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There is growing clinical interest in addressing relationship dynamics between service-users and their voices. The Talking With Voices (TwV) trial aimed to establish feasibility and acceptability of a novel dialogical intervention to reduce distress associated with voices amongst adults diagnosed with schizophrenia spectrum disorders. The single-site, single-blind (rater) randomised controlled trial recruited 50 participants who were allocated 1:1 to treatment as usual (TAU), or TAU plus up to 26 sessions of TwV therapy. Participants were assessed at baseline and again at end of treatment (six-months). The primary outcomes were quantitative and qualitative assessments of feasibility and acceptability. Secondary outcomes involved clinical measures, including targeted instruments for voice-hearing, dissociation, and emotional distress. The trial achieved 100 % of the target sample, 24 of whom were allocated to therapy and 26 to TAU. The trial had high retention (40/50 [80 %] participants at six-months) and high intervention adherence (21/24 [87.5 %] receiving ≥8 sessions). Signals of efficacy were shown in targeted measures of voice-hearing, dissociation, and perceptions of recovery. Analysis on the Positive and Negative Syndrome Scale indicated that there were no differences in means of general psychosis symptom scores in TwV compared to the control group. There were four serious adverse events in the therapy group and eight in TAU, none of which were related to study proceedings. The trial demonstrates the acceptability of the intervention and the feasibility of delivering it under controlled, randomised conditions. An adequately powered definitive trial is necessary to provide robust evidence regarding efficacy evaluation and cost-effectiveness. Trial registration: ISRCTN 45308981.

Background Radiotherapy (RT) of ependymoma in children is an important part of the interdisciplinary treatment concept. However, feasibility and dose concepts are still under investigation, particularly in very young children. The aim of this study was to evaluate the standard dose and volume of proton therapy (PT) in children with ependymoma. Methods In this analysis, 105 patients with localized, intracranial ependymoma under the age of 18 years treated with PT between 2013 and 2018 were included. Patient characteristics, treatment, outcome, and follow-up data were analyzed using descriptive statistics, Kaplan-Meier, and Cox regression analysis. Results The median age of patients at PT was 2.8 years (0.9-17.0 years). The molecular subgroup analysis was performed in a subset of 50 patients (37 EP-PFA, 2 EP-PFB, 7 EP-RELA, 2 EP-YAP, 2 NEC [not elsewhere classified]). The median total dose was 59.4 Gy (54.0-62.0 Gy). The median follow-up time was 1.9 years. The estimated 3-year overall survival (OS), local control (LC), and progression-free survival (PFS) rates were 93.7%, 74.1%, and 55.6%, respectively. Within univariable analysis, female gender and lower dose had a positive impact on OS, whereas age ≥4 years had a negative impact on OS and PT given after progression had a negative impact on PFS. In the multivariable analysis, multiple tumor surgeries were associated with lower PFS. New ≥3° late toxicities occurred in 11 patients. Conclusion For children with localized ependymoma, PT was effective and well tolerable. Multiple surgeries showed a negative impact on PFS.

Purpose This study aims to examine the following across a six-month period in post-graduate research (PGR) students: mental health and well-being; the effect of academic pressures on depression, anxiety and well-being; and the extent to which psychological resilience buffered against academic pressures. Design/methodology/approach This was a longitudinal questionnaire study with predictor variables of six types of academic pressure, outcome variables of depression, anxiety and well-being, and a moderator of resilience. Findings Well-being significantly worsened across the six-month timeframe, but levels of depression and anxiety remained relatively stable. Negative perceptions of academic challenges at baseline significantly predicted anxiety, but not depression or well-being, six months later. Negative appraisals of relationships with supervisors, other university staff and work peers were not predictors of anxiety. Social support resilience which was present at baseline buffered the relationship between perceived academic challenges and anxiety. Practical implications Higher education institutions have a duty of care towards PGR students, many of whom struggle with the escalating interactions between mental health problems and academic pressures. Actively nurturing psychological resilience related to social support is key at the level of individual students and the PGR community but more broadly at an institutional level. Originality/value To the best of the authors’ knowledge, this is the first study to examine the effects of negative perceptions of multiple facets of academic life on depression, anxiety and well-being longitudinally. Additionally, it is the first study to investigate, and demonstrate, the extent to which psychological resilience can lessen the relationship between academic challenges and anxiety over time.

Background: The COVID-19 pandemic exacerbated vulnerabilities and inequalities in children’s oral health and treatment activity virtually ceased during periods of lockdown. Primary care dentistry is still in the post-pandemic recovery phase and it may be some years before normal service is resumed in NHS dentistry. However, opportunities to support the dental workforce through offering some preventative care in outreach settings may exist. This has the additional benefit of potentially reaching children who do not routinely see a dentist. The aim of this research was therefore to explore views around upskilling practitioners working in strategic community settings to support families of pre-school aged children to adopt and maintain preventative oral health behaviours. Methods: Using the Capability, Opportunity and Motivation model of behaviour (COM-B) to structure our data collection and analysis, we conducted semi-structured interviews with 16 practitioners (dental and non-dental) and analysed the data using deductive framework analysis. Results: The data was a good fit with the COM-B model and further themes were developed within each construct, representing insights from the data. Conclusion: Early years practitioners can reach vulnerable children who are not usually brought to see a dentist and have capability, opportunity and motivation to support the oral health behaviours of families of children in their care. Further research is needed to identify training needs (oral health and behaviour change knowledge and skills), acceptability to parents, and supporting dental practice teams to work in partnership with early years settings.

Objectives: To explore the experiences and perspectives of refugee parents regarding health behaviour changes among their children (i.e. changes in diet, levels of physical activity) and the impact of these changes on the health of their children aged 2-12 years.Design: A qualitative approach using semi-structured interviews supported by photo-elicitation. Methods:Parents of 2 to 12 years old children who had relocated to the UK within the past three or more years were recruited from two refugee organisations in the UK. Semi-structured face-to-face interviews and photo-elicitation were used to stimulate face-to-face in-depth discussions with participants. Data were analysed using an inductive and latent thematic analysis approach. Results:Twenty-seven parent refugees were recruited. Participants were primarily mothers (85%) and from Syria (70%). Other countries of origin were Sudan, Eritrea, Iraq, Kuwait, Libya and Tunisia. Twenty-six interviews were conducted in Arabic and one in English. The analysis identified three themes: 1) Reflection on acculturation, 2) Changed parental role, and 3) Environmental barriers to being healthy. Participants described facing substantial changes to their lifestyle and personal context, including a restricted living space, restricted neighbourhood/community and inclement weather. These differences in the environment required parents to adjust their roles, and practices around their own and their child’s eating habits. These changes influenced refugee children’s health behaviours. Of particular concern to parents were increased sedentary behaviour and consumption of unhealthy snacks. Conclusions:Multiple factors were identified relating to changes in family circumstances and environments that influenced refugee children’s health behaviours. Targeting these behaviours in tailored interventions may help improve refugee children’s health.

Pain communication should be an integral part of clinical consultations, particularly in paediatric rheumatology where children and adolescents frequently present with chronic musculoskeletal pain. To date, literature exploring the nature of and extent to which pain communication occurs has focused on healthcare professionals as respondents, yielding inconsistent and incomplete findings. The aim of this study was to explore children and adolescents' experiences of pain communication in the context of paediatric rheumatology consultations.Data were collected using semi-structured telephone interviews with children and adolescents recruited from three tertiary paediatric rheumatology centres in the United Kingdom. A framework analysis approach was used to explore the similarities and divergences in participant accounts.Twenty-six children and adolescents (aged 6-18 years, median = 14, 58% female) participated. Diagnoses included: juvenile idiopathic arthritis, Chronic Idiopathic Pain Syndromes, Ehlers Danlos Syndrome/Hypermobility. Four themes were identified: (1) Co-ordination of pain communication; (2) Barriers to pain communication; (3) Facilitators of pain communication; (4) Dissatisfaction with pain communication. These themes particularly encompassed the process of communication, disclosure of effective and ineffective approaches and the impact of communication. Participants expected questions about pain, felt cared about and found talking about pain natural. Challenges included augmenting the feeling of being different to peers and concerns about management plans changing as a result of pain conversations.Children and adolescents recalled a range of effective and ineffective pain communication approaches. Our study informs recommendations which highlight how healthcare professionals can improve their communication about pain with children and adolescents in the future.Our findings demonstrate that children and adolescents attending paediatric rheumatology expect to be and value being asked about their pain during consultations with healthcare professionals. Children and adolescents remember many of the processes involved, experiences of and the outcomes of pain communication. The current study reveals insights which can improve healthcare professional pain communication with children and adolescents. Our study introduces key recommendations for healthcare professionals to have more effective pain conversations in future.

