'It's on your conscience all the time': a systematic review of qualitative studies examining views on obesity among young people aged 12-18 years in the UK

OBJECTIVE: To explore the perspectives of young people in the UK on obesity, body size, shape and weight. DESIGN: Systematic review of qualitative studies using thematic synthesis. DATA SOURCES: Sensitive searches of 18 electronic databases from 1997 to February 2010 supplemented by grey literature searches. STUDY SELECTION: Studies produced since 1997 using qualitative methods to collect perspectives of people aged 12-18 years in the UK, reporting methods for data collection or analysis. Studies of people with eating disorders and those rated low in reliability and usefulness were excluded. RESULTS: Searches identified 30 studies involving over 1400 young people from a range of contexts. Young people of all sizes placed considerable emphasis on personal responsibility, and on the social, rather than health implications of being overweight. Young people with experience of obesity described severe, unrelenting, size-related abuse and isolation. Regardless of their own size, young people were judgemental of individuals who were overweight, but those with experience of obesity described an environment that contained multiple barriers to weight loss. Only one study asked young people directly what might support them to have a healthy body size. Study findings were configured under three main themes, labelled with quotes from included studies: general perceptions of size and society's responses ('It's on your conscience all the time'); the experiences of young people who were overweight ('If I had the choice I wouldn't be this size') and these larger young people's experiences of trying to loose weight and suggestions for action ('Make sure, even when it's hard, you've got people there'). CONCLUSIONS: The perspectives of young people in the UK, when synthesised across the spectrum of body sizes, paint a picture of a stigmatising and abusive social world. Research and policy need to engage young people actively so as to address the social implications of obesity

Developing evidence-informed, employer-led workplace health: Final report

What do we want to know? We sought to understand whether workplace health programmes (WHPs) are effective for improving health and business outcomes, and to identify the characteristics of WHPs that are thought to influence their success. To address these issues, we undertook a systematic review of three sources of evidence: systematic reviews examining intervention effectiveness; research on stakeholders’ views and experiences; and key workplace health policy documents. / What did we find? We identified 24 systematic reviews of WHPs which examined statistically the impact on a variety of outcomes, including mental health, weight management, absenteeism (and its costs), work ability and job stress. The reviews demonstrated that workplace health interventions are effective in improving health and business outcomes, and that the magnitude of effects on those outcomes is modest. Evidence from 10 views studies and 17 policy documents were integrated with evidence from systematic reviews to identify key characteristics of WHPs. Four characteristics were identified across each of the three evidence sources, suggesting that they could be implemented to good effect: financial commitment, ease of uptake, accessibility, and structures to promote social support. Five characteristics were identified in systematic reviews and views studies but have yet to be addressed by policy recommendations; these included the extent of policy integration, the importance of the implementer’s role within the company, the content of an intervention, whether the intervention is tailored or individualised, and issues related to acceptability. Four characteristics were identified as important in views studies or policy documents but had not been examined in systematic reviews, suggesting a need for future evaluation. These included managerial support, organisational support, channels of communication and the provision of tailored advice. The provider approach and the use of web-based technologies were identified in views research only. Each of these characteristics can be implemented in a variety of ways, suggesting creative possibilities for the ways in which businesses could integrate them into employer-led workplace health. / What are the conclusions? The findings suggest that employers can derive benefits from establishing WHPs, both for the business and with respect to their employees’ health. Interventions that are supported by organisational policy, focus their content on specific health issues and engage employees have been shown to be effective and are supported by stakeholder research and policy documents. Employers may find additional benefit if they also include specific characteristics related to the context in which a WHP intervention takes place, is implemented or is received by participants. The impacts of many WHP characteristics on health and business outcomes have yet to be evaluated and should be integrated into future WHP intervention evaluations. / How did we get these results? Comprehensive searching of electronic databases and websites was carried out to identify the three relevant datasets. Using framework synthesis, we combined evidence from the systematic reviews, views studies and policy documents by using a framework of characteristics potentially influencing workplace health effectiveness. Data analysis themes were then organised to produce tabular and narrative summaries of key characteristics of WHPs to produce an overall narrative

