Development of an evidence-based complex intervention for community rehabilitation of patients with hip fracture using realist review, survey and focus groups

Objectives To develop an evidence and theory-based complex intervention for improving outcomes in elderly patients following hip fracture. Design Complex-intervention development (Medical Research Council (MRC) framework phase I) using realist literature review, surveys and focus groups of patients and rehabilitation teams. Setting North Wales. Participants Surveys of therapy managers (n=13), community and hospital-based physiotherapists (n=129) and occupational therapists (n=68) throughout the UK. Focus groups with patients (n=13), their carers (n=4) and members of the multidisciplinary rehabilitation teams in North Wales (n=13). Results The realist review provided understanding of how rehabilitation interventions work in the realworld context and three programme theories were developed: improving patient engagement by tailoring the intervention to individual needs; reducing fear of falling and improving self-efficacy to exercise and perform activities of daily living; and coordination of rehabilitation delivery. The survey provided context about usual rehabilitation practice; focus groups provided data on the experience, acceptability and feasibility of rehabilitation interventions. An intervention to enhance usual rehabilitation was developed to target these theory areas comprising: a physical component consisting of six additional therapy sessions; and a psychological component consisting of a workbook to enhance self-efficacy and a patient-held goal-setting diary for self-monitoring. Conclusions A realist approach may have advantages in the development of evidence-based interventions and can be used in conjunction with other established methods to contribute to the development of potentially more effective interventions. A rehabilitation intervention was developed which can be tested in a future randomised controlled trial (MRC framework phases II and III)

A pragmatic randomised controlled trial of the Welsh National Exercise Referral Scheme: protocol for trial and integrated economic and process evaluation

Background: The benefits to health of a physically active lifestyle are well established and there is evidence that a sedentary lifestyle plays a significant role in the onset and progression of chronic disease. Despite a recognised need for effective public health interventions encouraging sedentary people with a medical condition to become more active, there are few rigorous evaluations of their effectiveness. Following NICE guidance, the Welsh national exercise referral scheme was implemented within the context of a pragmatic randomised controlled trial. Methods/Design: The randomised controlled trial, with nested economic and process evaluations, recruited 2,104 inactive men and women aged 16+ with coronary heart disease (CHD) risk factors and/or mild to moderate depression, anxiety or stress. Participants were recruited from 12 local health boards in Wales and referred directly by health professionals working in a range of health care settings. Consenting participants were randomised to either a 16 week tailored exercise programme run by qualified exercise professionals at community sports centres (intervention), or received an information booklet on physical activity (control). A range of validated measures assessing physical activity, mental health, psycho-social processes and health economics were administered at 6 and 12 months, with the primary 12 month outcome measure being 7 day Physical Activity Recall. The process evaluation explored factors determining the effectiveness or otherwise of the scheme, whilst the economic evaluation determined the relative cost-effectiveness of the scheme in terms of public spending. Discussion: Evaluation of such a large scale national public health intervention presents methodological challenges in terms of trial design and implementation. This study was facilitated by early collaboration with social research and policy colleagues to develop a rigorous design which included an innovative approach to patient referral and trial recruitment, a comprehensive process evaluation examining intervention delivery and an integrated economic evaluation. This will allow a unique insight into the feasibility, effectiveness and cost effectiveness of a national exercise referral scheme for participants with CHD risk factors or mild to moderate anxiety, depression, or stress and provides a potential model for future policy evaluations. Trial registration: Current Controlled Trials ISRCTN4768044

Analysis of Pesticides Residues in Breast Milk of primiparous and multiparous women in Gilgit

Milk contains all the essential nutrients like fats, proteins, and minerals. The utilization of contaminated food can induce a proportion of pesticides in the body. The main purpose of the study was to determine the pesticide residues and current status of breast milk in primiparous and multiparous mothers. In a current study, a total of 50 samples were collected from different areas of District Gilgit and Astore.  The pesticides cypermethrin, deltamethrin, and chlorpyrifos were analyzed using gas chromatography. The presence of cypermethrin in 10 samples was in a range 0.00 – 0.012 mg/kg, while the detection of Deltamethrin in 07 with variation from 0.000.12mg/kg. Whereas chlorpyrifos was found in 05 samples with the ranges of 0.00-0.0062 mg/kg. Residue level was quite higher in urban areas than rural areas. The multiparous women had prominent residues level than primiparas and the concentration of Deltamethrin was higher than other pesticides. All the pesticides residues levels in the breast milk of primiparous and multiparous mothers were within the permissible limits of WHO. Yet the women of these areas are not vulnerable but prolong exposure may pose a serious threat to neonatal and maternal health and other relevant reproductive issues. To manage the risk of milk contamination in the future, the demand for public awareness campaigns and the adoption of alternative clean approaches to control pests and other disease-spreading vectors in the best interests of public health seems reasonable. Full tex

