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This article examines young people’s experiences of open access youth work in settings in the UK, Finland, Estonia, Italy and France. It analyses 844 individual narratives from young people, which communicate the impact of youthwork on their lives. These accounts are then analysed in the light of the European youth work policy goals. It concludes that it is encouraging that what young people identify as the positive impact of youth work are broadly consistent with many of these goals. There are however some disparities which require attention. These include the importance young people place on the social context of youth work, such as friendship, which is largely absent in EU youth work policy; as well as the importance placed on experiential learning. The paper also highlights a tension between ‘top down’ policy formulation and the ‘youth centric’ practices of youth work. It concludes with a reminder to policy makers that for youth work to remain successful the spaces and places for young people must remain meaningful to them ‘on their terms’.
To better understand barriers and facilitators that contribute to antibiotic overuse in long-term care and to use this information to inform an evidence and theory-informed program.
Information on barriers and facilitators associated with the assessment and management of urinary tract infections were identified from a mixed-methods survey and from focus groups with stakeholders working in long-term care. Each barrier or facilitator was mapped to corresponding determinants of behavior change, as described by the theoretical domains framework (TDF). The Rx for Change database was used to identify strategies to address the key determinants of behavior change.
In total, 19 distinct barriers and facilitators were mapped to 8 domains from the TDF: knowledge, skills, environmental context and resources, professional role or identity, beliefs about consequences, social influences, emotions, and reinforcements. The assessment of barriers and facilitators informed the need for a multifaceted approach with the inclusion of strategies (1) to establish buy-in for the changes; (2) to align organizational policies and procedures; (3) to provide education and ongoing coaching support to staff; (4) to provide information and education to residents and families; (5) to establish process surveillance with feedback to staff; and (6) to deliver reminders.
The use of a stepped approach was valuable to ensure that locally relevant barriers and facilitators to practice change were addressed in the development of a regional program to help long-term care facilities minimize antibiotic prescribing for asymptomatic bacteriuria. This stepped approach provides considerable opportunity to advance the design and impact of antimicrobial stewardship programs.
Tumor profiling tests can help to identify whether women with breast cancer need chemotherapy due to their risk of relapse, and some may be able to predict benefit from chemotherapy. We focused on four genetic tests: Oncotype DX (O-DX), MammaPrint (MMP), EndoPredict and Prosigna, and one immunohistochemistry test, IHC4, for the National Institute of Health and Care Excellence as part of their Diagnostic Appraisal Programme.
A systematic review was undertaken, including searching of nine databases in February 2017 plus other sources including a previous review published in 2013. The review included studies assessing clinical effectiveness of the five tumor profiling tests, with or without clinicopathological factors, to guide decisions about adjuvant chemotherapy in people with ER-positive, HER-2 negative, Stage I-II cancer with 0 to 3 positive lymph nodes (LN). The PROBAST tool and Cochrane risk of bias tools were used to assess risk of bias.
A total of 153 studies were included; the strength of evidence base for individual tests was varied. Results suggest all tests are prognostic for risk of relapse, though results were more varied in LN positive (+) patients than in LN negative (0) patients. Evidence was limited about whether tests can predict benefit from chemotherapy (available for MMP and O-DX only). Studies that assessed the impact of the tests on clinical decisions indicate that the net change in chemotherapy recommendations or decisions pre-/post-test ranged from an increase of one percent to a decrease of 23 percent among UK studies, and a decrease of zero percent to 64 percent across European studies.
The studies included in the review suggest that all of the tests can provide prognostic information on the risk of relapse; however results were more varied in LN+ patients than in LN0 patients. There is limited and varying evidence for prediction of chemotherapy benefit.
A series of very wide (up to 15 km) raised shore platforms in the Scottish Hebrides are identified and described for the first time and are considered part of a high rock platform shoreline in the western isles of Scotland described by W. B. Wright in his classic Geological Magazine paper a century ago as a ‘preglacial’ feature. Subsequent interpretations suggesting that the platforms were produced during the Pleistocene are rejected here in favour of a speculative hypothesis that the features are part of the well-known strandflat that is extensively developed across large areas of the northern hemisphere. It is argued that the Scottish strandflat developed during the Pliocene and was later subjected to extensive Pleistocene glacial erosion such that only a few areas of platform have survived in the Scottish Inner Hebrides (ice-proximal) while they are well-preserved in the Outer Hebrides (ice-distal). Support for a Pliocene hypothesis is provided by the marine oxygen isotope record for this time interval which points to prolonged periods of relative sea level stability as would be required for the production of such wide features. This hypothesis for the formation of a Scottish strandflat not only provides an elegant explanation for the origin and age of the raised rock platform fragments that occur throughout the western isles of Scotland, but it may also have relevance for other coastal areas of the northern hemisphere (e.g. Norway, Greenland, Alaska) where the strandflat is a well-developed feature.
