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The primary objective of the review was to collate the available evidence on factors associated with joint contractures in adults.A systematic literature search was conducted on MEDLINE, CINAHL, AMED, and EMBASE. Studies that involved participants aged ≥18 and assessed joint contracture as a primary or secondary outcome were included. Two independent reviewers screened studies against the eligibility criteria, performed data extraction, and assessed the quality of evidence. A narrative synthesis by domain and sub-domain was undertaken. The protocol was registered on PROSPERO: CRD42019145079.Forty-seven studies were included in the review. Identified factors were broadly classified into three major domains: sociodemographic factors, physical factors, and proxies for bed confinement. Sociodemographic factors were not associated with joint contractures. Functional ability, pain, muscle weakness, physical mobility, and bed confinement provided the most consistent evidence of association with joint contractures. The evidence regarding the relationship between spasticity and joint contractures remains unclear. Other factors might be important, but there was insufficient evidence to make inferences.The review identified and collated evidence on factors associated with joint contractures, which can be utilised to develop effective prevention and management strategies. Implications for rehabilitationClinical interventions based on the timely identification of risks related to joint contractures in vulnerable adults have the potential to prevent or ameliorate their development or progression.Quality and consistency of care for vulnerable adults would be enhanced by developing effective joint contracture prevention and rehabilitation strategies based on the evidence presented in this review.As many vulnerable adults are located in the community or non-acute care settings, strategies should target these loci of care.Structured risk assessments that can support non-physiotherapy staff working in these loci of care to identify risks related to joint contractures would provide an important resource for risk management.

The Goodwin Sands is a sandbank located four miles east of Kent, in southeast England. At low tides the intertidal areas become accessible, and this has led to the marine space being put to numerous, often contradictory, uses. The rich history and mythology of the Goodwin Sands is juxtaposed with a contemporary marine consent application to dredge aggregate from the subtidal sandbank areas. This article uses the triad of perceived, conceived and lived space found within Lefebvre’s Production of Space thesis to tell a tale of Goodwin Sands. This methodology allows for temporal connections between archival and contemporary expressions of the marine space to be understood. Using the marine consent application as its departure point allows for the story of the Sands to unfold as layered meanings emerge. But this is more than just a story of Goodwin Sands – an attempt to explain what they are – it is an exploration of social production within marine space, and an opportunity to rethink how space is represented within marine planning decision-making.

Summary: Background & aims: Malnutrition is associated with functional decline and poorer clinical outcomes for hospitalised patients. This study aimed to survey the knowledge of clinical staff concerning identification/diagnosis and management of inpatient malnutrition and to assess attitudes and knowledge of malnutrition as a shared inter-disciplinary responsibility. Methods: A survey designed to investigate the aims was distributed to clinical staff (medical, nursing, dietitians and allied health) across three hospital campuses including acute, sub-acute and rehabilitation sites. Results: Survey responses were received from 14% (n = 302) of eligible clinical staff (116 nursing, 68 medical, 20 dietitians and 98 other allied health staff). With the exception of dietitians, responses to questions regarding skills and knowledge in the areas of malnutrition identification, diagnosis, treatment and management indicated sub-optimal knowledge. Only 60% of medical/surgical staff and 42% of nursing staff self-reported the ability to diagnose malnutrition. Responses to questions regarding responsibility for malnutrition were highly variable and suggested no significant ‘shared ownership’ of malnutrition as clinical responsibility. Conclusion: Apart from dietitians, malnutrition management skills were modest and knowledge gaps of clinical staff were marked. Confusion also existed as to the responsibility for malnutrition care for inpatients. To improve inpatient nutrition further multidisciplinary engagement and improved education may be required.