Analysis of Pesticides Residues in Breast Milk of primiparous and multiparous women in Gilgit

Milk contains all the essential nutrients like fats, proteins, and minerals. The utilization of contaminated food can induce a proportion of pesticides in the body. The main purpose of the study was to determine the pesticide residues and current status of breast milk in primiparous and multiparous mothers. In a current study, a total of 50 samples were collected from different areas of District Gilgit and Astore.  The pesticides cypermethrin, deltamethrin, and chlorpyrifos were analyzed using gas chromatography. The presence of cypermethrin in 10 samples was in a range 0.00 – 0.012 mg/kg, while the detection of Deltamethrin in 07 with variation from 0.000.12mg/kg. Whereas chlorpyrifos was found in 05 samples with the ranges of 0.00-0.0062 mg/kg. Residue level was quite higher in urban areas than rural areas. The multiparous women had prominent residues level than primiparas and the concentration of Deltamethrin was higher than other pesticides. All the pesticides residues levels in the breast milk of primiparous and multiparous mothers were within the permissible limits of WHO. Yet the women of these areas are not vulnerable but prolong exposure may pose a serious threat to neonatal and maternal health and other relevant reproductive issues. To manage the risk of milk contamination in the future, the demand for public awareness campaigns and the adoption of alternative clean approaches to control pests and other disease-spreading vectors in the best interests of public health seems reasonable. Full tex

Association of Class Attendance and Test with Grades Attained in BDS Final Professional

OBJECTIVES: The purpose of this study was to verify the association of class attendance percentage, and regular test marks of each taught subject in BDS final year with marks obtained in final examination. METHODOLOGY: Class attendance and test performance records of all participants were obtained from the college authority, and the final professional examination marks sheet issued by UHS was obtained from the college office. Potential confounders like age, gender and parents’ occupation were also recorded for each student. Pearson’s correlation coefficient test was applied to verify the association of class attendance and class tests marks percentage for different subjects taught with final marks. Multivariate analysis was undertaken by adjusting for confounders in the model. RESULTS: This study found significant correlation between each taught subject class test marks with final marks obtained in each respective subject of the final year. Class attendance of each taught subject had weak, insignificant association with final marks except in one subject i.e., Operative Dentistry. CONCLUSION: Class test marks are a stronger predictor of final examination marks than class attendance percentage

Mixed-method process evaluation of the Welsh National Exercise Referral Scheme

<br>Purpose – Primary-care referral to community-based exercise specialists (exercise referral) is common in the UK despite limited evidence of effectiveness. A recent pragmatic randomised trial of the Welsh National Exercise Referral Scheme (NERS), demonstrated promising impacts upon physical activity and mental health. This paper presents a mixed-method process evaluation exploring how outcomes were achieved.</br> <br>Design/methodology/approach – Structured observation, implementer interviews and routine data assessed the extent to which NERS was implemented as intended. Baseline trial data were combined with routine monitoring data for the purposes of profiling uptake and adherence. Semi-structured patient interviews explored processes of change and the emergence of social patterning in responses to the scheme.</br> <br>Findings – NERS offered patients a programme of supervised, group-based discounted exercise. However, motivational interviewing, goal-setting and patient follow-up protocols were delivered poorly. The high degree of professional support was perceived as helping patients to build confidence and assimilate into exercise environments. Patient-only classes provided social contacts, a supportive context and realistic models. Patterning in uptake emerged from access issues, with uptake lower among non-car owners. Adherence was poorer among mental health patients, younger patients and those who were least active prior to referral to NERS.</br> <br>Originality/value – In practice, although the NERS RCT demonstrated positive impacts on physical activity and mental health, process evaluation data indicate that the intervention was not entirely delivered as intended. Mixed-method process evaluation served crucial functions in understanding implementation and functioning, offering insights into the roles of professional support and exercise classes in promoting activity and mental health, and the emergence of social patterning in responses to an ERS.</br