Bothered enough to change? A qualitative investigation of recalled adolescent experiences of obesity

Background: Although research suggests that obese children and adolescents are stigmatised, experience victimisation, have poor body image, body dissatisfaction, depression and low self-esteem, these findings have been inconsistent. There is increasing evidence to suggest that body perception rather than actual body size leads to negative psychosocial outcomes with many obese people miss-rating themselves as being ‘normal’ weight; body perception is also the strongest predictor of weight change attempts. The majority of studies in this area have been quantitative; the few previous qualitative studies have either not fully utilised qualitative methods or not focused on adolescents. This study uses qualitative methods, and a unique sampling strategy, to improve understanding of obesity related experiences and reasons for weight change behaviours and success in adolescence. Methods: 35 semi-structured interviews were conducted between November 2007 and April 2008. Young adult (aged approximately 24) males (17) and females (18) were purposively sub-sampled from The West of Scotland 11 to 16/16+ Study cohort based on measured adolescent obese status (SDS > 1.65 at one or more of the 11 to 16/16+ study age 11, 13 or 15 measurement points). A picture task was used to stimulate discussion about perceptions of health and weight and the interviews continued with discussion of adolescent experiences, weight related behaviours (diet and exercise) and any weight change attempts. Framework analysis was used to organise data and facilitate analysis. Findings: Initial quantitative secondary analysis of the 11 to 16/16+ data demonstrated that the majority of participants had been worried about both their weight and putting on weight in the future, although this did not translate into slimming behaviour for all. This study found that body size awareness and related ‘botheredness’ varied greatly and were inconsistently related to each other or to weight. While none of the most obese were among the least aware, some were among the least bothered and vice versa. Botheredness related to body concerns, comparisons with others, clothing, romantic relationships, and for approximately half the sample, victimisation. Although the majority of participants reported using changes in diet or exercise behaviours in order to try to lose weight at some time, botheredness did not always translate into effective weight change attempts. Participants were categorised as effective slimmers (active and successful weight change attempt), failed slimmers (active but unsuccessful weight change attempt), passive slimmers (weight loss without active weight change attempt), and passive maintainers (had made no attempts to change weight and had no weight loss). As young adults, 14 were non obese, 14 were obese and 5 were morbidly obese. Those who made successful long lasting weight changes described determination, a greater degree of behaviour change and continued behaviour monitoring. There appeared to be no real pattern to when or why effective changes were made. Age related transitions were often described as being tipping points as well as ‘just being ready’ to change. Those who described sudden unplanned changes were among those who showed the most sustained improvement in weight Conclusions: Not all those who are obese as adolescents are aware or bothered. Most adolescents are aware of how to lose weight. Being bothered is not enough of a motivator to make long lasting changes – obese individuals need to be ‘ready’ to change regardless of knowledge of health behaviours. More needs to be done to assist individuals in being ready to change, this might include raising; body awareness through periodic body measurements at transition points. Further study of ‘tipping points’ in obese adolescents may aid intervention targeting and design

Maternal and Child Health, Nutrition, and Hiv

Reducing maternal and child mortality was established as a global priority with the signing of the Millennium Declaration in September 2000. Neonatal vitamin A supplementation and very early breastfeeding initiation are scalable interventions which may improve infant survival. Although breastfeeding has proven benefits for infant health, the potential health consequences of breastfeeding for HIV-infected women are not well studied. In paper one, “The effect of neonatal vitamin A supplementation on morbidity and mortality at 12 months: A randomized trial”, we assessed the efficacy of neonatal vitamin A supplementation (NVAS) in reducing infant morbidity and mortality. Using data from an individually randomized clinical trial of 31,999 infants in Tanzania, we found that NVAS did not affect the risk of death or the incidence of morbidities. However, we noted that postpartum maternal vitamin A supplementation modified the effect of neonatal vitamin A supplementation on infant mortality. In paper two, “Effect of delayed breastfeeding initiation on infant survival: a systematic review and meta-analysis”, our objective was to synthesize the evidence regarding the association between breastfeeding initiation time and infant morbidity and mortality. We pooled five studies, including 136,047 infants. We found a clear dose-response relationship; the risk of neonatal mortality increased with increased delay in breastfeeding initiation. We found a similar pattern when the analysis was restricted to exclusively breastfed infants or low birthweight infants. There was limited evidence regarding the association between breastfeeding initiation time and infant morbidity and growth. We concluded that health policy frameworks and models to estimate newborn and infant survival should consider the independent survival benefit associated with early initiation of breastfeeding. In paper three, “Breastfeeding and Maternal Health among HIV-infected Women in Tanzania”, our objective was to assess the relationship between infant feeding practices and the incidence of maternal mortality, morbidity, and indicators of poor nutritional status from six weeks to two years postpartum in a prospective cohort of Tanzanian women living with HIV. We concluded that breastfeeding may be associated with mixed health outcomes. Additional research should investigate whether HIV-infected women require nutritional support, in addition to antiretroviral therapy, during and after lactation

