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Current first-line treatments for paediatric depression demonstrate mild-to-moderate effectiveness. This has spurred a growing body of literature on lifestyle recommendations pertaining to nutrition, sleep and exercise for treating paediatric depression.
Paediatric depression clinical practice guidelines (CPGs) were reviewed for quality and to catalogue recommendations on nutrition, sleep and exercise made by higher-quality CPGs.
Searches were conducted in Medline, EMBASE, PsycINFO, Web of Science and CINAHL, and grey literature CPGs databases for relevant CPGs. Eligible CPGs with a minimum or high-quality level, as determined by the Appraisal of Guidelines for Research and Evaluation, Second Edition instrument, were included if they were (a) paediatric; (b) CPGs, practice parameter or consensus or expert committee recommendations; (c) for depression; (d) the latest version and (e) lifestyle recommendations for nutrition, sleep or exercise. Key information extracted included author(s), language, year of publication, country, the institutional body issuing the CPG, target disorder, age group, lifestyle recommendation and the methods used to determine CPG lifestyle recommendations.
Ten paediatric CPGs for depression with a minimum or high-quality level contained recommendations on nutrition, sleep or exercise. Lifestyle recommendations were predominately qualitative, with quantitative details only outlined in two CPGs for exercise. Most recommendations were brief general statements, with 50% lacking supporting evidence from the literature.
Interest in lifestyle interventions for treatment in child and youth depression is growing. However, current CPG lifestyle recommendations for nutrition, sleep or exercise are based on expert opinion rather than clinical trials.
In recent years, a variety of efforts have been made in political science to enable, encourage, or require scholars to be more open and explicit about the bases of their empirical claims and, in turn, make those claims more readily evaluable by others. While qualitative scholars have long taken an interest in making their research open, reflexive, and systematic, the recent push for overarching transparency norms and requirements has provoked serious concern within qualitative research communities and raised fundamental questions about the meaning, value, costs, and intellectual relevance of transparency for qualitative inquiry. In this Perspectives Reflection, we crystallize the central findings of a three-year deliberative process—the Qualitative Transparency Deliberations (QTD)—involving hundreds of political scientists in a broad discussion of these issues. Following an overview of the process and the key insights that emerged, we present summaries of the QTD Working Groups’ final reports. Drawing on a series of public, online conversations that unfolded at www.qualtd.net, the reports unpack transparency’s promise, practicalities, risks, and limitations in relation to different qualitative methodologies, forms of evidence, and research contexts. Taken as a whole, these reports—the full versions of which can be found in the Supplementary Materials—offer practical guidance to scholars designing and implementing qualitative research, and to editors, reviewers, and funders seeking to develop criteria of evaluation that are appropriate—as understood by relevant research communities—to the forms of inquiry being assessed. We dedicate this Reflection to the memory of our coauthor and QTD working group leader Kendra Koivu.1
To describe epidemiologic and genomic characteristics of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak in a large skilled-nursing facility (SNF), and the strategies that controlled transmission.
Design, setting, and participants:
This cohort study was conducted during March 22–May 4, 2020, among all staff and residents at a 780-bed SNF in San Francisco, California.
Contact tracing and symptom screening guided targeted testing of staff and residents; respiratory specimens were also collected through serial point prevalence surveys (PPSs) in units with confirmed cases. Cases were confirmed by real-time reverse transcription–polymerase chain reaction testing for SARS-CoV-2, and whole-genome sequencing (WGS) was used to characterize viral isolate lineages and relatedness. Infection prevention and control (IPC) interventions included restricting from work any staff who had close contact with a confirmed case; restricting movement between units; implementing surgical face masking facility-wide; and the use of recommended PPE (ie, isolation gown, gloves, N95 respirator and eye protection) for clinical interactions in units with confirmed cases.
