Paediatric nurses' attitudes towards the promotion of healthy eating

This study assessed paediatric nurses' attitudes towards promoting healthy eating and their opinions regarding nurses as role models for health. In all, 67 nurses from 14 wards at an acute hospital trust completed questionnaires on weight, diet, physical activity, self-efficacy and attitudes towards nurses as role models for health. Forty-eight percent felt that they could incorporate health promotion into their patient care better, and 84% believed that nurses should present themselves as role models for health. Nurses felt that their own health behaviours influenced the quality of their care: 77% reported that patients and families would heed advice better from those who appeared to follow it themselves, and 48% reported difficulties in promoting health behaviours they did not adhere to themselves. These views were inconsistent with their own lifestyle choices, since one third of respondents did not meet physical-activity guidelines, almost half were an unhealthy weight, and the majority did not consume five portions of fruits/vegetables per day. Paediatric nurses identified barriers and facilitators to promoting healthy eating. Education, training and access to evidence-based resources may help to increase paediatric nurses' confidence to promote healthy eating to children and their families. Hospital workplaces should make provision to support nurses who seek to improve their own health

Formative interventions and practice-development: A methodological perspective on teacher rounds

Highlights • We examine Rounds in education from a methodological perspective. • In doing so, we class Rounds as a formative intervention and compare it to another means of formative intervention—Developmental Work Research. • We raise three methodological issues about both types of formative intervention: the role of theory; the relationship between the individual and the collective; and the meaning of collaboration

Financial incentives for smoking cessation in pregnancy: a single-arm intervention study assessing cessation and gaming.

AIMS: Financial incentives were the single most effective intervention for smoking cessation in pregnancy in a recent Cochrane Review, but based on a few small trials in the United States using only 7-day point prevalence measures of cessation. This study estimates (a) prolonged cessation in an unselected population of English pregnant smokers who are offered financial incentives for quitting and (b) 'gaming', i.e. false reporting of smoking status to enter the scheme or gain an incentive. DESIGN: Single-arm intervention study SETTING: Antenatal clinic and community PARTICIPANTS: A total of 239 pregnant smokers enrolled into the financial incentive scheme, attending for maternity care at one hospital in an area of high deprivation in England over a 42-week period. MEASUREMENTS: Smoking cessation at delivery and 6 months postpartum, assessed using salivary cotinine; gaming assessed using urinary and salivary cotinine at enrolment, 28 and 36 weeks gestation, and 2 days and 6 months postpartum. FINDINGS: Thirty-nine per cent (239 of 615) of smokers were enrolled into the scheme, 60% (143 of 239) of whom made a quit attempt. Of those enrolled, 20% [48 of 239; 95% confidence interval (CI) = 14.9%, 25.1%] were quit at delivery and 10% (25 of 239; 95% CI = 6.2%, 13.8%) at 6 months postpartum. There was no evidence that women gamed to enter the scheme, but evidence that 4% (10 of 239) of those enrolled gamed on one or more occasions to gain vouchers. CONCLUSIONS: Enrolment on an incentive scheme in an unselected English cohort of pregnant smokers was associated with prolonged cessation rates comparable to those reported in US trials. Rates of gaming were arguably insufficiently high to invalidate the use of such schemes.The scheme was funded by NHS Derbyshire County Primary Care Trust/Derbyshire County Council (from 1st 10 April 2013) Evaluation of the scheme was funded by the Wellcome Trust as part of a Strategic Award in Biomedical Ethics; program title: "The Centre for the Study of Incentives in Health"; grant number: 086031/Z/08/Z; PI Prof. TM Marteau. 086031/Z/08/Z).This is the final version of the article. It was first published by Wiley at http://onlinelibrary.wiley.com/doi/10.1111/add.12817/abstrac

Adolescent smoking and tertiary education: opposing pathways linking socio-economic background to alcohol consumption

Background and Aims If socio-economic disadvantage is associated with more adolescent smoking, but less participation in tertiary education, and smoking and tertiary education are both associated with heavier drinking, these may represent opposing pathways to heavy drinking. This paper examines contextual variation in the magnitude and direction of these associations. Design Comparing cohort studies. Setting United Kingdom. Participants Participants were from the 1958 National Child Development Study (NCDS58; n = 15 672), the British birth cohort study (BCS70; n = 12 735) and the West of Scotland Twenty-07 1970s cohort (T07; n = 1515). Measurements Participants self-reported daily smoking and weekly drinking in adolescence (age 16 years) and heavy drinking (> 14/21 units in past week) in early adulthood (ages 22?26 years). Parental occupational class (manual versus non-manual) indicated socio-economic background. Education beyond age 18 was coded as tertiary. Models were adjusted for parental smoking and drinking, family structure and adolescent psychiatric distress. Findings Respondents from a manual class were more likely to smoke and less likely to enter tertiary education (e.g. in NCDS58, probit coefficients were 0.201 and ?0.765, respectively; P < 0.001 for both) than respondents from a non-manual class. Adolescent smokers were more likely to drink weekly in adolescence (0.346; P < 0.001) and more likely to drink heavily in early adulthood (0.178; P < 0.001) than adolescent non-smokers. Respondents who participated in tertiary education were more likely to drink heavily in early adulthood (0.110 for males, 0.182 for females; P < 0.001 for both) than respondents with no tertiary education. With some variation in magnitude, these associations were consistent across all three cohorts. Conclusions In Britain, young adults are more likely to drink heavily both if they smoke and participate in tertiary education (college and university) despite socio-economic background being associated in opposite directions with these risk factors