Obesity and psychosocial stress are inter-related chronic conditions which lead to increased cardiovascular morbidity and mortality. The aim of this parallel randomized controlled trial was to determine whether the addition of a structured cognitive behavioral stress management (CBSM) on to a commercial online weight loss program, resulted in greater weight loss than the standard weight loss program in isolation. Eligible participants were adults between the ages 18-65, BMI 30-45 kg/m

Background and Aims Inflammatory bowel disease is associated with psychosocial issues which reduce quality of life and impair medical management. However, these issues are rarely addressed in routine care. A model of integrated psychological screening and intervention was trialled to measure prevalence, patient participation, and potential benefits to mental health and/or quality of life. Methods During a 12-month period, 490 adult patients at an established hospital-based service were approached to complete screening instruments for anxiety, depression, general distress, quality of life and medication adherence. Disease-specific and demographic data were also collected. Patients who scored highly on screening questionnaires were offered psychological intervention (in-service or externally referred). Participants were reassessed after 12 months. Results Psychological screening was well accepted with 68% (N = 335) participating. Psychological care was ‘needed’, with 55% (N = 183) scoring highly for anxiety, depression and/or general distress. Half of those ‘in need’ (N = 91) accepted intervention. In those who accepted, levels of anxiety (mean at intake [M1] = 12.11 vs mean at follow-up [M2] = 9.59, p < 0.001), depression (M1 = 8.38 vs M2 = 6.42, p < 0.001), general distress (M1 = 17.99 vs M2 = 13.96, p < 0.001), mental health quality of life (M1 = 54.64 vs M2 = 59.70, p < 0.001) and overall quality of life (M1 = 57.60 vs M2 = 64.10, p < 0.001) each improved between intake and follow-up. Engagement in psychological intervention was six times greater for those treated in-service vs externally referred (χ2[1] = 13.06, p < 0.001, odds ratio = 6.47). Conclusions Mental health issues are highly prevalent in people with inflammatory bowel disease. Patients are open to psychological screening and treatment. Psychological care can improve patient mental health and quality of life, and works best when integrated into routine management.

Background Little is known about the prevalence and best management of needle fear in adults with chronic disease, who may experience frequent and long-term exposure to needles for lifesaving therapies such as renal dialysis and cancer treatment. Identifying interventions that assist in management of needle fear and associated distress is essential to support these patients with repeated needle and cannula exposure. Method We followed the PRISMA methodology for scoping reviews and systematically searched PsychINFO, PubMed (MEDLINE), ProQuest, Embase and grey literature and reference lists between 1989 and October 2020 for articles related to needle discomfort, distress, anxiety, fear or phobia. The following chronic diseases were included: arthritis, asthma, chronic back pain, cancer, cardiovascular disease, chronic obstructive pulmonary disease, diabetes, and mental illness, or kidney failure. Literature concerning dentistry, vaccination, intravenous drug users and paediatric populations were excluded. Results We identified 32 papers reporting prevalence (n = 24), management (n = 5) or both (n = 3). Needle fear prevalence varied in disease cohorts: 17–52% (cancer), 25–47% (chronic kidney disease) and 0.2–80% (diabetes). Assessment methods varied across studies. Management strategies had poor evidence-base, but included needle-specific education, decorated devices, cognitive-behavioural stress management techniques, distraction, and changing the therapy environment or modality. Conclusion Although needle fear is common there is a paucity of evidence regarding interventions to address it among adults living with chronic disease. This scoping review has highlighted the need for improved identification of needle fear in adults and development of interventions are required for these cohorts.

Riparian plants provide an important source of energy for freshwater food webs through inputs of leaf litter. Planting riparian buffers with mixed species could enhance the detrital resource supply for invertebrates through varied leaf breakdown rates. To quantify leaf breakdown rates and invertebrate colonisation, we used leaves from eleven grass, shrub and tree species common along agricultural waterways in New Zealand. Breakdown of leaves immersed in a spring-fed stream differed significantly among species, being fastest for pasture grass (k = 0.0458 day−1) followed by broadleaf, pittosporum, willow, toetoe, poplar, gorse, Carex, eucalyptus, flax, and slowest for cabbage tree leaves (k = 0.0099 day−1). Invertebrate community composition did not differ between leaf species, but consumers were extremely abundant on some leaves (e.g. 51–83 Potamopyrgus snails g−1 pasture grass), indicating coarse detrital resources were in high demand for food or habitat. These breakdown rates could inform selection of riparian plant combinations that will enhance food availability for stream communities, especially continuity of supply, thereby contributing to waterway restoration.

