To evaluate differences in food consumption of Brazilian adults according to the presence of children and adolescents in the household.

Averages of two non-consecutive days of food records from the first Brazilian National Dietary Survey were analysed and classified into eighteen food groups according to nutritional characteristics and use in diet. We compared the mean percentage contribution to total daily energy intake of each food group according to three groups of household composition: adults living alone or with other adults (32·7 %), adults living with children (35·6 %) and adults living with adolescents (31·7 %).

Brazilian nationwide survey, 2008–2009.

Adults aged 20–59 years (n 6312; 52·1 % female).

Women living alone or with other adults had higher consumption of vegetables, milk and other drinks, and lower consumption of beans and rice, compared with those living with children or adolescents. Men living alone or with other adults had higher consumption of sweets & desserts and vegetables, and lower consumption of beans, compared with those living with children or adolescents. According to household income, adults in the highest tertile who lived with children or adolescents presented a mixed consumption of healthy and unhealthy foods, whereas their counterparts in the first income tertile presented a marked consumption of foods considered traditional of the Brazilian population.

There are differences in food consumption based on the presence of children and adolescents in the household, with greater variation according to gender and household income.

To identify risk behaviour patterns for chronic non-communicable diseases (NCD) in the Brazilian population and to investigate associated socio-economic and demographic factors.

Factor analysis was used to identify patterns considering the following risk behaviours: consumption of soft drinks/artificial juice, sweet foods, red meat with apparent fat, chicken skin; inadequate consumption of fruits and vegetables; alcohol abuse; smoking; absence of physical activity during leisure time; and time spent watching television. The χ2 test was used to compare ratios. All analyses accounted for weighting factors and the study’s complex sampling design effect. The socio-economic and demographic variables evaluated were gender, age, schooling level and macro region of residence.

National Health Survey, a household survey with national representation, conducted in 2013 in Brazil.

Individuals (n 60202) aged 18 years or over.

Four risk behaviour patterns were identified: ‘Physical inactivity in leisure time and Inadequate consumption of fruits and vegetables’, ‘Saturated fat’, ‘Alcohol and Smoking’ and ‘Sedentary behaviour and Sugar’, explaining 52·01 % of the total variance. Overall, greater adherence to ‘Saturated fat’ and ‘Alcohol and Smoking’ patterns was observed among men and those with lower education level. The ‘Sedentary behaviour and Sugar’ and ‘Physical inactivity in leisure time and Inadequate consumption of fruits and vegetables’ patterns had greater adherence among younger individuals, and the first was associated with higher education whereas the second with less education among individuals residing in the North and Northeast regions.

Risk behaviour patterns for NCD were heterogeneous, reflecting the socio-economic and demographic differences in Brazil.

Although patients value evidence-based therapeutic activities, little is known about nurses' perceptions.

To investigate whether implementing an activities training programme would positively alter staff perceptions of the ward or be detrimental through the increased workload (trial registration: ISRCTN 06545047).

We conducted a stepped wedge cluster randomised trial involving 16 wards with psychology-led nurse training as the intervention. The main outcome was a staff self-report measure of perceptions of the ward (VOTE) and secondary outcomes measuring potential deterioration were the Index of Work Satisfaction (IWS) and the Maslach Burnout Inventory (MBI). Data were analysed using mixed-effects regression models, with repeated assessments from staff over time.

There were 1075 valid outcome measurements from 539 nursing staff. VOTE scores did not change over time (standardised effect size 0.04, 95% CI –0.09 to 0.18, P = 0.54), neither did IWS or MBI scores (IWS, standardised effect size 0.02, 95% CI –0.11 to 0.16, P = 0.74; MBI standardised effect size –0.09, 95% CI –0.24 to 0.06, P = 0.24). There was a mean increase of 1.5 activities per ward (95% CI –0.4 to 3.4, P = 0.12) and on average 6.3 more patients attended groups (95% CI –4.1 to 16.6, P = 0.23) following training. Staff feedback on training was positive.

Our training programme did not change nurses' perceptions of the ward, job satisfaction or burnout. During the study period many service changes occurred, most having a negative impact through increased pressure on staffing, patient mix and management so it is perhaps unsurprising that we found no benefits or reduction in staff skill.

