Influences on recruitment to randomised controlled trials in mental health settings in England: a national cross-sectional survey of researchers working for the Mental Health Research Network

Background: Recruitment to trials is complex and often protracted; selection bias may compromise generalisability. In the mental health field (as elsewhere), diverse factors have been described as hindering researcher access to potential participants and various strategies have been proposed to overcome barriers. However, the extent to which various influences identified in the literature are operational across mental health settings in England has not been systematically examined. Methods: A cross-sectional, online survey of clinical studies officers employed by the Mental Health Research Network in England to recruit to trials from National Health Service mental health services. The bespoke questionnaire invited participants to report exposure to specified influences on recruitment, the perceived impact of these on access to potential participants, and to describe additional positive or negative influences on recruitment. Analysis employed descriptive statistics, the framework approach and triangulation of data. Results: Questionnaires were returned by 98 (58%) of 170 clinical studies officers who reported diverse experience. Data demonstrated a disjunction between policy and practice. While the particulars of trial design and various marketing and dommunication strategies could influence recruitment, consensus was that the culture of NHS mental health services is not donducive to research. Since financial rewards for recruitment paid to Trusts and feedback about studies seldom reaching frontline services, clinicians were described as distanced from research. Facing continual service change and demanding clinical workloads, clinicians generally did not prioritise recruitment activities. Incentives to trial participants had variable impact on access but recruitment could be enhanced by engagement of senior investigators and integrating referral with routine practice. Comprehensive, robust feasibility studies and reciprocity between researchers and clinicians were considered crucial to successful recruitment. Conclusions: In the mental health context, researcher access to potential trial participants is multiply influenced. Gatekeeping clinicians are faced with competing priorities and resources constrain research activity. It seems that environmental adjustment predicated on equitable resource allocation is needed if clinicians in NHS mental health services are to fully support the conduct of randomised controlled trials. Whilst cultural transformation, requiring changes in assumptions and values, is complex, our findings suggest that attention to practical matters can support this and highlight issues requiring careful consideration

Intervening to improve health indicators among Australian farm families

The Sustainable Farm Families project (http://www.sustainablefarmfamilies.org.au/) was a 3-year demonstration and education project designed to influence farmer behavior with respect to family health and well-being among cropping and grazing farmers in Victoria, New South Wales, and South Australia, Australia. The project was conducted by the Western District Health Service, Hamilton, Australia, in partnership with farmers; Farm Management 500 (peer discussion group); the Victorian Farmers Federation; Royal Melbourne Institute of Technology; and Land Connect. During the 3 years of the project, 128 farmers&mdash;men (70) and women (58)&mdash;were enrolled. The project utilized a combination of small group workshops, individualized health action plans, and health education opportunities to encourage farm safety and health behavior changes and to elicit sustained improvements in the following health indicators: body mass index (BMI), total cholesterol, fasting blood glucose, and blood pressure. Mean changes in these health indicators were analyzed using repeated measures analysis of variance (ANOVA) and McNemar\u27s test compared the proportion of individuals with elevated indicators. Among participants with elevated values at baseline, the following average reductions were observed: BMI 0.44 kg/m2 (p = .0034), total cholesterol 48.7 mg/dl (p &lt; .0001), blood glucose 10.1 mg/dl (p = .0016), systolic blood pressure 12.5 mm Hg (p &lt; .0001), and diastolic blood pressure 5.0 mm Hg (p = .0007). The proportion of participants with elevated total cholesterol at baseline decreased after 24 months (p &lt; .001). Such findings suggest that proactive intervention by farmer associations, rural health services, and government agencies may be an effective vehicle for promoting voluntary farm safety and health behavior change while empowering farm families to achieve measurable reductions in important health risk factors. <br /

Seroprevalence of hepatitis B and C viral co-infections among children infected with human immunodeficiency virus attending the paediatric HIV care and treatment center at Muhimbili National Hospital in Dar-es-Salaam, Tanzania

<p>Abstract</p> <p>Background</p> <p>With increased availability of antibiotics and antifungal agents hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are becoming a cause for significant concern in HIV infected children. We determined the seroprevalence and risk factors for HBV and HCV among HIV infected children aged 18 months to 17 years, attending the Paediatric HIV Care and Treatment Center (CTC) at Muhimbili National Hospital (MNH) in Dar-es-Salaam, Tanzania.</p> <p>Methods</p> <p>Investigations included; interviews, physical examination and serology for HBsAg, IgG antibodies to HCV and alanine aminotransferase (ALT) levels. HIV serostatus and CD4 counts were obtained from patient records.</p> <p>Results</p> <p>167 HIV infected children, 88(52.7%) males and 79(47.3%) females were enrolled. The overall prevalence of hepatitis co-infection was 15%, with the seroprevalence of HBV and HCV being 1.2% and 13.8%, respectively. Hepatitis virus co-infection was not associated with any of the investigated risk factors and there was no association between HBV and HCV. Elevated ALT was associated with hepatitis viral co-infection but not with ART usage or immune status.</p> <p>Conclusion</p> <p>The high seroprevalence (15%) of hepatitis co-infection in HIV infected children attending the Paediatrics HIV CTC at the MNH calls for routine screening of hepatitis viral co-infection and modification in the management of HIV infected children.</p

Self-reflection and academic performance: is there a relationship?

