AN EVALUATION OF THE NORTHAMPTON PHYSICAL HEALTH AND WELLBEING (PhyHWell) PROJECT

Abstract Background The first study to demonstrate that life expectancy in patients with a severe mental illness (SMI) was reduced was by Farr in 1841. More recently, comparative research has demonstrated a higher level of cardiovascular disease (CVD) than the rest of the population in this group. Despite this knowledge, little has changed in routine practice. One barrier could be that the educational needs of the primary care healthcare professionals in this area are not being met. Aims The aim of this programme of research is to address the physical health needs of people with SMI by improving the practice of healthcare professionals in primary care. Methods The methods employed are the development of a training package and a programme of research divided into eight studies: 1. A retrospective audit to find out whether patients will attend for a health check if they are invited. 2. A prospective audit to see if a tool used for people with physical illnesses to improve their lifestyle (a food diary) is as effective when used with the SMI population. 3. A systematic search to find out what evidence there is for the efficacy of healthcare professional educational outcomes in studies of physical health in SMI. 5 4. The development of a training package for practice nurses to teach them how to carry out physical health checks for people with SMI. 5. A retrospective audit to establish whether as many people with SMI are being screened for cardiovascular disease as people with physical conditions in Northampton. 6. An audit to find out whether as many people with SMI are being screened for cardiovascular disease as people with physical conditions in England. 7. A before and after study to measure the effect of a physical health and SMI training on the practice nurses’ motivation to carry out physical health checks for people with SMI. 8. A before and after study to establish whether training practice nurses to carry out physical health checks for people with SMI increases the level of screening for cardiovascular risk in this group. 9. A qualitative study using interviews with patients with SMI to find out what they think about the physical health checks. Results There were a total of 2,796 patients and eight healthcare professionals included in the programme in Northampton and 2,911,914 patients in the national study. People with SMI will attend for a health check if invited by letter giving them an appointment with a named practitioner (66%). The patients with schizophrenia were all successful in completing food diaries. There were no studies identified as suitable for a systematic review. In the five participating primary care practices in Northampton, the people with SMI received less CVD screening than those with diabetes (21% v 96%, CI=64.53 to 126.55: p<.01). In the 6 national study, patients with diabetes received higher levels of screening in the previous 15 months than those with SMI (97.3% vs 74.7%; p<0.0001). The attitudes of the practice nurses involved in the study towards their role in providing health checks appeared to be modified in a positive direction. Following the training of practice nurses, each individual patient received more CVD screening and lifestyle information (3.85 v 2.69: t=8.22, p<.05). The patients who were interviewed about their physical health check had a good understanding of the importance of a healthy diet and taking regular exercise but did not appear aware of the risk of cardiovascular disease. Conclusion Simple changes in the way patients with SMI are invited to attend a health check increases attendance rates. The quality of primary care health checks for this population is inferior to those provided to patients with diabetes. Training practice nurses improves the quality of the health checks but still not to the levels received by other patient groups

Ecology of Tridacna in Palau

Species composition, distribution, standing crop biomass, spawning, and growth rate of Tridacnidae clams were studied in Palau, Western Caroline Islands. The population was composed of six species: Tridama gigas, T. derasa, T. squamosa, T. maxima, T. crocea, and Hippopus hippopus. In random transects, T. crocea was the most frequent and abundant, while T. derasa and T. gigas made up the largest proportion of the standing crop biomass. Spawning was induced artificially in T. squamosa by addition of macerated gonad from one individual to an aquarium containing other individuals, but larval development was not observed. The growth rate of tagged Tridacnidae was slow and further study will be required before an estimate of biomass production can be derived

Is adherence therapy an effective adjunct treatment for patients with schizophrenia spectrum disorders? A systematic review and meta-analysis

Background Poor adherence to medication in schizophrenia spectrum disorders leads to inadequate symptom control. Adherence therapy (AT) is an intervention that seeks to reduce patients’ psychiatric symptoms by enhancing treatment adherence. We aimed to systematically review the trial evidence of the effectiveness of AT on improving clinical outcomes in these patients. Method Systematic review and meta-analysis of published RCTs. We included studies testing AT as an adjunct intervention against treatment as usual or a comparator intervention in the general adult psychiatric population. The primary outcome of interest was improvement in psychiatric symptoms. Results We included six studies testing AT in schizophrenia spectrum disorders published since 2006. A meta-analysis showed AT significantly reduced psychiatric symptoms compared to usual treatment over a follow-up period of less than 1 year. We found no significant effects of AT on patients’ adherence and adherence attitudes. Conclusions AT is an effective adjunctive treatment for people with schizophrenia spectrum disorders

A rhetoric-in-context approach to building commitment to multiple strategic goals

There are still few explanations of the micro-level practices by which top managers influence employee commitment to multiple strategic goals. This paper argues that, through their language, top managers can construct a context for commitment to multiple strategic goals. We therefore propose a rhetoric-in-context approach to illuminate some of the micro practices through which top managers influence employee commitment. Based upon an empirical study of the rhetorical practices through which top managers influence academic commitment to multiple strategic goals in university contexts, we demonstrate relationships between rhetoric and context. Specifically, we show that rhetorical influences over commitment to multiple goals are associated with the historical context for multiple goals, the degree to which top managers' rhetoric instantiates a change in that context, and the internal consistency of the rhetorical practices used by top managers. Copyright © 2007 SAGE Publications

