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Currently, there is limited knowledge on the impact of father-only sessions or parenting programs supporting impending fatherhood. This research explored an antenatal dads program aimed at fathers to assess the benefits of such interventions.
Literature regarding parenting programs and early childhood education initiatives, especially those aimed at children and families in disadvantaged circumstance, have been demonstrated to act as a buffer to poorer health and lifestyle outcomes in later life.
A qualitative research approach was used to explore the experiences of 16 fathers and 6 staff of a community-based parenting program with sessions focusing on fatherhood.
Four main themes were identified from the data regarding the experiences of groups engaged with the Antenatal Dads and First Year Families program. The first theme ‘Knowledge and Capacity Building’ stated that the information provided in the program helped fathers to be better informed and prepared for their impending fatherhood. The second theme was ‘Mental Health Awareness’ and identified the importance of raising awareness of depression and suicide in fathers, including where and how to get help. The third theme was ‘Soft-Entry’ and highlighted how the attendance at one service helped participants to learn about additional services through word of mouth and targeted promotion. The final theme was ‘Feeling Connected’, which helped fathers to feel more connected with the process of childbirth and development including playing and engaging with their children. Overall, the fathers found that the male-only sessions assisted them by supporting frank discussions on fatherhood. Additionally, the study helped identify the advantages of fathers meeting other fathers through attendance in the program, or even other couples in similar situations that helped fathers to feel less lonely regarding their situation.
This review evaluates whether brachytherapy can be considered as an alternative to whole breast irradiation (WBI) using criteria such as local recurrence rates, overall survival rates and quality of life (QoL) factors. This is an important issue because of a decline in local recurrence rates, suggesting that some women at very low risk of recurrence may be incurring the negative long-term side effects of WBI without benefitting from a reduction in local recurrence and greater overall survival. As such, the purpose of this literature review is to evaluate whether brachytherapy is a credible alternative to external beam radiation with a particular focus on the impact it has on patient QoL.
The search terms used were devised by using the Population Intervention Comparison Outcome framework, and a literature search was carried out using Boolean connectors and Medical Subject Headings in the PubMed database. The resultant articles were manually assessed for relevance and appraised using the Scottish Intercollegiate Guidelines Network tool. Additional papers were sourced from the citations of articles found using the search strategy. Government guidelines and regulations were also used following a manual search on the National Institute for Health and Care Excellence website. This process resulted in a total of 30 sources being included as part of the review.
Three types of brachytherapy were the foundation for the majority of the papers found: interstitial multi-catheter brachytherapy, intra-cavity brachytherapy and permanent seed implantation. The key themes that arose from the literature were that brachytherapy is equivalent to WBI both in terms of 5-year local recurrence rates and overall survival rates at 10–12 years. The findings showed that brachytherapy was superior to WBI for some QoL factors such as being less time-consuming and equal in terms of others such as breast cosmesis. The results did also show that brachytherapy does come with its own local toxicities that could impact upon QoL such as the poor breast cosmesis associated with some brachytherapy techniques.
In conclusion, brachytherapy was deemed a safe or acceptable alternative to WBI, but there is a need for further research on the long-term local recurrence rates, survival rates and quality of life issues as the volume of evidence is still significantly smaller for brachytherapy than for WBI. Specifically, there needs to be further investigation as to which patients will benefit from being offered brachytherapy and the influence that factors such as co-morbidities, performance status and patient choice play in these decisions.
To identify genetic risk loci for major depressive disorder (MDD), two broad study design approaches have been applied: (1) to maximize sample size by combining data from different phenotype assessment modalities (e.g. clinical interview, self-report questionnaires) and (2) to reduce phenotypic heterogeneity through selecting more homogenous MDD subtypes. The value of these strategies has been debated. In this review, we summarize the most recent findings of large genomic studies that applied these approaches, and we highlight the merits and pitfalls of both approaches with particular attention to methodological and psychometric issues. We also discuss the results of analyses that investigated the heterogeneity of MDD. We conclude that both study designs are essential for further research. So far, increasing sample size has led to the identification of a relatively high number of genomic loci linked to depression. However, part of the identified variants may be related to a phenotype common to internalizing disorders and related traits. As such, samples containing detailed clinical information are needed to dissect depression heterogeneity and enable the potential identification of variants specific to a more restricted MDD phenotype. A balanced portfolio reconciling both study design approaches is the optimal approach to progress further in unraveling the genetic architecture of depression.
