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Family-based strategies to reduce the risk of overweight in childhood are needed in the Caribbean.
To investigate the associations between parental characteristics and risk of overweight and explore possible mechanisms.
Data from a parenting intervention were analysed. Parental characteristics were obtained by questionnaire at enrolment. At 18 months, 501 infants (82.9% of cohort) had weight and length measured using standardized methods. The association of parents’ characteristics with risk of infant overweight was assessed using random-effects logistic regression. Four focus groups among mothers in Jamaica were conducted to explore mechanisms.
Overall, 20.6% of infants were ‘at risk of overweight’. Fathers were present in 52% of households. Fathers’ presence [OR (95% CI) 0.60 (0.37–0.96)] was associated with reduced risk of overweight independent of socioeconomic status. Mothers reported that fathers encouraged healthier practices.
Fathers may be important agents of change in intervention strategies to prevent childhood overweight.
Ticks represent a large global reservoir of zoonotic disease. Current surveillance systems can be time and labour intensive. We propose that the passive surveillance of companion animal electronic health records (EHRs) could provide a novel methodology for describing temporal and spatial tick activity. A total of 16 58 857 EHRs were collected over a 2-year period (31 March 2014 and 29 May 2016) from companion animals attending a large sentinel network of 192 veterinary clinics across Great Britain (the Small Animal Veterinary Surveillance Network – SAVSNET). In total, 2180 EHRs were identified where a tick was recorded on an animal. The relative risk of dogs presenting with a tick compared with cats was 0·73 (95% confidence intervals 0·67–0·80). The highest number of tick records were in the south central regions of England. The presence of ticks showed marked seasonality with summer peaks, and a secondary smaller peak in autumn for cats; ticks were still being found throughout most of Great Britain during the winter. This suggests that passive surveillance of companion animal EHRs can describe tick activity temporally and spatially in a large cohort of veterinary clinics across Great Britain. These results and methodology could help inform veterinary and public health messages as well as increase awareness of ticks and tick-borne diseases in the general population.
Despite a growing body of literature on integrated land–sea management (ILSM), very little critical assessment has been conducted in order to evaluate ILSM in practice on island systems. Here we develop indicators for assessing 10 integrated island management principles and evaluate the performance of planning and implementation in four island ILSM projects from the tropical Pacific across different governance structures. We find that where customary governance is still strongly respected and enabled through national legislation, ILSM in practice can be very effective at restricting access and use according to fluctuations in resource availability. However, decision-making under customary governance systems may be vulnerable to mismanagement. Government-led ILSM processes have the potential to design management actions that address the spatial scale of ecosystem processes and threats within the context of national policy and legislation, but may not fully capture broad stakeholder interests, and implementation may be poorly coordinated across highly dispersed island archipelagos. Private sector partnerships offer unique opportunities for resourcing island ILSM, although these are highly likely to be geared towards private sector interests that may change in the future and no longer align with community and/or national objectives. We identify consistent challenges that arise during island ILSM planning and implementation and offer recommendations for improvement.
Within acute psychiatric inpatient services, patients exhibiting severely disturbed behaviour can be transferred to a psychiatric intensive care unit (PICU) and/or secluded in order to manage the risks posed to the patient and others. However, whether specific patient groups are more likely to be subjected to these coercive measures is unclear. Using robust methodological and statistical techniques, we aimed to determine the demographic, clinical and behavioural predictors of both PICU and seclusion.
Data were extracted from an anonymised database comprising the electronic medical records of patients within a large South London mental health trust. Two cohorts were derived, (1) a PICU cohort comprising all patients transferred from general adult acute wards to a non-forensic PICU ward between April 2008 and April 2013 (N = 986) and a randomly selected group of patients admitted to general adult wards within this period who were not transferred to PICU (N = 994), and (2) a seclusion cohort comprising all seclusion episodes occurring in non-forensic PICU wards within the study period (N = 990) and a randomly selected group of patients treated in these wards who were not secluded (N = 1032). Demographic and clinical factors (age, sex, ethnicity, diagnosis, admission status and time since admission) and behavioural precursors (potentially relevant behaviours occurring in the 3 days preceding PICU transfer/seclusion or random sample date) were extracted from electronic medical records. Mixed effects, multivariable logistic regression analyses were performed with all variables included as predictors.
