Exercise Protects Bone after Stroke, or Does It? A Narrative Review of the Evidence

Physical inactivity contributes to accelerated bone loss after stroke, leading to heightened fracture risk, increased mortality, and reduced independence. This paper sought to summarise the evidence for the use of physical activity to protect bone in healthy adults and adults with stroke, and to identify international recommendations regarding any means of bone protection after stroke, in order to guide rehabilitation practice and future research. A search was undertaken, which identified 12 systematic reviews of controlled trials which investigated the effect of physical activity on bone outcomes in adults. Nine reviews included healthy adults and three included adults with stroke. Twenty-five current international stroke management guidelines were identified. High-impact loading exercise appears to have a site-specific effect on the microarchitecture of healthy postmenopausal women, and physical activity has a small effect on enhancing or maintaining bone mineral density in chronic stroke patients. It is not known whether this translates to reduce fracture risk. Most guidelines included recommendations for early mobilisation after stroke and falls prevention. Two recommendations were identified which advocated exercise for the prevention bone loss after stroke, but supporting evidence was limited. Research is required to determine whether targeted physical activity can protect bone from early after stroke, and whether this can reduce fracture risk

Exercise protects bone after stroke, or does it? A narrative review of the evidence

Physical inactivity contributes to accelerated bone loss after stroke, leading to heightened fracture risk, increased mortality, and reduced independence. This paper sought to summarise the evidence for the use of physical activity to protect bone in healthy adults and adults with stroke, and to identify international recommendations regarding any means of bone protection after stroke, in order to guide rehabilitation practice and future research. A search was undertaken, which identified 12 systematic reviews of controlled trials which investigated the effect of physical activity on bone outcomes in adults. Nine reviews included healthy adults and three included adults with stroke. Twenty-five current international stroke management guidelines were identified. Highimpact loading exercise appears to have a site-specific effect on the microarchitecture of healthy postmenopausal women, and physical activity has a small effect on enhancing or maintaining bone mineral density in chronic stroke patients. It is not known whether this translates to reduce fracture risk. Most guidelines included recommendations for early mobilisation after stroke and falls prevention. Two recommendations were identified which advocated exercise for the prevention bone loss after stroke, but supporting evidence was limited. Research is required to determine whether targeted physical activity can protect bone from early after stroke, and whether this can reduce fracture risk

Influences on recruitment to randomised controlled trials in mental health settings in England: a national cross-sectional survey of researchers working for the Mental Health Research Network

Background: Recruitment to trials is complex and often protracted; selection bias may compromise generalisability. In the mental health field (as elsewhere), diverse factors have been described as hindering researcher access to potential participants and various strategies have been proposed to overcome barriers. However, the extent to which various influences identified in the literature are operational across mental health settings in England has not been systematically examined. Methods: A cross-sectional, online survey of clinical studies officers employed by the Mental Health Research Network in England to recruit to trials from National Health Service mental health services. The bespoke questionnaire invited participants to report exposure to specified influences on recruitment, the perceived impact of these on access to potential participants, and to describe additional positive or negative influences on recruitment. Analysis employed descriptive statistics, the framework approach and triangulation of data. Results: Questionnaires were returned by 98 (58%) of 170 clinical studies officers who reported diverse experience. Data demonstrated a disjunction between policy and practice. While the particulars of trial design and various marketing and dommunication strategies could influence recruitment, consensus was that the culture of NHS mental health services is not donducive to research. Since financial rewards for recruitment paid to Trusts and feedback about studies seldom reaching frontline services, clinicians were described as distanced from research. Facing continual service change and demanding clinical workloads, clinicians generally did not prioritise recruitment activities. Incentives to trial participants had variable impact on access but recruitment could be enhanced by engagement of senior investigators and integrating referral with routine practice. Comprehensive, robust feasibility studies and reciprocity between researchers and clinicians were considered crucial to successful recruitment. Conclusions: In the mental health context, researcher access to potential trial participants is multiply influenced. Gatekeeping clinicians are faced with competing priorities and resources constrain research activity. It seems that environmental adjustment predicated on equitable resource allocation is needed if clinicians in NHS mental health services are to fully support the conduct of randomised controlled trials. Whilst cultural transformation, requiring changes in assumptions and values, is complex, our findings suggest that attention to practical matters can support this and highlight issues requiring careful consideration

Public health aspects of mental health care: implications and risks in a state owned southern Nigerian Psychiatric Hospital