Studies have examined the association between depressive symptoms and dietary patterns; however, only few studies focused on older adults. The present study examines the association between current and past dietary patterns and depression in a community-dwelling adult population aged 55 years and over. Adults (n 4082) were recruited into the Wellbeing, Eating and Exercise for a Long Life study in Victoria, Australia. In 2010 and 2014, data were collected using self-administered questionnaires including a 111-item FFQ, the RAND thirty-six-item Short Form Health Survey of health-related quality of life and the International Physical Activity Questionnaire. Depressive symptoms were assessed using the Geriatric Depression Scale in 2014. Current (2014) and past (2010) dietary patterns were determined using principal component analysis. Association between dietary patterns and depressive symptoms was assessed using a mixed model analysis with adjustment for covariates. Two similar dietary patterns were identified in men and women (n 2142). In women, a healthy dietary pattern (characterised by frequent intake of vegetables, fruits and fish) was associated with lower levels of depressive symptoms (current diet: β = −0·260, 95 % CI −0·451, −0·070; past diet: β = −0·201, 95 % CI −0·390, −0·013). A current unhealthy dietary pattern in women (characterised by frequent intake of red and processed meat, potatoes, hot chips, cakes, deserts and ice cream) was associated with higher levels of depressive symptoms (β = 1·367, 95 % CI 0·679, 2·056). No associations were identified in men. Further research is needed to confirm these findings and to understand the differences that may occur by sex.
Depression is a clinically heterogeneous disorder. Previous large-scale genetic studies of depression have explored genetic risk factors of depression case–control status or aggregated sums of depressive symptoms, ignoring possible clinical or genetic heterogeneity.
We analyse data from 148 752 subjects of white British ancestry in the UK Biobank who completed nine items of a self-rated measure of current depressive symptoms: the Patient Health Questionnaire (PHQ-9). Genome-Wide Association analyses were conducted for nine symptoms and two composite measures. LD Score Regression was used to calculate SNP-based heritability (h2SNP) and genetic correlations (rg) across symptoms and to investigate genetic correlations with 25 external phenotypes. Genomic structural equation modelling was used to test the genetic factor structure across the nine symptoms.
We identified nine genome-wide significant genomic loci (8 novel), with no overlap in loci across symptoms. h2SNP ranged from 6% (concentration problems) to 9% (appetite changes). Genetic correlations ranged from 0.54 to 0.96 (all p < 1.39 × 10−3) with 30 of 36 correlations being significantly smaller than one. A two-factor model provided the best fit to the genetic covariance matrix, with factors representing ‘psychological’ and ‘somatic’ symptoms. The genetic correlations with external phenotypes showed large variation across the nine symptoms.
Patterns of SNP associations and genetic correlations differ across the nine symptoms, suggesting that current depressive symptoms are genetically heterogeneous. Our study highlights the value of symptom-level analyses in understanding the genetic architecture of a psychiatric trait. Future studies should investigate whether genetic heterogeneity is recapitulated in clinical symptoms of major depression.
Consensus guidelines recommend that children consume reduced-fat (0·1–2 %) cow’s milk at age 2 years to reduce the risk of obesity. Behaviours and perspectives of parents and physicians about cow’s milk fat for children are unknown. Objectives were to: (i) understand what cow’s milk fat recommendations physicians provide to 2-year-old children; (ii) assess the acceptability of reduced-fat v. whole cow’s milk in children’s diets by parents and physicians; and (iii) explore attitudes and perceptions about cow’s milk fat for children.