None.

To evaluate the quality of food choices according to adolescent individual earnings in Brazil.

Adolescents were classified according to their individual earnings as having or not having spending power for their own expenses. Food records from two non-consecutive days of the Brazilian National Dietary Survey (NDS 2008–2009) were used to estimate food intake. Quality of food choices was based on two approaches: (i) the NOVA classification, which classifies processed and ultra-processed foods and drinks as unhealthy food groups; and (ii) traditional classification, with beans, milk, fruits and vegetables as healthy food groups, and soft drinks, sweets, snacks and crackers classified as unhealthy. We compared mean food intake (g/kJ or ml/kJ) according to per capita household income (tertiles) and adolescent individual earnings, with adolescent earnings adjusted for household income, using multiple linear regression.

Brazilian households (n 13 569).

Adolescents aged 14–18 years (n 3673).

Males without individual earnings had higher per capita household income than those with individual earnings. Household income was associated with all three food groups of the NOVA classification and seven of the eight groups of the traditional classification. However, only beans and snacks were consumed in significantly greater quantities by adolescents with individual earnings compared with those without earnings.

Adolescent individual earnings were not the main driver of food choices; however, per capita household income was associated with food choices. The consumption of both healthy and unhealthy items increased with increasing household income.

Substantial policy, communication and operational gaps exist between mental health services and the police for individuals with enduring mental health needs.

To map and cost pathways through mental health and police services, and to model the cost impact of implementing key policy recommendations.

Within a case-linkage study, we estimated 1-year individual-level healthcare and policing costs. Using decision modelling, we then estimated the potential impact on costs of three recommended service enhancements: street triage, Mental Health Act assessments for all Section 136 detainees and outreach custody link workers.

Under current care, average 1-year mental health and police costs were £10 812 and £4552 per individual respectively (n = 55). The cost per police incident was £522. Models suggested that each service enhancement would alter per incident costs by between −8% and +6%.

Recommended enhancements to care pathways only marginally increase individual-level costs.

Hospital care is still an integral part of mental healthcare services. But the impact of ward design on treatment outcomes is unclear.

To review the effects of ward design on patient outcomes and patient and staff well-being.

A systematic review of literature was carried out on Medline, Embase and PsycINFO. Papers on psychogeriatric and child and adolescent wards were excluded as these necessitate specific safety features.

Twenty-three papers were identified. No strong causal links between design and clinical outcomes were found. Private spaces and a homely environment may contribute to patient well-being. Different stakeholders may experience ward design in conflicting ways; design has a symbolic and social dimension for patients.

Data on the impact of design on treatment outcomes are inconclusive. Rigorous randomised controlled trials, qualitative studies and novel methods are called for. Different stakeholders' responses to the ward as a symbolic environment merit further investigation.

People with borderline personality disorder frequently experience crises. To date, no randomised controlled trials (RCTs) of crisis interventions for this population have been published.

To examine the feasibility of recruiting and retaining adults with borderline personality disorder to a pilot RCT investigating the potential efficacy and cost-effectiveness of using a joint crisis plan.

An RCT of joint crisis plans for community-dwelling adults with borderline personality disorder (trial registration: ISRCTN12440268). The primary outcome measure was the occurrence of self-harming behaviour over the 6-month period following randomisation. Secondary outcomes included depression, anxiety, engagement and satisfaction with services, quality of life, well-being and cost-effectiveness.

In total, 88 adults out of the 133 referred were eligible and were randomised to receive a joint crisis plan in addition to treatment as usual (TAU; n=46) or TAU alone (n=42). This represented approximately 75% of our target sample size and follow-up data were collected on 73 (83.0%) participants. Intention-to-treat analysis revealed no significant differences in the proportion of participants who reported self-harming (odds ratio (OR) =1.9, 95% CI 0.53-6.5,P = 0.33) or the frequency of self-harming behaviour (rate ratio (RR)=0.74, 95% CI 0.34-1.63, P=0.46) between the two groups at follow-up. No significant differences were observed between the two groups on any of the secondary outcome measures or costs.

It is feasible to recruit and retain people with borderline personality disorder to a trial of joint crisis plans and the intervention appears to have high face validity with this population. However, we found no evidence of clinical efficacy in this feasibility study.