Pregnancy is an opportune time for women to make healthy changes to their lifestyle, however, many women struggle to do so. Multiple reasons have been posited as to why this may be. This review aimed to synthesise this literature by identifying factors that influence women's health behaviour during pregnancy, specifically in relation to dietary behaviour, physical activity, smoking, and alcohol use. Bibliographic databases (MEDLINE, PsycINFO, CINAHL-P, MIDIRS) were systematically searched to retrieve studies reporting qualitative data regarding women's experiences or perceptions of pregnancy-related behaviour change relating to the four key behaviours. Based on the eligibility criteria, 30,852 records were identified and 92 studies were included. Study quality was assessed using the CASP tool and data were thematically synthesised. Three overarching themes were generated from the data. These were (1) A time to think about 'me', (2) Adopting the 'good mother' role, and (3) Beyond mother and baby. These findings provide an improved understanding of the various internal and external factors influencing women's health behaviour during the antenatal period. This knowledge provides the foundations from which future pregnancy-specific theories of behaviour change can be developed and highlights the importance of taking a holistic approach to maternal behaviour change in clinical practice.

Purpose This study aimed to address three key gaps in existing knowledge about postgraduate researchers’ (PGRs) well-being. It investigated 1) the frequency and nature of depression, anxiety and well-being amongst PGRs, and relatedly, characteristics that convey vulnerability, 2) factors that impact PGR well-being, and 3) factors that influence help-seeking. Design/methodology/approach The mixed-methods design comprised quantitative and qualitative approaches. Using opportunity sampling, 585 PGRs registered at a large UK University completed an online survey. The perspectives of a purposive sample of academic and Professional Services staff (n = 61) involved in supporting PGRs were sought through in-depth focus groups and semi-structured interviews, which were audio-recorded, transcribed verbatim and analysed using inductive thematic analysis. Findings PGRs scored lower on measures of well-being and higher on measures of anxiety and depression than aged-matched groups in the general population. PGR well-being was positively affected by personal and professional relationships, and negatively affected by academic challenges and mental health problems. Academic supervisors were the primary source of support for students experiencing well-being difficulties. Thematic analysis revealed four domains that impact upon PGR well-being: postgraduate researcher identity; pressures and expectations of postgraduate research; complexity of the supervisor role; and pinch points in postgraduate research. Each domain had associations with help-seeking behaviours. Originality/value This study provides evidence that the PGR experience is perceived to be distinct from that of other students, and this helps understand sources of stress and barriers to help-seeking. It provides a steer as to how higher education institutions could better support the PGR learning experience.

Thank you for this opportunity to share perspectives from our work within the Physiotherapy and Refugees Education Project, PREP, an Erasmus+ funded project within the KA2 strategic partnership program. Researchers, educators, students, and clinicians within institutions of higher education, health services and humanitarian organisations, have worked together in this project to define competencies that physiotherapists need in working with refugees. Based on this, we have made a course openly available for physiotherapists worldwide. A central aim of the work in PREP has been the creation of a network in which educators, students and clinicians can meet, discuss, and learn from each other. We welcome everyone who shares our interest to join us in this network. In this perspective paper, we want to share our thoughts and opinions on how such a collaboration can be used for building competence. We will discuss topics that are central for physiotherapists working with victims of torture, and finally, we will discuss what we believe are the important next steps within physiotherapy to be able to support this group.

Simple Summary Radiation therapy is an important cornerstone of the treatment of many different types of brain tumors occurring in childhood. Proton beam therapy offers the opportunity to reduce doses outside of the target volume due to its physical characteristics. By sparing a large volume of the brain from radiation doses, proton beam therapy aims at reducing long-term side effects and preserving cognitive function. Our study aims at better understanding side effects and therefore contributing to better treatment decisions in this vulnerable group of patients. Therefore, the study analyses outcome and side effects including imaging changes in a large cohort of children with brain tumors from a prospective registry. Abstract As radiotherapy is an important part of the treatment in a variety of pediatric tumors of the central nervous system (CNS), proton beam therapy (PBT) plays an evolving role due to its potential benefits attributable to the unique dose distribution, with the possibility to deliver high doses to the target volume while sparing surrounding tissue. Children receiving PBT for an intracranial tumor between August 2013 and October 2017 were enrolled in the prospective registry study KiProReg. Patient’s clinical data including treatment, outcome, and follow-up were analyzed using descriptive statistics, Kaplan–Meier, and Cox regression analysis. Adverse events were scored according to the Common Terminology Criteria for Adverse Events (CTCAE) 4.0 before, during, and after PBT. Written reports of follow-up imaging were screened for newly emerged evidence of imaging changes, according to a list of predefined keywords for the first 14 months after PBT. Two hundred and ninety-four patients were enrolled in this study. The 3-year overall survival of the whole cohort was 82.7%, 3-year progression-free survival was 67.3%, and 3-year local control was 79.5%. Seventeen patients developed grade 3 adverse events of the CNS during long-term follow-up (new adverse event n = 7; deterioration n = 10). Two patients developed vision loss (CTCAE 4°). This analysis demonstrates good general outcomes after PBT.

The COVID-19 pandemic exacerbated vulnerabilities and inequalities in children’s oral health and treatment activity virtually ceased during periods of lockdown. However, opportunities to support the dental workforce through offering some preventative care in outreach settings may exist. This has the additional benefit of potentially reaching children who do not routinely see a dentist. The aim of this study was therefore to investigate views around upskilling practitioners working in strategic community settings to support families of pre-school aged children to adopt and maintain preventative oral health behaviours. Using the Capability, Opportunity and Motivation model of behaviour (COM-B) to structure our research, we conducted semi-structured interviews with 16 practitioners (dental and non-dental) and analysed the data using deductive framework analysis. The data was a good fit with the COM-B model and further themes were developed within each construct, representing insights from the data. Early years practitioners can reach vulnerable children who are not usually brought to see a dentist. Staff have the capability, opportunity and motivation to support the oral health behaviours of families. Further research is needed to identify training needs, acceptability to parents, and supporting dental practice teams to work in partnership with early years settings. In brief: · Preventative dental activity was greatly diminished during the COVID-19 pandemic however there may be opportunities for professionals based outside general dental practice to have oral health behaviour change conversations with parents· Early years practitioners in particular can potentially reach vulnerable children who are not routinely brought to dental check-ups and have the capability, opportunity and motivation to have oral health behaviour change conversations with parents.· Further research is needed to identify training requirements and how to develop supportive relationships with NHS dental teams

OBJECTIVES. Mindfulness-based interventions (MBIs) have been widely implemented to improve self-regulation behaviors, often by targeting emotion-related constructs to facilitate change. Yet the degree to which MBIs engage specific measures of emotion-related constructs has not been systematically examined. METHODS. Using advanced meta-analytic techniques, this review examines construct and measurement engagement in trials of adults that used standardized applications of the two most established MBIs: Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT), or modified variations of these interventions that met defined criteria. RESULTS. Seventy-two studies (N=7,378) were included (MBSR k=47, MBCT k = 21, Modified k=4). MBIs led to significant improvement in emotion-related processing overall, compared to inactive controls (d=0.58; k =36), and in all constructs assessed: depression (d=0.66; k=26), anxiety (d =0.63; k=19), combined mental health (d =0.75; k=7 ) and stress (d =0.44; k=11). Reactions to pain, mood states, emotion regulation, and biological measures lacked sufficient data for analysis. MBIs did not outperform active controls in any analyses. Measurement tool and population-type did not moderate results, but MBI-type did, in that MBCT showed stronger effects than MBSR, although these effects were driven by a small number of studies. CONCLUSIONS. This review is the first to examine the full scope of emotion-related measures relevant to self-regulation, to determine which measures are most influenced by MBCT/MBSR. Compared to extant reviews, which typically focused on MBI outcomes, this work examined mechanistic processes based on measurement domains and tools. While effect sizes were similar among measurement tools, this review also includes a descriptive evaluation of measures and points of caution, providing guidance to MBI researchers and clinicians for selection of emotion-related measurement tools.