Background Depression and obesity are significant global health concerns that commonly occur together. An integrated group cognitive behavioural therapy program was therefore developed to simultaneously address comorbid depression and obesity. Methods Twenty-four participants (63% women, mean age 46 years) who screened positively for depression with a body mass index ≥25 were recruited from a self-referred general population sample. The group therapy program (10 two-hour weekly sessions) was examined in a single-arm, before-after pilot trial, conducted in a behavioural health clinic in Adelaide, Australia. Primary outcomes included survey and assessment-based analyses of depression, anxiety, body image, self-esteem, and weight (kg), assessed at four time-points: baseline, post-intervention, three-months and 12-months post program. Eighteen participants (75%) completed the program and all assessments. Results Significant improvements in depression, anxiety, self-esteem and body shape concern scores, several quality of life domains, eating behaviours and total physical activity (among others) – but not weight – were observed over the course of the trial. Conclusions Results from this pilot trial suggest that combining interventions for depression and obesity may be useful. Further development of the program, particularly regarding the potential for physical health benefits, and a randomised controlled trial, are warranted. Trial registration Trial registration: ANZCTR, ACTRN12617001079336, 13 July 2017. Retrospectively registered after date of the first consent (6 July 2017), but before the date of the first intervention session (20 July 2017).

Reality is a concept of things which really exist. In philosophy and science reality has discussed elaborately. This essay concerned this elaboration. In a wider definition, reality includes everything that is and has been, whether or not it is observable or comprehensible. A still broader definition includes everything that has existed, exists, or will exist. Reality is often contrasted with what is imaginary, delusional, (only) in the mind, dreams, what is false, what is fictional, or what is abstract. At the same time, what is abstract plays a role both in everyday life and in academic research.

Background Pharmacists are on the frontline caring for patients at risk of an opioid overdose and for patients with an opioid use disorder (OUD). Dispensing naloxone and medications for OUD and counseling patients about these medications are ways pharmacists can provide care. Key to pharmacists’ involvement is their willingness to take on these practice responsibilities. Methods The purpose of this scoping review is to identify, evaluate, and summarize published literature describing pharmacists’ attitudes toward naloxone and medications for OUD, i.e., methadone, buprenorphine, and naltrexone. All searches were performed on December 7, 2018, in 5 databases: Embase.com , PubMed.gov , Cumulative Index to Nursing and Allied Health Literature (CINAHL) via EBSCOhost, Cochrane Central Register of Controlled Trials via Wiley, and Clarivate Web of Science. Articles included original research conducted in the United States, described attitude-related language toward naloxone and medications for OUD, and pharmacists. Results A total of 1323 articles were retrieved, 7 were included. Five studies reported on pharmacists’ attitudes toward naloxone dispensing, 1 study reported on attitudes toward naloxone, buprenorphine, and buprenorphine/naloxone, and 1 reported on attitudes toward buprenorphine/naloxone. Respondents were diverse, including pharmacists from different practice specialties. Studies found that pharmacists agreed with a naloxone standing order, believed that naloxone should be dispensed to individuals at risk of an opioid overdose, and were supportive of dispensing buprenorphine. A minority of pharmacists expressed negative attitudes. Barriers cited to implementation included education and training, workflow, and management support. Conclusions Pharmacists were positive in their attitudes toward increased practice responsibilities for patients at risk of an opioid overdose or with an OUD. Pharmacists must receive education and training to be current in their understanding of OUD medications, and they must be supported in order to provide effective care to this patient population.

