Work of the NHS England Youth Forum and its effect on health services.

©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.AIM: To examine the role of members of the NHS England Youth Forum (NHSEYF) and the strategies used to influence health service provision for children and young people. METHOD: An evaluative mixed-methods study was commissioned by NHS England and undertaken by the University of Hertfordshire between July 2015 and September 2016. Data collection comprised activity logs, a form of questionnaire, and semi-structured interviews. FINDINGS: The analysis of the activity logs revealed that the young people were undertaking a wide range of activities across England. Seven themes emerged from the interviews: the young people; motivation; commitment; community (the local area as well as a community spirit); knowledge experts; youth workers; and funding. In summary, the members of the NHSEYF were committed to their role and their work was having a positive effect on health service provision. CONCLUSION: The NHSEYF has developed rapidly and successfully. It is enabling the voice of young people to be heard.Peer reviewedFinal Published versio

An Evaluation of the NHS England Youth Forum

More than five decades ago the Platt Report (Ministry of Health, 1959) recommended that hospitalised children needed to be treated differently to adults. It took until the 1980s for evidence to emerge that healthcare staff were beginning to implement Platt’s recommendations; Davies (2010) attributes this long awaited change of approach to a new generation of practitioners and a renewed focus from the Government that acknowledged the distinct needs of children and young people. In the early 1990s James and Prout (1990) produced work to suggest that children should not be viewed as passive recipients of care but should be recognised as having their own voice, referred to as the “emergence of children’s voice” (Hallett and Prout, 2003: 1)Peer reviewedFinal Published versio

Drought climate adaptation program: producing enhanced agricultural crop insurance systems: summary report

Queensland farmers are subject to highly variable climatic conditions, including drought and floods, which can undermine production. Insurance could play an important role in helping Queensland farmers manage their climate risk. However, currently, the use of insurance to manage climate-related production risk is poorly understood and utilised by farmers. This project aims to address this gap by providing information on climate risks and the role of insurance for managing these. This project conducted focused reviews on climate risk in agriculture and on how insurance products could be used to address these risks. The project also carried out on-ground surveys from cotton and sugar industry and conducted modelling to assess risks and the role of insurance for cotton and sugar cane farmers in Queensland. Prototype climate assessment risk and reporting tools were also developed. The reviews carried out in this project identified that Queensland’s agricultural sector is highly exposed to production volatility as a result of weather risks. It is our view that the Queensland agricultural sector has an excellent opportunity to provide its farmers with protection against uninsured seasonal risks to crop production. Key climate and farming systems risks were identified by interviewing a total of 55 farmers (23 cotton growers and 32 sugar cane growers) across Queensland. Key climate risks to the cotton industry include hail, drought/dry years (lack of rainfall during planting and season), quality downgrade (discolouration), excessive heat, floods and wet weather (during the season and especially during harvest). Similarly, for the sugar industry, key climate risks include drought, flood, excessive rainfall during harvest, cyclone, pests and disease. Key messages from farmer surveys are that current insurance products available to Queensland farmers (specifically, cotton and sugar cane farmers) may not address critical risks to the production and/or profitability of these systems and that farmers would prefer to have comprehensive insurance products available that cover them against profitability losses across multiple risk factors. Based on survey findings three prototype insurance products were developed for the cotton industry Insurance products developed were Drought Cover: insufficient rainfall during the planting season – August to November; Drought Cover: insufficient rainfall during growing season – November to February; and Wet Harvest Cover: excessive rainfall during harvest season – March to June. Two prototype insurance products were developed for the sugar industry. They include; Cyclone Cover: crop damage during cyclone season – November to April; and Wet Harvest Cover: excessive rainfall during harvest season – June to December Rainfall-indexed based worked examples were also developed for sugar and cotton industry growers

Drought climate adaptation program: producing enhanced agricultural crop insurance systems: final report

