An evaluation of the effect of a health promoting school approach, The Healthy Schools Programme, on the psychological health and well-being of primary school-aged children

Background: A ‘health promoting school’ approach has become an increasingly popular framework internationally within which to address the health needs of school communities. A growing evidence base indicates that, if applied successfully, a health promoting school approach can lead to improvements in both health and educational outcomes (including children’s psychological health and well-being). The Healthy Schools Programme (HSP) is an initiative developed through partnership between a Dublin-based voluntary sector organisation and a number of local urban DEIS band 1 schools, the aim of which is to promote positive health outcomes for children in their primary school years and including the psychological health and well-being of children (in line with health promoting principles). To date, few studies have comprehensively examined how such initiatives address the psychological health needs of children. Objectives: The overarching aim of this study was to examine how, and to what extent, the Healthy Schools Programme addressed the psychological health and well-being needs of a sample of primary school-aged children. The study assessed the impact of the initiative on children’s health outcomes including a focus on how the programme helped the schools to address psychological health. A secondary aim of the study was to explore the impact the implementation strategy on the overall effectiveness of the HSP. Method: A concurrent mixed methods design was used to address the study objectives. The study comprised two parallel phases: (1) a comparative impact evaluation of the HSP on children’s psychological health (aged 7-12 years) and; (2) a process evaluation of programme planning and implementation. Data were collected over a 24-month period using a number of methods including: (a) follow-up self-report health questionnaires with children (n = 434); and (b) one-to-one interviews and focus groups with key stakeholders (n=48) (i.e. HSP funders, Healthy Schools coordinators, school principals and staff, parents as well as health and educational professionals); and (c) non- participatory participant observation at steering committee meetings (n=9). The quantitative data were subjected to a series of descriptive and inferential statistical analyses including t-test, chi square, and ANOVA. Qualitative data were analysed thematically using Framework Analysis. Results: At baseline, children maintained average levels of psychological well-being as well as other aspects of health-related quality of life (e.g. physical well-being, peers and social support, autonomy and parental relations, school environment) relative to national and international studies. At follow-up, comparisons of self-report health measures between children in Intervention (n=5) and Comparison schools (n=2) found some health improvements for the entire sample over time. However, the lack of any substantial differences between Comparison and Intervention school samples suggest that any changes in health cannot be attributed to the HSP. The qualitative findings suggest some positive changes in how schools addressed health as a result of the HSP, although these were not demonstrated in the children’s health outcome data at the year 2 follow-up. The results of the process evaluation highlighted the slow, evolving and often challenging aspects of programme implementation. In particular, psychological health was not addressed by the HSP until the second half of the implementation period, and when prioritised, was identified by most participants as more challenging and complex than other aspects of health (i.e. nutrition and physical activity). A number of fundamental implementation factors were identified as not being sufficiently well developed to facilitate the effective implementation of the HSP in the local context. These included: a lack of a shared understanding of the HSP amongst all key stakeholders (including the planning group); an absence of appropriately experienced Healthy Schools Coordinators; poorly developed forms of collaboration and joined-up working; and the lack of a properly functioning national health promoting school framework/governmental support. It was evident that more coherent planning and a retrospective process of review (relating in particular to the quality of the HS manual and issues around implementation fidelity) were needed for more effective programme implementation. Conclusions: This study provided a comprehensive assessment of how a local health promoting school initiative attempted to address the psychological health and well-being of children in an Irish primary school setting. Importantly, the study also examined the process of programme implementation as well as the impact of the programme on children’s psychological health. The study findings clearly demonstrate the complexity and many challenges involved in developing and implementing a HSP initiative in an Irish context and also in using this approach to tackle the psychological/mental health needs of school children. The identification, in this study, of key enablers of, and barriers to, the implementation of the local health promoting school initiative is important in informing the design, planning and implementation of these kinds of initiatives both in Ireland and elsewhere

WISP genes are members of the connective tissue growth factor family that are up-regulated in Wnt-1-transformed cells and aberrantly expressed in human colon tumors

Wnt family members are critical to many developmental processes, and components of the Wnt signaling pathway have been linked to tumorigenesis in familial and sporadic colon carcinomas. Here we report the identification of two genes, WISP-1 and WISP-2, that are up-regulated in the mouse mammary epithelial cell line C57MG transformed by Wnt-1, but not by Wnt-4. Together with a third related gene, WISP-3, these proteins define a subfamily of the connective tissue growth factor family. Two distinct systems demonstrated WISP induction to be associated with the expression of Wnt-1. These included (i) C57MG cells infected with a Wnt-1 retroviral vector or expressing Wnt-1 under the control of a tetracyline repressible promoter, and (ii) Wnt-1 transgenic mice. The WISP-1 gene was localized to human chromosome 8q24.1-8q24.3. WISP-1 genomic DNA was amplified in colon cancer cell lines and in human colon tumors and its RNA overexpressed (2- to >30-fold) in 84% of the tumors examined compared with patient-matched normal mucosa. WISP-3 mapped to chromosome 6q22-6q23 and also was overexpressed (4- to >40-fold) in 63% of the colon tumors analyzed. In contrast, WISP-2 mapped to human chromosome 20q12-20q13 and its DNA was amplified, but RNA expression was reduced (2- to >30-fold) in 79% of the tumors. These results suggest that the WISP genes may be downstream of Wnt-1 signaling and that aberrant levels of WISP expression in colon cancer may play a role in colon tumorigenesis

Hydrocortisone granules are bioequivalent when sprinkled onto food or given directly on the tongue

