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As with many Anglophone nations, Australia displays a dualistic housing system dominated by private ownership and private rental, both of which demonstrate an ongoing and intensifying lack of affordability. Despite extensive public subsidisation, rates of ownership have dropped in recent years while the proportion of renters is increasing. Alongside calls for private rental reforms to make this more appropriate as a form of long-term tenure, there is growing interest in intermediate tenure forms to allow easier access to ownership, ease the pressure on the country's marginalised social housing, and provide a greater range of options. Due to their small scale and relative newness in Australia, intermediate tenures such as shared equity, community land trusts, and housing co-operatives remain under-researched and unfamiliar, with previous research showing limited interest in shared equity products amongst potential buyers. This paper presents data from more recent focus groups amongst would-be buyers, showing latent market interest in resale-restricted products, with policy and market implications of both national and international relevance. The work also highlights a role for research in fostering awareness and understanding of such models. [ABSTRACT FROM AUTHOR]

Poverty impacts negatively on children's health and future life chances. Access to the UK's National Health Service (NHS) is based on clinical need rather than the ability to pay but horizontal inequities in access exist. Children North East, a charity supporting children experiencing poverty, are working with partners to reduce the impacts of poverty on NHS access. This collaborative study aimed to understand barriers to healthcare access faced by families living on low incomes to validate and support further development of a Poverty Proofing© healthcare tool. Twenty-four parents and eight Voluntary Community Social Enterprise sector staff participated in qualitative interviews or focus groups. Data were analysed thematically, and three main themes were identified as impacting access to healthcare: hidden costs, securing appointments and developing relationships with healthcare providers. We conclude that low-income families experience both financial and other barriers to accessing NHS healthcare and that these barriers are exacerbated for low-income families living in remote/rural areas. [ABSTRACT FROM AUTHOR]

Recent decades have seen the re-discovery or emergence of a diverse range of housing models such as cohousing, co-operatives, community land trusts, and other forms that seek to address various persistent issues of social, environmental, and economic justice. This has generated commensurate growth in research on the objectives and outcomes of such models, including the creation of relevant typologies of conceptual approaches and schemas of organisational objectives to build understanding of the field's theoretical and practical implications. Despite the growth of relevant models, their relative unfamiliarity and diversity of forms and objectives means practitioners, researchers, policymakers, and others associated with the field may not understand the forms and objectives of models under examination and development, leading to delays, project failures, and confusion. This paper therefore presents a glossary of community-led housing as a base on which to continue to foster understanding and growth of relevant models, and enable collaborative and comparative work. [ABSTRACT FROM AUTHOR]

Background: Internationally, colorectal cancer screening participation remains low despite the availability of home‐based testing and numerous interventions to increase uptake. To be effective, interventions should be based on an understanding of what influences individuals' decisions about screening participation. This study investigates the association of defensive information processing (DIP) with fecal immunochemical test (FIT)–based colorectal cancer screening uptake. Methods: Regression modeling of data from a cross‐sectional survey within a population‐based FIT screening program was conducted. The survey included the seven subdomains of the McQueen DIP measure. The primary outcome variable was the uptake status (screening user or nonuser). Multivariable logistic regression was used to estimate the odds ratio (OR) for screening nonuse by DIP (sub)domain score, with adjustments made for sociodemographic and behavioral factors associated with uptake. Results: Higher scores (equating to greater defensiveness) on all DIP domains were significantly associated with lower uptake in the model adjusted for sociodemographic factors. In the model with additional adjustments for behavioral factors, the suppression subdomains of "deny immediacy to be tested" (OR, 0.53; 95% confidence interval [CI], 0.43–0.65; p <.001) and "self‐exemption" (OR, 0.80; 95% CI, 0.68–0.96; p <.001) independently predicted nonuse of FIT‐based screening. Conclusions: This is the first study outside the United States that has identified DIP as a barrier to colorectal cancer screening uptake, and it is the first focused specifically on FIT‐based screening. The findings suggest that two suppression barriers, namely denying the immediacy to be tested and self‐exempting oneself from screening, may be promising targets for future interventions to improve uptake. Defensive information processing, in the form of suppression, is associated with lower fecal immunochemical test‐based colorectal cancer screening uptake. Two suppression barriers, denying the immediacy to be tested and self‐exempting oneself from screening, are promising targets for future interventions. [ABSTRACT FROM AUTHOR]

Planetary health is a concept that emerged from public health and is of central interest for geographers. Blue Mountains City Council (BMCC) launched its planetary health initiative in 2020, which is a first instance of it being adopted by an Australian local government as a sustainability policy framework. This article presents an initial case study arguing for and testing how to gain empirical insights from developing local planetary health initiatives. Using an online survey of Blue Mountains residents from 2020, we elucidate key opportunities and challenges associated with implementing planetary health in local contexts. We found that respondents experience the impacts of environmental change in varied ways and want to do more to address environmental change. They demand action from governments and others to act, yet do not understand well the mechanisms available to local governments to undertake such action. We also established that planetary health shows promise in its ability to accommodate diverse and scalar experiences and action from personal to communal. Thus, our key claim is that it could be an inclusive basis upon which local governments and communities can deliberate and make decisions about sustainability. However, local governments could experience difficulties in implementing planetary health should deliberation not improve community understanding of the levers available to local government to act on environmental change and the nature of shared responsibility for place‐based sustainability. We suggest geographers could do more work on such matters. [ABSTRACT FROM AUTHOR]

Summary: Maternal obesity increases risks of adverse fetal and infant outcomes. Guidelines use body mass index to diagnose maternal obesity. Evidence suggests body fat distribution might better predict individual risk, but there is a lack of robust evidence during pregnancy. We explored associations between maternal adiposity and infant health. Searches included six databases, references, citations, and contacting authors. Screening and quality assessment were carried out by two authors independently. Random effects meta‐analysis and narrative synthesis were conducted. We included 34 studies (n = 40,143 pregnancies). Meta‐analysis showed a significant association between maternal fat‐free mass and birthweight (average effect [AE] 18.07 g, 95%CI 12.75, 23.38) but not fat mass (AE 8.76 g, 95%CI −4.84, 22.36). Women with macrosomic infants had higher waist circumference than controls (mean difference 4.93 cm, 95% confidence interval [CI] 1.05, 8.82). There was no significant association between subcutaneous fat and large for gestational age (odds ratio 1.06 95% CI 0.91, 1.25). Waist‐to‐hip ratio, neck circumference, skinfolds, and visceral fat were significantly associated with several infant outcomes including small for gestational age, preterm delivery, neonatal morbidity, and mortality, although meta‐analysis was not possible for these variables. Our findings suggest that some measures of maternal adiposity may be useful for risk prediction of infant outcomes. Individual participant data meta‐analysis could overcome some limitations in our ability to pool published data. [ABSTRACT FROM AUTHOR]

