Clustering of attitudes towards obesity: a mixed methods study of Australian parents and children

BACKGROUND: Current population-based anti-obesity campaigns often target individuals based on either weight or socio-demographic characteristics, and give a \u27mass\u27 message about personal responsibility. There is a recognition that attempts to influence attitudes and opinions may be more effective if they resonate with the beliefs that different groups have about the causes of, and solutions for, obesity. Limited research has explored how attitudinal factors may inform the development of both upstream and downstream social marketing initiatives. METHODS: Computer-assisted face-to-face interviews were conducted with 159 parents and 184 of their children (aged 9-18 years old) in two Australian states. A mixed methods approach was used to assess attitudes towards obesity, and elucidate why different groups held various attitudes towards obesity. Participants were quantitatively assessed on eight dimensions relating to the severity and extent, causes and responsibility, possible remedies, and messaging strategies. Cluster analysis was used to determine attitudinal clusters. Participants were also able to qualify each answer. Qualitative responses were analysed both within and across attitudinal clusters using a constant comparative method. RESULTS: Three clusters were identified. Concerned Internalisers (27% of the sample) judged that obesity was a serious health problem, that Australia had among the highest levels of obesity in the world and that prevalence was rapidly increasing. They situated the causes and remedies for the obesity crisis in individual choices. Concerned Externalisers (38% of the sample) held similar views about the severity and extent of the obesity crisis. However, they saw responsibility and remedies as a societal rather than an individual issue. The final cluster, the Moderates, which contained significantly more children and males, believed that obesity was not such an important public health issue, and judged the extent of obesity to be less extreme than the other clusters. CONCLUSION: Attitudinal clusters provide new information and insights which may be useful in tailoring anti-obesity social marketing initiatives

Recruiting pregnant smokers for a placebo-randomised controlled trial of nicotine replacement therapy

BACKGROUND: Smoking in pregnancy is a public health problem and effective methods for reducing this are required. Although nicotine replacement therapy (NRT) is effective for smoking cessation in non-pregnant people, there is no direct evidence concerning its effectiveness in pregnancy. Despite this, clinical guidelines recommend the cautious use of NRT during pregnancy. Randomised controlled trials are needed to determine the safety and efficacy of NRT when used by pregnant women for smoking cessation, but the feasibility of recruiting women to such trials is unknown. Consequently, in this study we aimed to determine i) the feasibility of recruiting women to a RCT of NRT in pregnancy as they attend hospital antenatal ultrasound examinations, ii) the proportion of such women who are eligible for and interested in trial enrolment and iii) research staff perceptions of how one method of trial recruitment could be improved. METHODS: During a one month period, all women attending for antenatal ultrasound examination in an English teaching hospital were asked to complete a questionnaire which determined their eligibility to enrol in a proposed placebo controlled randomised trial investigating the effectiveness of NRT in pregnancy. Women who were eligible to participate were asked whether they would do so and those who accepted enrolment were offered an appointment with a smoking cessation advisor. RESULTS: Over 99% (851/858) of women agreed to complete a questionnaire about smoking habits whilst waiting for ultrasound examinations. 10.3% (88/851) of women attending for antenatal ultrasound fitted eligibility criteria for a proposed RCT of NRT in pregnancy, but only 3.6% [(31/851), 95% CI, 2.4 to 4.9%] indicated on the questionnaire that they would like to take part in a study involving randomisation to placebo or active patches. Researchers offered trial enrolment to 26 of these 31 women and 96% (25) accepted. Staff recruiting women believed that trial recruitment would be maximised if women attending the ultrasound department knew about trial recruitment before attending and greater staff resources were made available for this. It was also perceived that women generally under-reported the amount they smoked on questionnaires completed whilst waiting in ultrasound department areas. CONCLUSIONS: It is feasible to recruit women for a trial of NRT in pregnancy as they wait for antenatal ultrasound examinations. Using similar recruitment methods, researchers can expect to recruit between 24 and 49 women per 1000 approached

D&T making a difference in black ethnic minority education: the Sheffield LEA ICSYS partnership

