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Objective. To quantify the association between obesity and somatic hospital costs and number of overall somatic hospital contacts – number of inpatient admissions, number of outpatient visits, and number of emergency department visits – based on anthropometric measurements of waist circumference (WC) and information from The National Patient Registry and The Danish Case-Mix System (DRG).

Participants. The study population consisted of two sub-samples from the Inter99 study at Research Centre for Prevention and Health in 1999–2001. One sub-sample used WC as an indicator for obesity (n=5,151), whereas the other used BMI as an indicator for obesity (n=4,048). Using WC, obesity was defined as WC > 102cm for men and > 88cm for women. Normal weight was defined as circumference < 94cm for men and < 80cm for women. Using BMI, obesity was defined as BMI > 30kg/m2, whereas individuals with BMI=18.5–24.9kg/m2 were defined as normal weight. Individuals with BMI < 18.5kg/m2 were excluded from both sub-samples.

Design. We undertook a 3-year retrospective study of the relationship between obesity and use of hospital resources. Data on hospital contacts and costs were obtained from The National Patient Registry and DRG. Analyses were performed using two-part models and Poisson regression. Outcome variables were costs and hospital contacts.

Results. This study has demonstrated that obese individuals have a greater use of hospital services and greater hospital costs compared with normal weight individuals. When using WC as an indicator for obesity, mean hospital costs were 33.8% greater among obese women and 45.3% greater among obese men in a 3-year period but the differences were not significant. When using BMI to measure obesity, obese men had significantly greater costs (57.5%) than normal weight men.

Furthermore, obese men and women (indicated byWC) had an increased number of hospital contacts compared with normal weight individuals (rate ratio 1.32, 95% CI 1.21–1.43 for men and 1.20, 95% CI 1.11–1.28 for women) including inpatient admissions, outpatient visits, and emergency department visits. The same trends were seen when obesity was indicated by BMI.

The purpose of this paper is to examine the use and applicability of cultural probes – an explorative participatory method to gain insights into a person’s life and thoughts – to achieve person-centeredness and active involvement in self-management education for people with chronic illness.

An education toolkit inspired by the ideas of cultural probes was developed and feasibility tested in 49 education settings in Denmark. Questionnaires, interviews, and observations were used to collect data, which were analysed using descriptive statistics, analysis of variance, and systematic text condensation.

Educators emphasized the applicability of the toolkit, and between 69 and 82 per cent of educators reported that the toolkit supported them in facilitating person-centred education and active involvement to a high or very high degree. Most educators (81 per cent) reported that they would like to apply the toolkit again in future education to a high or very high degree. Five categories of educator experiences were identified: interaction and activity; person-centeredness; group dynamics and synergy; openness; and light and cheerful atmosphere. Educators talked significantly less in situations where the toolkit was applied. This indicates the ability of the toolkit to facilitate talk among participants and thereby let participants become the focal point of education. Applying cultural probes in patient education targeting people with chronic illness seems to be a useful method to achieve patient-centeredness and active involvement in patient education and to support educators in facilitating this process.

Introducing fully flexible education toolkits inspired by cultural probes may, in the future, lead to improved self-management patient education among people with chronic illness.

The purpose of this paper is to explore educator competencies and roles needed to perform participatory patient education, and develop a comprehensive model describing this.

Data collection in the qualitative study proceeded through two phases. In the first phase, 28 educators were involved in exploring educator competencies needed to perform participatory, group-based patient education. The paper used qualitative methods: dialogue workshops, interviews and observations. In the second phase, 310 educators were involved in saturating and validating the insights from phase one using workshop techniques such as brainstorming, reflection exercises and the story-dialogue method. A grounded theory approach was used to analyse data.

A model called “The Health Education Juggler” was developed comprising four educator roles necessary to perform participatory patient education: the Embracer, the Facilitator, the Translator and the Initiator. The validity of the model was confirmed in phase two by educators and showed fit, grab, relevance, workability and modifiability.

The model provides a tool that can be used to support the focus on “juggling” skills in educators: the switching between different educator roles when performing participatory, group-based patient education. The model is useful as an analytical tool for reflection and supervision, as well as for observation and evaluation of participatory, group-based patient education.

The study proposes a comprehensive model consisting of four equally important roles for educators performing participatory, group-based patient education.

The purpose of this paper is to explore educators’ experiences of putting a participatory and patient-centered education model, “The Health Education Juggler,” into practice after having attended a one-day seminar. The model consists of four educator roles in participatory group-based patient education in chronic illness: embracer (takes care of the group), facilitator (generates dialogue and participation), translator (communicates professional knowledge) and initiator (motivates action in patients).

Qualitative analysis of observations of eight group-based patient education sessions and seven in-depth semi-structured interviews with 11 educators.

Educators find it difficult to include disease-specific knowledge when working with a flexible patient-centered approach. They tend to stay in the role they find most comfortable during education sessions (most often that of embracer), rather than adopting new and more challenging roles in the teaching process. Educators theoretically understand the role of facilitator, but they do not know how to perform in this role in practice. The ability to juggle all educator roles depends on the ability to master each.

The Health Education Juggler model shows promise in promoting participation and patient-centeredness and as a reflection tool for educators and an analytic tool for quality assessment of patient education. These findings support further development of model use.

This model of educator roles in group-based patient education in chronic illness provides a new approach to patient education. It indicates the need for various professional competencies among educators to provide patient-centered education in a flexible way, with a strong focus on patient-identified problems and challenges, social learning processes and generation of internal motivation in patients.

Five papers in the volume use economic models to predict obesity and related behaviours. Two of the papers are theoretical. Liqun Liu, Andrew J. Rettenmaier, and Thomas R. Saving analyse the importance of food quality for bodyweight. Bodyweight is treated as a variable of choice – the individual derives utility from health, food consumption and consumption of a composite good. Bodyweight is assumed to decrease health whenever it differs from its physiologically optimal level. Their model implies that much of further income growth will be used to improve food quality rather than increase caloric intake.

The following classified, annotated list of titles is intended to provide reference librarians with a current checklist of new reference books, and is designed to supplement the RSR review column, “Recent Reference Books,” by Frances Neel Cheney. “Reference Books in Print” includes all additional books received prior to the inclusion deadline established for this issue. Appearance in this column does not preclude a later review in RSR. Publishers are urged to send a copy of all new reference books directly to RSR as soon as published, for immediate listing in “Reference Books in Print.” Reference books with imprints older than two years will not be included (with the exception of current reprints or older books newly acquired for distribution by another publisher). The column shall also occasionally include library science or other library related publications of other than a reference character.