We investigate the effect on firm performance of the motivation for applying maturity models in manufacturing and information technology organizations. We expect the association between profitability and maturity models to be less if motivated by external contract requirements (e.g., for certain government contracts), than if motivated internally to improve processes. Using a sample of firm-year observations for 1,105 SEC registrants in the manufacturing (Standard Industry Classification (SIC): 3600~3812) and IT industries (SIC: 7370~7374) for 2017 and 2018, and CMMI information from the CMMI institute published appraisal results system, it is observed that 28 public firms (17 IT firm-years and 23 manufacturing firm-years) in the sample had CMMI appraisals between 2017 and 2018. We use logistic regression to test if the likelihood of CMMI appraisal is positively associated with government sales. The results support for the manufacturing industry, but not for the IT industry, prior research's assertion that maturity is a source for competitive advantage. [ABSTRACT FROM AUTHOR]

Background: The aetiology of neuroblastic tumours is likely to involve both genetic and environmental factors. A number of possible environmental risk factors have been suggested, including infection. If an irregular temporal pattern in incidence is found, this might suggest that a transient agent, such as an infection, is implicated. Previous work has found evidence for temporal clustering in children and young adults living in northern England.Methods: We examined data from a second population-based registry from Ontario, Canada to determine whether there was evidence of temporal clustering of neuroblastic tumours. Cases diagnosed in children and young adults aged 0-19 years between 1985 and 2016 were extracted from the population-based Pediatric Oncology Group of Ontario Networked Information System (POGONIS). A modified version of the Potthoff-Whittinghill method was used to test for temporal clustering. Estimates of extra-Poisson variation (EPV) and standard errors (SE) were obtained.Results: Eight hundred seventy-six cases of neuroblastic tumours were diagnosed during the study period. Overall, no evidence of temporal clustering was found between fortnights, between months or between quarters within years. However, significant EPV was found between years within the full study period (EPV = 1.05, SE = 0.25; P = 0.005).Conclusions: The findings are consistent with the possibility that a transient agent, such as an infection that is characterised by 'peaks and troughs' in its occurrence, might be implicated in the aetiology of neuroblastic tumours. However, this pattern may also reflect a long-term increase in the numbers of cases, rather than peaks and troughs. [ABSTRACT FROM AUTHOR]

Introduction: an increased risk of breast cancer associated with high socio-economic status has been reported in high income countries. A few available African studies have reported inconsistent findings using different single socio-economic measures. Our aim was to investigate the association between socio-economic status and the risk of breast cancer among Nigerian women based on a range of socio-economic status measures. Methods: we conducted a hospital-based case-control study involving participants from five hospitals in Lagos and Abuja. Women were interviewed in-person between October 2016 and May 2017 using a semi-structured questionnaire. Socio-economic status was assessed based on education, occupation, income, wealth, and socioeconomic index. Multivariable logistic regression was applied in data analysis using Statistical Package for Social Sciences (SPSS) version 23. Level of significance was based on 95% confidence interval or p-values less than 0.05. Results: we recruited 379 histologically confirmed breast cancer cases and 403 controls. Following full adjustments, breast cancer risk reduced as socio-economic index increased (p for trend=0.028). Although women in the highest categories of educational attainment [Odds ratio (OR)=0.21, 95% confidence interval (CI): 0.09, 0.53], and personal income (OR=0.37, 95% CI: 0.19, 0.72) had a reduced risk of breast cancer compared to women in the lowest categories respectively after adjustments for relevant covariates, income alone exhibited a significant risk reduction following mutual adjustment for other socio-economic status measures (p for trend=0.014). Conclusion: the observed associations between high socio-economic status and lower breast cancer risk in Nigeria contrast with predominant findings in high-income countries. It suggests the need for socio-economic intervention and other preventive programmes such as improved access to screening and diagnostic services targeted at women of low socio-economic status in Nigeria. [ABSTRACT FROM AUTHOR]

Background: Bereavement from a twin pregnancy can result in complex emotions as parents are often caring for a surviving sibling while mourning the loss of their infant. Health professionals have reported feeling ill-equipped to deal with the specific needs of parents in this situation. Our aim was to ascertain the current knowledge, training needs and self-rated confidence of health professionals in providing support to parents who have experienced a loss from a twin pregnancy.Methods: We used an online survey, sent by email via professional organisations and clinical networks, to neonatal and fetal medicine doctors, neonatal nurses, and midwives. Respondents provided anonymous responses to questions on their experience of training and knowledge of existing guidelines, confidence in supporting parents and current practice in their hospital neonatal unit.Results: We received 293 responses. Less than half (47.3%) of respondents had received training for supporting parents and 62% felt more training and further guidelines were required. Less than a third of respondents reported having no or some confidence when providing emotional support to parents.Conclusions: Current training and guidelines in the UK to support health professionals caring for parents who have experienced a loss from a twin pregnancy are inadequate. Guidelines for healthcare professionals who support parents experiencing the loss of a baby from a twin pregnancy are needed. [ABSTRACT FROM AUTHOR]

Background: Pregnancy is a teachable moment for behaviour change. Multiple guidelines target pregnant women for behavioural intervention. This systematic review of systematic reviews reports the effectiveness of interventions delivered during pregnancy on changing women's behaviour across multiple behavioural domains. Methods: Fourteen databases were searched for systematic reviews published from 2008, reporting interventions delivered during pregnancy targeting smoking, alcohol, diet or physical activity as outcomes. Data on behaviour change related to these behaviours are reported here. Quality was assessed using the JBI critical appraisal tool for umbrella reviews. Consistency in intervention effectiveness and gaps in the evidence-base are described. Results: Searches identified 24,388 results; 109 were systematic reviews of behaviour change interventions delivered in pregnancy, and 36 reported behavioural outcomes. All smoking and alcohol reviews identified reported maternal behaviours as outcomes (n = 16 and 4 respectively), whereas only 16 out of 89 diet and/or physical activity reviews reported these behaviours. Most reviews were high quality (67%) and interventions were predominantly set in high-income countries. Overall, there was consistent evidence for improving healthy diet behaviours related to increasing fruit and vegetable consumption and decreasing carbohydrate intake, and fairly consistent evidence for increase in some measures of physical activity (METs and VO2 max) and for reductions in fat intake and smoking during pregnancy. There was a lack of consistent evidence across reviews reporting energy, protein, fibre, or micronutrient intakes; smoking cessation, abstinence or relapse; any alcohol behaviours. Conclusions: The most consistent review evidence is for interventions improving dietary behaviours during pregnancy compared with other behaviours, although the majority of diet reviews prioritised reporting health-related outcomes over behavioural outcomes. Heterogeneity between reported behaviour outcomes limits ability to pool data in meta-analysis and more consistent reporting is needed. Limited data are available for alcohol interventions in pregnancy or interventions in low- or middle-income-countries, which are priority areas for future research. [ABSTRACT FROM AUTHOR]

The article focuses on a commentary that examines a study on adverse childhood experiences (ACE) screening in adolescent primary care, with psychological flexibility as a moderator. Topics include the importance of gathering holistic developmental data, the significance of screening methods in capturing relevant aspects of a young person's life, and the critical role of psychological flexibility in addressing ACEs in youth and promoting well-being.