Queensland farmers are subject to highly variable climatic conditions, including drought and floods, which can undermine production. Insurance could play an important role in helping Queensland farmers manage their climate risk. However, currently the use of insurance to manage climate related production risk is poorly understood and utilised by farmers. This project aims to address this gap by providing information on climate risks and the role of insurance for managing these. This project conducted focussed reviews on climate risk in agriculture and on how insurance products could be used to address these risks. The project also carried out on-ground surveys from cotton and sugar industry and conducted modelling to assess risks and the role of insurance for cotton and sugar cane farmers in Queensland. Prototype climate assessment risk and reporting tools were also developed. The reviews carried out in this project identified that Queensland’s agricultural sector is highly exposed to production volatility as a result of weather risks. It is our view that the Queensland agricultural sector has an excellent opportunity to provide its farmers with protection against uninsured seasonal risks to crop production. Key climate and farming systems risks were identified by interviewing a total of 55 farmers (23 cotton growers and 32 sugar cane growers) across Queensland. Key climate risks to the cotton industry include hail, drought/dry years (lack of rainfall during planting and season), quality downgrade (discolouration), excessive heat, floods and wet weather (during season and especially during harvest). Similarly, for the sugar industry, key climate risks include, drought, flood, excessive rainfall during harvest, cyclone, pests and disease. Key messages from farmer surveys are that current insurance products available to Queensland farmers (specifically, cotton and sugar cane farmers) may not address critical risks to the production and/or profitability of these systems and that farmers would prefer to have comprehensive insurance products available that cover them against profitability losses across multiple risk factors. A ‘climate and agricultural risk assessment and reporting tool’ (prototype) was developed as part of the project. This ‘tool’ allows quantification of key climate risks, initially for the sugar and cotton industry. The tool provides an option to generate a detail climate risk report based on historical data and a future seasonal climate forecast for an individual location. The tool data also serves as a dataset portal, allowing for the download of data in a required template. Cotton and sugarcane crop models APSIM and DSSAT were employed to simulate the growth and yield for 10 and 12 sites, respectively, across Queensland over the period 1940-2017 for various crop management factors. Comparing the simulated yields (from each model or the mean simulated value from ensemble models) to the observed yield (available at regional scale) the trend in year to year variability is satisfactorily captured for cotton on average, whereas for sugarcane there is a trend to overestimate or underestimate the yield depending on the site. Based on survey findings three prototype insurance products were developed for the cotton industry Insurance products developed were Drought Cover: insufficient rainfall during the planting season – August to November; Drought Cover: insufficient rainfall during growing season – November to February; and Wet Harvest Cover: excessive rainfall during harvest season – March to June. Two prototype insurance products were developed for sugar industry. They include; Cyclone Cover: crop damage during cyclone season – November to April; and Wet Harvest Cover: excessive rainfall during harvest season – June to December. Rainfall-indexed based worked examples were also developed for sugar and cotton industry growers to better appreciate the insurance mechanisms

Drought climate adaptation program: producing enhanced agricultural crop insurance systems: final report

Queensland farmers are subject to highly variable climatic conditions, including drought and floods, which can undermine production. Insurance could play an important role in helping Queensland farmers manage their climate risk. However, currently the use of insurance to manage climate related production risk is poorly understood and utilised by farmers. This project aims to address this gap by providing information on climate risks and the role of insurance for managing these. This project conducted focussed reviews on climate risk in agriculture and on how insurance products could be used to address these risks. The project also carried out on-ground surveys from cotton and sugar industry and conducted modelling to assess risks and the role of insurance for cotton and sugar cane farmers in Queensland. Prototype climate assessment risk and reporting tools were also developed. The reviews carried out in this project identified that Queensland’s agricultural sector is highly exposed to production volatility as a result of weather risks. It is our view that the Queensland agricultural sector has an excellent opportunity to provide its farmers with protection against uninsured seasonal risks to crop production. Key climate and farming systems risks were identified by interviewing a total of 55 farmers (23 cotton growers and 32 sugar cane growers) across Queensland. Key climate risks to the cotton industry include hail, drought/dry years (lack of rainfall during planting and season), quality downgrade (discolouration), excessive heat, floods and wet weather (during season and especially during harvest). Similarly, for the sugar industry, key climate risks include, drought, flood, excessive rainfall during harvest, cyclone, pests and disease. Key messages from farmer surveys are that current insurance products available to Queensland farmers (specifically, cotton and sugar cane farmers) may not address critical risks to the production and/or profitability of these systems and that farmers would prefer to have comprehensive insurance products available that cover them against profitability losses across multiple risk factors. A ‘climate and agricultural risk assessment and reporting tool’ (prototype) was developed as part of the project. This ‘tool’ allows quantification of key climate risks, initially for the sugar and cotton industry. The tool provides an option to generate a detail climate risk report based on historical data and a future seasonal climate forecast for an individual location. The tool data also serves as a dataset portal, allowing for the download of data in a required template. Cotton and sugarcane crop models APSIM and DSSAT were employed to simulate the growth and yield for 10 and 12 sites, respectively, across Queensland over the period 1940-2017 for various crop management factors. Comparing the simulated yields (from each model or the mean simulated value from ensemble models) to the observed yield (available at regional scale) the trend in year to year variability is satisfactorily captured for cotton on average, whereas for sugarcane there is a trend to overestimate or underestimate the yield depending on the site. Based on survey findings three prototype insurance products were developed for the cotton industry Insurance products developed were Drought Cover: insufficient rainfall during the planting season – August to November; Drought Cover: insufficient rainfall during growing season – November to February; and Wet Harvest Cover: excessive rainfall during harvest season – March to June. Two prototype insurance products were developed for sugar industry. They include; Cyclone Cover: crop damage during cyclone season – November to April; and Wet Harvest Cover: excessive rainfall during harvest season – June to December. Rainfall-indexed based worked examples were also developed for sugar and cotton industry growers to better appreciate the insurance mechanisms

