to either the`learner centred' group (who received a lea¯et and were invited to attend an interactive seminar), the`expert group' (who received the lea¯et) or the control group. At the one month follow up, practice nurses were also asked to give a brief questionnaire to ®ve consecutive patients, who they saw for weight loss advice, concerning the content and style of the consultation. After 6 months, practice nurses, and patients were sent a questionnaire about their consultation style and weight loss, respectively. RESULTS: The packages had no differential effects on practice nurses' beliefs about obesity. However, practice nurses in the`learner group' reported spending longer on their consultations and being more patient centred. Their patients rated themselves as more satis®ed with the consultation and reported that they were offered calorie controlled diets less often. In contrast, practice nurses in the`expert group' reported giving weight loss advice more frequently, being less patient centred and their patients reported greater con®dence in, and likelihood of, weight loss and reported that they were more likely to be offered traditional weight loss interventions. The packages had no differential effects on patient weight. CONCLUSION: Practice nurses' and patients' beliefs and behaviour and the style of their interactions can be changed by both expert and learner centred educational packages. The style of packages should be chosen in terms of both the available resources and the desired outcomes.Keywords: educational packages; changing beliefs; obesity management; practice nurses IntroductionWith increased focus on health promotion at the level of primary care, primary health care professionals, particularly practice nurses, have to make daily decisions about weight related issues. Such professionals, however, report feeling unskilled when offering weight management and dietary change advice, and state that they ®nd dealing with weight issues dif®cult, inconvenient and professionally unrewarding. 1±3 They also report holding negative and stereotypical attitudes towards obese patients. 3,4 Further, practice nurses show a discrepancy between their assessments of the processes involved in their advice giving and the resulting outcomes, with high ratings for the standard of their advice contrasting with low ratings for their success in bringing about change. 5 This is supported by research highlighting that the actual success rates from primary health care interventions for weight loss are poor. 6 The literature therefore suggests that practice nurses need to be better equipped to manage weight related problems. However, any attempt to modify a health professionals beliefs an...

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The treatment of pregnant rats with the carbonic anhydrase inhibitor, acetazolamide, produced gross limb malformations primarily affecting the forepaw, but also producing variable ulnar dysmelia. Analysis of the cytoarchitecture of the ulnar dysmelic limbs showed the presence of cartilaginous and fibrocartilaginous connections between the ulnar and radial chondroepiphyses, with variable deformation of the radial chondroepiphysis by the tethering effect (although the growth plate, per se, did not appear affected at the stage of development studied). The extremely variable experimental appearances duplicated most of the variations seen in the human disease analogue, and suggest this drug-induced embryopathy may be useful as a model for the study of postaxial forelimb deformities in the postnatal phase in order to adequately assess the structural changes of disparate growth between radius and ulna due to the presence of the cellular continuity between the two distal chondroepiphyses. ImagesFIG. 1FIG. 2FIG. 3FIG. 4FIG. 5FIG. 6FIG. 7FIG. 8FIG. 9

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