Models in the delivery of depression care: a systematic review of randomised and controlled intervention trials

BACKGROUND: There is still debate as to which features, types or components of primary care interventions are associated with improved depression outcomes. Previous reviews have focused on components of collaborative care models in general practice settings. This paper aims to determine the effective components of depression care in primary care through a systematic examination of both general practice and community based intervention trials. METHODS: Fifty five randomised and controlled research trials which focused on adults and contained depression outcome measures were identified through PubMed, PsycInfo and the Cochrane Central Register of Controlled Trials databases. Trials were classified according to the components involved in the delivery of treatment, the type of treatment, the primary focus or setting of the study, detailed features of delivery, and the discipline of the professional providing the treatment. The primary outcome measure was significant improvement on the key depression measure. RESULTS: Components which were found to significantly predict improvement were the revision of professional roles, the provision of a case manager who provided direct feedback and delivered a psychological therapy, and an intervention that incorporated patient preferences into care. Nurse, psychologist and psychiatrist delivered care were effective, but pharmacist delivery was not. Training directed to general practitioners was significantly less successful than interventions that did not have training as the most important intervention. Community interventions were effective. CONCLUSION: Case management is important in the provision of care in general practice. Certain community models of care (education programs) have potential while others are not successful in their current form (pharmacist monitoring)

‘Channel Shift’:technologically-mediated policing and procedural justice

In recent years, police forces in the United Kingdom have introduced various technologies that alter the methods by which they interact with the public. In a parallel development, many forces have also begun to embrace the concept of procedural justice as a method through which to secure legitimacy and (in turn) public compliance and cooperation. What has not received sufficient attention, within policing or academia, is the extent to which these two trends are compatible, with the procedural justice literature still predicated on an assumption that police–public ‘contacts’ or ‘encounters’ are in-person. The effect of technologically mediating police–public contacts on ‘policing by consent’, is therefore unknown. In this article, we focus specifically on the possible implications of the Single Online Home (SOH) (a portal through which the public can report crime, get updates on cases, give feedback and pay fines, among other things, which is currently being rolled out across forces), considering ‘interactions’ between police and public where there is no physical co-presence. Noting the unique context that is policing, we draw on the limited existing research on procedural justice encounters in technologically mediated contexts to explore whether procedural justice theory is ‘future-proof’ for a policing context increasingly reliant on such encounters. We conclude that, through empirical research, we must update our conceptual understanding of what ‘contact’ can mean, and accept that current developments may in fact be transforming relationships rather than simply facilitating existing ones

Multi-taxa consequences of management for an avian umbrella species

Whether management for so-called umbrella species actually benefits co-occurring biota has rarely been tested. Here, we studied consequences for multiple invertebrate taxa of two ground-disturbance treatments designed to support an avian umbrella species (Eurasian stone-curlew, Burhinus oedicnemus), and whether analysing ecological requirements across the regional species pool predicted beneficiaries. Responses were assessed for the abundance of five bird species of conservation concern, and the abundance, species richness and composition of carabids, staphylinids, other beetles (non-carabid, non-staphylinid), true bugs and ants, sampling 31258 individuals of 402 species in an extensively-replicated experiment across the UK’s largest grass-heath. Both treatments provided suitable habitat for the umbrella species, in contrast to controls. Treatment influenced the abundance of only one bird species; but carabid, other beetle and ant richness increased with one or both treatments, while staphylinid richness and abundance increased and true bug richness and abundance decreased with both treatments. Richness of ‘priority’ (rare, scarce or threatened) invertebrates a priori considered to share ecological requirements with the umbrella species (predicted beneficiaries) increased with both treatments. Resampling and rarefaction showed landscapes diversified by treatment supported a greater cumulative species richness of other beetles, ants and true bugs, and importantly priority invertebrates, than a landscape comprising only untreated controls. Such experiments provide strong evidence to assess co-benefits of umbrella species management, but are costly and time consuming. The systematic examination of the autoecological requirements of co-occurring taxa (the ‘Biodiversity Audit Approach’) successfully predicted likely beneficiaries. Demonstrating wider biodiversity benefits strengthens the case for avian conservation management

Differences in maternal and early child nutritional status by offspring sex in lowland Nepal.

