A qualitative study of young peoples’ thoughts and attitudes to follow a more plant-based diet

Funding: This work was supported by the University of St Andrews.Plant-based diets (PBDs) refer to dietary habits that reduce the consumption of animal-based products and increase the consumption of nutritionally rich plant foods. PBD’s have been shown to provide significant health benefits, such as reducing obesity and improving psychological wellbeing, and are environmentally friendly. However, few studies have investigated factors that influence young people’s thoughts and attitudes toward following a PBD in western societies, particularly in the United Kingdom. Understanding these factors may benefit public health interventions that encourage the consumption of more fruit and vegetables. The aim of this study was to explore the factors that affect young people’s intentions toward following a PBD. Twenty-one young people (18–24 years) participated in this qualitative study. Participants were asked about their views of PBDs in a semi-structured interview. Thematic analysis was utilized to explore views and the barriers and facilitators to following a PBD. The Theory of Planned Behavior (TPB) was used as a framework to organise the findings. Within attitudes, the sub-themes identified were an awareness of a healthy diet, environmental concerns, health concerns and distrust, perceptions of PBDs and associated stereotypes, perceived restriction and lack of enjoyment, and need for education. Within subjective norms, the sub-themes identified were cultural and familial norms, peer influence, and exposure through social media. Within perceived behavioral control (PBC), the sub-themes identified were a lack of independence and parental control, lack of knowledge and perceived difficulty, lack of inclusiveness and accessibility, and inconvenience. Overall, the findings suggest that increased provision of education and knowledge about PBDs to young people, and widening access to PBDs, could encourage and help improve their understanding and intention to follow this dietary style. Tailored health promotion strategies, which also consider additional barriers and facilitators found within this study, could motivate young people to consume a more PBD.Publisher PDFPeer reviewe

Issues of alcohol misuse among older people : attitudes and experiences of social work practitioners

This small-scale qualitative research focused on the experiences of social workers vis--vis older people who misuse alcohol. Based in an Older People's Team in the west of Scotland, the study explored service provision for alcohol misuse and examined whether practitioners felt the existing services provided by the Substance Misuse Team were effective in meeting the needs of older people with an alcohol problem. Using semi-structured interviews, data were collected from 18 participants, the majority (14) of whom were female and whose ages ranged from 31 to 54 years. Several key themes emerged including the extent of alcohol problems among older people and the complex reasons that cause older people to misuse alcohol. These reasons commonly related to the increasing challenges of old age. The data also demonstrated that current services are not meeting the needs of older people. Practitioners identified a need for an 'age-specific' approach to target more effectively the complex needs of older people. Recommendations from practitioners included ways to develop new and more effective services, including a more age-specific service, such as providing longer term support in older people's own homes, using a specialised support worker, and increasing staff training on alcohol use among older people

Improving blood pressure control in primary care: The ImPress study

Background Hypertension is a preventable risk factor for cardiovascular disease, the leading cause of death globally. When hypertension is present with tobacco smoking, poor nutrition, physical inactivity or excessive alcohol consumption, risk of cardiovascular disease is increased. Given the prolonged engagement and ongoing relationship with patients, general practice nurses are ideally situated to actively engage with patients about optimal blood pressure control and lifestyle risk reduction. Objectives This study will test the effectiveness of a nurse-led intervention to reduce blood pressure in adults with hypertension and high cardiovascular risk. Design A multi-site, cluster randomised control trial where the general practice is the unit of randomisation. Methods General Practices (n = 20) will be block randomised to the intervention or usual care group. Adults with hypertension and high cardiovascular risk will be identified through an audit of electronic medical records and invited to attend an assessment visit. Eligible consenting patients will be recruited to the study. The intervention involves three face-to-face consultations and two telephone consultations with the nurse to assess lifestyle risk and develop an action plan. An appointment with the general practitioner will optimise pharmacotherapy. The primary outcome is blood pressure, with secondary outcomes of lifestyle risk factors; smoking, nutrition, alcohol and physical activity body mass index and medication adherence. Patients will have outcome measures evaluated at 6 and 12 months. Discussion ImPress is innovative in its proactive approach of identifying those at greatest risk of cardiovascular disease in combination with the emerging role of the general practice nurse to target care towards improved blood pressure control. If successful, findings from this trial could enhance the nursing role, improve health outcomes, inform health policy and provide an evidence base from which to transform blood pressure management in general practice

