Interventions to increase free school meal take-up

Purpose: The purpose of this paper is to design and implement interventions to increase free school meal (FSM) uptake in pilot schools. This paper describes the interventions, reports on acceptability (as perceived by school working parties) and explores the process of implementing change. Design/methodology/approach: The research consisted of two phases, an exploratory phase followed by an intervention phase. Findings from the latter are presented. Ten pilot schools (five primary and five secondary) in Leeds, England were recruited. Each established a working party, examined current claiming processes and implemented individualised action plans. This paper draws on the final action plans and interviews/focus groups with working parties. Findings: Interventions to improve FSM claiming process, minimise discrimination and maximise awareness were designed. The majority were implemented successfully, the exception being amending anti-bullying policies. Creative ways of delivering interventions were demonstrated. The process of change was effective, critical factors being having individualised action plans that allowed flexibility in implementation, reflecting on current claiming processes, and setting up working parties. Practical implications: Ways of working with schools to increase FSM uptake and more generally improve nutritional policies are suggested. Amending claiming systems in schools is recommended as is greater pupil and parent involvement in nutrition policies. Originality/value: An estimated 300,000 UK children do not take FSMs they are entitled to – with many schools unaware of the issue. This study worked with schools to discover how to address this issue and evaluated the perceived acceptability and feasibility of the approach

Interventions for neurocognitive dysfunction

Purpose of review: To evaluate current barriers to HIV cure strategies and interventions for neurocognitive dysfunction with a particular focus on recent advancements over the last three years. Recent findings: Optimal anti-retroviral therapy (ART) poses challenges to minimise neurotoxicity, whilst ensuring blood brain barrier penetration and minimising the risk of cerebrovascular disease. CSF biomarkers, BCL11B and neurofilament light chain may be implicated with a neuroinflammatory cascade leading to cognitive impairment. Diagnostic imaging with diffusion tensor imaging as well as resting-state fMRI show promise in future diagnosis and monitoring of HAND. Summary: The introduction of ART has resulted in a dramatic decline in HIV-associated dementia. Despite this reduction, milder forms of HIV-associated neurocognitive disorder (HAND) are still prevalent and are clinically significant. The central nervous system (CNS) has been recognised as a probable reservoir and sanctuary for HIV, representing a significant barrier to management interventions

Designing theoretically-informed implementation interventions

Clinical and health services research is continually producing new findings that may contribute to effective and efficient patient care. However, the transfer of research findings into practice is unpredictable and can be a slow and haphazard process. Ideally, the choice of implementation strategies would be based upon evidence from randomised controlled trials or systematic reviews of a given implementation strategy. Unfortunately, reviews of implementation strategies consistently report effectiveness some, but not all of the time; possible causes of this variation are seldom reported or measured by the investigators in the original studies. Thus, any attempts to extrapolate from study settings to the real world are hampered by a lack of understanding of the effects of key elements of individuals, interventions, and the settings in which they were trialled. The explicit use of theory offers a way of addressing these issues and has a number of advantages, such as providing: a generalisable framework within which to represent the dimensions that implementation studies address, a process by which to inform the development and delivery of interventions, a guide when evaluating, and a way to allow for an exploration of potential causal mechanisms. However, the use of theory in designing implementation interventions is methodologically challenging for a number of reasons, including choosing between theories and faithfully translating theoretical constructs into interventions. The explicit use of theory offers potential advantages in terms of facilitating a better understanding of the generalisability and replicability of implementation interventions. However, this is a relatively unexplored methodological area

Scaling up HIV/AIDS interventions through expanded partnerships (STEPs) in Malawi

"This paper discusses enabling and constraining factors related to the scaling-up of the Scaling Up HIV/AIDS Interventions Through Expanded Partnerships (STEPs) initiative, supported by Save the Children U.S.A. (SC), to combat HIV/AIDS in Malawi. It also discusses potential threats to and contextual factors limiting scaling up of STEPs. The report draws primarily upon the available literature and qualitative data collected during a five-day visit to SC Malawi in December 2002. STEPs started in 1995 as Community-Based Options for Protection and Empowerment (COPE). COPE was a service-delivery program in Mangochi District to assist children affected by HIV/AIDS. Through evaluations, SC realized that such an approach was unsustainable, not cost-effective, and not scalable. Based on the recommendations of the evaluations and on field experience, the program changed course to mobilize collective action to combat the epidemic. Working in the Namwera community in Mangochi under the National AIDS Commission (NAC), STEPs revitalized the dormant decentralized AIDS committees and their technical subcommittees at the district, community, and village levels. Based on the positive experience in Namwera, the program changed its initial strategy to that of an external change agent, assisting communities with community mobilization and capacity building so that communities became empowered to act collectively to address their problems. Village AIDS committees (VACs) first identify the vulnerable. Then VACs plan responses on the basis of the nature and magnitude of vulnerability within the villages, needs of the vulnerable, and capacity within villages to respond. The committees also monitor activities and mobilize resources. As the needs of the most affected communities are crosscutting, the program has become truly multisectoral, with activities along the continuum of prevention, care, support, and mitigation. STEPs has also been influencing national policies related to HIV/AIDS and children." Authors' AbstractCapacity building ,HIV/AIDS Africa ,Collective action ,Community organizations ,Community mobilization ,Scaling up ,

