Sex, Violence, and Drugs Among Latin American and Caribbean Adolescents : Do Engaged Parents Make a Difference?

This paper uses data from the Global School-based Student Health Survey to investigate the prevalence of health risk behaviors—in particular, substance use, risky sexual behavior, and violence—among adolescents in 15 Latin American and Caribbean countries. Using logit regressions and meta-analysis, we find that having parents engaged in raising their children is associated with significantly reduced problem behaviors in adolescents. That said, in the Caribbean the prevalence of health risk behaviors in adolescents is higher and engaged parents is lower than in Latin America, and the correlation between engaged parenting and reduced risk behaviors is generally weaker. Nonetheless, for both subgroups of countries, engaged parents do appear to make a difference

A revised edition of the readiness to change questionnaire (treatment version)

The UK Alcohol Treatment Trial provided an opportunity to examine the factor structure of the Readiness to Change Questionnaire-Treatment Version (RCQ[TV]) in a large sample (N = 742) of individuals in treatment for alcohol problems who were given the RCQ[TV] at baseline, 3-months and 12-months follow-up. Confirmatory factor analysis of the previously reported factor structure (5 items for each of Precontemplation, Contemplation and Action scales) resulted in a relatively poor fit to the data. Removal of one item from each of the scales resulted in a 12-item instrument for which goodness-of-fit indices were improved, without loss of internal consistency of the three scales, on all three measurement occasions. Inspection of relationships between stage allocation by the new instrument and negative alcohol outcome expectancies provided evidence of improved construct validity for the revised edition of the RCQ[TV]. There was also a strong relationship between stage allocation at 3-months follow-up and outcome of treatment at 12 months. The revised edition of the RCQ[TV] offers researchers and clinicians a shorter and improved measurement of stage of change in the alcohol treatment population

Post-cataract eye drops can be avoided by depot steroid injections.

There are over 400 000 cataract operations now being performed annually in the UK. With the majority of those patients being older people, comorbidities such as dementia or arthritis can prevent patients putting in their own post-operative eye drops. Where there is a lack of family or other support, district nursing services are often called upon to administer these eye drops, which are typically prescribed four times a day for 4 weeks, thus potentially totalling 112 visits for drop instillation per patient. To reduce the burden of these post-operative eye drops on district nursing services, administration of an intra-operative sub-Tenon's depot steroid injection is possible for cataract patients who then do not require any post-operative drop instillation. As a trial of this practice, 16 such patients were injected in one year, thus providing a reduction of 1792 in the number of visits requested. Taking an estimated cost of each district nurse visit of £38, this shift in practice potentially saved more than £68 000; the additional cost of the injection over the cost of eye drops was just £8.80 for the year. This practice presents an opportunity to protect valuable community nursing resources, but advocacy for change in practice would be needed with secondary care, or via commissioners

Editorial: Deep Pelagic Ecosystem Dynamics in a Highly Impacted Water Column: The Gulf of Mexico After Deepwater Horizon

The intermediate-sized midwater fauna (fishes, shrimps, and cephalopods; “micronekton” collectively) are dominant components of the pelagic ocean, which is by far the largest ecosystem type on Earth by several metrics (volume, organismal numbers, biomass, and productivity). Deep-pelagic micronekton, those animals residing in the water column below 200 m depth during the day, are the direct link between plankton and oceanic top predators, and through the linked processes of feeding and daily vertical migration facilitate one of Earth\u27s most important ecosystem services to humans, carbon sequestration. Despite increasing recognition of this importance, a disconnect exists between stewardship and human impact; only a miniscule fraction of the deep-pelagic ocean has been studied in detail, while anthropogenic threats to that system are increasing rapidly. Perhaps nowhere on Earth is that dichotomy more demonstrable than the Gulf of Mexico (Gulf hereafter), a complex, high-diversity ecosystem under intense human usage and subjected to arguably the worst marine pollution event in human history. Assessment of the impacts of the Deepwater Horizon disaster to the deep-pelagic biota was impeded from the start by the lack of pre-event information, both in terms of baselines (faunal composition, abundance, and distribution) and in terms of understanding natural variability, against which impacts of anthropogenic disturbance could be detected and quantified. In this Research Topic, we present a description of three interlinked research programs (ONSAP, DEEPEND, and DEEPEND|RESTORE, described below) that began in 2010 and continue as of this writing. These programs were designed to investigate key aspects of the Gulf pelagic ecosystem, including its faunal structure, biophysical drivers of that structure, organismal and community ecology, natural variability, and potential resilience to disturbance. The contributed papers are grouped below by major themes, indicated in the conceptual model (Figure 1) of DEEPEND (Deep Pelagic Nekton Dynamics; www.deependconsortium.org), the largest of the three aforementioned research programs