Public health issues appear often ignored in hospital settings and lack of public health infrastructure like basic  hygiene facilities, being part of basic human requirement, affects the quality of life and patient’s physical and mental  health states and outcomes. This cross-sectional descriptive study examined the often-neglected public health  aspects of mental health care as exemplified by the risks associated with environmental health neglect in a state- owned psychiatric hospital in South-south Nigeria. Data was collected using the National Health Management  Information System-based Health Facility Daily Attendance Register (Version 2013), while Hospital In-patient  Facilities Checklist (for Psychiatric Units) was used for facility assessment and its compliance to standards. The data analysis was done using SPSS software Version 17. Results showed deficiencies in environmental health  infrastructure like absence of toilet facilities, window panes and mosquito nets and protocol/facilities for handling  sharps, as well as lack of bed-sheets or laundry facilities and inadequate beds; with many patients lying on the  ground. The common infections recorded in the hospital were malaria (13.5%), acute gastroenteritis (9.4%), and  those affecting the skin (8.5%). Thus, new policies that would favour good infrastructure and high standard of environmental hygiene in psychiatric hospitals are suggested to improve patient outcome. Keywords: Public, health risk, neglect, psychiatric hospita

The experiences of detained mental health service users: issues of dignity in care.

BACKGROUND: When mental health service users are detained under a Section of the Mental Health Act (MHA), they must remain in hospital for a specific time period. This is often against their will, as they are considered a danger to themselves and/or others. By virtue of being detained, service users are assumed to have lost control of an element of their behaviour and as a result their dignity could be compromised. Caring for detained service users has particular challenges for healthcare professionals. Respecting the dignity of others is a key element of the code of conduct for health professionals. Often from the service user perspective this is ignored. METHODS: This paper reports on the experiences of 19 adult service users who were, at the time of interview, detained under a Section of the MHA. These service users had experienced coercive interventions and they gave their account of how they considered their dignity to be protected (or not), and their sense of self respected (or not). RESULTS: The service users considered their dignity and respect compromised by 1) not being 'heard' by staff members, 2) a lack of involvement in decision-making regarding their care, 3) a lack of information about their treatment plans particularly medication, 4) lack of access to more talking therapies and therapeutic engagement, and 5) the physical setting/environment and lack of daily activities to alleviate their boredom. CONCLUSIONS: Dignity and respect are important values in recovery and practitioners need time to engage with service user narratives and to reflect on the ethics of their practice

Penal characteristics as predictors of depression in a Southern Nigerian prison

This study examined the penal characteristics acting as predictors of depressive disorders among 400 prison inmates using the stratified random sampling technique and the Depression component of WHO Schedule for Clinical Assessment in Neuropsychiatry (SCAN). Data analysis was performed with the SPSS software package (Version 17) with the test of significance set at p<0.05. Results revealed a prevalence of 14.8% mild depression; 14.2% moderate depression with somatic features; 6.2% severe depression without psychotic features; 4.5% severe depression with psychotic features and an overall prevalence of 37%. Significant penal factors were nature of crime, reasons for delay in trial, and duration of stay. `The most frequently violated criminal code was Criminal code 401 (Armed Robbery). Logistic regression analysis indicated that the strongest predictor of depression was the duration of time spent in prison (or: 1.43, ci=1.19-1.73, p=0.00). Our findings suggest that duration of stay in prison increases the risk of depression among inmates and that the penal predictors for depression during imprisonment could help identify people for mental health interventions. It is recommended that concerned agencies of government should, as a matter of urgent public health importance, consider reforming the criminal justice system to reduce the duration of  stay in prisons.Keywords: Crime, penal, depression, offender, prison population

Prevalence, methods and characteristics of self-harm among asylum seekers in Australia: Protocol for a systematic review

Introduction Asylum seekers are at increased risk of self-harm compared with the general population, and the experience of detention may further exacerbate this risk. Despite this, evidence regarding the prevalence, methods and characteristics of self-harm among asylum seekers in Australia (including those detained in onshore and offshore immigration detention) has not been synthesised. Such information is necessary to inform evidence-based prevention initiatives, and effective clinical and governmental responses to self-harm. This review will synthesise findings from the literature regarding the prevalence, methods and characteristics of self-harm among asylum seekers in both detained and community-based settings in Australia. Methods and analysis We searched key electronic health, psychology and medical databases (PsycINFO, Scopus, PubMed and MEDLINE) for studies published in English between 1 January 1992 and 31 December 2021. Our primary outcome is self-harm among asylum seekers held in onshore and/or offshore immigration detention, community detention and/or in community-based arrangements in Australia. We will include all study designs (except single case studies) that examine the prevalence of self-harm in asylum seekers. Studies published between 1992 - the commencement of Australia's policy of mandatory immigration detention - and 2021 will be included. We will not apply any age restrictions. The Methodological Standard for Epidemiological Research scale will be used to assess the quality of included studies. If there are sufficient studies, and homogeneity between them, we will conduct meta-analyses to calculate pooled estimates of self-harm rates and compare relevant subgroups. If studies report insufficient data, or there is substantial heterogeneity, findings will be provided in narrative form. Ethics and dissemination This review is exempt from ethics approval as it will synthesise findings from published studies with pre-existing ethics approval. Our findings will be disseminated through a peer-reviewed journal article and conference presentations. PROSPERO registration number CRD42020203444