It's what you do and where you do it: perceived similarity in household water saving behaviours

In the face of continued environmental degradation, policy makers need to accelerate public uptake of pro-environmental behaviours. Promoting behaviours which catalyse the adoption of other similar behaviours through the spillover effect has been proposed as a potential solution. This requires understanding which behaviours are seen as similar and what criteria are used to identify behavioural similarity. We used a sorting procedure with 32 householders in Melbourne, Australia, to investigate the perceived similarity of household water conservation behaviours and identify the underlying constructs used to distinguish between similar and dissimilar behaviours. Location was the primary attribute used to define behavioural similarity, specifically whether behaviours took place indoors or outdoors. Participants also distinguished between curtailment, efficiency and maintenance-type behaviours. Our findings provide empirical support for existing theoretical behaviour taxonomies. The results could inform design of future water-saving campaigns to promote catalytic behaviours, by leveraging off similar, existing behaviours for effective behaviour change results

Process evaluation of a peer-led antenatal breastfeeding class for fathers: perceptions of facilitators and participants

Background: The Parent Infant Feeding Initiative (PIFI) was a factorial, randomised controlled trial that aimed to prolong exclusive breastfeeding by targeting expecting fathers. One of the intervention strategies evaluated was a father-focused breastfeeding class facilitated by a male peer facilitator. The aim of this mixed-methods descriptive study was to 1) evaluate the feedback provided from participants of the class and 2) explore the motivations and experiences of volunteer male peer facilitators trained to deliver the class. Methods: Father-focused breastfeeding antenatal (FFAB) classes were conducted in six Western Australian hospitals between August 2015 and December 2016. Following each peer facilitated FFAB class, expecting father participants completed an evaluation form to assess their satisfaction with the format, facilitation and content, in addition to whether their expectations and confidence to manage breastfeeding problems had changed. Feedback to open-ended questions was analysed using content analysis to identify learnings and suggestions for improvements. At the completion of PIFI, individual telephone interviews were undertaken with 14 peer facilitators to gain insight into their motivations for volunteering and experiences of conducting the classes. Transcripts from interviews were analysed using Braun and Clarke’s six phases for thematic analysis. Results: Participant evaluation forms were completed by 678 of the 697 father participants (98%). Overall satisfaction with class format, facilitation and content was high with 90% or more of fathers either strongly agreeing or agreeing with each positively-phrased evaluation item. Class participants enjoyed interacting with other fathers, appreciated validation of their role, were not always aware of the importance of breastfeeding or potential difficulties, valued the anticipatory guidance around what to expect in the early weeks of parenting and appreciated learning practical breastfeeding support strategies. Peer facilitators indicated they felt well prepared and supported to conduct FFAB classes. Analysis of interview transcripts revealed common experiences of the peer facilitators incorporating four themes: ‘Highlights of being a facilitator’, ‘Challenges’, ‘Mourning the project completion’ and ‘Satisfaction with training and support’. Conclusion: Father-focused breastfeeding classes supported by volunteer male peer facilitators are a feasible and acceptable way of engaging fathers as breastfeeding supporters. Trial registration: ACTRN12614000605695. Registered 6 June 2014