Sex-selective abortion: a systematic map of the volume and nature of research

Background - This report takes the form of a systematic map examining the volume and nature of research concerning sex-selective abortion. The map is not intended to supply an answer to the question "What is the extent of sex-selective abortion in England, Wales and -Scotland?" Rather, the purpose of the map is to describe the volume and key characteristics of research concerning sex-selective abortion; i.e. to identify and describe what research has been carried out in this area. Methodology Empirical, quantitative, English language research focussed upon sex-selective abortion and published from the year 2000 onwards was sought via bibliographic database and citation searching. Results – volume and nature of the research A sizeable international literature in relation to sex-selective abortion was found totalling 332 studies. The country of focus was India in almost half (153) of these studies, China in 79 studies (24%), and Asia (not including India, China or Pakistan) in 37 (11%) of studies. OECD countries were examined in 23 (7%) reports of 20 relevant studies (four secondary, linked reports of existing analyses were identified). Six unique studies focussed upon populations within the UK, five the US, four Canada, two Greece, two Norway and one Italy. The extent of sex-selective abortion taking place in a population is often assessed by examining the sex ratio at birth (SRB) – the number of boys born alive per 100 girls born alive. The research in this map appeared to examine relatively few confounders or moderators of the SRB, although this is likely due to the constraints imposed by analysis of pre-existing datasets. Conclusions/Further research To the extent that it is possible, future research should give further consideration to important confounders such as socio-economic status, marital status, birth order, parity and parental age. Future research might also be situated within the context of alternative explanations for perturbations and prevailing trends in the SRB. In order to establish the extent to which sex-selective abortion is taking place in UK-relevant contexts, relevant studies would have to be subjected to critical appraisal to assess the reliability of their findings. Where results are robust but inconsistent, examination of the scope of the studies and the specification of their analytical models would be required in order to explain mixed and conflicting findings

The Effect of Time Constraints on Older and Younger Driver Decisions to Turn at Intersections Using a Modified Change Blindness Paradigm

After age 75, the risk of intersection accident involvement for older drivers increases for most intersection maneuvers. Failure to yield right-of-way and violation of traffic controls are common citations. Previous research has argued that age-related declines in attentional breadth and switching can discriminate between those who are and are not more likely to be in an accident. The present study examined the effect of time constraints on older and younger driver intersection decisions. It was expected that less time to decide, process and act upon intersection decisions would adversely affect older drivers more so than younger drivers. The change blindness or flicker paradigm was modified to address these questions (see, e.g., Rensink, et al., 1997). Typically, an image (A) is alternated with a modified image (A’) each for a short duration (250 ms) with a blank field or mask (80 ms) between A and A’. In the present study, a focus screen (or prime) that indicated the expected direction of travel (i.e., left, right, or straight) was added prior to the alternation of images. Forty-eight images were selected from 2500 intersection approaches in Calgary, Winnipeg and Montreal that were filmed using a digital camera during the day. Photoshop was used to create the A’ images by manipulating a variety of elements including pedestrians, vehicles, signs, and signals. The goal of the participant was to decide if the indicated direction of travel in the pair of intersection images was safe (press accelerator) or not (press brake). Sixteen younger (M = 22.3) and 16 older drivers (M = 73.6) drivers were screened for visual acuity, contrast sensitivity, and medication use. Length of image alternation was the primary independent variable (4 and 8 s). As expected, older drivers were more likely to miss intersection changes at shorter exposure durations than younger drivers. A number of qualitative probes were also collected that clearly illustrate the contextual demands of intersections on attention. The implications of the results for intersection design and older driver selective attention are discussed

Older and Younger Driver Performance at Complex Intersections: Implications for Using Perception-Response Time and Driving Simulation

Older drivers are at increased accident risk at intersections for a variety of maneuvers. To examine why, a study was conducted to assess older driver performance at complex intersections in a driving simulator. The University of Calgary Driving Simulator was used to test healthy older drivers (65-83, M = 71.4) and younger drivers (19-22, M = 20.7). Critical scenarios included the sudden appearance of a pedestrian in an intersection, a lastsecond yellow light, an unexpected change during a left, and a vehicle violating a stoplight. Older drivers had significantly higher perception response times (PRT) than younger drivers for the latter three of the four intersection scenarios. Analysis of specific maneuvers also revealed qualitative response differences between young and old groups. In contradiction to expectation, more older drivers ran the yellow light than younger drivers. The capability of older drivers to respond under time constraints is implicated. The utility of driving simulators to assess older driver performance at intersections was limited by the prevalence of simulator sickness

Older and Younger Driver Performance at Complex Intersections: Implications for Using Perception-Response Time and Driving Simulation

Older drivers are at increased accident risk at intersections for a variety of maneuvers. To examine why, a study was conducted to assess older driver performance at complex intersections in a driving simulator. The University of Calgary Driving Simulator was used to test healthy older drivers (65-83, M = 71.4) and younger drivers (19-22, M = 20.7). Critical scenarios included the sudden appearance of a pedestrian in an intersection, a lastsecond yellow light, an unexpected change during a left, and a vehicle violating a stoplight. Older drivers had significantly higher perception response times (PRT) than younger drivers for the latter three of the four intersection scenarios. Analysis of specific maneuvers also revealed qualitative response differences between young and old groups. In contradiction to expectation, more older drivers ran the yellow light than younger drivers. The capability of older drivers to respond under time constraints is implicated. The utility of driving simulators to assess older driver performance at intersections was limited by the prevalence of simulator sickness

Do In-Vehicle Advance Signs Benefit Older and Younger Driver Intersection Performance?