Enhanced smoking cessation support for newly abstinent smokers discharged from hospital (The Hospital to Home trial): A randomised controlled trial

Background and aimsThe United Kingdom's National Institute for Health and Care Excellence guidance (NICE PH48) recommends that pharmacotherapy combined with behavioural support be provided for all smokers admitted to hospital; however, relapse to smoking after discharge remains common. This study aimed to assess the effect of adding home support for newly?abstinent smokers to conventional NICE?recommended support in smokers discharged from hospital.Designindividually?randomised parallel group trial.SettingOne UK acute hospital.Participants404 smokers aged >18 admitted to acute medical wards between June 2016 and July 2017 were randomised in equal numbers to each treatment group.Interventions and comparatorsThe intervention provided 12 weeks of at?home cessation support which included help in maintaining a smoke?free home, help in accessing and using medication, further behavioural support and personalised feedback on home air quality. The comparator was NICE PH48 care as usual.MeasuresThe primary outcome was self?reported continuous abstinence from smoking validated by an exhaled carbon monoxide level ?6ppm four?weeks after discharge from hospital.FindingsIn an intention?to?treat analysis at the four?week primary endpoint, 38 participants (18.8%) in the usual care group and 43 (21.3%) in the intervention group reported continuous abstinence from smoking (odds ratio 1.17, 95% confidence interval 0.72 to 1.90, Bayes factor 0.33). There were no significant differences in any secondary outcomes, including self?reported cessation at 3 months, having a smoke?free home, or number of cigarettes smoked per day in those who did not quit.ConclusionsProvision of a home visit and continued support to prevent relapse to smoking after hospital discharge did not appear to increase subsequent abstinence rate above usual care in accordance with UK guidance from the National Institute of Health and Care Excellence

Community singing groups for people with chronic obstructive pulmonary disease: participant perspectives

Aim Chronic obstructive pulmonary disease (COPD) is a major public health issue which is irreversible and progressive, but previous research suggests that singing may have beneficial effects. The aim of this study was to establish the views of participants with COPD taking part in a singing for better breathing programme. Methods This was a descriptive qualitative study nested within a single-cohort feasibility study which included measures of lung function and wellbeing. Participants (n=37) were interviewed following a community singing programme that ran over ten months in South East England. Results Findings support those from previous studies regarding the impact of singing on respiratory wellbeing. These included: the teaching on breath control, relaxation and the breathing exercises; singing as a means to deflect attention away from breathing problems, leading to increased activity levels; and the mutual support for respiratory problems. Beyond the impact on breathing, the singing was also seen as fun, and provided friendship and a ‘feel-good’ factor which led to motivation to participate in further activities. For some it was the highlight of the week, and singing together in a group was felt to be central to the benefits experienced. Findings are compared with the quantitative measures within the same study. Conclusions The majority of participants reported improvements in respiratory symptoms as well as mental and social wellbeing following the programme. The study contributes to the evidence base in supporting and highlighting the consistently positive experiences of a large sample of participants, despite variable outcomes in clinical measures

The smart grid as commons: exploring alternatives to infrastructure financialisation

This paper explores a tension between financialisation of electricity infrastructures and efforts to bring critical urban systems into common ownership. Focusing on the emerging landscape of electricity regulation and e-mobility in the United Kingdom (UK), it examines how electricity grid ownership has become financialised, and why the economic assumptions that enabled this financialisation are being called into question. New technologies, such as smart electricity meters and electric vehicles, provide cities with new tools to tackle poor air quality and greenhouse gas emissions. Electricity grids are key enabling infrastructures but the companies that run them do not get rewarded for improving air quality or tackling climate change. UK government regulation of electricity grids both enables financialisation and forecloses opportunities to manage the infrastructure for wider environmental and public benefit. Nonetheless, the addition of smart devices to this network - the ‘smart grid’ – opens up an opportunity for common ownership of the infrastructure. Transforming the smart grid into commons necessitates deep structural reform to the entire architecture of infrastructure regulation in the UK

End of life care: The experiences of advance care planning amongst family caregivers of people with advanced dementia - A qualitative study

Background: End of life decisions for people with advanced dementia are reported as often being difficult for families as they attempt to make appropriate and justified decisions. Aim: To explore the experiences of advance care planning amongst family caregivers of people with advanced dementia. Design: Qualitative research including a series of single cases (close family relatives). Methods: A purposive sample of 12 family caregivers within a specialist dementia unit was interviewed about their experiences of advance care planning between August 2009 and February 2010. Results/Findings: Family caregivers need encouragement to ask the right questions during advance care planning to discuss the appropriateness of nursing and medical interventions at the end of life. Conclusions: Advance care planning can be facilitated with the family caregiver in the context of everyday practice within the nursing home environment for older people with dementia