Objectives The Bipolar at Risk Trial (BART) was a feasibility randomized controlled trial investigating cognitive behavioral therapy (CBT) compared with treatment as usual (TAU) in young people at high risk of developing bipolar disorder (BD). This qualitative study aimed to investigate participants' experiences of trial involvement, and the acceptability of CBT for this population. Design Participants were those identified as being at risk of bipolar disorder, determined by current symptoms or family history. A purposive sample of twenty-one participants from both the intervention and TAU arms of the trial was recruited. Methods Twenty-one semi-structured interviews were conducted by service user researchers (13 participants had received therapy and 8 TAU). Interviews were audio recorded with consent from participants and transcribed verbatim. NVivo 11 Pro software was used to conduct an inductive thematic analysis. Results Super-ordinate themes were "adaptability and flexibility," "feeling understood and valued," and "relevance of study and intervention" which had two sub-themes-"value of the trial therapy" and "acceptability of trial processes." Participating in the trial and having therapy enabled participants to feel understood and valued by research assistants (RAs) and therapists. Participants viewed therapy as relevant to their current concerns and valued adaptability and flexibility of RAs and therapists. Conclusions Findings highlight the importance and value of flexibility, adaptability, and understanding in relationships between participants and trial staff. Findings also indicate that the trial processes and CBT focusing on mood swings are acceptable and relevant to participants from this at risk population. Practitioner points Young people at risk of bipolar disorder value a flexible approach to assessments and therapy, developing a rapport with research assistants and therapists and opening up to them when they feel comfortable to do so. CBT focusing on coping with mood swings was acceptable to the majority of participants who received it and it was perceived as helpful in ways that were personal to each participant.

OBJECTIVE Out-of-class mindfulness meditation practice is a health behavior that is considered to be a crucial ingredient in mindfulness-based interventions (MBIs), yet participant adherence to practice recommendations is often inconsistent. Furthermore, MBIs may enhance factors that lead to greater adherence to medical regimens in other contexts. This study examined baseline factors previously found to relate to adherence to medical regimen, MBI-related changes in these baseline factors, and treatment-related factors as predictors of meditation adherence in an 8-week MBI. METHODS Baseline traits (personality, depressive symptoms, and executive function) were entered into regression models (n = 96) to predict intervention and postintervention out-of-class meditation adherence. Trait changes and treatment-related factors were entered into models to predict postintervention meditation adherence. RESULTS Baseline conscientiousness (β = 0.33, p = .002), openness (β = 0.23, p = .019), and depressive symptoms (β = 0.19, p = .042) predicted intervention meditation adherence, whereas conscientiousness (β = 0.21, p = .044) and depressive symptoms (β = 0.22, p = .020) predicted postintervention meditation adherence. Although all trait variables except for agreeableness changed significantly pre-to-post intervention, these changes did not predict postintervention meditation adherence. Retreat attendance (β = 0.38, p = .029) and instructor/group-related therapeutic factors collectively predicted postintervention meditation adherence (R2 = 0.21, p = .019). CONCLUSIONS The identified baseline trait factors could be used to increase adherence in these interventions as a method of increasing their effectiveness. An emphasis on the MBI retreat and social factors during the intervention may be important for participant out-of-class practice postintervention.Trial Registration:ClinicalTrials.govNCT01831362.

Introduction Lenalidomide plus dexamethasone is effective and well tolerated in relapsed/refractory multiple myeloma (RRMM). In this observational, noninterventional European post-authorization safety study, the safety profile of lenalidomide plus dexamethasone was investigated and compared with that of other agents in the treatment of RRMM in a real-world setting. Patients and Methods Patients had received ≥ 1 prior antimyeloma therapy; prior lenalidomide was excluded. Treatment was per investigator’s routine practice. Adverse events were analyzed by incidence rates per 100 person-years to account for differences in observation length and treatment duration. Results In total, 2150 patients initiated lenalidomide, and 1479 initiated any other antimyeloma therapy, predominately bortezomib (80.3%), which was primarily administered intravenously (74.3%). The incidence rate of neuropathy was lower with lenalidomide (10.5) than with bortezomib (78.9) or thalidomide (38.7). Lenalidomide also had a lower incidence rate of infections (68.7) versus bortezomib (95.9) and thalidomide (76.0). Conversely, the incidence rate of neutropenia was higher with lenalidomide (38.0) than with bortezomib (18.2) or thalidomide (25.7). The incidence rates of thrombocytopenia were 24.4, 40.4, and 14.4 with lenalidomide, bortezomib, and thalidomide, respectively. Conclusion No new safety signals for lenalidomide were identified in this study, which is the largest prospective real-world European study of lenalidomide in patients with RRMM to date. These results confirm that the safety profile of lenalidomide plus dexamethasone in RRMM in a real-world setting is comparable to that reported in clinical trials.

Background The role of schools in addressing rising childhood obesity levels has been acknowledged, and numerous diet- and physical activity-related interventions exist. Aside from formal interventions, opportunistic parent-educator conversations about child weight can arise, particularly in primary school settings, yet little is known about how useful these are. This study aimed to understand the utility of child weight related conversations with parents through exploring educators’ experiences and perspectives. Methods This qualitative study consisted of semi-structured interviews conducted with primary school teaching staff in the United Kingdom (N = 23), recruited through purposive and subsequent snowball sampling. Interviews were audio-recorded, transcribed, and analysed using thematic analysis. Results Participants identified opportunities and need for child weight discussions in schools. However, conversations were prevented by the indirect and sensitive nature of conversations, and educators’ professional identity beliefs. Using pre-existing face-to-face opportunities, good parent-teacher relationships and holistic approaches to child health and wellbeing were reported as important in optimising these conversations. Conclusions Whilst educator-parent child weight discussions are necessary, discussions are highly challenging, with contradictory views on responsibility sometimes resulting in avoidance. Educators’ roles should be clarified, and communication training tailored to increase teacher confidence and skills. Current social distancing will likely reduce opportunistic encounters, highlighting a need to further improve communication routes.

Background Children undergoing cranial or craniospinal radiotherapy may require over 30 treatments within a six-week period. Facilitating these many treatments with the patient under anesthesia presents a significant challenge, and the most preferred anesthetic methods remain unknown. The primary goal of this study was to determine the most preferred anesthetic methods and agents for children undergoing daily cranial or craniospinal radiotherapy. Methods An 83-item web-based survey was developed. An introductory email was sent to 505 physicians and child-life specialists with expertise in pediatric anesthesia and/or affiliated with pediatric radiation oncology departments. Results The response rate was 128/505 (25%) and included specialists from Africa (5, 4%), Asia (18, 14%), Australia/Oceania (5, 4%), Europe (45, 35%), North America (50, 39%), and South America (5, 4%). The 128 respondents included 91 anesthesiologists (71%), 20 physicians who were not anesthesiologists (16%), 14 child life/social education specialists (11%), one radiotherapist, one pediatric radiation nurse, and one non-specified medical professional (all = 2%). Of the 128 respondents, 95 (74%) used anesthesia or sedation to facilitate repetitive cranial or craniospinal radiotherapy. Overall, total intravenous anesthesia without intubation was preferred by 67 of 95 (71%) specialists during one or more forms of radiotherapy. During photon-based radiotherapy, total intravenous anesthesia without intubation was the preferred anesthetic method with the patient in the supine (57/84, 68%) and prone positions (25/40, 63%). Propofol was the most used anesthetic agent for both supine (73/84, 87%) and prone positions (38/40, 95%). For proton radiotherapy, total intravenous anesthesia without intubation was the most preferred anesthetic method for the supine (32/42, 76%) and prone treatment positions (11/18, 61%), and propofol was the most used anesthetic (supine: 40/43, 93%; prone: 16/18, 89%). Conclusions In this survey of 95 specialists responsible for anesthesia or sedation of children undergoing repetitive cranial or craniospinal radiotherapy, propofol-based total intravenous anesthesia without intubation was the preferred anesthetic technique.

