Opportunistic health promotion among overweight children

Aim To explore children’s nurses’ attitudes to providing health promotion advice to overweight children and their families during hospital admissions. Methods Individual semi-structured interviews were conducted in a private room in the ward setting. Interviews were recorded and transcribed, and thematic analysis of the transcripts was undertaken. Findings The six themes generated from responses were: responsibility for health promotion; sensitivity of the topic; long-term benefits; parents – a barrier; need for training; and need for institutional support. Conclusion Further research with acute care children’s nurses in the UK is required to validate the study findings. More work is also needed to explore the ethics of health promotion in the acute care setting

Food Preferences of the Brushtail Possum (Trichosurus vulpecula)

The common brushtail possum (Trichosurus vulpecula) has been reported to eat vegetation, fruit, invertebrates, and occasionally fungi, eggs and meat. The relative preference between food types found in the wild, however, has not been investigated systematically in a controlled laboratory study. This research investigated captive possums’ food choice using two different methods of preference assessment. The first experiment involved a single stimulus assessment of possums’ (n = 20) consumption of individually presented food items. More than 75% of possums consumed berries, locusts and mushrooms but fewer than 50% of possums consumed fivefinger, raw chicken and eggs. The second experiment that used a paired stimulus assessment to establish relative preference for those foods revealed that no single food was preferred by all possums. Overall locusts were the most preferred food, followed in order of preference by berries, egg, mushrooms, chicken and foliage. The single stimulus preference assessment confirmed the palatability of foods. The paired stimulus assessment provided a rank order of food preferences

Feature-based characterisation of evolving surface topographies in finishing operations for additive manufacturing

Finishing operations play a fundamental role in the additive manufacture of components. Conventional surface metrology solutions allow for the characterisation of surface roughness through texture parameters, but are not fully suitable to capture the evolution of individual surface topographic formations as they undergo changes as a result of finishing operations. Feature-based characterisation of topography offers a new perspective in the investigation of surfaces. The approach consists of the identification, isolation, and dimensional characterisation of surface topography formations (surface features). In this work an original feature- based solution is proposed for the quantitative comparison of topographies before and after a finishing operation: the approach is based on the registration of areal topography datasets and quantitative analysis of shape and size differences pertaining to the relevant topographic features. A variety of finishing operations are investigated on metallic samples manufactured via powder bed fusion

Neutropenia as an adverse event following vaccination : results from randomized clinical trials in healthy adults and systematic review

Background : In the context of early vaccine trials aimed at evaluating the safety profile of novel vaccines, abnormal haematological values, such as neutropenia, are often reported. It is therefore important to evaluate how these trials should be planned not to miss potentially important safety signals, but also to understand the implications and the clinical relevance. Methodology : We report and discuss the results from five clinical trials (two with a new Shigella vaccine in the early stage of clinical development and three with licensed vaccines) where the absolute neutrophil counts (ANC) were evaluated before and after vaccination. Additionally, we have performed a systematic review of the literature on cases of neutropenia reported during vaccine trials to discuss our results in a more general context. Principal Findings : Both in our clinical trials and in the literature review, several cases of neutropenia have been reported, in the first two weeks after vaccination. However, neutropenia was generally transient and had a benign clinical outcome, after vaccination with either multiple novel candidates or well-known licensed vaccines. Additionally, the vaccine recipients with neutropenia frequently had lower baseline ANC than non-neutropenic vaccinees. In many instances neutropenia occurred in subjects of African descent, known to have lower ANC compared to western populations. Conclusions : It is important to include ANC and other haematological tests in early vaccine trials to identify potential safety signals. Post-vaccination neutropenia is not uncommon, generally transient and clinically benign, but many vaccine trials do not have a sampling schedule that allows its detection. Given ethnic variability in the level of circulating neutrophils, normal ranges taking into account ethnicity should be used for determination of trial inclusion/exclusion criteria and classification of neutropenia related adverse events

Psychotic Symptoms in Kenya - Prevalence, Risk Factors, and Relationship with Common Mental Disorders