Highlights • 39% of NHS Trusts are not compliant with all NICE GDM risk-factor screening criteria. • Main non-compliance was for previous GDM, BMI ≥ 30 and ethnicity risk-factors. • Barriers to BMI ≥ 30 compliance were capacity, resource and funding for screening. • 41% used diagnostic thresholds for GDM which differed from NICE recommendations. • Resources are required to fully implement and sustain risk-factor screening. Abstract Aims To describe national implementation of gestational diabetes (GDM) risk-factor based screening guidelines, and barriers to implementation relating to maternal body mass index (BMI). Methods National online survey of NHS Trusts offering maternity services in England. A questionnaire was emailed to clinical staff involved in care of pregnant women assessing compliance with NICE guidelines for risk-factor based screening, BMI thresholds for offering OGTT and barriers to offering OGTT to women with BMI ≥ 30 kg/m2. Results Health professionals from 113 (84%) of NHS Trusts in England responded to the survey. Most Trusts (81%) offered OGTT at 26–28 weeks gestation to women with selected risk factors for GDM. However, almost 40% of Trusts were not fully compliant with NICE screening criteria for all risk factors, mainly due to not offering OGTT to women with previous GDM (25% of Trusts), BMI ≥ 30 kg/m2 or ethnic minority groups (22% of Trusts). The main barriers to compliance with the BMI threshold were lack of capacity, resource and funding given the high prevalence of maternal obesity. Forty one percent of Trusts used diagnostic thresholds for GDM which differed from NICE recommendations. Conclusions Additional resources are required for NHS Trusts to fully implement and sustain risk-factor screening, especially for women with previous GDM, BMI ≥ 30 kg/m2 and ethnic minority groups. [ABSTRACT FROM AUTHOR]

Aims: To describe national implementation of gestational diabetes (GDM) risk-factor based screening guidelines, and barriers to implementation relating to maternal body mass index (BMI).Methods: National online survey of NHS Trusts offering maternity services in England. A questionnaire was emailed to clinical staff involved in care of pregnant women assessing compliance with NICE guidelines for risk-factor based screening, BMI thresholds for offering OGTT and barriers to offering OGTT to women with BMI ≥ 30 kg/m2.Results: Health professionals from 113 (84%) of NHS Trusts in England responded to the survey. Most Trusts (81%) offered OGTT at 26-28 weeks gestation to women with selected risk factors for GDM. However, almost 40% of Trusts were not fully compliant with NICE screening criteria for all risk factors, mainly due to not offering OGTT to women with previous GDM (25% of Trusts), BMI ≥ 30 kg/m2 or ethnic minority groups (22% of Trusts). The main barriers to compliance with the BMI threshold were lack of capacity, resource and funding given the high prevalence of maternal obesity. Forty one percent of Trusts used diagnostic thresholds for GDM which differed from NICE recommendations.Conclusions: Additional resources are required for NHS Trusts to fully implement and sustain risk-factor screening, especially for women with previous GDM, BMI ≥ 30 kg/m2 and ethnic minority groups. [ABSTRACT FROM AUTHOR]

Depression, anxiety and stress are common problems among adolescents. Teaching young people coping strategies in school-based intervention programs is one promising approach hoped to remedy the negative consequences of distress in adolescence. The aim of the two pilot studies was to examine the effect of a brief intervention based on the principles of Acceptance and Commitment Therapy (ACT) on depressive symptomatology (Australian study, N = 66) and stress (Swedish study, N = 32) among adolescents screened for psychosocial problems in school settings. In both studies, subjects were assigned to receive the ACT-group-intervention, or a control intervention featuring individual support from the school health care. The Australian study was a planned comparison, with random allocation for girls, plus one replication of a boys group. The Swedish study used a randomized controlled design. The ACT-intervention was an 8-session manualized group program. The Australian study showed significant reductions in depressive symptoms with a large effect, and significant reductions in psychological inflexibility with a medium effect when compared to the control group who received standard care. In the Swedish study, the ACT-intervention group, when compared to the control group, reported significantly lower levels of stress with a large effect size, and marginally significant decrease of anxiety, and marginally significant increased mindfulness skills. Taken together, the ACT-intervention seems to be a promising intervention for reducing stress and depressive symptoms among young adolescents in school and should be tested in full-sized studies. Limitations of these two pilots include small samples. [ABSTRACT FROM AUTHOR]

Background: Maternal obesity is associated with an increased risk of pregnancy complications, including gestational diabetes. Physical activity (PA) might improve glucose metabolism and reduce the incidence of gestational diabetes. The purpose of this study was to explore patterns of PA and factors associated with change in PA in obese pregnant women. Methods: PA was assessed objectively by accelerometer at 16 - 18 weeks' (T0), 27 - 28 weeks' (T1) and 35 - 36 weeks' gestation (T2) in 183 obese pregnant women recruited to a pilot randomised trial of a combined diet and PA intervention (the UPBEAT study). Results: Valid PA data were available for 140 (77%), 76 (42%) and 54 (30%) women at T0, T1 and T2 respectively. Moderate and vigorous physical activity as a proportion of accelerometer wear time declined with gestation from a median of 4.8% at T0 to 3% at T2 (p < 0.05). Total activity as a proportion of accelerometer wear time did not change. Being more active in early pregnancy was associated with a higher level of PA later in pregnancy. The intervention had no effect on PA. Conclusions: PA in early pregnancy was the factor most strongly associated with PA at later gestations. Women should be encouraged to participate in PA before becoming pregnant and to maintain their activity levels during pregnancy. There is a need for effective interventions, tailored to the needs of individuals and delivered early in pregnancy to support obese women to be sufficiently active during pregnancy. [ABSTRACT FROM AUTHOR]

Background: Breast cancer (BC) is a leading cause of premature death in women and the most expensive malignancy to treat. Since the introduction of targeted therapies has resulted in changes to BC therapy practices, health economic evaluations have become more important in this area. Taking generic medications, Aromatase Inhibitors (AIs), as a case study, we conducted a systematic review of the recent economic evaluations of AIs for estrogen receptor-positive breast cancer patients and evaluated the quality of these health economic studies. Objective: To systematically review and examine the quality of the available economic studies of AIs in estrogen receptor-positive breast cancer. Methods: A literature search was performed using six relevant databases (MEDLINE, Embase, Database of Abstracts of Reviews of Effects, Health Technology Assessment Database, NHS Economic Evaluation Database, and SCOPUS) from January 2010 to July 2021. All economic studies were independently assessed by two reviewers using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist to evaluate the quality of the economic evaluations. This systematic review is registered in the PROSPERO database. To compare the different currencies used in these studies, all costs were converted to international dollars (2021). Results: A total of eight studies were included in the review; six (75%) were performed from the healthcare providers' perspective. They were conducted in seven different countries, and all were model-based analyses using Markov models. Six (75%) considered both Quality Adjusted Life Years (QALYs) and Life Years (LY) outcomes, and all costs were derived from national databases. When compared to tamoxifen, AIs were generally cost-effective in postmenopausal women. Only half of the studies addressed the increased mortality following adverse events, and none mentioned medication adherence. For the quality assessment, six studies fulfilled 85% of the CHEERS checklist requirements and are deemed good quality. Conclusion: AIs are generally considered cost-effective compared to tamoxifen in estrogen receptor-positive breast cancer. The overall quality of the included studies was between high and average but characterizing heterogeneity, and distributional effects should be considered in any future economic evaluation studies of AIs. Studies should include adherence and adverse effects profiles to provide evidence to facilitate decision-making among policymakers. Highlights: This is a systematic review looking at Aromatase Inhibitors (AIs) in breast cancer since 2010. Overall, the studies included were of high and average quality. The reporting of the models has improved. The structural uncertainty is still underreported and has not incorporated issues such as medication adherence and side-effect profile. [ABSTRACT FROM AUTHOR]