Interactions about children’s weight and weight-related behaviours occur from an early stage in school settings between various stakeholders, and are often intended to facilitate weight-related behavioural change in children and/or families. This meta-synthesis (PROSPERO - CRD42019133231) aimed to investigate stakeholder reported experiences and challenges of these encounters. Studies were eligible if they included school stakeholders (teaching or non-teaching staff, parents, caregivers or children), explored communication topics related to child obesity (weight, diet or activity), were conducted within an early school setting (primary school stage or international equivalent), and used qualitative methods. Database searches conducted March - July 2019 (updated November 2020), identified 40 studies (2,324 participants) from seven countries. Included studies were assessed for quality using the Critical Appraisal Skills Programme. Using inductive thematic analysis, we identified four core themes across this database: (1) ‘Conversation characteristics and consequences’, (2) ‘Missing components’, (3) ‘Avoiding stigma’, and (4) ‘School responsibilities’. Overall, stakeholders recognised that schools are well-positioned to provide positive influential messages about childhood obesity and reported that discussions on this topic do occur in early school settings but that stakeholders find them difficult, complex, and lack the necessary skills to deliver the non-judgemental, consistent and tailored support that they desire.

Direct fed microbials (DFM) dietary mixture effects on beef cattle ruminal variables, intake, and apparent total tract digestibility were evaluated. Six ruminally cannulated beef steers (BW = 520 ± 30 kg) were used in a duplicated 3 × 3 Latin square design and offered a steam-flaked corn-based finishing diet ad libitum for three 28-d periods (21-d adaptation and 7-d collection). Treatments assigned were: 1) Control (no DFM mixture; lactose only); 2 and 3) DFM mixtures at distinct concentrations [Mixture A and B, at 2 g/animal-daily (lactose used as carrier)]. Ruminal pH and temperature were measured every 6 min (wireless probes). Ruminal samples were collected at 0, 2, 4, 8, 16, and 23 h post-feeding on d28. Feed and fecal samples (collected once and twice daily, respectively) were composited by period and analyzed. Fecal output was estimated with a dietary internal marker (288-h indigestible-NDF). Data were analyzed using the GLIMMIX procedure of SAS. No treatment × time interactions (P ≥ 0.20) were observed. Steers offered mixture-A experienced 300 min/d less (P = 0.04) time under the ruminal pH 5.6, tended (P = 0.13) for a lesser area under the curve of ruminal pH 5.6, while showing a greater (P = 0.04) ruminal pH average (5.67 vs. 5.50), and tended (P = 0.06) for a lesser ruminal temperature (39.2 vs. 39.4°C) compared to control. The ruminal concentration of NH3-N was greater (P = 0.02) for mixture-A compared with control (10.78 vs. 4.35 mg/dL), while animals offered mixture-B tended (P = 0.07) to be greater (9.11 mg/dL) than control. Steers offered DFM mixture-A increased (P = 0.04) ADF digestibility compared with control (39.8 vs. 54.0%), while not affecting DM intake (P = 0.61). The DFM mixture-A induced a safer ruminal pH environment and encouraging fiber degradation and NH3-N release, while not affecting animal intake

The effects of dietary inclusion of live bacteria on feedlot beef cattle apparent total tract nutrient digestibility were evaluated. Crossbred-Angus yearling steers (n = 192; initial BW = 409 kg ± 8 kg) were blocked by body weight (BW) and randomly assigned into 48 pens (4 steers/pen; 16 pens/treatment) following a randomized complete block design. A steam-flaked corn-based fishing diet was offered ad libitum once daily containing the following treatments: 1) Control, in which no direct fed microbial (DFM) was offered (lactose as carrier only); 2 and 3) Probiotic mixtures at distinct concentrations [Mixture A and B, at 2g/animal-daily (lactose used as carrier)]. Orts DM were quantified (if any) daily and subtracted from total dietary DM offered to calculate DM intake. Fecal samples were collected twice daily (0700 and 1700 h) for 5 consecutive days (d 68 to 72) from at least 3 steers per pen, while feed samples were collected daily. Samples were composited within period, dehydrated (55°C), and ground (1mm) for further analyses. Total fecal output was estimated with a dietary internal marker (288-h indigestible NDF) and used to calculate nutrient digestibility. Data were analyzed using the GLIMMIX procedure of SAS and pen was considered the experimental unit. Intakes of DM, OM, NDF, and ADF during the digestibility assessment were not affected (P ≥ 0.13) by treatments. Steers offered DFM mixture-A tended to increase digestibility of DM (P = 0.07; 79.3 vs. 77.1%), NDF (P = 0.10; 56.9 vs. 51.6%), and hemicellulose (P = 0.08; 59.4 vs. 53.9%) compared with control, while digestibility of ADF was not affected (P = 0.24) by treatment. The DFM mixture-A seemed to positively affect apparent digestibility of nutrients in steers consuming a steam-flaked corn-based finishing diet, in which improvements in the fiber fraction digestion seemed to be a meaningful contributor.

The effects of a nutritional packet containing a direct-fed microbial combined with vitamins/electrolytes offered to beef steers in a calf-fed system on apparent total tract nutrient digestibility were evaluated. Angus crossbred steer-calves (n = 60; BW = 234 ± 4 kg) were assigned to a randomized complete block design (block = body weight; steer = experimental unit) and stratified into 2 treatments: a) control (no packet, finely-ground corn carrier only); and b) 30 g of DM/animal-daily of a nutritional packet [live-yeast (Saccharomyces cerevisiae; 8.7 Log CFU/g), Vitamin C (5.4 g/kg of Ascorbic acid), Vitamin B1 (13.33 g/kg of Thiamine hydrochloride), and electrolytes of NaCl (80 g/kg) and KCl (80 g/kg)]. Animals were individually offered [electronic feed-bunks (Smart-Feed/C-Lock Inc.)] a steam-flaked corn-based finishing diet ad libitum, once daily for 233 d. Treatments were offered during the first (phase-1) and last (phase-2) 60 d on feed. At the conclusion of each phase, feed samples were collected once daily (1400 h), while fecal samples twice daily (0700 and 1700 h) from each steer during 4 consecutive days. Fecal and feed sample composites were dehydrated (55oC), ground (1 mm), and analyzed to assess DM, OM, NDF, ADF, and hemicellulose. The 288-h indigestible NDF was used as dietary internal marker to estimate fecal output and used to calculate nutrient digestibility. Data were analyzed using the GLIMMIX procedure of SAS. Intake of DM, OM, and fiber components during both digestibility trials were not affected (P ≥ 0.56) by treatments. Steers offered the nutritional packet had increased (P < 0.01) apparent total tract digestibility of DM, OM, NDF, ADF, and hemicellulose by at least 2.4, 2.4, 8.3, 10, and 7.5%, respectively, in both digestibility phases. Superior nutrient digestibility without affecting nutrient intake may justify a potential enhanced carcass energy deposition.

The effects of a nutritional packet containing a direct-fed microbial combined with vitamins/electrolytes offered to beef steers in a calf-fed system on ruminal papillae morphology and volatile fatty acid (VFA) profile were evaluated. Angus crossbred steer-calves (n = 60; BW = 234 ± 4 kg) were assigned to a randomized complete block design (block = body weight; steer = experimental unit) and stratified into two treatments: a) control (no packet, finely-ground corn carrier only); and b) 30 g of DM/animal-daily of a nutritional packet [live-yeast (Saccharomyces cerevisiae; 8.7 Log CFU/g), Vitamin C (5.4 g/kg of Ascorbic acid), Vitamin B1 (13.33 g/kg of Thiamine hydrochloride), and electrolytes of NaCl (80 g/kg) and KCl (80 g/kg)]. Animals were individually offered [electronic feed-bunks (Smart-Feed/C-Lock Inc.)] a steam-flaked corn-based finishing diet ad libitum once daily for 233 d, while treatments were offered during the first and last 60 days on feed only. Upon harvest (federally inspected facility), individual samples of ruminal cranial sac epithelium and rumen content (quickly frozen) were collected. Preserved (70% alcohol at 5oC) ruminal tissue fragments were trimmed (1 cm2), in which papillae were counted, followed by a random removal of 12 individual papillae for further area measurement using electronic scanning (ImageJ). Data were analyzed using the GLIMMIX procedure of SAS. Steers offered to nutritional packet had a 30% increased (P = 0.02) average papillae area, which induced a tendency (P = 0.14) to improve ruminal absorptive surface area (89 vs. 93%), while not affecting ruminal papillae number (P = 0.39). Molar proportions of acetate, butyrate, and propionate were not affected (P ≥ 0.51) by treatments, while total VFA (mM) tended (P = 0.09) to increase by 8% for animals consuming the nutritional packet. The nutritional packet seemed to improve ruminal fermentation products while positively affecting ruminal papillae morphology.