Of 725 staff and residents tested through targeted testing and serial PPSs, 21 (3%) were SARS-CoV-2 positive: 16 (76%) staff and 5 (24%) residents. Fifteen cases (71%) were linked to a single unit. Targeted testing identified 17 cases (81%), and PPSs identified 4 cases (19%). Most cases (71%) were identified before IPC interventions could be implemented. WGS was performed on SARS-CoV-2 isolates from 4 staff and 4 residents: 5 were of Santa Clara County lineage and the 3 others were distinct lineages.
Early implementation of targeted testing, serial PPSs, and multimodal IPC interventions limited SARS-CoV-2 transmission within the SNF.
Families who attract the attention of child protection services most often have ongoing lived experiences of poverty, gender-based domestic and family violence, problematic substance use and, sometimes, formally diagnosed mental health conditions. Without broader contextual knowledge and understanding, particularly regarding ongoing poverty, decision-making by child protection workers often leads to the removal of children, while the family’s material poverty and experiences of violence remain unaddressed. Case studies are a common tool to succinctly capture complex contexts. In this article, we make explicit, through case examples and analysis, how poverty is almost always the backdrop to the presence of worrying risk factors before and during child protection intervention. Further, we expose the existential poverty that parents live with after they lose their children into care and which invariably exacerbates material poverty. In the final section, we consider the multi-faceted organisational poverty that blights the work environment of child protection workers, and we suggest strategies for improved practice with families living in poverty.
Outbreaks of cyclosporiasis, a food-borne illness caused by the coccidian parasite Cyclospora cayetanensis have increased in the USA in recent years, with approximately 2300 laboratory-confirmed cases reported in 2018. Genotyping tools are needed to inform epidemiological investigations, yet genotyping Cyclospora has proven challenging due to its sexual reproductive cycle which produces complex infections characterized by high genetic heterogeneity. We used targeted amplicon deep sequencing and a recently described ensemble-based distance statistic that accommodates heterogeneous (mixed) genotypes and specimens with partial genotyping data, to genotype and cluster 648 C. cayetanensis samples submitted to CDC in 2018. The performance of the ensemble was assessed by comparing ensemble-identified genetic clusters to analogous clusters identified independently based on common food exposures. Using these epidemiologic clusters as a gold standard, the ensemble facilitated genetic clustering with 93.8% sensitivity and 99.7% specificity. Hence, we anticipate that this procedure will greatly complement epidemiologic investigations of cyclosporiasis.
To detect modest associations of dietary intake with disease risk, observational studies need to be large and control for moderate measurement errors. The reproducibility of dietary intakes of macronutrients, food groups and dietary patterns (vegetarian and Mediterranean) was assessed in adults in the UK Biobank study on up to five occasions using a web-based 24-h dietary assessment (n 211 050), and using short FFQ recorded at baseline (n 502 655) and after 4 years (n 20 346). When the means of two 24-h assessments were used, the intra-class correlation coefficients (ICC) for macronutrients varied from 0·63 for alcohol to 0·36 for polyunsaturated fat. The ICC for food groups also varied from 0·68 for fruit to 0·18 for fish. The ICC for the FFQ varied from 0·66 for meat and fruit to 0·48 for bread and cereals. The reproducibility was higher for vegetarian status (κ > 0·80) than for the Mediterranean dietary pattern (ICC = 0·45). Overall, the reproducibility of pairs of 24-h dietary assessments and single FFQ used in the UK Biobank were comparable with results of previous prospective studies using conventional methods. Analyses of diet–disease relationships need to correct for both measurement error and within-person variability in dietary intake in order to reliably assess any such associations with disease in the UK Biobank.
The Royal College of Psychiatrists (2009) recommend that a senior psychiatrist, preferably a consultant, is responsible for the ECT clinic. For a standard clinical service, a minimum of one contracted session per week is recommended for the duties of an ECT consultant. The ECT consultant is responsible for making sure that the clinic keeps up to date with developments in ECT practice, achieves the necessary quality standards, and that all medical staff giving ECT are properly trained and supervised.
