Using normalisation process theory to understand barriers and facilitators to implementing mindfulness-based stress reduction for people with multiple sclerosis

Objectives: To study barriers and facilitators to implementation of mindfulness-based stress reduction for people with multiple sclerosis. Methods: Qualitative interviews were used to explore barriers and facilitators to implementation of mindfulness-based stress reduction, including 33 people with multiple sclerosis, 6 multiple sclerosis clinicians and 2 course instructors. Normalisation process theory provided the underpinning conceptual framework. Data were analysed deductively using normalisation process theory constructs (coherence, cognitive participation, collective action and reflexive monitoring). Results: Key barriers included mismatched stakeholder expectations, lack of knowledge about mindfulness-based stress reduction, high levels of comorbidity and disability and skepticism about embedding mindfulness-based stress reduction in routine multiple sclerosis care. Facilitators to implementation included introducing a pre-course orientation session; adaptations to mindfulness-based stress reduction to accommodate comorbidity and disability and participants suggested smaller, shorter classes, shortened practices, exclusion of mindful-walking and more time with peers. Post-mindfulness-based stress reduction booster sessions may be required, and objective and subjective reports of benefit would increase clinician confidence in mindfulness-based stress reduction. Discussion: Multiple sclerosis patients and clinicians know little about mindfulness-based stress reduction. Mismatched expectations are a barrier to participation, as is rigid application of mindfulness-based stress reduction in the context of disability. Course adaptations in response to patient needs would facilitate uptake and utilisation. Rendering access to mindfulness-based stress reduction rapid and flexible could facilitate implementation. Embedded outcome assessment is desirable

More than simply hanging out : The nature of participant observation and research relationships

Participant observation is a research activity used in qualitative inquiry, particularly ethnography, where the aim is to understand the meanings and experiences of social actors. Researchers employing this activity take part in people\u27s lives as a way of learning about them and their culture, and to gain understanding of social life processes. Often these activities in the field are referred to as hanging out : that is, interacting with participants in an uncontrived fashion as they go about their daily lives. Participation observation is multifaceted: participant observation is conducted within the framework of scientists\u27 own and others\u27 life worlds; participant observers try to experience the lives of others to the extent possible; researchers\u27 relationships with participants, often personally and emotionally involved, are central to success; participant observers are present in the field concurrently in multiple dimensions; the situations that settings present determine, for the most part, researchers\u27 experiences; and, as situations and participants\u27 lives unfold, so do researchers\u27 experiences. In settings, these aspects coalesce to result in many unknowns and complexities for participant observers. This study examined the lived experiences of scientists who used participant observation as a research activity. Using Seidman\u27s (1998) three-interview structure, I interviewed twelve researchers about their participant observation experiences. Two questions central to my study were what meaning do participant observers give to their participant observation experiences and to their research relationships? Phenomenology as my lens allowed me to access the complexity of this research method, particularly relationships formed for research purpose, from the perspectives of participant observers. I used van Manen\u27s (1990) empirical approach to phenomenological research that involves the interplay of the following six research activities: (1) Turning to the nature of lived experience; (2) Investigating experience as we live it; (3) Reflecting on the essential themes; (4) The art of writing and rewriting; (5) Maintaining a strong and oriented relation; and, (6) Balancing the research context by considering parts and whole. Based on my analysis of my participants\u27 accounts of their experiences, first I identify and characterize using the following terms five essential themes of participant observation arising from my participants\u27 experiences: existential, experiential, multidimensional, situational, and processual. I then describe essential themes of participant observation relationships. I identify them as having a professional/personal duality, built on commonalities, and trustful, respectful, and reciprocal. Within each theme, I describe constitutive components using my participants\u27 words wherever possible. Following, I explore implications of my findings in two areas and suggest directions for future inquiry: one area concerns the nature of participant observation and the preparation of scientists who engage in it; the second area concerns informed consent in participant observation research

Infant and early childhood dietary predictors of overweight at age 8 years in the CAPS population

BACKGROUND/OBJECTIVES: Programs to address obesity are a high priority for public policy especially for young children. Research into dietary determinants of obesity is challenging but important for rational planning of interventions to prevent obesity, given that both diet and energy expenditure influence weight status. We investigated whether early life dietary factors were predictive of weight status at 8 years in a cohort of Australian children. SUBJECTS/METHODS: We used data from the Childhood Asthma Prevention Study-a birth cohort at high risk of asthma. Dietary data (3-day weighed food records) were collected at 18 months and height, weight and waist circumference were collected at 8 years. We assessed the relationship between dietary predictor variables and measures of adiposity using linear regression. RESULTS: Intakes of protein, meat and fruit at age 18 months were positively associated with measures of adiposity at age 8 years, namely, body mass index and/or waist circumference. We also showed a significant negative relationship between these measures of adiposity at 8 years and intake at 18 months of dairy foods as a percent of total energy, and intake of energy dense cereal-based foods such as cookies and crackers. CONCLUSIONS: This birth cohort study with rigorous design, measures and analyses, has shown a number of associations between early dietary intake and subsequent adiposity that contribute to the growing evidence base in this important field.National Health and Medical Research Council of AustraliaHjärt- och LungfondenSvenska LäkarsällskapetManuscrip