Background: Obesity in pregnancy is associated with fetal macrosomia, a raised neonatal fat mass and an increased risk of obesity and poor metabolic health in childhood which persists into adulthood. The offspring of obese women are more likely to be obese than the offspring of lean women when they become pregnant themselves, perpetuating a cycle of obesity and its associated negative metabolic consequences. Increasing physical activity during pregnancy could improve insulin sensitivity and reduce the risk of maternal and offspring adverse outcomes. The UK Pregnancy Better Eating and Activity Trial (UPBEAT) is a trial of a complex intervention designed to improve pregnancy outcomes through dietary changes and physical activity. Data from the pilot trial of 183 women were available for analysis. The relationship between the time spent at different physical activity levels and maternal and infant pregnancy outcomes was examined. Key Messages: Strong evidence exists that physical activity improves insulin sensitivity in non-pregnant populations, and lifestyle interventions of proven effectiveness in non-pregnant populations have been developed. Women who are active in pregnancy demonstrate better glucose control and favourable pregnancy outcomes. There is a lack of effective interventions to support obese pregnant women to be physically active. Conclusions: No difference was detected in objectively measured physical activity between women randomised to the intervention and control arms of the UPBEAT pilot trial. Light-intensity physical activity was lower in early pregnancy in women who delivered macrosomic infants. Maternal sedentary time at 35-36 weeks' gestation was positively associated and moderate-intensity physical activity was inversely associated with neonatal abdominal circumference. Maternal physical activity is associated with infant birth weight and abdominal circumference and is an appropriate target for intervention to improve infant outcomes. The challenge remains to develop an effective intervention to support obese pregnant women to be physically active. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The current study examined the effects of acceptance of thoughts, mindful awareness of breathing, and spontaneous coping on both pain tolerance and pain threshold during a cold pressor task. Eligible participants ( N = 58), 16 males and 42 females ( M = 29.31, SD = 11.21), were randomized into three groups and completed two cold pressor trials. The first cold pressor trial formed a baseline for all three groups. The acceptance of thoughts and mindfulness of breathing groups listened to recorded instructions and then completed a second administration of the cold pressor task. The spontaneous coping group completed the cold pressor task twice with instructions to select their own coping style. Multilevel linear modeling showed significant group differences in pain tolerance. The acceptance of thoughts and mindfulness of breathing conditions resulted in significantly higher pain tolerance in post hoc analysis than spontaneous coping. Results were interpreted to be consistent with Acceptance and Commitment Therapy. Further examination of the effects of ACT processes on experimentally induced pain tolerance is needed. [ABSTRACT FROM AUTHOR]

Acceptance and commitment therapy ( ACT) is a transdiagnostic cognitive behavioural therapy that predominantly teaches clients acceptance and mindfulness skills, as well as values clarification and enactment skills. Australian treatment guideline providers have been cautious in recognising ACT as empirically supported. This article reviews evidence from randomised controlled trials published since Öst's review, and examines the extent to which the methodology of ACT research has improved since. Since 2008, ACT research has improved its use of adherence and competence monitoring. Good-quality studies could be considered to offer National Health and Medical Research Council Level II evidence for chronic pain, obsessive-compulsive disorder, and a subset of other anxiety disorders (panic disorder, social phobia, and generalised anxiety disorder). The majority of studies demonstrated that ACT significantly improved primary outcomes but used comparison conditions that did not rule out therapy-unspecific factors, including use of concurrent treatments, as explanations for the improvements. Recommendations for future ACT research are presented. [ABSTRACT FROM AUTHOR]

Objective: Outcomes are presented from a public mental health early intervention program for children aged 5-9 years with disruptive behaviours. Method: This was a school-based intervention initiative, delivered within a psychiatric child and adolescent mental health service and includes child, parent and teacher components. Participants were 235 children selected via school-based population assessments. Results: A baseline period was used as a form of control that would demonstrate the stability of problem behaviours. Results showed that during a 26-week baseline period, teachers reported increasing levels of problem behaviour, and that the behaviour was creating increased difficulty in the classroom. The shorter 7-week baseline also showed the difficult behaviours were ongoing. Following the intervention, significant improvements in children's behaviour were seen on the Strengths and Difficulties Questionnaire reported by parents (η2 = 0.30) and teachers (η2 = 0.23), and on the parent Eyberg Child Behaviour Inventory (η2 = 0.35), and teacher Sutter-Eyberg Student Behaviour Inventory (η2 = 0.22). Conclusion: The outcomes show promising results from an early intervention program delivered in schools by a public mental health service and are discussed within the context of dissemination of evidence-based programs though mental health services. [ABSTRACT FROM AUTHOR]

The objective of this review is to summarise the evidence for mindfulness and acceptance approaches in the treatment of adolescent depression. The article begins by summarising the outcomes of three broad approaches to the treatment of adolescent depression — primary prevention, pharmacotherapy, and psychotherapy — in order to advocate for advances in treatment. With regard to psychotherapy, we restrict this to comparisons of meta-analytic studies, in order to cover the breadth of the outcome literature. In the second half of this article, we introduce the reader to mindfulness and acceptance-based psychotherapy, with a particular focus on Acceptance and Commitment Therapy (ACT) and the applicability with adolescents. We provide an overview of the philosophical arguments that underlie this approach to psychotherapy and consider how each of these might contribute to treatment approaches for adolescents with depression. [ABSTRACT FROM AUTHOR]

