Abstract
Background
Alcohol Screening and Brief Intervention (ASBI) helps reduce risky drinking in adults, but less is known about its effectiveness with young people. This article explores ...implementation of DrinkThink, an ASBI co-produced with young people, by health, youth and social care professionals trained in its delivery.
Methods
A qualitative evaluation was conducted using focus groups with 33 staff trained to deliver DrinkThink, and eight interviews with trained participants and service managers. These were recorded, transcribed and a thematic analysis undertaken.
Results
DrinkThink was not delivered fully by health, youth or social care agencies. The reasons for this varied by setting but included: the training staff received, a working culture that was ill-suited to the intervention, staff attitudes towards alcohol which prioritized other health problems presented by young people, over alcohol use.
Conclusions
Implementation was limited because staff had not been involved in the design and planning of DrinkThink. Staffs’ perceptions of alcohol problems in young people and the diverse cultures in which they work were subsequently not accounted for in the design. Co-producing youth focused ASBIs with the professionals expected to deliver them, and the young people whom they target, may ensure greater success in integrating them into working practice.
Schools offer a valuable setting to promote good health and mental well-being amongst young people. Schools are complex systems and therefore systems interventions are needed to improve pupil health ...and well-being. This paper presents a qualitative process evaluation of the South West- School Health Research Network, a systems level intervention. The evaluation is based on interviews with school staff, local authorities and wider stakeholders. Given the complexity of England's educational system there is a need to intervene and monitor health at multiple levels and to ensure close partnership working to effectively improve adolescent health through schools.
•Applying systems thinking to school health research networks.•Evaluating a regional school health research network.•Creating a school health research network systems map for England.•Close partnership working at multiple levels to improve health through schools.•Using school health research networks to inform policy.
Schools play a significant role in promoting health and well-being and the reciprocal links between health and educational attainment are well-evidenced. Despite recognition of the beneficial impact ...of school-based health improvement programmes, significant barriers to improving health and well-being within schools remain. This study pilots a School Health Research Network in the South West of England (SW-SHRN), a systems-based health intervention bringing together schools, academic health researchers and public health and/or education teams in local authorities to share knowledge and expertise to improve the health and well-being of young people. A maximum of 20 secondary schools will be recruited to the pilot SW-SHRN. All students in Years 8 (age 12-13) and 10 (age 14-15) will be invited to complete a health and well-being questionnaire, generating a cohort of approximately 5000 adolescents. School environment questionnaires will also be completed with each school to build a regional picture of existing school health policies and programmes. Each school will be provided with a report summarising data for their students benchmarked against data for all schools in the network. Quantitative analysis will model associations between health risk behaviours and mental health outcomes and a qualitative process evaluation will explore the feasibility and sustainability of the network. This study will create adolescent health data to help provide schools and local authorities with timely and robust information on the health and well-being of their students and help them to identify areas in which public health interventions may be required. SW-SHRN will also help public health professionals focus their resources in the areas most at need.
Background
Schools in the UK increasingly have to respond to anxiety, depression and conduct disorder as key causes of morbidity in children and young people.
Objective
The objective was to assess ...the comparative effectiveness of educational setting-based interventions for the prevention of anxiety, depression and conduct disorder in children and young people.
Design
This study comprised a systematic review, a network meta-analysis and an economic evaluation.
Data sources
The databases MEDLINE, EMBASE™ (Elsevier, Amsterdam, the Netherlands), PsycInfo
®
(American Psychological Association, Washington, DC, USA) and Cochrane Central Register of Controlled Trials (CENTRAL) were searched to 4 April 2018, and the NHS Economic Evaluation Database (NHS EED) was searched on 22 May 2019 for economic evaluations. No language or date filters were applied.
Main outcomes
The main outcomes were post-intervention self-reported anxiety, depression or conduct disorder symptoms.
Review methods
Randomised/quasi-randomised trials of universal or targeted interventions for the prevention of anxiety, depression or conduct disorder in children and young people aged 4–18 years were included. Screening was conducted independently by two reviewers. Data extraction was conducted by one reviewer and checked by a second. Intervention- and component-level network meta-analyses were conducted in OpenBUGS. A review of the economic literature and a cost–consequence analysis were conducted.