OBJECTIVE: On average, boys grow faster than girls in early life but appear more susceptible to undernutrition. We investigated sex differences in early child growth, and whether maternal nutritional status and diet differed by offspring sex during and after pregnancy in an undernourished population. METHODS: We analyzed longitudinal data from a cluster-randomized trial from plains Nepal, stratifying results by child or gestational age. Children's outcomes (0-20 months) were weight, length, and head circumference and their z-scores relative to WHO reference data in 2-monthly intervals (n range: 24837 to 25 946). Maternal outcomes were mid-upper arm circumference (MUAC), and body mass index (BMI) during pregnancy (12-40 weeks) (n = 5550 and n = 5519) and postpartum (n = 15 710 and n = 15 356), and diet in pregnancy. We fitted unadjusted and adjusted mixed-effects linear and logistic regression models comparing boys with girls. RESULTS: Boys were larger than girls, however relative to their sex-specific reference they had lower length and head circumference z-scores from birth to 12 months, but higher weight-for-length z-scores from 0 to 6 months. Mothers of sons had higher MUAC and BMI around 36 weeks gestation but no other differences in pregnancy diets or pregnancy/postpartum maternal anthropometry were detected. Larger sex differences in children's size in the food supplementation study arm suggest that food restriction in pregnancy may limit fetal growth of boys more than girls. CONCLUSIONS: Generally, mothers' anthropometry and dietary intake do not differ according to offspring sex. As boys are consistently larger, we expect that poor maternal nutritional status may compromise their growth more than girls. Copyright © 2021 John Wiley & Sons, Ltd

Views and experiences of community pharmacists and superintendent pharmacists regarding the New Medicine Service in England prior to implementation

Background: The New Medicine Service (NMS) was introduced to community pharmacies in England in October 2011. The NMS aims to improve adherence to new medicines in patients with selected long term conditions. The service consists of two follow-up consultations within 1 month in addition to usual care. Objectives: This study explored community pharmacist and superintendent pharmacist views and experiences of the NMS in the 5 weeks prior to its implementation to identify potential facilitators and barriers to its success. The study also investigated participant experiences of the introduction and provision of existing pharmacy services in order to contrast with the implementation of the NMS. Methods: This study consisted of four focus groups with a total of 15 community pharmacists representing locums and employees of small, medium and large chain pharmacies. In addition, 5 semi-structured interviews were conducted with superintendent pharmacists representing independent, small chain, supermarket and large multiple pharmacies. Data were audio-recorded, transcribed verbatim and thematically analyzed. Results: Both pharmacists and superintendent pharmacists were positive about the NMS and identified potential benefits for patients and the pharmacy profession. Awareness of the service was high, however, some confusion between the NMS and changes to Medicine Use Reviews was evident in all focus groups due to their similarity and coincidental implementation. This confusion was not observed in the interviews with superintendent pharmacists. Participants identified pharmacists' positive attitude, the similarity to current practice and the self-accreditation procedure as potential facilitators to service implementation. Potential barriers identified included a perceived lack of interest and awareness by GPs of the service, and the payment structure. Participants were concerned about the speed of implementation, and the absence of some materials needed prior to the start of the service. Conclusions: Participants were enthusiastic about the potential of the NMS to benefit patients and the pharmacy profession. Participants were able to identify several potential barriers and facilitators to the provision of the service. It remains to be seen whether the factors identified affected the early implementation of the service

‘Channel shift’: Technologically mediated policing and procedural justice

In recent years, police forces in the United Kingdom have introduced various technologies that alter the methods by which they interact with the public. In a parallel development, many forces have also begun to embrace the concept of procedural justice as a method through which to secure legitimacy and (in turn) public compliance and cooperation. What has not received sufficient attention, within policing or academia, is the extent to which these two trends are compatible, with the procedural justice literature still predicated on an assumption that police–public ‘contacts’ or ‘encounters’ are in-person. The effect of technologically mediating police–public contacts on ‘policing by consent’, is therefore unknown. In this article, we focus specifically on the possible implications of the Single Online Home (SOH) (a portal through which the public can report crime, get updates on cases, give feedback and pay fines, among other things, which is currently being rolled out across forces), considering ‘interactions’ between police and public where there is no physical co-presence. Noting the unique context that is policing, we draw on the limited existing research on procedural justice encounters in technologically mediated contexts to explore whether procedural justice theory is ‘future-proof’ for a policing context increasingly reliant on such encounters. We conclude that, through empirical research, we must update our conceptual understanding of what ‘contact’ can mean, and accept that current developments may in fact be transforming relationships rather than simply facilitating existing ones

‘Channel Shift’: technologically-mediated policing and procedural justice

In recent years, police forces in the United Kingdom have introduced various technologies that alter the methods by which they interact with the public. In a parallel development, many forces have also begun to embrace the concept of procedural justice as a method through which to secure legitimacy and (in turn) public compliance and cooperation. What has not received sufficient attention, within policing or academia, is the extent to which these two trends are compatible, with the procedural justice literature still predicated on an assumption that police–public ‘contacts’ or ‘encounters’ are in-person. The effect of technologically mediating police–public contacts on ‘policing by consent’, is therefore unknown. In this article, we focus specifically on the possible implications of the Single Online Home (SOH) (a portal through which the public can report crime, get updates on cases, give feedback and pay fines, among other things, which is currently being rolled out across forces), considering ‘interactions’ between police and public where there is no physical co-presence. Noting the unique context that is policing, we draw on the limited existing research on procedural justice encounters in technologically mediated contexts to explore whether procedural justice theory is ‘future-proof’ for a policing context increasingly reliant on such encounters. We conclude that, through empirical research, we must update our conceptual understanding of what ‘contact’ can mean, and accept that current developments may in fact be transforming relationships rather than simply facilitating existing ones

Adolescents' perspectives on a school-based physical activity intervention: A mixed method study.