PICU cases were significantly more likely to be younger in age, have a diagnosis of bipolar disorder and to be held on a formal section compared with patients who were not transferred to PICU; female sex and longer time since admission were associated with lower odds of transfer. With regard to behavioural precursors, the strongest predictors of PICU transfer were incidents of physical aggression towards others or objects and absconding or attempts to abscond. Secluded patients were also more likely to be younger and legally detained relative to non-secluded patients; however, female sex increased the odds of seclusion. Likelihood of seclusion also decreased with time since admission. Seclusion was significantly associated with a range of behavioural precursors with the strongest associations observed for incidents involving restraint or shouting.
Whilst recent behaviour is an important determinant, patient age, sex, admission status and time since admission also contribute to risk of PICU transfer and seclusion. Alternative, less coercive strategies must meet the needs of patients with these characteristics.
Studies indicate that risk of mortality is higher for patients admitted
to acute hospitals at the weekend. However, less is known about clinical
outcomes among patients admitted to psychiatric hospitals.
To investigate whether weekend admission to a psychiatric hospital is
associated with worse clinical outcomes.
Data were obtained from 45 264 consecutive psychiatric hospital
admissions. The association of weekend admission with in-patient
mortality, duration of hospital admission and risk of readmission was
investigated using multivariable regression analyses. Secondary analyses
were performed to investigate the distribution of admissions, discharges,
in-patient mortality, episodes of seclusion and violent incidents on
different days of the week.
There were 7303 weekend admissions (16.1%). Patients who were aged
between 26 and 35 years, female or from a minority ethnic group were more
likely to be admitted at the weekend. Patients admitted at the weekend
were more likely to present via acute hospital services, other
psychiatric hospitals and the criminal justice system than to be admitted
directly from their own home. Weekend admission was associated with a
shorter duration of admission (B coefficient –21.1 days,
95% CI –24.6 to –17.6, P<0.001) and an increased risk
of readmission in the 12 months following index admission (incidence rate
ratio 1.13, 95% CI 1.08 to 1.18, P<0.001), but
in-patient mortality (odds ratio (OR) = 0.79, 95% CI 0.51 to 1.23,
P = 0.30) was not greater than for weekday admission.
Fewer episodes of seclusion occurred at the weekend but there was no
significant variation in deaths during hospital admission or violent
incidents on different days of the week.
Being admitted at the weekend was not associated with an increased risk
of in-patient mortality. However, patients admitted at the weekend had
shorter admissions and were more likely to be readmitted, suggesting that
they may represent a different clinical population to those admitted
during the week. This is an important consideration if mental healthcare
services are to be implemented across a 7-day week.
Aims of this study are to explore the associations of readmission to psychiatric hospital over time, to develop a statistical model for early readmission to psychiatric hospital and to assess the feasibility of predicting early readmission.
The sample comprised 7891 general psychiatric discharges in South London, taken from a large anonymised repository of electronic patient records. We initially explored time to readmission using Cox regression – this included investigation of time-dependent effects. Subsequently, we used logistic regression to create a predictive model for 90-day readmission. We investigated the effect on readmission of a set of variables that included demographic variables, diagnosis and legal status during the index admission, previous service use, housing variables and individual item scores on the Health of the Nation Outcome Scales (HoNOS) at admission and at discharge.
Fifteen per cent of those discharged were readmitted within 90 days. Cox regression demonstrated that the estimated baseline hazard of readmission declined steeply after discharge and that the effects of several predictors, especially diagnosis, changed over time – most notably, personality disorder was associated with increased readmission relative to schizophrenia at the time of discharge, but did not significantly differ by 1-year postdischarge. In the logistic regression, increased readmission was associated with personality disorder diagnosis; shorter length of the index admission (excepting zero length admissions); number of discharges in the preceding 2 years; and having a high score at discharge on the HoNOS overactive and aggressive behaviour item, cognitive problems item or hallucinations and delusions items. Detention under Section 3 or a forensic section of the Mental Health Act during the index admission was associated with reduced readmission. The coefficient of discrimination for the logistic regression, which is equivalent to r2, was 0.04 and the estimated area under the receiver operating curve was 0.65.
