The effectiveness of the Mediterranean Diet for primary and secondary prevention of cardiovascular disease: An umbrella review

AIMS: This study aimed to review meta-analyses of randomised controlled trials that evaluated the effectiveness of the Mediterranean Diet for the primary and secondary prevention of cardiovascular disease.METHODS: Five databases (Medline, Embase, Cochrane, CINAHL and ProQuest) were searched from inception to November 2022. Inclusion criteria were: (i) systematic review of randomised controlled studies with metanalysis; (ii) adults ≥18 years from the general population with (secondary prevention) and without (primary prevention) established cardiovascular disease; (iii) Mediterranean Diet compared with another dietary intervention or usual care. Review selection and quality assessment using AMSTAR-2 were completed in duplicate. GRADE was extracted from each review, and results were synthesised narratively.RESULTS: Eighteen meta-analyses of 238 randomised controlled trials were included, with an 8% overlap of primary studies. Compared to usual care, the Mediterranean Diet was associated with reduced cardiovascular disease mortality (n = 4 reviews, GRADE low certainty; risk ratio range: 0.35 [95% confidence interval: 0.15-0.82] to 0.90 [95% confidence interval: 0.72-1.11]). Non-fatal myocardial infarctions were reduced (n = 4 reviews, risk ratio range: 0.47 [95% confidence interval: 0.28-0.79] to 0.60 [95% confidence interval: 0.44-0.82]) when compared with another active intervention. The methodological quality of most reviews (n = 16/18; 84%) was low or critically low and strength of evidence was generally weak.CONCLUSIONS: This review showed that the Mediterranean Diet can reduce fatal cardiovascular disease outcome risk by 10%-67% and non-fatal cardiovascular disease outcome risk by 21%-70%. This preventive effect was more significant in studies that included populations with established cardiovascular disease. Better quality reviews are needed.</p

How many doctors does it take to manage an Elective General Surgical patient? Individualised Surgeon Specific Outcomes Data misrepresent modern team centred work practices

Peer reviewedPostprin

Peer Supporters’ Mental Health and Emotional Wellbeing needs:Key Factors and Opportunities for Co-Produced Training

Abstract Introduction Peer supporters are a valuable asset to mental health and support services, but their own mental health needs are often overlooked in research and practice. This study explored peer supporters' perceived challenges of maintaining their mental health and emotional wellbeing and co‐produced training needs. Methods A qualitative approach was used to explore factors affecting peer supporters' mental health and emotional wellbeing. Semi‐structured interviews and focus groups were conducted online with 11 peer supporters across North East England. Results A thematic analysis identified: ‘Lack of training and support’, ‘Role ambiguity’ and ‘Emotional labour’ as challenges experienced by peer supporters in relation to maintaining their mental health and emotional wellbeing. Peer supporters' own lived experiences had the potential to act as a barrier towards providing support to others. Conflict with peer ‘supportees’ sometimes negatively impacted on the peer supporter experience. Participant responses emphasised a need for person‐centred, co‐produced training. Conclusion This work highlights the need for targeted training for peer supporters, including both role‐specific education and strategies to support their mental health and emotional wellbeing. Patient or Public Contribution Participants were contacted and asked to provide feedback on finalised themes to ensure the analysis was congruent with their experiences, further enabling the future development of an emotional wellbeing training programme for peer supporters

Stroke awareness in the general population: knowledge of stroke risk factors and warning signs in older adults

<p>Abstract</p> <p>Background</p> <p>Stroke is a leading cause of death and functional impairment. While older people are particularly vulnerable to stroke, research suggests that they have the poorest awareness of stroke warning signs and risk factors. This study examined knowledge of stroke warning signs and risk factors among community-dwelling older adults.</p> <p>Methods</p> <p>Randomly selected community-dwelling older people (aged 65+) in Ireland (n = 2,033; 68% response rate). Participants completed home interviews. Questions assessed knowledge of stroke warning signs and risk factors, and personal risk factors for stroke.</p> <p>Results</p> <p>Of the overall sample, 6% had previously experienced a stroke or transient ischaemic attack. When asked to identify stroke risk factors from a provided list, less than half of the overall sample identified established risk factors (e.g., smoking, hypercholesterolaemia), hypertension being the only exception (identified by 74%). Similarly, less than half identified established warning signs (e.g., weakness, headache), with slurred speech (54%) as the exception. Overall, there were considerable gaps in awareness with poorest levels evident in those with primary level education only and in those living in Northern Ireland (compared with Republic of Ireland).</p> <p>Conclusion</p> <p>Knowledge deficits in this study suggest that most of the common early symptoms or signs of stroke were recognized as such by less than half of the older adults surveyed. As such, many older adults may not recognise early symptoms of stroke in themselves or others. Thus, they may lose vital time in presenting for medical attention. Lack of public awareness about stroke warning signs and risk factors must be addressed as one important contribution to reducing mortality and morbidity from stroke.</p

A Qualitative Exploration of Peer Supporters’ Experiences of Undertaking a Co-Produced Mental Health and Emotional Wellbeing Training Programme