Online questionnaires and individual interviews were conducted. Questionnaire data were analysed using descriptive statistics. Interview transcripts were analysed using a general inductive approach and thematic analysis.
The TARGet Kids! practice-based research network in Toronto, Canada.
Questionnaire respondents included fifty parents and fifteen physicians; individual interviews were conducted with with fourteen parents and twelve physicians.
Physicians provided various milk fat recommendations for 2-year-old children. Parents also provided different cow’s milks: eighteen (36 %) provided whole milk and twenty-nine (58 %) provided reduced-fat milk. Analysis of qualitative interviews revealed three themes: (i) healthy eating behaviours, (ii) trustworthy nutrition information and (iii) importance of dietary fat for children.
Parents provide, and physicians recommend, a variety of cow’s milks for children and hold mixed interpretations of the role of cow’s milk fat in children’s diets. Clarity about its effect on child adiposity is needed to help make informed decisions about cow’s milk fat for children.
We examine the motion in a shear flow at zero Reynolds number of particles with two planes of symmetry. We show that in most cases the rotational motion is qualitatively similar to that of a non-axisymmetric ellipsoid, and characterised by a combination of chaotic and quasiperiodic orbits. We use Kolmogorov–Arnold–Moser (KAM) theory and related ideas in dynamical systems to elucidate the underlying mathematical structure of the motion and thence to explain why such a large class of particles all rotate in essentially the same manner. Numerical simulations are presented for curved spheroids of varying centreline curvature, which are found to drift persistently across the streamlines of the flow for certain initial orientations. We explain the origin of this migration as the result of a lack of symmetries of the particle’s orientation orbit.
This study used a single case experimental design to investigate the use of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) among a sample of individuals with depression and anxiety who also presented with borderline personality disorder (BPD). Eight women received individual treatment with the UP over the course of 14–16 treatment sessions, and were assessed for anxiety and depression severity on a weekly basis over a 2–6 week baseline period and throughout treatment. Three of the eight participants demonstrated reliable pre- to post-treatment clinical improvements on depression and stress scales, and one participant demonstrated a reliable reduction on an anxiety scale. Two participants demonstrated a reliable improvement in overall anxiety. The results indicate that the UP applied to individuals diagnosed with primary BPD may lead to clinical improvement in depression, stress and anxiety for some individuals. However, the majority of individuals with BPD in our sample did not show strong improvement, and this suggests the need for additional sessions of UP or an intervention that focuses on the symptoms of BPD specifically for some women.
Key learning aims
(1)To describe the applicability of the Unified Protocol in the treatment of individuals with borderline personality and co-occurring anxiety or depression.
(2)To understand the value of utilizing a transdiagnostic approach as an alternative to diagnosis-specific approaches to treatment.
(3)To identify the four core modules of the Unified Protocol and describe the general format for individual treatment.
The Ginzburg–Landau functional is a phase transition model which is suitable for classification type problems. We study the asymptotics of a sequence of Ginzburg–Landau functionals with anisotropic interaction potentials on point clouds Ψn where n denotes the number data points. In particular, we show the limiting problem, in the sense of Γ-convergence, is related to the total variation norm restricted to functions taking binary values, which can be understood as a surface energy. We generalize the result known for isotropic interaction potentials to the anisotropic case and add a result concerning the rate of convergence.
The consistency of a non-local anisotropic Ginzburg–Landau type functional for data classification and clustering is studied. The Ginzburg–Landau objective functional combines a double well potential, that favours indicator valued functions, and the p-Laplacian, that enforces regularity. Under appropriate scaling between the two terms, minimisers exhibit a phase transition on the order of ɛ = ɛn, where n is the number of data points. We study the large data asymptotics, i.e. as n → ∝, in the regime where ɛn → 0. The mathematical tool used to address this question is Γ-convergence. It is proved that the discrete model converges to a weighted anisotropic perimeter.