Purpose:To examine adolescent experiences and perspectives of the GoActive intervention (ISRCTN31583496) using mixed methods process evaluation to determine satisfaction with intervention components and interpret adolescents' experiences of the intervention process in order to provide insights for future intervention design. Methods:Participants (n = 1542; 13.2 ±  0.4 years, mean ± SD) provided questionnaire data at baseline (shyness, activity level) and post-intervention (intervention acceptability, satisfaction with components). Between-group differences (boys vs. girls and shy/inactive vs. others) were tested with linear regression models, accounting for school clustering. Data from 16 individual interviews (shy/inactive) and 11 focus groups with 48 participants (mean = 4; range 2-7) were thematically coded. Qualitative and quantitative data were merged in an integrative mixed methods convergence matrix, which denoted convergence and dissonance across datasets. Results:Effect sizes for quantitative results were small and may not represent substantial between-group differences. Boys (vs. girls) preferred class-based sessions (β = 0.2, 95% confidence interval (CI): 0.1-0.3); qualitative data suggested that this was because boys preferred competition, which was supported quantitatively (β = 0.2, 95%CI: 0.1-0.3). Shy/inactive students did not enjoy the competition (β = -0.3, 95%CI: -0.5 to -0.1). Boys enjoyed trying new activities more (β = 0.1, 95%CI: 0.1-0.2); qualitative data indicated a desire to try new activities across all subgroups but identified barriers to choosing unfamiliar activities with self-imposed choice restriction leading to boredom. Qualitative data highlighted critique of mentorship; adolescents liked the idea, but older mentors did not meet expectations. Conclusion:We interpreted adolescent perspectives of intervention components and implementation to provide insights into future complex interventions aimed at increasing young people's physical activity in school-based settings. The intervention component mentorship was liked in principle, but implementation issues undesirably impacted satisfaction; competition was disliked by girls and shy/inactive students. The results highlight the importance of considering gender differences in preference of competition and extensive mentorship training

Effectiveness and cost-effectiveness of the GoActive intervention to increase physical activity among UK adolescents: A cluster randomised controlled trial

Background: Less than 20% of adolescents globally meet recommended levels of physical activity, and not meeting these recommended levels is associated with social disadvantage and rising disease risk. The determinants of physical activity in adolescents are multilevel and poorly understood, but the school’s social environment likely plays an important role. We conducted a cluster randomised controlled trial to assess the effectiveness of a school-based programme (GoActive) to increase moderate-to-vigorous physical activity (MVPA) among adolescents. Methods and findings: Non-fee-paying, co-educational schools including Year 9 students in the UK counties of Cambridgeshire and Essex were eligible for inclusion. Within participating schools (n = 16), all Year 9 students were eligible and invited to participate. Participants were 2,862 13- to 14-year-olds (84% of eligible students). After baseline assessment, schools were computer-randomised, stratified by school-level pupil premium funding (below/above county-specific median) and county (control: 8 schools, 1,319 participants, mean [SD] participants per school n = 165 [62]; intervention: 8 schools, 1,543 participants, n = 193 [43]). Measurement staff were blinded to allocation. The iteratively developed, feasibility-tested 12-week intervention, aligned with self-determination theory, trained older adolescent mentors and in-class peer-leaders to encourage classes to conduct 2 new weekly activities. Students and classes gained points and rewards for engaging in any activity in or out of school. The primary outcome was average daily minutes of accelerometer-assessed MVPA at 10-month follow-up; a mixed-methods process evaluation evaluated implementation. Of 2,862 recruited participants (52.1% male), 2,167 (76%) attended 10-month follow-up measurements; we analysed the primary outcome for 1,874 participants (65.5%). At 10 months, there was a mean (SD) decrease in MVPA of 8.3 (19.3) minutes in the control group and 10.4 (22.7) minutes in the intervention group (baseline-adjusted difference [95% confidence interval] −1.91 minutes [−5.53 to 1.70], p = 0.316). The programme cost £13 per student compared with control; it was not cost-effective. Overall, 62.9% of students and 87.3% of mentors reported that GoActive was fun. Teachers and mentors commented that their roles in programme delivery were unclear. Implementation fidelity was low. The main methodological limitation of this study was the relatively affluent and ethnically homogeneous sample. Conclusions: In this study, we observed that a rigorously developed school-based intervention was no more effective than standard school practice at preventing declines in adolescent physical activity. Interdisciplinary research is required to understand educational-setting-specific implementation challenges. School leaders and authorities should be realistic about expectations of the effect of school-based physical activity promotion strategies implemented at scale. Trial registration: ISRCTN Registry ISRCTN31583496