An experimental study was conducted to determine if intersection behavior of those 18 to 24 and 65+ benefited from advanced in-vehicle signs presented in a head-up display (HUD) format. The University of Calgary Driving Simulator (UCDS) was used to determine whether intersection performance improved in the presence of several advanced signs or whether unwanted adaptive behaviors occurred (e.g., increasing speed to run the light instead of stopping). Invehicle signs facilitated an increase in stopping occurrences for both younger and older drivers at intersections with relatively short yellow onsets. In addition, eye movement analysis revealed significant age effects with regard to vertical and horizontal gaze variablity, with younger drivers showing increases in vertical gaze variability compared to the older drivers. Younger drivers also looked more often and had longer percentage of durations fixating on the HUD compared to the older drivers

Depression, anxiety, pain and quality of life in people living with chronic hepatitis C: A systematic review and meta-analysis

Objectives: Individuals infected with hepatitis C virus (HCV) can develop extrahepatic conditions which may have a significant impact on life expectancy and quality of life. We conducted a systematic review to assess the causal relationship between HCV and extrahepatic conditions and the impact of HCV upon health-related quality of life of people in the UK. / Methods: HCV advocacy groups identified conditions that they thought most important to research, and the perspectives of various stakeholders informed the scope of the review. A comprehensive literature search of a range of electronic databases and websites was undertaken. Screening, quality assessment and data extraction were conducted using specialist software. The key criterion for inclusion in a synthesis was a study’s testing of the association between HCV and either quality of life or conditions specified as important by advocacy groups: depression, anxiety or painful conditions. Other criteria relating to study populations, measures and matching of study groups were also applied. Two reviewers assessed included studies, with disagreements resolved by a third reviewer where necessary. Studies were assessed for methodological quality using standardised appraisal tools. Metaanalyses were performed. Based on the consistency and sufficiency of research evidence, the findings were graded as strong, promising, tentative or inconclusive. / Results: 71 studies were included in the review’s syntheses. All studies were judged to be at a moderate or high risk of bias. Only two UK studies met our inclusion criteria. / Quality of life: Evidence from 22 studies indicates that people with HCV have worse quality of life than ‘general’ or ‘healthy’ populations; meta-analysis of nine studies indicated\ud that the physical (PCS) and mental health (MCS) domains of quality of life on the Health-Related Quality of Life Scale were both statistically and clinically worse among HCV-infected people (PCS: MD 5.54, 95% CI 3.73-7.35, MCS: MD 3.81, 95% CI 1.97-5.64). Evidence from seven included studies suggests that people co-infected with HCV and HIV have worse quality of life than individuals with HIV only; metaanalysis of five studies indicated that both the physical and mental health domains of quality of life were significantly worse among people who were co-infected (PCS: MD 2.57, 95% CI 1.08-4.06, MCS: MD 1.88, 95% CI 0.06-3.69). / Depression and anxiety: Evidence from 22 studies indicates that depression and anxiety are more severe, and depression is more common among people with HCV compared to those without it. Meta-analysis of 12 studies identified the severity of depression in people with HCV to be significantly greater than in those without HCV (Mean difference 0.98, 95% CI 0.43-1.53). Meta-analysis of nine studies identified the severity of clinical anxiety to be significantly greater among people with HCV (Mean difference 0.47, 95% CI 0.09-0.86). Meta-analysis of seven studies identified participants with HCV to be approximately three times more likely to be depressed compared to those without HCV (OR 2.77, 95% CI 1.62-4.74). No statistically significant evidence that anxiety is more common among people with HCV was found. / Pain: Evidence was appraised from 26 studies on painful conditions. A meta-analysis of four studies indicates that people with HCV are 17% more likely to suffer from arthralgia than those without HCV (RR 1.17, 95% CI 1.04-1.31). A meta-analysis of five studies suggested that people with HCV are significantly more likely to suffer from fibromyalgia; key differences across the studies in terms of the health status (co-morbidities) of HCV patients and comparison groups mean it is not possible to quantify the increased risk attributable to HCV. Other studies, including those on arthritis, were not amenable to meta-analysis. / Conclusions: Evidence suggests an association between HCV infection and depression, anxiety, fibromyalgia, arthralgia and health-related quality of life. However, the evidence was graded as ‘promising’ or ‘tentative’ rather than ‘strong’. More high-quality research on the association between HCV and these conditions is needed

Learning-by-doing as an approach to teaching social entrepreneurship

Many studies have explored the use of learning-by-doing in higher education, but few have applied this to social entrepreneurship contexts and applications: this paper addresses this gap in the literature. Our programme involved students working with different stakeholders in an interactive learning environment to generate real revenue for social enterprises. Our results show that learning-by-doing enables students to develop their entrepreneurial skills and enhance their knowledge of social businesses. The findings also show that students became more effective at working in teams and in formulating and applying appropriate business strategies for the social enterprises. Overall, the learning-by-doing approach discussed in this paper is capable of developing the entrepreneurial skills of students, but there are challenges that need to be addressed if such an approach is to be effective

Experiences with stacking the first four ATLAS submodules at Argonne

This note is to review our experience at Argonne with assembling the first four sumodules constructed at this location. We will try to cover all of the experiences, and at the end add some comments about changes that were incorporated into the current modules, and suggested changes that may be incorporated into future modules