‘Eurafrica’, the continental-scale fusion of Europe and Africa into one political entity, was first developed as a political concept in the 1920s by the Pan-European Union, and named as such in a 1929 article by its founder and leader Richard Coudenhove-Kalergi. Within five years, this neologism had become a commonplace, as Eurafrica exploded across public political discourse. This paper unpacks what Eurafrica entailed in its original expression, what made it a useful concept for the Pan-European Union to employ, and what made it so appealing to a wider (European) public. It does so with particular reference to the way in which Eurafrica was presented as a means of opening up colonialism to those European states that lacked their own colonies. Partly, this meant appealing to German colonialists resentful at the stripping of Germany’s colonies at Versailles. Crucially, however, it also meant appealing to the broader ‘historical injustices’ that meant that Central European countries did not have access to colonies, and promising a future in which these intra-European ‘injustices’ could be transcended and Central Europeans could thus become equal partners in Europe’s mission civilisatrice in Africa.
The development of international family law, initiated by the 1980 Hague Abduction Convention and progressed by a number of other European and global instruments, led to the rapid rise of litigation in the many domestic courts of transnational jurisdiction. In the 1990s the younger judges felt the urge to communicate directly with a judge in the other court seised and a corresponding sense of frustration if prevented from doing so.
This natural development was not restricted to cross-border family proceedings. It was an equally prominent feature of international insolvency practice. Mr Justice Baragwanath of the New Zealand High Court drew attention to this developing trend, which he labelled ‘Judicial Activism’. I learned from him and was able to repay him with my experience in international family proceedings, which were not his sphere.
It has been said that the earliest reported case recording direct judicial collaboration was the Canadian case of D v B, decided on 17 May 1996 in the Superior Court of Quebec. In our law reports direct judicial communication seems to make its first appearance in the case of Re HB (Abduction: children's objections)  1 FLR 422. I was in the court together with Lady Justice Butler-Sloss and Sir John Vinelott. At first instance Wall J had endeavoured to establish direct communication, an endeavour which we supported. Another strong supporter of direct judicial communication in the Family Division was Singer J, who tackled the topic head on in his judgment in Re MJ (Abduction: international judicial collaboration)  1 FLR 803.
But these judicial pronouncements must be set in a much broader context. The 1980 Abduction Convention depended for its function on the creation and operation of Central Authorities, one in each state party to the convention. This was mandated. But the text of the Convention more or less took for granted the effective operation of judicial authority. That this was not a safe given was subsequently to be demonstrated by innumerable return applications malfunctioning in the courts of many states party to the Convention. As the mesh of countries operating the Convention steadily advanced and enlarged it became increasingly evident that the successful operation of the Convention depended not only upon the effective work of the Central Authorities but also upon the effective work of the judges.
Background: There is no available estimate of the incidence and mortality of epilepsy in all age groups in the Canadian population. This study aimed to measure the incidence, prevalence, mortality and the secular trends for epilepsy in Saskatchewan between 2005 and 2010. Methods: A population-based cohort study was established from Saskatchewan’s provincial health administrative data. The population was followed until termination of coverage, death, or 31 December 2010. Individuals with epilepsy were identified based on ICD codes algorithms from 2005 to 2010. Results: The age-standardized incidence of epilepsy was 62 per 100,000 person-year. The age-standardized incidence rate of epilepsy in self-declared Registered Indians was 122 per 100,000 person-year. There was a significant decrease in the incidence of epilepsy for all groups over the study period. The age-standardized prevalence of epilepsy was 9 per 1,000 people. There was a significant increase in the prevalence of epilepsy over this time period. The adjusted mortality rate was 0.023 per 1000 person-year, and the all-cause Standardized Mortality Ration for epilepsy was 2.45. The SMR remained constant over the six-year period of the study. Conclusions: This study is the first in Canada to measure the incidence and all-cause mortality of epilepsy in all age groups.
