Adolescent self-harm in the community: An update on prevalence using a self-report survey of adolescents aged 13-18 in England

© The Author 2016. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. Background To establish an estimate of prevalence in a nationally representative sample of community adolescents. To examine associations between self-harm and wellbeing. Methods An anonymous self-report survey completed by 2000 adolescents aged 13-18 years across England.Wellbeing was measured using theWarwick-Edinburgh MentalWellbeing Scale (WEMWBS). Results In total 15.5% (n = 309) of participants reported ever having self-harmed (95% confidence intervals 13.9-17.1). The median age of onset was 13.0 years. Females aged 13-15 years reported the highest incidence of self-harm within the past year (54.9%). Cutting elsewhere (other than on the arms) was more prevalent amongst females (56.4%). The mean wellbeing score for the whole sample (45.6) was lower than the WEMWBS validation score (48.8). Self-harm was associated with a significantly lower wellbeing score, with mean scores of 38.7 (ever selfharmed) and 46.8 (never self-harmed). Conclusions Self-harm remains prevalent amongst adolescents aged 13-18 years in England. An awareness of the age of peak incidence and risks associated with preferred harming behaviours is crucial during assessment and intervention. The promotion of wellbeing is important for all young people. Further study is needed on the ways in which wellbeing may prevent, or ameliorate, the distress associated with self-harm

Garden enhanced education: Report on the growing skills programme in Food for Life partnership schools

Research shows that a diet rich in fruit and vegetables is associated with a decreased risk of many chronic diseases and can form part of an effective weight management strategy. However, only one in five children consume the recommended daily intake of fruit and vegetables - and there are wider concerns about the steady increase in childhood obesity.Garden enhanced education in schools is increasingly recognised as a promising strategy for promoting healthier eating for children. It may also have other benefits, such as promoting environmental awareness. Whilst a growing body of research indicates the positive impact of focused interventions led by external experts, less is known about the effectiveness of multi-component programmes sustained by stakeholders from the school community.The Food for Life Partnership Flagship growing skills programme is one part of a whole school food reform initiative in England in which schools are assisted to make comprehensive changes to their garden based educational work. Drawing upon the reports of lead teaching staff, this report focuses on 76 participating schools (55 primary, 19 secondary, 2 special) from the year prior to enrolment to approximately 18 months into the programme. Prior to enrolment, the majority of schools lacked the basic facilities needed to deliver an effective garden enhanced education; staff with applied horticultural skills; specific safety guidelines; or multiple links between growing activities and the curriculum.The FFLP growing skills programme is associated with a range of positive changes for schools:New training in horticultural education for staff in over three quarter of cases.Newly developed areas for growing that have expanded, on average, by a third the size of a full size allotment per school.Better resourced growing areas for nearly all schools in terms of the facilities that are prerequisites for effective educational work.A considerable rise in the local production and the diversity of groups of crops grown.An average three fold increase in parent and community volunteer active participation.In primary schools, a rise in participation in growing activities from an average of 28.6%to 74.4% of pupils. For the schools sampled this equates to an additional 6,701 children participating in growing activities per annum.In secondary schools, a considerable increase of pupils in growing activities, albeit from a very low baseline. Initially less than 1% of pupils took part in growing activities in the schools sampled. This rose to an average of 12.3%: or an additional 1,960 students perannum.An increase in the active involvement of pupils in practical aspects of food growing.An increase in pupils taking part in growing activities that are linked to multiple aspects of their curricular studies.The majority of school leads attribute these changes to effective engagement with the FFLP approach. Qualitative feedback indicates that this effectiveness connects to the strategic, integrated and visionary character of the FFLP growing skills programme.External research shows that these short term programme outcomes will support sustainable work to promote healthier eating for children. Further evaluation, currently in progress, will provide supplementary evidence to examine these associations more fully

Food for life partnership evaluation: summary report

Summary report of the Food for Life Partnership evaluation conducted by UWE,Bristol and Cardiff University. May 201

Intramuscular oxytocin versus Syntometrine® versus carbetocin for prevention of primary postpartum haemorrhage after vaginal birth: a randomised double-blinded clinical trial of effectiveness, side effects and quality of life

