Case note review of community mental health services for children and young people in a UK rural location

PurposeThe aim of the review is to investigate the reasons for referral to this child and adolescent mental health (CAMH) service and determine whether these had been met by the service.Design/methodology/approachThis is a retrospective case note analysis that was conducted of 66 referrals to CAMHS for children and young people serving a rural community of 132,000. Case notes were selected by the NHS CAMHS manager based on referrals during the pre-defined date set. Of the 66 referrals to CAMHS, 19 were not included in the analysis because they had not been accepted into the service. Data were analysed on the remaining 47 cases who were referred, accepted into the service and had been offered an assessment by the service.FindingsGeneral practitioners represented the most frequent health care practitioner to refer to the service (n = 33, 70.2%). Self harm, suicidal intent, thoughts or overdose represented the highest percentage of referrals to the CAMHS service (38.3%); depression, low mood and sadness represented the next highest figure (19%) and anxiety and depression (10.6%) broadly speaking 68% of referrals related to low mood. Out of the 44 cases that were examined, 14/44 (32%) were referred back to the GP and no specific intervention was provided. Interventions provided to five cases were unspecified.Research limitations/implicationsA number of opportunities for developing the service that allowed for a focus on the core business of helping children and young people with low mood were identified. One of the limitations of this retrospective review was the time frame selected because it had been identified as a particularly high period for referral into the service and may not have been representative of the usual trend.Practical implicationsThis informed a training strategy and resource allocation and a redefinition of discrete roles within the service.Originality/valueThis study highlighted the evidence about where the demand was on this service and hence the requirement to focus on their core business. This evidence generated by the review prompted a redirection of resources within the service. Additional reflections and discussion informed the development of a new training strategy and a redefinition of discrete roles within the service

Study of Motivational Interviewing in adolescents with type 1 diabetes

Motivational Interviewing (MI) has been shown to be effective in facilitating change in health-related behaviour in adults. The objective of this study was to examine the efficacy of MI for adolescents aged 14-17 years with type 1 diabetes. The study was divided into two parts. Study I was a randomised controlled trial (RCT) analysed by intention to treat. Sixty six adolescents with type 1 diabetes, attending diabetes clinics in South Wales, were randomly assigned to the MI intervention group (n=38) and to the control group (n=28) who received support counselling based on education and self management skills. All participants received individual sessions over 12 months. The main outcome measures were serum glycosylated haemoglobin (HbAic) concentrations and psychosocial measures which included quality of life and well- being. These were assessed at baseline, 12 months (end of intervention) and at 24 months (one year post intervention). Sixty patients completed data at 12 months. At 12 months the mean HbA C in the MI group was significantly lower than in the control group (p=0.04), after adjusting for baseline values. At 24 months follow up, this difference in HbAic had increased (p=0.003). There were differences in psychosocial variables at 12 months, with the MI group indicating more positive well-being, enhanced quality of life and differences in their personal models of illness (all p<0.001). Some of these differences were maintained at 24 months. Study II explored the relationships between quality of life and HbAic retrospectively based on a priori hypotheses. Better quality of life (satisfaction and impact) predicted reductions in HbAic at 24 months explaining 0.9% of the variance in HbAic. Conclusions: Motivational Interviewing appeared to be an effective method of facilitating adolescents with type 1 diabetes to reduce their HbAic, along with enhancements in some aspects of psychosocial functioning.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Study of Motivational Interviewing in adolescents with type 1 diabetes.

Motivational Interviewing (MI) has been shown to be effective in facilitating change in health-related behaviour in adults. The objective of this study was to examine the efficacy of MI for adolescents aged 14-17 years with type 1 diabetes. The study was divided into two parts. Study I was a randomised controlled trial (RCT) analysed by intention to treat. Sixty six adolescents with type 1 diabetes, attending diabetes clinics in South Wales, were randomly assigned to the MI intervention group (n=38) and to the control group (n=28) who received support counselling based on education and self management skills. All participants received individual sessions over 12 months. The main outcome measures were serum glycosylated haemoglobin (HbAic) concentrations and psychosocial measures which included quality of life and well- being. These were assessed at baseline, 12 months (end of intervention) and at 24 months (one year post intervention). Sixty patients completed data at 12 months. At 12 months the mean HbA C in the MI group was significantly lower than in the control group (p=0.04), after adjusting for baseline values. At 24 months follow up, this difference in HbAic had increased (p=0.003). There were differences in psychosocial variables at 12 months, with the MI group indicating more positive well-being, enhanced quality of life and differences in their personal models of illness (all p<0.001). Some of these differences were maintained at 24 months. Study II explored the relationships between quality of life and HbAic retrospectively based on a priori hypotheses. Better quality of life (satisfaction and impact) predicted reductions in HbAic at 24 months explaining 0.9% of the variance in HbAic. Conclusions: Motivational Interviewing appeared to be an effective method of facilitating adolescents with type 1 diabetes to reduce their HbAic, along with enhancements in some aspects of psychosocial functioning

Rumen Protozoa Play a Significant Role in Fungal Predation and Plant Carbohydrate Breakdown

