Trauma exposure characteristics, past traumatic life events, coping strategies, posttraumatic stress disorder, and psychiatric comorbidity among people with anaphylactic shock experience

Objectives: This study investigated the interrelationship between trauma exposure characteristics, past traumatic life events, coping strategies, posttraumatic stress disorder (PTSD) symptoms, and psychiatric comorbidity among people after anaphylactic shock experience. Method: The design was cross-sectional in that 94 people with anaphylactic shock experience responded to a postal survey. They completed the Posttraumatic Stress Disorder Checklist, the General Health Questionnaire 28, and the COPE Scale. They also answered questions on trauma exposure characteristics. The control group comprised 83 people without anaphylaxis. Results: Twelve percent of people with anaphylactic shock experience fulfilled the diagnostic criteria for full PTSD. As a group, people with anaphylaxis reported significantly more past traumatic life events and psychiatric comorbidity than did the control. Partial least squares analysis showed that trauma exposure characteristics influenced postanaphylactic shock PTSD symptoms and psychiatric comorbidity, which, in turn, influenced coping strategies. Conclusions: People could develop PTSD and psychiatric comorbidity symptoms after their experience of anaphylactic shock. The way they coped with anaphylactic shock was affected by the severity of these symptoms. Past traumatic life events had a limited role to play in influencing outcomes. © 2011 Elsevier Inc. All rights reserved

Origins, Destinations and Catchments: Mapping travel to work in Ireland in 2002

Over recent years there has emerged an increased awareness of the importance of strategic spatial planning and of the extent to which concepts such as place and space really matter. An enhanced understanding of the geography of living and of the economy requires not only a knowledge of where people and objects are but also of how those places relate to one another. This requires fundamentally sound data on movement patterns, of which the most important is probably the daily journey to work (Horner, 1999). In this paper we explore for the first time several aspects of the journey to work using data from the CSO 2002 Census of Population (CSO 2003a, CSO 2003b. CSO 2004a). While the approach at this stage is mainly descriptive supported by detailed mapping it is timely and it will hopefully contribute to discussion in a number of areas of public policy. These include the estimation of regional per capita levels of output (per capita GVA), the extent of the catchment areas of the National Spatial Strategy Gateways and hubs, the environmental sustainability of new trip patterns, and the impact of longer and more stressful journey times on quality of life

Origins, Destinations and Catchments: Mapping travel to work in Ireland in 2002

Over recent years there has emerged an increased awareness of the importance of strategic spatial planning and of the extent to which concepts such as place and space really matter. An enhanced understanding of the geography of living and of the economy requires not only a knowledge of where people and objects are but also of how those places relate to one another. This requires fundamentally sound data on movement patterns, of which the most important is probably the daily journey to work (Horner, 1999). In this paper we explore for the first time several aspects of the journey to work using data from the CSO 2002 Census of Population (CSO 2003a, CSO 2003b. CSO 2004a). While the approach at this stage is mainly descriptive supported by detailed mapping it is timely and it will hopefully contribute to discussion in a number of areas of public policy. These include the estimation of regional per capita levels of output (per capita GVA), the extent of the catchment areas of the National Spatial Strategy Gateways and hubs, the environmental sustainability of new trip patterns, and the impact of longer and more stressful journey times on quality of life

What are the mechanisms and contexts by which care groups achieve social and behavioural change in low- and middle-income countries? Group motivation findings from a realist synthesis