Background & Aims Inflammatory bowel diseases (IBD) are associated with high psychosocial burden and economic cost. Integrating psychological care into routine management might lead to savings. We performed a 2-year investigation of the effects of integrated psychological care in reducing healthcare use and costs. Methods We performed a prospective study of 335 adult patients treated at a hospital-based IBD service in Australia. Participants were recruited between September 2015 and August 2016 and completed screening instruments to evaluate mental health and quality of life. Data on healthcare use and costs for the previous 12 months were also collected. Patients found to be at risk for mental health issues were offered psychological intervention. Patients were followed up 12 months after screening (between September 2016 and August 2017). Results A significantly higher proportion of subjects at risk for mental health issues had presented to an emergency department in the 12 months before screening (51/182; 28%) compared to psychologically healthy subjects (28/152; 18%; X2(1) = 4.23; P = .040). Higher levels of depression and general distress (but not anxiety) were related to increased odds of hospital admission (adjusted odds ratios, 1.07 and 1.05, respectively). Among the patients who accepted psychological intervention, the number who presented to emergency departments was reduced significantly in the 12 months after screening (follow-up) compared to the 12 months before screening (P = .047), resulting in a cost saving of AU$30,140 ($20,816 USD). A cost-benefit analysis of the integrated psychological care model revealed a net saving of AU$84,905 ($58,647 USD) over a 2-year period. Conclusions Risk for mental health issues is associated with higher healthcare costs in people with IBD. Providing integrated psychological care to individuals at risk for mental health issues can reduce costs, particularly by decreasing visits to emergency departments. Further studies are required to determine the best care to provide to reduce costs.

Research letter. The opioid epidemic is also affecting families and, most importantly, children. People who died of an overdose were most frequently between age 25 to 54 years and in their child-rearing years. The goal of this study was to determine the number of children who experienced unexpected parental loss because of opioid-related overdoses in Allegheny County. It also sought to understand their human service encounters and mental health services use subsequent to parental loss.

Introduction: Psychological issues are known to be prevalent in people with Inflammatory Bowel Disease (IBD), and are risk factors for poor outcomes such as hospitalisation, low medication adherence and persistent smoking. Despite this, psychological care is not routinely provided to IBD patients in outpatient settings. Short description of practice change implemented: At the Royal Adelaide Hospital, psychological screening and intervention have been integrated into the IBD service. Screening measures are administered at scheduled outpatient appointments, and individual psychological intervention is offered to patients where results indicate likely need. Aim and theory of change: This study aims to explore the possible benefits of incorporating psychological screening and therapy in an already established IBD service. By improving accessibility to psychological care and bypassing potential barriers, the aim is to improve patient outcomes (mental health, medication adherence, quality of life), and possibly healthcare utilisation. Targeted population and stakeholders: The target population is outpatients of the Inflammatory Bowel Disease Service at the Royal Adelaide Hospital, South Australia (which comprises approximately 1200 patients). Gastroenterologists and IBD nurses in the team are helping the psychologist with the integration of these changes. Timeline: The initial data collection phase is currently being conducted between September 2015 and September 2016. Twelve-month follow-up data will then be collected, concluding in September 2017. Highlights: This is a novel initiative in IBD healthcare, with early data uncovering a high need for psychological support. To date, 380 patients in the service have been approached, with 249 (66%) participating. 137 (55%) participants scored within the clinical range on mental health screening questionnaires. Fifty-eight participants (42% of those with clinical results) subsequently accepted psychological support. The screening process has so far been easy to implement, with positive feedback from both patients and staff. Comments on sustainability: The current initiative is a pilot study to explore the importance of psychological support in IBD patients and the usefulness of a more holistic approach to IBD healthcare. Study outcomes will inform both funding requirements and health practitioners regarding the need to address psychological factors in chronic disease management. Comments on transferability: Early data highlights the need to address psychological factors in IBD patients within the hospital setting. Similar services could be implemented in other hospitals in Australia and around the world, subject to funding. Conclusions :(key findings) Outcomes to date support the need for, and acceptability of, the integration of psychological care in the routine care environment. Discussions: Results are so far promising and support our hypotheses. Data collection will continue until September 2017 when analysis of longer-term outcomes will be possible. Lessons learned: While the initiative is still being piloted, initial evidence for the usefulness of integrating psychological support for IBD outpatients is solid.