Background: Obesity remains a major public health problem, associated with a cluster of metabolic abnormalities. However, individuals exist who are very obese but have normal metabolic parameters. The aim of this study was to determine to what extent differences in metabolic health in very obese women are explained by differences in body fat distribution, insulin resistance and level of physical activity. Methods: This was a cross-sectional pilot study of 39 obese women (age: 28-64 yrs, BMI: 31-67 kg/m²) recruited from community settings. Women were defined as 'metabolically normal' on the basis of blood glucose, lipids and blood pressure. Magnetic Resonance Imaging was used to determine body fat distribution. Detailed lifestyle and metabolic profiles of participants were obtained. Results: Women with a healthy metabolic profile had lower intra-abdominal fat volume (geometric mean 4.78 l [95% CIs 3.99-5.73] vs 6.96 l [5.82-8.32]) and less insulin resistance (HOMA 3.41 [2.62-4.44] vs 6.67 [5.02-8.86]) than those with an abnormality. The groups did not differ in abdominal subcutaneous fat volume (19.6 l [16.9-22.7] vs 20.6 [17.6-23.9]). A higher proportion of those with a healthy compared to a less healthy metabolic profile met current physical activity guidelines (70% [95% CIs 55.8-84.2] vs 25% [11.6-38.4]). Intra-abdominal fat, insulin resistance and physical activity make independent contributions to metabolic status in very obese women, but explain only around a third of the variance. Conclusion: A sub-group of women exists who are metabolically normal despite being very obese. Differences in fat distribution, insulin resistance, and physical activity level are associated with metabolic differences in these women, but account only partially for these differences. Future work should focus on strategies to identify those obese individuals most at risk of the negative metabolic consequences of obesity and on identifying other factors that contribute to metabolic status in obese individuals. [ABSTRACT FROM AUTHOR]

In Australia, we are facing a period of mental health reform with the establishment of federally funded community youth services in rural areas of the country. These new services have great potential to improve the mental health of rural adolescents. In the context of this new initiative, we have four main objectives with this article. First, we consider the notion of social capital in relation to mental health and reflect on the collective characteristics of rural communities. Second, we review lessons learned from two large community development projects targeting youth mental health. Third, we suggest ways in which the social capital of rural communities might be harnessed for the benefit of youth mental health by using asset-based community development strategies and fourth, we consider the role that rural clinicians might play in this process. [ABSTRACT FROM AUTHOR]

The objectives of this article are to expand and comment upon a recent review in Australian Psychologist of the literature in relation to mental health problems in rural contexts by Jackson et al. (2007). In the present article we review recently published qualitative research on the help-seeking attitudes and experiences of rural Australian adolescents. While we agree on the utility of the Macintyre, Ellaway, and Cummins (2002) conceptual framework based on notions of health and place, we note that this framework specifically emphasises the importance of the collective dimension. We present a broader perspective on health and place than Jackson et al. (2007) by incorporating social geographic research. We argue that rural mental health research has been hampered by a simplistic view of social stigma of mental illness and that a more thorough conceptualisation of the phenomenon is needed. Finally, we make some further recommendations based on a broader perspective of mental health in rural contexts: one that incorporates an in-depth understanding of the help-seeking attitudes and experiences of rural adolescents as well as an appreciation of the collective social functioning of rural communities. [ABSTRACT FROM AUTHOR]

Background: Reliable studies of the incidence and characteristics of medical end-of-life decisions with a certain or possible life shortening effect (ELDs) are indispensable for an evidence-based medical and societal debate on this issue. This article presents the protocol drafted for the 2007 ELD Study in Flanders, Belgium, and outlines how the main aims and challenges of the study (i.e. making reliable incidence estimates of end-of-life decisions, even rare ones, and describing their characteristics; allowing comparability with past ELD studies; guaranteeing strict anonymity given the sensitive nature of the research topic; and attaining a sufficient response rate) are addressed in a post-mortem survey using a representative sample of death certificates. Study design: Reliable incidence estimates are achievable by using large at random samples of death certificates of deceased persons in Flanders (aged one year or older). This entails the cooperation of the appropriate administrative authorities. To further ensure the reliability of the estimates and descriptions, especially of less prevalent end-of-life decisions (e.g. euthanasia), a stratified sample is drawn. A questionnaire is sent out to the certifying physician of each death sampled. The questionnaire, tested thoroughly and avoiding emotionally charged terms is based largely on questions that have been validated in previous national and European ELD studies. Anonymity of both patient and physician is guaranteed through a rigorous procedure, involving a lawyer as intermediary between responding physicians and researchers. To increase response we follow the Total Design Method (TDM) with a maximum of three follow-up mailings. Also, a nonresponse survey is conducted to gain insight into the reasons for lack of response. Discussion: The protocol of the 2007 ELD Study in Flanders, Belgium, is appropriate for achieving the objectives of the study; as past studies in Belgium, the Netherlands, and other European countries have shown, strictly anonymous and thorough surveys among physicians using a large, stratified, and representative death certificate sample are most suitable in nationwide studies of incidence and characteristics of end-of-life decisions. There are however also some limitations to the study design. [ABSTRACT FROM AUTHOR]

Objective: This study provides normative and clinical levels of problem behaviours from a large community sample of Australian early primary school children. Method: From a large community sample (n = 1928) of children aged 5 to 10 years (mean = 7.70, SD = 0.89) normative data are provided using the teacher-reported version of the Strengths and Difficulties Questionnaire (SDQ). A response rate of 88% ensures the data are representative. Results: Mean scores on total difficulties between this Australian sample and UK norms were comparable. Some differences in the clinical cut-off scores are evident in the Australian sample, and adjusted clinical cut-offs are provided. Australian teacher reports of problem behaviour revealed lower clinical levels of emotional problems. Boys had significantly greater problems than girls on the Conduct, Hyperactivity, Peer and Prosocial scales. Overall, 5.3% of boys had scores in the clinical range on four of the five subscales. Comparisons of the factor structure revealed that for boys the Peer scale has two interpretations, with two items loading with Conduct problems and associated with greater problem behaviours. For girls, conduct problems are more strongly associated with poorer prosocial skills. Conclusions: Teachers are able provide valuable predictive information on externalizing behaviours. Australian normative comparisons reveal minor variations in teacher interpretation of items. The present data is representative of the Australian community and should be used to assess behaviour difficulties in early primary school children. Future studies on older age children are required to understand the developmental progression of problem behaviours in the community. [ABSTRACT FROM AUTHOR]

A model of monitoring interactions was proposed that is based on behavioural principles and places episodic parent-adolescent interactions at the centre of analysis for monitoring. The process-monitoring model contends that monitoring is an interactive process between parents and their adolescents, nested within a social setting. In the model it is proposed that monitoring occurs in discrete episodes that change over the course of adolescent development. To explain monitoring interactions it is essential to expand research to include a functional assessment of monitoring exchanges between parents and adolescents and to also measure the quality of parent-adolescent relationships, consider adolescent age and development, parental characteristics, and the context of the family. [ABSTRACT FROM AUTHOR]

The article investigates the validity of self-reported responses to questions on current smoking in two cohorts based in Northern England, and also investigates the effect of altering the cutoff level of exhaled carbon monoxide on the ability to distinguish between smokers and nonsmokers. In conclusion, epidemiologic studies should continue to use biochemical markers to validate the responses to smoking surveys. However, the use of exhaled carbon monoxide measurements as a method of assessing the validity of self-reported smoking status may require additional analyses of whether the cutoff level should vary for different populations and how this may affect sensitivity and specificity.

