Gilinsky A.S.,University of Stirling |
Dale H.,NHS Fife |
Robinson C.,c o Tayvallich |
Hughes A.R.,University of Strathclyde |
And 2 more authors.
Health Psychology Review | Year: 2015
This systematic review and meta-analysis reports the efficacy of post-natal physical activity change interventions with content coding of behaviour change techniques (BCTs). Electronic databases (MEDLINE, CINAHL and PsychINFO) were searched for interventions published from January 1980 to July 2013. Inclusion criteria were: (i) interventions including ≥1 BCT designed to change physical activity behaviour, (ii) studies reporting ≥1 physical activity outcome, (iii) interventions commencing later than four weeks after childbirth and (iv) studies including participants who had given birth within the last year. Controlled trials were included in the meta-analysis. Interventions were coded using the 40-item Coventry, Aberdeen & London - Refined (CALO-RE) taxonomy of BCTs and study quality assessment was conducted using Cochrane criteria. Twenty studies were included in the review (meta-analysis: n = 14). Seven were interventions conducted with healthy inactive post-natal women. Nine were post-natal weight management studies. Two studies included women with post-natal depression. Two studies focused on improving general well-being. Studies in healthy populations but not for weight management successfully changed physical activity. Interventions increased frequency but not volume of physical activity or walking behaviour. Efficacious interventions always included the BCTs ‘goal setting (behaviour)’ and ‘prompt self-monitoring of behaviour’. © 2014 Taylor & Francis.
Quinn T.,University of Surrey |
Johnsen S.,University of Surrey |
Gale C.P.,University of Leeds |
Gale C.P.,York Teaching Hospital |
And 4 more authors.
Heart | Year: 2014
Objective: To describe patterns of prehospital ECG (PHECG) use and determine its association with processes and outcomes of care in patients with ST-elevation myocardial infarction (STEMI) and non-STEMI. Methods: Population-based linked cohort study of a national myocardial infarction registry. Results: 288 990 patients were admitted to hospitals via emergency medical services (EMS) between 1 January 2005 and 31 December 2009. PHECG use increased overall (51% vs 64%, adjusted OR (aOR) 2.17, 95% CI 2.12 to 2.22), and in STEMI (64% vs 79%, aOR 2.34, 95% CI 2.25 to 2.44). Patients who received PHECG were younger (71 years vs 74 years, P<0.0001); and less likely to be female (33.1% vs 40.3%, OR 0.87, 95% CI 0.86 to 0.89), or to have comorbidities than those who did not. For STEMI, reperfusion was more frequent in those having PHECG (83.5% vs 74.4%, p<0.0001). PHECG was associated with more primary percutaneous coronary intervention patients achieving call-to-balloon time <90 min (27.9% vs 21.4%, aOR 1.38, 95% CI 1.24 to 1.54) and more patients who received fibrinolytic therapy achieving door-to-needle time <30 min (90.6% vs 83.7%, aOR 2.13, 95% CI 1.91 to 2.38). Patients with PHECG exhibited significantly lower 30-day mortality rates than those who did not (7.4% vs 8.2%, aOR 0.94, 95% CI 0.91 to 0.96). Conclusions: Findings from this national MI registry demonstrate a survival advantage in STEMI and non-STEMI patients when PHECG was used.
Benjamin L.A.,University of Liverpool |
Benjamin L.A.,Malawi Liverpool Wellcome Major Overseas Clinical Research Programme |
Benjamin L.A.,Walton Center Foundation Trust |
Bryer A.,University of Cape Town |
And 8 more authors.
The Lancet Neurology | Year: 2012
HIV infection can result in stroke via several mechanisms, including opportunistic infection, vasculopathy, cardioembolism, and coagulopathy. However, the occurrence of stroke and HIV infection might often be coincidental. HIV-associated vasculopathy describes various cerebrovascular changes, including stenosis and aneurysm formation, vasculitis, and accelerated atherosclerosis, and might be caused directly or indirectly by HIV infection, although the mechanisms are controversial. HIV and associated infections contribute to chronic inflammation. Combination antiretroviral therapies (cART) are clearly beneficial, but can be atherogenic and could increase stroke risk. cART can prolong life, increasing the size of the ageing population at risk of stroke. Stroke management and prevention should include identification and treatment of the specific cause of stroke and stroke risk factors, and judicious adjustment of the cART regimen. Epidemiological, clinical, biological, and autopsy studies of risk, the pathogenesis of HIV-associated vasculopathy (particularly of arterial endothelial damage), the long-term effects of cART, and ideal stroke treatment in patients with HIV are needed, as are antiretrovirals that are without vascular risk. © 2012 Elsevier Ltd.