The effects of dietary inclusion of live bacteria on feedlot beef cattle growth performance and carcass characteristics were evaluated. Crossbred-Angus yearling steers (n = 192; initial BW = 409 kg ± 8 kg) were blocked by body weight (BW) and randomly assigned into 48 pens (4 steers/pen; 16 pens/treatment) following a randomized complete block design. A steam-flaked corn-based fishing diet was offered ad libitum once daily containing the following treatments: 1) Control, in which no direct fed microbial (DFM) was offered (lactose as carrier only); 2 and 3) Probiotic mixtures at distinct concentrations [Mixture A and B, at 2g/animal-daily (lactose used as carrier)]. Orts DM were quantified daily and subtracted from total dietary DM offered to calculate DM intake. Two-day consecutive unshrunk BW were recorded before feeding on d 0, 30, 60, 90, 121, and 153 (prior to shipment to a federally inspected slaughter facility). Data were analyzed using the GLIMMIX procedure of SAS and pen was considered the experimental unit, in which F-test protected pre-planned contrasts comparing control versus DFM mixture-A and control versus DFM mixture-B were used. Steers offered mixture-A increased carcass-adjusted ADG (P = 0.03) by 6.7%, gain efficiency (P < 0.01) by 6%, tended to increase carcass-adjusted final BW (P = 0.07) by 15kg and hot carcass weight (P = 0.07) by 10kg. The overall (d 0 to end) DM intake (P = 0.36) was not affected by treatment; however, a subtle (1.2%) decrease (P < 0.01) during the initial 30 days for steers offered DFM mixture-B was observed. Carcass variables (dressing percentage, 12th rib fat, longissimus muscle area, marbling, yield grade, and liver scores) were not affected (P ≥ 0.13) by treatments. Growth performance was improved with DFM mixture-A which seemed to positively affect carcass weight without inducing deleterious effects on other carcass characteristics.

Objectives: Theoretical models have informed the understanding of pregnancy as a ‘teachable moment’ for health behaviour change. However, these models have not been developed specifically for, nor widely tested, in this population. Currently, no pregnancy-specific model of behaviour change exists, which is important given it is a unique yet common health event. This study aimed to assess the extent to which factors influencing antenatal behaviour change are accounted for by the COM-B model and Teachable Moments (TM) model, and to identify which model is best used to understand behaviour change during pregnancy. Design: Theoretical mapping exercise.Methods: A deductive approach was adopted; nine sub-themes identified in a previous thematic synthesis of 92 studies were mapped to the constructs of the TM and COM-B models. The sub-themes reflected factors influencing antenatal health behaviour.Findings: All sub-themes mapped to the COM-B model constructs, whereas the TM model failed to incorporate three sub-themes. Missed factors were non-psychological, including practical and environmental factors, social influences, and physical pregnancy symptoms. In contrast to the COM-B model, the TM model provided an enhanced conceptual understanding of pregnancy as a teachable moment for behaviour change, however neither model accounted for the changeable salience of influencing factors throughout the pregnancy experience.Conclusions: The TM and COM-B models are both limited when applied within the context of pregnancy. Nevertheless, both models offer valuable insight that should be drawn upon when developing a pregnancy-specific model of behaviour change.

Pregnancy is often conceptualised as a 'teachable moment' for health behaviour change. However, it is likely that different stages of pregnancy, and individual antenatal events, provide multiple distinct teachable moments to prompt behaviour change. Whilst previous quantitative research supports this argument, it is unable to provide a full understanding of the nuanced factors influencing eating behaviour. The aim of this study was to explore influences on women's eating behaviour throughout pregnancy.In-depth interviews were conducted online with 25 women who were less than six-months postpartum. Interviews were audio-recorded and transcribed verbatim. Data were analysed thematically.Five themes were generated from the data that capture influences on women's eating behaviour throughout pregnancy: 'The preconceptual self', 'A desire for good health', 'Retaining control', 'Relaxing into pregnancy', and 'The lived environment'.Mid-pregnancy may provide a more salient opportunity for eating behaviour change than other stages of pregnancy. Individual antenatal events, such as the glucose test, can also prompt change. In clinical practice, it will be important to consider the changing barriers and facilitators operating throughout pregnancy, and to match health advice to stages of pregnancy, where possible. Existing models of teachable moments may be improved by considering the dynamic nature of pregnancy, along with the influence of the lived environment, pregnancy symptoms, and past behaviour. These findings provide an enhanced understanding of the diverse influences on women's eating behaviour throughout pregnancy and provide a direction for how to adapt existing theories to the context of pregnancy.

Background Suicidal ideation is a key precursor for suicide attempts and suicide deaths. Performing routine screening of suicide precursors can help identify people who are at high risk of death by suicide. This is, arguably, an important suicide prevention effort. The aim of this study was to assess the validity, reliability, and factor structure of the Suicidal Ideation Attributes Scale (SIDAS) in a three-month longitudinal study with people with a diagnosis of schizophrenia or non-affective psychosis and experiences of suicidal ideation and/or behaviours. It was predicted that the SIDAS would have high internal consistency, test-retest reliability, convergent, discriminant and construct validity. Methods Ninety-nine participants experiencing psychosis completed the SIDAS at baseline and 89 participants completed it 3 months later. Additionally, participants completed a demographic questionnaire, the Beck Scale for Suicide Ideation, the Beck Hopelessness Scale, and the Defeat and Entrapment Scales. The internal consistency, test-retest reliability, convergent validity, and discriminant validity of the SIDAS were investigated in comparison to other constructs. Factor analysis was performed to examine the factor structure of the scale. Results Principal component analysis yielded a theoretically coherent one-dimensional factor structure of SIDAS, suggesting good construct validity (PCA = .71). The SIDAS had high internal consistency (α = .89) and good test-retest reliability (α = .73). It was highly correlated with other self-report measures, including the Beck Scale for Suicide Ideation, Beck Hopelessness Scale, Defeat and Entrapment scales, indicating excellent construct validity. Conclusion The SIDAS is a valid and reliable self-report instrument for assessing the severity of suicidal ideation in a population of people with a diagnosis of schizophrenia or non-affective psychosis. Further research should test the psychometric properties of the scale in individuals experiencing different mental health problems in cross-cultural settings, in order to establish its broader validity, reliability, and clinical utility.

Exclusive enteral nutrition (EEN) is the first-line therapy for pediatric-onset Crohn's disease (CD) patients. CEDATA-GPGE® is the largest patient registry for children and adolescents with inflammatory bowel disease (IBD) in Europe, collecting data from over 5000 patients since 2004 in Germany and Austria. Since the application of EEN over 8 weeks is difficult and a high dropout rate is often described, the mode of application including a supporting structure is crucial for success. The aim of this study was to ascertain the variation in the application of EEN across the participating centers and to associate these with the outcome.Thirty-one centers responded to the survey (81.6%). 88.5% of CD patients were recommended EEN for induction therapy, 71.8% actually started with EEN, and 22.1% terminated the EEN prematurely. The duration of EEN typically lasted 6 to 8 weeks, and the polymeric formula was mainly used. 80.6% of the clinics added flavorings to the formulas. After EEN, the most preferred diet for maintenance therapy was a healthy, well-balanced diet considering individual intolerances.EEN is widely recommended as an induction therapy by the German and Austrian pediatric gastroenterologists for children and adolescents with CD. However, this questionnaire-based study has shown a wide variation in EEN protocols used by the different pediatric clinics of CEDATA-GPGE®.

