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The aim of this study was to explore staff perceptions of the impact of the COVID-19 pandemic on mental health service delivery and outcomes for women who were pregnant or in the first year after birth (‘perinatal’ women). Secondary analysis was undertaken of an online mixed-methods survey open to all mental health care staff in the UK involving 363 staff working with women in the perinatal period. Staff perceived the mental health of perinatal women to be particularly vulnerable to the impact of stressors associated with the pandemic such as social isolation (rated by 79.3% as relevant or extremely relevant; 288/363) and domestic violence and abuse (53.3%; 192/360). As a result of changes to mental health and other health and social care services, staff reported feeling less able to assess women, particularly their relationship with their baby (43.3%; 90/208), and to mobilise safeguarding procedures (29.4%; 62/211). While 42% of staff reported that some women engaged poorly with virtual appointments, they also found flexible remote consulting to be beneficial for some women and helped time management due to reductions in travel time. Delivery of perinatal care needs to be tailored to women’s needs; virtual appointments are perceived not to be appropriate for assessments but may be helpful for some women in subsequent interactions. Safeguarding and other risk assessment procedures must remain robust in spite of modifications made to service delivery during pandemics.

Over the past several decades, transformational leadership theory and research have made considerable contributions in addressing factors relevant for leader effectiveness. Trait emotional intelligence (TEI), dark personality traits, and HEXACO personality factors correlate significantly with transformational leadership. However, due to overlap among measures, there remains a need for incremental analysis. This study investigates how TEI and Dark Tetrad traits predict transformational leadership beyond HEXACO personality factors. Participants (195 women, 104 men) between the ages of 17 and 36 years (Mage = 18.44, SD = 1.45) completed self-report measures of transformational leadership, HEXACO personality factors, TEI, and Dark Tetrad traits. Regression analyses revealed that HEXACO personality factors provide significant predictive value for transformational leadership. TEI, narcissism, Machiavellianism, and psychopathy also accounted for additional variance in transformational leadership scores beyond HEXACO personality factors. This study supports the use of TEI and dark personality traits in addition to HEXACO personality factors when appraising transformational leadership potential. These findings have implications for screening and selection of applicants for leadership positions across a variety of contexts (business, military, education, athletic coaching, etc.).

There is growing evidence for a role of maternal diabetes in the pathogenesis of neurodevelopmental disorders. However, the specific association between gestational diabetes (GDM), as opposed to pre-gestational diabetes, has been poorly isolated. Thus the aim was to systematically review and meta-analyse literature pertaining to prevalence and risk for two neurodevelopmental disorders: autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), when exposed to GDM. PubMed, Cochrane Library, EMBASE, PsycINFO and CINAHL were systematically searched for eligible literature, with forward and backward citation tracking. Screening for eligibility, risk of bias assessment and data extraction were performed by two independent reviewers. 18 studies measuring ASD and 15 measuring ADHD met inclusion criteria. On meta-analysis there was an increased risk of ASD (OR 1.42; 95% CI 1.22, 1.65) but not ADHD (OR 1.01; 95% CI 0.79, 1.28). We discuss potential mechanisms for these differing risks. Greater understanding of risk factors, including GDM, for these neurodevelopmental disorders and potential mechanisms may help inform strategies aimed at prevention of exposure to these adversities during pregnancy.