Williams I.,University of Birmingham |
Phillips D.,NHS County Durham and Darlington |
Nicholson C.,University of Southampton |
Shearer H.,NHS Fife
Leadership in Health Services | Year: 2014
Purpose: The purpose of this paper is to describe and evaluate a novel approach to citizen engagement in health priority setting carried out in the context of Primary Care Trust (PCT) commissioning in the English National Health Service. Design/methodology/approach: Four deliberative events were held with 139 citizens taking part in total. Events design incorporated elements of the Twenty-first Century Town Meeting and the World Café, and involved specially-designed dice games. Evaluation surveys reporting quantitative and qualitative participant responses were combined with follow-up interviews with both PCT staff and members of the public. An evaluation framework based on previous literature was employed. Findings: The evaluation demonstrates high levels of enjoyment, learning and deliberative engagement. However, concerns were expressed over the leading nature of the voting questions and, in a small minority of responses, the simplified scenarios used in dice games. The engagement exercises also appeared to have minimal impact on subsequent Primary Care Trust resource allocation, confirming a wider concern about the influence of public participation on policy decision making. The public engagement activities had considerable educative and political benefits and overall the evaluation indicates that the specific deliberative tools developed for the exercise facilitated a high level of discussion. Originality/value: This paper helps to fill the gap in empirical evaluations of deliberative approaches to citizen involvement in health care priority setting. It reports on a novel approach and considers a range of implications for future research and practice. The study raises important questions over the role of public engagement in driving priority setting decision making. © Emerald Group Publishing Limited.
Gillespie D.C.,Western General Hospital |
Bowen A.,University of Manchester |
Chung C.S.,NHS Fife |
Cockburn J.,Retired |
And 2 more authors.
Clinical Rehabilitation | Year: 2015
Background: Although cognitive impairments are common following stroke, there is considerable uncertainty about the types of interventions that can reduce activity restrictions and improve quality of life. Indeed, a recent project to identify priorities for research into life after stroke determined that the top priority for patients, carers and health professionals was how to improve cognitive impairments. Objective: To provide an overview of the evidence for the effectiveness of cognitive rehabilitation for patients with stroke and to determine the main gaps in the current evidence base. Methods: Evidence was synthesised for the six Cochrane reviews relating to rehabilitation for post-stroke cognitive impairment and any subsequently published randomized controlled trials to February 2012. Results: Data arising from 44 trials involving over 1500 patients was identified. Though there was support for the effectiveness of cognitive rehabilitation for some cognitive impairments, significant gaps were found in the current evidence base. All of the Cochrane reviews identified major limitations within the evidence they identified. Conclusions: There is currently insufficient research evidence, or evidence of insufficient quality, to support clear recommendations for clinical practice. Recommendations are made as to the research required to strengthen the evidence base, and so facilitate the delivery of effective interventions to individuals with cognitive impairment after stroke. © 2014 The Author(s).
Hacker T.,Universitatsmedizin Rostock |
Stone P.,NHS Fife |
Macbeth A.,University of Edinburgh
Journal of Affective Disorders | Year: 2016
Acceptance and Commitment Therapy (ACT) has accrued a substantial evidence base. Recent systematic and meta-analytic reviews suggest that ACT is effective compared to control conditions. However, these reviews appraise the efficacy of ACT across a broad range of presenting problems, rather than addressing specific common mental health difficulties. Focussing on depression and anxiety we performed a meta-analysis of trials of ACT. We incorporated sequential meta-analysis (SMA) techniques to critically appraise the sufficiency of the existing evidence base. Findings suggest that ACT demonstrates at least moderate group and pre-post effects for symptom reductions for both anxiety and depression. However using SMA findings are more qualified. There is currently insufficient evidence to confidently conclude that ACT for anxiety is efficacious when compared to active control conditions or as primary treatment for anxiety. Similarly, using SMA, there is currently insufficient evidence to suggest a moderate efficacy of ACT for depression compared to active control conditions. To stimulate further research we offer specific estimates of additional numbers of participants required to reach sufficiency to help inform future studies. We also discuss the appropriate strategies for future research into ACT for anxiety given the current evidence suggests no differential efficacy of ACT in the treatment of anxiety compared to active control conditions. © 2015 Elsevier B.V.