Clinical characteristics, activity levels and mental health problems in children with long coronavirus disease: a survey of 510 children

Background: Whether long coronavirus disease pertains to children as well is not yet clear. Methods: The authors performed a survey in children suffering from persistent symptoms since initial infection. A total of 510 children infected between January 2020 and January 2021 were included. Results: Symptoms such as fatigue, headache, muscle and joint pain, rashes and heart palpitations and issues such as lack of concentration and short-term memory problems were particularly frequent and confirm previous observations, suggesting that they may characterize this condition. Conclusion: A better comprehension of long coronavirus disease is urgently needed

Developing a comparative marine socio-economic framework for the European Atlantic Area

Availability and easy access to a wide range of natural and human-activity data on the oceans and coastal regions of Europe is the basis for strategic decision-making on coastal and marine policy. Strategies within Europe’s Integrated Maritime Policy, including the Maritime Strategy for the Atlantic Area, Blue Growth, Maritime Spatial Planning and Marine Data and Knowledge, require coherent and comparable socio-economic data across European countries. Similarly, the Marine Strategy Framework Directive requires member states to carry out economic and social analysis of their waters and the reformed Common Fisheries Policy includes a social dimension requiring socio-economic data. However, the availability of consistent, accessible marine socio-economic data for the European Atlantic Arc regions is limited. Ocean economy studies have been undertaken in some countries (for example, Ireland, France, and UK) but timescales and methodologies are not necessarily comparable. Marnet is an EU transnational co-operation project involving eight partners from five member states of the Atlantic Area (Ireland, Spain, UK, France and Portugal). Marnet has developed a methodology to collate comparable marine socio-economic data across the Atlantic regions. The comparative marine socio-economic information system developed by Marnet could provide a template for other European States to follow that could potentially facilitate the construction of a Europe-wide marine economic information system as envisaged under the EU Integrated Maritime Policy

Altered Glycosylated PrP Proteins Can Have Different Neuronal Trafficking in Brain but Do Not Acquire Scrapie-like Properties

N-Linked glycans have been shown to have an important role in the cell biology of a variety of cell surface glycoproteins, including PrP protein. It has been suggested that glycosylation of PrP can influence the susceptibility to transmissible spongiform encephalopathy and determine the characteristics of the many different strains observed in this particular type of disease. To understand the role of carbohydrates in influencing the PrP maturation, stability, and cell biology, we have produced and analyzed gene-targeted murine models expressing differentially glycosylated PrP. Transgenic mice carrying the PrP substitution threonine for asparagine 180 (G1) or threonine for asparagine 196 (G2) or both mutations combined (G3), which eliminate the first, second, and both glycosylation sites, respectively, have been generated by double replacement gene targeting. An in vivo analysis of altered PrP has been carried out in transgenic mouse brains, and our data show that the lack of glycans does not influence PrP maturation and stability. The presence of one chain of sugar is sufficient for the trafficking to the cell membrane, whereas the unglycosylated PrP localization is mainly intracellular. However, this altered cellular localization of PrP does not lead to any overt phenotype in the G3 transgenic mice. Most importantly, we found that, in vivo, unglycosylated PrP does not acquire the characteristics of the aberrant pathogenic form (PrPSc), as was previously reported using in vitro models

Study protocol for a randomised controlled trial of invasive versus conservative management of primary spontaneous pneumothorax

INTRODUCTION: Current management of primary spontaneous pneumothorax (PSP) is variable, with little evidence from randomised controlled trials to guide treatment. Guidelines emphasise intervention in many patients, which involves chest drain insertion, hospital admission and occasionally surgery. However, there is evidence that conservative management may be effective and safe, and it may also reduce the risk of recurrence. Significant questions remain regarding the optimal initial approach to the management of PSP

Chemoreflex Mediated Arrhythmia during Apnea at 5050m in Low but not High Altitude Natives