Engaging and empowering first-year students through curriculum design: perspectives from the literature

There is an increasing value being placed on engaging and empowering first-year students and first-year curriculum design is a key driver and opportunity to ensure early enculturation into successful learning at university. This paper summarises the literature on first-year curriculum design linked to student engagement and empowerment. We present conceptualisations of ‘curriculum’ and examples from first-year curriculum design. We also note the limited literature where students have been involved in designing first-year curricula. The results of the literature review suggest that key characteristics of engaging first-year curricula include active learning, timely feedback, relevance and challenge. The literature also points to the importance of identifying students' abilities on entry to university as well as being clear about desired graduate attributes and developmental goals. Acknowledging realities and constraints, we present a framework for the first-year curriculum design process based on the literature

Molecular Analysis of Predator Scats Reveals Role of Salps in Temperate Inshore Food Webs

High precision, high coverage DNA-based diet analysis tools allow great insight into the food web interactions of cryptic taxa. We used DNA fecal-metabarcoding to look for unrecorded taxa within the diet of a generalist central-placed predator, the little penguin Eudyptula minor. We examined 208 scats from 106 breeding pairs throughout August–February in a large colony at Phillip Island, Australia. While we confirmed a largely piscivorous diet, we also recovered DNA sequences from gelatinous and crustaceous plankton groups that have not previously been detected in the little penguin diet using other diet analysis methods. Gelatinous plankton, including salps, appendicularians, scyphozoans, and hydrozoans were present in 76% of samples and represented 25% of all sequences. DNA recovered from minute copepods and appendicularians may indicate links between trophic levels through secondary predation. Percentage frequency of occurrence (%FOO) demonstrated that little penguin diet composition changed over months and stages (incubation, guard, and post-guard) of the breeding season (month: χ2 = 201.91, df = NA, p < 0.01; stage: χ2 = 33.221, df = NA, p = 0.015). Relative read abundance (RRA) uncovered variations in the relative abundance of taxa in the diet over months and stages (month: F = 53.18, df = 59, p < 0.001; stage: F = 66.56, df = 29, p < 0.001). The diet became progressively fish-focused over months of the season and stages, while salps were only present in 4 out of 6 months, with a peak in September. Based on their prevalence in this dataset, in this year of very high breeding success (2.15 chicks per pair), salps may constitute a food source for this largely piscivorous generalist. Our work highlights how DNA metabarcoding can improve our understanding of the trophic role of gelatinous plankton and other cryptic taxa

A novel method to allow noninvasive, longitudinal imaging of the murine immune system in vivo

In vivo imaging has revolutionized understanding of the spatiotemporal complexity that subserves the generation of successful effector and regulatory immune responses. Until now, invasive surgery has been required for microscopic access to lymph nodes (LNs), making repeated imaging of the same animal impractical and potentially affecting lymphocyte behavior. To allow longitudinal in vivo imaging, we conceived the novel approach of transplanting LNs into the mouse ear pinna. Transplanted LNs maintain the structural and cellular organization of conventional secondary lymphoid organs. They participate in lymphocyte recirculation and exhibit the capacity to receive and respond to local antigenic challenge. The same LN could be repeatedly imaged through time without the requirement for surgical exposure, and the dynamic behavior of the cells within the transplanted LN could be characterized. Crucially, the use of blood vessels as fiducial markers also allowed precise re-registration of the same regions for longitudinal imaging. Thus, we provide the first demonstration of a method for repeated, noninvasive, in vivo imaging of lymphocyte behavior

Process evaluation of an implementation trial to improve the triage, treatment and transfer of stroke patients in emergency departments (T3 trial): a qualitative study

