Dependence and motivation to stop smoking as predictors of success of a quit attempt among smokers seeking help to quit.

INTRODUCTION: It is not known how well motivation to stop smoking predicts abstinence in a clinical sample relative to the most widely used measure of cigarette dependence. METHODS: A secondary analysis was conducted from a trial with 864 smokers making quit attempt. Fagerström Test of Cigarette Dependence (FTCD), Heaviness of Smoking Index (HSI), and motivation to stop smoking (composite of determination to quit and importance of quitting) were measured at baseline. Continuous smoking abstinence, validated by expired-air carbon monoxide, was assessed at 4weeks, 6months and 12months post-quit date. FTCD, HSI, non-HSI items in FTCD, and motivation were assessed as predictors of abstinence. RESULTS: In multiple-logistic regressions, controlling for age, gender and medication use, lower scores for FTCD, HSI and non-HSI all significantly predicted abstinence at all follow-ups, while motivation did not predict abstinence at any time. Likelihood ratio tests showed that the FTCD contributed most to the model at 4weeks and 6months; at 12months FTCD and non-HSI equally contributed most to the model. At 4weeks and 6months, predictions were improved by combining HSI and non-HSI components, compared with using these components alone. CONCLUSIONS: Cigarette dependence, measured by the FTCD, or by its HSI or non-HSI components, predicts both short-term and medium-term outcomes of attempts to stop smoking in treatment-seeking smokers involved in a clinical trial, whereas strength of motivation to stop predicts neither. Both the HSI and non-HSI components may be considered as briefer alternatives to the full FTCD

Co-producing Randomized Controlled Trials: How Do We Work Together?

In the light of the declaration “Nothing about us without us” (Charlton, 2000), interest in co-production, and coproduced research is expanding. Good work has been done establishing principles for co-production (Hickey et al., 2018) and for good quality involvement (Involve, 2013; 4Pi, 2015) and describing how this works in practice in mental health research (Gillard et al., 2012a,b, 2013). In the published literature, co-production has worked well in qualitative research projects in which there is often methodological flexibility. However, to change treatment guidelines in the UK, e.g., the National Institute for Health and Care Excellence guidelines, and influence service commissioning, high quality quantitative research is also needed. This type of research is characterized by formal methodological rules, which pose challenges for the scope of co-production. In this paper we describe the significant challenges and solutions we adopted to design and deliver a coproduced randomized controlled trial of mental health peer support. Given the methodological rigidity of a randomized controlled trial, establishing clearly which methodological and practical decisions and processes can be coproduced, by whom, and how, has been vital to our ongoing co-production as the project has progressed and the team has expanded. Creating and maintaining space for the supported dialogue, reflection, and culture that co-production requires has been vital. This paper aims to make our learning accessible to a wide audience of people developing co-production of knowledge in this field

Inhibition of Serine Palmitoyl Transferase I Reduces Cardiac Ceramide Levels and Increases Glycolysis Rates following Diet-Induced Insulin Resistance

Objective: Diet-induced obesity (DIO) leads to an accumulation of intra-myocardial lipid metabolites implicated in causing cardiac insulin resistance and contractile dysfunction. One such metabolite is ceramide, and our aim was to determine the effects of inhibiting de novo ceramide synthesis on cardiac function and insulin stimulated glucose utilization in mice subjected to DIO. Materials and Methods: C57BL/6 mice were fed a low fat diet or subjected to DIO for 12 weeks, and then treated for 4 weeks with either vehicle control or the serine palmitoyl transferase I (SPT I) inhibitor, myriocin. In vivo cardiac function was assessed via ultrasound echocardiography, while glucose metabolism was assessed in isolated working hearts. Results: DIO was not associated with an accumulation of intra-myocardial ceramide, but rather, an accumulation of intra-myocardial DAG (2.63±0.41 vs. 4.80±0.97 nmol/g dry weight). Nonetheless, treatment of DIO mice with myriocin decreased intra-myocardial ceramide levels (50.3±7.7 vs. 26.9±2.7 nmol/g dry weight) and prevented the DIO-associated increase in intra-myocardial DAG levels. Interestingly, although DIO impaired myocardial glycolysis rates (7789±1267 vs. 2671±326 nmol/min/g dry weight), hearts from myriocin treated DIO mice exhibited an increase in glycolysis rates. Conclusions: Our data reveal that although intra-myocardial ceramide does not accumulate following DIO, inhibition of de novo ceramide synthesis nonetheless reduces intra-myocardial ceramide levels and prevents the accumulation of intra-myocardial DAG. These effects improved the DIO-associated impairment of cardiac glycolysis rates, suggesting that SPT I inhibition increases cardiac glucose utilization. © 2012 Ussher et al.published_or_final_versio

