Building a future...An exploration of the contribution of educational provision to clients’ well-being at Southwark Day Centre for Asylum Seekers

This research project builds on previous work, ‘Beneath the Surface’ (Cogo, Inman, McCormack, Rogers 2018) which focussed on how clients at Southwark Day Centre for Asylum Seekers (SDCAS) understood and evaluated their well-being. One of the areas touched on in that research was the role of educational activities in developing the well-being of clients. This report describes in depth the ways in which the educational provision offered in the centre contributes to the well-being of clients and how this contribution might be enhanced. The report focuses on two areas of education provision; gardening and storytelling and explains how they contribute to the well-being of the clients. The interview data confirms that the activities in these two areas help to build clients’ psychological, physical and social resources and have a positive effect on how clients feel and how they function in the world. The report ends with recommendations as to how SDCAS might ensure that gardening and storytelling continue to benefit the well-being of clients and also as to what might be put in place to strengthen the activities

Stories from lockdown: the impact of the Covid19 pandemic on the well-being of clients at Southwark Day Centre for Asylum Seekers (SDCAS)

The report describes the findings of research on how the Covid 19 related lockdowns affected the well-being of clients at the Southwark Day Centre for Asylum Seekers. A small number of clients were interviewed about the practical issues of housing, food, money and about their physical and mental health during the periods of lockdowns. They were also asked about support from the Southwark Day Centre for Asylum Seekers. The report describes the experiences of these clients between March 2020 and March 202

A systematic review of cost-effectiveness analyses of complex wound interventions reveals optimal treatments for specific wound types.

BackgroundComplex wounds present a substantial economic burden on healthcare systems, costing billions of dollars annually in North America alone. The prevalence of complex wounds is a significant patient and societal healthcare concern and cost-effective wound care management remains unclear. This article summarizes the cost-effectiveness of interventions for complex wound care through a systematic review of the evidence base.MethodsWe searched multiple databases (MEDLINE, EMBASE, Cochrane Library) for cost-effectiveness studies that examined adults treated for complex wounds. Two reviewers independently screened the literature, abstracted data from full-text articles, and assessed methodological quality using the Drummond 10-item methodological quality tool. Incremental cost-effectiveness ratios were reported, or, if not reported, calculated and converted to United States Dollars for the year 2013.ResultsOverall, 59 cost-effectiveness analyses were included; 71% (42 out of 59) of the included studies scored 8 or more points on the Drummond 10-item checklist tool. Based on these, 22 interventions were found to be more effective and less costly (i.e., dominant) compared to the study comparators: 9 for diabetic ulcers, 8 for venous ulcers, 3 for pressure ulcers, 1 for mixed venous and venous/arterial ulcers, and 1 for mixed complex wound types.ConclusionsOur results can be used by decision-makers in maximizing the deployment of clinically effective and resource efficient wound care interventions. Our analysis also highlights specific treatments that are not cost-effective, thereby indicating areas of resource savings. Please see related article: http://dx.doi.org/10.1186/s12916-015-0288-5

Disaturated-phosphatidylcholine and Surfactant protein-B turnover in human acute lung injury and in control patients

<p>Abstract</p> <p>Background</p> <p>Patients with Adult Respiratory Distress Syndrome (ARDS) and Acute Lung Injury (ALI) have low concentrations of disaturated-phosphatidylcholine and surfactant protein-B in bronchoalveolar lavage fluid. No information is available on their turnover.</p> <p>Objectives</p> <p>To analyze disaturated-phosphatidylcholine and surfactant protein-B turnover in patients with ARDS/ALI and in human adults with normal lungs (controls).</p> <p>Methods</p> <p>²H₂O as precursor of disaturated-phosphatidylcholine-palmitate and 1¹³C-Leucine as precursor of surfactant protein-B were administered intravenously to 12 patients with ARDS/ALI and to 8 controls. Disaturated-phosphatidylcholine and surfactant protein-B were isolated from serial tracheal aspirates, and their fractional synthetic rate was derived from the ²H and ¹³C enrichment curves, obtained by gas chromatography mass spectrometry. Disaturated-phosphatidylcholine, surfactant protein-B, and protein concentrations in tracheal aspirates were also measured.</p> <p>Results</p> <p>1) Surfactant protein-B turned over at faster rate than disaturated-phosphatidylcholine both in ARDS/ALI patients and in controls. 2) In patients with ARDS/ALI the fractional synthesis rate of disaturated-phosphatidylcholine was 3.1 times higher than in controls (p < 0.01), while the fractional synthesis rate of surfactant protein-B was not different. 3) In ARDS/ALI patients the concentrations of disaturated-phosphatidylcholine and surfactant protein-B in tracheal aspirates were markedly and significantly reduced (17% and 40% of the control values respectively).</p> <p>Conclusions</p> <p>1) Disaturated-phosphatidylcholine and surfactant protein-B have a different turnover both in healthy and diseased lungs. 2) In ARDS/ALI the synthesis of these two surfactant components may be differently regulated.</p

