Developments in mental health service provision: views of service users and carers

This paper reports on a study in two NHS Mental Health Trusts in England in 2008-2009. Data were collected from staff, service users and carers to inform service and workforce developments. The findings reported relate to service users and carers and concur with staff views. They relate to modernisation of services, the challenges of a multiplicity of stakeholders and organisations, as well as the need to involve users and carers in developments. The findings resonate with national and local policy with a move away from traditional psychiatric care to integrated person-centred community care with a focus on recovery, rehabilitation and self care

Uptake of the NICE osteoarthritis guidelines in primary care: a survey of older adults with joint pain

Background Osteoarthritis (OA) is a leading cause of pain and disability. NICE OA guidelines (2008) recommend that patients with OA should be offered core treatments in primary care. Assessments of OA management have identified a need to improve primary care of people with OA, as recorded use of interventions concordant with the NICE guidelines is suboptimal in primary care. The aim of this study was to i) describe the patient-reported uptake of non-pharmacological and pharmacological treatments recommended in the NICE OA guidelines in older adults with a self-reported consultation for joint pain and ii) determine whether patient characteristics or OA diagnosis impact uptake. Methods A cross-sectional survey mailed to adults aged ≥45 years (n = 28,443) from eight general practices in the UK as part of the MOSAICS study. Respondents who reported the presence of joint pain, a consultation in the previous 12 months for joint pain, and gave consent to medical record review formed the sample for this study. Results Four thousand fifty-nine respondents were included in the analysis (mean age 65.6 years (SD 11.2), 2300 (56.7%) females). 502 (12.4%) received an OA diagnosis in the previous 12 months. More participants reported using pharmacological treatments (e.g. paracetamol (31.3%), opioids (40.4%)) than non-pharmacological treatments (e.g. exercise (3.8%)). Those with an OA diagnosis were more likely to use written information (OR 1.57; 95% CI 1.26,1.96), paracetamol (OR 1.30; 95% CI 1.05,1.62) and topical NSAIDs (OR 1.30; 95% CI 1.04,1.62) than those with a joint pain code. People aged ≥75 years were less likely to use written information (OR 0.56; 95% CI 0.40,0.79) and exercise (OR 0.37; 95% CI 0.25,0.55) and more likely to use paracetamol (OR 1.91; 95% CI 1.38,2.65) than those aged < 75 years. Conclusion The cross-sectional population survey was conducted to examine the uptake of the treatments that are recommended in the NICE OA guidelines in older adults with a self-reported consultation for joint pain and to determine whether patient characteristics or OA diagnosis impact uptake. Non-pharmacological treatment was suboptimal compared to pharmacological treatment. Implementation of NICE guidelines needs to examine why non-pharmacological treatments, such as exercise, remain under-used especially among older people

The differential importance of deep and shallow seagrass to Nekton assemblages of The Great Barrier Reef

Seagrass meadows are an important habitat for a variety of animals, including ecologically and socioeconomically important species. Seagrass meadows are recognised as providing species with nursery grounds, and as a migratory pathway to adjacent habitats. Despite their recognised importance, little is known about the species assemblages that occupy seagrass meadows of different depths in the coastal zone. Understanding differences in the distribution of species in seagrass at different depths, and differences in species diversity, abundance, biomass, and size spectra, is important to fully appreciate both the ecological significance and economic importance of these seagrass meadows. Here, we assess differences in the assemblage characteristics of fish, crustacea, and cephalopods (collectively, nekton) between deep ( > 9 m; Halophila spinulosa dominant) and shallow water ( < 2 m; Halodule uninervis and/or Zostera muelleri dominant) seagrass meadows of the central Great Barrier Reef coast of Queensland, Australia. Nekton assemblage structure differed between deep and shallow seagrass. Deeper meadows were typified by juvenile emperors (e.g., Lethrinus genivittatus), hairfinned leatherjacket (Paramonacanthus japonicus) and rabbitfish (e.g., Siganus fuscescens) in both biomass per unit effort (BPUE) and catch per unit effort (CPUE), whereas shallow meadows were typified by the green tiger prawn (Penaeus semisulcatus) and pugnose ponyfish (Secutor insidiator) in both BPUE and CPUE. Both meadow depths were distinct in their nekton assemblage, particularly for socioeconomically important species, with 11 species unique to both shallow and deep meadows. However, both meadow depths also included juveniles of socioeconomically important species found in adjacent habitats as adults. The total nekton CPUE was not different between deep and shallow seagrass, but the BPUE and body mass of individual animals were greater in deep than shallow seagrass. Size spectra analysis indicated that in both deep and shallow meadows, smaller animals predominated, even more so than theoretically expected for size spectra. Our findings highlight the unique attributes of both shallow and deeper water seagrass meadows, and identify the distinct and critically important role of deep seagrass meadows within the Great Barrier Reef World Heritage Area (GBRWHA) as a habitat for small and juvenile species, including those of local fisheries value