Dale H.L.,NHS Fife |
Adair P.M.,NHS Fife |
Humphris G.M.,University of St. Andrews
Psycho-Oncology | Year: 2010
Objectives: The psychosocial impacts of a cancer diagnosis include reduced quality of life, poorer inter-personal relationships, hopelessness and mental illness. Worse outcomes, including mortality rates have been found for single men with cancer compared with women and partnered men. The aim of this systematic review was to examine the effectiveness of post-treatment psychosocial and behaviour change interventions for adult men with cancer, in order to inform the development of an intervention. A focus on single men was intended. Methods: Ten databases were searched via Ovid and Web of Science. Papers were systematically extracted by title, abstract and full paper according to the inclusion/exclusion criteria. Full papers were assessed by two authors. Inclusion criteria: participants at any stage of a cancer diagnosis, ≥50% male and aged 18+; psychosocial and/or behavioural post-treatment interventions, using any format; a one-three level of evidence. Couple/carer/family interventions were excluded. Results: From 9948 studies initially identified, 11 were finally included in the review. They implemented cognitive behaviour therapy, hypnosis or psychoeducational interventions. All studies had some positive results, however, lack of reporting of intervention content and methodological issues limit the findings. No studies intervened with single men, and none provided comparative outcomes for marital status. Conclusions: Effectiveness of interventions was difficult to assess as, while all had benefits, their generalisability was limited due to methodological and reporting limitations. Improved reporting procedures are required to allow for replication. Copyright © 2009 John Wiley & Sons, Ltd.
Chung C.S.,NHS Fife
The Cochrane database of systematic reviews | Year: 2013
Executive functions are the controlling mechanisms of the brain and include the processes of planning, initiation, organisation, inhibition, problem solving, self monitoring and error correction. They are essential for goal-oriented behaviour and responding to new and novel situations. A high number of people with acquired brain injury, including around 75% of stroke survivors, will experience executive dysfunction. Executive dysfunction reduces capacity to regain independence in activities of daily living (ADL), particularly when alternative movement strategies are necessary to compensate for limb weakness. Improving executive function may lead to increased independence with ADL. There are various cognitive rehabilitation strategies for training executive function used within clinical practice and it is necessary to determine the effectiveness of these interventions. To determine the effects of cognitive rehabilitation on executive dysfunction for adults with stroke or other non-progressive acquired brain injuries. We searched the Cochrane Stroke Group Trials Register (August 2012), the Cochrane Central Register of Controlled Trials (The Cochrane Library, August 2012), MEDLINE (1950 to August 2012), EMBASE (1980 to August 2012), CINAHL (1982 to August 2012), PsycINFO (1806 to August 2012), AMED (1985 to August 2012) and 11 additional databases. We also searched reference lists and trials registers, handsearched journals and conference proceedings, and contacted experts. We included randomised trials in adults after non-progressive acquired brain injury, where the intervention was specifically targeted at improving cognition including separable executive function data (restorative interventions), where the intervention was aimed at training participants in methods to compensate for lost executive function (compensative interventions) or where the intervention involved the training in the use of an adaptive technique for improving independence with ADL (adaptive interventions). The primary outcome was global executive function and the secondary outcomes were specific components of executive function, working memory, ADL, extended ADL, quality of life and participation in vocational activities. We included studies in which the comparison intervention was no treatment, a placebo intervention (i.e. a rehabilitation intervention that should not impact on executive function), standard care or another cognitive rehabilitation intervention. Two review authors independently screened abstracts, extracted data and appraised trials. We undertook an assessment of methodological quality for allocation concealment, blinding of outcome assessors, method of dealing with missing data and other potential sources of bias. Nineteen studies (907 participants) met the inclusion criteria for this review. We included 13 studies (770 participants) in meta-analyses (417 traumatic brain injury, 304 stroke, 49 other acquired brain injury) reducing to 660 participants once non-included intervention groups were removed from three and four group studies. We were unable to obtain data from the remaining six studies. Three studies (134 participants) compared cognitive rehabilitation with sensorimotor therapy. None reported our primary outcome; data from one study was available relating to secondary outcomes including concept formation and ADL. Six studies (333 participants) compared cognitive rehabilitation with no treatment or placebo. None reported our primary outcome; data from four studies demonstrated no statistically significant effect of cognitive rehabilitation on secondary outcomes. Ten studies (448 participants) compared two different cognitive rehabilitation approaches. Two studies (82 participants) reported the primary outcome; no statistically significant effect was found. Data from eight studies demonstrated no statistically significant effect on the secondary outcomes. We explored the effect of restorative interventions (10 studies, 468 participants) and compensative interventions (four studies, 128 participants) and found no statistically significant effect compared with other interventions. We identified insufficient high-quality evidence to reach any generalised conclusions about the effect of cognitive rehabilitation on executive function, or other secondary outcome measures. Further high-quality research comparing cognitive rehabilitation with no intervention, placebo or sensorimotor interventions is recommended.