There have been few epidemiological surveys to establish prevalence and associated risk factors of psychosis in Sub-Saharan Africa. This paper reports a population- based epidemiological survey in rural Kenya of the prevalence of psychotic symptoms and their relationship with demographic, socio-economic and other risk factors. A random sample of 2% of all adults living in Maseno, Kisumu District of Nyanza province, Kenya (50,000 population) were studied, aiming for a sample size of 1,000 people. The psychosis screening questionnaire was used to assess the prevalence of psychotic symptoms in the preceding twelve months. The response rate was 87.6%. The prevalence of single psychotic symptoms in rural Kenya was 8% of the adult population, but only 0.6% had two symptoms and none had three or more psychotic symptoms in this sample size. Psychotic symptoms were evenly distributed across this relatively poor rural population and were significantly associated with presence of common mental disorders, and to a lesser extent with poor physical health and housing type. We conclude that single psychotic symptoms are relatively common in rural Kenya and rates are elevated in those with CMD, poor physical health and poor housing

How effective are on-farm mitigation measures for delivering an improved water environment? A systematic map

Background\ud Agricultural activities are estimated to contribute 70% of nitrates, 28% of phosphates and 76% of sediments measured in UK rivers. Catchments dominated by agriculture also have elevated levels of pesticides and bacterial pathogens. European member states have a policy commitment to tackle this pollution through the water framework directive. Here we report on the results of a systematic map to investigate and describe the nature and coverage of research pertaining to the effectiveness of 6 on-farm mitigation measures, slurry storage, cover/catch crops, woodland creation; controlled trafficking, subsoiling and vegetated buffer strips for delivering an improved water environment in terms of a reduction in nitrogen (N), phosphorus (P), sediment, pesticides and faecal indicator organisms (FIOs) or pathogens from faecal material.\ud Methods\ud Research evidence for the effectiveness of the 6 on-farm mitigation measures for delivering an improved water environment (as detailed above) was collated using English language search terms for temperate farming systems in Europe, Canada, New Zealand and northern states of the United States of America. Searches for literature were made from online publication databases, search engines, specialist websites and bibliographies of topic specific reviews. Recognised experts, authors and practitioners were also contacted to identify unpublished literature. Articles were screened for relevance at title, abstract and full text using predefined inclusion criteria set out in an a priori published protocol. All relevant articles were mapped in a searchable database using pre-defined coding and critically appraised for relevance and reliability. Articles reporting the same study were removed. All full text studies without confounding factors were identified and coded for in a separate searchable database.\ud Results\ud A total of 718 articles were included in the database. Buffer strips were the most commonly studied intervention followed by cover crops and slurry storage. Little evidence was found for woodland creation and sub-soiling. No studies were found for controlled trafficking on grassland. Nitrogen was most frequently measured, followed by P, sediment, pesticides and FIOs or pathogens from faecal material.\ud Conclusions\ud The majority of the evidence collated in this map investigated the effectiveness of buffer strips and cover crops for improving water quality. This evidence was predominantly focussed on reducing N pollution. An evidence gap exists for the impact of cover/catch crops in reducing leaching of pesticides, FIOs and pathogens, and for organic forms of N and P. There was limited research investigating the effectiveness of buffer strips for reducing leaching of organic forms of N or P, or for pesticides that are currently authorised for use/commonly used in UK agriculture. Further, long term studies across different seasons with controls, pre and post water quality measurements and multiple sampling points from both field and rivers would improve the evidence base. Evidence gaps exist for woodland creation, subsoiling and controlled trafficking on grassland

Catch 22? Disclosing assisted conception treatment at work

Purpose: The purpose of this study was to explore factors influencing decision-making about disclosure of Assisted Reproductive Technology (ART) use in the workplace. Design: A qualitative study design was used. Thirty-one women and six men who were using or had recently used ART were recruited from British fertility networks and interviewed. Data were transcribed verbatim and thematically analysed. Findings: Two main strands were identified each encompassing two themes: i) ‘Concerns about disclosure’ covered the very personal nature of disclosing ART treatment and also career concerns and ii) ‘Motives for disclosure’ covered feeling it was necessary to disclose and also the influence of workplace relationships. Research limitations: The relatively small, self-selected sample of participants was recruited from fertility support networks, and lacked some diversity. Practical implications: Clarity about entitlements to workplace support and formal protection against discrimination, along with management training and awareness raising about ART treatment is needed to help normalise requests for support and to make decisions about disclosure within the workplace easier. Originality/ value: The study has highlighted an understudied area of research in ART populations. The data provide insight into the challenging experiences of individuals combining ART with employment and, in particular, the complexity of decisions about whether or not to disclose