Habitat complexity influences the structure of food webs in Great Barrier Reef seagrass meadows

Structural habitat complexity is a fundamental attribute influencing ecological food webs. Simplification of complex habitats occurs due to both natural and anthropogenic pressures that can alter productivity of food webs. Relationships between food web structure and habitat complexity may be influenced by multiple mechanisms, and untangling these can be challenging. We investigated whether (1) size spectra vary across a gradient of habitat complexity in seagrass meadows and (2) structural complexity changes the importance of different primary producers supporting the food web (determined using stable isotope analysis) in the Great Barrier Reef World Heritage Area. We found that moderately complex meadows had much steeper size spectra slopes, caused by a higher abundance of smaller animals and fewer larger animals, while meadows on either end of the complexity scale (low and a single meadow with very high complexity) had shallower slopes, indicative of a more balanced distribution of animal sizes across the spectrum. We also found that the importance of epiphytic algae as a food source was high in most meadows, despite the increase in seagrass surface area on which epiphytes could grow. The consistent importance of epiphytic algae suggests that the changes in the availability of different potential food sources did not affect food web structure. Our findings indicate that food web structure may change with variations in structural complexity because of changes in the abundance of smaller and/or larger animals. Food web structure and food sources are important determinants of the dynamic stability of food webs. Size spectra analysis is already used as a monitoring tool for assessing populations of key fisheries species in commercial fishing operations, and thus, we recommend using size spectra as a proxy for assessing the structure of the food webs in different types of seagrass meadows. Size spectra may be a useful indicator of how different meadows provide for ecosystem services such as fisheries

The Familial Clustering of Age at Menarche in Extended Twin Families

The timing of puberty is complex, possibly involving many genetic factors that may interact with environmental influences. Familial resemblance for age at menarche was studied in a sample of 4,995 female twins, 1,296 sisters, 2,946 mothers and 635 female spouses of male twins. They had indicated their age at menarche as part of a larger longitudinal survey. We assessed assortative mating for age at menarche, gene–environment interaction effects and estimated the heritability of individual differences in pubertal timing. There was significant evidence of gene–environment interaction, accounting for 1.5% of the variance. There was no indication of consistent mate assortment on age at menarche. Individual differences in age at menarche are highly heritable, with additive genetic factors explaining at least 70% of the true variation. An additional 1.5% of the variation can be explained by a genotype–environment interaction effect where environmental factors are more important in individuals genetically predisposed for late menarche

Presence of chemotherapy-induced toxicity predicts improved survival in patients with localised extremity osteosarcoma treated with doxorubicin and cisplatin: a report from the European Osteosarcoma Intergroup.

Chemotherapy-induced toxicity is an independent prognostic indicator in several cancers. We aimed to determine whether toxicity was related to survival and histological response in high-grade localised extremity osteosarcoma. We undertook a retrospective analysis of patients treated within three consecutive randomised controlled trials (RCTs) of the European Osteosarcoma Intergroup

Disabling knee pain – another consequence of obesity: Results from a prospective cohort study