An innovative interpretation of the Inequality Challenge for South Yorkshire Schools (ICSYS) project by Sheffield LEA has resulted in a partnership between the LEA, local schools and Sheffield Hallam University (SHU). The aim of the project is to provide black ethnic minority (BEM) pupils with a high quality Design and Technology (D&T) experience, which promotes career opportunities in the field of contemporary manufacturing and engineering. To achieve this aim computer aided design and manufacturing (CAD/CAM), acknowledged as a highly motivating aspect of the modern D&T curriculum, has been selected as the vehicle for the teaching and learning experiences that the pupils will be exposed to. The project is funded by Objective 1 European Social Funding via the Learning and Skills Council. To achieve the aim the project incorporated the following elements: • DATA accredited CAD/CAM INSET in Speedstep and Artcam for teachers in participating schools. • A programme of pupil visits to manufacturing industry where the focus was on applications of CAD/CAM processes in ‘high tech’ industry. • CAD/CAM workshops for pupils in the university where they participated in small group activities led by D&T initial teacher education (ITE) students. • The development of innovative CAD/CAM projects with the aim of encouraging BEM pupils to consider careers in ‘high tech’ manufacturing. • Opportunities for BEM pupils to gain experience of ‘university life’. • Follow up CAD/CAM teaching in schools by university staff. • Opportunities for pupils to develop their presentation skills. Initial research drawn from industrial sources highlighted the need for increasing the supply of engineers, particularly in South Yorkshire, and called for further educational initiatives. Research of national data confirmed the LEA’s view that engineering and manufacturing were not strong career aspirations for BEM pupils. Further research with BEM pupils confirmed this. During the ICSYS experience pupils’ views of manufacturing, particularly the ‘high tech.’ aspect represented by CAD/CAM were monitored by questionnaires. Triangulation of the research was by an independent evaluation using semi-structured interview techniques. The paper concludes with details of the extent to which pupils attitudes can be changed by this type of positive intervention. Additionally, it details those areas of the project which have been particularly successful so providing helpful information to both present and future D&T teachers whose groups include BEM pupils

The potential to improve ascertainment and intervention to reduce smoking in Primary Care: a cross sectional survey

<p>Abstract</p> <p>Background</p> <p>Well established clinical guidelines recommend that systematic ascertainment of smoking status and intervention to promote cessation in all smokers should be a fundamental component of all health care provision. This study aims to establish the completeness and accuracy of smoking status recording in patients' primary care medical records and the level of interest in receiving smoking cessation support amongst primary care patients in an inner city UK population.</p> <p>Methods</p> <p>Postal questionnaires were sent to all patients aged over 18 from 24 general practices in Nottingham UK who were registered as smokers or had no smoking status recorded in their medical notes.</p> <p>Results</p> <p>The proportion of patients with a smoking status recorded varied between practices from 42.4% to 100% (median 90%). Of the recorded smokers who responded to our questionnaire (35.5% of the total), a median of 20.3% reported that they had not smoked cigarettes or tobacco in the last 12 months. Of respondents with no recorded smoking status, 29.8% reported themselves to be current smokers. Of the 6856 responding individuals thus identified as current smokers, 41.4% indicated that they would like to speak to a specialist smoking adviser to help them stop smoking. This proportion increased with socioeconomic disadvantage (measured by the Townsend Index) from 39.1% in the least deprived to 44.6% in the most deprived quintile.</p> <p>Conclusion</p> <p>Whilst in many practices the ascertainment of smoking status is incomplete and/or inaccurate, failure to intervene appropriately on known status still remains the biggest challenge.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN71514078.</p

Long-term effectiveness and cost-effectiveness of cognitive behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depression in primary care: follow-up of the CoBalT randomised controlled trial

Background: Cognitive behavioural therapy (CBT) is an effective treatment for people whose depression has not responded to antidepressants. However, the long-term outcome is unknown. In a long-term follow-up of the CoBalT trial, we examined the clinical and cost-effectiveness of cognitive behavioural therapy as an adjunct to usual care that included medication over 3–5 years in primary care patients with treatment-resistant depression. Methods: CoBalT was a randomised controlled trial done across 73 general practices in three UK centres. CoBalT recruited patients aged 18–75 years who had adhered to antidepressants for at least 6 weeks and had substantial depressive symptoms (Beck Depression Inventory [BDI-II] score ≥14 and met ICD-10 depression criteria). Participants were randomly assigned using a computer generated code, to receive either usual care or CBT in addition to usual care. Patients eligible for the long-term follow-up were those who had not withdrawn by the 12 month follow-up and had given their consent to being re-contacted. Those willing to participate were asked to return the postal questionnaire to the research team. One postal reminder was sent and non-responders were contacted by telephone to complete a brief questionnaire. Data were also collected from general practitioner notes. Follow-up took place at a variable interval after randomisation (3–5 years). The primary outcome was self-report of depressive symptoms assessed by BDI-II score (range 0–63), analysed by intention to treat. Cost-utility analysis compared health and social care costs with quality-adjusted life-years (QALYs). This study is registered with isrctn.com, number ISRCTN38231611. Findings: Between Nov 4, 2008, and Sept 30, 2010, 469 eligible participants were randomised into the CoBalT study. Of these, 248 individuals completed a long-term follow-up questionnaire and provided data for the primary outcome (136 in the intervention group vs 112 in the usual care group). At follow-up (median 45·5 months [IQR 42·5–51·1]), the intervention group had a mean BDI-II score of 19·2 (SD 13·8) compared with a mean BDI-II score of 23·4 (SD 13·2) for the usual care group (repeated measures analysis over the 46 months: difference in means −4·7 [95% CI −6·4 to −3·0, p&lt;0·001]). Follow-up was, on average, 40 months after therapy ended. The average annual cost of trial CBT per participant was £343 (SD 129). The incremental cost-effectiveness ratio was £5374 per QALY gain. This represented a 92% probability of being cost effective at the National Institute for Health and Care Excellence QALY threshold of £20 000. Interpretation: CBT as an adjunct to usual care that includes antidepressants is clinically effective and cost effective over the long-term for individuals whose depression has not responded to pharmacotherapy. In view of this robust evidence of long-term effectiveness and the fact that the intervention represented good value-for-money, clinicians should discuss referral for CBT with all those for whom antidepressants are not effective