Results
A total of 142 studies were included in the review, and 109 contributed to the network meta-analysis. Of the 109 studies, 57 were rated as having an unclear risk of bias for random sequence generation and allocation concealment. Heterogeneity was moderate. In universal secondary school settings, mindfulness/relaxation interventions standardised mean difference (SMD) –0.65, 95% credible interval (CrI) –1.14 to –0.19 and cognitive–behavioural interventions (SMD –0.15, 95% CrI –0.34 to 0.04) may be effective for anxiety. Cognitive–behavioural interventions incorporating a psychoeducation component may be effective (SMD –0.30, 95% CrI –0.59 to –0.01) at preventing anxiety immediately post intervention. There was evidence that exercise was effective in preventing anxiety in targeted secondary school settings (SMD –0.47, 95% CrI –0.86 to –0.09). There was weak evidence that cognitive–behavioural interventions may prevent anxiety in universal (SMD –0.07, 95% CrI –0.23 to 0.05) and targeted (SMD –0.38, 95% CrI –0.84 to 0.07) primary school settings. There was weak evidence that cognitive–behavioural (SMD –0.04, 95% CrI –0.16 to 0.07) and cognitive–behavioural + interpersonal therapy (SMD –0.18, 95% CrI –0.46 to 0.08) may be effective in preventing depression in universal secondary school settings. Third-wave (SMD –0.35, 95% CrI –0.70 to 0.00) and cognitive–behavioural interventions (SMD –0.11, 95% CrI –0.28 to 0.05) incorporating a psychoeducation component may be effective at preventing depression immediately post intervention. There was no evidence of intervention effectiveness in targeted secondary, targeted primary or universal primary school settings post intervention. The results for university settings were unreliable because of inconsistency in the network meta-analysis. A narrative summary was reported for five conduct disorder prevention studies, all in primary school settings. None reported the primary outcome at the primary post-intervention time point. The economic evidence review reported heterogeneous findings from six studies. Taking the perspective of a single school budget and based on cognitive–behavioural therapy intervention costs in universal secondary school settings, the cost–consequence analysis estimated an intervention cost of £43 per student.
Limitations
The emphasis on disorder-specific prevention excluded broader mental health interventions and restricted the number of eligible conduct disorder prevention studies. Restricting the study to interventions delivered in the educational setting may have limited the number of eligible university-level interventions.
Conclusions
There was weak evidence of the effectiveness of school-based, disorder-specific prevention interventions, although effects were modest and the evidence not robust. Cognitive–behavioural therapy-based interventions may be more effective if they include a psychoeducation component.
Future work
Future trials for prevention of anxiety and depression should evaluate cognitive–behavioural interventions with and without a psychoeducation component, and include mindfulness/relaxation or exercise comparators, with sufficient follow-up. Cost implications must be adequately measured.
Study registration
This study is registered as PROSPERO CRD42016048184.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in
Public Health Research
; Vol. 9, No. 8. See the NIHR Journals Library website for further project information.
MINI PCNL in a Pediatric Population Wah, Tze M.; Kidger, Lizi; Kennish, Steven ...
Cardiovascular and interventional radiology,
02/2013, Letnik:
36, Številka:
1
Journal Article
Recenzirano
Purpose
We report our initial experience of MINI percutaneous nephrolithotomy (PCNL) in a pediatric population using a miniature nephroscope through a 16F metal access sheath.
Methods
All pediatric ...patients who underwent PCNL from August 2007 to September 2010 using a 14F miniature nephroscope through a 16F metal access sheath for renal stone extraction were evaluated. Patients’ demographic details, procedural information, and posttreatment outcomes were prospectively documented.
Results
A total of 23 MINI PCNLs were performed on 23 kidneys of 12 patients whose ages ranged from 1.6 to 14.6 years. The median stone burden was 3.44 cm
2
, and there were 11 “Staghorn” stones. The procedure was primary via a single puncture in 19 kidneys and secondary using a preexisting nephrostomy tract in 4 kidneys. Access was successful in all primary and two secondary cases, for a total of success rate of 91.3 %. Stones were fragmented using a Holmium laser and/or lithoclast, and fragments were irrigated or sequentially removed by various stone grasping devices. The mean procedural X-ray screening time and total stone extraction period were 4.5 and 109.4 min, respectively. The primary stone free rate was 83.6 %, which increased to 90.5 % after treating the residual fragments. Postoperative hydrothorax developed in one patient, which required a chest drain. Symptoms of chest infection and positive urine culture were detected in one and two patients, respectively.
Conclusions
Our initial experience supports previous reports that MINI PCNL is safe and effective for the management of renal stones in children.