Issue addressed Health promotion has adopted the planetary health perspective to address the threats posed by climate change, environmental degradation and environmental deprivation. Nature is a setting for health promotion that can produce co-benefits for human health and the protection of the environment. This paper presents the findings of a New South Wales (NSW) study of peoples' motivations for, and co-benefits of, environmental volunteering. Methods This paper combines the findings of a literature review and qualitative data from a larger mixed-methods study of environmental volunteering (eg administration and co-ordination, bush regeneration, advocacy, tour guiding) in NSW. A review of international literature from 2005 yielded 100 documents for analysis. Maximum variation and stratified purposeful sampling strategies were applied to engage 12 environmental volunteers and 30 employees of environmental organisations in a series of focus groups (n = 2) and interviews (n = 22). Qualitative thematic analysis techniques were applied and data triangulated. Results Motivations for environmental volunteering include the following: personal, for example, new skills or knowledge, environmental, for example, improve the environment and social/community, for example, forming connections. Environmental volunteering offers a range of benefits for individuals, environmental organisations and the natural environment. These include enhanced mental and social health, and connection to place and learning about the environment. Conclusions Environmental volunteering has the potential to address key determinants of health - social inclusion, employment and education. From a planetary health perspective, there are multiple co-benefits of human-environmental interaction arising from environmental volunteering. Environmental volunteering is a planetary health strategy that could be incorporated into community-based health promotion. SO WHAT?: Health promotion has a mandate to act on ecological determinants of health. Environmental volunteering is an untapped resource for community-based health promotion and for achieving planetary health goals.

Intimate partner violence (IPV) is a major international public health concern that poses significant mental and physical health risks for affected individuals. To improve prevention efforts, it is imperative that researchers and government bodies understand risk factors for IPV. One such risk factor concerns the extent to which violence is intergenerational, such that exposure to violence predisposes individuals to engage in violence toward intimate partners. The purpose of this research is to assess childhood exposure to violence as a risk factor for perpetration of IPV in adulthood, and to evaluate the Dark Tetrad personality traits as mediators in this relationship. We recruited 153 men and 246 women (age range = 18–73, Mage = 33.50, SDage = 10.26) through Amazon’s Mechanical Turk to complete a series of questionnaires and an open-ended IPV perpetration assessment. Results showed no relationship between IPV perpetration and childhood IPV exposure, indicating that mediation analyses were not possible. Possible explanations are discussed. Follow-up exploratory analyses demonstrated that gender moderated the relationships between childhood IPV exposure and levels of Factor 1 psychopathy and Machiavellianism. Specifically, men who were exposed to IPV in childhood were more likely to develop higher levels of Factor 1 psychopathy and Machiavellianism, whereas women were not. Overall, our findings highlight the importance of providing researchers and clinicians with a greater understanding of environmental events preceding maladaptive trait development. It is also important for researchers and clinicians to consider gender differences in pathways between exposure to IPV and subsequent development of dark personality traits. Theoretical and practical implications are discussed.

IntroductionPerinatal depression is common and can often lead to adverse health outcomes for mother and child. Multiple pharmacological and non-pharmacological treatments have been evaluated against usual care or placebo controls in meta-analyses for preventing and treating perinatal depression compared. It is not yet established which of these candidate treatments might be the optimal approach for prevention or treatment.Methods and analysisA systematic review and Bayesian network meta-analyses will be conducted. Eight electronic databases shall be searched for randomised controlled trials that have evaluated the effectiveness of treatments for prevention and/or treatment of perinatal depression. Screening of articles shall be conducted by two reviewers independently. One network meta-analysis shall evaluate the effectiveness of interventions in preventing depression during the perinatal period. A second network meta-analysis shall compare the effectiveness of treatments for depression symptoms in women with perinatal depression. Bayesian 95% credible intervals shall be used to estimate the pooled mean effect size of each treatment, and surface under cumulative ranking area will be used to rank the treatments’ effectiveness.Ethics and disseminationWe shall report our findings so that healthcare providers can make informed decisions on what might be the optimal approach for addressing perinatal depression to prevent cases and improve outcomes in those suffering from depression through knowledge exchange workshops, international conference presentations and journal article publications.PROSPERO registration numberCRD42020200081.

