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Background In 2010, a multidisciplinary, group-based, intensive rehabilitation programme for individuals with early to mid-stage Huntington9s disease (HD) was established at two rehabilitation centres in Norway. The programme included intensive physical training, information and support related to speech, nutrition, activities of daily living and cognitive function. There was also a programme for care givers. Aims To explore patients and care givers9 experiences with an intensive rehabilitation programme, and to explore health professionals9 experiences and views about rehabilitation of individuals with HD. Methods We did a qualitative study and interviewed a total of 20 participants, including 11 individuals with early- and mid-stage HD, and nine care givers. We did two focus group interviews with a total of 15 health professionals. Results Central areas where participants reported positive effects were gait function and balance, being member in a group and increased self-confidence. Challenging areas that was reported in more negative ways were the intensity of the programme and difficulties related to goal-setting. Clinical tests were well tolerated by participants and such tests were sometimes used for motivating participants by documenting improvement. Both participants and health professionals reported positive experiences with a system with a contact person at the institution. Contact between the rehabilitation centres and the participants9 municipalities was experienced as important for mobilising local rehabilitation services and health care in the community. Conclusions The rehabilitation programme was well tolerated by participants, who reported a multitude of self-perceived positive effects. A system with contact persons in the institution is important to facilitate an individualised and coordinated programme for each participant. Community outreach initiatives by the rehabilitation centre may secure long-term effects of the programme.

Background Studies suggest that persons with Huntington9s disease (HD) benefit from intensive rehabilitation. Aims To assess preliminary results of a multidisciplinary rehabilitation programme on quality of life, cognitive and motor function. Methods 12 patients with early and middle stage (stages I–III of the Shoulson and Fahn Rating Scale) HD underwent a 3 week rehabilitation programme of up to 8 h 5 days per week including cognitive training, speech, physical and occupational therapy, group discussions and lectures on topics such as nutrition. A family member participated during the first week of the programme. Inclusion criteria: mild or moderate grade of HD, age 18+ years, no severe psychiatric illness, none/slight reduction in cognitive function and full/mostly full independence in Active Daily Living functions. Results Mean age was 48 years with an average of 6 years since symptom debut. Mean total functional capacity (TFC) score was 9 (not working and in need of light assistance i ADL function), mean Mini-Mental State Examination indicated a reduced general cognitive function (24 of 30) and mean Hospital Anxiety and Depression Scale score of 9 showed slight depression. Mean on Activity Specific Confidence scale showed 81% confidence to maintain balance in different situations. All subjects showed improvement in gait (6 min walking test (mean change +31.42 m (p=0.03); 10 m walking test (mean change −0.80 s (p=0.02); stand up and go test (mean change −1.24 s (p=0.003)). Bergs Balance Scale showed significant improvement (mean change 2 points, p=0.03). Conclusion A multidisciplinary intensive rehabilitation programme is associated with improved balance and walking function in persons in the early and middle stages of HD.

Background: Physician leadership development programs typically aim to strengthen physicians’ leadership competencies and improve organizational performance. We conducted a systematic review of medical literature on physician leadership development programs in order to characterize the setting, educational content, teaching methods, and learning outcomes achieved. Methods: Articles were identified through a search in Ovid MEDLINE from 1950 through November 2013. We included articles that described programs designed to expose physicians to leadership concepts, outlined teaching methods, and reported evaluation outcomes. A thematic analysis was conducted using a structured data entry form with categories for setting/target group, educational content, format, type of evaluation and outcomes. Results: We identified 45 studies that met eligibility criteria, of which 35 reported on programs exclusively targeting physicians. The majority of programs focused on skills training and technical and conceptual knowledge, while fewer programs focused on personal growth and awareness. Half of the studies used pre/post intervention designs, and four studies used a comparison group. Positive outcomes were reported in all studies, although the majority of studies relied on learner satisfaction scores and self-assessed knowledge or behavioral change. Only six studies documented favorable organizational outcomes, such as improvement in quality indicators for disease management. The leadership programs examined in these studies were characterized by the use of multiple learning methods, including lectures, seminars, group work, and action learning projects in multidisciplinary teams. Discussion: Physician leadership development programs are associated with increased self-assessed knowledge and expertise; however, few studies have examined outcomes at a system level. Our synthesis of the literature suggests important gaps, including a lack of programs that integrate non-physician and physician professionals, limited use of more interactive learning and feedback to develop greater self-awareness, and an overly narrow focus on individual-level rather than system-level outcomes. This article is distributed under the terms of the Creative Commons Attribution License.