Intro: Peer supporters play a crucial role in mental health and support services, but their own mental health and emotional wellbeing are often neglected by themselves, and, often, their organisations. Here, we report findings from a qualitative interview study of peer supporters who completed a co-produced emotional wellbeing training programme. Method: Ten semi-structured interviews with peer supporters working in the North East of England were conducted to explore their experiences of the training programme. Results: Thematic analysis of the data produced three overarching themes. In theme 1, ‘Increasing psychological preparedness and identifying self-care and coping strategies’, we found that peer supporters improved their knowledge of how to manage sensitive topics such as aggression and suicide and felt more confident in their peer support roles resultantly. In theme 2, ‘It’s good to know you’re not alone’, peer supporters discussed their experience of loneliness in their roles, and as a result realised their own need for peer support to help maintain their wellbeing. Theme 3, ‘Toward the future: next steps’ encapsulated peer supporters’ willingness to continue their role development and to create a peer support network to continue to obtain mutual support. Conclusion: Our findings emphasise the perceived emotional wellbeing benefits of a coproduced peer supporter training programme. Participants highlighted the need for coproduced training programmes that are (1) emotion-focussed, (2) provide access to other peer supporters, and (3) provide future avenues for a peer supporter network of mutual support and professional development activities and training opportunities. Patient or Public Contribution: Individuals with lived experience of mental ill health and peer support were consulted in the development of interview questions, and provided feedback on the finalised themes to ensure the analysis and interpretations were congruent with their experiences

Evaluating Student Partnership for Enhancement

Student engagement has been a core pillars of our Scottish Quality Enhancement Framework from its inception, ensuring a strong and meaningful student voice and contribution to our assurance and enhancements agendas, works and achievements. With a wide spread shift across the sector from engagement of students to partnership working, and the celebration of 20 years of enhancement, it feels fitting and timely to ask the question ‘How do we evaluate our ideas and practices of partnership, and their impacts enhancing the student experience?’. This presentation utilises the presenters own institutional context as a case study, and initial findings from a small-scale research project, to explore how we currently evaluate student partnerships in their many forms, and where we may need to expand our evaluative practice and approach to examine the impacts of partnership for the future

Association of longitudinal alcohol consumption trajectories with coronary heart disease: a meta-analysis of six cohort studies using individual participant data.

BACKGROUND: Studies have shown that alcohol intake trajectories differ in their associations with biomarkers of cardiovascular functioning, but it remains unclear if they also differ in their relationship to actual coronary heart disease (CHD) incidence. Using multiple longitudinal cohort studies, we evaluated the association between long-term alcohol consumption trajectories and CHD. METHODS: Data were drawn from six cohorts (five British and one French). The combined analytic sample comprised 35,132 individuals (62.1% male; individual cohorts ranging from 869 to 14,247 participants) of whom 4.9% experienced an incident (fatal or non-fatal) CHD event. Alcohol intake across three assessment periods of each cohort was used to determine participants' intake trajectories over approximately 10 years. Time to onset for (i) incident CHD and (ii) fatal CHD was established using surveys and linked medical record data. A meta-analysis of individual participant data was employed to estimate the intake trajectories' association with CHD onset, adjusting for demographic and clinical characteristics. RESULTS: Compared to consistently moderate drinkers (males: 1-168 g ethanol/week; females: 1-112 g ethanol/week), inconsistently moderate drinkers had a significantly greater risk of incident CHD [hazard ratio (HR) = 1.18, 95% confidence interval (CI) = 1.02-1.37]. An elevated risk of incident CHD was also found for former drinkers (HR = 1.31, 95% CI = 1.13-1.52) and consistent non-drinkers (HR = 1.47, 95% CI = 1.21-1.78), although, after sex stratification, the latter effect was only evident for females. When examining fatal CHD outcomes alone, only former drinkers had a significantly elevated risk, though hazard ratios for consistent non-drinkers were near identical. No evidence of elevated CHD risk was found for consistently heavy drinkers, and a weak association with fatal CHD for inconsistently heavy drinkers was attenuated following adjustment for confounding factors. CONCLUSIONS: Using prospectively recorded alcohol data, this study has shown how instability in drinking behaviours over time is associated with risk of CHD. As well as individuals who abstain from drinking (long term or more recently), those who are inconsistently moderate in their alcohol intake have a higher risk of experiencing CHD. This finding suggests that policies and interventions specifically encouraging consistency in adherence to lower-risk drinking guidelines could have public health benefits in reducing the population burden of CHD. The absence of an effect amongst heavy drinkers should be interpreted with caution given the known wider health risks associated with such intake. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03133689

Adolescents' Understanding of What Causes Emotional Distress: A Qualitative Exploration in a Non-clinical Sample Using Ideal-Type Analysis

From Frontiers via Jisc Publications RouterHistory: collection 2021, received 2021-02-27, accepted 2021-04-21, epub 2021-05-24Publication status: PublishedBackground: There is increased interest in early intervention and prevention of mental health difficulties during adolescence; thus, we are seeing increased efforts to optimize well-being during this epoch. Positive emotional experiences are a central component of overall well-being. However, research exploring what adolescents perceive to be the cause(s) of their emotional difficulties is lacking. Improving understanding of this issue within non-clinical adolescent groups may provide useful insight into how to develop strategies to support young people as they navigate emotional difficulties. Objectives: The aim of this research was to explore if meaningful categories of perceived cause(s) for emotional distress exist for non-clinical adolescent groups. Methods: The data for this study were drawn from interviews across 6 sites in England conducted as part of the 5-year national evaluation of the HeadStart Learning Programme. The sample comprised of 32 young people aged 11–12 years from the first annual wave of qualitative data collection in 2017. Ideal type analysis—a qualitative form of person-centered analysis—was used to construct a typology of adolescents perceived cause(s) for emotional distress. Findings: We identified five distinct categories of perceived cause: (1) perceived lack of control; (2) unfair treatment; (3) others, their actions and judgements as the catalyst; (4) concerns for self and others; and, (5) self as cause. Conclusions: Our findings illustrate that distinct categories for perceived cause of emotional distress exist among adolescents considered to be “at risk” of developing mental health difficulties, which provides a foundation for future necessary work seeking to investigate the possible link between perceived cause for emotional distress and help-seeking behavior among sub-clinical groups