Objective: To compare intramuscular oxytocin, Syntometrine® and carbetocin for prevention of postpartum haemorrhage after vaginal birth. Design: Randomised double-blinded clinical trial. Setting: Six hospitals in England. Population: A total of 5929 normotensive women having a singleton vaginal birth. Methods: Randomisation when birth was imminent. Main outcome measures: Primary: use of additional uterotonic agents. Secondary: weighed blood loss, transfusion, manual removal of placenta, adverse effects, quality of life. Results: Participants receiving additional uterotonics: 368 (19.5%) oxytocin, 298 (15.6%) Syntometrine and 364 (19.1%) carbetocin. When pairwise comparisons were made: women receiving carbetocin were significantly more likely to receive additional uterotonics than those receiving Syntometrine (odds ratio [OR] 1.28, 95% CI 1.08–1.51, P=0.004); the difference between carbetocin and oxytocin was non-significant (P=0.78); Participants receiving Syntometrine were significantly less likely to receive additional uterotonics than those receiving oxytocin (OR 0.75, 95% CI 0.65–0.91, P=0.002). Non-inferiority between carbetocin and Syntometrine was not shown. Use of Syntometrine reduced non-drug PPH treatments compared with oxytocin (OR 0.64, 95% CI 0.42–0.97) but not carbetocin (P=0.64). Rates of PPH and blood transfusion were not different. Syntometrine was associated with an increase in maternal adverse effects and reduced ability of the mother to bond with her baby. Conclusions: Non-inferiority of carbetocin to Syntometrine was not shown. Carbetocin is not significantly different to oxytocin for use of additional uterotonics. Use of Syntometrine reduced use of additional uterotonics and need for non-drug PPH treatments compared with oxytocin. Increased maternal adverse effects are a disadvantage of Syntometrine. Tweetable abstract: IM carbetocin does not reduce additional uterotonic use compared with IM Syntometrine or oxytocin

Intraputamenal cerebral dopamine neurotrophic factor in Parkinson's disease: a randomized, double‐blind, multicenter phase 1 trial

Background: Cerebral dopamine neurotrophic factor (CDNF) is an unconventional neurotrophic factor that protects dopamine neurons and improves motor function in animal models of Parkinson's disease (PD). Objective: The primary objectives of this study were to assess the safety and tolerability of both CDNF and the drug delivery system (DDS) in patients with PD of moderate severity. Methods: We assessed the safety and tolerability of monthly intraputamenal CDNF infusions in patients with PD using an investigational DDS, a bone‐anchored transcutaneous port connected to four catheters. This phase 1 trial was divided into a placebo‐controlled, double‐blind, 6‐month main study followed by an active‐treatment 6‐month extension. Eligible patients, aged 35 to 75 years, had moderate idiopathic PD for 5 to 15 years and Hoehn and Yahr score ≤ 3 (off state). Seventeen patients were randomized to placebo (n = 6), 0.4 mg CDNF (n = 6), or 1.2 mg CDNF (n = 5). The primary endpoints were safety and tolerability of CDNF and DDS and catheter implantation accuracy. Secondary endpoints were measures of PD symptoms, including Unified Parkinson's Disease Rating Scale, and DDS patency and port stability. Exploratory endpoints included motor symptom assessment (PKG, Global Kinetics Pty Ltd, Melbourne, Australia) and positron emission tomography using dopamine transporter radioligand [18F]FE‐PE2I. Results: Drug‐related adverse events were mild to moderate with no difference between placebo and treatment groups. No severe adverse events were associated with the drug, and device delivery accuracy met specification. The severe adverse events recorded were associated with the infusion procedure and did not reoccur after procedural modification. There were no significant changes between placebo and CDNF treatment groups in secondary endpoints between baseline and the end of the main and extension studies. Conclusions: Intraputamenally administered CDNF was safe and well tolerated, and possible signs of biological response to the drug were observed in individual patients. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society

Selecting the best population: A decision theoretic approach: The case of Pareto distribution