Objective: To examine suicide epidemiology in Newfoundland and Labrador from 1997 to 2001. Method: Data from the Office of the Chief Medical Examiner (CME) were linked with data derived from the Canadian Vital Statistics Death Database. Ninety-five percent confidence intervals (CI) were calculated to assess variation of rates. We used the chi-square test to compare categorical data. Results: The CME recorded 225 suicide deaths, compared with 187 in the Canadian Vital Statistics Death Database. Most deaths not coded as suicide in the national database were coded as accidental. Using the CME data, the overall suicide rate was 9.5/100 000, aged 10 years and older. The rate among males (15.8/100 000, 95%CI, 10.7 to 20.8) was almost 5 times that of females (3.3/100 000; 95%CI, 1.0 to 5.5). Age-standardized rates decreased over the study period, from 10.9 to 8.0/100 000; however, the difference was not significant. The proportionate mortality ratio for suicide deaths was highest among those aged 10 to 19 years (20.0%) and decreased with age. The suicide rate was highest among those aged 50 to 59 years. The rate for unpartnered individuals (17.0/100 000, 95%CI, 10.7 to 23.0) was significantly higher, compared with partnered individuals (5.1/100 000; 95%CI, 2.5 to 7.8). Males used more violent methods than females. Suicide was significantly higher in Labrador (27.7/100 000, 95%CI, 18.4 to 37.0), an area with a higher Aboriginal population, compared with the island of Newfoundland (8.5/100 000, 95%CI, 7.3 to 9.7). Psychiatric illness was the most common predisposing factor. Conclusions: Suicide deaths are highest among males, unpartnered individuals, and individuals with psychiatric disorders. Can J Psychiatry 2008;53(4):252-259 Clinical Implications * Psychiatric illness is a common, predisposing factor for suicide. * Males and individuals who are unpartnered are at a higher risk of suicide than their partnered counterparts. * Evidence suggests that suicide is underreported in national statistics in Canada. Limitations * Not all psychiatric conditions were confirmed using DSM-IV criteria; however, CME records indicated medical care for psychiatric illness. * Estimates of predisposing factors may be underestimated owing to the limited information available for some individuals. * Partnered status might not be accurately reflected because any individual living common law would have been classified as single or unpartnered. Key Words: suicide, epidemiology, Newfoundland and Labrador Abbreviations used in this article BD bipolar disorder CI confidence interval CME Chief Medical Examiner ICD International Statistical Classification of Diseases PMR proportionate mortality ratios SD standard deviation Suicide is a significant, but largely preventable, public health concern. In 2000, about 1 million people worldwide died from suicide, representing a global mortality rate of 14.5/100 000, or 1 death every 40 seconds.1 Worldwide, suicide rates have increased by 60% in the last 45 years.2 Although it is well known that suicide is highest among males and rates tend to increase with age, rates among young individuals have been increasing at a greater pace than in the elderly, a phenomenon that has been referred to as the ungreying of suicide.3 The most recent data available for Canada indicates that suicide claimed more than 3700 lives in 2003.4 The overall age-standardized suicide rate in Canada for 2003 was 11.3/100 000: 17.8/100 000 males and 5.1/100 000 females.4 Trend data indicate an overall decline in the suicide rate in Canada from 1979 and 1998.5 The accuracy of official statistics has been the subject of debate for decades and it is generally recognized that suicide tends to be underreported in all jurisdictions.6 It has been suggested that underreporting is attributable to numerous factors, including aspects of the death certification process; knowledge, attitudes, or practices of individuals responsible for certification; cultural, religious, and legal considerations; limitations in the system for gathering and compiling suicide data; and the ambiguous nature of some suicidal acts. …