Tropical cyclone insurance for Queensland agriculture

This report is for Queensland agricultural producers and related industries as well as local and state governments interested in insurance options that mitigate the financial risks associated with cyclones. The report outlines the risks and impacts of cyclones on the Queensland agricultural sector and the availability of insurance solutions to mitigate the financial consequences of such events. The cyclone insurance solutions outlined in this report are preliminary and the parameters and pricing will vary according to the location covered and as more data become available

Women In the weighing room: gender discrimination on the thoroughbred racetrack

Women jockeys are a small minority on the thoroughbred racetrack and securesignificantly fewer racing mounts than their male counterparts. This suggests female jockeys are facing discriminatory barriers, in one of the only major professional sportswhere men and women compete against each other on equal terms. This exploratorystudy considers discriminatory barriers that exist and the effects they have on women’scomparative profile and participation in the flat racing industry. Six participants wererecruited for the study from different areas within the industry, and with at least threeyears experience. Information was derived from semi structured individual interviews. The data was analysed using discourse analysis techniques. Five main themes wereevident: a culture of sexism, including the sense that women are more nurturing;opportunities, including for women to become trainers; body shape and strength; riskand danger; industry fashion and trends. The results from this study suggest women face discrimination in horseracing onaccount of a number of factors, the three main perceived reasons are due to theirphysical strength, body shape and the tradition and history embedded within theindustry. Whilst there is a shift starting to occur where more women are coming throughin flat racing, this is slow. Participants consider that women may find these barriers andperceptions held by others difficult to overcome, which may result in their inability toachieve equality in this sport. Given the exploratory character of the study, conclusionsare tentative and we propose a number of areas for further research

Making environmental and health equal, diverse, and inclusive: Reflections from a Centre of Environment and Human Health (REACH)

The REACH Project has allowed the Centre to take initial stock of current and future research and training as well as the Centre culture through a lens of decolonisation and anti-racism. The Reflections from a Centre of Environment and Human Health (REACH) Project was funded under the Natural Environment Research Council (NERC) Making environment and health equal, diverse, and inclusive Programme

Psychological and pharmacological interventions for post-traumatic stress disorder and comorbid mental health problems following complex traumatic events: systematic review and component network meta-analysis