Background The implementation of evidence-based protocols for stroke management in the emergency department (ED) for the appropriate triage, administration of tissue plasminogen activator to eligible patients, management of fever, hyperglycaemia and swallowing, and prompt transfer to a stroke unit were evaluated in an Australian cluster-randomised trial (T3 trial) conducted at 26 emergency departments. There was no reduction in 90-day death or dependency nor improved processes of ED care. We conducted an a priori planned process influential factors that impacted upon protocol uptake. Methods Qualitative face-to-face interviews were conducted with purposively selected ED and stroke clinicians from two high- and two low-performing intervention sites about their views on factors that influenced protocol uptake. All Trial State Co-ordinators (n = 3) who supported the implementation at the 13 intervention sites were also interviewed. Data were analysed thematically using normalisation process theory as a sensitising framework to understand key findings, and compared and contrasted between interviewee groups. Results Twenty-five ED and stroke clinicians, and three Trial State Co-ordinators were interviewed. Three major themes represented key influences on evidence uptake: (i) Readiness to change: reflected strategies to mobilise and engage clinical teams to foster cognitive participation and collective action; (ii) Fidelity to the protocols: reflected that beliefs about the evidence underpinning the protocols impeded the development of a shared understanding about the applicability of the protocols in the ED context (coherence); and (iii) Boundaries of care: reflected that appraisal (reflexive monitoring) by ED and stroke teams about their respective boundaries of clinical practice impeded uptake of the protocols. Conclusions Despite initial high 'buy-in' from clinicians, a theoretically informed and comprehensive implementation strategy was unable to overcome system and clinician level barriers. Initiatives to drive change and integrate protocols rested largely with senior nurses who had to overcome contextual factors that fell outside their control, including low medical engagement, beliefs about the supporting evidence and perceptions of professional boundaries. To maximise uptake of evidence and adherence to intervention fidelity in complex clinical settings such as ED cost-effective strategies are needed to overcome these barriers.The T3 Trial was funded by a NHMRC Project Grant 1024812 (2012–2017). The following authors received research fellowship funding from the NHMRC: Dominique Cadilhac (co-funded with Heart Foundation: 1063761 and 1154273) and Chris Levi (Practitioner: 1043913). Jeremy Grimshaw holds a Canada Research Chair in Health Knowledge Transfer and Uptake. Non-material support provided by the trial sponsor, Australian Catholic University, to house members of the trial team including authors SM, SD, EM, RP, OF, VS and LC

Does the Addition of Non-Approved Inclusion and Exclusion Criteria for rtPA Impact Treatment Rates? Findings in Australia, the UK, and the USA

Background: Strict criteria for recombinant tissue plasminogen activator (rtPA) eligibility are stipulated on licences for use in ischaemic stroke, however, practitioners may also add non-standard rtPA criteria. We examined eligibility criteria variation in 3 English-speaking countries including use of non-standard criteria, in relation to rtPA treatment rates. Methods: Surveys were mailed to 566 eligible hospitals in Australia (AUS), United Kingdom (UK) and the United States (USA). Criteria were pre-classified as standard (approved indication and contraindications ) or non-standard (approved warning or researcher ‘decoy’). Percentage for criterion selection was calculated/compared; linear regression was used to assess the association between use of non-standard criteria and rtPA treatment rates, and to identify factors associated with addition of non-standard criteria. Results: Response rates were 74% AUS, 65% UK, and 68% USA; mean rtPA treatment rates were 8.7% AUS, 12.7% UK and 8.7% USA. Median percentage of non-standard inclusions was 33% (all 3 countries) and included National Institutes of Health Stroke Scale (NIHSS) scores >4, computed tomography (CT) angiography documented occlusion, and favourable CT perfusion. Median percentage of non-standard exclusions was 25% AUS, 28% UK, and 60% USA, and included depressed consciousness, NIHSS>25, and use of antihypertensive infusions. No AUS or UK sites selected 100% of standard exclusions. Conclusions: Non-standard criteria for rtPA eligibility was evident in all three countries and could, in part, explain comparably low use of rtPA. Differences in the use of standard criteria may signify practitioner intolerance for those derived from original efficacy studies that are no longer relevant