Integrating online communities and social networks with computerised treatment for insomnia: a qualitative study of service user and primary health care professional perspectives

The problem: Insomnia is the most commonly reported psychological complaint in Britain. Although hypnotic drugs are widely used for treatment of insomnia, they are only licensed short term and adverse effects are common. Cognitive Behavioural Therapy for insomnia (CBT-I), which is effective and safe long term, is recommended first line but is not widely used nor available, in part because of the lack of trained providers. In response to this, Computerised Cognitive Behavioural Therapy (CCBT) has been advocated. Existing CCBT programmes can suffer from poor rates of uptake, adherence and completion. We aimed to investigate patients and practitioners’ views on how CCBT for insomnia (CCBT-I) could be improved by incorporating features of modern technology including social networking functions. The approach: We used a qualitative design and the theory of planned behaviour to underpin the study. Interviews and focus groups were held with adult service users and health professionals using a topic guide designed to elicit participants’ beliefs, intentions and controlling factors that might facilitate or create barriers to the uptake and adherence to CCBT-I. We explored the data using thematic analysis supported by Nvivo. Findings: We interviewed 23 health professionals and 28 patients. We identified multi-faceted issues focused on meta-themes of trust and functionality which were perceived to increase likelihood of successful uptake and adherence. Trust and confidence would be increased if CCBT-I was perceived to be evidence-based and accredited; when referral was from a trusted professional within a supervised package of care; and when online support and follow-up were provided. Interaction with other users, by integrating CCBT-I with social networking, was perceived to provide mutual support but concerns from people with sleep problems included apprehension about online ‘strangers’ and concerns from practitioners included information security. Asynchronous communication such as posting a note, commenting on a forum or adding to a thread was considered safer than engaging in real-time on-line communication. To improve functionality patients wanted mobile applications; access in short periods; self-assessment of insomnia and its causes; more personalised information on sleep; an interactive approach; and contact with other users to be moderated or overseen. Consequences: Although previous qualitative studies have looked at CCBT uptake and adherence, none have looked at insomnia exclusively or explored the feasibility, advantages and drawbacks of online communication between participants. Improving uptake and adherence to online programmes for insomnia requires attention to design features which are focused on trust and functionality. Although computerised therapies for insomnia would allow more people to access treatment, some would not be suitable for online therapies because of lack of online access or poor computer literacy. The results of the study are being used the development of a novel platform for CCBT for insomnia and other health conditions

Integrating online communities and social networks with computerised treatment for insomnia: a qualitative study of service user and multiprofessional primary health care perspectives

Purpose: We explored patient and multiprofessional health perspectives to inform the development of a computerised cognitive behavioural therapy programme for insomnia (CCBT-I) that includes social networking. Theory: We used a qualitative design and theory of planned behaviour to underpin the analysis. Methods: Interviews and focus groups were held with service users and health professionals to elicit beliefs and intentions that might facilitate or create barriers to the uptake and adherence to CCBT-I. Findings: We interviewed 23 health professionals and 28 patients. Features designed to increase confidence in CCBT-I; engender trust in professional relationships; provide online support and improve programme functionality were perceived to increase the successful uptake and adherence. Interaction with other users via integrated social networking would provide mutual support but concerns included apprehension about online ‘strangers’ and information security. Patients wanted mobile applications; access in short periods; self-assessment; more interactive, personalised information on sleep and moderated contact with other users. Discussion: Improving uptake and adherence to online programmes for insomnia requires design features which are focused on trust and functionality. Computerised therapies for insomnia would allow access treatment for more people across geographical and heath system borders

'My expectations remain the same. The student has to be competent to practise' : practice assessor perspectives on the new social work degree qualification in England

Research has emphasized the importance of practice learning to social work qualifying education but has tended to feature social work educator and student perspectives more strongly than the views of those responsible for assessing students' practice in the field. This article draws on 195 responses to a postal questionnaire sent at two points in time to practice assessors working with students from nine social work qualifying programmes run in six higher education institutions collected as part of the evaluation of the new social work degree qualification in England. While practice assessors described changes in their role and in the opportunities available to students, they also emphasized continuities, particularly in the skills that they expected students to possess. The key difficulty they identified was the heavy workload resulting from combining their role as practice assessors with their other responsibilities at work. Increases in the number of social work students and changes to the organization of services are likely to create further pressures on practice assessors. Given that these issues are faced by a number of different professions, the article concludes that there is potential for future studies to look at the experiences of practice educators across different professional qualifying programmes

Temporal Changes in Cd Sorption and Plant Bioavailability in Compost-Amended Soils