Medication-overuse headache (MOH) is common in the general population, and the majority of sufferers are managed in primary health care. Brief Intervention (BI) has been used as a motivational technique for patients with drug and alcohol overuse, and may a have role in the treatment of MOH.

Background Family work is one of the best researched psychosocial interventions for patients with chronic psychosis. However, family work is less studied for patients with a first episode psychosis and the studies have revealed contradicting results. To our knowledge, no previous studies have examined qualitatively group leaders’ experiences with family work. In the present study we wanted to explore challenges faced by mental health professionals working as group leaders for family interventions with first episode psychosis patients. Method A qualitative exploratory study was carried out based on digitally recorded in-depth interviews and a focus group interview with nine experienced mental health professionals. The interviews were transcribed in a slightly modified verbatim mode and analysed by systematic text condensation. Results Challenges faced by group leaders was classified into six categories: (1) Motivating patients to participate, encouraging potential participants was demanding and time-consuming; (2) Selecting participants by identifying those who can form a functional group and benefit from the intervention; (3) Choosing group format to determine whether a single or multi-family group is best for the participants; (4) Preserving patient independence, while also encouraging them to participate in the intervention; (5) Adherence to the protocol, while customizing adjustments as needed; (6) Fostering good problem-solving by creating a fertile learning environment and choosing the most appropriate problem to solve. Conclusions Group leaders face challenges related to recruitment and selection of participants for family work, as well as in conducting sessions. Awareness of these challenges could help health professionals more specifically to tailor the intervention to the specific needs of patients and their families.

Background Tuberculosis is a major public health problem in Ethiopia, and a high number of TB patients are co-infected with HIV. There is a need for more knowledge about factors influencing treatment adherence in co-infected patients on concomitant treatment. The aim of the present study is to explore patients' and health care professionals' views about barriers and facilitators to TB treatment adherence in TB/HIV co-infected patients on concomitant treatment for TB and HIV. Methods Qualitative study using in-depth interviews with 15 TB/HIV co-infected patients and 9 health professionals and focus group discussions with 14 co-infected patients. Results We found that interplay of factors is involved in the decision making about medication intake. Factors that influenced adherence to TB treatment positively were beliefs in the curability of TB, beliefs in the severity of TB in the presence of HIV infection and support from families and health professionals. Barriers to treatment adherence were experiencing side effects, pill burden, economic constraints, lack of food, stigma with lack of disclosure, and lack of adequate communication with health professionals. Conclusion Health professionals and policy makers should be aware of factors influencing TB treatment in TB/HIV co-infected patients on concomitant treatment for TB and HIV. Our results suggest that provision of food and minimal financial support might facilitate adherence. Counseling might also facilitate adherence, in particular for those who start ART in the early phases of TB treatment, and beliefs related to side-effects and pill burden should be addressed. Information to the public may reduce TB and HIV related stigma.

Background Huntington’s disease (HD) is a rare neurodegenerative disorder with a prevalence of 6 per 100.000. Despite increasing research activity on HD, evidence on healthcare utilization, patients’ needs for healthcare services and Health-Related Quality of Life (HRQoL) is still sparse. The present study describes HRQoL in a Norwegian cohort of HD patients, and assesses associations between unmet healthcare and social support service needs and HRQoL. Methods In this cross-sectional population-based study, 84 patients with a clinical diagnosis of HD living in the South-East of Norway completed the HRQoL questionnaire EuroQol, EQ-5D-3L. Unmet needs for healthcare and social support services were assessed by the Needs and Provision Complexity Scale (NPCS). Furthermore, functional ability was determined using the Unified Huntington’s Disease Rating Scale (UHDRS) Functional assessment scales. Socio-demographics (age, gender, marital status, occupation, residence, housing situation) and clinical characteristics (disease duration, total functional capacity, comorbidity) were also recorded. Descriptive statistics were used to describe the patients’ HRQoL. Regression analyses were conducted in order to investigate the relationship between unmet healthcare needs and self-reported HRQoL. Results The patients were divided across five disease stages as follows: Stage I: n = 12 (14%), Stage II: n = 22 (27%), Stage III: n = 19 (23%), Stage IV: n = 14 (16%), and Stage V: n = 17 (20%). Overall HRQoL was lowest in patients with advanced disease (Stages IV and V), while patients in the middle phase (Stage III) showed the most varied health profile for the five EQ-5D-3L dimensions. The regression model including level of unmet needs, clinical characteristics and demographics (age and education) accounted for 42% of variance in HRQoL. A higher level of unmet needs was associated with lower HRQoL (β value - 0.228; p = 0.018) whereas a better total functional capacity corresponded to higher HRQoL (β value 0.564; p