Progressive stage transition does mean getting better: a further test of the Transtheoretical Model in recovery from alcohol problems

Aims To test two central assumptions of the Transtheoretical Model (TTM) regarding recovery from alcohol problems: (i) individuals making a forward transition from pre-action to action stages will show greater drinking improvements than those remaining in pre-action stages; and (ii) individuals remaining in pre-action stages will not demonstrate improvements in drinking outcomes. Design and setting Large, multi-centre, randomized controlled trial of treatment for alcohol problems [United Kingdom Alcohol Treatment Trial (UKATT)]. Measurements Stage of change, drinks per drinking day and percentage days abstinent at baseline, 3- and 12-month follow-ups. Findings In support of TTM assumption 1, improvements in drinking outcomes were consistently greater among clients who showed a forward stage transition (Cohen's d = 0.68) than among those who did not (d = 0.10). Two tests of assumption 2 showed a significant improvement in drinking outcomes in non-transition groups, inconsistent with the TTM; one test showed a significant deterioration and the other showed equivalent drinking outcomes across time. An explanation is offered as to why, under the relevant assumption of the TTM, clients in non-transition groups showed small changes in drinking outcomes. Conclusions In contrast to a previous study by Callaghan and colleagues, our findings largely support the TTM account of recovery from alcohol problems in treatment. The discrepancy can be explained by the use in our study of a more reliable and valid method for assigning stage of change

Safety and physiological effects of two different doses of elosulfase alfa in patients with morquio a syndrome: A randomized, double-blind, pilot study.

The primary treatment outcomes of a phase 2, randomized, double-blind, pilot study evaluating safety, physiological, and pharmacological effects of elosulfase alfa in patients with Morquio A syndrome are herewith presented. Patients aged ≥7 years and able to walk ≥200 m in the 6-min walk test (6MWT) were randomized to elosulfase alfa 2.0 or 4.0 mg/kg/week for 27 weeks. The primary objective was to evaluate the safety of both doses. Secondary objectives were to evaluate effects on endurance (6MWT and 3-min stair climb test [3MSCT]), exercise capacity (cardio-pulmonary exercise test [CPET]), respiratory function, muscle strength, cardiac function, pain, and urine keratan sulfate (uKS) levels, and to determine pharmacokinetic parameters. Twenty-five patients were enrolled (15 randomized to 2.0 mg/kg/week and 10 to 4.0 mg/kg/week). No new or unexpected safety signals were observed. After 24 weeks, there were no improvements versus baseline in the 6MWT, yet numerical improvements were seen in the 3MSCT with 4.0 mg/kg/week. uKS and pharmacokinetic data suggested no linear relationship over the 2.0-4.0 mg/kg dose range. Overall, an abnormal exercise capacity (evaluated in 10 and 5 patients in the 2.0 and 4.0 mg/kg/week groups, respectively), impaired muscle strength, and considerable pain were observed at baseline, and there were trends towards improvements in all domains after treatment. In conclusion, preliminary data of this small study in a Morquio A population with relatively good endurance confirmed the acceptable safety profile of elosulfase alfa and showed a trend of increased exercise capacity and muscle strength and decreased pain

The IDEAL household energy dataset, electricity, gas, contextual sensor data and survey data for 255 UK homes

