Right from the start: protocol for a pilot study for a randomised trial of the New Baby Programme for improving outcomes for children born to socially vulnerable mothers:protocol for a pilot study for a randomised trial of the New Baby Programme for improving outcomes for children born to socially vulnerable mothers

Background: Children born to mothers who experience social complexity (e.g. substance misuse, intimate partner violence, mental ill health, a history of maltreatment) are at increased risk for a range of adverse outcomes at birth and during development. Home visiting programmes have been advocated as a strategy for improving outcomes for disadvantaged mothers and children, such as the Nurse-Family Partnership for young, socially disadvantaged first-time mothers. However, no evidence-based programme is available for multiparous women or older first-time mothers. The New Baby Programme was developed in Northern Ireland. It augments the universal health visiting service available in the UK with a content designed to promote maternal health and well-being in pregnancy, maximise secure attachments of children and parents and enhance sensitive parenting and infant cognitive development.Methods/Design: This pilot study is designed to investigate whether it is possible to recruit and retain socially vulnerable mothers in a randomised trial that compares the effects of the New Baby Programme with standard antenatal and postnatal care. Feasibility issues include the referral/recruitment pathway (including inclusion and exclusion criteria), the consent and randomisation, the ability to maintain researcher blinding, the acceptability of the intervention to participants, and the feasibility and acceptability of the outcome measures. The results of the study will inform a definitive phase-3 RCT.Discussion: Trials of complex social interventions often encounter challenges that lead to the trial being abandoned (e.g. because of problems in recruitment) or present considerable analytic challenges relating to dropout, attrition and bias. This pilot study aims to maximise the chances of successful implementation.Trial registration: ISRCTN35456296 retrospectively registered.</p

The understanding, acceptability, and relevance of personalised multidimensional physical activity feedback among urban adults: evidence from a qualitative feasibility study in Sri Lanka

BackgroundWearable technologies are being used to provide personalised feedback across multiple physical activity dimensions in countries such as the UK, but their feasibility has not been tested in South Asia, where physical inactivity is increasing. This study assessed the understanding, acceptability, and relevance of personalised multidimensional physical activity feedback in urban dwellers in Colombo, Sri Lanka.MethodsA qualitative feasibility study was conducted among 35 adults to assess a community-based approach to provide multidimensional physical activity feedback. Healthy adults, adults at risk of non-communicable diseases and community-based primary healthcare professionals wore a physical activity monitor for 7 days and were then guided through their personalised multidimensional physical activity feedback. One-to-one interviews were conducted, transcribed verbatim and analysed using framework analysis.ResultsFour themes were generated: understanding of personalised physical activity feedback, perceived novelty of the feedback, motivation, and consideration of the multidimensional nature of physical activity. A majority of participants required guidance initially to understand the feedback, following which most were quickly able to interpret the data shown, and were willing to use the feedback as a basis for identifying goals to improve physical activity. Participants perceived the feedback and its delivery as novel because it provided new knowledge about physical activity guidelines and awareness on their own behaviour through graphics. Comparisons of personal performance against recommended physical activity levels and information on sedentary time were the most commonly motivating aspects of the feedback, prompting talk about behaviour change. All three groups showed poor planning on goal achievement, with some noticeable differences between those with and without health risk of non-communicable diseases. Following the feedback, most participants understood that physical activity is composed of several dimensions, while around half could recognise more suitable options to change behaviour. Of the physical activity dimensions, calorie burn received more attention than others.ConclusionsMultidimensional physical activity feedback was considered understandable and acceptable and has the potential to support behaviour change among urban Sri Lankans with or without identified health risk. These findings highlight the feasibility of this technology-enabled approach as a personalised intervention to improve knowledge and motivation for physical activity behaviour

Developing non-exercise activity thermogenesis (NEAT) through building design

Purpose: Physical inactivity has a considerable negative impact on health. Physical activity has reduced partly due to workplace and lifestyle changes, causing people to spend more time in buildings and increasing sedentary behaviour. The purpose of this paper is to address a largely untapped opportunity for designers and managers to improve building users’ health by designing buildings that raise users’ Non-Exercise Activity Thermogenesis (NEAT) levels. In this research a conceptual model was developed to assess buildings’ performance in providing NEAT-promoting opportunities through building design features and management, in relation to building users’ propensity for NEAT behaviours. Design/methodology/approach: The conceptual model was developed by a multi-disciplinary team of researchers and data to populate the model was obtained through a survey of 75 buildings in Jakarta (Indonesia). Findings: The presented proof-of-concept shows that the model’s “meso-scale” approach to study physical activity and building design can lead to potential improvements of NEAT levels and physical activity in buildings. Originality/value: The review of precedent models shows that this subject has been researched at micro-scale (i.e. detailed monitoring of individuals’ movement) and macro-scale (i.e. epidemiological studies of populations’ health). The presented model is original, as it explores a “meso-scale”(i.e. building scale) that is unique.</p