Human wellbeing is inextricably linked to the health of the environment. In the Anthropocene, new measures of progress are required to support high levels of human health and quality of life whilst ensuring a sustainable, healthy environment. The sustainable development goals (SDGs), New Urban Agenda, and Paris Agreement on Climate Change provide the global mandates for change; however, localised actions and indicators are required to bring this to fruition. Taking the position that human wellbeing and health of environment need to be equitable partners, it is proposed that local level composite indicators, which securely bind human health to the health of the environment, are required to support local actions to achieve the SDGs. This paper examines twelve current indices that aim to measure sustainable progress and critiques their ability to securely bond human wellbeing with the health of the environment and their potential as local level indices. Out of these indices, we propose the Happy Planet Index, a composite index developed by the New Economics Foundation, as a suitable index that achieves this goal. Using locally or regionally relevant datasets, the Happy Planet Index can be modified to mobilise conversations and drive actions towards achieving the SDGs where human wellbeing and health of the environment are conceptually linked.

This article describes experiences of users (staff, patients and visitors) who have had access to green spaces within an urban healthcare setting. A systematic mixed studies review was undertaken to review the quantitative and qualitative evidence on user experiences during passive/quasi passive access to green spaces within a healthcare setting, as well to review the methodological quality of the studies eligible for inclusion. A total of 24 articles met the inclusion criteria and were included in the review. User experiences were classified under three key themes on experiencing "control, choice, escape, privacy and autonomy", "opportunities for socialisation" and "engagement with and stimulation by nature". The findings can be explained by theories of human-nature interaction and are likely to contribute towards generating convincing, credible and usable evidence on the topic. Cohesively, this article highlights the importance of incorporating green spaces into urban healthcare settings and contributes to the evidence base accessible to designers, planners, policy makers and hospital administrators who aim to create and support health promoting settings.

Issue addressed: In addition to food, physical activity, mental health and environmental benefits, community gardens (CGs) provide opportunities for social inclusion and increased social capital. These are particularly important to the socially isolated residents of social housing developments (SHDs). This scoping study explored the feasibility of a CG program for tenants of SHD in inner eastern Melbourne by assessing their interest in, and requirements for, inclusively designed CGs. Methods: In this phenomenological enquiry, focus group discussions, supported by photo-elicitation, were employed. Three focus groups (N = 19) were conducted with self-selected participants who consented to participate. Two focus groups were conducted with English-speaking tenants while a third focus group was conducted with Mandarin-speaking tenants. Results: There was a demand for CGs by the English-speaking participants driven by desire for networking, social connectedness and inclusion; for improved access to fresh produce, connection with nature, physical activity and mental well-being. Participants expressed interest in a garden located near their SHD with supportive physical and social environments including disability access, plot autonomy, fencing, socio-cultural events, training programs and management opportunities. However, the Mandarin-speaking tenants maintained that age, language difficulty and neighbourhood insecurity posed significant barriers to their participation. Conclusion: Guided by the Ottawa Charter for Health Promotion, social inclusion and community development theories, the study recommends that to establish socially inclusive CGs, a dynamic relationship of the design principles of a CG and the socio-ecological determinants of health should be established to address any barriers and successfully facilitate engagement. In addition, CG programs need to be guided by community development principles. Future research could employ community-based participatory research models in the implementation and evaluation of a CG program for socially isolated population groups.

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. To assess the effectiveness and safety of brexanolone and related neurosteroid GABAA positive allosteric modulators in comparison with any other treatment (pharmacological, psychological, or psychosocial), placebo, or treatment as usual for postnatal depression (PND).