This paper is based on research funded by the UK Engineering and Physical Sciences Research Council and undertaking in the projects Intelligent Domestic Energy Advice Loop (grant reference EP/K002732/1) and Data-Driven Methods for a New National Household Energy Survey (grant reference EP/M008223/1). The authors are grateful to the research funding agency and to all those who participated directly in these projects alongside the authors: Prof. D.K. Arvind, Cillian Brewitt, Edmund Farrow, Elaine Farrow, Prof. Johanna Moore, Dr. Evan Morgan and Prof. David Shipworth. Thanks also to the participants in the project, whose participation made this dataset and other work in the projects possible, and to Changeworks (https://www.changeworks.org.uk/) for identifying and recruiting potential participants, managing participant interactions, and installing and maintaining homes’ sensor and app systemsPeer reviewedPublisher PD

Trajectories of Quality of Life after Hematopoietic Cell Transplantation: Secondary Analysis of BMT CTN 0902 Data

Quality of life is increasingly recognized as an important secondary endpoint of hematopoietic cell transplantation (HCT). The current study examined the extent to which attrition results in biased estimates of patient quality of life. The study also examined whether patients differ in terms of trajectories of quality of life in the first six months post-transplant. A secondary data analysis was conducted of 701 participants who enrolled in the Blood and Marrow Transplantation Clinical Trials Network (BMT CTN) 0902 trial. Participants completed the SF-36, a measure of quality of life, prior to transplant and 100 and 180 days post-transplant. Results indicated that attrition resulted in slightly biased overestimates of quality of life but the amount of overestimation remained stable over time. Patients could be grouped into three distinct classes based on physical quality of life: 1) low and stable; 2) average and declining, then stable; and 3) average and stable. Four classes of patients emerged for mental quality of life: 1) low and stable; 2) average, improving, then stable; 3) higher than average (by almost 1 SD) and stable; and 4) average and stable. Taken together, these data provide a more comprehensive understanding of quality of life that can be used to educate HCT recipients and their caregivers

Unintended Consequences of Incentive Provision for Behaviour Change and Maintenance around Childbirth

Financial (positive or negative) and non-financial incentives or rewards are increasingly used in attempts to influence health behaviours. While unintended consequences of incentive provision are discussed in the literature, evidence syntheses did not identify any primary research with the aim of investigating unintended consequences of incentive interventions for lifestyle behaviour change. Our objective was to investigate perceived positive and negative unintended consequences of incentive provision for a shortlist of seven promising incentive strategies for smoking cessation in pregnancy and breastfeeding. A multi-disciplinary, mixed-methods approach included involving two service-user mother and baby groups from disadvantaged areas with experience of the target behaviours as study co-investigators. Systematic reviews informed the shortlist of incentive strategies. Qualitative semi-structured interviews and a web-based survey of health professionals asked open questions on positive and negative consequences of incentives. The participants from three UK regions were a diverse sample with and without direct experience of incentive interventions: 88 pregnant women/recent mothers/partners/family members; 53 service providers; 24 experts/decision makers and interactive discussions with 63 conference attendees. Maternity and early years health professionals (n = 497) including doctors, midwives, health visitors, public health and related staff participated in the survey. Qualitative analysis identified ethical, political, cultural, social and psychological implications of incentive delivery at population and individual levels. Four key themes emerged: how incentives can address or create inequalities; enhance or diminish intrinsic motivation and wellbeing; have a positive or negative effect on relationships with others within personal networks or health providers; and can impact on health systems and resources by raising awareness and directing service delivery, but may be detrimental to other health care areas. Financial incentives are controversial and generated emotive and oppositional responses. The planning, design and delivery of future incentive interventions should evaluate unexpected consequences to inform the evidence for effectiveness, cost-effectiveness and future implementation

Attention Restoration Theory: A Systematic Review of the Attention Restoration Potential of Exposure to Natural Environments

All authors contributed to the design of this review, critically revised the article, and approved the final versions. HO contributed to all stages of the systematic review (searching, screening, data extraction, quality appraisal and synthesis) and drafted the article. MW and BW contributed to double data extraction and preparation of the article. AB devised the search strategy, ran the literature searches, carried out citation searching, and contributed to double screening. OU and VN provided statistical advice and designed and conducted the meta-analyses. RG conceived the idea for the review, contributed to double screening, double data extraction, quality appraisal, and preparation of the article, and is the guarantor