Background Immediate-release hydrocortisone granules in capsules for opening in paediatric appropriate doses have recently been licensed for children with adrenal insufficiency. This study evaluated the bioavailability of hydrocortisone granules administered as sprinkles onto soft food and yoghurt compared to direct administration to the back of the tongue. Methods Randomised, three-period crossover study in 18 dexamethasone-suppressed healthy men. In each period the fasted participants received hydrocortisone granules 5mg either directly to the back of the tongue, or sprinkled onto soft food (applesauce), or yoghurt, followed by 240mL of water. Serum cortisol was measured by LC-MS/MS. Results The cortisol geometric mean Cmax and AUC for direct administration, sprinkles onto yoghurt, and sprinkles onto soft food were: Cmax 428, 426, 427 nmol/L & AUC0-inf 859, 886, 844 h*nmol/L, & AUC0-t 853, 882, 838 h*nmol/L respectively. The 90% confidence intervals (CI) for the ratios of Cmax, AUC0-inf & AUC0-t for administration with soft food or yoghurt to direct administration were well within the bioequivalent range, 80-125%. Median Tmax was similar between methods of administration: 0.63h administered directly, 0.75h on soft food and 0.75h on yoghurt. No adverse events occurred during the study. Conclusions Hydrocortisone granules administered as sprinkles onto soft food or yoghurt but not mixed with are bioequivalent to those administered directly to the back of the tongue. Carers, parents or patients may choose to administer hydrocortisone granules either directly or sprinkled onto soft food or yoghurt

Access to interpreting services in England: secondary analysis of national data

Background: Overcoming language barriers to health care is a global challenge. There is great linguistic diversity in the major cities in the UK with more than 300 languages, excluding dialects, spoken by children in London alone. However, there is dearth of data on the number of non-English speakers for planning effective interpreting services. The aim was to estimate the number of people requiring language support amongst the minority ethnic communities in England. Methods: Secondary analysis of national representative sample of subjects recruited to the Health Surveys for England 1999 and 2004. Results: 298,432 individuals from the four main minority ethnic communities (Indian, Pakistani, Bangladeshi and Chinese) who may be unable to communicate effectively with a health professional. This represents 2,520,885 general practice consultations per year where interpreting services might be required. Conclusion: Effective interpreting services are required to improve access and health outcomes of non-English speakers and thereby facilitate a reduction in health inequalities

The global field of multi-family offices: An institutionalist perspective

We apply the notion of the organisational field to internationally operating multi-family offices. These organisations specialise on the preservation of enterprising and geographically dispersed families’ fortunes. They provide their services across generations and countries. Based on secondary data of Bloomberg’s Top 50 Family Offices, we show that they constitute a global organisational field that comprises two clusters of homogeneity. Clients may decide between two different configurations of activities, depending on their preferences regarding asset management, resource management, family management, and service architecture. The findings also reveal that multi-family offices make relatively similar value propositions all over the world. The distinctiveness of the clusters within the field is not driven by the embeddedness of the multi-family offices in different national environments or their various degrees of international experience. Rather, it is weakly affected by two out of four possible value propositions, namely the exclusiveness and the transparency of services

Stroma AReactive Invasion Front Areas (SARIFA): a novel histopathologic biomarker in colorectal cancer patients and its association with the luminal tumour proportion

Background Stroma AReactive Invasion Front Areas (SARIFA) is a novel prognostic histopathologic biomarker measured at the invasive front in haematoxylin & eosin (H&E) stained colon and gastric cancer resection specimens. The aim of the current study was to validate the prognostic relevance of SARIFA-status in colorectal cancer (CRC) patients and investigate its association with the luminal proportion of tumour (PoT). Methods We established the SARIFA-status in 164 CRC resection specimens. The relationship between SARIFA-status, clinicopathological characteristics, recurrence-free survival (RFS), cancer-specific survival (CSS), and PoT was investigated. Results SARIFA-status was positive in 22.6% of all CRCs. SARIFA-positivity was related to higher pT, pN, pTNM stage and high grade of differentiation. SARIFA-positivity was associated with shorter RFS independent of known prognostic factors analysing all CRCs (RFS: hazard ratio (HR) 2.6, p = 0.032, CSS: HR 2.4, p = 0.05) and shorter RFS and CSS analysing only rectal cancers. SARIFA-positivity, which was measured at the invasive front, was associated with PoT-low (p = 0.009), e.g., higher stroma content, and lower vessel density (p = 0.0059) measured at the luminal tumour surface. Conclusion Here, we validated the relationship between SARIFA-status and prognosis in CRC patients and provided first evidence for a potential prognostic relevance in the subgroup of rectal cancer patients. Interestingly, CRCs with different SARIFA-status also showed histological differences measurable at the luminal tumour surface. Further studies to better understand the relationship between high luminal intratumoural stroma content and absence of a stroma reaction at the invasive front (SARIFA-positivity) are warranted and may inform future treatment decisions in CRC patients

Prevalence of Salmonella serotypes on pig carcasses from high- and low-risk herds slaughtered in three abattoirs

The aim of this study was to compare the prevalence of Salmonella serotypes at two different sites on pig carcasses from herds classified as high-risk or low-risk and to elucidate the relationship between carcass contamination levels and serological status. Caecal samples and carcass surface swabs were cultured for Salmonella from a total of 210 pigs from low risk herds (\u3c 19 % of pigs in herd Salmonella seropositive) and 209 pigs from high risk herds (\u3e 32% of pigs in herd Salmonella seropositive) in three abattoirs