BackgroundCorona Virus Disease 19 (COVID-19) is a new pandemic, declared a public health emergency by the World Health Organization, which could have negative consequences for pregnant and postpartum women. The scarce evidence published to date suggests that perinatal mental health has deteriorated since the COVID-19 outbreak. However, the few studies published so far have some limitations, such as a cross-sectional design and the omission of important factors for the understanding of perinatal mental health, including governmental restriction measures and healthcare practices implemented at the maternity hospitals. Within the Riseup-PPD COST Action, a study is underway to assess the impact of COVID-19 in perinatal mental health. The primary objectives are to (1) evaluate changes in perinatal mental health outcomes; and (2) determine the risk and protective factors for perinatal mental health during the COVID-19 pandemic. Additionally, we will compare the results between the countries participating in the study.MethodsThis is an international prospective cohort study, with a baseline and three follow-up assessments over a six-month period. It is being carried out in 11 European countries (Albania, Bulgaria, Cyprus, France, Greece, Israel, Malta, Portugal, Spain, Turkey, and the United Kingdom), Argentina, Brazil and Chile. The sample consists of adult pregnant and postpartum women (with infants up to 6months of age). The assessment includes measures on COVID-19 epidemiology and public health measures (Oxford COVID-19 Government Response Tracker dataset), Coronavirus Perinatal Experiences (COPE questionnaires), psychological distress (BSI-18), depression (EPDS), anxiety (GAD-7) and post-traumatic stress symptoms (PTSD checklist for DSM-V).DiscussionThis study will provide important information for understanding the impact of the COVID-19 pandemic on perinatal mental health and well-being, including the identification of potential risk and protective factors by implementing predictive models using machine learning techniques. The findings will help policymakers develop suitable guidelines and prevention strategies for perinatal mental health and contribute to designing tailored mental health interventions.Trial registrationClinicalTrials.gov Identifier: NCT04595123. COST Action RiseupEuropean Cooperation in Science and Technology (COST) [PPD CA 18138]; COST under COST Action Riseup [PPD CA18138]; Spanish Ministry of HealthInstituto de Salud Carlos IIISpanish Government; Institute of Health Carlos IIIInstituto de Salud Carlos III; European Regional Development Fund <> by the Prevention and Health Promotion Research Network 'redIAPP' [RD16/0007]; FSEEuropean Social Fund (ESF); FCTPortuguese Foundation for Science and TechnologyEuropean Commission [SFRH/BPD/117597/2016]; Bar-Ilan Dangoor Centre for Personalized Medicine, Israel; Portuguese Foundation for Science and Technology (FCT)Portuguese Foundation for Science and Technology; EU through the European Social Fund; Human Potential Operational Program [IF/00750/2015]; CAPES/ProexCoordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES) [0653/2018]; CAPES/PrInt grant [88887.310343/2018-00] The project is part of the COST Action Riseup-PPD CA 18138 and was supported by COST under COST Action Riseup-PPD CA18138; also, by the Spanish Ministry of Health, the Institute of Health Carlos III, and the European Regional Development Fund << Una manera de hacer Europa >> by the Prevention and Health Promotion Research Network `redIAPP' (RD16/0007). Raquel Costa is supported by the FSE and FCT under an individual Post-Doctoral Grant SFRH/BPD/117597/2016. Rena Bina and Drorit Levy received funding from the Bar-Ilan Dangoor Centre for Personalized Medicine, Israel. Ana Mesquita is supported from the Portuguese Foundation for Science and Technology (FCT) and from EU through the European Social Fund and from the Human Potential Operational Program -IF/00750/2015. Ana Osorio received financial support from CAPES/Proex no. 0653/2018 and CAPES/PrInt grant no. 88887.310343/2018-00.The funders of the study had no role in the study design or the writing the protocol. The corresponding author had final responsibility for the decision to submit for publication.

Introduction Depression is a common morbidity of the perinatal period (during pregnancy and up to one year postpartum). There is evidence for an association between diet and physical activity, and depression in the non-pregnant population but this association has been relatively less explored during the perinatal period; particularly poorly understood is the relationship between specific dietary components and depression. The aim of this study was to explore the association between glycaemic load, saturated fat intake and physical activity and depressive symptoms in a high-risk population of obese pregnant women. Methods In a cohort of 1522 women participating in the UPBEAT trial, physical activity, glycaemic load and saturated fat intake were used as predictors of depressive symptoms measured using the Edinburgh Postnatal Depression Scale (EPDS). Measures taken in early pregnancy were used in linear and logistic regression models. Repeated measures at three points during pregnancy and at six months postpartum were utilised in multilevel mixed effects models. Multiple imputation was used to account for missing data. Results Increased glycaemic load was associated with small increases in levels of depressive symptoms across the perinatal period (adjusted beta coefficient 0.01; 95% CI 0.01,0.02). There was no evidence for an association between reduced physical activity and increased saturated fat intake and increased levels of depressive symptoms. Conclusions Glycaemic load may be a useful focus for interventions aiming to optimise the mental health of obese women in the perinatal period.