Introduction: Approximately 2-3 percent of emergency department (ED) visits are due to eye-related complaints, adding to the ED workload. Many of these could be seen instead by an optometrist who specializes in the examination, diagnosis and treatment of eye-related disorders. We sought to determine the proportion of ED patients with isolated eye-related complaints that could be managed by an optometrist. Methods: We performed an administrative database study and descriptive analysis of all patients presenting to Calgary EDs with eye-related complaints during a one-year period. We determined optometry eligibility by reviewing discharge diagnoses and assessing whether that condition was within the Alberta Association of Optometrys (AAO) defined scope of practice. Patients were considered ineligible if their condition was related to bites, stings, thermal burns, assault, MVA or operative complications; if they required hospitalization or referral to a non-eye specialist (e.g. neurology); if they had associated headache, dizziness, syncope, hypertension, neurologic abnormality (e.g. diplopia); if they had facial cellulitis, orbital infections, adverse drug effects, or if they underwent observation in the ED because of concerns about a cardiac or neurological condition. Results: In 2015, 7686 patients were seen in Calgarys 5 EDs with eye related complaints. Of these, 76.2% were optometry-eligible and 75% of optometry-eligible patients arrived during day or evening hours (0800-2100). The most common presenting complaints were visual disturbance (24.8%), redness (22.1%), and pain or photophobia (16.4%). Optometry-eligible patients waited an average of 110 min and had an ED LOS of 149 min. Conclusion: Approximately 3 in every 4 patients seen in the ED for eye related complaints could alternatively be seen by an optometrist. Further research is required to establish the feasibility of diversion to an optometrist from the ED for eye-related complaints.
To characterise parent presentations of fussy eating and mealtime interactions at a point of crisis, through analyses of real-time recordings of calls to a parenting helpline.
Qualitative analysis included an inductive thematic approach to examine clinical parent presentations of fussy eating and derive underlying themes relating to mealtime interactions.
Calls made to the Child Health Line regarding feeding concerns were recorded and transcribed verbatim.
From a corpus of 723 calls made during a 4-week period in 2009, twelve were from parents of children aged 6–48 months.
Parents of infants (≤12 months, n 6) presented feeding concerns as learning challenges in the process of transitioning from a milk-based to a solid-based diet, while parents of toddlers (13–48 months, n 6) presented emotional accounts of feeding as an intractable problem. Parents presented their child’s eating behaviour as a battle (conflict), in which their children’s agency over limited intake and variety of foods (child control) was constructed as ‘bad’ or ‘wrong’. Escalating parent anxiety (parent concern) had evoked parent non-responsive feeding practices or provision of foods the child preferred.
Real-time descriptions of young children’s fussy eating at a time of crisis that initiated parents’ call for help have captured the highly charged emotional underpinnings of mealtime interactions associated with fussy eating. Importantly, they show the child’s emerging assertion of food autonomy can escalate parents’ emotional distress that, in the short term, initiates non-responsive feeding practices. The current study identifies the importance of educational and emotional support for parents across the period of introducing solids.
To assess the benefits of the introduction of routine vitamin D serum sampling for all patients admitted to a secure in-patient hospital in the North of England providing medium security, low security and rehabilitation services for offenders with intellectual and developmental disability. The vitamin D levels of 100 patients were analysed at baseline. Those with insufficient or deficient levels were offered treatment and retested after 1 year. Vitamin D levels were analysed in the context of level of security, seasonality of test and co-prescription of psychotropic medications.
Eighty-three per cent of patients had suboptimal vitamin D levels at initial test (41% deficient and 42% insufficient). This was seen among established patients and new admissions. Regression analysis of baseline vitamin D levels revealed no differences for levels of security, seasonality, whether patients were taking antipsychotic or anticonvulsant medication, or length of stay. Patients with deficiency or insufficiency were all offered supplementation. Those who opted in had significantly higher vitamin D levels at follow-up, compared with those who declined treatment.
Established and newly admitted patients in our secure mental health services had substantial levels of vitamin D insufficiency. In the light of the morbidities that are associated with deficient vitamin D levels, routine screening and the offer of supplementation is advisable.