Exercise and Lifestyle Therapy Improves Weight Maintenance in Young People With Psychosis: A Service Evaluation

INTRODUCTION Young people with psychosis typically have higher rates of premature cardiovascular disease and metabolic disorders compared to non-psychotic peers. This has been primarily due to a sedentary lifestyle, poor diet composition, misuse of harmful substances and higher rates of obesity and smoking. When prescribed obesogenic antipsychotic medication, a weight gain of >12 kg within 2 years is typical. PURPOSE: To examine the benefits of a 12 wk exercise and lifestyle intervention entitled ‘Supporting Health and Promoting Exercise’ (SHAPE) for young people recently diagnosed with psychosis. METHODS Participants (n=26; 8 females; mean age 27.7 ± 5.1) engaged in weekly 45’ education sessions on healthy lifestyle behaviors, including: managing anxiety and depression, mindfulness and relaxation training, substance misuse, smoking cessation, healthy eating and nutritional advice, dental and sexual health care. This was followed by a 45’ exercise session including activities such as circuit and resistance training, yoga, and badminton, led by qualified exercise instructors. Anthropometric data were measured at baseline, 12 wk and 12 month post-intervention. Lifestyle behaviors and clinical measurements, including resting heart rate, blood pressure, total cholesterol, triglycerides, HbA1c and prolactin, were assessed at baseline and 12 months post-intervention as part of their routine clinical care plan. Significant differences over time were assessed using Paired Sample t-tests. RESULTS SHAPE participants (n=26) presented with first episode psychosis (n=11), schizophrenia (n=11), bipolar disorder (n=2), at risk mental state (n=1), and persistent delusion disorder (n=1) of which 52% were prescribed highly obesogenic antipsychotic medications (Clozapine and Olanzepine). Mean baseline data suggests participants were at an increased health risk due to elevated values in mean BMI (70% were overweight or obese), waist circumference, resting heart rate, and triglycerides (see Table 1 & 2). Over 50% reported smoking daily and 85% had elevated resting blood pressure (>120/80 mm Hg). At 12 wk post-intervention, no changes were observed in mean BMI or waist circumference (see Table 1); 19 participants either maintained (mean 0.5 kg: range ± 2 kg) or decreased (mean -5.7 kg: range 2-7 kg) weight; 7 participants increased weight (mean 4.9 kg: range 2.0-9.6 kg). At 12 month post-intervention (n=16), no change was evident in mean BMI, waist circumference, or any other clinical variable (see Table 2). Positive impacts on lifestyle behaviors included 7 participants eating ~400g of fruit/vegetables daily, 2 ceased substance use, 2 ceased alcohol use, 4 ceased smoking and 5 were less sedentary. CONCLUSION At the start of the programme, participants were already at an increased risk for cardiometabolic disorders. Findings suggest that SHAPE supported young people with psychosis to: -attenuate their physical health risk following a 12 wk exercise and lifestyle intervention which were sustained at 12 months follow up. -make positive lifestyle behavior changes leading to sustained improvements in weight maintenance and physical health

Early Intervention in Psychosis: Effectiveness and Implementation of a Combined Exercise and Health Behavior Intervention within Routine Care

Aim: Young-people with psychosis have higher rates of obesity, premature cardiovascular disease and death compared to non-psychotic peers in the general population due to changes in metabolic regulation linked to antipsychotic medication and adverse health risk behaviors. The aim of this paper is to outline the development, implementation, and evaluation of a combined 12-week exercise and health behavior intervention delivered as part of an Early Intervention in Psychosis (EIP) routine service, within the UK. Methods: Participants (n=27) completed a 12-week combined intervention program, engaging in weekly, 90-minute sessions comprising a healthy behavior education session (45 minutes), followed by a facilitated exercise session (45 minutes). Anthropometric data from participants (n=26) were collected at baseline, 12 weeks, and 12 months post-intervention. Health behaviors and clinical measurements were assessed at baseline and 12 months. Results: Mean baseline data suggests participants were at an increased health risk on entry to the program, with elevated values in mean body mass index (BMI; 70% overweight/obese), waist circumference, resting heart rate, and triglycerides. Fifty percent reported smoking daily, 64% ate 0.05). At 12 months, participants reported a positive impact on health behaviors including improved diet, increased physical activity levels, and cessation of substance use (n=2), alcohol use (n=2), and smoking (n=4). Focus groups captured participant experiences, engagement with and satisfaction with the program, including challenges/barriers to program adherence. Conclusions: The 12-week exercise and health behaviors program supported participants to attenuate their physical health risk which was sustained at 12 months follow up. Self-reported positive health behavior changes are likely to have contributed to the prevention of excessive weight gain in this high-risk period. The evaluation was designed to have validity for a ’real world EIP setting’ and reflect the complexity of delivery amongst this participant group. Evaluation findings influenced subsequent commissioning of the physical health intervention as an ongoing element of routine EIP care within the participant site

