Can nurses rise to the public health challenge? How a novel solution in nurse education can address this contemporary question.

This paper raises the problem of how improvements in health outcomes, a key component in many governments' strategies, can be achieved. The work highlights a novel undergraduate educational approach which offers solutions to public health challenges within nursing. Against the backdrop of one UK university institution it discusses approaches that can guide nursing students towards a deeper understanding and engagement within the principles of public health. It then proposes how nurses can use their learning to become leaders of health improvement

Robust methods in Mendelian randomization via penalization of heterogeneous causal estimates.

Methods have been developed for Mendelian randomization that can obtain consistent causal estimates under weaker assumptions than the standard instrumental variable assumptions. The median-based estimator and MR-Egger are examples of such methods. However, these methods can be sensitive to genetic variants with heterogeneous causal estimates. Such heterogeneity may arise from over-dispersion in the causal estimates, or specific variants with outlying causal estimates. In this paper, we develop three extensions to robust methods for Mendelian randomization with summarized data: 1) robust regression (MM-estimation); 2) penalized weights; and 3) Lasso penalization. Methods using these approaches are considered in two applied examples: one where there is evidence of over-dispersion in the causal estimates (the causal effect of body mass index on schizophrenia risk), and the other containing outliers (the causal effect of low-density lipoprotein cholesterol on Alzheimer's disease risk). Through an extensive simulation study, we demonstrate that robust regression applied to the inverse-variance weighted method with penalized weights is a worthwhile additional sensitivity analysis for Mendelian randomization to provide robustness to variants with outlying causal estimates. The results from the applied examples and simulation study highlight the importance of using methods that make different assumptions to assess the robustness of findings from Mendelian randomization investigations with multiple genetic variants

Immunosuppressive therapy for Vogt-Koyanagi-Harada disease: a retrospective study and review of literature

BACKGROUND: Vogt-Koyanagi-Harada (VKH) disease is an idiopathic autoimmune disease which targets melanin-containing tissues such as the uvea, meninges, ear and skin. This typically presents in the eye with acute findings of granulomatous anterior uveitis, diffuse choroidal thickening, multiple focal areas of sub-retinal fluid and, in severe cases, optic nerve involvement with bullous serous retinal detachment can occur. Early initiation of treatment has been advocated to prevent progression to the chronic stage of the disease, which can result to a sunset glow fundus with devastatingly poor visual outcome. Treatment is usually initiated with corticosteroids followed by an early introduction of immunosuppressive treatment (IMT) to achieve immediate response after disease presentation, although the choice of IMT for VKH can vary. MAIN FINDINGS: We conducted a retrospective case-series to investigate the management trend of treating VKH over a 20-year period. Twenty-six patients were included and we found a shift from steroid monotherapy to combined IMT/low-dose steroid for the management of acute initial-onset of VKH in the last 10 years. Our average time from diagnosis to initiation of IMT was 2.1 months. 81% (21 of 26 patients) of our patients treated with combined IMT/steroid were able to achieve disease stability with significant good visual outcome at 24 months (Median VApre-IMT = 0.3 Logmar vs VApost-IMT = 0.0 Logmar, p = 0.0001). MMF monotherapy was the most common IMT used and it was well-tolerated by our patients. Even so, 50% of our patients who were treated with MMF did not achieve disease control. We then performed a literature review to identify any IMT which could be superior in the treatment of VKH. We also share our experience (where applicable) on the various treatment options found from the literature review. SHORT CONCLUSION: Our study found that patients with VKH who were treated with combined IMT/low-dose steroids achieved significantly better visual improvement at 24 months compared to steroid monotherapy. We frequently chose MMF and this appears to be well tolerated by our patients. Since its introduction, anti-TNF agents are increasingly becoming a popular choice of treatment for VKH as these have been shown to be safe and effective. However, more data is required to provide evidence that anti-TNF agents can be used as first-line treatment and as monotherapy

Eff ects of recurrent violence on post-traumatic stress disorder and severe distress in confl ict-aff ected Timor-Leste:a 6-year longitudinal study

Background Little is known about the eff ect of recurrent episodes of communal violence on mental health in countries recovering from mass confl ict. We report results of a 6-year longitudinal study in post-confl ict Timor-Leste assessing changes in mental health after a period of communal violence. Methods We assessed 1022 adults (600 from a rural village, 422 from an urban district) exposed to mass confl ict during the Indonesian occupation after independence in 2004, and again in 2010–11, following a period of internal confl ict. We took a census of all adults living at the two sites. The survey included measures of post-traumatic stress disorder, severe distress, traumatic events, poverty, ongoing confl ict, and injustice. Findings 1247 (80%) of 1554 invited adults participated in the baseline survey. 1038 (89% of those eligible) were followed up. The analysis included 1022 people who had suffi cient data at baseline and follow-up. The prevalence of post-traumatic stress disorder increased from 23 of 1022 (2∙3%) in 2004, to 171 of 1022 (16∙7%) in 2010. The prevalence of severe distress also increased, from 57 of 1022 (5∙6%) in 2004, to 162 of 1022 (15∙9%) in 2010. Both these outcomes were associated with disability at follow-up. Having post-traumatic stress at follow-up was associated with being a woman (odds ratio [OR] 1·63, 95% CI 1∙14–2∙32), experience of human rights trauma (OR 1∙25, 95% CI 1∙07–1∙47), or exposure to murder (OR 1∙71, 95% CI 1∙38–2∙10) during the Indonesian occupation (1975–99), human rights trauma during the period of internal violence in 2006–07 (OR 1∙46, 95% CI 1∙04–2∙03), and ongoing family or community confl ict (OR 1∙80, 95% CI 1∙15–2∙80) or preoccupations with injustice for two or three historical periods (OR 4∙06, 2∙63–6∙28). Severe distress at follow-up was associated with health stress (OR 1∙47, 1∙14–1∙90), exposure to murder (OR 1∙57, 1∙27–1∙95), and natural disaster (OR 1∙65, 1∙03–2∙64) during the Indonesian occupation, confl ict-related trauma during the internal violence (OR 1∙33, 1∙02–1∙74), and ongoing poverty (OR 1∙53, 1∙36–1∙72) or preoccupations with injustice for two or three historical periods (OR 2∙09, 1∙25–3∙50). Interpretation Recurrent violence resulted in a major increase in post-traumatic stress disorder and severe distress in a community previously exposed to mass confl ict. Poverty, ongoing community tensions, and persisting feelings of injustice contributed to mental disorders. The fi ndings underscore the importance of preventing recurrent violence, alleviating poverty, and addressing injustices in countries emerging from confl ict

A systematic review of the effectiveness of strategies and interventions to improve the transition from student to newly qualified nurse

Background The transition from student to newly qualified nurse can be stressful for many newly qualified nurses who feel inadequately prepared. A variety of support strategies to improve the transition process have been reported across the international literature but the effectiveness of such strategies is unknown. Objectives/aim To determine the effectiveness of the main strategies used to support newly qualified nurses during the transition into the clinical workplace and, where identified, evaluate the impact of these on individual and organisational outcomes. Design Systematic review

Empowering Public Employment Service Practitioners’ peer facilitation with peer coaching training

In a changing world of work with high youth unemployment rates, an ageing society and flexible work force, practitioners in Public Employment Services need to cope with continually growing demands. In this paper we present the EmployID project which introduced a blended learning approach for Public Employment Services in Croatia, designed to support professional identity transformation through peer facilitation and learning. The evaluation shows that learners benefited from higher knowledge and skills development related to peer coaching, along with an increase in activities related to collaborative, reflective learning