The rumen protozoa, alongside fungi, comprise the eukaryotic portion of the rumen microbiome. Rumen protozoa may account for up to 50% of biomass, yet their role in this ecosystem remains unclear. Early experiments inferred a role in carbohydrate and protein metabolism, but due to their close association with bacteria, definitively attributing these functions to the protozoa was challenging. The advent of ‘omic technologies has created opportunities to broaden our understanding of the rumen protozoa. This study aimed to utilise these methods to further our understanding of the role that protozoa play in the rumen in terms of their metabolic capacities, and in doing so, contribute valuable sequence data to reduce the chance of mis or under-representation of the rumen protozoa in meta’omic datasets. Rumen protozoa were isolated and purified using glucose-based sedimentation and differential centrifugation, extracted RNA was Poly(A) fraction enriched and DNase treated before use in a phage-based, cDNA metatranscriptomic library. Biochemical activity testing of the phage library showed 6 putatively positive plaques in response to carboxymethyl cellulose agar (indicative of cellulose activity), and no positive results for tributyrin (indicative of esterase/lipase activity) or egg yolk agar (indicative of proteolysis). Direct sequencing of the cDNA was also conducted using the Illumina HiSeq 2500. The metatranscriptome identified a wealth of carbohydrate-active enzymes which accounted for 8% of total reads. The most highly expressed carbohydrate-active enzymes were glycosyl hydrolases 5 and 11, polysaccharide lyases and deacetylases, xylanases and enzymes active against pectin, mannan and chitin; the latter likely used to digest rumen fungi which contain a chitin-rich cell membrane. Codon usage analysis of expressed genes also showed evidence of horizontal gene transfer, suggesting that many of these enzymes were acquired from the rumen bacteria in an evolutionary response to the carbohydrate-rich environment of the rumen. This study provides evidence of the significant contribution that the protozoa make to carbohydrate breakdown in the rumen, potentially using horizontally acquired genes, and highlights their predatory capacity

Evaluation of a national lung cancer symptom awareness campaign in Wales

Background Lung cancer is the leading cause of cancer mortality in Wales. We conducted a before- and after- study to evaluate the impact of a four-week mass-media campaign on awareness, presentation behaviour and lung cancer outcomes. Methods Population-representative samples were surveyed for cough symptom recall/recognition and worry about wasting doctors’ time pre-campaign (June 2016; n = 1001) and post-campaign (September 2016; n = 1013). GP cough symptom visits, urgent suspected cancer (USC) referrals, GP-ordered radiology, new lung cancer diagnoses and stage at diagnosis were compared using routine data during the campaign (July–August 2016) and corresponding control (July–August 2015) periods. Results Increased cough symptom recall (p < 0.001), recognition (p < 0.001) and decreased worry (p < 0.001) were observed. GP visits for cough increased by 29% in the target 50+ age-group during the campaign (p < 0.001) and GP-ordered chest X-rays increased by 23% (p < 0.001). There was no statistically significant change in USC referrals (p = 0.82), new (p = 0.70) or early stage (p = 0.27) diagnoses, or in routes to diagnosis. Conclusions Symptom awareness, presentation and GP-ordered chest X-rays increased during the campaign but did not translate into increased USC referrals or clinical outcomes changes. Short campaign duration and follow-up, and the small number of new lung cancer cases observed may have hampered detection effects

An updated report on the incidence and epidemiological trends of keratinocyte cancers in the United Kingdom 2013-2018

Introduction: The most common cancers in the UK are keratinocyte cancers (KCs): the combined term for basal cell carcinomas (BCCs) and cutaneous squamous cell carcinomas (cSCCs). Registration of KC is challenging due to high numbers and multiplicity of tumours per person. Methods: We provide an updated report on the descriptive epidemiology of trends in KC incidence for the resident populations of UK countries (England, Northern Ireland, Scotland and Wales) using population-based cancer registry and pathology report data, 2013-18. Results: Substantial increases in cSCC incidence in England, Scotland and Northern Ireland can be detected for the period of 2013-18, and the incidence of cSCC also increased in Wales from 2016 to 2018. In contrast, however, the pattern of annual change in the incidence of BCC across the nations differs. In England, the incidence of BCC declined slightly from 2016 to 2018, however, the overall trend across 2013-18 is not statistically significant. In Scotland, the incidence of BCC shows some variability, declining in 2017 before increasing in 2018, and the overall trend across 2013-18 was also not statistically significant. In Northern Ireland, the incidence of BCC increased significantly over the study period, and in Wales, the incidence of BCC increased from 2016 to 2018. One in five people will develop non-melanoma skin cancers (NMSC) in their lifetime in England. This estimate is much higher than the lifetime risk of melanoma (1 in 36 males and 1 in 47 females born after 1960 in the UK), which further highlights the burden of the disease and importance of early prevention strategies. Conclusions: We highlight how common these tumours are by publishing the first ever lifetime incidence of NMSC. Additionally, the first time reporting of the age standardised incidence of KC in Wales further confirms the scale of the disease burden posed by these cancers in the UK. With approximately one in five people developing NMSC in their lifetime, optimisation of skin cancer prevention, management and research are essential