In search of knowledge and understanding: working with individuals suffering from serious mental illness and their families

This research study describes a journey taken by ten health care professionals on an educational course, the English National Board for Nursing, Midwifery and Health Visiting (ENB) A28, which aimed to enable them to develop the therapeutic skills and confidence to work effectively with the families/carers of individuals suffering from a major mental illness. Their previous education and training had not equipped them to meet the clinical demands now made of them since the focus of mental health care relocated from hospital to the • community' . The course was based in a Family Intervention Service provided in an Inner London Mental Health Trust whose clinicians had developed a treatment model which they termed 'psychosocial' and combined systemic theory. expressed emotion research findings and limited behavioural methods. Grounded Theory was the chosen research method for this study as it was important to be able to access the experience and views of each student as they emerged. The students were interviewed twice, using a semi-structured interview schedule: at the beginning of the course and within three months after its completion. The questions posed at interview were informed following a pilot study of eight of the previous year's students. The students concluded that three elements in the course teaching had most contributed to achieving their aims; theory, practice and live supervision. The role of management and its influence in the clinical life of the students emerged as important. Consequently eight managers were interviewed and revealed the degree to which they supported both the students and the aims of the course. On this depended whether the Trust's clinical services would be able to maximise the benefits from its investment in this educational resource. A retrospective study by questionnaire. and subsidiary to the main investigation. is reported on in Appendices A through F. It focussed on the experience of students who had successfully completed the course during the previous years since its validation. As in the main study. the questionnaire was formulated from information given following a pilot study of eight of the previous year's student group. The aim was to ascertain the long term effects on their clinical practice. The results were analysed using a descriptive analysis technique. Although there had been changes to the original course. the findings were similar to those in the main study and showed the importance of theoretical understanding and supervised practice. Overall. the findings indicate that the respondents valued the systemic approach which was the cornerstone of the educational experience and continued to exert an influence on their practice. They gained an awareness of the extent to which social and family systems impacted on the lives of individuals during the lengthy course of major mental illness

A multi-level framework approach to improve organisational business process understanding within automotive manufacturing

This thesis was submitted for the award of Doctor of Philosophy and was awarded by Brunel University LondonBusiness processes are an integral part of today’s multinational corporations, allowing them to create best practice working models. Not only do business processes play an important role in defining working practices, they can also provide a basis for understanding and improvement. One key difficulty is to capture multiple aspects of a process. Capturing these allows an organisation to use these models for multiple purposes, such as learning while obtaining a high process maturity. There is not a single modelling technique that spans over multiple purposes. This research provides a critical overview of the literature of business process modelling to propose a multi-level framework (MLF). This framework aims to model a single crossfunctional process using multiple modelling techniques to address different organisational purposes and achieve a higher process maturity. Three modelling techniques were identified as appropriate to form part of such a framework: Rich Picture Diagrams (RPD), Business Process Modelling Notation (BPMN) and 4D ontologies. Design Science Research was used in three iterations to build the levels of the multi-level framework in an iterative and incremental design approach. The first two iterations used semistructured interviews to gather data, involve stakeholders and evaluate the models, whilst the third iteration proposes a method to develop and evaluate 4D ontologies. The created artefacts form the process overview (using RPD), application view (using BPMN) and semantic view (4D) levels for the final MLF of a cross-functional process. It addresses organisational purposes such as learning, process development and IT requirements, and covers maturity levels from process creation to optimisation. Involvement of stakeholders in the development and evaluation revealed high satisfaction with the provided views and increased their understanding of the process. Future work would further evaluate the overall framework and study the effects of full implementation within industry

Nature of the evidence base and frameworks underpinning dietary recommendations for prevention of non-communicable diseases: a position paper from the Academy of Nutrition Sciences

Abstract This Position Paper from the Academy of Nutrition Sciences is the first in a series which describe the nature of the scientific evidence and frameworks that underpin nutrition recommendations for health. This first paper focuses on evidence which underpins dietary recommendations for prevention of non-communicable diseases. It considers methodological advances made in nutritional epidemiology and frameworks used by expert groups to support objective, rigorous and transparent translation of the evidence into dietary recommendations. The flexibility of these processes allows updating of recommendations as new evidence becomes available. For CVD and some cancers, the paper has highlighted the long-term consistency of a number of recommendations. The innate challenges in this complex area of science include those relating to dietary assessment, misreporting and the confounding of dietary associations due to changes in exposures over time. A large body of experimental data is available that has the potential to support epidemiological findings, but many of the studies have not been designed to allow their extrapolation to dietary recommendations for humans. Systematic criteria that would allow objective selection of these data based on rigour and relevance to human nutrition would significantly add to the translational value of this area of nutrition science. The Academy makes three recommendations: (i) the development of methodologies and criteria for selection of relevant experimental data, (ii) further development of innovative approaches for measuring human dietary intake and reducing confounding in long-term cohort studies and (iii) retention of national nutrition surveillance programmes needed for extrapolating global research findings to UK populations.</jats:p

What can the food and drink industry do to help achieve the 5% free sugars goal?