A randomised controlled trial of a complex intervention to reduce children’s exposure to secondhand smoke in the home

Objectives: Exposing children to secondhand tobacco smoke (SHS) causes significant harm and occurs predominantly through smoking by caregivers in the family home. We report a trial of a complex intervention designed to reduce secondhand smoke exposure of children whose primary caregiver feels unable or unwilling to quit smoking. Design: An open-label, parallel, randomised controlled trial. Setting: Deprived communities in Nottingham City and County, England Participants: Caregivers resident in Nottingham City and County in England who were at least 18 years old, the main caregiver of a child aged under 5 years living in their household, and reported that they were smoking tobacco inside their home. Interventions: We compared a complex intervention combining personalised feedback on home air quality, behavioural support and nicotine replacement therapy for temporary abstinence with usual care. Main outcomes: The primary outcome was change in air quality in the home, measured as average 16–24 hours levels of particulate matter of <2.5 µm diameter (PM2.5), between baseline and 12 weeks. Secondary outcomes included changes in maximum PM2.5, proportion of time PM2.5 exceeded WHO recommended levels of maximum exposure of 25 µg/mg3, child salivary cotinine, caregivers’ cigarette consumption, nicotine dependence, determination to stop smoking, quit attempts and quitting altogether during the intervention. Results: Geometric mean PM2.5 decreased significantly more (by 35.2%; 95% CI 12.7% to 51.9%) in intervention than in usual care households, as did the proportion of time PM2.5 exceeded 25 µg/mg3, child salivary cotinine concentrations, caregivers’ cigarette consumption in the home, nicotine dependence, determination to quit and likelihood of having made a quit attempt. Conclusions: By reducing exposure to SHS in the homes of children who live with smokers unable or unwilling to quit, this intervention offers huge potential to reduce children’s’ tobacco-related harm. Trial registration number ISRCTN81701383. This trial was funded by the UK National Institute for Health Research (NIHR): RP-PG-0608-10020 http://dx.doi.org/10.1136/tobaccocontrol-2016-05327

Evaluating the impact of atmospheric forcing and air–sea coupling on near-coastal regional ocean prediction

Atmospheric forcing applied as ocean model boundary conditions can have a critical impact on the quality of ocean forecasts. This paper assesses the sensitivity of an eddy-resolving (1.5 km resolution) regional ocean model of the north-west European Shelf (NWS) to the choice of atmospheric forcing and atmosphere–ocean coupling. The analysis is focused on a month-long simulation experiment for July 2014 and evaluation of simulated sea surface temperature (SST) in a shallow near-coastal region to the south-west of the UK (Celtic Sea and western English Channel). Observations of the ocean and atmosphere are used to evaluate model results, with a particular focus on the L4 ocean buoy from the Western Channel Observatory as a rare example of co-located data above and below the sea surface. The impacts of differences in the atmospheric forcing are illustrated by comparing results from an ocean model run in forcing mode using operational global-scale numerical weather prediction (NWP) data with an ocean model run forced by a convective-scale regional atmosphere model. The value of dynamically representing feedbacks between the atmosphere and ocean state is assessed via the use of these model components within a fully coupled ocean–wave–atmosphere system. Simulated SSTs show considerable sensitivity to atmospheric forcing and to the impact of model coupling in near-coastal areas. A warm ocean bias relative to in situ observations in the simulation forced by global-scale NWP (0.7 K in the model domain) is shown to be reduced (to 0.4 K) via the use of the 1.5 km resolution regional atmospheric forcing. When simulated in coupled mode, this bias is further reduced (by 0.2 K). Results demonstrate much greater variability of both the surface heat budget terms and the near-surface winds in the convective-scale atmosphere model data, as might be expected. Assessment of the surface heat budget and wind forcing over the ocean is challenging due to a scarcity of observations. However, it can be demonstrated that the wind speed over the ocean simulated by the convective-scale atmosphere did not agree as well with the limited number of observations as the global-scale NWP data did. Further partially coupled experiments are discussed to better understand why the degraded wind forcing does not detrimentally impact on SST results