The purposes of the present study were two-fold: first, to evaluate whether reflection journal writing was effective in promoting self-reflection and learning, and whether students become better at self-reflection if they engage continuously in reflection journal writing. To that end, the reflection journals of 690 first-year applied science students at a local polytechnic were studied by means of an automated coding procedures using software. Data was collected twice, once at the beginning and again towards the end of an academic year. Outcomes of the textual content analyses revealed that students reflected on both the process and contents of their learning: critical review of past learning experiences, learning strategies and summaries of what was learned. Correlational analyses showed weak to moderate inter-relationship

The relations between DISC-IV DSM diagnoses of ADHD and multi-informant CBCL-AP syndrome scores

Background: Previous studies have examined the relation between attention problems (APs) obtained with the Child Behavior Checklist (CBCL) and attention deficit hyperactivity disorder (ADHD) assessed with the Diagnostic and Statistical Manual of Mental Disorders (DSM). We will examine this relation across sex using multi-informant data. Methods: Parents of 12 538 twins, aged 7, 10, and 12 years, and teachers of twins, aged 10 years, completed the questionnaires. The mothers of a sample of 283 boys and 291 girls who scored either low or high on longitudinal maternal CBCL-AP were interviewed. Results: Children with a low AP score obtained a negative ADHD diagnosis in 96% of cases. Children with a high AP score obtained a positive diagnosis in 36% (girls) and 59% (boys) of cases. The association between paternal and maternal AP ratings and ADHD was the same, whereas the association between teacher AP ratings and ADHD was low. Conclusions: The association between AP and ADHD is higher in boys than girls, possibly because of a bias toward the male manifestation of ADHD. © 2006 Elsevier Inc. All rights reserved

Effective suckling in relation to naked maternal-infant body contact in the first hour of life: an observation study

Background Best practice guidelines to promote breastfeeding suggest that (i) mothers hold their babies in naked body contact immediately after birth, (ii) babies remain undisturbed for at least one hour and (iii) breastfeeding assistance be offered during this period. Few studies have closely observed the implementation of these guidelines in practice. We sought to evaluate these practices on suckling achievement within the first hour after birth. Methods Observations of seventy-eight mother-baby dyads recorded newborn feeding behaviours, the help received by mothers and birthing room practices each minute, for sixty minutes. Results Duration of naked body contact between mothers and their newborn babies varied widely from 1 to 60 minutes, as did commencement of suckling (range = 10 to 60 minutes). Naked maternal-infant body contact immediately after birth, uninterrupted for at least thirty minutes did not predict effective suckling within the first hour of birth. Newborns were four times more likely to sustain deep rhythmical suckling when their chin made contact with their mother’s breast as they approached the nipple (OR 3.8; CI 1.03 - 14) and if their mothers had given birth previously (OR 6.7; CI 1.35 - 33). Infants who had any naso-oropharyngeal suctioning administered at birth were six times less likely to suckle effectively (OR .176; CI .04 - .9). Conclusion Effective suckling within the first hour of life was associated with a collection of practices including infants positioned so their chin can instinctively nudge the underside of their mother’s breast as they approach to grasp the nipple and attach to suckle. The best type of assistance provided in the birthing room that enables newborns to sustain an effective latch was paying attention to newborn feeding behaviours and not administering naso-oropharyngeal suction routinely

Association between asymptomatic hyperuricemia and new-onset chronic kidney disease in Japanese male workers: a long-term retrospective cohort study