Highlights • No association between gestational diabetes and common mental disorders prior to and during pregnancy. • One of the largest cohort studies in multi-ethnic UK population of 12,239 women with 13,539 pregnancies. • No increase in risk observed with increasing levels of hyperglycaemia used as a continuous measure. • Reassuring findings for women with GDM and/or CMD., Background anxiety and depression are common in women with gestational diabetes but it is not clear whether they are more likely to precede the onset of gestational diabetes or to co-occur with it. Our aims were to compare the strength of association between common mental disorders of anxiety and depression (i) before pregnancy and (ii) during pregnancy in women with and without gestational diabetes. Methods the sample comprised 12,239 women with 13,539 pregnancies from the UK's Born in Bradford cohort. Gestational diabetes was diagnosed by oral glucose tolerance test (OGTT). Indicators of common mental disorders were obtained from linked primary care records. Multivariable robust Poisson and logistic regression were employed. Multiple imputation by chained equations was implemented to handle missing data. Models were adjusted for maternal age, ethnicity, education and obstetric complications. Analyses of common mental disorders during pregnancy were additionally adjusted for maternal smoking, pre-pregnancy BMI, multiple pregnancy and common mental disorders prior to pregnancy. Results there was no evidence for an association between common mental disorders prior to pregnancy and gestational diabetes (adjusted RR 0.96; 95% CI 0.80,1.15) or between gestational diabetes and common mental disorders during pregnancy (adjusted OR 0.91; 95% CI 0.73,1.12). Limitations high levels of deprivation and multi-ethnic composition of the cohort may limit generalisability of these findings to other populations. Conclusions routine primary care records did not identify an increased risk of gestational diabetes in women with common mental disorders prior to pregnancy or of gestational diabetes in women with common mental disorders during pregnancy.

Introduction: The purpose of this study was to document the variability of faculty surgeon electrodermal activity (EDA) peaks during laparoscopic donor nephrectomy (LDN) to determine the effect of case difficulty and learner expertise on the stress response. Methods: EDA for a single faculty surgeon was captured over 15 LDN cases using an Empatica E4 wristband. During each case, one of three transplant fellows (novice, intermediate, or expert level LDN expertise) participated. Difficulty was rated preoperatively as “low/moderate/high” by the faculty. EDA peaks were collected and analyzed; the frequency and magnitude of EDA peaks, case difficulty, and fellow expertise were compared using a two-way factorial ANOVA. Results: The main effects of learner expertise (F[2, 308]=11.27, p

Purposethe aim of this study was to explore staff perceptions of the impact of the COVID-19 pandemic on mental health service delivery and outcomes for women who were pregnant or in the first year after birth (‘perinatal’ women).Methodssecondary analysis of an online mixed-methods survey open to all mental health care staff in the UK involving 363 staff working with women in the perinatal period.Resultsstaff perceived the mental health of perinatal women to be particularly vulnerable to the impact of stressors associated with the pandemic such as social isolation (rated by 79.3% as relevant or extremely relevant; 288/363) and domestic violence and abuse (53.3%; 192/360). As a result of changes to mental health and other health and social care services, staff reported feeling less able to assess women, particularly their relationship with their baby (43.3%; 90/208), and to mobilise safeguarding procedures (29.4%; 62/211). While 42% of staff reported that some women engaged poorly with virtual appointments, they also found flexible remote consulting to be beneficial for some women and helped time management due to reductions in travel time.Conclusionsdelivery of perinatal care needs to be tailored to the needs of women; virtual appointments are perceived not to be appropriate for assessments but may be helpful for some women in subsequent interactions. Safeguarding and other risk assessment procedures must remain robust in spite of modifications made to service delivery during pandemics.