Background: Complex traumatic events associated with armed conflict, forcible displacement, childhood sexual abuse and domestic violence are increasingly prevalent. People exposed to complex traumatic events are at not only at risk of post-traumatic stress disorder (PTSD) but also other mental health comorbidities. While evidence-based psychological and pharmacological treatments are effective for single event PTSD it is not known if people who have experienced complex traumatic events can benefit and tolerate these commonly available treatments. Furthermore, it is not known which components of psychological interventions are most effective for managing PTSD in this population. We performed a systematic review and component network meta-analysis to assess the effectiveness of psychological and pharmacological interventions for managing mental health problems in people exposed to complex traumatic events.Methods and Findings: We searched CINAHL, Cochrane Central Register of Controlled Trials, EMBASE, International Pharmaceutical Abstracts, MEDLINE, Published International Literature on Traumatic Stress, PsycINFO, and Science Citation Index for randomised and non-randomised controlled trials of psychological and pharmacological treatments for PTSD symptoms n people exposed to complex traumatic events, published up to 25th October 2019. We adopted a non-diagnostic approach and included studies of adults who have experienced complex trauma. Complex trauma sub-groups were: veterans; childhood sexual abuse; war-affected; refugees; and domestic violence. The primary outcome was reduction in PTSD symptoms. Secondary outcomes were depressive and anxiety symptoms, quality of life, sleep quality, and positive and negative affect. We included 116 studies, of which 50 were conducted in hospital settings, 24 were delivered in community settings, seven were delivered in military clinics for veterans or active military personnel, five were conducted in refugee camps, four used remote delivery via web based or telephone platforms, four were conducted in specialist trauma clinics, two were delivered in home settings, and two were delivered in primary care clinics; clinical setting was not reported in 17 studies. Ninety-four RCTs for a total of 6158 participants were included in meta-analyses across the primary and secondary outcomes; 19 RCTs for a total of 933 participants were included in the component network meta-analysis. The mean age of participants in the included RCTs was 42.6 ±9.3 years, and 42% were male. Nine non-randomised controlled trials were included. The mean age of participants in the non-randomised controlled trials was 40.6 ±9.4 years, and 47% were male. The average length of follow-up across all included studies at post-treatment for the primary outcome was 11.5 weeks. The pair-wise meta-analysis showed that psychological interventions reduce PTSD symptoms more than inactive control (k=46; n=3389; standardised mean difference, SMD=-0.82, 95% CI: -1.02 to -0.63) and active control (k-9; n=662; SMD=-0.35, 95% CI: -0.56 to -0.14) at post-treatment, and also compared with inactive control at 6-month follow-up (k=10; n=738; SMD=-0.45, 95% CI: -0.82 to -0.08). Psychological interventions reduced depressive symptoms (k=31; n=2075; SMD=-0.87, 95% CI: -1.11 to -0.63; I2=82.7%, p=0.000) and anxiety (k=15; n=1395; SMD=-1.03, 95% CI: -1.44 to -0.61; p=0.000) at post-treatment comparted with inactive control. Sleep quality was significantly improved at post-treatment by psychological interventions compared with inactive control (k=3; n=111; SMD=-1.00, 95% CI: -1.49 to-0.51; p=0.245). There were no significant differences between psychological interventions and inactive control group at post-treatment for quality of life (k=6; n=401; SMD=0.33, 95% CI: -0.01 to 0.66; p=0.021). Antipsychotic medicine (k=5; n=364; SMD=–0.45; –0.85 to –0.05; p=0.085) and Prazosin (k=3; n=110; SMD=-0.52; -1.03 to -0.02; p=0.182) were effective in reducing PTSD symptoms. Phase-based psychological interventions that included skills based strategies along with trauma-focused strategies were the most promising interventions for emotional dysregulation and interpersonal problems. Compared with pharmacological interventions we observed that psychological interventions were associated with greater reductions in PTSD and depression symptoms and improved sleep quality. Sensitivity analysis showed that psychological interventions were acceptable with lower drop out, even in studies rated at low risk of attrition bias. Trauma-focused psychological interventions were superior to non-trauma focused interventions across trauma sub-groups for PTSD symptoms, but effects among veterans and war-affected populations were significantly reduced. The network meta-analysis showed that multi-component interventions that included cognitive restructuring and imaginal exposure were the most effective for reducing PTSD symptoms (k=17; n=1077; mean difference=-37.95, 95% CI: -60.84 to -15.16). Our use of a non-diagnostic inclusion strategy may have over-looked certain complex trauma populations with severe and enduring mental comorbidities. Additionally, the relative contribution of skills-based intervention components were not feasibly evaluated in the network meta-analysis.Conclusions: In this systematic review and meta-analysis we observed that trauma-focused psychological interventions are effective for managing mental health problems and comorbidities in people exposed to complex trauma. Multi-component interventions, which can include phase-based approaches, were the most effective treatment package for managing PTSD in complex trauma. Establishing optimal ways to deliver multicomponent psychological interventions for people exposed to complex traumatic events is a research and clinical priority