The main ideas in selecting the best populations meeting some prescribed optimality criterion have been mooted originally by Bechchofer and Gupta and the subject has gone from strength to strength by several contributions by several statisticians over the last three decades. In this paper, the selection problem is tackled from a decision theoretic point of view. In selecting the best population, we take into account the cost of sampling and the penalties for taking a wrong decision. We are basically interested in selecting the best Pareto population following the lead given by Somerville and Ofosu. The Pareto proposed this model to study the distribution of incomes in various societies for comparison. In medical circles, this has been used as a model for the remission rate of discharged psychiatric patients as a survival model for cardiac patients waiting for a heart transplant operation. This paper considers four different types of penalty functions including the one considered by Ofosu. Under three of these penalty function we derive the minimax sample sizes. The maximum of the resultant loss function is explicitly derived overcoming the difficulty faced by Ofosu

Personal birth preferences and actual mode of delivery outcomes of obstetricians and gynaecologists in South West England; With comparison to regional and national birth statistics

© 2014 Elsevier Ireland Ltd. All rights reserved. Objective: To determine personal birth preferences of obstetricians in various clinical scenarios, in particular elective caesarean section for maternal request. To determine actual rates of modes of deliveries amongst the same group. To compare the obstetrician's mode of delivery rates, to the general population.Study design: Following ethical approval, a piloted online survey link was sent via email to 242 current obstetricians and gynaecologists, (consultants and trainees) in South West England. Mode of delivery results were compared to regional and national population data, using Hospital Episode Statistics and subjected to statistical analysis.Results: The response rate was 68%. 90% would hypothetically plan a vaginal delivery, 10% would consider a caesarean section in an otherwise uncomplicated primiparous pregnancy. Of the 94/165 (60%) respondents with children (201 children), mode of delivery for the first born child; normal vaginal delivery 48%, caesarean section 26.5% (elective 8.5%, emergency 18%), instrumental 24.5% and vaginal breech 1%. Only one chose an elective caesarean for maternal request. During 2006-2011 obstetricians have the same overall actual modes of birth as the population (p = 0.9).Conclusions: Ten percent of obstetricians report they would consider requesting caesarean section for themselves/their partner, which is the lowest rate reported within UK studies. However only 1% actually had a caesarean solely for maternal choice. When compared to regional/national statistics obstetricians currently have modes of delivery that are not significantly different than the population and suggests that they choose non interventional delivery if possible

On the selection of the best gamma population. Determination of minimax sample sizes

Selecting the best Gamma population from a given set of Gamma populations is treated from a decision theoretic point of view. Cost of sampling and penalties for wrong decision play a role in the determination of optimum common sample sizes. Minimax sample sizes are determined under two different penalty function

The safety of general anaesthesia in paediatric patients undergoing the application of Biobrane® for small scalds

© 2015 Elsevier Ltd and ISBI. All rights reserved. Background Each year more than 5000 children present to English and Welsh hospitals for the management of scalds; 60% of these are small scalds of less than 10% body surface area. There are no agreed UK care pathways for this injury. One method of management is to use a biosynthetic wound dressing after thorough wound cleaning. In children, this usually utilises general anaesthesia. This study investigates the incidence of adverse events during anaesthesia for the application of biosynthetic dressings in children with small-area scalds. Methods The medical records of 500 consecutive admissions to a tertiary care paediatric burn centre between July 1st 2007 and June 30th 2012 were analysed. The primary outcome was any patient-related adverse event incurred as a result of the general anaesthesia. Secondary outcomes included delays in discharge and any recovery sequelae to the adverse events. Results There were 21 (4.2%) documented adverse events associated with 500 episodes of anaesthesia. Of these, the majority (52%) were documented as self-resolving laryngospasm. All episodes were temporary with no recovery sequelae and did not delay discharge from the post-anaesthetic recovery area. Conclusions The use of general anaesthesia in this setting for the application of biosynthetic dressings in children with small-area scalds has a low incidence of anaesthesia-related complications with no associated long-term sequelae. This incidence is similar to that quoted for adverse events related to anaesthesia for other procedures and is lower than that reported for procedures using sedation