What you need to know ### Case scenario A 30 year old primiparous woman is delighted to find herself pregnant and comes to your surgery for confirmation of the pregnancy. You discover that she is smoking 20 cigarettes a day, and she is worried that she went to a friend’s wedding around the time of conception and drank so much that she couldn’t remember what had happened until the next day. She also reports occasional recreational use of cannabis. #### Next steps Advise her of the risks of smoking and of alcohol and cannabis use during pregnancy. The biggest risk for her pregnancy at present is her smoking. Offer referral to a specialist pregnancy smoking cessation clinic. Clarify with her how much cannabis and alcohol she is using. Brief intervention may be sufficient, but regular or heavy use of either substance may warrant referral to specialist drug and alcohol services. Many women use substances during pregnancy. For example, the global prevalence of alcohol consumption during pregnancy is 9.8%.1 Moreover, 10.4% of pregnant women in England were known to be smoking tobacco at the time of delivery.2 Prevalence of cannabis use during pregnancy in a UK cohort has been reported as 5%3 but is likely to increase over coming years.4 Pregnancy may be a woman’s first time engaging with health services and may be a motivator to stop or reduce her substance use.5 In this article we offer an overview of assessment and interventions for substance use in the perinatal period. We focus on alcohol, tobacco, and cannabis …

Background The National Patient Safety Agency (2008) has advised against routine reliance on flumazenil for reversal of sedation and encourages regular audit to help identify issues with excessive dosing of midazolam. This multi-centre audit of flumazenil use across both community-based special care and dental hospital oral surgery specialist services was conducted to compare practice against that reported from other UK sedation services.Methods A six-year retrospective audit was conducted using controlled drug records and patient case notes.Results Both services used flumazenil at very infrequent levels and far below the agreed standard. The dose of flumazenil and justification for its use was recorded in all records. There was variability in the nature of the justifications between the two services, which likely relates to the differing patient groups seen by the specialties. The majority of cases related to supporting the patient's escort for their journey home; however, this was not always pre-planned.Conclusions There was a low level of flumazenil use over an extended period of time, supporting the concept of a culture of safe sedation provision in both services. The audit highlighted variation in record-keeping and need for improved communication with patients about escort requirements.

Depression is a common morbidity of the perinatal period (during pregnancy and up to one year postpartum). There is evidence for an association between diet and physical activity, and depression in the non-pregnant population but this association has been relatively less explored during the perinatal period; particularly poorly understood is the relationship between specific dietary components and depression. The aim of this study was to explore the association between glycaemic load, saturated fat intake and physical activity and depressive symptoms in a high-risk population of obese pregnant women.In a cohort of 1522 women participating in the UPBEAT trial, physical activity, glycaemic load and saturated fat intake were used as predictors of depressive symptoms measured using the Edinburgh Postnatal Depression Scale (EPDS). Measures taken in early pregnancy were used in linear and logistic regression models. Repeated measures at three points during pregnancy and at six months postpartum were utilised in multilevel mixed effects models. Multiple imputation was used to account for missing data.Increased glycaemic load was associated with small increases in levels of depressive symptoms across the perinatal period (adjusted beta coefficient 0.01; 95% CI 0.01,0.02). There was no evidence for an association between reduced physical activity and increased saturated fat intake and increased levels of depressive symptoms.Glycaemic load may be a useful focus for interventions aiming to optimise the mental health of obese women in the perinatal period.