Clinical effectiveness and cost-effectiveness of cognitive behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depression in primary care: the CoBalT randomised controlled trial

Background: Only one-third of patients with depression respond fully to treatment with antidepressant medication. However, there is little robust evidence to guide the management of those whose symptoms are 'treatment resistant'.&lt;p&gt;&lt;/p&gt; Objective: The CoBalT trial examined the clinical effectiveness and cost-effectiveness of cognitive behavioural therapy (CBT) as an adjunct to usual care (including pharmacotherapy) for primary care patients with treatment-resistant depression (TRD) compared with usual care alone.&lt;p&gt;&lt;/p&gt; Design: Pragmatic, multicentre individually randomised controlled trial with follow-up at 3, 6, 9 and 12 months. A subset took part in a qualitative study investigating views and experiences of CBT, reasons for completing/not completing therapy, and usual care for TRD.&lt;p&gt;&lt;/p&gt; Setting: General practices in Bristol, Exeter and Glasgow, and surrounding areas.&lt;p&gt;&lt;/p&gt; Participants: Patients aged 18-75 years who had TRD [on antidepressants for 6 weeks, had adhered to medication, Beck Depression Inventory, 2nd version (BDI-II) score of 14 and fulfilled the International Classification of Diseases and Related Health Problems, Tenth edition criteria for depression]. Individuals were excluded who (1) had bipolar disorder/psychosis or major alcohol/substance abuse problems; (2) were unable to complete the questionnaires; or (3) were pregnant, as were those currently receiving CBT/other psychotherapy/secondary care for depression, or who had received CBT in the past 3 years.&lt;p&gt;&lt;/p&gt; Interventions: Participants were randomised, using a computer-generated code, to usual care or CBT (12-18 sessions) in addition to usual care.&lt;p&gt;&lt;/p&gt; Main outcome measures: The primary outcome was 'response', defined as 50% reduction in depressive symptoms (BDI-II score) at 6 months compared with baseline. Secondary outcomes included BDI-II score as a continuous variable, remission of symptoms (BDI-II score of &lt; 10), quality of life, anxiety and antidepressant use at 6 and 12 months. Data on health and social care use, personal costs, and time off work were collected at 6 and 12 months. Costs from these three perspectives were reported using a cost-consequence analysis. A cost-utility analysis compared health and social care costs with quality adjusted life-years.&lt;p&gt;&lt;/p&gt; Results: A total of 469 patients were randomised (intervention: n = 234; usual care: n = 235), with 422 participants (90%) and 396 (84%) followed up at 6 and 12 months. Ninety-five participants (46.1%) in the intervention group met criteria for 'response' at 6 months compared with 46 (21.6%) in the usual-care group {odds ratio [OR] 3.26 [95% confidence interval (CI) 2.10 to 5.06], p &lt; 0.001}. In repeated measures analyses using data from 6 and 12 months, the OR for 'response' was 2.89 (95% CI 2.03 to 4.10, p &lt; 0.001) and for a secondary 'remission' outcome (BDI-II score of &lt; 10) 2.74 (95% CI 1.82 to 4.13, p &lt; 0.001). The mean cost of CBT per participant was £910, the incremental health and social care cost £850, the incremental QALY gain 0.057 and incremental cost-effectiveness ratio £14,911. Forty participants were interviewed. Patients described CBT as challenging but helping them to manage their depression; listed social, emotional and practical reasons for not completing treatment; and described usual care as mainly taking medication.&lt;p&gt;&lt;/p&gt; Conclusions: Among patients who have not responded to antidepressants, augmenting usual care with CBT is effective in reducing depressive symptoms, and these effects, including outcomes reflecting remission, are maintained over 12 months. The intervention was cost-effective based on the National Institute for Health and Care Excellence threshold. Patients may experience CBT as difficult but effective. Further research should evaluate long-term effectiveness, as this would have major implications for the recommended treatment of depression.&lt;p&gt;&lt;/p&gt