Youth chances: integrated report

This document provides an overview of the key findings from this five-year ground-breaking research project about the experiences of lesbian, gay, bisexual, trans and questioning (LGBTQ) 16-25year olds in England funded by the Big Lottery Fund and conducted by METRO Charity in collaboration with Ergo Consulting and the University of Greenwich. Methods: The project surveyed 7,126 young people aged 16-25. Of these 6,514 were LGBTQ young people. 612 were heterosexual non-trans young people and 956 were trans young people. 29 commissioners of services for young people and 52 relevant service providers across England were also surveyed. Findings: Show high levels of discrimination, abuse and mental health issues that young LGBTQ people face which indicate a need for more to be done to improve the lives of LGBTQ young people. Sections of the report are: 1. Being different Over half of LGBQ respondents (53%) knew they were LGBQ by the age of 13. Over half of trans respondents (58%) knew they were trans by the same age. When coming out as LGBQ or trans, over four fifths of LGBQ respondents (81%) and nearly two thirds of trans respondents (62%) told a friend first. Over a quarter of LGBQ young people (29%) have not told their mother, nearly a half (45%) have not told their father, and 5% have not told anybody. Approximately half of trans respondents have not told parents or siblings that they are trans and 28% have not told anybody. Young people tell us that they most want emotional support to help them when they are coming out but most are not getting it. The second most important thing to them is to meet other LGBTQ people and again over half of them did not get this opportunity. 2. Participation LGBTQ young people are twice as likely not to feel accepted in the area where they currently live, compared to heterosexual non-trans young people. 59% of LGBTQ young people that would be interested in joining a religious organisation have stopped or reduced their involvement owing to their sexuality or gender identity. Over a third of LGBTQ young people (34%) are not able to be open about their sexuality or gender identity at a sports club they are involved in. 3. Staying safe 73% of the LGBTQ sample agreed that discrimination against LGB people is still common and 90% of the LGBTQ sample agreed that discrimination against trans people is still common. About three quarters of LGBTQ young people (74%) have experienced name calling, nearly a half (45%) have experienced harassment or threats and intimidation and almost a quarter (23%) have experienced physical assault. 88% of LGBTQ young people do not report incidents to the police and when cases are reported only 10% lead to a conviction. 29% of LGBTQ respondents reported domestic or familial abuse, compared to 25% of the heterosexual non trans group. Over a third (36%) of LGBTQ respondents cited their sexuality or gender identity as at least a contributing factor in the abuse. Almost one in five (18%) LGBTQ young people have experienced some form of sexual abuse, compared with one in ten (11%) of non-trans heterosexuals in our sample. Most LGBTQ respondents who have experienced sexual abuse (79%) have not received any help or support. Nearly one in ten LGBTQ young people report that they have had to leave home for reasons relating to their sexuality or gender identity. 4. Enjoying and achieving Nearly half of LGBTQ young people (49%) reported that their time at school was affected by discrimination or fear of discrimination. Consequences reported included missing lessons, achieving lower grades, feeling isolated and left out and having to move schools are all reported. 61% reported name calling because they were LGBTQ or people thought they were. This figure includes the experiences of heterosexual non-trans respondents: it is an issue for all young people. About one in five LGBTQ young people experience physical attack at school on account of their sexual identity or gender identity. The majority do not report this and only a small proportion of those who do experience resolution. For some reporting the abuse means that it gets worse. Around two thirds of LGBTQ young people say they learn a lot about relationships and safer sex between a man and a woman, compared to less than 5% who say they learn a lot about same sex relationships and safer sex. 89% of LGBTQ young people report learning nothing about bisexuality issues and 94% report learning nothing about transgender issues. Only 25% of LGBTQ young people report that they learned anything at school about safer sex for a male couple