Women with a BMI ≥ 30 kg/mA secondary analysis of eighteen semi-structured interviews with women with a BMI ≥ 30 kg/mDeductive thematic analysis was used to apply a framework of psychological factors to the data, and investigate the extent to which they feature within the women's breastfeeding experiences.All psychological factors were reported as part of women's experiences. Planning to breastfeed, planning short durations and having high confidence, factual and social knowledge positively influenced initiation and maintenance. Believing in their ability to produce nutritionally adequate and sufficient milk, that breastfeeding would assist weight loss, and that others around them approved of breastfeeding also had a positive impact. Novel relationships between psychological factors were found.Psychological factors influence women's breastfeeding experiences. A model of breastfeeding in women with a BMI ≥ 30 kg/m

Participation in suicide-related research is generally associated with more positive than negative outcomes. However, sparse research has examined the longevity of any effects of participation. Here, we report the first qualitative examination of both the immediate and long-term views of participating in suicide-related research interviews. Thematic analysis indicated that participants had positive experiences, including increased altruism and self-understanding. For some participants, these benefits remained in the months post-participation. Follow-up data revealed that participants can be susceptible to short-term dips in mood, which may not emerge until a few hours/days post-participation. However, any negative effects of participation were confined to the days immediately following the study. Participant-informed recommendations were developed to support researchers in optimizing the well-being of participants in suicide-related research.

The effects of the dietary inclusion of live bacteria mixtures on feedlot beef cattle ruminal papillae morphology were evaluated. Crossbred-Angus yearling steers (n = 192; initial BW = 409 kg ± 8 kg) were blocked by body weight (BW) and randomly assigned into 48 pens (4 steers/pen; 16 pens/treatment) following a randomized complete block design. A steam-flaked corn-based fishing diet was offered ad libitum once daily during 153 d containing the following treatments: 1) Control, in which no direct-fed microbial (DFM) was offered (lactose as carrier only); 2 and 3) Probiotic mixtures at distinct concentrations [Mixture A and B, at 2g/animal-daily (lactose used as carrier)]. Upon harvest at a federally inspected slaughter facility, epithelium samples were collected from the cranial sac of the rumen, immersed in a 70% alcohol, and preserved under refrigeration (5°C). Ruminal tissue fragments were trimmed (1cm2), in which papillae were completely counted within the fragment, followed by the removal of 12 random individual papillae for further area measurement using electronic scanning (ImageJ). Data were analyzed using the GLIMMIX procedure of SAS and pen was considered the experimental unit with the fixed effect of treatment and the random effect of block. Regardless of treatments, average papillae area in cm2 (P = 0.39; control: 0.38, DFM mixture-A: 0.40, DFM mixture-B: 0.37), papillae number within fragment (P = 0.70; control: 47, DFM mixture-A: 52, DFM mixture-B: 49), absorptive surface area in cm2/fragment cm2 (P = 0.87; control: 37, DFM mixture-A: 39, DFM mixture-B: 38), and ruminal absorptive surface area (P = 0.74; control: 97%, DFM mixture-A: 97%, DFM mixture-B: 97%) were not affected compared with control. The addition of DFM mixtures did not seem to affect ruminal papillae physical aspect, although the long-term effects of dietary inclusion of live bacteria on ruminal morphology needs to be further evaluated.

The effects of dietary inclusion of live bacteria mixtures on feedlot beef cattle feeding behavior were evaluated. Crossbred-Angus yearling steers (n = 192; initial BW = 409 kg ± 8 kg) were blocked by body weight (BW) and randomly assigned into 48 pens (4 steers/pen; 16 pens/treatment) following a randomized complete block design. A steam-flaked corn-based fishing diet was offered ad libitum once daily containing the following treatments: 1) Control, in which no direct fed microbial (DFM) was offered (lactose as carrier only); 2 and 3) Probiotic mixtures at distinct concentrations [Mixture A and B, at 2g/animal-daily (lactose used as carrier)]. Orts DM were quantified daily and subtracted from total dietary DM offered to calculate DM intake. Feeding behavior activities (continuous 24 h) were visually assessed (d 106 and 113) by trained personnel, where time spent on each activity was recorded every 5 min. Data were analyzed using the GLIMMIX procedures of SAS and pen was considered the experimental unit. No treatment × period interactions (P ≥ 0.21) were observed. Main feeding behavior variables consisting of time spent ruminating, chewing, eating, and drinking in minutes per day were not affected (P ≥ 0.17) by treatments, while steers in general ruminated, ate, chewed, and were more active (P ≤ 0.01) during the second behavioral assessment, regardless of treatments. Rates of intake in minutes per kg of DM, OM, fiber and digestible DM, OM, and fiber were not affected (P ≥ 0.12) by treatments; however more time spent (P < 0.01) ruminating, eating, and chewing in minutes per kg were observed on d113 compared to d106 regardless of treatments. Drinking time (min/d) and drinking rates (min/kg) were not affected (P ≥ 0.81) by period. The DFM mixtures did not negatively affect feeding behavior of yearling steers consuming steam-flaked corn-based finishing diets.

The effects of a nutritional packet containing a direct-fed microbial combined with vitamins/electrolytes offered at the beginning and end of the finishing phase to beef steers in a calf-fed system on feeding behavior were evaluated. Angus crossbred steer-calves (n = 18; BW = 234 ± 4 kg) were assigned to a randomized complete block design (block = body weight; steer = experimental unit) and stratified into two treatments: a) control (no packet, finely-ground corn carrier only); and b) 30 g of DM/animal-daily of a nutritional packet [live-yeast (Saccharomyces cerevisiae; 8.7 Log CFU/g), vitamin C (5.4 g/kg of ascorbic acid), vitamin B1 (13.33 g/kg of thiamine hydrochloride), and electrolytes of NaCl (80 g/kg) and KCl (80 g/kg)]. Animals were individually offered [electronic feed-bunks (Smart-Feed/C-Lock Inc.)] a steam-flaked corn-based finishing diet ad libitum once daily for 233 d, while treatments were offered during the first (phase-1) and last 60 d (phase-2) on feed only. Feeding behavior activities were assessed in min/d by using CowManagerTM ear tag sensors. Data were analyzed using the GLIMMIX procedure of SAS. There was no treatment × phase interactions (P ≥ 0.15), except that steers receiving the nutritional packet tended (P = 0.10) to spend more time (6 vs. 9 min/kg) eating digestible DM during phase-2 only. Regardless of phase, steers consuming the nutritional packet spent more time (P = 0.04) eating per kg of hemicellulose. Regardless of treatment, a decreased rumination (P ≤ 0.03) and chewing (P ≤ 0.01) activity-variables were observed for the phase-2 compared to phase-1. Steers receiving the nutritional packet exhibited superior time spent on eating activities, especially during the final 60 d before slaughter, and fiber seems to be the major driver inducing such effect. Towards the end of the finishing phase, cattle reduced rumination and chewing compared to the arrival phase.

The effects of a nutritional packet containing a direct-fed microbial combined with vitamins/electrolytes offered to beef steers in a calf-fed system on growth performance and carcass characteristics were evaluated. Angus crossbred steer-calves (n = 60; BW = 234 ± 4 kg) were assigned to a randomized complete block design (block = body weight; steer = experimental unit) and stratified into two treatments: a) control (no packet, finely-ground corn carrier only); and b) 30 g of DM/animal-daily of a nutritional packet [live-yeast (Saccharomyces cerevisiae; 8.7 Log CFU/g), Vitamin C (5.4 g/kg of Ascorbic acid), Vitamin B1 (13.33 g/kg of Thiamine hydrochloride), and electrolytes of sodium chloride (80 g/kg) and potassium chloride (80 g/kg)]. Animals were individually offered [electronic feed-bunks (Smart-Feed/C-Lock Inc.)] a steam-flaked corn-based finishing diet ad libitum, once daily for 233 d. Treatments were offered during the first (phase-1) and last (phase-2) 60 d on feed. Body weight measurements were taken every 30 d before feeding. Data were analyzed using the GLIMMIX procedure of SAS. Steers offered the nutritional packet had 14% less (P < 0.01) intake and 18% greater gain efficiency during the initial 30-d on feed, while such advantage did not (P ≥ 0.26) persist when accounting for the initial 60 d for either variable. Overall intake (d0 to d233) was 6% greater (P = 0.02), while carcass-adjusted ADG (1.61 vs. 1.56), and carcass-adjusted gain efficiency (0.198 vs. 0.204) were unaffected (P ≥ 0.44) compared with control, respectively. Dressing percent of steers offered the packet was 1 percentage-unit greater (P = 0.02), while other carcass variables were unaffected (P ≥ 0.33). Calf-fed steers seem to benefit from such nutritional packet during the initial 30 d after feedlot arrival, while both superior intake and dressing percentage appears to last until cattle harvest.