Caspases, a family of cysteine-dependent aspartate-specific proteases, are central to the maintenance of cellular and organismal homoeostasis by functioning as key mediators of the inflammatory response and/or apoptosis. Both metabolic inflammation and apoptosis play a central role in the pathogenesis of metabolic disease such as obesity and the progression of nonalcoholic steatohepatisis (NASH) to more severe liver disease. Obesity and nonalcoholic fatty liver disease (NAFLD) are the leading global health challenges associated with the development of numerous comorbidities including insulin resistance, type-2 diabetes and early mortality. Despite the high prevalence, current treatment strategies including lifestyle, dietary, pharmaceutical and surgical interventions, are often limited in their efficacy to manage or treat obesity, and there are currently no clinical therapies for NAFLD/NASH. As mediators of inflammation and cell death, caspases are attractive therapeutic targets for the treatment of these metabolic diseases. As such, pan-caspase inhibitors that act by blocking apoptosis have reached phase I/II clinical trials in severe liver disease. However, there is still a lack of knowledge of the specific and differential functions of individual caspases. In addition, cross-talk between alternate cell death pathways is a growing concern for long-term caspase inhibition. Evidence is emerging of the important cell-death-independent, non-apoptotic functions of caspases in metabolic homoeostasis that may be of therapeutic value. Here, we review the current evidence for roles of caspases in metabolic disease and discuss their potential targeting as a therapeutic strategy. Refereed/Peer-reviewed

Purpose This study aims to investigate the sustainability of the food culture at Deakin University and to determine what the barriers to increasing the sustainability of food on the Burwood campus may be. Design/methodology/approach An online survey of staff and students from the Faculty of Health at the Burwood campus of Deakin University (n = 697) was undertaken. The survey included questions relating to eating habits on campus, views on the current food culture, food security, food disposal, visions for the future and demographic information. In addition, a short paper-based survey was developed for the ten food outlets on campus. Findings The results show that although sustainability considerations are important to staff and students, cost is the main issue and is a significant barrier to the development of a more sustainable food culture. It is also a significant barrier to staff and students making healthy choices when it comes to the purchase of food on campus. However, sustainable food initiatives such as community gardens could help alleviate this barrier and also contribute to improving student engagement. Research limitations/implications The online survey was limited to the Faculty of Health, and, therefore, a potential bias exists towards individuals who may have an interest in health. This should be considered when interpreting the results. Originality/value This research demonstrates that although cost may be a barrier to universities improving the sustainability of their food culture, there are other ways in which universities can create an environment that embraces sustainable food production to benefit both the environment and the university community.

Young adults are increasingly reliant on parental support, with co-residence as a result of a return home increasingly common. Despite this, little is known about how family members negotiate financial and domestic contributions post-return. This qualitative study used a phenomenological methodology to explore the experiences of Australian parents and young adults who returned to co-residence in terms of the younger family members’ contributions to their household. Findings revealed that the young adults acknowledged the need to contribute but often varied in how much assistance they offered. For the most part, the extent of this contribution reflected their parents’ actions; the tendency not to ask for assistance and undertake tasks themselves meant offspring were not given incentives to contribute. While this at times resulted in unmet expectations and frustration among parents, they continued to act in ways that favourably accommodated their offspring. These findings highlight the importance of understanding the negotiation between parents and young adults in regards to household contributions, and the need for further qualitative investigation in this area.

SummaryIt is increasingly recognised that the preconception period is a window of opportunity to intervene to improve outcomes for women and the next generation. The importance of preconception mental health and comorbidity problems has not traditionally been taken into account by policy makers or mental health service providers. We argue that by addressing preconception physical and mental health in men and women, medical health professionals could improve health outcomes across the whole life course.

