Use, acceptability and impact of booklets designed to support mental health self-management and help seeking in schools:Results of a large randomised controlled trial in England

Mental health booklets may provide a low-cost means of promoting mental health self-management and help seeking in schools. The aim of the study was to assess the (a) use, (b) acceptability and (c) impact of booklets for students in primary (10-11 years) and secondary school (12-13 years) alone and in conjunction with funding for targeted mental health support. This was a 2 × 2 factorial cluster randomized controlled trial, in which 846 schools in England were randomly allocated to receive/not receive: (1) booklets for students containing information on mental health self-management and help seeking, and (2) funding for mental health support as part of a national mental health initiative. 14,690 students (8139 primary, 6551 secondary) provided self-report on mental health, quality of life (baseline and 1 year follow-up) and help seeking (follow-up). (a) Approximately, 40 % primary school students and 20 % secondary school students reported seeing the booklets. (b) Of these, 87 % of primary school students reported that the booklet was 'very helpful' or 'quite helpful', compared with 73 % in secondary school. (c) There was no detectable impact of booklets on mental health, quality of life or help seeking, either alone or in conjunction with additional funding through the national mental health initiative. Lack of discernable impact of booklets underscores the need for caution in adopting such an approach. However, it is feasible that the impact was obscured by low uptake or that booklets may be more effective when used in a targeted way

Mutation in LBX1/Lbx1 precludes transcription factor cooperativity and causes congenital hypoventilation in humans and mice

The respiratory rhythm is generated by the preBötzinger complex in the medulla oblongata, and is modulated by neurons in the retrotrapezoid nucleus (RTN), which are essential for accelerating respiration in response to high CO2. Here we identify a LBX1 frameshift (LBX1FS) mutation in patients with congenital central hypoventilation. The mutation alters the C-terminal but not the DNA-binding domain of LBX1. Mice with the analogous mutation recapitulate the breathing deficits found in humans. Furthermore, the mutation only interferes with a small subset of Lbx1 functions, and in particular with development of RTN neurons that coexpress Lbx1 and Phox2b. Genome-wide analyses in a cell culture model show that Lbx1FS and wild-type Lbx1 proteins are mostly bound to similar sites, but that Lbx1FS is unable to cooperate with Phox2b. Thus, our analyses on Lbx1FS (dys)function reveals an unusual pathomechanism; that is, a mutation that selectively interferes with the ability of Lbx1 to cooperate with Phox2b, and thus impairs the development of a small subpopulation of neurons essential for respiratory control

Dose-Response Relationship of a Web-Based Tailored Intervention Promoting Human Papillomavirus Vaccination: Process Evaluation of a Randomized Controlled Trial

BACKGROUND: In the Netherlands, HPV vaccination uptake remains low. To improve informed decision making (IDM) and HPV vaccination acceptability, we systematically developed an interactive, Web-based tailored intervention for mothers of Dutch girls to-be-invited. OBJECTIVE: The aim of this study is to provide insight into the intervention's working mechanisms by evaluating (1) program use, (2) program acceptability, and (3) the relationship of program use with (a) program acceptability, and (b) intervention effects (i.e., dose-response). METHODS: Only mothers from the intervention arm of a randomized controlled study (RCT) that assessed the effectiveness of the Web-based, tailored intervention were included. They were invited to visit the Web-based intervention between baseline (January 2015, just before access to the intervention) and follow-up (March 2015, prior to the first HPV vaccination). Indicators for program use were time of website use (i.e., duration of intervention exposure) and completeness (i.e., the proportion of all available webpages visited). HPV vaccination uptake registered by Praeventis was used as the primary outcome. Secondary outcomes were informed decision-making (IDM), decisional conflict, and social psychological determinants of HPV vaccination uptake. RESULTS: From the 3995 invited mothers, 2509 mothers (62.80%) logged in. Of these, 2239 mothers (89.24%) visited at least one page of the intervention components. On average, mothers spent 21.39 minutes on the website (SD = 12.41 minutes) and completed 50.04% (SD = 26.18%) of the website. Participants rated the website with a 7.64 on a 10-point scale (SD = 1.39). Program acceptability was significantly associated with completeness (β = 4.36, P < .001), but not with time of website use (β = -.07, P =.77). Intention-to-treat analysis (N = 3,995) showed a significant positive effect of completeness on all outcome measures (P's <.003; Bonferroni corrected alpha=.05/15 factors), including on HPV vaccination uptake. Time of website use had a significant positive effect on all outcomes (P's <.003), except for uptake (P = .195), risk perception when not vaccinated (P = .144), subjective norms (P = .032), and habit (P = .013). CONCLUSIONS: Program use and acceptability of the intervention was adequate. Completeness was positively associated with acceptability. Furthermore, positive effects (i.e., dose-response effects) were found of completeness and time of website use on the mothers IDM, decisional conflict, and almost all of the social-psychological determinants of HPV vaccination acceptability. In addition, the extent to which mothers completed the intervention had a positive impact on their daughters' vaccination uptake. This indicates that the Web-based, tailored intervention fits well with the mothers' needs, and that completeness of use is essential for improving HPV vaccination uptake, acceptability, and IDM. Program use should therefore be promoted. CLINICALTRIAL: Trialregister.nl NTR4795; https://www.trialregister.nl/trial/4795