Peripheral chemoreflex mediated increases in both parasympathetic and sympathetic drive under chronic hypoxia may evoke bradyarrhythmias during apneic periods. We determined whether 1) voluntary apnea unmasks arrhythmia at low (344 m) and high (5,050 m) altitude, 2) high-altitude natives (Nepalese Sherpa) exhibit similar cardiovagal responses at altitude, and 3) bradyarrhythmias at altitude are partially chemoreflex mediated. Participants were grouped as Lowlanders ( n = 14; age = 27 ± 6 yr) and Nepalese Sherpa ( n = 8; age = 32 ± 11 yr). Lowlanders were assessed at 344 and 5,050 m, whereas Sherpa were assessed at 5,050 m. Heart rate (HR) and rhythm (lead II ECG) were recorded during rest and voluntary end-expiratory apnea. Peripheral chemoreflex contributions were assessed in Lowlanders ( n = 7) at altitude after 100% oxygen. Lowlanders had higher resting HR at altitude (70 ± 15 vs. 61 ± 15 beats/min; P &lt; 0.01) that was similar to Sherpa (71 ± 5 beats/min; P = 0.94). High-altitude apnea caused arrhythmias in 11 of 14 Lowlanders [junctional rhythm ( n = 4), 3° atrioventricular block ( n = 3), sinus pause ( n = 4)] not present at low altitude and larger marked bradycardia (nadir −39 ± 18 beats/min; P &lt; 0.001). Sherpa exhibited a reduced bradycardia response during apnea compared with Lowlanders ( P &lt; 0.001) and did not develop arrhythmias. Hyperoxia blunted bradycardia (nadir −10 ± 14 beats/min; P &lt; 0.001 compared with hypoxic state) and reduced arrhythmia incidence (3 of 7 Lowlanders). Degree of bradycardia was significantly related to hypoxic ventilatory response (HVR) at altitude and predictive of arrhythmias ( P &lt; 0.05). Our data demonstrate apnea-induced bradyarrhythmias in Lowlanders at altitude but not in Sherpa (potentially through cardioprotective phenotypes). The chemoreflex is an important mechanism in genesis of bradyarrhythmias, and the HVR may be predictive for identifying individual susceptibility to events at altitude. NEW &amp; NOTEWORTHY The peripheral chemoreflex increases both parasympathetic and sympathetic drive under chronic hypoxia. We found that this evoked bradyarrhythmias when combined with apneic periods in Lowlanders at altitude, which become relieved through supplemental oxygen. In contrast, high-altitude residents (Nepalese Sherpa) do not exhibit bradyarrhythmias during apnea at altitude through potential cardioprotective adaptations. The degree of bradycardia and bradyarrhythmias was related to the hypoxic ventilatory response, demonstrating that the chemoreflex plays an important role in these findings. </jats:p

A digital intervention for adolescent depression ‘MoodHwb’: mixed-methods feasibility evaluation

Background: Treatment and prevention guidelines highlight the key role of health information and evidence-based psychosocial interventions for adolescent depression. Digital health technologies and psychoeducational interventions have been recommended to help engage young people, provide accurate health information, enhance self-management skills and promote social support. However, few digital psychoeducational interventions for adolescent depression have been robustly developed and evaluated. Objective: We aimed to evaluate the feasibility, acceptability and potential impact of a theory-informed, co-designed digital intervention programme, ‘MoodHwb’. Methods: We used a mixed-methods (quantitative and qualitative) approach to evaluate the programme and the assessment process. Adolescents with or at elevated risk of depression and their parents/carers were recruited from mental health services, school counsellors/nurses and participants from a previous study. They completed questionnaires before and after the programme (to gather views and assess changes in mood, knowledge/attitudes and behaviour), and their Web usage was monitored. A subsample was also interviewed. A focus group was conducted with professionals from health, education, social and youth services/charities. Interview and focus group transcripts were analysed using inductive thematic analysis with NVivo 10. Results: Forty-four young people and 31 parents/carers were recruited, and 36 (82%) young people and 21 (68%) parents/carers completed follow-up questionnaires. Nineteen young people and 12 parents/carers were interviewed. Thirteen professionals from a range of disciplines participated in the focus group. Overall, participants found the intervention engaging, clear, user-friendly, comprehensive and helpful (particularly the ‘self help’ section), and stated it could be integrated into existing services. The findings provided initial support for the intervention programme theory, for example depression literacy improved after using the intervention. Conclusions: Findings from this early-stage evaluation suggest that ‘MoodHwb’ and the assessment process were feasible and acceptable, and that the intervention has potential to be helpful for young people and families/carers as an early intervention programme in health, education, youth and social services/charities. A randomised controlled trial is needed to further evaluate the digital programme