Women in the fire service : investigating the influence of conformity to masculine gender role norms and perceived social support on trauma symptomology

Research on masculinity has typically paid little attention to how masculine gender socialization affects women. Gender socialization is particularly important to understand within highly-masculinized occupations, such as the fire service, in which women are subjected to frequent negative experiences such as coworker hostility, the silent treatment, close and punitive supervision, and sexual harassment. These negative experiences may lead to a reduction in female firefighter’s perceived levels of social support. The stress-buffering model of social support highlights the critical role perceptions of social support play in an individual’s appraisal of their ability to cope with stressors and subsequent use of coping skills. It is crucial to understand variables that influence female firefighter’s perceptions of social support and its relationship to trauma symptomology. Masculine gender role conformity of female firefighters is likely to influence interactions within the male-dominated environment, resulting in relationships between masculine gender vii conformity and perceived social support at work. This study explored the relationship between conformity to masculine norms (CMN) and trauma symptom severity (TSS), as assessed by the Conformity to Masculine Norms Inventory – 46 (CMNI-46) and PTSD Civilian Checklist – 5 (PCL-5) respectively, and further sought to investigate whether the association between CMN and TSS is mediated by perceived social support (PSS). This study also investigated CMN amongst female firefighters in comparison to that of normative data samples of women. Data were collected through self-report questionnaires distributed to all active-duty female firefighters employed by two large municipal fire departments in the Southwestern region of the United States. The mediated model was assessed using the PROCESS macro by Hayes (2013) and indicated support for the overall model (β = -.132, SE = .061, CI = -.266, -.026), and the significant indirect effect (b = - 0.132) indicated that PSS mediated the relationship between CMN and TSS. Results from the CMNI-46 indicated significant differences in CMN between this sample of female firefighters and samples of women from previous studies. These findings indicate conformity to gender roles has significant indirect effects on the health of women in the fire department and highlight the importance of social support for the wellbeing of female firefightersEducational Psycholog

Impact of Pulsed Electric Field Treatment on Barley Germination for Malting

The malting process takes one week to steep, germinate, and kiln barley to make malt. Making quality malt is critically important to achieve the desired attributes of the finished beer, and the process is time-intensive and costly. Malt quality is assessed by indicators including β-glucan quantity, α-amylase activity, Free Amino Nitrogen (FAN) content, and overall extract concentration in the finished malt. Here, we report Pulsed Electric Field (PEF) treatment of barley to accelerate malt production. A small-scale trial of 250 g to 1.00 kg barley, was evaluated for germination at two PEF treatment conditions, generically referred to as “low” and “high”, that resulted in increased barley rootlet length during germination of 1.3 mm longer than was observed for the control. Large-scale trials of 1.00 kg–3.00 kg barley, resulted in an increase in germination rate and a decrease of β-glucan concentration in the PEF treated barley. Micromalted barley using PEF parameters of 1.0 kV/cm and 15.0 kJ/kg displayed a reduction in β-glucan concentration by 38%, and increase in malt extract by 1.5%, FAN by 6.2%, and α-amylase by 8.4%, supporting the hypothesis that PEF treated barley generates more and better malt, leading to greater efficiency in the beer making process

Breast Cancer Survival among Economically Disadvantaged Women: The Influences of Delayed Diagnosis and Treatment on Mortality

Breast cancer affects thousands each year in the United States, and disproportionately affects certain subgroups. For example, the incidence of breast cancer in South Carolina is lower in African American compared with European American women by ~12% to 15%, but their mortality rate is twice as high as in European American women. The purpose of the study was to assess factors associated with breast cancer mortality between African American and European American women. Participants (n = 314) in South Carolina\u27s Breast and Cervical Cancer Early Detection Program (SCBCCEDP), which provides breast cancer screening and treatment services, during the years 1996-2004 were included in the study. Data, including tumor characteristics, delay intervals, and race, were examined using the χ2 test and the Wilcoxon rank-sum test. Cox regression modeling was used to assess the relationship between delay intervals and other factors. No racial differences were found in age at diagnosis, tumor characteristics, or delay intervals. Time delay intervals did not explain differences and mortality rates by race. Survival, however, was affected by prognostic factors as well as by a significant interaction between hormone-receptor status and race. Despite the excellent record of the SCBCCEDP in screening and diagnostic or treatment referrals, the racial disparities in breast cancer mortality continue to exist in South Carolina. These findings highlight the need for future research into the etiology of racial differences, and their impact on breast cancer survival