Drug interventions for the treatment of obesity in children and adolescents

BACKGROUND: Child and adolescent obesity has increased globally, and can be associated with significant short- and long-term health consequences. OBJECTIVES: To assess the efficacy of drug interventions for the treatment of obesity in children and adolescents. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, PubMed (subsets not available on Ovid), LILACS as well as the trial registers ICTRP (WHO) and ClinicalTrials.gov. Searches were undertaken from inception to March 2016. We checked references and applied no language restrictions. SELECTION CRITERIA: We selected randomised controlled trials (RCTs) of pharmacological interventions for treating obesity (licensed and unlicensed for this indication) in children and adolescents (mean age under 18 years) with or without support of family members, with a minimum of three months' pharmacological intervention and six months' follow-up from baseline. We excluded interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or included participants with a secondary or syndromic cause of obesity. In addition, we excluded trials which included growth hormone therapies and pregnant participants. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted data following standard Cochrane methodology. Where necessary we contacted authors for additional information. MAIN RESULTS: We included 21 trials and identified eight ongoing trials. The included trials evaluated metformin (11 trials), sibutramine (six trials), orlistat (four trials), and one trial arm investigated the combination of metformin and fluoxetine. The ongoing trials evaluated metformin (four trials), topiramate (two trials) and exenatide (two trials). A total of 2484 people participated in the included trials, 1478 participants were randomised to drug intervention and 904 to comparator groups (91 participants took part in two cross-over trials; 11 participants not specified). Eighteen trials used a placebo in the comparator group. Two trials had a cross-over design while the remaining 19 trials were parallel RCTs. The length of the intervention period ranged from 12 weeks to 48 weeks, and the length of follow-up from baseline ranged from six months to 100 weeks.Trials generally had a low risk of bias for random sequence generation, allocation concealment and blinding (participants, personnel and assessors) for subjective and objective outcomes. We judged approximately half of the trials as having a high risk of bias in one or more domain such as selective reporting.The primary outcomes of this review were change in body mass index (BMI), change in weight and adverse events. All 21 trials measured these outcomes. The secondary outcomes were health-related quality of life (only one trial reported results showing no marked differences; very low certainty evidence), body fat distribution (measured in 18 trials), behaviour change (measured in six trials), participants' views of the intervention (not reported), morbidity associated with the intervention (measured in one orlistat trial only reporting more new gallstones following the intervention; very low certainty evidence), all-cause mortality (one suicide in the orlistat intervention group; low certainty evidence) and socioeconomic effects (not reported).Intervention versus comparator for mean difference (MD) in BMI change was -1.3 kg/m(2) (95% confidence interval (CI) -1.9 to -0.8; P < 0.00001; 16 trials; 1884 participants; low certainty evidence). When split by drug type, sibutramine, metformin and orlistat all showed reductions in BMI in favour of the intervention.Intervention versus comparator for change in weight showed a MD of -3.9 kg (95% CI -5.9 to -1.9; P < 0.00001; 11 trials; 1180 participants; low certainty evidence). As with BMI, when the trials were split by drug type, sibutramine, metformin and orlistat all showed reductions in weight in favour of the intervention.Five trials reported serious adverse events: 24/878 (2.7%) participants in the intervention groups versus 8/469 (1.7%) participants in the comparator groups (risk ratio (RR) 1.43, 95% CI 0.63 to 3.25; 1347 participants; low certainty evidence). A total 52/1043 (5.0%) participants in the intervention groups versus 17/621 (2.7%) in the comparator groups discontinued the trial because of adverse events (RR 1.45, 95% CI 0.83 to 2.52; 10 trials; 1664 participants; low certainty evidence). The most common adverse events in orlistat and metformin trials were gastrointestinal (such as diarrhoea, mild abdominal pain or discomfort, fatty stools). The most frequent adverse events in sibutramine trials included tachycardia, constipation and hypertension. The single fluoxetine trial reported dry mouth and loose stools. No trial investigated drug treatment for overweight children. AUTHORS' CONCLUSIONS: This systematic review is part of a series of associated Cochrane reviews on interventions for obese children and adolescents and has shown that pharmacological interventions (metformin, sibutramine, orlistat and fluoxetine) may have small effects in reduction in BMI and bodyweight in obese children and adolescents. However, many of these drugs are not licensed for the treatment of obesity in children and adolescents, or have been withdrawn. Trials were generally of low quality with many having a short or no post-intervention follow-up period and high dropout rates (overall dropout of 25%). Future research should focus on conducting trials with sufficient power and long-term follow-up, to ensure the long-term effects of any pharmacological intervention are comprehensively assessed. Adverse events should be reported in a more standardised manner specifying amongst other things the number of participants experiencing at least one adverse event. The requirement of regulatory authorities (US Food and Drug Administration and European Medicines Agency) for trials of all new medications to be used in children and adolescents should drive an increase in the number of high quality trials