Infant and under-five mortality rates in low- and middle-income countries (LMIC) can be reduced by encouraging behaviours such as sleeping under insecticide-treated bed nets, exclusive breast-feeding for the first 6 months, regular handwashing, etc. Community-based volunteer or peer-to-peer mechanisms are cost-effective ways of promoting these lifesaving practices. However, the sustainability and reach of community-based behaviour change promotion remains a challenge. Our inquiry focuses on the utilisation, by non-governmental organisations (NGO), of Care Groups, a peer-to-peer behaviour change intervention. We asked: What are the mechanisms and contexts by which Care Groups achieve social and behavioural change in nutrition, health and other sectors? Design: Realist synthesis reviewing forty-two texts that contained empirical evidence about Care Group interventions. Setting: LMIC. Participants: We held consultations with a research reference group, which included Care Group and nutrition experts, and Care Group – implementing NGO staff in Malawi. Results: Different types of motivation drive the establishment and the sustainability of peer group interventions. A certain amount of motivation was derived from the resources provided by the NGO establishing the Care Groups. Subsequently, both volunteers and neighbourhood group members were motivated by the group dynamics and mutual support, as well as support from the wider community. Finally, volunteers and group members alike became self-motivated by their experience of being involved in group activities. Conclusions: When designing and implementing community-based behaviour change interventions, awareness of the multi-directional nature of the motivating drivers that are experienced by peer- or community group members is important, to optimise these groups’ reach and sustainability

Exploring how and why care groups work to improve infant feeding practices in low and middle-income countries: a realist review protocol

Background: Within our inquiry into the implementation of breastfeeding policy in Malawi, Care Groups have been mentioned as a means to improve maternal and child health and nutrition outcomes. The ‘Care Group model’ is an approach primarily used in international development settings, whereby social and behaviour changes are promoted through supported peer-to-peer (mostly mother-to-mother) knowledge sharing. The aim of most Care Groups is to promote improved infant nutrition, improve hygiene and increase the number of children who are fully vaccinated and exclusively breastfed for the first 6 months. The behavioural changes promoted by Care Groups (such as safe infant feeding, frequent hand washing, consistent mosquito net usage, providing suitable complementary foods from 6 months old) have the potential of averting preventable deaths particularly among children under five. While a variety of approaches are used to promote improved health and nutrition for children under five, the Care Groups model was best known and frequently referenced during our discussions with key stakeholders regarding the delivery at community level of Malawi’s National Multi-Sector Nutrition Policy 2018-2022. A better understanding of how Care Groups achieve their social and behaviour change results and how community-based efforts are sustained can potentially help to ensure more effective planning and budgeting for Care Group interventions and enable greater sustainability and increased coverage of infant feeding support countrywide. This realist review is designed to improve our understanding of how, why, to what extent and under what circumstances Care Groups improve infant feeding practices in low- and middle-income countries (LMICs). Methods and analysis: A realist review is a theory-driven approach to evidence synthesis. To undertake this realist review, we will gather evidence by conducting peer-reviewed and grey literature database searches in order to find peer reviewed articles, programme guidelines and evaluation reports, among other texts, associated with the implementation of Care Groups in low- and middle-income countries. Our review process has five key steps: (1) locating existing theories; (2) searching for evidence in literature; (3) selecting articles and other suitable evidence; (4) extracting data, identifying configurations of context-mechanism-outcomes; and (5) synthesising the evidence, drawing conclusions Discussion: The results of this realist review will be written up according to RAMESES guidelines and disseminated through a stakeholder workshop in Malawi, through conference presentations and peer-reviewed publications. It is intended to improve the understanding of the potential and limits of working through Care Groups globally and among relevant Malawi Ministry of Health staff and the donor and NGO community, both internationally and within Malawi. This systematic review protocol has been submitted for registration on the PROSPERO database (receipt number: 170261)

Findings from the first phase of developing a receptive vocabulary test for the Irish language

Aims and objectives: The aim of this study was to develop and pilot a test of receptive vocabulary for bilingual Irish-English-speaking children, based on a model from Welsh. Design/Methodology/Approach: 310 typically developing children aged five, six and seven years took part. The children were all attending Irish-medium education in Irish-dominant Gaeltacht regions and in immersion education schools outside of these regions. Data and Analysis: Participants were identified as being from either bilingual Irish- and English-speaking homes or English-dominant homes. A mixed-factorial analysis of variance found a significant main effect of age and language background, but no interaction. Post hoc comparisons revealed that those from Bilingual-speaking homes had significantly higher Irish receptive vocabulary scores than those from English-dominant homes. Linear regression models showed that the receptive vocabulary scores of children in immersion schools grew by an average of 21 words per year between the ages of five and seven, compared to almost 12 words per year in Gaeltacht schools. Findings/Conclusions: The findings demonstrate the advantages of immersion education and the need for vocabulary enrichment of children in the Gaeltacht. However, the complexities of developing assessments for first language speakers of a minority language that is in conflict with a second language variety of that language and the majority English language are also highlighted. Significance/Implications: The implications of this study are that immersion schooling is advantageous to the Irish vocabulary of children, but that children from Gaeltacht schools may require vocabulary enrichment that is sufficiently complex to address their needs. Limitations: Limitations to this study include the uneven number of children from each language background/school location and incomplete background details from the children, such as socio-economic status and language use amongst peers