Recent data have shown that the BRAF gene is mutated at a high frequency in human malignancies. We have analyzed the migratory characteristics of B-raf-/- mouse embryonic fibroblasts (MEFs) and compared these with the organization of the actin cytoskeleton and the activity of signaling pathways that are known to influence this organization. Disruption of B-raf significantly reduced the levels of phospho-ERK½ and, surprisingly, induced an ≈1.5-fold increase in cell migration. Consistent with these findings, the high level of actin stress fibers normally present in MEFs was considerably reduced following disruption of B-raf, and the F-actin content of B-raf-/- cells was less than half that of B-raf+/+ cells. Phosphorylation of the myosin light chain on Thr18/Ser19 residues was not reduced in B-raf-/- cells. Rather, reduced ROCKII expression and attenuated phosphorylation of ADF/cofilin on serine 3 occurred. Normal stress fiber and phosphocofilin levels were restored by the expression of human B-Raf and catalytically active MEK and by the overexpression of LIM kinase (LIMK). These results have important implications for the role of the B-Raf/ERK signaling pathway in regulating cell motility in normal and malignant cells. They suggest that B-Raf is involved in invasiveness by regulating the proper assembly of actin stress fibers and contractility through a ROCKII/ LIMK/cofilin signaling pathway. [ABSTRACT FROM AUTHOR]

A model of parental monitoring behaviors, comprising rule setting and supervision, was proposed. The hypothesized relationship between rules, supervision, conflict, and adolescent problem behavior was tested using structured equation modeling on self-report data from 1,285 adolescents aged 14 to 15 years. The model was an adequate fit of the data, accounting for 40% of the variance in problem behavior. Specifically, lax rules predicted poor supervision and high conflict. High conflict and low supervision were predictors of the adolescent problem behavior construct, which encompassed conduct problems, rebelliousness, and sensation seeking. Adequate rules appear to form the foundation for better supervision and less conflict, and hence lower levels of adolescent problem behaviors. [ABSTRACT FROM AUTHOR]

Examines the challenges facing Victorian schools in developing an integrated service model to meet the health and welfare needs of young people. Theoretical underpinnings of the Framework for Student Support Services in Victorian Government Schools; Objectives and strategies of the framework; Information on the curriculum approach to student support; Lessons from the United States on welfare reform in schools.

Background and Aims Of the many threats to global food security, one of the most pressing is the increased incidence of extreme weather events. In addition to extreme rainfall, a combination of global sea level rise and storm surge is likely to result in frequent episodes of seawater flooding in arable systems along low-lying coasts. Our aim was to elucidate the effects of simulated seawater and freshwater flooding on the survival, growth and reproductive potential of four cultivars of the important seed crop, Brassica napus [canola, or oilseed rape (OSR)]. Methods Established plants were exposed to 24 or 96 h freshwater or seawater root zone immersion (with a no immersion 'control'). Initial post-treatment performance over 7 weeks was quantified using dry weight biomass. A second group of plants, cultivated until maturity, were used to quantify reproductive yield (siliqua and seed number, and seed size) and subsequent progeny performance (germination and seedling growth). Results Oilseed rape growth and reproductive responses were unaffected by freshwater, but seawater negatively affected growth and siliqua number for all cultivars, and seed mass for two ('Agatha' and 'Cubic'). In addition to impacts on crop yield, the growth of seedlings cultivated from seed collected from maternal plants subjected to seawater immersion was also reduced. Conclusions Our results demonstrate the potential impact of seawater inundation on coastal cropping systems; although OSR may survive acute saline flooding, there are longer term impacts on growth and yield for some cultivars. The threat may necessitate changes in land-use practice and/or the development of salt-tolerant cultivars to maintain economically viable yields. In addition, by evidencing a hitherto unknown effect on reproductive performance (i.e. reduced seed yield) and subsequent seedling growth, our study highlights an important potential impact of coastal flooding on plant community dynamics for (semi-) natural habitats. [ABSTRACT FROM AUTHOR]

Background: Maternal obesity is associated with an increased risk of pregnancy complications, including gestational diabetes. Physical activity (PA) might improve glucose metabolism and reduce the incidence of gestational diabetes. The purpose of this study was to explore patterns of PA and factors associated with change in PA in obese pregnant women.Methods: PA was assessed objectively by accelerometer at 16 - 18 weeks' (T0), 27 - 28 weeks' (T1) and 35 - 36 weeks' gestation (T2) in 183 obese pregnant women recruited to a pilot randomised trial of a combined diet and PA intervention (the UPBEAT study).Results: Valid PA data were available for 140 (77%), 76 (42%) and 54 (30%) women at T0, T1 and T2 respectively. Moderate and vigorous physical activity as a proportion of accelerometer wear time declined with gestation from a median of 4.8% at T0 to 3% at T2 (p < 0.05). Total activity as a proportion of accelerometer wear time did not change. Being more active in early pregnancy was associated with a higher level of PA later in pregnancy. The intervention had no effect on PA.Conclusions: PA in early pregnancy was the factor most strongly associated with PA at later gestations. Women should be encouraged to participate in PA before becoming pregnant and to maintain their activity levels during pregnancy. There is a need for effective interventions, tailored to the needs of individuals and delivered early in pregnancy to support obese women to be sufficiently active during pregnancy.Trial Registration: Current Controlled Trials ISRCTN89971375 (Registered 28/11/2008). [ABSTRACT FROM AUTHOR]

Background: Despite mortality from breast cancer in Africa being higher than in high income countries, breast cancer has not been extensively studied in the region. The aim of this paper was to highlight the rising burden of breast cancer with an emphasis on sub-Saharan Africa as well as trends, characteristics, controversies and their implications for regional development. Methodology: A review of published studies and documents was conducted in Medline, Scopus, Pubmed and Google using combinations of key words-breast neoplasm, breast cancer, cancer, incidence, mortality, Africa, Nigeria. Graphical and frequency analyses were carried out on some of the incidence and mortality figures retrieved from published papers and the GLOBOCAN website. Findings: Globally, about 25% and 15% of all new cancer cases and cancer deaths respectively among females were due to breast cancer. Africa currently had the highest age-standardized breast cancer mortality rate globally, with the highest incidence rates being recorded within the sub-Saharan African sub-region. Incidence trends such as inherently aggressive tumour and younger age profile had been subject to controversies. Certain factors such as westernized diet, urbanization and possibly increasing awareness had been implicated, though their specific contributions were yet to be fully established. Conclusion: Unless urgent action is taken, breast cancer will compound sub-Saharan Africa's disease burden, increase poverty and gender inequality as well as reverse the current global gains against maternal and neonatal mortality. [ABSTRACT FROM AUTHOR]

A response by Louise Hayes and colleagues to a letter to the editor about their article "Patterns of physical activity and relationship with risk markers for cardiovascular disease and diabetes in Indian, Pakistani, Bangladeshi and European adults in a UK population" in the 2002 issue is presented.