Feed interventions and skatole deposition

Skatole produced in the large intestine of the pig and the testicular steroid androstenone are the main substances contributing to boar tainted meat from entire male pigs. Boar taint decreases the quality of the meat and is not accepted by consumers. Until now boar taint has been avoided by castrating male pigs. Surgical castration reduces lean meat percentage, growth rate and feed efficiency, and it causes pain to the animal. This constitutes a problem in relation to productivity and welfare. Different attempts on avoiding surgical castration were either not fully effective, not accepted by the market, or they have a long time horizon for implementation. However, when focusing on the effect of feed interventions on boar taint, previous studies have showed a reducing effect through reduced skatole production in the large intestine after a one week application period. Skatole is produced from the microbial fermentation of L-tryptophan in the large intestine. In the literature it is well documented that skatole production in the large intestine is positively correlated with skatole deposition in adipose tissue. Moreover skatole production can be decreased by adding non-digestible and easy fermentable carbohydrates to the feed. However, little is known about skatole producing bacteria from the large intestine of pigs, and how these bacteria can be affected. This thesis reviews skatole production and metabolism in the pig, and how skatole production can be reduced by affecting the microbial production of skatole in the large intestine. A skatole producing bacterium SK9 K4 was isolated from the gastrointestinal tract of pigs. No such bacterium has previously been described. The bacterium was characterised by 16S RNA sequencing, gram stain, analysis of DNA G-C content, cellular fatty acids composition and DNA hybridisation with closely related bacteria. The fermentation of different carbohydrate sources, the growth pattern, the production of organic acids and the skatole production were studied in vitro. The production of skatole in the large intestine was correlated with skatole deposition in adipose tissue. Skatole production could be reduced when adding a minimum of 20 % raw potato starch or 9 % inulin to the feed. The problem concerning deposition of skatole in adipose tissue seems to be solved through the introduction of feed interventions. However high concentrations of androstenone deposited in adipose tissue remains a challenge. Thus, the feed interventions were not fully effective against boar taint. SK9 K4 was described as cells being strictly anaerobic, occurred singly or in pairs and were gram positive. It was identical with an Olsenella sp. strain isolated from the rumen, an uncultured Olsenella sp. clone isolated from sludge and an uncultured bacterium colon isolated from the oral cavity. Moreover SK9 K4 was closely related to Olsenella uli, Olsenella profusa, Olsenella umbonata and Atopobium parvulum. SK9 K4 and O. uli produced skatole from idole-3-acetic acid but not from L-tryptophan. The major fermentation products were lactic acid together with acetic acid and formic acid. SK9 K4 was not able to ferment raw potato starch, inulin and raw corn starch. Thus, when feeding resistant starch or inulin, the growth of skatole producing bacteria might be reduced followed by a reduced ability to produce skatole. The characterisation of a skatole producing bacterium isolated from the gastrointestinal tract of pigs gives the opportunity to further study the bacterium in vivo. Studies should be conducted to investigate the effect of a control diet compared to a diet added a non-digestible and easy fermentable carbohydrate on the growth of SK9 K4 in the large intestine of the pig

Measuring the 'success' of telehealth interventions

Despite substantial investment over recent years in telehealth there appears to be little consensus regarding what a successful implementation should achieve. However, defining success is often controversial and complex due to differing views from the large number of stakeholders involved, the local environment where telehealth is deployed and the scope, or size, of any planned initiative. Nevertheless, a number of generic measures are proposed in this paper which then provides a framework for the measurement of success. The local context can then be applied to determine the exact emphasis on specific measures, but it is proposed that all of the measures should be included in the holistic measurement of success. Having considered what constitutes success attention is then given to how success should be quantified. Robust evaluation is fundamental and there is much debate as to whether the �gold standard� Randomised Control Trial (RCT) is the most appropriate methodology for telehealth. If the intervention, technology and system, can be maintained in a stable state then the RCT may well provide the most authoritative evidence for decision makers. However, ensuring such stability, in what is still a novel combination of technology and service, is difficult and consequently other approaches may be more appropriate when stability is unlikely to be maintained

The impact of antenatal psychological group interventions on psychological well-being : a systematic review of the qualitative and quantitative evidence

Depression, anxiety and stress in the perinatal period can have serious, long-term consequences for women, their babies and their families. Over the last two decades, an increasing number of group interventions with a psychological approach have been developed to improve the psychological well-being of pregnant women. This systematic review examines interventions targeting women with elevated symptoms of, or at risk of developing, perinatal mental health problems, with the aim of understanding the successful and unsuccessful features of these interventions. We systematically searched online databases to retrieve qualitative and quantitative studies on psychological antenatal group interventions. A total number of 19 papers describing 15 studies were identified; these included interventions based on cognitive behavioural therapy, interpersonal therapy and mindfulness. Quantitative findings suggested beneficial effects in some studies, particularly for women with high baseline symptoms. However, overall there is insufficient quantitative evidence to make a general recommendation for antenatal group interventions. Qualitative findings suggest that women and their partners experience these interventions positively in terms of psychological wellbeing and providing reassurance of their ‘normality’. This review suggests that there are some benefits to attending group interventions, but further research is required to fully understand their successful and unsuccessful features