Expression of endogenous Mkp1 in 6-OHDA rat models of Parkinson's disease.

We have previously demonstrated that mitogen-activated protein kinase phosphatase 1, Mkp1, is expressed in the developing and rat adult substantia nigra and striatum, where it promotes the growth of nigral dopaminergic neurons. Mkp1 may therefore have therapeutic potential for Parkinson's disease. In the present study, we have assessed the expression of Mkp1 and TH in the substantia nigra and striatum of parkinsonian rat models. Expression was measured at 4 and 10 days post-lesion in the 6-hydroxydopamine (6-OHDA) medial forebrain bundle lesion model and after 4, 10 and 28 days in the 6-OHDA striatal lesion model. Our results show that Mkp1 expression was transiently up-regulated in the substantia nigra at 4 days post-6-OHDA administration in the two models while TH expression was decreased at the later time-points examined. These data suggest that Mkp1 may play a role in counteracting the neurotoxic effects of 6-OHDA in nigral dopaminergic neurons

Statins versus placebo for people with chronic obstructive pulmonary disease

Background: Chronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable respiratory disease. COPD exacerbations are associated with worse quality of life, increased hospitalisations, and increased mortality. Currently available pharmacological interventions have variable impact on exacerbation frequency. The anti‐inflammatory effects of statins may lead to decreased pulmonary and systemic inflammation, resulting in fewer exacerbations of COPD. Several observational studies have shown potential benefits of statins for patients with COPD. Objectives: This review aims to evaluate available evidence on benefits and harms associated with statin therapy compared with placebo as adjunct therapy for patients with COPD. Primary objectives include the following • To determine whether statins reduce mortality rates in COPD • To determine whether statins reduce exacerbation frequency, improve quality of life, or improve lung function in COPD • To determine whether statins are associated with adverse effects. Search methods: We identified trials from the Cochrane Airways Trials Register, which contains studies identified through multiple electronic searches and handsearches of other sources. We also searched trial registries and reference lists of primary studies. We conducted the most recent search on 20 May 2019. Selection criteria: Parallel, randomised controlled trials recruiting adults with COPD. Data collection and analysis: We used standard methods as expected by Cochrane. Prespecified primary outcomes were number of exacerbations, all‐cause mortality, and COPD‐specific mortality. Main results: Eight studies including 1323 participants with COPD were included in the review. Participants had a mean age of 61.4 to 72 years, and most were male (median 73.4%). Mean baseline forced expiratory volume in one second (FEV₁) ranged from 41% to 90% predicted. All studies compared moderate‐ or high‐intensity statin therapy versus placebo. The duration of treatment ranged from 12 weeks to 36 months. We found no statistically significant difference between statins and placebo in our primary outcome of number of exacerbations per person‐year (mean difference (MD) ‐0.03, 95% confidence interval (CI) ‐0.25 to 0.19, 1 trial, 877 participants), including number of exacerbations requiring hospitalisation per person‐year (MD 0.00, 95% CI ‐0.10 to 0.10, 1 trial, 877 exacerbations). This evidence was of moderate quality after downgrading for unclear risk of bias. Our primary outcomes of all‐cause mortality (odds ratio (OR) 1.03, 95% CI 0.61 to 1.74, 2 trials, 952 participants) and COPD‐specific mortality (OR 1.25, 95% CI 0.38 to 4.13, 1 trial, 877 participants) showed no significant difference between statins and placebo, with wide confidence intervals suggesting uncertainty about the precision of the results. This evidence was of low quality after downgrading for unclear risk of bias and imprecision. Results of the secondary outcomes analysis showed no clear differences between statins and placebo for FEV₁ (% predicted) (MD 1.18, 95% CI ‐2.6 to 4.97, 6 trials, 325 participants) but did show a statistically significant improvement in FEV₁/forced vital capacity (FVC) (MD 2.66, 95% CI 0.12 to 5.2; P = 0.04; 6 trials, 