Glastir Monitoring & Evaluation Programme. Second year annual report

What is the purpose of Glastir Monitoring and Evaluation Programme? Glastir is the main scheme by which the Welsh Government pays for environmental goods and services whilst the Glastir Monitoring and Evaluation Programme (GMEP) evaluates the scheme’s success. Commissioning of the monitoring programme in parallel with the launch of the Glastir scheme provides fast feedback and means payments can be modified to increase effectiveness. The Glastir scheme is jointly funded by the Welsh Government (through the Rural Development Plan) and the EU. GMEP will also support a wide range of other national and international reporting requirements. What is the GMEP approach? GMEP collects evidence for the 6 intended outcomes from the Glastir scheme which are focussed on climate change, water and soil quality, biodiversity, landscape, access and historic environment, woodland creation and management. Activities include; a national rolling monitoring programme of 1km squares; new analysis of long term data from other schemes combining with GMEP data where possible; modelling to estimate future outcomes so that adjustments can be made to maximise impact of payments; surveys to assess wider socio-economic benefits; and development of novel technologies to increase detection and efficiency of future assessments. How has GMEP progressed in this 2nd year? 90 GMEP squares were surveyed in Year 2 to add to the 60 completed in Year 1 resulting in 50% of the 300 GMEP survey squares now being completed. Squares will be revisited on a 4 year cycle providing evidence of change in response to Glastir and other pressures such as changing economics of the farm business, climate change and air pollution. This first survey cycle collects the baseline against which future changes will be assessed. This is important as GMEP work this year has demonstrated land coming into the scheme is different in some respects to land outside the scheme. Therefore, future analysis to detect impact of Glastir will be made both against the national backdrop from land outside the scheme and this baseline data from land in scheme. A wide range of analyses of longterm data has been completed for all Glastir Outcomes with the exception of landscape quality and historic features condition for which limited data is available. This has involved combining data with 2013/14 GMEP data when methods allow. Overall analysis of long term data indicates one of stability but with little evidence of improvement with the exception of headwater quality, greenhouse gas emissions and woodland area for which there has been improvement over the last 20 years. Some headline statistics include: 51% of historic features in excellent or sound condition; two thirds of public rights of way fully open and accessible; improvement in hedgerow management with 85% surveyed cut in the last 3 years but < 1% recently planted; 91% of streams had some level of modification but 60% retained good ecological quality; no change topsoil carbon content over last 25 years. What is innovative? GMEP has developed various new metrics to allow for more streamlined reporting in the future. For example a new Priority Bird species Index for Wales which combines data from 35 species indicates at least half have stable or increasing populations. The new GMEP Visual Quality Landscape Index has been tested involving over 2600 respondents. Results have demonstrated its value as an objective and repeatable method for quantifying change in visual landscape quality. A new unified peat map for Wales has been developed which has been passed to Glastir Contract Managers to improve targeting of payments when negotiating Glastir contracts. An estimate of peat soil contribution to current greenhouse gas emissions due to human modification has been calculated. Models have allowed quantification of land area helping to mitigate rainfall runoff. We are using new molecular tools to explore the effects of Glastir on soil organisms and satellite technologies to quantify e.g. small woody features and landcover change. Finally we are using a community approach to develop a consensus on how to define and report change in High Nature Value Farmland which will be reported in the Year 3 GMEP report

Glastir Monitoring & Evaluation Programme. Final report

Final Report to Welsh Government, prepared by CEH on behalf of the Glastir Monitoring & Evaluation Programme Team. The Glastir Monitoring and Evaluation Programme (GMEP) provides a comprehensive programme to establish a baseline against which future assessments of Glastir can be made. GMEP also contributes national trend data which supports a range of national and international biodiversity and environmental targets. GMEP fulfils a commitment by the Welsh Government to establish a monitoring programme concurrently with the launch of the Glastir scheme. The use of models and farmer surveys provides early indicators of the likely direction, magnitude and timing of future outcomes. The programme ensures compliance with the rigorous requirements of the European Commission’s Common Monitoring and Evaluation Framework (CMEF) through the Rural Development Plan (RDP) for Wales. This report represents the final results of the GMEP programme which ran from 2012 to 2016