The association found between early readmission and personality disorder diagnosis merits further investigation, as does the possible trade-off between reduction in length of stay and increased readmission. Other novel findings such as the associations found with HoNOS item scores also merit replication. As with previous studies, we found that the rate of readmission declines steeply after hospital discharge, so that the period immediately subsequent to discharge is a period of comparatively high risk. However, prediction of early readmission within this high-risk group remains challenging – it seems most likely that many unmeasured influences operate subsequent to the time of discharge.
There has been little research into the facilitated discharge (FD) function of Home Treatment Teams (HTTs). We aimed to explore and describe the prevalence and associations of FD and to estimate its effects on bed days during the index admission (length of stay corrected for ward leave) and on readmission.
Descriptive and regression analyses of data collected by South London and Maudsley NHS Foundation Trust on discharges from its general psychiatric wards, with multiple imputation of missing covariate values.
Overall, 29% of our sample of 7891 hospital admissions involved a FD. FD was associated with female gender, diagnosis of a severe mental illness, previous home treatment, having a longer previous admission, neither being discharged to a new address nor to a care home, having no other community team and having HoNOS item scores consistent with an active depressive or psychotic mental illness. In the regression analysis, FD was associated with 4.0 fewer bed days (95% confidence interval −6.7 to −1.3; p = 0.0004). There was no effect on readmission.
Our analysis provides some support for the effectiveness of FD in slightly reducing the time spent in hospital and suggests that this may be achieved without increasing the rate of readmission. Further studies in this area are important, especially given existing research that suggests that the introduction of HTTs in England and Wales was associated with little or no change in service utilisation.
Attempts have been made to improve the efficiency of in-patient acute care. A novel method has been the development of a ‘triage system’ in which patients are assessed on admission to develop plans for discharge or transfer to an in-patient ward.
To compare a triage admission system with a traditional system.
Length of stay and readmission data for all admissions in a 1-year period between the two systems were compared using the participating trust's anonymised records.
Despite reduced length of stay on the actual triage ward, the average length of stay was not reduced and the triage system did not lead to a greater number of readmissions. There was no significant difference in costs between the two systems.
Based on our findings we cannot conclude that the triage system reduced length of stay, but we can conclude that it does not increase the number of readmissions as some have feared.
Examining the relationship between glucose intolerance and dietary intake in genetically similar populations with different dietary patterns and rates of type 2 diabetes may provide important insights into the role of diet in the pathogenesis of this disease. The objective of the present study was to assess the relationship between dietary variables and dysglycaemia/type 2 diabetes among three populations of African origin. The study design consists of a cross-sectional study of men and women of African descent aged 24–74 years from Cameroon (n 1790), Jamaica (n 857) and Manchester, UK (n 258) who were not known to have diabetes. Each participant had anthropometric measurements and underwent a 2 h 75 g oral glucose tolerance test. Habitual dietary intake was estimated with quantitative FFQ, developed specifically for each country. The age-adjusted prevalence of undiagnosed type 2 diabetes in Cameroon was low (1·1 %), but it was higher in Jamaica (11·6 %) and the UK (12·6 %). Adjusted generalised linear and latent mixed models used to obtain OR indicated that each 1·0 % increment in energy from protein, total fat and saturated fats significantly increased the odds of type 2 diabetes by 9 (95 % CI 1·02, 1·16) %, 5 (95 % CI, 1·01, 1·08) % and 16 (95 % CI 1·08, 1·25) %, respectively. A 1 % increase in energy from carbohydrates and a 0·1 unit increment in the PUFA:SFA ratio were associated with significantly reduced odds of type 2 diabetes. The results show independent effects of dietary factors on hyperglycaemia in African origin populations. Whether modifying intake of specific macronutrients helps diabetes prevention needs testing in randomised trials.