BACKGROUND: Obesity is linked to knee osteoarthritis (OA) and knee pain. These are disabling problems that are more prevalent in older adults. No prospective study has estimated the impact of excess weight avoidance on the occurrence of knee pain in the general older population. The aim of this study was to investigate the influence of overweight and obesity on the onset and progression of knee pain and disability in older adults living in the community. METHODS: A prospective cohort study of people aged 50 and over registered with three general practices in North Staffordshire, UK. 5784 people who had responded to a survey in March 2000 were mailed a follow-up questionnaire in March 2003. The main outcome measures were self-reported knee pain and severe knee pain and disability at 3 years measured by the Western Ontario and McMaster Universities Osteoarthritis index. RESULTS: Adjusted response to follow-up was 75%. Among responders with no knee pain at baseline, obesity predicted onset of severe knee pain (relative risk 2.8; 95% CI 1.8, 4.5 compared to normal body mass index (BMI) category). Considering overweight and obese categories together, 19% of new cases of severe knee pain over a 3-year period could potentially be avoided by a one-category shift downwards in BMI; this includes almost half of the new cases that arose in the obese group. CONCLUSION: Obesity accounts for a substantial proportion of severe disabling knee pain. As knee pain is a common disabling condition in older adults living in the community, effective public health interventions about avoidance of excess weight could have a major impact on future lower limb disability in older adults

The INCLUDE study: INtegrating and improving Care for patients with infLammatory rheUmatological DisordErs in the community; identifying multimorbidity: Protocol for a pilot randomized controlled trial.

Background: Patients with inflammatory rheumatic conditions such as rheumatoid arthritis, polymyalgia rheumatica and ankylosing spondylitis are at increased risk of common comorbidities such as cardiovascular disease, osteoporosis and anxiety and depression which lead to increased morbidity and mortality. These associated morbidities are often un-recognized and under-treated. While patients with other long-term conditions such as diabetes are invited for routine reviews in primary care, which may include identification and management of co-morbidities, at present this does not occur for patients with inflammatory conditions, and thus, opportunities to diagnose and optimally manage these comorbidities are missed. Objective: To evaluate the feasibility and acceptability of a nurse-led integrated care review (the INtegrating and improving Care for patients with infLammatory rheUmatological DisordErs in the community (INCLUDE) review) for people with inflammatory rheumatological conditions in primary care. Design: A pilot cluster randomized controlled trial will be undertaken to test the feasibility and acceptability of a nurse-led integrated primary care review for identification, assessment and initial management of common comorbidities including cardiovascular disease, osteoporosis and anxiety and depression. A process evaluation will be undertaken using a mixed methods approach including participant self-reported questionnaires, a medical record review, an INCLUDE EMIS template, intervention fidelity checking using audio-recordings of the INCLUDE review consultation and qualitative interviews with patient participants, study nurses and study general practitioners (GPs). Discussion: Success of the pilot study will be measured against the engagement, recruitment and study retention rates of both general practices and participants. Acceptability of the INCLUDE review to patients and practitioners and treatment fidelity will be explored using a parallel process evaluation. Trial Registration: ISRCTN12765345

Designing a primary care pharmacist-led review for people treated with opioids for persistent pain: a multi-method qualitative study.

oai:repository.canterbury.ac.uk:97w90Opioids are frequently prescribed for persistent non-cancer pain despite limited evidence of long-term effectiveness and risk of harm. Evidence-based interventions to address inappropriate opioid prescribing are lacking. To explore perspectives of people living with persistent pain to understand barriers and facilitators in reducing opioids in the context of a pharmacist-led primary care review, and identify review components and features for optimal delivery. Primary care multi-method qualitative study. Adults with experience of persistent pain and taking opioids participated in semi-structured interviews (n=15, 73% female) and an online discussion forum (n=31). The Theoretical Domains Framework (TDF) provided a framework for data collection and thematic analysis, involving deductive analysis to TDF domains, inductive analysis within-domains to generate subthemes, and subtheme comparison to form across-domain overarching themes. The behaviour change technique taxonomy v.1 and motivational behaviour change technique classification system were used to systematically map themes to behaviour change techniques to identify potential review components and delivery features. 32 facilitator and barrier subthemes for patients reducing opioids were identified across 13 TDF domains. These combined into six overarching themes: learning to live with pain, opioid reduction expectations, assuming a medical model, pharmacist-delivered reviews, pharmacist-patient relationship and patient engagement. Subthemes mapped to 21 unique behaviour change techniques, yielding 17 components and five delivery features for the proposed PROMPPT review. This study generated theoretically-informed evidence for design of a practice pharmacist-led PROMPPT review. Future research will test the feasibility and acceptability of the PROMPPT review and pharmacist training. [Abstract copyright: Copyright © 2024, The Authors.