Background: The fatty acid (FA) composition of blood can be used as an objective biomarker of dietary FA intake. It remains unclear how the nutritional state influences the FA composition of plasma lipid fractions, and thus their usefulness as biomarkers in a non-fasted state. Objectives: To investigate the associations between palmitate, oleate and linoleate in plasma lipid fractions and self-reported dietary FA intake, and assess the influence of meal consumption on the relative abundance of these FA in plasma lipid fractions (i.e. triglyceride [TG], phospholipids [PLs] and cholesterol esters [CEs]). Design: Analysis was performed in plasma samples collected from 49 (34 males and 15 females) participants aged 26–57 years with a body mass index (BMI) between 21.6 and 34.2 kg/m2, all of whom had participated in multiple study visits, thus a pooled cohort of 98 data sets was available for analysis. A subset (n = 25) had undergone nutritional interventions and was therefore used to investigate the relationship between the FA composition of plasma lipid fractions and dietary fat intake. Results: Significant (P < 0.05) positive associations were observed between dietary polyunsaturated fat and linoleate abundance in plasma CE. When investigating the influence of meal consumption on postprandial FA composition, we found plasma TG palmitate significantly (P < 0.05) decreased across the postprandial period, whereas oleate and linoleate increased. A similar pattern was observed in plasma PL, whereas linoleate abundance decreased in the plasma CE. Conclusion: Our data demonstrate that the FA composition of plasma CE may be the lipid fraction to utilise as an objective biomarker when investigating recent (i.e. previous weeks-months) dietary FA intakes. In addition, we show that the consumption of a high-fat meal influences the FA composition of plasma TG, PL and CE over the course of the postprandial period, and therefore, suggest that fasting blood samples should be utilised when using FA composition as a biomarker of dietary FA intake.

Background. Obesity rates are higher among people of lower socioeconomic status. Whilst numerous health behaviour interventions targeting obesity exist, they are more successful at engaging higher socioeconomic status populations, leaving those in less affluent circumstances with poorer outcomes. This highlights a need for more tailored interventions. The aim of this study was to enhance an existing weight loss course for adults living in low socioeconomic communities. Methods. The Behaviour Change Wheel approach was followed to design an add on intervention to an existing local authority run weight loss group, informed by mixed methods research and stakeholder engagement. Results. The COM-B analysis of qualitative data revealed that changes were required to psychological capability, physical & social opportunity and reflective motivation to enable dietary goal setting behaviours. The resulting SMART-C booklet included six weeks of dietary goal setting, with weekly behavioural contract and review. Conclusion. This paper details the development of the theory and evidence informed SMART-C intervention. This is the first report of the Behaviour Change Wheel being used to design an add-on tool to enhance existing weight loss services. The process benefitted from a further checking stage with stakeholders. Patient or Public contribution. Contributors were involved in a range of ways, including providing feedback on study documentations, and both staff and public providing feedback on iterations of the intervention design with the aim of increasing suitability and future implementation success.

Chlamydia (C.) abortus is an emerging zoonotic pathogen. Since data on its antimicrobial susceptibility are lacking, we aimed to determine minimal inhibitory (MIC) and minimal bactericidal concentrations (MBC) for azithromycin and doxycycline in HeLa-cells and primary human macrophages (M1). We also examined the MDM2-p53-inhibitor nutlin-3, an anti-infective imidazoline analog. Azithromycin and doxycycline demonstrated MICs and MBCs equal or below their peak serum concentrations (PSC) after standard dosing in both cell types. While doxycycline exhibited an MIC 64-fold and an MBC 4-fold below its PSC in HeLa-cells, the MIC of azithromycin was 4-fold below, the MBC equal to the PSC. However, azithromycin revealed lower MBCs in M1. The pharmacological advantage of azithromycin accumulation in phagocytes and their role as chlamydial reservoirs remain uncertain. However, our data suggest possible therapeutic advantages of doxycycline in epithelial cells and we provide first evidence for an anti-C. abortus effect of nutlin-3 in M1.

Suicide deaths in people with non-affective psychosis represent a major health care concern. Previous research has shown that psychosis and the associated distress increase suicidal experiences, whereas psychological resilience weakens the impact of suicide precursors, such as defeat, entrapment, and hopelessness on suicidal experiences. The moderating roles of psychosis, distress, and psychological resilience in the relationships between defeat, entrapment, hopelessness, and suicidal thoughts and behaviors have not been tested longitudinally. This 3-month longitudinal study used moderated mediation analysis to investigate: (1) the impact of defeat/entrapment and hopelessness on suicidal thoughts and behaviors and (2) the moderating effects of psychosis, distress, and psychological resilience in the relationships between defeat/entrapment, hopelessness, and suicidal thoughts and behaviors. Individuals with non-affective psychosis-related diagnosis (including schizophrenia, schizophreniform disorder, schizoaffective disorder, delusional disorder, or psychotic disorders not otherwise specified) and lifetime experiences of suicidal thoughts, plans, and/or acts were recruited from the North-West of England, UK. Of the 100 participants at baseline, 90 took part in the follow-up assessment. At baseline, most of the participants had experienced one or more lifetime suicide attempts. Suicidal thoughts and behaviors scores were significantly lower at follow-up, compared with baseline. Over time, defeat/entrapment predicted suicidal thoughts and behaviors when the severity of psychosis and the associated distress were moderate and high, and resilience was lowest. The impact of defeat/entrapment, psychosis, distress due to psychosis, and resilience needs to be incorporated into interventions aiming to reduce suicidal experiences. These findings impact psychosis and resilience-focused suicide prevention interventions for people with non-affective psychosis.

Este artículo se encuentra disponible en la siguiente URL: https://recyt.fecyt.es/index.php/ASSN/article/view/83163 Background. The TEnT PEGS framework is a behavior change communication toolkit which has been shown to be useful in increasing health professional trainees’ skills and knowledge about obesity-related behavior change techniques. There is no version of the behavioral change intervention toolkit in Spanish. Therefore, the objectives of this study were 1) to translate the TEnT PEGS framework into Spanish and apply it to a Spanish nursing student population; 2) To analyze whether training with the Spanish toolkit (DEPREMIO) had a positive impact on students’ skills in encouraging obesity-related behavioral change. Methods. First year nursing students (n=95) attended two face-to-face (2 hours per session) obesity management training sessions. A specifically designed pre-post test was carried out. Data were collected using an ad-hoc questionnaire of fourteen items, ten of them evaluated the student’s knowledge and attitude about behavior change techniques, and four evaluated the student’s perception of their skills in developing different strategies. Results. Training significantly increased most students’ knowledge and attitudes with a 0.05 level of significance and effect sizes were between 0.36 and 0.77. It also increased students’ skills, although not to any significant extent. Conclusion. The DEPREMIO toolkit helped nursing students to acquire more knowledge, attitudes and skills in obesity management. It therefore seems that this adaptation is an acceptable and feasible training tool for the Spanish nursing student population. Fundamento. El programa TEnT PEGS es un conjunto de herramientas de comunicación para el cambio de comportamiento que se ha demostrado útil para aumentar las habilidades y conocimiento de los profesionales de la salud sobre técnicas de cambio de comportamiento relacionadas con la obesidad. No existe ningún manual de intervención para cambiar la conducta en español. Por lo tanto, los objetivos de este estudio fueron 1) traducir TEnT PEGS al español y aplicarlo en una población de estudiantes de enfermería españoles; 2) Analizar si este programa en español (DEPREMIO) tuvo un impacto positivo en las habilidades de los estudiantes para fomentar el cambio de comportamiento relacionado con la obesidad. Metodología. Los estudiantes de primer año de enfermería (n = 95) asistieron a dos sesiones presenciales (2 horas por sesión) de control de la obesidad. Se utilizó un diseño prepost. Los datos se recogieron a través de un cuestionario ad-hoc de catorce ítems, diez de ellos evaluaban los conocimientos y actitudes de los estudiantes sobre técnicas de cambio de conducta y cuatro evaluaban la percepción de los estudiantes sobre sus habilidades para desarrollar diferentes técnicas. Resultados. La intervención aumentó significativamente la mayoría de los conocimientos y actitudes de los estudiantes con un nivel de significación de 0,05 y tamaños de efecto entre 0,36 y 0,77. También aumentaron las habilidades de los estudiantes, aunque no significativamente. Conclusión. La herramienta DEPREMIO ayudó a los estudiantes de enfermería a alcanzar mayores habilidades y actitudes en el manejo de la obesidad, por lo que sería una intervención aceptable y factible para la población española de estos estudiantes.