Summary: Maternal obesity increases pregnancy‐related risks. Women with a body mass index (BMI) ≥ 30 kg/m2 are considered to be at risk and should receive additional care, although approximately half will have uncomplicated pregnancies. This systematic review aimed to identify early pregnancy measures of adiposity associated with adverse maternal health outcomes. Searches included six databases, reference lists, citations, and contacting authors. Screening and quality assessment were carried out by two authors independently. Random effects meta‐analysis and narrative synthesis were conducted. Seventy studies were included with a pooled sample of 89,588 women. Meta‐analysis showed significantly increased odds of gestational diabetes mellitus (GDM) with higher waist circumference (WC) categories (1.40, 95% confidence interval [CI] 1.04, 1.88) and per unit increase in WC (1.31, 95% CI 1.03, 1.67). Women with GDM had higher WC than controls (mean difference [MD] 6.18 cm, 95% CI 3.92, 8.44). WC was significantly associated with hypertensive disorders, delivery‐related outcomes, metabolic syndrome, and composite pregnancy outcomes. Waist to hip ratio was significantly associated with GDM, hypertensive disorders, and delivery‐related outcomes. Fat mass, neck circumference, skinfolds, and visceral fat were significantly associated with adverse outcomes, although limited data were available. Our findings identify the need to explore how useful adiposity measures are at predicting risk in pregnancy, compared with BMI, to direct care to women with the greatest need. [ABSTRACT FROM AUTHOR]

Abstract: The aim of the current study was to explore the relative contribution of parental depression, anxiety and stress and parenting satisfaction and efficacy to the explanation of variance in controlling parental feeding styles and practices. The sample comprised 124 mothers (M =36.80 years, SD =4.62 years) who reported on both themselves and a selected child (59 male, 65 female; M =6.46 years, SD =0.95 years). Mothers completed several questionnaires examining demographic information, parental feeding styles, parental feeding practices, parental depression, anxiety and stress and parenting satisfaction and efficacy. Parenting satisfaction contributed significantly to the prediction of the parental feeding practice pressure to eat. Parenting satisfaction and parental anxiety contributed significantly to the prediction of the parental feeding practice restriction. The results of this study provide important insight into maternal characteristics associated with the use of controlling parental feeding styles and practices. [Copyright &y& Elsevier]

Summary: International guidelines recommend women with an overweight or obese body mass index (BMI) aim to reduce their body weight prior to conception to minimize the risk of adverse perinatal outcomes. Recent systematic reviews have demonstrated that interpregnancy weight gain increases women's risk of developing adverse pregnancy outcomes in their subsequent pregnancy. Interpregnancy weight change studies exclude nulliparous women. This systematic review and meta‐analysis was conducted following MOOSE guidelines and summarizes the evidence of the impact of preconception and interpregnancy weight change on perinatal outcomes for women regardless of parity. Sixty one studies met the inclusion criteria for this review and reported 34 different outcomes. We identified a significantly increased risk of gestational diabetes (OR 1.88, 95% CI 1.66, 2.14, I2 = 87.8%), hypertensive disorders (OR 1.46 95% CI 1.12, 1.91, I2 = 94.9%), preeclampsia (OR 1.92 95% CI 1.55, 2.37, I2 = 93.6%), and large‐for‐gestational‐age (OR 1.36, 95% CI 1.25, 1.49, I2 = 92.2%) with preconception and interpregnancy weight gain. Interpregnancy weight loss only was significantly associated with increased risk for small‐for‐gestational‐age (OR 1.29 95% CI 1.11, 1.50, I2 = 89.9%) and preterm birth (OR 1.06 95% CI 1.00, 1.13, I2 = 22.4%). Our findings illustrate the need for effective preconception and interpregnancy weight management support to improve pregnancy outcomes in subsequent pregnancies. [ABSTRACT FROM AUTHOR]

Summary: Background: Maternal obesity is associated with offspring cardiometabolic risk. UPBEAT was a randomised controlled trial of an antenatal diet and physical activity intervention in 1555 women with obesity. The intervention was associated with lower gestational weight gain, healthier diet and metabolic profile in pregnancy, and reduced infant adiposity at six months. Objective: We have investigated whether the UPBEAT intervention influenced childhood cardiometabolic outcomes or was associated with sustained improvements in maternal lifestyle 3‐years after delivery. Methods: In UPBEAT mother‐child dyads at the 3‐year follow‐up, we assessed childhood blood pressure, resting pulse rate, and adiposity (body mass index, skinfold thicknesses, body fat, waist and arm circumferences) and maternal diet, physical activity, and anthropometry. Results: 514 three‐year‐old children attended the appointment (49% intervention, 51% standard care). There was no difference in the main outcome of interest, subscapular skinfold thickness, between the trial arms (−0.30 mm, 95% confidence interval: −0.92, 0.31). However, the intervention was associated with a lower resting pulse rate (−5 bpm [−8.41, −1.07]). There was also a non‐significant lower odds of overweight/obesity (OR 0.73; 0.50, 1.08). Maternal dietary improvements observed in the UPBEAT trial, including glycaemic load and saturated fat were maintained 3‐years postpartum. Conclusion: This study has demonstrated that an antenatal dietary and physical activity intervention in women with obesity is associated with lower offspring pulse rate and sustained improvement in maternal diet. Whilst larger than previous cohorts, there remains potential for bias from attrition and these findings require validation in future cohorts. [ABSTRACT FROM AUTHOR]

Background: Lewy body dementia, comprising both dementia with Lewy bodies and Parkinson's disease dementia, is challenging to manage because of a complex symptom profile and lack of clear evidence‐based management guidelines. Objectives: We assessed the feasibility of undertaking a cluster randomized study of the introduction of an evidence‐based management toolkit for Lewy body dementia, assessing the outcomes for patients and carers as secondary measures. Methods: We randomized 23 memory/dementia, movement disorder, or nonspecialist secondary care services to the management toolkit or usual care. People with dementia with Lewy bodies or Parkinson's disease dementia underwent assessments of cognition, motor and neuropsychiatric symptoms, and global outcome at baseline and 3 and 6 months. Healthcare, personal and social care costs, and carer‐related outcomes of carer stress, depression, and anxiety were also examined. Results: A total of 131 participants were recruited (target 120), for whom 6‐month data were available on 108 (83%). There was a benefit of being in the intervention arm for carers (reduced Zarit Burden Scale [P < 0.01], reduced depressive symptoms [P < 0.05]), who also reported less marked patient deterioration on the global outcome measure (P < 0.05). There were no significant differences in other outcomes or in costs between groups. Conclusions: The introduction of an evidence‐based management toolkit for Lewy body dementia was feasible and associated with some benefits, especially for carers. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society [ABSTRACT FROM AUTHOR]