Assessing the validity of the Long-Term Conditions Questionnaire (LTCQ) in women during pregnancy and the first year following birth

Background: The aim of this study was to validate a generic patient-reported outcome measure, the Long-Term Conditions Questionnaire (LTCQ), among pregnant and postpartum women living with a pre-existing long-term condition (LTC). Methods: Cognitive interviews were conducted with women who were currently pregnant or had given birth within the past year and living with a pre-existing LTC (n=11) and with healthcare professionals working in maternal care (n=11) to explore the acceptability of LTCQ items. An online survey was subsequently administered among women who were pregnant or had given birth within the past year and living with a pre-existing LTC (n=718). Tests of validity were performed including assessing correlations between the LTCQ and reference measures, the Well-being in Pregnancy (WiP) Questionnaire and the EuroQol EQ-5D-5L. Internal consistency was assessed using the Cronbach’s alpha statistic. Results: All LTCQ items were considered relevant and appropriate for use with women who were pregnant or had given birth within the past year. The most commonly reported LTC among the online survey sample (n=718) was a mental health condition (n=350, 48.7%) followed by joint, bone and connective tissues (n= 212, 29.5%) and gastrointestinal (n=143, 19.9%) condition. Data indicated LTCQ scores behaved in a predictable pattern, demonstrating poorer scores for women reporting a greater number of LTCs; mean (SD) scores, one LTC= 61.86 (17.8), two LTCs= 55.29 (16.0), three LTCs= 49.84 (15.52) and four LTCs= 44.94 (12.2). Poorer scores were also reported for women living with at least one mental health condition compared to those reporting no mental health condition, mean score = 66.18 (SD 16.7) v 48.64 (SD 13.3), p< 0.001 respectively. As anticipated, LTCQ scores demonstrated significant correlations in the expected direction with both the EQ-5D-5L and WiP scores. For all LTCQ items, the Cronbach’s alpha statistic was 0.93. Conclusion: Data presented here indicate that the LTCQ, which assesses living well with one or more LTC, is suitable for use among pregnant and postpartum women, from both the woman’s perspective and from the perspectives of maternity healthcare professionals. Use of the LTCQ would facilitate the identification of unmet needs within this high-risk cohort and support the exploration of how LTCs may affect women throughout the pregnancy and post-natal period. Understanding unmet needs within this cohort of women provides an opportunity to link up specialist care within maternity services and enhance personalised care

Demystifying a relationship between voluntary work and Māori

The purpose of this thesis is to provide evidence that critically reviews the relationship between Māori and voluntary work in social service organisations. Since colonisation very little research has been initiated that investigated the involvement of Māori in voluntary activity yet recent statistics show that Māori are the highest participants in this type of work. This thesis provides an analysis of the relationship of Māori to voluntary work and its evolution in a Colonial State, Liberal State, Welfare State, and Neo-Liberal State in New Zealand. Three perspectives of Māori voluntary work provide the foundation for the analysis of this relationship. The first perspective describes voluntary work from a personal experience as an insider. The second perspective explores literature that records Māori involvement in voluntary activity. The third perspective documents life experiences from Māori voluntary workers in New Zealand communities. The three perspectives provide an empirical foundation for the type of relationship that has developed between Māori and voluntary work; Māori and the State; Māori and their place in New Zealand society. My interest in Te Ao Māori (the Māori world) as a valid and thriving ontological position and my academic interest in critical theory provide the theoretical lens for my analysis. Personal experience as a Māori volunteer opened doors to the communities I entered and added strength to the research, the first perspective. Western research in Māori communities often by non-Māori researchers, was conducted to gather knowledge for Western policy makers. Māori knowledge was not recognised as valid and the people were treated as objects. Knowing this, I searched for an approach that valued Māori participants, valued Māori people, and contained cultural aspects that separated the procedure from Western research. A review of literature, the second perspective, introduced a cultural approach to research termed kaupapa Māori research, generated out of and for Te Ao Māori detailed further in Chapter Three. Participants’ life experiences coupled with literature provide a wealth of knowledge and a testimony to the type of relationship that exists between Māori and voluntary work. Criticism from Māori communities as to the exploitation of Māori volunteers has swelled in recent years so that the environment volunteers work in is no longer attractive to Māori people. Therefore, documenting the life experiences of Māori who participate in voluntary work as the primary source of information was imperative and produced evidence to describe the relationship between Māori and voluntary work in the thesis. A triangular study: case study, community study, and cross-section study (Chapters Six, Seven, and Eight), provide the ‘grass roots voices’ and represent the third perspective. My observation of Māori organisations’ involvement in voluntary work generated in me a deep concern in what appeared to be an involvement in activity that improved neither the lives of the volunteers nor the wider problems to which they attributed their aroha. This involvement activity is a product of historical developments whereby the Western ideology of voluntary work became confused with a Māori ideology of collective participation. This confusion has created an environment where Māori voluntary organisations are working unpaid with insufficient resources in oppressive conditions in the attempt to provide social solutions. I argue that the Māori ideology of collective participation has been co-opted in the emerging conflict of neo-liberalism to provide social services in communities which government agencies exploit. In conclusion, the thesis is a journey through the world of voluntary work for Māori in communal organisations