The duties of the psychiatrist responsible for ECT can be divided into four main areas:
organisation of the clinic
training and supervision; achieving competency
achieving and maintaining appropriate service standards.
This chapter outlines the role of the psychiatrist responsible for ECT and describes how medical staff achieve and demonstrate their competencies.
Organisation of the clinic
The location and fabric of the ECT clinic, including the ECT machine, should meet the standards set out in Chapter 2.
The clinic should be served by a small core team of senior anaesthetists, supported by appropriately trained personnel with a special interest in ECT and with whom discussion can take place regarding treatment protocols and responsibilities.
Nurse staffing should be as described in Chapter 11 and there should be good liaison with nurse management to ensure that these guidelines are being adhered to.
The ECT rota should be organised in such a way to ensure that continuity of patient care is maximised and that trainees have the opportunity to treat patients over several consecutive treatments. It is important that doctors training in psychiatry receive training in the practice of ECT, and the core curriculum states that ‘all Core training programmes must ensure that there is training and supervision in the use of ECT so that trainees become proficient in the prescribing, administration and monitoring of this treatment’ (Royal College of Psychiatrists, 2009). Electroconvulsive therapy consultants who have difficulty in maintaining the attendance of trainees are advised to consider whether this should be treated as an issue of professional practice/probity. These issues should be raised using the standard routes as set out in the Gold Guide (Modernising Medical Careers, 2010). This is likely to include discussion with the educational supervisor and training programme director in the first instance.
This article reports on qualitative research conducted to evaluate parents’ perspectives of their experiences of Talking Matters Bendigo (TMB), a screening programme initiated between health and educational professionals in regional Victoria to improve access to speech pathologists for parents of preschool-aged children with speech, language and communication concerns. Drop-in clinics are conducted in three Bendigo schools monthly. The programme is a collaborative partnership between the Victorian Department of Education and Training, Maternal and Child Health and ‘Off to an Early Start’ (City of Greater Bendigo), Bendigo Health and the disciplines of Speech Pathology and Education at La Trobe University, Bendigo. La Trobe Education (Honours) student researchers interviewed a group of 10 parents attending TMB using face to face interviews and collected data using an online survey after parents attended a session. Thematic analysis of the data was completed and inter-reliability checks were completed by two external La Trobe PhD students to increase reliability and validity. Results indicated parents were satisfied with the information provided by the speech pathologists and they reported that they intended to utilise this new knowledge at home with their children. This study provides preliminary evidence that novel service delivery options such as TMB can be successful in engaging parents early in health literacy so that speech, language and communication problems in preschool-aged children can be identified, managed and even prevented.
The co-occurring development of internalizing and externalizing problems were examined in an inception cohort of 392 children diagnosed with autism spectrum disorder at age 3 who were assessed on four occasions. Results indicated that internalizing and externalizing problems were stable over time and highly comorbid. Joint trajectory analysis suggested that 13% of the sample followed a dual high-risk trajectory. High risk was not found to be associated with intellectual ability or autism spectrum disorder symptom severity but was linked to lower income and gender: more girls than boys were found in the high/stable internalizing problems trajectory. The results suggest that 1 in 4 preschoolers followed a trajectory of internalizing or externalizing problems (or a combination of the two) that could be characterized as clinically elevated.
Tackling vital issues of politics, identity and experience in performance, this book asks what Shakespeare's plays mean when extended beyond the English language. From April to June 2012 the Globe to Globe Festival offered the unprecedented opportunity to see all of Shakespeare's plays performed in many different world languages. Thirty-eight productions from around the globe were presented in six weeks as part of the World Shakespeare Festival, which formed a cornerstone of the Cultural Olympics. This book provides the only complete critical record of that event, drawing together an internationally renowned group of scholars of Shakespeare and world theatre with a selection of the UK's most celebrated Shakespearean actors. Featuring a foreword by Artistic Director Dominic Dromgoole and an interview with the Festival Director Tom Bird, this volume highlights the energy and dedication that was necessary to mount this extraordinary cultural experiment.