The application of Cd-contaminated phosphate fertiliser has enriched concentrations of this non-essential element in many agricultural soils. Consequently, concentrations of the metal in some agricultural products exceed the Maximum Limit in foods. Composts can reduce the transfer of Cd from soil to plants; however, it is unclear how long this beneficial effect endures. We aimed to determine temporal changes of phytoavailable Cd in two market garden soils (an Allophanic Orthic Granular Soil and a Recent Silt Loam). Soils were amended with either municipal green waste compost or sawdust and animal waste compost at a rate of 2.5% w/w under three incubation regimes: at 19 °C, at 30 °C, and at 30 °C with additional N added as urea at 0.6 g urea/kg soil added over 1 year. Each replicate was sampled after 1, 5, 9, 13, 21, 31, and 49 weeks, and phytoavailable Cd was estimated through 0.05 M Ca(NO3)2 extraction. Seed potato (Solanum tuberosum), ‘Nadine’ variety, was grown in the Pukekohe Allophanic Orthic Granular Soil, freshly amended with municipal compost and the same soil aged for one year. The concentration of Cd in all samples was analysed using an ICP-OES (Inductively Coupled Plasma-Optical Emission Spectrometer). The C concentration in the soil—compost mixtures decreased over the year, with the greatest decreases occurring in the soils incubated at 30 °C with added N. Unexpectedly, the concentration of Ca(NO3)2-extractable Cd in the compost-amended soils did not increase over time and in some cases even decreased. This was confirmed through a pot experiment, which showed the Cd concentration in potato was reduced by 50% in both the freshly amended soil and the amended soil aged for one year. Cadmium immobilisation in soils might be due to both the sorption of Cd by organic matter and the occlusion of sorbed Cd by oxy-hydroxides of iron and aluminium. Over 49 weeks, soluble Cd does not increase as organic matter oxidises. The application of municipal compost to soil will reduce both plant Cd solubility and plant Cd uptake for at least one year in the soils tested

Frontal theta dynamics during response conflict in long-term mindfulness meditators

Mindfulness meditators often show greater efficiency in resolving response conflicts than non-meditators. However, the neural mechanisms underlying the improved behavioral efficiency are unclear. Here, we investigated frontal theta dynamics—a neural mechanism involved in cognitive control processes—in long-term mindfulness meditators. The dynamics of EEG theta oscillations (4–8 Hz) recorded over the medial frontal cortex (MFC) were examined in terms of their power (MFC theta power) and their functional connectivity with other brain areas (the MFC-centered theta network). Using a flanker-type paradigm, EEG data were obtained from 22 long-term mindfulness meditators and compared to those from 23 matched controls without meditation experience. Meditators showed more efficient cognitive control after conflicts, evidenced by fewer error responses irrespective of response timing. Furthermore, meditators exhibited enhanced conflict modulations of the MFC-centered theta network shortly before the response, in particular for the functional connection between the MFC and the motor cortex. In contrast, MFC theta power was comparable between groups. These results suggest that the higher behavioral efficiency after conflicts in mindfulness meditators could be a function of increased engagement to control the motor system in association with the MFC-centered theta network

Adding web-based behavioural support to exercise referral schemes for inactive adults with chronic health conditions: the e-coachER Randomised Controlled Trial

BACKGROUND: There is modest evidence that exercise referral schemes increase physical activity in inactive individuals with chronic health conditions. There is a need to identify additional ways to improve the effects of exercise referral schemes on long-term physical activity. OBJECTIVES: To determine if adding the e-coachER intervention to exercise referral schemes is more clinically effective and cost-effective in increasing physical activity after 1 year than usual exercise referral schemes. DESIGN: A pragmatic, multicentre, two-arm randomised controlled trial, with a mixed-methods process evaluation and health economic analysis. Participants were allocated in a 1 : 1 ratio to either exercise referral schemes plus e-coachER (intervention) or exercise referral schemes alone (control). SETTING: Patients were referred to exercise referral schemes in Plymouth, Birmingham and Glasgow. PARTICIPANTS: There were 450 participants aged 16-74 years, with a body mass index of 30-40 kg/m2, with hypertension, prediabetes, type 2 diabetes, lower limb osteoarthritis or a current/recent history of treatment for depression, who were also inactive, contactable via e-mail and internet users. INTERVENTION: e-coachER was designed to augment exercise referral schemes. Participants received a pedometer and fridge magnet with physical activity recording sheets, and a user guide to access the web-based support in the form of seven 'steps to health'. e-coachER aimed to build the use of behavioural skills (e.g. self-monitoring) while strengthening favourable beliefs in the importance of physical activity, competence, autonomy in physical activity choices and relatedness. All participants were referred to a standard exercise referral scheme. PRIMARY OUTCOME MEASURE: Minutes of moderate and vigorous physical activity in ≥ 10-minute bouts measured by an accelerometer over 1 week at 12 months, worn ≥ 16 hours per day for ≥ 4 days including ≥ 1 weekend day. SECONDARY OUTCOMES: Other accelerometer-derived physical activity measures, self-reported physical activity, exercise referral scheme attendance and EuroQol-5 Dimensions, five-level version, and Hospital Anxiety and Depression Scale scores were collected at 4 and 12 months post randomisation. RESULTS: Participants had a mean body mass index of 32.6 (standard deviation) 4.4 kg/m2, were referred primarily for weight loss and were mostly confident self-rated information technology users. Primary outcome analysis involving those with usable data showed a weak indicative effect in favour of the intervention group (n = 108) compared with the control group (n = 124); 11.8 weekly minutes of moderate and vigorous physical activity (95% confidence interval -2.1 to 26.0 minutes; p = 0.10). Sixty-four per cent of intervention participants logged on at least once; they gave generally positive feedback on the web-based support. The intervention had no effect on other physical activity outcomes, exercise referral scheme attendance (78% in the control group vs. 75% in the intervention group) or EuroQol-5 Dimensions, five-level version, or Hospital Anxiety and Depression Scale scores, but did enhance a number of process outcomes (i.e. confidence, importance and competence) compared with the control group at 4 months, but not at 12 months. At 12 months, the intervention group incurred an additional mean cost of £439 (95% confidence interval -£182 to £1060) compared with the control group, but generated more quality-adjusted life-years (mean 0.026, 95% confidence interval 0.013 to 0.040), with an incremental cost-effectiveness ratio of an additional £16,885 per quality-adjusted life-year. LIMITATIONS: A significant proportion (46%) of participants were not included in the primary analysis because of study withdrawal and insufficient device wear-time, so the results must be interpreted with caution. The regression model fit for the primary outcome was poor because of the considerable proportion of participants [142/243 (58%)] who recorded no instances of ≥ 10-minute bouts of moderate and vigorous physical activity at 12 months post randomisation. FUTURE WORK: The design and rigorous evaluation of cost-effective and scalable ways to increase exercise referral scheme uptake and maintenance of moderate and vigorous physical activity are needed among patients with chronic conditions. CONCLUSIONS: Adding e-coachER to usual exercise referral schemes had only a weak indicative effect on long-term rigorously defined, objectively assessed moderate and vigorous physical activity. The provision of the e-coachER support package led to an additional cost and has a 63% probability of being cost-effective based on the UK threshold of £30,000 per quality-adjusted life-year. The intervention did improve some process outcomes as specified in our logic model. TRIAL REGISTRATION: Current Controlled Trials ISRCTN15644451. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 63. See the NIHR Journals Library website for further project information.</p