Intention, beliefs and mood assessed using electronic diaries predicts attendance at cardiac rehabilitation:An observational study

Background: Cardiac rehabilitation is effective in promoting physical/psychological recovery following acute coronary syndrome. Yet, rates of attendance at outpatient cardiac rehabilitation by eligible patients are low. Objectives: This study examined the determinants of attendance at outpatient cardiac rehabilitation in acute coronary syndrome patients following discharge until cardiac rehabilitation commencement. Design: A weekly electronic diary measured cardiac-related cognitions and mood and examined their relation to attendance at outpatient cardiac rehabilitation. Settings: Three United Kingdom National Health Service secondary care settings in two Health Board areas in Scotland. Participants: Acute coronary syndrome patients were recruited from March 2012 to June 2013 prior to hospital discharge. Of 488 eligible patients referred for cardiac rehabilitation, 214 consented. Results: 166 participants provided, on average, 5 weeks of diary entries before cardiac rehabilitation commenced. High intention (i.e. low “do not intend”) to attend CR and its rate of increase over time predicted attendance. Low negative emotional representation, high perceived necessity, high confidence in maintaining function, low negative affect, and high positive affect following discharge predicted attendance at cardiac rehabilitation. The rate of change in cardiac-related mood and these cognitions was not predictive. Baseline and rate of change in “do not intend” entirely mediated relationships between a) perceived necessity, b) negative affect and attendance at cardiac rehabilitation. Conclusions: Negative affect in the first weeks following discharge represents the key challenge to a patient maintaining their intention to attend cardiac rehabilitation. Intervention to improve attendance should focus on improving intention to attend following discharge and during recovery by improving patient understanding of cardiac rehabilitation and reducing negative affect

Past major tsunamis and the level of tsunami risk on the Aitape coast of Papua New Guinea

This paper reports the results of an investigation into past major tsunamis on the Aitape coast of Papua New Guinea. The investigation was mounted to gather information to help assess the level of ongoing tsunami risk, in the aftermath of a catastrophic tsunami that struck this coast in 1998. We found that local residents have a strong oral tradition of a great tsunami at some time in the past, date unknown. A possible geological record of past major tsunamis was found in a submerged rock face that comprised clay-rich mudstone with three centimetric interbeds of peat, two of which contained coarse detrital sediment of marine origin. The topmost peat contained much marine detrital sediment, some of it very coarse (pebbles to 4 cm), and was dated at around AD 1440–1600. The second peat contained a much smaller proportion of detrital sediment, finer sediment than was in the topmost, and was dated at around AD 1150–1240. The lowermost peat was dated at around AD 980–1050. The two occurrences of coarse detrital sediments are presumed to be a record of past marine incursions into coastal swamps, probably as tsunamis or possibly as storm waves. The more recent, and more energetic, incursion, at around AD 1440–1600, was very likely the great tsunami of legend. In the thousand years recorded in the submerged rock face, there have been, at most, three major tsunamis, at approximate intervals of 300–500 years.We thank the Australian aid program for a grant which covered the cost of drilling

Accuracy of urine pH testing in a regional metabolic renal clinic: is the dipstick accurate enough?

Urine pH is a useful marker for assessing treatment need and efficacy in patients with nephrolithiasis. Though the gold standard of measurement is with a pH electrode, dipsticks offer the convenience of cost, ease of use, and the possibility of patients measuring their own values outside the clinic. The aim of this study was to determine whether dipsticks offer the same accuracy as the electrode. Paired measurements of freshly voided urine pH with both electrode and dipstick were analysed in a multidisciplinary renal clinic. We found that although there was a high Pearson correlation between the samples (0.89, p = 0.001), urine dipstick measurements carried an approximately 1 in 4 risk of producing clinically significant differences (pH differences  > 0.5 pH unit) from meter values. We also found that at high and low urine pH, the dipstick tended to over- and underestimate true pH readings, respectively. Examining the values in the 98 patients where a need for pharmacological urinary pH manipulation was indicated by the true pH, we found 14 who would not have been appropriately treated, and 5 who would have been unnecessarily medicated, if the stick pH value had been used. We conclude that dipstick pH measurement is insufficiently reliable for guiding clinical decision-making