<p>Abstract</p> <p>Background</p> <p>Hyperuricemia is prevalent in patients with chronic kidney disease (CKD). We explored the hypothesis that asymptmatic hyperuricemia may be associated with new-onset CKD.</p> <p>Methods</p> <p>The participants were all male factory workers in Kanagawa, Japan (n = 1,285). All were over 40 years of age and had undergone annual health examinations from 1990 to 2007. Individuals with a history of gouty attacks were excluded from the study. A retrospective cohort study was conducted by following the estimated glomerular filtration rate (eGFR) for each participant over a maximum period of 18 years. The endpoint was new-onset CKD defined as eGFR < 60 mL/min/1.73 m². The associations between new-onset CKD and the presence of hyperuricemia, low serum high-density lipoprotein cholesterol, hypertension, diabetes, and obesity were analyzed.</p> <p>Results</p> <p>The mean (± standard deviation) follow-up period was 95.2 (± 66.7) months, and new-onset CKD was observed in 100 participants (7.8%) during this follow-up. Cox proportional hazards model revealed that the hazard ratio of new-onset CKD due to hyperuricemia, low serum high-density lipoprotein cholesterol, hypertension and obesity were 3.99 (95% confidence interval: 2.59-6.15), 1.69 (1.00-2.86), 2.00 (1.29-3.11) and 1.35 (0.87-2.10), respectively. Concerning hyperuricemia, low serum high-density lipoprotein cholesterol, hypertension and obesity, the log-rank tests showed <it>P </it>values of < 0.01, 0.01, < 0.01 and < 0.01, respectively.</p> <p>Conclusion</p> <p>The results of this study suggest that asymptomatic hyperuricemia is a predictive factor for new-onset CKD for Japanese male workers.</p

Latent class analysis of the Child Behavior Checklist Obsessive-Compulsive Scale

The Obsessive-Compulsive Scale (OCS) of the Child Behavior Checklist (CBCL) predicts obsessive-compulsive disorder and is highly heritable. Latent class analysis (LCA) of the OCS was used to identify profiles within this 8-item scale and to examine heritability of those profiles. The LCA was performed on maternal CBCL reports of their 6- to 18-year-old children from 2 US nationally representative samples from 1989 (n = 2475, 50% male) and 1999 (n = 2029, 53% male) and from Dutch twins in the Netherlands Twin Registry at ages 7 (n = 10 194, 49.3% male), 10 (n = 6448, 48.1% male), and 12 (n = 3674, 48.6% male) years. The heritability of the resultant classes was estimated using odds ratios of twin membership across classes. A 4-class solution fitted all samples best. The resulting classes were a "No or Few Symptoms" class, a "Worries and Has to Be Perfect" class, a "Thought Problems" class, and an "OCS" class. Within-class odds ratios were higher than across-class odds ratios and were higher for monozygotic than dizygotic twins. We conclude that LCA identifies an OCS class and that class is highly heritable using across-twin comparisons. © 2009 Elsevier Inc. All rights reserved

Working conditions, self-perceived stress, anxiety, depression and quality of life: A structural equation modelling approach

<p>Abstract</p> <p>Background</p> <p>The relationships between working conditions [job demand, job control and social support]; stress, anxiety, and depression; and perceived quality of life factors [physical health, psychological wellbeing, social relationships and environmental conditions] were assessed using a sample of 698 male automotive assembly workers in Malaysia.</p> <p>Methods</p> <p>The validated Malay version of the Job Content Questionnaire (JCQ), Depression Anxiety Stress Scales (DASS) and the World Health Organization Quality of Life-Brief (WHOQOL-BREF) were used. A structural equation modelling (SEM) analysis was applied to test the structural relationships of the model using AMOS version 6.0, with the maximum likelihood ratio as the method of estimation.</p> <p>Results</p> <p>The results of the SEM supported the hypothesized structural model (<it>χ</it>²= 22.801, <it>df </it>= 19, <it>p </it>= 0.246). The final model shows that social support (JCQ) was directly related to all 4 factors of the WHOQOL-BREF and inversely related to depression and stress (DASS). Job demand (JCQ) was directly related to stress (DASS) and inversely related to the environmental conditions (WHOQOL-BREF). Job control (JCQ) was directly related to social relationships (WHOQOL-BREF). Stress (DASS) was directly related to anxiety and depression (DASS) and inversely related to physical health, environment conditions and social relationships (WHOQOL-BREF). Anxiety (DASS) was directly related to depression (DASS) and inversely related to physical health (WHOQOL-BREF). Depression (DASS) was inversely related to the psychological wellbeing (WHOQOL-BREF). Finally, stress, anxiety and depression (DASS) mediate the relationships between job demand and social support (JCQ) to the 4 factors of WHOQOL-BREF.</p> <p>Conclusion</p> <p>These findings suggest that higher social support increases the self-reported quality of life of these workers. Higher job control increases the social relationships, whilst higher job demand increases the self-perceived stress and decreases the self-perceived quality of life related to environmental factors. The mediating role of depression, anxiety and stress on the relationship between working conditions and perceived quality of life in automotive workers should be taken into account in managing stress amongst these workers.</p