325 participants). A sensitivity analysis excluding two trials at high risk of bias showed no statistically significant difference in FEV₁/FVC (MD 2.05, 95% CI ‐0.87 to ‐4.97; P = 0.17; 4 trials, 255 participants). We also found no significant differences between the two groups in functional capacity measured by six‐minute walk distance in metres (MD 1.79, 95% CI ‐52.51 to 56.09, 3 trials, 71 participants), with wide confidence intervals suggesting uncertainty about the precision of the results. Results show no clear difference in quality of life, which was reported in three trials, and a slight reduction in C‐reactive protein (CRP) in the intervention group, which was statistically significant (MD ‐1.03, 95% CI ‐1.95 to ‐0.11; I² = 0%, P = 0.03; 3 trials, 142 participants). We noted a significant reduction in interleukin (IL)‐6 in the intervention group (MD ‐2.11, 95% CI ‐2.65 to ‐1.56; I² = 0%, P ≤ 0.00001; 2 trials, 125 participants). All trials mentioned adverse events and indicated that statins were generally well tolerated. One study reported adverse events in detail and indicated that rates of all non‐fatal adverse events (the number of serious adverse events per person‐year) were similar in both groups (0.63 ± 1.56 events (intervention group) and 0.62 ± 1.48 events (control group); P > 0.20) for all comparisons, except for non‐fatal serious adverse events involving the gastrointestinal tract, which were more frequent in the intervention group (in 30 patients (0.05 events per person‐year) vs 17 patients (0.02 events per person‐year); P = 0.02). Another trial lists the total numbers and percentages of adverse events in the intervention group (12 (26%)) and in the control group (21 (43%)) and of serious adverse events in the intervention group (4 (9%)) and in the control group (3 (6%)).The other trials stated that researchers found no significant adverse effects of statins but did not report adverse events in detail. Authors' conclusions: A small number of trials providing low‐ or moderate‐quality evidence were suitable for inclusion in this review. They showed that use of statins resulted in a reduction in CRP and IL‐6, but that this did not translate into clear clinical benefit for people with COPD. Further randomised controlled trials are needed to explore this topic

The role of the traditional leader in implementing maternal, newborn and child health policy in Malawi

Traditional leaders play a prominent role at the community level in Malawi, yet limited research has been undertaken on their role in relation to policy implementation. This article seeks to analyse the role of traditional leaders in implementing national maternal, newborn and child health (MNCH) policy and programmes at the community level. We consider whether the role of the chief embodies a top-down (utilitarian) or bottom-up (empowerment) approach to MNCH policy implementation. Primary data were collected in 2014/15, through 85 in-depth interviews and 20 focus group discussions in two districts in Malawi. We discovered that traditional leaders play a pivotal role in supporting MNCH service utilization, through mobilization for MNCH campaigns, and encouraging women to give birth at the health facility rather than at home or in the community setting. Women and their families responded to bylaws to deliver in the facility out of respect for the traditional leader, which is ingrained in Malawian culture. Fines were imposed on women for delivering at home, in the form of goats, chickens and money. Fear and coercion were often used by traditional leaders to ensure that women delivered at the health facility. Chiefs who failed to enforce these bylaws were also fined. Although the role of the traditional leader was often positive and encouraging in relation to MNCH service utilization, this was sometimes carried out in a coercive manner. Results show evidence of a utilitarian top-down model of policy implementation, where the goal of health service utilization justified the means, through encouragement, fear, punishment or coercion. Although the bottom-up approach would be associated with a more empowerment approach, it is unlikely that this would have been successful in Malawi, given the hierarchical nature of society. Further research on policy implementation in the context of community participation is needed