(i) To assess change in confidence in having conversations that support parents with healthy eating and physical activity post-training. (ii) To assess change in staff competence in using ‘open discovery’ questions (those generally beginning with ‘how’ and ‘what’ that help individuals reflect and identify barriers and solutions) post-training. (iii) To examine the relationship between confidence and competence post-training.
A pre–post evaluation of ‘Healthy Conversation Skills’, a staff training intervention.
Sure Start Children's Centres in Southampton, England.
A total of 145 staff working in Sure Start Children's Centres completed the training, including play workers (43 %) and community development or family support workers (35 %).
We observed an increase in median confidence rating for having conversations about healthy eating and physical activity (both P < 0·001), and in using ‘open discovery’ questions (P < 0·001), after staff attended the ‘Healthy Conversation Skills’ training. We also found a positive relationship between the use of ‘open discovery’ questions and confidence in having conversations about healthy eating post-training (r = 0·21, P = 0·01), but a non-significant trend was observed for having conversations about physical activity (r = 0·15, P = 0·06).
The ‘Healthy Conversation Skills’ training proved effective at increasing the confidence of staff working at Sure Start Children's Centres to have more productive conversations with parents about healthy eating. Wider implementation of these skills may be a useful public health nutrition capacity building strategy to help community workers support families with young children to eat more healthy foods.
Self-poisoning is a common method of suicide and often involves ingestion of antidepressants. Information on the relative toxicity of antidepressants is therefore extremely important.
To assess the relative toxicity of specific tricyclic antidepressants (TCAs), a serotonin and noradrenaline reuptake inhibitor (SNRI), a noradrenergic and specific serotonergic antidepressant (NaSSA), and selective serotonin reuptake inhibitors (SSRIs).
Observational study of prescriptions (UK), poisoning deaths involving single antidepressants receiving coroners' verdicts of suicide or undetermined intent (England and Wales) and non-fatal self-poisoning episodes presenting to six general hospitals (in Oxford, Manchester and Derby) between 2000 and 2006. Calculation of fatal toxicity index based on ratio of rates of deaths to prescriptions, and case fatality based on ratio of rates of deaths to non-fatal self-poisonings.
Fatal toxicity and case fatality indices provided very similar results (rho for relative ranking of indices 0.99). Case fatality rate ratios showed greater toxicity for TCAs (13.8, 95% CI 13.0–14.7) than the SNRI venlafaxine (2.5, 95% CI 2.0–3.1) and the NaSSA mirtazapine (1.9, 95% CI 1.1–2.9), both of which had greater toxicity than the SSRIs (0.5, 95% CI 0.4–0.7). Within the TCAs, compared with amitriptyline both dosulepin (relative toxicity index 2.7) and doxepin (2.6) were more toxic. Within the SSRIs, citalopram had a higher case fatality than the other SSRIs (1.1, 95% CI 0.8–1.4 v. 0.3, 95% CI 0.2–0.4).
There are wide differences in toxicity not only between classes of antidepressants, but also within classes. The findings are relevant to prescribing decisions, especially in individuals at risk, and to regulatory policy.
Quantitative research about self-harm largely deals with self-poisoning,
despite the high incidence of self-injury.
We compared patterns of hospital care and repetition associated with
self-poisoning and self-injury.
Demographic and clinical data were collected in a multicentre,
prospective cohort study, involving 10 498 consecutive episodes of
self-harm at six English teaching hospitals.
Compared with those who self-poisoned, people who cut themselves were
more likely to have self-harmed previously and to have received support
from mental health services, but they were far less likely to be admitted
to the general hospital or receive a psychosocial assessment. Although
only 17% of people repeated self-harm during the 18 months of study,
survival analysis that takes account of all episodes revealed a
repetition rate of 33% in the year following an episode: 47% after
episodes of self-cutting and 31% after self-poisoning (P<0.001). Of
those who repeated, a third switched method of self-harm.
Hospital services offer less to people who have cut themselves, although
they are far more likely to repeat, than to those who have self-poisoned.
Attendance at hospital should result in psychosocial assessment of needs
regardless of method of self-harm.
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