Bradbury-Jones C.,University of Dundee |
Innes N.,University of Dundee |
Evans D.,University of Dundee |
Ballantyne F.,NHS Fife |
Taylor J.,University of Edinburgh
BMC Public Health | Year: 2013
Background: Child neglect is a pernicious child protection issue with adverse consequences that extend to adulthood. Simultaneously, though it remains prevalent, childhood dental caries is a preventable disease. Public health nurses play a pivotal role in assessing oral health in children as part of general health surveillance. However, little is known about how they assess dental neglect or what their thresholds are for initiating targeted support or instigating child protection measures. Understanding these factors is important to allow improvements to be made in care pathways. Methods. We investigated public health nurses' assessment of oral health in preschool children in relation to dental neglect and any associations they make with child neglect more broadly. A qualitative study was conducted in Scotland during 2011/12. Sixteen public health nurses were recruited purposively from one health region. Individual, semi-structured interviews were undertaken and data were analyzed inductively using a framework approach. Categories were subsequently mapped to the research questions. Results: Public health nurses assess oral health through proxy measures, opportunistic observation and through discussion with parents. Dental neglect is rarely an isolated issue that leads on its own to child protection referral. It tends to be other presenting issues that initiate a response. Threshold levels for targeted support were based on two broad indicators: social issues and concerns about child (and parental) dental health. Thresholds for child protection intervention were untreated dental caries or significant dental pain. Barriers to intervention are that dental neglect may be 'unseen' and 'unspoken'. The study revealed a communication gap in the care pathway for children where a significant dental problem is identified. Conclusions: Public health nurses take their child protection role seriously, but rarely make a link between dental caries and child neglect. Clear guidance on oral health assessment is required for public health nurses. Establishing formal communication pathways between child dental care providers and public health nurses may help close gaps in care pathways. However, further research is required into how these communication mechanisms can be improved. © 2013 Bradbury-Jones et al.; licensee BioMed Central Ltd.
Are we under-estimating the association between autism symptoms?: The importance of considering simultaneous selection when using samples of individuals who meet diagnostic criteria for an autism spectrum disorder
Murray A.L.,University of Edinburgh |
McKenzie K.,Community Child Health |
Kuenssberg R.,NHS Fife |
O'Donnell M.,University of Ulster
Journal of Autism and Developmental Disorders | Year: 2014
The magnitude of symptom intercorrelations in diagnosed individuals has contributed to the evidence that autism spectrum disorders (ASD) is a fractionable disorder. Such correlations may substantially under-estimate the population correlations among symptoms due to simultaneous selection on the areas of deficit required for diagnosis. Using statistical simulations of this selection mechanism, we provide estimates of the extent of this bias, given different levels of population correlation between symptoms. We then use real data to compare domain intercorrelations in the Autism Spectrum Quotient, in those with ASD versus a combined ASD and non-ASD sample. Results from both studies indicate that samples restricted to individuals with a diagnosis of ASD potentially substantially under-estimate the magnitude of association between features of ASD. © 2014, Springer Science+Business Media New York.