Surviving streptococcal toxic shock syndrome: a case report

Streptococcal toxic shock syndrome and associated myositis caused by group A beta-hemolytic streptococcus pyogenes generally have a poor outcome despite aggressive operative treatment. Frequently the diagnosis is missed initially as the clinical features are non-specific. The progression to a toxic state is rapid and unless definitive treatment measures are initiated early, the end result can be catastrophic. We report a previously healthy patient who had features of toxic shock syndrome due to alpha haemolytic (viridans) streptococcus mitis which was treated successfully with antibiotics, aggressive intensive care support including the use of a 'sepsis care bundle', monitoring and continuous multidisciplinary review. Life and limb threatening emergencies due to streptococcus mitis in an immune-competent person are rare and to our knowledge, have not previously been described in the English scientific literature. Successful outcome is possible provided a high degree of suspicion is maintained and the patient is intensively monitored

Mapping the Birch and Grass Pollen Seasons in the UK Using Satellite Sensor Time-series

Grass and birch pollen are two major causes of seasonal allergic rhinitis (hay fever) in the UK and parts of Europe affecting around 15-20% of the population. Current prediction of these allergens in the UK is based on (i) measurements of pollen concentrations at a limited number of monitoring stations across the country and (ii) general information about the phenological status of the vegetation. Thus, the current prediction methodology provides information at a coarse spatial resolution only. Most station-based approaches take into account only local observations of flowering, while only a small number of approaches take into account remote observations of land surface phenology. The systematic gathering of detailed information about vegetation status nationwide would therefore be of great potential utility. In particular, there exists an opportunity to use remote sensing to estimate phenological variables that are related to the flowering phenophase and, thus, pollen release. In turn, these estimates can be used to predict pollen release at a fine spatial resolution. In this study, time-series of MERIS Terrestrial Chlorophyll Index (MTCI) data were used to predict two key phenological variables: the start of season and peak of season. A technique was then developed to estimate the flowering phenophase of birch and grass from the MTCI time-series. For birch, the timing of flowering was defined as the time after the start of the growing season when the MTCI value reached 25% of the maximum. Similarly, for grass this was defined as the time when the MTCI value reached 75% of the maximum. The predicted pollen release dates were validated with data from nine pollen monitoring stations in the UK. For both birch and grass, we obtained large positive correlations between the MTCI-derived start of pollen season and the start of the pollen season defined using station data, with a slightly larger correlation observed for birch than for grass. The technique was applied to produce detailed maps for the flowering of birch and grass across the UK for each of the years from 2003 to 2010. The results demonstrate that the remote sensing-based maps of onset flowering of birch and grass for the UK together with the pollen forecast from the Meteorology Office and National Pollen and Aerobiology Research Unit (NPARU) can potentially provide more accurate information to pollen allergy sufferers in the UK

Re-visiting Meltsner: Policy Advice Systems and the Multi-Dimensional Nature of Professional Policy Analysis

10.2139/ssrn.15462511-2

Rethinking Policy ‘Impact’:Four Models of Research-Policy Relations

Abstract Political scientists are increasingly exhorted to ensure their research has policy ‘impact’, most notably via Research Excellence Framework (REF) impact case studies, and ‘pathways to impact’ statements in UK Research Council funding applications. Yet the assumptions underpinning these frameworks often fail to reflect available evidence and theories. Notions of ‘impact’, ‘engagement’ and ‘knowledge exchange’ are typically premised on simplistic, linear models of the policy process, according to which policy-makers are keen to ‘utilise’ expertise to produce more ‘effective’ policies. Such accounts overlook the rich body of literature in political science, policy studies, and sociology of knowledge, which offer more complex and nuanced accounts. Drawing on this wider literature, this paper sets out four different approaches to theorising the relationship: (1) knowledge shapes policy; (2) politics shapes knowledge; (3) co-production; and (4) autonomous spheres. We consider what each of these four approaches suggests about approaches to incentivising and measuring research impact

Five insights from the Global Burden of Disease Study 2019

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a rules-based synthesis of the available evidence on levels and trends in health outcomes, a diverse set of risk factors, and health system responses. GBD 2019 covered 204 countries and territories, as well as first administrative level disaggregations for 22 countries, from 1990 to 2019. Because GBD is highly standardised and comprehensive, spanning both fatal and non-fatal outcomes, and uses a mutually exclusive and collectively exhaustive list of hierarchical disease and injury causes, the study provides a powerful basis for detailed and broad insights on global health trends and emerging challenges. GBD 2019 incorporates data from 281 586 sources and provides more than 3.5 billion estimates of health outcome and health system measures of interest for global, national, and subnational policy dialogue. All GBD estimates are publicly available and adhere to the Guidelines on Accurate and Transparent Health Estimate Reporting. From this vast amount of information, five key insights that are important for health, social, and economic development strategies have been distilled. These insights are subject to the many limitations outlined in each of the component GBD capstone papers.Peer reviewe