This study examined the use of relativistic operations in everyday problem solving by elderly women. Thirty-two community residents and 32 nursing hostel residents aged between 65-90 years participated. Structured interviews canvassed the role of residence and other factors thought to contribute to the maintenance of problem-solving skills. Path analysis was used to test the developed model of the influences of age, engagement in problem-solving activities, control orientation, problem familiarity and residence on the use of relativistic operations. Partial support was found for the proposed model. Community residents used significantly more relativistic operations to solve the problems than did hostel residents. A revised model showed that in addition to residence and control orientation, the use of relativistic operations was influenced indirectly by the level of everyday problem-solving activity, through the orientation of perceived control. Increased problem-solving activity was associated with an internal control orientation, which in turn was directly related to the use of relativistic operations. The influence of age on problem solving was indirect, through problem-solving activity and residence. Our findings provide initial evidence of the extent to which variables other than age can influence everyday problem-solving performance.

The random amino acid copolymer poly(Y,E,A,K)(n) (Copaxone®) is widely used in multiple sclerosis treatment and a second generation copolymer poly(Y,F,A,K)(n) with enhanced efficacy in experimental autoimmune encephalomyelitis in mice has been described. A major mechanism through which copolymers function to ameliorate disease is the generation of immunosuppressive IL-10-secreting regulatory T cells entering the CNS. In addition, the antigen presenting cell to which these copolymers bind through MHC Class II proteins may have an important role. Here, both CCL22 (a Th2 cell chemoattractant) in large amounts and CXCL13 in much smaller amounts are shown to be secreted after administration of YFAK to mice and to a smaller extent by YEAK parallel to their serum concentrations. Moreover, bone marrow-derived macrophages secrete CCL22 in vitro in response to YFAK and to higher concentrations of YEAK. Strikingly, these chemokines are also secreted into serum of MHC Class II -/- mice, indicating that an innate immune receptor on these cells also has an important role. Thus, both the innate and the adaptive immune systems are involved in the mechanism of EAE amelioration by YFAK. The enhanced ability of YFAK to stimulate the innate immune system may account for its enhanced efficacy in EAE treatment.

Since the early 2000s, almost 300 SDT-relevant empirical journal articles and approximately the same number of dissertations have been published, with at least half appearing in the last five years. A review of the studies published in peer-reviewed journals (see Table 1) shows that half of these studies (56%) utilize questionnaire surveys with closed-ended questions and cross-sectional designs, yielding quantitative data, which is analyzed through descriptive statistics and more or less complex correlational techniques (e.g., bivariate correlations; factor analysis; multiple regression; structural equation modeling and related techniques). Consistent with trends in the broader SLA field, qualitative (19%) and mixed methods (26%) are almost as prevalent as quantitative methods. Perhaps reflecting LL researchers’ interest in complex dynamic systems theory and developmental science (Ortega & Han, 2017), there is an increasing number of longitudinal studies (Noels et al., 2019c). There remains, however, a lack of experimental or intervention studies, which would provide more definitive conclusions about hypothesized causal relations and point to possible avenues for enhancing motivation. As mentioned earlier, contemporary LL research has primarily focused on the dynamics within the classroom, and this trend is evident in SDT research as well. Research participants tend to be adults enrolled in post-secondary institutions (65%) who are learning English (79%) as foreign language (81%). Although the research is largely limited to adult EFL learners, the national contexts in which SDT research is conducted is strikingly diverse: the largest body of research comes from Japan (20%), followed by China (10%), the US (10.5%), and Canada (7.7%), with the remaining ~50 nations ranging from New Zealand, to Turkey, to Malaysia, to Ecuador. This widespread interest in SDT underscores the potential that the LL domain offers for comparative, cross-cultural research examining the universality and cultural specificity of aspects of SDT, provided that instruments with satisfactory psychometric properties across cultures can be developed and sufficiently comparable samples can be obtained (e.g., similar age, target language, pedagogical approach, etc).