We present the results of observations of blazar PKS 1510-089 with the Herschel Space Observatory PACS and SPIRE instruments, together with multiwavelength data from Fermi/LAT, Swift, SMARTS, and ...Submillimeter Array. The source was found in a quiet state, and its far-infrared spectrum is consistent with a power law with a spectral index of {alpha} {approx_equal} 0.7. Our Herschel observations were preceded by two 'orphan' gamma-ray flares. The near-infrared data reveal the high-energy cutoff in the main synchrotron component, which cannot be associated with the main gamma-ray component in a one-zone leptonic model. This is because in such a model the luminosity ratio of the external-Compton (EC) and synchrotron components is tightly related to the frequency ratio of these components, and in this particular case an unrealistically high energy density of the external radiation would be implied. Therefore, we consider a well-constrained two-zone blazar model to interpret the entire data set. In this framework, the observed infrared emission is associated with the synchrotron component produced in the hot-dust region at the supra-parsec scale, while the gamma-ray emission is associated with the EC component produced in the broad-line region at the sub-parsec scale. In addition, the optical/UV emission is associated with the accretion disk thermal emission, with the accretion disk corona likely contributing to the X-ray emission.
Over one thousand objects have so far been discovered orbiting beyond Neptune. These trans-Neptunian objects (TNOs) represent the primitive remnants of the planetesimal disk from which the planets ...formed and are perhaps analogous to the unseen dust parent-bodies in debris disks observed around other main-sequence stars. The dynamical and physical properties of these bodies provide unique and important constraints on formation and evolution models of the Solar System. While the dynamical architecture in this region (also known as the Kuiper Belt) is becoming relatively clear, the physical properties of the objects are still largely unexplored. In particular, fundamental parameters such as size, albedo, density and thermal properties are difficult to measure. Measurements of thermal emission, which peaks at far-IR wavelengths, offer the best means available to determine the physical properties. While Spitzer has provided some results, notably revealing a large albedo diversity in this population, the increased sensitivity of Herschel and its superior wavelength coverage should permit profound advances in the field. Within our accepted project we propose to perform radiometric measurements of 139 objects, including 25 known multiple systems. When combined with measurements of the dust population beyond Neptune (e.g. from the New Horizons mission to Pluto), our results will provide a benchmark for understanding the Solar debris disk, and extra-solar ones as well.
A prospective study of tardive dyskinesia was carried out to gain information regarding the natural history of the condition and to identify risk factors. Out of an original cohort of 182 psychiatric ...patients receiving maintenance antipsychotic drugs 99 were available for reassessment after 3 years. In this follow-up group the point prevalence of oro-facial dyskinesia increased from 39% to 47% over the 3-year period. Twenty-two patients developed the disorder, while remission occurred in 14 others. Risk factors predicting the presence of oro-facial dyskinesia at follow-up included being over 50 years of age and the presence of akathisia. There was no convincing association between the duration of antipsychotic drug treatment and the presence or severity of oro-facial dyskinesia. Patients receiving over 1000 mg chlorpromazine equivalents of antipsychotic drug per day were unlikely to have the condition. The amount of purposeless trunk and limb movement present proved to be a relatively stable phenomenon, showing only a slight increase with age and no change over the follow-up period. The implications of these findings are discussed, with particular consideration being given to the effects of loss of patients to follow-up.
We present the results of observations of blazar PKS 1510-089 with the Herschel Space Observatory PACS and SPIRE instruments, together with multiwavelength data from Fermi/LAT, Swift, SMARTS and SMA. ...The source was found in a quiet state, and its far-infrared spectrum is consistent with a power-law with a spectral index of alpha ~ 0.7. Our Herschel observations were preceded by two 'orphan' gamma-ray flares. The near-infrared data reveal the high-energy cut-off in the main synchrotron component, which cannot be associated with the main gamma-ray component in a one-zone leptonic model. This is because in such a model the luminosity ratio of the External-Compton and synchrotron components is tightly related to the frequency ratio of these components, and in this particular case an unrealistically high energy density of the external radiation would be implied. Therefore, we consider a well-constrained two-zone blazar model to interpret the entire dataset. In this framework, the observed infrared emission is associated with the synchrotron component produced in the hot-dust region at the supra-pc scale, while the gamma-ray emission is associated with the External-Compton component produced in the broad-line region at the sub-pc scale. In addition, the optical/UV emission is associated with the accretion disk thermal emission, with the accretion disk corona likely contributing to the X-ray emission.
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