Environmental quality standards for trace metals in the aquatic environment

The scientific basis for the regulation of metals that are potentially toxic to aquatic life is widely debated, especially with respect to bioavailability. Environmetal Quality Standards (EQSs) based on total metal concentrations and laboratory toxicity data for conditions unrepresentative of field situations, may both underprotect and overprotect. The setting of EQSs could be informed by knowledge about dose-response relationships in the field. The work described in this report was performed to attempt to establish dose-response relationships for macroinvertebrates and diatoms in streamwaters contaminated to different extents with trace metals (nickel, copper, zinc, cadmium, lead). Different possible variables were used to express metal concentrations and bioavailability. The results obtained were then used to evaluate different approaches to EQS setting. We carried out field studies of the ecology and chemistry of upland streams, influenced by past mining activity. We conducted field sampling and performed analyses at carefully-chosen field sites, and analysed the data to attempt to establish quantitative relationships between the chemical and ecological variables. The chosen sites were perceived to have several advantages, notably similarity in their physical characteristics, appreciable ranges of water and metal chemistries, and the absence of other pollutants. Therefore they made it possible to explore the effects of differences in streamwater chemistry on ecological response, with few confounding factors. The ecological part of the field work was conducted in Spring 2006, and comprised sampling and enumeration of benthic invertebrates and diatoms. Chemical characterisation of the streamwaters was achieved by repeated sampling during the 6 weeks before the ecological fieldwork. As well as carrying out conventional chemical analyses, we also used analytical speciation techniques (Diffusive Gradients in Thin films, DGT, and the Donnan Membrane Technique, DMT), and applied the WHAM chemical speciation model to calculate free metal ion activities and other variables. We collected separate samples of key invertebrate taxa and analysed them for metal body burdens, and we collected samples of stream bryophytes and analysed them for metals. In another supporting study, we collected water samples from the study sites and used them in laboratory toxicity experiments with an algal and a daphnid species. We carried out a literature review of metal mixture effects, to aid interpretation of field data from those sites (the majority) where more than one metal may exert a toxic effect. We also reviewed methods for setting EQSs. The chemical compositions of the study streams covered appreciable ranges of acidity, alkalinity, total ionic concentration and DOC concentration. The nutrient concentrations were sufficiently low for there to be negligible effects on either macroinvertebrates or diatoms. Suspended particulate matter concentrations were in the range 0 - 50 mg l-1. As expected because of the historical mining activities, most of the streamwaters were contaminated with trace metals, at levels exceeding EQS values. The study sites included several acid streamwaters, some of which were contaminated with trace metals, but all of which had high levels of aluminium. The results of DGT and DMT measurements, and of chemical speciation calculations, indicated that zinc and cadmium are present largely in inorganic forms in the streamwaters, whereas there was appreciable organic complexation of aluminium, copper and lead, and to a lesser extent nickel. The metal contents of both bryophytes and macroinvertebrates varied considerably with streamwater chemistry. The metal contents of both types of organism were approximately predictable using chemical speciation concepts, which is direct evidence that biota respond to the chemistry of the medium. Analysis of the relationships between ecological and chemical variables, and of the results of the laboratory toxicity measurements, led to the following conclusions. 1. Toxic metals were demonstrated to reduce species numbers of both macroinvertebrates and diatoms in the field. 2. Laboratory tests confirmed that 8 of the streamwaters in which field effects were observed contained metals at toxic concentrations. 3. The macroinvertebrate community provides an effective and sensitive tool for detecting metal toxicity. In the study sites, toxicity could be attributed definitely to Al and Zn, and there was some evidence of toxic effects due to H+ and Cu. 4. For diatoms, which were less sensitive than macroinvertebrates, the most likely toxicant was zinc, but cadmium may also have been active. 5. A function combining free metal ion concentrations and pH provided the best solution-based measure of metal toxicity towards macroinvertebrates, because it accounted best for aluminium effects. 6. Toxicity towards diatoms was expressed best, in terms of solution concentrations, by either total dissolved metal concentration or the metal concentration measured by DGT. 7. The field data permitted the formulation and partial parameterisation of the Toxicity Binding Model (TBM), which is based on Biotic Ligand Model principles, but applicable to mixtures of metals. The model permits clear toxicity thresholds to be identified, and quantifies the contributions of different metals to the overall toxicity. 8. Because of the dominant effect of zinc, among the trace metals, the available data did not permit conclusions to be drawn about the effect of chemical speciation on copper or lead toxicity. However, the finding that aluminium effects are best expressed in terms of the free ion, and the promising results from the TBM, imply that speciation-based measures provide the best way to describe the toxic effects of metals in the field. We considered the implications of the results of this work in the assessment and setting of Environmental Quality Standards for metals in freshwaters. The following points can be made. A. The results of the present study add significant weight to the use of bioavailability and chemical speciation in deriving EQSs. B. A full assessment of the effects of toxic metals in contemporary waters requires knowledge about past “pristine” conditions. In the contaminated streamwaters of the present study, dissolved concentrations of trace metals were considerably higher (by 10 to 1000 times) than those estimated for similar uncontaminated sites under pristine conditions. As well as solution concentrations, calculated loadings of biotic ligands with toxic metals can be compared, and when this is done with the TBM it appears that at present-day uncontaminated sites the loadings can be substantial, not much lower than threshold values. C. If bioavailability and chemical speciation are to be used in EQS setting, the biotic ligand approach is currently the best way forward. Although its application relies on calculations, the chemical speciation results can be tested with in situ analytical devices (DGT and DMT), lending robustness to the method. D. There may be regulatory advantages to confining EQS setting to individual metals. However, the results of the present study suggest a significant role of “natural” Al in field toxicity, and this implies that the issue of mixtures should be addressed. This can be done using biotic ligand concepts. E. By showing that metal toxicity operates in the field, with dose-response relationships, and in line with bioavailability and chemical speciation concepts, the study provides support for metals regulation through EQSs. It further shows that targeted fieldwork can provide the information necessary for EQS evaluation and modification