Learning Communities in de Logistiek : de TIP-ontwikkelmethode

Hoe kan LLO in de logistiek vormgegeven worden, om daarmee het innovatievermogen van de sector te versterken? Learning Communities lijken een kansrijk middel om dit vraagstuk aan te pakken. In deze publicatie wordt dieper ingegaan op het concept Learning Communities en wordt het belang hiervan geschetst voor het vormgeven van LLO in de logistiek en het innovatief vermogen van de sector

Dose-Response Relationship of a Web-Based Tailored Intervention Promoting Human Papillomavirus Vaccination:Process Evaluation of a Randomized Controlled Trial

BACKGROUND: In the Netherlands, HPV vaccination uptake remains low. To improve informed decision making (IDM) and HPV vaccination acceptability, we systematically developed an interactive, Web-based tailored intervention for mothers of Dutch girls to-be-invited. OBJECTIVE: The aim of this study is to provide insight into the intervention's working mechanisms by evaluating (1) program use, (2) program acceptability, and (3) the relationship of program use with (a) program acceptability, and (b) intervention effects (i.e., dose-response). METHODS: Only mothers from the intervention arm of a randomized controlled study (RCT) that assessed the effectiveness of the Web-based, tailored intervention were included. They were invited to visit the Web-based intervention between baseline (January 2015, just before access to the intervention) and follow-up (March 2015, prior to the first HPV vaccination). Indicators for program use were time of website use (i.e., duration of intervention exposure) and completeness (i.e., the proportion of all available webpages visited). HPV vaccination uptake registered by Praeventis was used as the primary outcome. Secondary outcomes were informed decision-making (IDM), decisional conflict, and social psychological determinants of HPV vaccination uptake. RESULTS: From the 3995 invited mothers, 2509 mothers (62.80%) logged in. Of these, 2239 mothers (89.24%) visited at least one page of the intervention components. On average, mothers spent 21.39 minutes on the website (SD = 12.41 minutes) and completed 50.04% (SD = 26.18%) of the website. Participants rated the website with a 7.64 on a 10-point scale (SD = 1.39). Program acceptability was significantly associated with completeness (β = 4.36, P < .001), but not with time of website use (β = -.07, P =.77). Intention-to-treat analysis (N = 3,995) showed a significant positive effect of completeness on all outcome measures (P's <.003; Bonferroni corrected alpha=.05/15 factors), including on HPV vaccination uptake. Time of website use had a significant positive effect on all outcomes (P's <.003), except for uptake (P = .195), risk perception when not vaccinated (P = .144), subjective norms (P = .032), and habit (P = .013). CONCLUSIONS: Program use and acceptability of the intervention was adequate. Completeness was positively associated with acceptability. Furthermore, positive effects (i.e., dose-response effects) were found of completeness and time of website use on the mothers IDM, decisional conflict, and almost all of the social-psychological determinants of HPV vaccination acceptability. In addition, the extent to which mothers completed the intervention had a positive impact on their daughters' vaccination uptake. This indicates that the Web-based, tailored intervention fits well with the mothers' needs, and that completeness of use is essential for improving HPV vaccination uptake, acceptability, and IDM. Program use should therefore be promoted. CLINICALTRIAL: Trialregister.nl NTR4795; https://www.trialregister.nl/trial/4795