"Am iz kwiin" (I'm his queen): Combining interpretative phenomenological analysis with a feminist approach to work with gems in a resource-constrained setting

This article focuses on working with gems using a feminist approach to interpretative phenomenological analysis (IPA) in a resource-constrained setting. The research explores the experiences of maternal disclosure of HIV to children of HIV positive mothers in Kingston, Jamaica. A feminist approach helps recognise power imbalances within research relationships and the women’s lived experiences. We present three “gems” which illuminate women’s lived experiences and explore how popularised representations of women’s sexuality and mothering influence disclosure discourses. We use emotion work as a conceptual resource to structure the women’s narratives and challenge existing policy discourses, which arguably represent disclosure within a binary, rationalist, decision-making framework. This article adds to global literature on maternal HIV disclosure and problematises policy discourses by bringing into relief the emotion work women engage in when deciding if and how to communicate their HIV status to their children. It adds to the body of research using IPA, particularly in resource-constrained settings where IPA has thus far had little application

Exercise therapy in adults with serious mental illness: a systematic review and meta-analysis

Background: Individuals with serious mental illness are at a higher risk of physical ill health. Mortality rates are at least twice those of the general population with higher levels of cardiovascular disease, metabolic disease, diabetes, and respiratory illness. Although genetics may have a role in the physical health problems of these patients, lifestyle and environmental factors such as levels of smoking, obesity, poor diet, and low levels of physical activity also play a prominent part.<p></p> Objective: To conduct a systematic review and meta-analysis of randomised controlled trials comparing the effect of exercise interventions on individuals with serious mental illness.<p></p> Methods: Searches were made in Ovid MEDLINE, Embase, CINAHL, PsycINFO, Biological Abstracts on Ovid, and The Cochrane Library (January 2009, repeated January 2013) through to February 2013.<p></p> Results: Eight RCTs were identified in the systematic search. Six compared exercise versus usual care. One study assessed the effect of a cycling programme versus muscle strengthening and toning exercises. The final study compared the effect of adding specific exercise advice and motivational skills to a simple walking programme. Exercise programmes were noted by their heterogeneity in terms of the type of exercise intervention, setting, and outcome measures. The review found that exercise improved levels of exercise activity (n=13, standard mean difference [SMD] 1.81, CI 0.44 to 3.18, p = 0.01). No beneficial effect was found on negative (n = 84, SMD = -0.54, CI -1.79 to 0.71, p = 0.40) or positive symptoms of schizophrenia (n = 84, SMD = -1.66, CI -3.78 to 0.45, p = 0.12). No change was found on body mass index compared with usual care (n= 151, SMD = -0.24, CI -0.56 to 0.08, p = 0.14), or body weight (n = 77, SMD = 0.13, CI -0.32 to 0.58, p = 0.57). No beneficial effect was found on anxiety and depressive symptoms (n = 94, SMD = -0.26, CI -0.91 to 0.39, p = 0.43), or quality of life in respect of physical and mental domains. One RCT measured the effect of exercise on exercise intensity, attendance, and persistence at a programme. No significant effect was found on these measures.<p></p> Conclusions: This systematic review showed that exercise therapies can lead to a modest increase in levels of exercise activity but overall there was no noticeable change for symptoms of mental health, body mass index, and body weight.<p></p&gt

"It's not just about walking.....it's the practice nurse that makes it work": a qualitative exploration of the views of practice nurses delivering complex physical activity interventions in primary care

