Culinary skills: Immediate and intermediate impacts of a peer-education intervention for adolescents

Inadequate household food preparation equipment has been identified as a barrier to home meal preparation. In a cross-sectional study of households in the United States, food secure households reported owning significantly more unique food preparation equipment items than food insecure households (mean±SD, 39.5±4.6 items vs. 34.1±5.2 items, P=0.002). Access to unique food preparation items may influence the frequency of home prepared meals and indirectly youth culinary skills education. While youth culinary skills education has been emphasized as an important component of nutrition education, the intermediate- and long-term follow-up to support such claims is lacking. The aim of the culinary skills lessons was to determine the efficacy of peer-educators compared to adult-educators in lesson fidelity as well as participant psychosocial parameters of knowledge, attitude and self-efficacy. Two culinary skills lessons were implemented, and the immediate and intermediate effects of the intervention delivered by peer-educators or adult-educators to an adolescent population were evaluated. Adolescents, 11-14 years of age, were recruited from the Champaign-Urbana, Illinois, area to participate in two, 2-hour culinary skills lessons. Based on availability, youths were randomized into peer-educator group (PEG) (n=22) or adult-educator group (AEG) (n=20). Participants attended the lessons that addressed the topics of knife skills, cooking methods and recipe following. Lessons included demonstrations, hands-on practice, discussions, food tastings and physical activity. Program feasibility was measured by fidelity checklists. Participants completed psychosocial questionnaires at pre-lesson, post-lesson, 3-months post-lesson and 6-months post-lesson. All adolescents (N=42) were 12.1±1.1 years of age (mean±SD) with 50% (n=21) female and 57% (n=24) Caucasian. At 6-months post-intervention all adolescents had increased knowledge scores compared to baseline (P<0.001). Attitude, cooking self-efficacy and cooking methods self-efficacy did not significantly increase at 6-months post-lesson compared to baseline. In conclusion, peer-educators and adult-educators were equally proficient at delivering culinary skills lessons that resulted in increased participant knowledge at 6-months post-intervention. Peer-educators were able to lead culinary skills lessons with comparable fidelity as compared to adult-educators. Peer-education may be a novel approach to adolescent culinary skills education

Benign Keratosis: A Useful Term?

Introduction:  Seborrheic keratosis (SK), lichen planus-like keratosis (LPLK), and solar lentigo (SL) are common benign skin lesions. These lesions are frequently seen adjacent to each other or can arise from one another. They can sometimes be difficult to differentiate despite having distinct histopathological features.  Objectives: We evaluated dermoscopic images of 80 skin lesions to confirm the term ‘benign keratosis’ is useful for an undifferentiated SK/LPLK/SL where there are overlapping clinical and dermoscopic characteristics. Methods: Clinical and dermoscopic images were sourced from a teledermoscopy service database of 13,000 lesions in 7,000 patients. The database was queried for SK, SL or LPLK in sun-exposed sites. Each lesion was evaluated based on specific dermoscopic criteria and the results analyzed. Results:  Lesions were identified with mixed clinical and dermoscopic criteria of SK and SL, and in some, dermoscopic criteria for LPLK were also present. Conclusions: This study highlights the relationship between these lesions. We confirm the term ‘benign keratosis’ is useful for mixed lesions or for those that are difficult to classify.

Experience with quality assurance in two store-and-forward telemedicine networks

Published version. Also available at http://dx.doi.org/10.3389/fpubh.2015.00261Despite the increasing use of telemedicine around the world, little has been done to incorporate quality assurance (QA) into these operations. The purpose of the present study was to examine the feasibility of QA in store-and-forward teleconsulting using a previously published framework. During a 2-year study period, we examined the feasibility of using QA tools in two mature telemedicine networks [Médecins Sans Frontières (MSF) and New Zealand Teledermatology (NZT)]. The tools included performance reporting to assess trends, automated follow-up of patients to obtain outcomes data, automated surveying of referrers to obtain user feedback, and retrospective assessment of randomly selected cases to assess quality. In addition, the senior case coordinators in each network were responsible for identifying potential adverse events from email reports received from users. During the study period, there were 149 responses to the patient follow-up questions relating to the 1241 MSF cases (i.e., 12% of cases), and there were 271 responses to the follow-up questions relating to the 639 NZT cases (i.e., 42% of cases). The collection of user feedback reports was combined with the collection of patient follow-up data, thus producing the same response rates. The outcomes data suggested that the telemedicine advice proved useful for the referring doctor in the majority of cases and was likely to benefit the patient. The user feedback was overwhelmingly positive, over 90% of referrers in the two networks finding the advice received to be of educational benefit. The feedback also suggested that the teleconsultation had provided cost savings in about 20% of cases, either to the patient/family, or to the hospital/clinic treating the patient. Various problems were detected by regular monitoring, and certain adverse events were identified from email reports by the users. A single aberrant quality reading was detected by using a process control chart. The present study demonstrates that a QA program is feasible in store-and-forward telemedicine, and shows that it was useful in two different networks, because certain problems were detected (and then solved) that would not have been identified until much later. It seems likely that QA could be used much more widely in telemedicine generally to benefit patient care