Objective Radiotherapy (RT) is an integral part of the interdisciplinary treatment of patients with high-risk neuroblastoma (NB). With the continuous improvements of outcome, the interest in local treatment strategies that reduce treatment-related side effects while achieving optimal oncological results is growing. Proton beam therapy (PBT) represents a promising alternative to conventional photon irradiation with regard to the reduction of treatment burden. Method Retrospective analysis of children with high or intermediate risk NB receiving PBT of the primary tumor site during first-line therapy between 2015 and 2020 was performed. Data from the prospective in-house registry Standard Protonentherapie WPE – Kinder- (KiProReg) with respect to tumor control and treatment toxicity were analyzed. Adverse events were classified according to CTCAE Version 4 (V4.0) before, during, and after PBT. Results In total, 44 patients (24 male, 20 female) with high (n = 39) or intermediate risk NB (n = 5) were included in the analysis. Median age was 3.4 years (range, 1.4–9.9 years). PBT doses ranged from 21.0 to 39.6 Gray (Gy) (median 36.0 Gy). Five patients received PBT to the MIBG-avid residual at the primary tumor site at time of PBT according to the NB-2004 protocol. In 39 patients radiation was given to the pre-operative tumor bed with or without an additional boost in case of residual tumor. After a median follow-up (FU) of 27.6 months, eight patients developed progression, either local recurrence (n = 1) or distant metastases (n = 7). Four patients died due to tumor progression. At three years, the estimated local control, distant metastatic free survival, progression free survival, and overall survival was 97.7, 84.1, 81.8, and 90.9%, respectively. During radiation, seven patients experienced higher-grade (CTCAE ≥ °3) hematologic toxicity. No other higher grade acute toxicity occurred. After PBT, one patient developed transient myelitis while receiving immunotherapy. No higher grade long-term toxicity was observed up to date. Conclusion PBT was a well tolerated and effective local treatment in children with high and intermediate risk NB. The role of RT in an intensive multidisciplinary treatment regimen remains to be studied in the future in order to better define timing, doses, target volumes, and general need for RT in a particularly sensitive cohort of patients.

Purpose: To establish literature regarding healthcare professionals' perceptions of pulmonary rehabilitation as a management strategy for patients with chronic obstructive pulmonary disease.Method: A critical interpretive synthesis was conducted; CINAHL, PsychINFO and MEDLINE were searched between 1988 and August 2019, using MeSH headings and key terms. Reference lists of accepted papers were also searched. Qualitative, quantitative and mixed methods studies, written in English, including healthcare professionals' perceptions of pulmonary rehabilitation were included. The search yielded 133 papers which were assessed for eligibility; 20 met the inclusion criteria.Results: Two themes were identified, the first explored "Barriers to Pulmonary Rehabilitation" from a healthcare professional's perspective. This incorporated a lack of knowledge, a lack of resources, practical barriers, patient barriers, and healthcare professional's being unsure it is their role to refer. The second entitled "General Perceptions of Pulmonary Rehabilitation", highlighted ways in which the programme could be improved, the perceived positives and negatives, facilitators to referral, and perceptions of patients referred.Conclusions: This is the first systematic review to encompass the perceptions of healthcare professionals with ability to refer and those who deliver pulmonary rehabilitation. Referral was low, highlighting potential influencing factors such as a lack of programme knowledge, pulmonary rehabilitation beliefs, and communication skills. Given inclusion of studies from multiple geographical locations, the findings provide implications for any healthcare system that develops and delivers pulmonary rehabilitation. With respect of a lack of referrals to the programme, further research should highlight healthcare professionals' perceptions of the referral process, and the views of those in Secondary Care.Implications for rehabilitationChronic obstructive pulmonary disease:•Pulmonary rehabilitation is a proven cost-effective management strategy for patients with chronic obstructive pulmonary disease, which reduces associated hospital admissions and increases quality of life.•Due to a lack of knowledge and negative perceptions surrounding pulmonary rehabilitation, further training and education is required for healthcare professionals surrounding non-pharmacological management strategies.•Pulmonary rehabilitation programmes should consider ways to increase awareness of the service amongst those with chronic obstructive pulmonary disease.•Those delivering pulmonary rehabilitation should consider ways to support healthcare professionals referring to the programme.

BackgroundGlaesserella parasuis, the causative agent of Glӓsser’s disease, is widespread in swine globally resulting in significant economic losses to the swine industry. Prevention of Glӓsser’s disease in pigs has been plagued with an inability to design broadly protective vaccines, as many bacterin based platforms generate serovar or strain specific immunity. Subunit vaccines are of interest to provide protective immunity to multiple strains ofG. parasuis. Selected proteins for subunit vaccination should be widespread, highly conserved, and surface exposed.ResultsTwo candidate proteins for subunit vaccination (RlpB and VacJ) againstG. parasuiswere identified using random mutagenesis and an in vitro organ culture system. Pigs were vaccinated with recombinant RlpB and VacJ, outer membrane proteins with important contributions to cellular function and viability. Though high antibody titers to the recombinant proteins and increased interferon-γ producing cells were found in subunit vaccinated animals, the pigs were not protected from developing systemic disease.ConclusionsIt appears there may be insufficient RlpB and VacJ exposed on the bacterial surface for antibody to bind, preventing high RlpB and VacJ specific antibody titers from protecting animals fromG. parasuis. Additionally, this work confirms the importance of utilizing the natural host species when assessing the efficacy of vaccine candidates.

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Background There is poor medication adherence in patients of South Asian origin with rheumatoid arthritis (RA). There are limited interventions to improve patient engagement. The objective of this study was to explore how patients of South Asian origin make sense of their disease after receiving written leaflets compared to online information or visualising real-time Doppler Ultrasound (DUS) images of their inflamed joints. Methods Patients of South Asian origin with RA were recruited from two NHS hospitals in the West Midlands, UK. In-depth semi-structured interviews were undertaken following exposure to vignettes designed to elicit patients’ perspectives on: (1) written leaflets, (2) online information to complement face-to-face interaction with healthcare professionals, and (3) DUS during the early stages of the disease journey. Data were analysed thematically until data saturation was reached in twenty individuals. Results The responses to vignette scenarios were described by patients: [1] perspectives on written leaflets at the early stages of the disease journey, [2] perspectives of online information to compliment face-to-face interaction with healthcare professionals, [3] perspective of DUS during the early stages of the disease journey. Overall, patients found real-time DUS more valuable in understanding RA and RA medications compared to other methods. Patients reported DUS reduced anxiety and helped address misconceptions about long-term disease and its ability to be controlled. Conclusion We have developed new understanding regarding the educational utility of a DUS session in patients of South Asian origin and how these sessions can be optimised to increase patient engagement and medication adherence. Disclosures K. Kumar None. C. Bradbury-Jones None. C. Armitage None. S. Peters None. S. Raizada None. P. Wong None.