England's Time To Change (TTC) social marketing campaign emphasised social contact between people with and without mental health problems to reduce stigma and discrimination.

We aimed to assess the effectiveness of the mass media component and also that of the mass social contact events.

Online interviews were performed before and after each burst of mass media social marketing to evaluate changes in knowledge, attitudes and behaviour and associations between campaign awareness and outcomes. Participants at social contact events were asked about the occurrence and quality of contact, attitudes, readiness to discuss mental health and intended behaviour towards people with mental health problems.

Prompted campaign awareness was 38-64%. A longitudinal improvement was noted for one intended behaviour item but not for knowledge or attitudes. Campaign awareness was positively associated with greater knowledge (β = 0.80, 95% CI 0.52-1.08) and more favourable attitudes (commonality OR 1.37, 95% CI 1.10-1.70; dangerousness OR 1.41, 95% CI 1.22-1.63) and intended behaviour (β = 0.75, 95% CI 0.53-0.96). Social contact at events demonstrated a positive impact (M=2.68) v. no contact (M = 2.42) on perceived attitude change; t(211)= 3.30, P=0.001. Contact quality predicted more positive attitude change (r=0.33, P<0.01) and greater confidence to challenge stigma (r=0.38, P<0.01).

The favourable short-term consequences of the social marketing campaign suggest that social contact can be used by anti-stigma programmes to reduce stigma.

Better newspaper coverage of mental health-related issues is a target for the Time to Change (TTC) anti-stigma programme in England, whose population impact may be influenced by how far concurrent media coverage perpetuates stigma and discrimination.

To compare English newspaper coverage of mental health-related topics each year of the TTC social marketing campaign (2009-2011) with baseline coverage in 2008.

Content analysis was performed on articles in 27 local and national newspapers on two randomly chosen days each month.

There was a significant increase in the proportion of anti-stigmatising articles between 2008 and 2011. There was no concomitant proportional decrease in stigmatising articles, and the contribution of mixed or neutral elements decreased.

These findings provide promising results on improvements in press reporting of mental illness during the TTC programme in 2009-2011, and a basis for guidance to newspaper journalists and editors on reporting mental illness.

Research suggests that levels of discrimination against people using mental health services are high; however, reports of these people's experiences are rare.

To determine whether the Time to Change (TTC) programme target of 5% reduction in discrimination has been achieved.

Separate samples of people using mental health services were interviewed annually from 2008 to 2011 using the Discrimination and Stigma Scale to record instances of discrimination.

Ninety-one per cent of participants reported one or more experiences of discrimination in 2008 compared with 88% in 2011 (z=-1.9, P=0.05). The median negative discrimination score was 40% in 2008 and 28% in 2011 (Kruskal-Wallis χ2=83.4, P < 0.001).

The proportion of participants experiencing no discrimination increased significantly over the course of TTC but by less than the initial target The overall median discrimination score fell by 11.5%. Data from 2010 and 2011 suggest that these gains may be hard to maintain during economic austerity.

Mental health service users are at high risk of domestic violence but this is often not detected by mental health services.

To explore the facilitators and barriers to disclosure of domestic violence from a service user and professional perspective.

A qualitative study in a socioeconomically deprived south London borough, UK, with 18 mental health service users and 20 mental health professionals. Purposive sampling of community mental health service users and mental healthcare professionals was used to recruit participants for individual interviews. Thematic analysis was used to determine dominant and subthemes. These were transformed into conceptual maps with accompanying illustrative quotations.

Service users described barriers to disclosure of domestic violence to professionals including: fear of the consequences, including fear of Social Services involvement and consequent child protection proceedings, fear that disclosure would not be believed, and fear that disclosure would lead to further violence; the hidden nature of the violence; actions of the perpetrator; and feelings of shame. The main themes for professionals concerned role boundaries, competency and confidence. Service users and professionals reported that the medical diagnostic and treatment model with its emphasis on symptoms could act as a barrier to enquiry and disclosure. Both groups reported that enquiry and disclosure were facilitated by a supportive and trusting relationship between the individual and professional.

Mental health services are not currently conducive to the disclosure of domestic violence. Training of professionals in how to address domestic violence to increase their confidence and expertise is recommended.