Clinical effectiveness and cost-effectiveness of cognitive behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depression in primary care: the CoBalT randomised controlled trial

Background: Only one-third of patients with depression respond fully to treatment with antidepressant medication. However, there is little robust evidence to guide the management of those whose symptoms are 'treatment resistant'.<p></p> Objective: The CoBalT trial examined the clinical effectiveness and cost-effectiveness of cognitive behavioural therapy (CBT) as an adjunct to usual care (including pharmacotherapy) for primary care patients with treatment-resistant depression (TRD) compared with usual care alone.<p></p> Design: Pragmatic, multicentre individually randomised controlled trial with follow-up at 3, 6, 9 and 12 months. A subset took part in a qualitative study investigating views and experiences of CBT, reasons for completing/not completing therapy, and usual care for TRD.<p></p> Setting: General practices in Bristol, Exeter and Glasgow, and surrounding areas.<p></p> Participants: Patients aged 18-75 years who had TRD [on antidepressants for 6 weeks, had adhered to medication, Beck Depression Inventory, 2nd version (BDI-II) score of 14 and fulfilled the International Classification of Diseases and Related Health Problems, Tenth edition criteria for depression]. Individuals were excluded who (1) had bipolar disorder/psychosis or major alcohol/substance abuse problems; (2) were unable to complete the questionnaires; or (3) were pregnant, as were those currently receiving CBT/other psychotherapy/secondary care for depression, or who had received CBT in the past 3 years.<p></p> Interventions: Participants were randomised, using a computer-generated code, to usual care or CBT (12-18 sessions) in addition to usual care.<p></p> Main outcome measures: The primary outcome was 'response', defined as 50% reduction in depressive symptoms (BDI-II score) at 6 months compared with baseline. Secondary outcomes included BDI-II score as a continuous variable, remission of symptoms (BDI-II score of < 10), quality of life, anxiety and antidepressant use at 6 and 12 months. Data on health and social care use, personal costs, and time off work were collected at 6 and 12 months. Costs from these three perspectives were reported using a cost-consequence analysis. A cost-utility analysis compared health and social care costs with quality adjusted life-years.<p></p> Results: A total of 469 patients were randomised (intervention: n = 234; usual care: n = 235), with 422 participants (90%) and 396 (84%) followed up at 6 and 12 months. Ninety-five participants (46.1%) in the intervention group met criteria for 'response' at 6 months compared with 46 (21.6%) in the usual-care group {odds ratio [OR] 3.26 [95% confidence interval (CI) 2.10 to 5.06], p < 0.001}. In repeated measures analyses using data from 6 and 12 months, the OR for 'response' was 2.89 (95% CI 2.03 to 4.10, p < 0.001) and for a secondary 'remission' outcome (BDI-II score of < 10) 2.74 (95% CI 1.82 to 4.13, p < 0.001). The mean cost of CBT per participant was £910, the incremental health and social care cost £850, the incremental QALY gain 0.057 and incremental cost-effectiveness ratio £14,911. Forty participants were interviewed. Patients described CBT as challenging but helping them to manage their depression; listed social, emotional and practical reasons for not completing treatment; and described usual care as mainly taking medication.<p></p> Conclusions: Among patients who have not responded to antidepressants, augmenting usual care with CBT is effective in reducing depressive symptoms, and these effects, including outcomes reflecting remission, are maintained over 12 months. The intervention was cost-effective based on the National Institute for Health and Care Excellence threshold. Patients may experience CBT as difficult but effective. Further research should evaluate long-term effectiveness, as this would have major implications for the recommended treatment of depression.<p></p&gt