Background: Physical activity (PA) is important for physical and mental health in adults and older adults. Interventions incorporating theory-based behaviour change techniques (BCTs) can be useful in helping people to increase their PA levels and can be delivered by practice nurses in primary care. We undertook two primary care based complex walking interventions among adults and older adults. Both interventions were underpinned by BCTs and delivered by practice nurses and we sought their views and experiences of delivering over 1400 complex PA consultations.  Methods: Semi structured interviews with two practice nurse groups (n = 4 and n = 5) and two individual interviews (total n = 11) were conducted by independent facilitators; audio-recorded, transcribed verbatim and analysed using thematic analysis.  Results: Five key themes emerged as enablers and/or barriers to delivering the intervention: preparation and training; initial and ongoing support; adherence to the protocol; the use of materials and equipment; and engagement of participants. The themes were organised into a framework of 'pre-trial' and 'delivery of the intervention'. Two additional 'post-trial' themes were identified; changed practice and the future feasibility of the intervention. Nurses believed that taking part in the trial, especially the BCT training, enhanced the quality and delivery of advice and support they provided within routine consultations, although the lack of time available routinely makes this challenging.  Conclusion: Delivering an effective behaviour change intervention in primary care requires adequate training and support for practice nurses both initially and throughout the trial as well as adequate consultation time. Enhanced skills from participating in such trials can lead to long-term changes, including more patient-centred consulting.  Trial registration: PACE-Lift ISRCTN 42122561, PACE-UP ISRCTN 98538934

Automated, high frequency, on-line dimethyl sulfide measurements in natural waters using a novel “microslug” gas-liquid segmented flow method with chemiluminescence detection

Dimethyl sulfide (DMS) is the major biogenic volatile sulfur compound in surface seawater. Good quality DMS data with high temporal and spatial resolution are desirable for understanding reduced sulfur biogeochemistry. Here we present a fully automated and novel “microslug” gas-liquid segmented flow-chemiluminescence (MSSFCL) based method for the continuous in-situ measurement of DMS in natural waters. Samples were collected into a flow tank and DMS transferred from the aqueous phase to the gas phase using a vario-directional coiled flow, in which microvolume liquid and gas slugs were interspersed. The separated DMS was reacted with ozone in a reaction cell for CL detection. The analytical process was automated, with a sample throughput of 6.6 h− 1. Using MSSF for DMS separation was more effective and easily integrated with CL detection compared with the commonly used bubbling approach. Key parameters of the proposed method were investigated. The linear range for the method was 0.05–500 nM (R2 = 0.9984) and the limit of detection (3 x S/N) was 0.015 nM, which is comparable to the commonly used gas chromatography (GC) method and sensitive enough for direct DMS measurement in typical aquatic environments. Reproducibility and recovery were assessed by spiking natural water samples (river, lake, reservoir and pond) with different concentrations of DMS (10, 20 and 50 nM), giving relative standard deviations (RSDs) ≤1.75% (n = 5) and recoveries of 94.4–107.8%. This fully automated system is reagent free, easy to assemble, simple to use, portable (weight ~5.1 kg) and can be left in the field for several hours of unattended operation. The instrumentation can provide high quality DMS data for natural waters with an environmentally relevant temporal resolution of ~9 min

A hisztériával kapcsolatos diskurzusok tanulságai a szomatizációs jelenségek és a betegségmagatartás megértéséhez = The relevance of discourses about hysteria in the understanding of somatization phenomena and illness behaviour

Napjainkban a magatartástudományok képviselőinek egyszerre kell számolniuk a betegségekkel kapcsolatos bizonyosság és tudás konfliktusait előhívó medikalizációs-technicizációs orvostudományi tendenciákkal és a társadalomtudományok ezekre reflektáló, kritikai és „posztmodern” megközelítéseivel. Ebből adódóan igen fontos kihívásként jelentkezik az interdiszciplináris megközelítés szükségessége. Különösen így van ez a nehezen definiálható betegségek - a szomatizációs és pszichoszomatikus zavarok - esetében, ahol a betegségmagatartás gyakorlati problémái, továbbá a tünetek, a diagnózisok és a szenvedés „valódiságának” episztemológiai kérdései egyszerre vannak jelen. Az utóbbi másfél évtized kritikai társadalomtudományi kutatásaiban rendkívüli figyelmet kapott a szomatizációs zavarok és a klasszikus pszichoszomatikus kórképek elődjének számító hisztéria kérdésköre. A tanulmány a szakmai és laikus szóhasználatban nem hivatalosan máig tovább élő betegséggel kapcsolatos társadalomtudományi és orvosi megközelítések közül azokat mutatja be, amelyek szempontokkal szolgálhatnak a szomatizációs és pszichoszomatikus kórképek, valamint a velük kapcsolatos érzelmi és viselkedéses reakciók elemzéséhez és megértéséhez