MODELLING THE PREVALENCE OF DOWN SYNDROME WITH APPLICATIONS OF MARKOV CHAIN MONTE CARLO METHODS

This thesis was motivated by applications in the epidemiology of Down syndrome and prenatal screening for Down syndrome. Methodological problems arising in these applications include under-ascertainment of cases in livebirth studies, double-sampled data with missing observations and coarsening of data. These issues are considered from a classical perspective using maximum likelihood and from a Bayesian viewpoint employing Markov chain Monte Carlo (MCMC) techniques. Livebirth prevalence studies published in the literature used a variety of data collection methods and many are of uncertain completeness. In two of the nine studies an estimate of the level of under-reporting is available. We present a meta-analysis of these studies in which maternal age-related risks and the levels of under-ascertainment in individual studies are estimated simultaneously. A modified logistic model is used to describe the relationship between Down syndrome prevalence and maternal age. The model is then extended to include data from several studies of prevalence rates observed at times of chorionic villus sampling (CVS) and amniocentesis. New estimates for spontaneous loss rates between the times" of CVS, amniocentesis and live birth are presented. The classical analysis of live birth prevalence data is then compared with an MCMC analysis which allows prior information concerning ascertainment to be incorporated. This approach is particularly attractive since the double-sampled data structure includes missing observations. The MCMC algorithm, which uses single-component Metropolis-Hastings steps to simulate model parameters and missing data, is run under three alternative prior specifications. Several convergence diagnostics are also considered and compared. Finally, MCMC techniques are used to model the distribution of fetal nuchal translucency (NT), an ultrasound marker for Down syndrome. The data are a mixture of measurements rounded to whole millimetres and measurements more accurately recorded to one decimal place. An MCMC algorithm is applied to simulate the proportion of measurements rounded to whole millimetres and parameters to describe the distribution of NT in unaffected and Down syndrome pregnancies. Predictive probabilities of Down syndrome given NT and maternal age are then calculated

Building capacity to use and undertake applied health research: establishing a training programme for the health workforce in the West of England

ObjectivesIncreasing research capacity is important for health services as part of improving the conduct of high quality research which addresses the needs of patients and the public. It is a core function of the 13 Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) established in England between 2008 and 2013. This paper reports on the development of an innovative capacity building programme in CLAHRC West over an 18-month period (May 2015-December 2016). It aims to disseminate the learning from the initiative and share our experience with other CLAHRCs.Study DesignThe study design was an evaluation of a training programme to build research capacity.MethodsWe carried out a training needs assessment among local stakeholders and scoped existing provision of research-related training. This informed the development of a programme of free short courses which were targeted at health and social care professionals including those working in local authorities and the voluntary sector. We aimed to engage professionals working at all levels in these organisations and to promote interprofessional education, in order to build a research culture. We engaged a variety of educators to provide a range of one-day courses at an introductory level which were accessible to practitioners.ResultsDuring the first 18 months of the training programme we delivered 31 courses and trained 350 participants. Attendees came from secondary care (20%), voluntary sector (18%) and local authorities (18%). Professionals working in the mental health sector comprised 11% and commissioning 6%. Less well represented were primary care (3%) and community care (4%). The largest professional group was public health, followed by medical, nursing and allied health professionals in approximately equal proportions. Courses were evaluated on a scale of 1 (poor) to 4 (excellent) with the mean being 3.6 (range 3.3-4.0).ConclusionsThe training programme has been highly successful with many courses over-subscribed and all courses being well evaluated by participants. It has met the needs of local professionals for brief, applied training in research, as well as attracting those from other parts of the UK, suggesting the courses are both appropriate and helping to fill a gap in provision. We are building on this work to further engage audiences working in areas such as the wider determinants of health and commissioning, as well as primary and community sectors. CLAHRCs are uniquely placed to drive a culture change in the use, understanding and application of research across the healthcare community

Changes in objectively measured BMI in children aged 4-11 years: Data from the National Child Measurement Programme

© 2015 The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: [email protected]. Background This study looked at the degree of weight gain between the first (Reception) and last year (Year 6) of primary school and how weight status in Reception predicts becoming overweight/obese by Year 6. Methods A longitudinal sample of 1863 children was created using two time points (2006/7, 2012/13) from the National Child Measurement Programme (NCMP) in South Gloucestershire. T-test and logistic regression were used to test the difference between the BMI z-scores and BMI percentiles, and predict the probability of being overweight (BMI ≥ 85th) or obese (≥95th) at Year 6 based on BMI percentile in Reception. Results Of those children who were obese at Reception age, 68% were obese at Year 6. Compared with children with a BMI in the 2nd to 49th percentile range, children between the 75th and 84th percentiles of BMI at Reception age were 10 times more likely (odds ratio (OR) = 10.18, P < 0.01), and those with a BMI between the 85th and 94th percentiles were 13 times more likely (OR = 13.38, P < 0.01), to become obese by Year 6. Boys were more likely than girls to revert to a healthy weight. Conclusions This is the first study to link data from the NCMP. It provides estimates of prevalence and offers new evidence on obesity emergence and gender differences

Practice of Namaste Care for People Living with Dementia in the UK

Originating in the US, Namaste Care aims to improve quality of life for people with advanced dementia. However, recognition in the UK is sparse. This article reports on research that aims to create consistent understanding of the purpose, application and effect of Namaste Care. Using an online survey, telephone interviews and discussion group with UK practitioners we explored Namaste Care practice, its components and implementation challenges. Findings show that Namaste Care has potential to improve quality of life in advanced dementia and is held in high regard by practitioners. However, understanding is inconsistent and practical implementation highly varied