Background: Increasingly, national policy initiatives and programmes have been developed to increase physical activity (PA). However, challenges in implementing and translating these policies into effective local-level programmes have persisted, and change in population PA levels has been small. This may be due to insufficient attention given to the implementation context, and the limited interactions between local policy-makers, practitioners and researchers. In this paper we use a case study of a cross-sectoral network in Northeast England, to identify the local-level challenges and opportunities for implementing PA policies and programmes, particularly the updated 2019 UK PA guidelines.Methods: Five focus groups (n = 59) were conducted with practice partners, local policy-makers and researchers during an initial workshop in April 2018. Through facilitated discussion, participants considered regional priorities for research and practice, along with barriers to implementing this agenda and how these may be overcome. During a second workshop in December 2018, overarching findings from workshop one were fedback to a similar group of stakeholders, along with national policy-makers, to stimulate feedback from delegates on experiences that may support the implementation of the UK PA guidelines locally, focusing on specific considerations for research, evidence and knowledge exchange.Results: In workshop one, three overarching themes were developed to capture local challenges and needs: (i) understanding complexity and context; (ii) addressing the knowledge and skills gap; and (iii) mismatched timescales and practices. In workshop two, participants' implementation plans encompassed: (i) exploring a systems approach to implementation; (ii) adapting policy to context; and (iii) local prioritising.Conclusions: Our findings suggest that academics, practitioners and policy-makers understand the complexities of implementing PA strategies, and the challenges of knowledge exchange. The updated UK PA guidelines policy presented an opportunity for multiple agencies to consider context-specific implementation and address enduring tensions between stakeholders. An organically derived implementation plan that prioritises PA, maps links to relevant local policies and supports a context-appropriate communication strategy, within local policy, practice and research networks, will help address these. We present 10 guiding principles to support transferable knowledge exchange activities within networks to facilitate implementation of national PA policy in local contexts. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to understand the factors influencing the use of surgical options by New Zealand women with newly diagnosed breast cancer. Methods: Using data from the Auckland and Waikato breast cancer registers, we included 11 798 women diagnosed with stage I–III breast cancer from June 2000 to May 2013. The characteristics of women receiving different surgical treatments and having immediate breast reconstruction following mastectomy were examined. A logistic regression was used to estimate the odds ratio of having breast‐conserving surgery (BCS) versus mastectomy and immediate post‐mastectomy reconstruction. Bilateral breast cancer cases and women with unilateral breast cancer, but who had bilateral surgery, were also identified. Results: Fifty‐two percent of women received BCS and 44% had mastectomy over the study period. Key influences associated with BCS were age, mode of diagnosis, socio‐economic status and public or private treatment. Just under half of the women who underwent bilateral surgery did not have bilateral cancer. Nineteen percent of women undergoing mastectomy underwent immediate reconstruction. Implant use increased slightly over the study period but there was a decrease in the use of autologous flap procedures. Conclusion: Surgical management of women with localized breast cancer was generally in line with guidelines, but with potential to further increase the use of breast conservation and immediate reconstruction in suitable cases. [ABSTRACT FROM AUTHOR]

This study explored the feasibility and potential effectiveness of a videoconferencing group intervention for parents of children with a life-threatening illness. Parent functioning was assessed at pre, post, and 6-month follow-up (N = 13). Semistructured interviews explored parent experiences of the program and clinicians’ experiences were systematically recorded. Attendance was high (92%) and parents reported comfort with the online delivery. Quantitative data revealed significant reductions on three of the nine measures examined (parent guilt/worry; unresolved sorrow/anger; lack of psychological flexibility). Clinician data are described and highlights the skills and program modifications required to adapt to the videoconferencing modality. A randomized controlled trial is now underway. [ABSTRACT FROM PUBLISHER]

In five experiments, rehearsal and recall phenomena were examined using the free recall and immediate serial recall (ISR) tasks. In Experiment 1, participants were presented with lists of eight words, were precued or postcued to respond using free recall or ISR, and rehearsed out loud during presentation. The patterns of rehearsal were similar in all the conditions, and there was little difference between recall in the precued and postcued conditions. In Experiment 2, both free recall and ISR were sensitive to word length and presentation rate and showed similar patterns of rehearsal. In Experiment 3, both tasks were sensitive to word length and articulatory suppression. The word length effects generalized to 6-item (Experiment 4) and 12-item (Experiment 5) lists. These findings suggest that the two tasks are underpinned by highly similar rehearsal and recall processes. [ABSTRACT FROM AUTHOR]

There is no doubt that communicable diseases will remain the predominant health problem for the populations in sub-Saharan Africa, including adults, for the next 10–20 years. Concern has been expressed that the available resources to deal with this problem would be reduced by increasing the emphasis on noncommunicable diseases. The latter, however, already present a substantial burden because their overall age-specific rates are currently higher in adults in sub-Saharan Africa than in populations in Established Market Economies. There is also evidence that the prevalence of certain noncommunicable diseases, such as diabetes and hypertension, is increasing rapidly, particularly in the urban areas, and that significant demands are being made on the health services by patients with these diseases. To ignore the noncommunicable diseases would inevitably lead to an increase in their burden; the provision of health services for them would be largely undirected by issues of clinical and cost effectiveness, and their treatment and prevention would be left to the mercy of local and global commercial interests. Improved surveillance of all diseases within sub-Saharan Africa is needed in order to place noncommunicable diseases properly within the context of the overall burden of disease. Research is needed to guide improvements in the clinical and cost effectiveness of resources currently committed to the care of patients with noncommunicable diseases, and to direct and evaluate preventive measures. [ABSTRACT FROM AUTHOR]

Background: Complex interventions in obese pregnant women should be theoretically based, feasible and shown to demonstrate anticipated behavioural change prior to inception of large randomised controlled trials (RCTs). The aim was to determine if a) a complex intervention in obese pregnant women leads to anticipated changes in diet and physical activity behaviours, and b) to refine the intervention protocol through process evaluation of intervention fidelity.Methods: We undertook a pilot RCT of a complex intervention in obese pregnant women, comparing routine antenatal care with an intervention to reduce dietary glycaemic load and saturated fat intake, and increase physical activity. Subjects included 183 obese pregnant women (mean BMI 36.3 kg/m2).Results: Compared to women in the control arm, women in the intervention arm had a significant reduction in dietary glycaemic load (33 points, 95% CI -47 to -20), (p < 0.001) and saturated fat intake (-1.6% energy, 95% CI -2.8 to -0. 3) at 28 weeks' gestation. Objectively measured physical activity did not change. Physical discomfort and sustained barriers to physical activity were common at 28 weeks' gestation. Process evaluation identified barriers to recruitment, group attendance and compliance, leading to modification of intervention delivery.Conclusions: This pilot trial of a complex intervention in obese pregnant women suggests greater potential for change in dietary intake than for change in physical activity, and through process evaluation illustrates the considerable advantage of performing an exploratory trial of a complex intervention in obese pregnant women before undertaking a large RCT.Trial Registration: Trial Registration Number: ISRCTN89971375. [ABSTRACT FROM AUTHOR]