Respiratory Effects of Exposure to Traffic-Related Air Pollutants During Exercise

Traffic-related air pollution (TRAP) is increasing worldwide. Habitual physical activity is known to prevent cardiorespiratory diseases and mortality, but whether exposure to TRAP during exercise affects respiratory health is still uncertain. Exercise causes inflammatory changes in the airways, and its interaction with the effects of TRAP or ozone might be detrimental, for both athletes exercising outdoor and urban active commuters. In this Mini-Review, we summarize the literature on the effects of exposure to TRAP and/or ozone during exercise on lung function, respiratory symptoms, performance, and biomarkers. Ozone negatively affected pulmonary function after exercise, especially after combined exposure to ozone and diesel exhaust (DE). Spirometric changes after exercise during exposure to particulate matter and ultrafine particles suggest a decrease in lung function, especially in patients with chronic obstructive pulmonary disease. Ozone frequently caused respiratory symptoms during exercise. Women showed decreased exercise performance and higher symptom prevalence than men during TRAP exposure. However, performance was analyzed in few studies. To date, research has not identified reliable biomarkers of TRAP-related lung damage useful for monitoring athletes' health, except in scarce studies on airway cells obtained by induced sputum or bronchoalveolar lavage. In conclusion, despite partly counteracted by the positive effects of habitual exercise, the negative effects of TRAP exposure to pollutants during exercise are hard to assess: outdoor exercise is a complex model, for multiple and variable exposures to air pollutants and pollutant concentrations. Further studies are needed to identify pollutant and/or time thresholds for performing safe outdoor exercise in cities

Stuck Outside and Inside: An Exploratory Study on the Effects of the COVID-19 Outbreak on Italian Parents and Children\u2019s Internalizing Symptoms

The Covid-19 outbreak and the subsequent lockdown have profoundly impacted families\u2019 daily life, challenging their psychological resilience. Our study aimed to investigate the immediate psychological consequences of the pandemic on Italian parents and children focusing on internalizing and post-traumatic symptoms. We also wanted to explore the impact of possible risk and resilience factors, e.g., lifestyle and behaviors, emotional and cognitive beliefs, on parents and children\u2019s reaction to the emergency distress. An online survey was administered during the country\u2019s nationwide lockdown to 721 Italian parents of at least one child aged between 6 and 18 years. The respondent completed the survey for himself/herself and his/her child. The survey included socio-demographic items and validated questionnaires on parents\u2019 post-traumatic stress symptoms, depression and anxiety levels, and on children\u2019s internalizing problems. Parents were asked to fill the questionnaires twice: once referring to the current emergency condition and once recalling how they and their child felt a few months before Covid-19 outbreak. Multiple regression analyses showed that specific demographic characteristics (i.e., sex and age) and psychological factors of children and parents, such as fear of contagion and the opportunity to think about possible secondary positive effects of the pandemic, had a predictive value on the presence of internalizing symptoms of both parents and children. Moreover, parents\u2019 behaviors during the lockdown period (i.e., employment status and sport practiced) were significantly related to their own internalizing symptoms; these symptoms, in turn, had a strong and positive predictive value on children\u2019s internalizing problems. Besides, analyses of variance showed that internalizing symptoms of parents and children were significantly higher during the Covid-19 pandemic than before it started. In addition to showing a direct effect of the pandemic on the psychological health of parents and children, the present results also give a series of important information on how parents perceive, and therefore influence, their children in this period of emergency. Our findings thus highlight the urgent need to provide parents with adequate support to take care of their own psychological wellbeing and to help their children coping with the direct and indirect effects of the pandemic

Vellozia flavicans Mart. ex Schult. hydroalcoholic extract inhibits the neuromuscular blockade induced by Bothrops jararacussu venom

FAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULOBackground: Snakebite is a significant public health issue in tropical countries. In Brazil, some of the most common snake envenomations are from Bothrops. Bothrops bites trigger local and systemic effects including edema, pain, erythema, cyanosis, infections, and necrosis. Vellozia flavicans is a plant from the Brazilian " cerrado" (savanna) that is popularly used as an anti-inflammatory medicine. Since inflammation develops quickly after Bothrops bites, which can lead to infection, the aim of the present study was to observe possible anti-snake venom and antimicrobial activities of V. flavicans (Vf). Methods: The chromatographic profile of the main constituents from the Vf leaf hydroalcoholic extract was obtained by thin-layer chromatography (TLC). The anti-snake venom activity was measured by Vf's ability to neutralize the in vitro neuromuscular blockade caused by Bothrops jararacussu venom (Bjssu) in a mouse phrenic nerve-diaphragm model (PND). After a 20 min incubation, preparations of PND were added to Tyrode's solution (control); Vf (0.2, 0.5, 1, and 2 mg/mL); 40 μg/mL Bjssu; pre-incubation for 30 min with Bjssu and 1 mg/mL Vf; and a Bjssu pretreated preparation (for 10 min) followed by 1 mg/mL Vf. Myographic recording was performed, and the contractile responses were recorded. The antimicrobial activity (minimum inhibitory concentration [MIC] and minimum bactericidal concentration [MBC]) was obtained for Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, and Enterococcus faecalis, using gentamicin and vancomycin as positive controls. Results: TLC analysis yielded several compounds from Vf, such as flavonoids (quercetin) and phenolic acids (chlorogenic acid). Bjssu completely blocked the contractile responses of PND preparations, while Vf preserved 97% (±10%) of the contractile responses when incubated with Bjssu. In the PND pretreated with Bjssu, Vf was able to inhibit the neuromuscular blockade progress. MIC and MBC of Vf ranged from 2.5 to 5.0 mg/mL for P. aeruginosa and S. aureus strains, while no antimicrobial activity was observed for E. coli and E. faecalis.Conclusions: The hydroalcoholic extract from Vf leaves was able to neutralize and decrease the in vitro neuromuscular blockade caused by Bjssu. However, it did not show significant antimicrobial activity against the tested bacteria. © 2014 Tribuiani et al.; licensee BioMed Central Ltd.Snakebite is a significant public health issue in tropical countries. In Brazil, some of the most common snake envenomations are from Bothrops. Bothrops bites trigger local and systemic effects including edema, pain, erythema, cyanosis, infections, and necrosis. Vellozia flavicans is a plant from the Brazilian "cerrado" (savanna) that is popularly used as an anti-inflammatory medicine. Since inflammation develops quickly after Bothrops bites, which can lead to infection, the aim of the present study was to observe possible anti-snake venom and antimicrobial activities of V. flavicans (Vf). The chromatographic profile of the main constituents from the Vf leaf hydroalcoholic extract was obtained by thin-layer chromatography (TLC). The anti-snake venom activity was measured by Vf's ability to neutralize the in vitro neuromuscular blockade caused by Bothrops jararacussu venom (Bjssu) in a mouse phrenic nerve-diaphragm model (PND). After a 20 min incubation, preparations of PND were added to Tyrode's solution (control); Vf (0.2, 0.5, 1, and 2 mg/mL); 40 μg/mL Bjssu; pre-incubation for 30 min with Bjssu and 1 mg/mL Vf; and a Bjssu pretreated preparation (for 10 min) followed by 1 mg/mL Vf. Myographic recording was performed, and the contractile responses were recorded. The antimicrobial activity (minimum inhibitory concentration [MIC] and minimum bactericidal concentration [MBC]) was obtained for Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, and Enterococcus faecalis, using gentamicin and vancomycin as positive controls. TLC analysis yielded several compounds from Vf, such as flavonoids (quercetin) and phenolic acids (chlorogenic acid). Bjssu completely blocked the contractile responses of PND preparations, while Vf preserved 97% (±10%) of the contractile responses when incubated with Bjssu. In the PND pretreated with Bjssu, Vf was able to inhibit the neuromuscular blockade progress. MIC and MBC of Vf ranged from 2.5 to 5.0 mg/mL for P. aeruginosa and S. aureus strains, while no antimicrobial activity was observed for E. coli and E. faecalis. 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Effect of preoperative pulmonary hemodynamic and cardiopulmonary bypass on lung function in children with congenital heart disease

In children with congenital heart disease (CHD), pulmonary blood flow (Qp) contributes to alterations of pulmonary mechanics and gas exchange, while cardiopulmonary bypass (CPB) induces lung edema. We aimed to determine the effect of hemodynamics on lung function and lung epithelial lining fluid (ELF) biomarkers in biventricular CHD children undergoing CPB. CHD children were classified as high Qp (n = 43) and low Qp (n = 17), according to preoperative cardiac morphology and arterial oxygen saturation. We measured ELF surfactant protein B (SP-B) and myeloperoxidase activity (MPO) as indexes of lung inflammation and ELF albumin as index of alveolar capillary leak in tracheal aspirate (TA) samples collected before surgery and in 6 hourly intervals within 24 h after surgery. At the same time points, we recorded dynamic compliance and oxygenation index (OI). The same biomarkers were measured in TA samples collected from 16 infants with no cardiorespiratory diseases at the time of endotracheal intubation for elective surgery. Preoperative ELF biomarkers in CHD children were significantly increased than those found in controls. In the high Qp, ELF MPO and SP-B peaked 6 h after surgery and tended to decrease afterward, while they tended to increase within the first 24 h in the low Qp. ELF albumin peaked 6 h after surgery and decreased afterwards in both CHD groups. Dynamic compliance/kg and OI significantly improved after surgery only in the High Qp. Conclusion: In CHD children, lung mechanics, OI, and ELF biomarkers were significantly affected by CPB, according to the preoperative pulmonary hemodynamics.What is Known:• Congenital heart disease children, before cardiopulmonary run, exhibit changes in respiratory mechanics, gas exchange, and lung inflammatory biomarkers that are related to the preoperative pulmonary hemodynamics.• Cardiopulmonary bypass induces alteration of lung function and epithelial lining fluid biomarkers according to preoperative hemodynamics.What is New:• Our findings can help to identify children with congenital heart disease at high risk of postoperative lung injury who may benefit of tailored intensive care strategies, such as non-invasive ventilation techniques, fluid management, and anti-inflammatory drugs that can improve cardiopulmonary interaction in the perioperative period