Trends in suicide in Scotland 1981 – 1999: age, method and geography

BACKGROUND: Male suicide rates continued to increase in Scotland when rates in England and Wales declined. Female rates decreased, but at a slower rate than in England and Wales. Previous work has suggested higher than average rates in some rural areas of Scotland. This paper describes trends in suicide and undetermined death in Scotland by age, gender, geographical area and method for 1981 – 1999. METHODS: Deaths from suicide and undetermined cause in Scotland from 1981 – 1999 were identified using the records of the General Registrar Office. The deaths of people not resident in Scotland were excluded from the analysis. Death rates were calculated by area of residence, age group, gender, and method. Standardised Mortality Ratios (SMRs) and 95% confidence intervals were calculated for rates by geographical area. RESULTS: Male rates of death by suicide and undetermined death increased by 35% between 1981 – 1985 and 1996 – 1999. The largest increases were in the youngest age groups. All age female rates decreased by 7% in the same period, although there were increases in younger female age groups. The commonest methods of suicide in men were hanging, self-poisoning and car exhaust fumes. Hanging in males increased by 96.8% from 45 per million to 89 per million, compared to a 30.7% increase for self-poisoning deaths. In females, the commonest method of suicide was self-poisoning. Female hanging death rates increased in the time period. Male SMRs for 1981 – 1999 were significantly elevated in Western Isles (SMR 138, 95% CI 112 – 171), Highland (135, CI 125 – 147), and Greater Glasgow (120, CI 115 – 125). The female SMR was significantly high only in Greater Glasgow (120, CI 112 – 128). CONCLUSION: All age suicide rates increased in men and decreased in women in Scotland in 1981 – 1999. Previous findings of higher than expected male rates in some rural areas were supported. Rates were also high in Greater Glasgow, one of the most deprived areas of Scotland. There were changes in the methods used, with an increase in hanging deaths in men, and a smaller increase in hanging in women. Altered choice of method may have contributed to the increased male deaths

A novel pancoronavirus RT-PCR assay: frequent detection of human coronavirus NL63 in children hospitalized with respiratory tract infections in Belgium

BACKGROUND: Four human coronaviruses are currently known to infect the respiratory tract: human coronaviruses OC43 (HCoV-OC43) and 229E (HCoV-229E), SARS associated coronavirus (SARS-CoV) and the recently identified human coronavirus NL63 (HCoV-NL63). In this study we explored the incidence of HCoV-NL63 infection in children diagnosed with respiratory tract infections in Belgium. METHODS: Samples from children hospitalized with respiratory diseases during the winter seasons of 2003 and 2004 were evaluated for the presence of HCoV-NL63 using a optimized pancoronavirus RT-PCR assay. RESULTS: Seven HCoV-NL63 positive samples were identified, six were collected during January/February 2003 and one at the end of February 2004. CONCLUSIONS: Our results support the notation that HCoV-NL63 can cause serious respiratory symptoms in children. Sequence analysis of the S gene showed that our isolates could be classified into two subtypes corresponding to the two prototype HCoV-NL63 sequences isolated in The Netherlands in 1988 and 2003, indicating that these two subtypes may currently be cocirculating