Evaluating the clinical and cost effectiveness of a behaviour change intervention for lowering cardiovascular disease risk for people with severe mental illnesses in primary care (PRIMROSE study):study protocol for a cluster randomised controlled trial

BACKGROUND: People with severe mental illnesses die up to 20 years earlier than the general population, with cardiovascular disease being the leading cause of death. National guidelines recommend that the physical care of people with severe mental illnesses should be the responsibility of primary care; however, little is known about effective interventions to lower cardiovascular disease risk in this population and setting. Following extensive peer review, funding was secured from the United Kingdom National Institute for Health Research (NIHR) to deliver the proposed study. The aim of the trial is to test the effectiveness of a behavioural intervention to lower cardiovascular disease risk in people with severe mental illnesses in United Kingdom General Practices. METHODS/DESIGN: The study is a cluster randomised controlled trial in 70 GP practices for people with severe mental illnesses, aged 30 to 75 years old, with elevated cardiovascular disease risk factors. The trial will compare the effectiveness of a behavioural intervention designed to lower cardiovascular disease risk and delivered by a practice nurse or healthcare assistant, with standard care offered in General Practice. A total of 350 people will be recruited and followed up at 6 and 12 months. The primary outcome is total cholesterol level at the 12-month follow-up and secondary outcomes include blood pressure, body mass index, waist circumference, smoking status, quality of life, adherence to treatments and services and behavioural measures for diet, physical activity and alcohol use. An economic evaluation will be carried out to determine the cost effectiveness of the intervention compared with standard care. DISCUSSION: The results of this pragmatic trial will provide evidence on the clinical and cost effectiveness of the intervention on lowering total cholesterol and addressing multiple cardiovascular disease risk factors in people with severe mental illnesses in GP Practices. TRIAL REGISTRATION: Current Controlled Trials ISRCTN13762819 . Date of Registration: 25 February 2013. Date and Version Number: 27 August 2014 Version 5

Accounting, Soci(et)al Risks, and Public Reason: Governmental Risk Discourses About the ILVA Steel Plant in Taranto (Italy)

The case of the ILVA steel plant in Taranto represents an example of con- trasting, incommensurable sustainability issues, explored in terms of “social” and “societal” risks (Asenova et al. in Managing the risks of public spending cuts in Scotland, 2013; Redistribution of social and societal risk: the impact on individuals, their networks and communities, 2015) [Asenova et al. (2015) refer to social risks as the risks of unemployment, and to societal risks as environmental and health risks.]. The case of ILVA has received significant attention for the great amount of dangerous pollutants spread in the environment, as well as the evidence of higher illness and mortality rates in the districts nearest to the plant. In July 2012, the Italian Judiciary halted activity in the steel plant. Four months after, the Italian Government declared the steel plant site as a “Strategic National Interest Site”, and allowed the company to restart its activity. Drawing on governmentality (Foucault in Questions of method, 1991), the paper aims to explore the role of accounting—here broadly intended as calculative practices (Miller in Soc Res 68:379–396, 2001)—in moulding ministerial discourse to support decisions when the governance of contrasting risks is needed to safeguard public interest. Supported by discourse analysis of governmental speech, the research shows that the Italian Government based its decision on various experts’ risk appraisals: accounting shaped governmental discourse by giving more visibility and relevance to “social” risks (i.e. unemployment, economic development, produc- tivity and competitiveness risks), while silencing “societal” ones (i.e. environmental and health risks). Focusing on a case of incommensurable contrasting issues, the findings contribute to show that accounting concurrently plays a significant role in government decisions legitimizing the business continuity through the creation of a specific risk discourse

Predictors of Breast and Cervical Cancer Screening among Chamorro Women in Southern California

This study examined the role of sociodemographic characteristics, health insurance, cancer knowledge, perceived health risk, and having a recent physicians’ visit on breast and cervical cancer screening utilization among a randomly selected group of Chamorro women (n = 250) residing in San Diego, California. Data were collected by a telephone survey and analyzed using multiple logistic regression models. After adjusting for covariates, having a recent full exam was the strongest predictor of having had a Pap exam in the past 2 years for women 21 years and older and a clinical breast exam in the past 2 years for women 40 years and over

Localization of type 1 diabetes susceptibility to the MHC class I genes HLA-B and HLA-A

The major histocompatibility complex (MHC) on chromosome 6 is associated with susceptibility to more common diseases than any other region of the human genome, including almost all disorders classified as autoimmune. In type 1 diabetes the major genetic susceptibility determinants have been mapped to the MHC class II genes HLA-DQB1 and HLA-DRB1 (refs 1-3), but these genes cannot completely explain the association between type 1 diabetes and the MHC region. Owing to the region's extreme gene density, the multiplicity of disease-associated alleles, strong associations between alleles, limited genotyping capability, and inadequate statistical approaches and sample sizes, which, and how many, loci within the MHC determine susceptibility remains unclear. Here, in several large type 1 diabetes data sets, we analyse a combined total of 1,729 polymorphisms, and apply statistical methods - recursive partitioning and regression - to pinpoint disease susceptibility to the MHC class I genes HLA-B and HLA-A (risk ratios >1.5; Pcombined = 2.01 × 10-19 and 2.35 × 10-13, respectively) in addition to the established associations of the MHC class II genes. Other loci with smaller and/or rarer effects might also be involved, but to find these, future searches must take into account both the HLA class II and class I genes and use even larger samples. Taken together with previous studies, we conclude that MHC-class-I-mediated events, principally involving HLA-B*39, contribute to the aetiology of type 1 diabetes. ©2007 Nature Publishing Group