Aims: To contribute evidence and make recommendations to assist in achieving free sugars reduction, with due consideration to the broader picture of weight management and dietary quality. Methods: An expert workshop in July 2016 addressed options outlined in the Public Health England report ‘Sugar reduction: The evidence for action’ that related directly to the food industry. Panel members contributed expertise in food technology, public heath nutrition, marketing, communications, psychology and behaviour. Recommendations were directed towards reformulation, reduced portion sizes, labelling and consumer education. These were evaluated based on their feasibility, likely consumer acceptability, efficacy and cost. Results: The panel agreed that the 5% target for energy from free sugars is unlikely to be achievable by the UK population in the near future, but a gradual reduction from average current level of intake is feasible. Progress requires collaborations between government, food industry, non-government organisations, health professionals, educators and consumers. Reformulation should start with the main contributors of free sugars in the diet, prioritising those products high in free sugars and relatively low in micronutrients. There is most potential for replacing free sugars in beverages using high-potency sweeteners and possibly via gradual reduction in sweetness levels. However, reformulation alone, with its inherent practical difficulties, will not achieve the desired reduction in free sugars. Food manufacturers and the out-of-home sector can help consumers by providing smaller portions. Labelling of free sugars would extend choice and encourage reformulation; however, government needs to assist industry by addressing current analytical and regulatory problems. There are also opportunities for multi-agency collaboration to develop tools/communications based on the Eatwell Guide, to help consumers understand the principles of a varied, healthy, balanced diet. Conclusion: Multiple strategies will be required to achieve a reduction in free sugars intake to attain the 5% energy target. The panel produced consensus statements with recommendations as to how this might be achieved. </jats:sec

Vegetable, fruit and antioxidant nutrient consumption and subsequent risk of hepatocellular carcinoma: a prospective cohort study in Japan

In a population-based prospective study of 19 998 Japanese individuals, consumption of vegetables, green–yellow and green leafy vegetables was inversely associated with the risk of hepatocellular carcinoma (101 cases), with multivariable hazard ratios for the highest vs lowest tertile of 0.61 (95% confidence interval (CI)=0.36–1.03, Ptrend=0.07), 0.65 (95% CI=0.39–1.08, Ptrend=0.06) and 0.59 (95% CI=0.35–1.01, Ptrend=0.04), respectively

Exposure to the Chinese Famine in Early Life and the Risk of Metabolic Syndrome in Adulthood

Objective: To examine whether exposure to the Chinese famine during fetal life and early childhood is associated with the risks of metabolic syndrome and whether this association is modified by later life environment. Research Design and Methods: We used data of 7,874 adults born between 1954 and 1964 from the 2002 China National Nutrition and Health Survey. Famine exposure groups were defined as nonexposed; fetal exposed; and early childhood, midchildhood, or late childhood exposed. Excess death rate was used to determine the severity of the famine. The ATP III criteria were used for the definition of metabolic syndrome (three or more of the following variables: elevated fasting triglyceride levels, lower HDL cholesterol levels, elevated fasting glucose levels, higher waist circumference, high blood pressure). Results: In severely affected famine areas, adults who were exposed to the famine during fetal life had a higher risk of metabolic syndrome, as compared with nonexposed subjects (odds ratio 3.13 [95% CI 1.24–7.89, P = 0.016]). Similar associations were observed among adults who were exposed to the famine during early childhood, but not for adults exposed to the famine during mid- or late childhood. Participants who were born in severely affected famine areas and had Western dietary habits in adulthood or were overweight in adulthood had a particularly high risk of metabolic syndrome in later life. Conclusions: Exposure to the Chinese famine during fetal life or infancy is associated with an increased risk of metabolic syndrome in adulthood. These associations are stronger among subjects with a Western dietary pattern or who were overweight in adulthood

No consistent effects of prenatal or neonatal exposure to Spanish flu on late-life mortality in 24 developed countries

Abstract: We test the effects of early life exposure to disease on later health by looking for differences in late-life mortality in cohorts born around the 1918-1919 flu pandemic using data from the Human Mortality Database for 24 countries. After controlling for age, period, and sex effects, residual mortality rates did not differ systematically for flu cohorts relative to surrounding cohorts. We calculate at most a 20-day reduction in life expectancy for flu cohorts; likely values are much smaller. Estimates of influenza incidence during the pandemic suggest that exposure was high enough for this to be a robust negative result