Factors related to medical students’ and doctors’ attitudes towards older patients: A systematic review

Background:Studies have sought to identify the possible determinants of medical students’ and doctors’ attitudes towards older patients by examining relationships with a variety of factors: demographic; educational/training; exposure to older people; personality/cognitive; and job/career factors. This review collates and synthesises these findings. Methods: An electronic search of ten databases was performed (ABI/Inform, ASSIA, British Nursing Index, CINAHL, Informa Health, Medline, PsycINFO, Science Direct, Scopus, and Web of Science) through to 7 February 2017. Results: The main search identified 2332 articles; 37 studies met the eligibility criteria set. All included studies analysed self-reported attitudes based on correlational analyses or difference testing, therefore causation could not be determined. However, self-reported positive attitudes towards older patients were related to: (i) intrinsic motivation for studying medicine; (ii) increased preference for working with older patients; and (iii) good previous relationships with older people. Additionally, more positive attitudes were also reported in those with higher knowledge scores but these may relate to the use of a knowledge assessment which is an indirect measure of attitudes (i.e. Palmore’s Facts on Aging Quizzes). Four out of the five high quality studies included in this review reported more positive attitudes in females compared to males. Conclusion:This paper identifies factors associated with medical students’ and doctors’ positive attitudes towards older patients. Future research could bring greater clarity to the relationship between knowledge and attitudes by using a knowledge measure which is distinct from attitudes and also measures knowledge that is relevant to clinical care

Loss of ELK1 has differential effects on age-dependent organ fibrosis and integrin expression

ETS domain-containing protein-1 (ELK1) is a transcription factor important in regulating αvβ6 integrin expression. αvβ6 integrins activate the profibrotic cytokine Transforming Growth Factor β1 (TGFβ1) and are increased in the alveolar epithelium in idiopathic pulmonary fibrosis (IPF). IPF is a disease associated with aging and therefore we hypothesised that aged animals lacking Elk1 globally would develop spontaneous fibrosis in organs where αvβ6 mediated TGFβ activation has been implicated. Here we identify that Elk1-knockout (Elk1−/0) mice aged to one year developed spontaneous fibrosis in the absence of injury in both the lung and the liver but not in the heart or kidneys. The lungs of Elk1−/0 aged mice demonstrated increased collagen deposition, in particular collagen 3α1, located in small fibrotic foci and thickened alveolar walls. Despite the liver having relatively low global levels of ELK1 expression, Elk1−/0 animals developed hepatosteatosis and fibrosis. The loss of Elk1 also had differential effects on Itgb1, Itgb5 and Itgb6 expression in the four organs potentially explaining the phenotypic differences in these organs. To understand the potential causes of reduced ELK1 in human disease we exposed human lung epithelial cells and murine lung slices to cigarette smoke extract, which lead to reduced ELK1 expression andmay explain the loss of ELK1 in human disease. These data support a fundamental role for ELK1 in protecting against the development of progressive fibrosis via transcriptional regulation of beta integrin subunit genes, and demonstrate that loss of ELK1 can be caused by cigarette smoke

Accuracy of PECARN, CATCH, and CHALICE head injury decision rules in children: a prospective cohort study

© 2017 Elsevier Ltd Background Clinical decision rules can help to determine the need for CT imaging in children with head injuries. We aimed to validate three clinical decision rules (PECARN, CATCH, and CHALICE) in a large sample of children. Methods In this prospective observational study, we included children and adolescents (age

Imagining the future at the global and national scale: a comparative study of British and Dutch press coverage of Rio 1992 and Rio 2012

Climate change and imagined futures are intricately linked, discussed by policymakers and reported in the media. In this article we focus on the construction of future expectation in the press coverage of the 1992 and 2012 United Nations conferences in Rio de Janeiro in British and Dutch national newspapers. We use a novel combination of methods, semantic co-word networks and metaphor analysis to analyse imagined futures. Our findings show that between 1992 and 2012 there was a switch from future-oriented hope to past-oriented disappointment regarding implementing international agreements on climate change policy. While the UK focused on global issues, the Netherlands focused on national (including colonial) and local ones, reflecting different views and expectations about the future of climate change adaptation and mitigation