Prospective pathways to depressive symptoms and disordered eating in adolescence: A 7-year longitudinal cohort study

Eating pathology and depressive symptoms increase during adolescence, yet predictive pathways remain predominantly unexplored, despite their implications for prevention. The present study aimed to identify shared risk factors for eating pathology and depressive symptoms by evaluating an adapted Dual-Pathway Model of disordered eating, which postulated that higher BMI would predict disordered eating and depressive symptoms via pathways between body dissatisfaction, later BMI, depressive symptoms, and visible indicators of puberty (breast development for girls, height for boys). The participants were 8,915 children (49% girls) from the Avon Longitudinal Study of Parents and Children, a population-based cohort study of British children, who were assessed at different intervals between the age of 7 to 14 years. Path analyses revealed that, for girls, childhood BMI exerted indirect effects on disordered eating via body dissatisfaction, depressive symptoms, and more advanced breast development, with indirect pathways identified to depressive symptoms via earlier depressive symptoms and more advanced breast development. For boys, childhood BMI had indirect effects on disordered eating via later BMI and body dissatisfaction, while only earlier depressive symptoms were found to have an independent and direct effect on adolescent depressive symptoms. This study reveals shared and independent risk factors for eating pathology and depressive symptoms in adolescence and suggests targets for preventative interventions, including higher BMI, body dissatisfaction, and depressive symptoms, in addition to advanced breast development, for girls

Systematic Review of the Health and Equity Impacts of Remediation and Redevelopment of Contaminated Sites

(1) Background: Globally there is a vast legacy of contaminated sites from past industrial, commercial and military activity, waste disposal, and mineral extraction. This review examined the extent to which the remediation of contaminated sites reduces health risks to new and existing populations. (2) Methods: Standard academic databases were searched for papers that reported on health-related outcomes in humans following remediation and redevelopment of contaminated sites. Title/abstract screening, followed by full-text screening identified sixteen papers that met the eligibility criteria. (3) Results: Most studies were set in the United States of America and reported changes in blood lead concentrations in children, following soil remediation and, in some cases, public health campaigns to reduce exposure. Two further studies examined the impacts of remediation on soil contaminated with chromium and sediments contaminated with polychlorinated biphenyls (PCBs). (4) Conclusions: Overall, the evidence suggests that remediation via removal, capping, and replacing soil, and planting vegetation is effective at reducing concentrations of lead and chromium in blood and urine in children. There is also evidence that sediment dredging can reduce PCB concentrations in umbilical cords in infants. Study designs are relatively weak and some recommendations are provided for those wishing to examine the health impacts of remediation

A randomised controlled trial of student nurse performance of cardiopulmonary resuscitation in a simulated family-witnessed resuscitation scenario

© 2017 Elsevier Ltd This randomized controlled trial, conducted in a UK University nursing department, compared student nurses' performance during a simulated cardiac arrest. Eighteen teams of four students were randomly assigned to one of three scenarios: 1) no family witness; 2) a “quiet” family witness; and 3) a family witness displaying overt anxiety and distress. Each group was assessed by observers for a range of performance outcomes (e.g. calling for help, timing to starting cardiopulmonary resuscitation), and simulation manikin data on the depth and timing of three cycles of compressions. Groups without a distressed family member present performed better in the early part of the basic life support algorithm. Approximately a third of compressions assessed were of appropriate pressure. Groups with a distressed family member present were more likely to perform compressions with low pressure. Groups with no family member present were more likely to perform compressions with too much pressure. Timing of compressions was better when there was no family member present. Family presence appears to have an effect on subjectively and objectively measured performance. Further study is required to see how these findings translate into the registered nurse population, and how experience and education modify the impact of family member presence

School Health Assistant delivery of an extended brief intervention for overweight children aged 4-5 years: Evaluation report

This is a report on the RE-AIM evaluation of a healthy weight extended brief intervention (EBI), a pilot project developed by Bristol City Council, North Somerset Council, and South Gloucestershire Council, with Sirona care and health, which ran from January to August 2023. The aim of the evaluation was to assess the impact of the pilot and to provide recommendations to guide its future development across Bristol, North Somerset, and South Gloucestershire local authority areas

Developing a framework to guide the evaluation of training in research skills for health and care professionals

Background: Delivering research skills training to health professionals through short, applied sessions outside a formal higher education program, can help fill gaps in training and build research capacity in clinical settings. This has been the endeavor of some of the Applied Research Collaborations funded by the National Institute for Health and Care Research in England since 2014. How to evaluate this type of training in terms of the wider impact it may have, has not featured heavily in the literature and methods have largely borrowed from more generic approaches to training evaluation which can over-simplify outcomes and ignore longer-term impacts. Methods: We developed the framework in four stages: mapping potential impacts of our research skills training courses to identify key concepts; shaping into three domains in which impact could be expected, informed by established definitions of research capacity building; testing the initial framework and adapting wording of impacts; refining the framework into a practical tool. Results: The final framework specifies types of impact in three domains of influence – individual, group/organization and health system, and maps these against key questions to guide inquiry, as well as suggested methods for capturing the impact and expected timeframe for each type of impact. Discussion: The framework provides a structure for guiding the evaluation of research training as well as a focus on medium-longer term impacts, encouraging a broader and continuous approach to evaluation. It is hoped this will support educators in other contexts and fields, in the planning of a wider range of training evaluation activities, to capture impact more fully