Validación psicométrica del instrumento audio guiado rBVQ para la evaluación del bullying

The revised Olweus Bully/Victim Questionnaire (rBVQ) is an internationally used instrument to identify bullying, but due to Brazilian students’ low proficiency in reading and writing, it had to be adapted for audio-guided use through smartphones. We investigated construct validity, using Confirmatory Factor Analysis (CFA), under a two-correlated factor solution. Participated 1,742 fifth graders and 2,316 seventh graders from 30 public schools in the city of São Paulo. We found excellent fit indices models for both grades (fifth grade: CFI=0.985, RMSEA=0.020; seventh grade: CFI=0.990, RMSEA=0.015), as well as factor loading higher than 0.4 for all items, indicating their relevance to the construct. The rBVQ demonstrated excellent psychometric properties and may help future studies that aim to investigate bullying in populations with similar profiles. In addition, this study innovates by evaluating an audio-guided instrument and using mobile technology.El Cuestionario Revisado de Bullying de Olweus (rBVQ) es un instrumento utilizado internacionalmente para identificar bullying, pero debido a las dificultades de estudiantes brasileños en la lectura y la escritura, se ha adaptado su uso por medio de audioguías en smartphones. Se investigó la validez del constructo mediante el Análisis Factorial Confirmatorio, bajo un modelo de dos factores. Participaron 1742 y 2316 estudiantes de quinto y séptimo curso de 30 escuelas públicas de São Paulo. Excelentes tasas de adecuación fueron encontradas para ambos casos (quinto año: CFI=0,985, RMSEA=0,020; séptimo año: CFI=0,990, RMSEA=0,015), además de cargas factoriales superiores a 0,4 para todos los ítems, lo que indica su relevancia para el constructo. El instrumento rBVQ ha presentado excelentes propiedades psicométricas y puede ayudar a futuros estudios pretendan investigar el bullying en poblaciones con perfiles similares. Además, este estudio innova al evaluar un instrumento guiado por audio, empleando la tecnología móvil.publishedVersio

Protective continuous ventilation strategy during cardiopulmonary bypass in children undergoing surgery for congenital heart disease: a prospective study

OBJECTIVES: The aim of this study was to evaluate if a 'protective' (low-tidal/low-frequency) ventilation strategy can shorten the postoperative ventilation time and minimize acute lung injury in children with congenital heart disease (CHD) undergoing repair with cardiopulmonary bypass (CPB). METHODS: This is a single-centre prospective, interventional study, including children with CHD under the age of 5 years, undergoing open-heart surgery with a CPB &gt;60 min, in hypothermia, haemodynamically stable, and without evident genetic abnormalities. Assist-control ventilation (tidal volume of 4 ml/kg, 10 breaths/min, positive end-expiratory pressure 5 cmH2O and FiO2 0.21) was applied in a cohort of patients during CPB. We compared clinical outcomes and in fully ventilated versus non-ventilated (control) patients. Propensity score was used to weigh ventilated and control groups to correct for the effect of other confounding clinical variables. Clinical and ventilation parameters and lung inflammatory biomarkers in tracheal aspirates were measured. The primary outcome was the postoperative intubation time of more or less than 48 h. RESULTS: We included 140 children (53 ventilated, 87 non-ventilated) with different CHD. There were no deaths or adverse events in ventilated patients. Using a weighted generalized linear model, we found no sufficient evidence for an effect of intraoperative ventilation on postoperative intubation time [estimate 0.13 (95% confidence interval, -0.08; 0.35), P = 0.22]. CONCLUSIONS: Continuous low-tidal/low-frequency mechanical ventilation during CPB is safe and harmless. However, no significant advantages were found when compared to non-ventilated patients in terms of postoperative ventilation time