Establishing Foundation Archives: A Reader and Guide to First Steps

This publication is an anthology of papers presented at a conference held at the Rockefeller Archive Center in January 1990, and sponsored by the Council on Foundations. This collaboration of the Archive Center and the Council provided a rare opponunity for foundations to learn both why preserving documents is imponant and how several foundations have approached finding a repository or setting up and managing an archives. Participants in the conference had the added privilege of conferring with experts and seeing an operating archive as they toured the Rockefeller Archive Center.Foundations are institutions that are shaping private initiatives for the public good, so documenting this aspect of American society falls uniquely under the stewardship of the organizations themselves. Foundation documents often provide the only surviving records of the important contributions of nonprofits and foundations to civic life. These records will help to inform future judgments and ensure that the history of the field is not lost. The publication of this volume was intended to make the information shared at the conference more widely available and to provide an entry point and a primer for foundations as they begin their records and archives journey

Aggressive behaviour in childhood and adolescence : the role of smoking during pregnancy, evidence from four twin cohorts in the EU-ACTION consortium

Background Maternal smoking during pregnancy (MSDP) has been linked to offspring's externalizing problems. It has been argued that socio-demographic factors (e.g. maternal age and education), co-occurring environmental risk factors, or pleiotropic genetic effects may account for the association between MSDP and later outcomes. This study provides a comprehensive investigation of the association between MSDP and a single harmonized component of externalizing: aggressive behaviour, measured throughout childhood and adolescence. Methods Data came from four prospective twin cohorts - Twins Early Development Study, Netherlands Twin Register, Childhood and Adolescent Twin Study of Sweden, and FinnTwin12 study - who collaborate in the EU-ACTION consortium. Data from 30 708 unrelated individuals were analysed. Based on item level data, a harmonized measure of aggression was created at ages 9-10; 12; 14-15 and 16-18. Results MSDP predicted aggression in childhood and adolescence. A meta-analysis across the four samples found the independent effect of MSDP to be 0.4% (r = 0.066), this remained consistent when analyses were performed separately by sex. All other perinatal factors combined explained 1.1% of the variance in aggression across all ages and samples (r = 0.112). Paternal smoking and aggressive parenting strategies did not account for the MSDP-aggression association, consistent with the hypothesis of a small direct link between MSDP and aggression. Conclusions Perinatal factors, including MSDP, account for a small portion of the variance in aggression in childhood and adolescence. Later experiences may play a greater role in shaping adolescents' aggressive behaviour.Peer reviewe

Geographic variation in plant community structure of salt marshes: species, functional and phylogenetic perspectives.

In general, community similarity is thought to decay with distance; however, this view may be complicated by the relative roles of different ecological processes at different geographical scales, and by the compositional perspective (e.g. species, functional group and phylogenetic lineage) used. Coastal salt marshes are widely distributed worldwide, but no studies have explicitly examined variation in salt marsh plant community composition across geographical scales, and from species, functional and phylogenetic perspectives. Based on studies in other ecosystems, we hypothesized that, in coastal salt marshes, community turnover would be more rapid at local versus larger geographical scales; and that community turnover patterns would diverge among compositional perspectives, with a greater distance decay at the species level than at the functional or phylogenetic levels. We tested these hypotheses in salt marshes of two regions: The southern Atlantic and Gulf Coasts of the United States. We examined the characteristics of plant community composition at each salt marsh site, how community similarity decayed with distance within individual salt marshes versus among sites in each region, and how community similarity differed among regions, using species, functional and phylogenetic perspectives. We found that results from the three compositional perspectives generally showed similar patterns: there was strong variation in community composition within individual salt marsh sites across elevation; in contrast, community similarity decayed with distance four to five orders of magnitude more slowly across sites within each region. Overall, community dissimilarity of salt marshes was lowest on the southern Atlantic Coast, intermediate on the Gulf Coast, and highest between the two regions. Our results indicated that local gradients are relatively more important than regional processes in structuring coastal salt marsh communities. Our results also suggested that in ecosystems with low species diversity, functional and phylogenetic approaches may not provide additional insight over a species-based approach

BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation