Effects of Cocaine and/or Heroin Use on Resting Cardiovascular Function

Background: Regular cocaine and/or heroin use is associated with major health risks, especially cardiovascular disease (CVD), but confounded by other factors. Objectives: We examined effects of chronic (years of regular use) and recent (past-month) use of cocaine and heroin, controlling for other factors, on resting cardiovascular function. Methods: In a sample of cocaine and/or heroin users (N=292), we obtained data on demographics, body mass index (BMI), history of substance use, and electrocardiogram, heart rate (HR) and blood pressure (BP). Following bivariate correlations, three-block (1: demographics, BMI; 2: tobacco, alcohol, marijuana; 3: cocaine, heroin) regression analyses were conducted to predict cardiovascular measures. Results: Higher BMI predicted increased systolic and diastolic BP (as did older age), increased supine HR, and longer QRS duration, QTc interval, PR interval, and P-wave duration. Recent substance use had more reliable effects than chronic use on cardiovascular measures. Past-month marijuana-use days predicted higher systolic BP, lower supine HR, and greater likelihood of early repolarization and ST elevation, whereas average daily marijuana use predicted shorter QTc interval. Average daily alcohol use predicted higher diastolic BP, higher supine HR and lower likelihood of sinus bradycardia (HRbpm). Past-month tobacco-use days predicted shorter QTc interval and increased likelihood of profound bradycardia (HRbpm). Past-month heroin-use days predicted lower seated HR, greater likelihood of sinus bradycardia and lower likelihood of left ventricular hypertrophy. More years of regular cocaine use and past-month cocaine-use days predicted longer QTc interval. Conclusions: Cocaine and heroin incrementally predicted modest variance in resting bradycardia and QTc interval. Clinicians should first consider demographics and recent use of tobacco, alcohol and marijuana before assuming cocaine and heroin affect these measures

Measuring the impact and costs of a universal group based parenting programme : protocol and implementation of a trial

Background Sub-optimal parenting is a common risk factor for a wide range of negative health, social and educational outcomes. Most parenting programmes have been developed in the USA in the context of delinquency prevention for targeted or indicated groups and the main theoretical underpinning for these programmes is behaviour management. The Family Links Nurturing Programme (FLNP) focuses on family relationships as well as behaviour management and is offered on a universal basis. As a result it may be better placed to improve health and educational outcomes. Developed in the UK voluntary sector, FLNP is popular with practitioners, has impressed policy makers throughout the UK, has been found to be effective in before/after and qualitative studies, but lacks a randomised controlled trial (RCT) evidence base. Methods/Design A multi-centre, investigator blind, randomised controlled trial of the FLNP with a target sample of 288 south Wales families who have a child aged 2-4 yrs living in or near to Flying Start/Sure Start areas. Changes in parenting, parent child relations and parent and child wellbeing are assessed with validated measures immediately and at 6 months post intervention. Economic components include cost consequences and cost utility analyses based on parental ranking of states of quality of life. Attendance and completion rates and fidelity to the FLNP course delivery are assessed. A nested qualitative study will assess reasons for participation and non-participation and the perceived value of the programme to families. By the end of May 2010, 287 families have been recruited into the trial across four areas of south Wales. Recruitment has not met the planned timescales with barriers including professional anxiety about families entering the control arm of the trial, family concern about video and audio recording, programme facilitator concern about the recording of FLNP sessions for fidelity purposes and delays due to the new UK research governance procedures. Discussion Whilst there are strong theoretical arguments to support universal provision of parenting programmes, few universal programmes have been subjected to randomised controlled trials. In this paper we describe a RCT protocol with quantitative and qualitative outcome measures and an economic evaluation designed to provide clear evidence with regard to effectiveness and costs. We describe challenges implementing the protocol and how we are addressing these

Citizenship Education and the Role of Immigrant Students in the Nordic Countries

This chapter addresses the issue of citizenship education and the role of immigrant students in the Nordic countries from the perspective of liberal theories of citizenship education. Liberal approaches to citizenship education have recently encountered rigorous critique: the critics argue that the supposedly democratic, rational, and neutral principles and ideals associated with liberal theories are in reality rooted in a particular way of life and national identity. Accordingly, inculcating these principles and ideals in citizenship education excludes and marginalizes students belonging to minorities, immigrant students in particular. This chapter aims to respond to this critique by separating between two branches of liberal theories of citizenship education, ‘patriotic’ and ‘political’. The chapter argues that while the ‘patriotic’ approach is vulnerable to the aforementioned critique, it does not apply to the ‘political’ line of thought. Rather, the ‘political’ approach, rooted in John Rawls’ political liberalism and the notion of reasonableness, provides a foundation for criticizing policies and practices that marginalize students with immigrant backgrounds. Finally, utilizing Rawlsian theory of citizenship education as a starting point, the chapter makes some suggestions on how the status of immigrant students could be improved in the Nordic countries.Peer reviewe

A community-based parent-support programme to prevent child maltreatment : Protocol for a randomised controlled trial

The prevention of child abuse and neglect is a global public health priority due to its serious, long-lasting effects on personal, social, and economic outcomes. The Children At Risk Model (ChARM) is a wraparound-inspired intervention that coordinates evidence-based parenting- and home-visiting programmes, along with community-based supports, in order to address the multiple and complex needs of families at risk of child abuse or neglect. This paper presents the protocol for a study that will be carried out to evaluate this new service model (i.e. no results available as yet). The study comprises a multi-centre, randomised controlled trial, with embedded economic and process evaluations. The study will be conducted in two child-welfare agencies within socially disadvantaged settings in Ireland. Families with children aged 3-11 years who are at risk of maltreatment (n = 50) will be randomised to either the 20-week ChARM programme (n = 25) or to standard care (n = 25) using a 1:1 allocation ratio. The primary outcomes are incidences of child maltreatment and child behaviour and wellbeing. Secondary outcomes include quality of parent-child relationships, parental stress, mental health, substance use, recorded incidences of substantiated abuse, and out-of-home placements. Assessments will take place at pre-intervention, and at 6- and 12-month follow-up periods. The study is the first evaluation of a wraparound-inspired intervention, incorporating evidence-based programmes, designed to prevent child abuse and neglect within high risk families where children are still living in the home. The findings will offer a unique contribution to the development, implementation and evaluation of effective interventions in the prevention of child abuse and neglect. The trial is registered with the International Standard Randomised Controlled Trial Number Registe

Mechanisms of international influence on domestic elite sport policy

In the analysis of sport policy the permeability of domestic policy processes and the significance of non-domestic policy influences is increasingly acknowledged. There is also a growing awareness of the role of domestic institutional arrangements in mediating influences external to the domestic policy system. Taking the interaction between non-domestic influences and domestic policy processes as its starting point the article evaluates, in relation to elite sport, the variety of mechanisms that have been identified as linking the domestic and non-domestic policy spheres. It is argued that the mechanisms vary in relation to the locus of initiative, the basis of engagement, the key relationships and the nature of power relationships. It is also argued that in many countries in relation to elite sport policy there is a dual process in operation of domestically initiated policy learning and non-domestically initiated policy harmonisation through policy regimes

A cross-sectional survey investigating women's information sources, behaviour, expectations, knowledge and level of satisfaction on advice received about diet and supplements before and during pregnancy

Background The reported long-term effects of poor maternal nutrition and uptake of recommended supplements before and during pregnancy was the impetus behind this study. Our objectives were to investigate and understand women’s expectations, knowledge, behaviour and information sources used regarding the use of nutrition and vitamin supplements before and during pregnancy. Methods A cross-sectional survey using a self-administered questionnaire was undertaken. A purposive sampling technique was used. Women attending the antenatal clinic at Croydon University Hospital during 2015 were invited to take part in the study. The data was analysed using descriptive statistics, paired sample T-tests and Chi-squared tests, with the level of significance set at 5% (p < 0.05). Results A total of 133 pregnant women completed the survey. Analysis of the results showed that women are currently using electronic resources (33%, n = 42) rather than healthcare professionals (19%, n = 25) as an information source before pregnancy. Women who sourced information through the internet were significantly more likely to take folic acid (p = 0.006) and vitamin D (p = 0.004) before pregnancy. Women preferred to receive information from the antenatal clinic (62%, n = 83), internet (46%, n = 61) and from mobile applications (27%, n = 36). Although women believed they had sufficient knowledge (60%, n = 80) and had received adequate advice (53%, n = 70) concerning the correct supplements to take, this was not demonstrated in their behaviour, with only a small number of women (37%, n = 49) taking a folic acid supplement before pregnancy. Women mistakenly perceived the timing of supplement advice as correct, with only a small number of women (18%, n = 23) considering the advice on supplements as too late. Conclusions Despite the small sample size, this study demonstrated that women did not receive timely and/or accurate advice to enable them to take the recommended supplements at the optimal time. Women had the misconception that they understood the correct use of pregnancy supplements. This misunderstanding may be prevented by providing women intending to become pregnant with a structured, approved electronic source of information that improves their supplements uptake

Deregulation, Privatisation and Marketisation of Nordic Comprehensive Education : Social Changes Reflected in Schooling

Peer reviewe

Early parenting intervention: Family risk and first-time parenting related to intervention effectiveness

The effects of cumulative risk and parity on the effectiveness of a home based parenting intervention were tested in a randomized controlled trial with 237 families with 1- to 3-year-old children screened for high levels of externalizing behavior. The intervention was aimed at enhancing positive parenting and decreasing externalizing behaviors. The results showed that cumulative risk was not associated with either change in child externalizing behaviors or change in positive parenting. When intervention effectiveness was compared for primiparas (i.e., first-time mothers) versus multiparas (i.e., mothers with more than one child), we found that intervention mothers of first-born children displayed an increase in their use of positive discipline strategies as compared to first-time mothers in the control group, whereas a similar effect for multiparas was absent. Among multiparas we found an intervention effect on sensitivity, with control group mothers showing an increase in sensitivity, whereas the intervention group showed a constant level of sensitivity over time. These results suggest that parity may be a moderator of intervention effectiveness. Implications for investigating moderators of intervention effectiveness are discussed. © 2007 Springer Science+Business Media, LLC

Effectiveness of Motivational Interviewing in improving lipid level in patients with dyslipidemia assisted by general practitioners: Dislip-EM study protocol

<p>Abstract</p> <p>Background</p> <p>The non-pharmacological approach to cholesterol control in patients with hyperlipidemia is based on the promotion of a healthy diet and physical activity. Thus, to help patients change their habits, it is essential to identify the most effective approach. Many efforts have been devoted to explain changes in or adherence to specific health behaviors. Such efforts have resulted in the development of theories that have been applied in prevention campaigns, and that include brief advice and counseling services. Within this context, Motivational Interviewing has proven to be effective in changing health behaviors in specific cases. However, more robust evidence is needed on the effectiveness of Motivational Interviewing in treating chronic pathologies -such as dyslipidemia- in patients assisted by general practitioners. This article describes a protocol to assess the effectiveness of MI as compared with general practice (brief advice), with the aim of improving lipid level control in patients with dyslipidemia assisted by a general practitioner.</p> <p>Methods/Design</p> <p>An open, two-arm parallel, multicentre, cluster, controlled, randomized, clinical trial will be performed. A total of 48-50 general practitioners from 35 public primary care centers in Spain will be randomized and will recruit 436 patients with dyslipidemia. They will perform an intervention based either on Motivational Interviewing or on the usual brief advice. After an initial assessment, follow-ups will be performed at 2, 4, 8 and 12 months. Primary outcomes are lipid levels (total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides) and cardiovascular risk. The study will assess the degree of dietary and physical activity improvement, weight loss in overweight patients, and adherence to treatment guidelines.</p> <p>Discussion</p> <p>Motivational interview skills constitute the primary strategies GPs use to treat their patients. Having economical, simple, effective and applicable techniques is essential for primary care professionals to help their patients change their lifestyle and improve their health. This study will provide scientific evidence on the effectiveness of Motivational interviewing, and will be performed under strict control over the data collected, ensuring the maintenance of therapeutic integrity.</p> <p>Trials Registration</p> <p>ClinicalTrials.gov (<a href="http://www.clinicaltrials.gov/ct2/show/NCT01282190">NCT01282190</a>).</p