Aim Gestational diabetes (GDM) and mental disorder are common perinatal morbidities and are associated with adverse maternal and child outcomes. While there is a relationship between type 2 diabetes and mental disorder, the relationship between GDM and mental disorder has been less studied. We conducted a systematic review and meta‐analysis of the prevalence of mental disorders in women with GDM and their risk for mental disorders compared with women without GDM. Methods Published, peer‐reviewed literature measuring prevalence and/or odds of GDM and perinatal mental disorders was reviewed systematically. Risk of bias was assessed using a checklist. Two independent reviewers were involved. Analyses were grouped by stage of peripartum, i.e. antepartum at the time of GDM diagnosis and after diagnosis, and in the postpartum. Results Sixty‐two studies were included. There was an increased risk of depressive symptoms in the antenatal period around the time of diagnosis of GDM [odds ratio (OR) 2.08; 95% confidence interval (CI) 1.42, 3.05] and in the postnatal period (OR 1.59; 95% CI 1.26, 2.00). Conclusions Given the potential relationship between GDM and perinatal mental disorders, integration of physical and mental healthcare in women experiencing GDM and mental disorders could improve short‐ and long‐term outcomes for women and their children., What's new? Type 2 diabetes is associated with an increased risk of mental disorder, particularly depression.There is some emerging evidence that gestational diabetes (GDM) may also be associated with mental disorder, particularly postnatal depression.GDM is associated with an increased risk of both antenatal and postnatal depressive symptoms, with the highest risk around the time of GDM diagnosis.All healthcare professionals working with women with GDM should be aware of this increased risk for mental disorder because effective treatment of the disorder could improve outcomes for women and their children.

Objectives This study describes the experiences of Pet Support Program clients in Melbourne, Australia and how the programs reduce the social isolation of the elderly. The study also describes the role of pets and associated health benefits of pet ownership. Method The qualitative description study comprised of two phases: a secondary data analysis of interviews with 14 PSP clients, and key informant interviews with four PSP providers. Results The interviews were thematically analysed which resulted in three interconnected themes: Attachment, Support and Social Isolation. Social isolation was reduced by the PSP through access to social support groups, as well as the provision of a regular visitor who provides meaningful conversation and companionship. Conclusion These results align with literature on pet ownership and Attachment Theory. The results also offer an insight into how PSPs allow the elderly to maintain pet ownership and age in place, thus enhancing their health and well-being.

Commentary on: Rasmussen M-LH, Strom M, Wohlfahrt J et al . Risk, treatment duration, and recurrence risk of postpartum affective disorder in women with no prior psychiatric history: a population-based cohort study. PLoS Med . 2017;14(9): e1002392. Postpartum depression (PPD) has an estimated prevalence of 10%–15%1 with associated negative maternal and child sequelae if left untreated. Following an episode of PPD, women are more likely to experience recurrent postpartum and non-postpartum depressive episodes, regardless of whether this was a first or subsequent depressive episode.2 PPD prevalence estimates typically include women with and without pre-existing psychiatric diagnoses. Thus, there is a poor understanding of potential differences in recurrence risk and treatment duration between these two groups. Data were linked from Danish national registers to follow 457 317 primiparous women without previous psychiatric diagnoses delivering between 1996 and 2013.3 These women were followed up until 31 …

Issue addressed Public health concerns about insufficient consumption of vegetables across all demographics in Australia have led to 20 years of behaviour change interventions ranging from social marketing to interactive small group programs, with modest results. To maximise health promotion intervention outcomes, practitioners need up-to-date information that helps them navigate the complexity of food systems and eating behaviours. Methods This scoping review of Australian and international research, including peer-reviewed and grey literature, provides a picture of health promotion nutrition interventions, as well as other initiatives that may promote increased vegetable consumption. Search terms related to nutrition and vegetable consumption, type of intervention or initiative, for example, campaign; and consumer values and behaviour. A wide range of data sources were used including scholarly papers, market research reports and publicly available websites of community organisations (eg, OOOOBY). A broad food systems typology was developed to provide a framework for the review. Results The review finds an emerging group of community-driven initiatives within local food systems that appear to have positive impacts on vegetable consumption. These initiatives sit within a multi-faceted approach to health and well-being that is consistent with the tenets of the Ottawa Charter for Health Promotion, including community engagement, social justice and sustainability goals. Conclusions More research into the impact of these new frontiers is needed, but our preliminary findings point to the potential for health promotion practitioners to collaborate on local/community food system initiatives that are not motivated primarily by health goals, but have the potential to deliver multiple health and environmental outcomes. SO WHAT?: This review demonstrated community-driven initiatives around local food systems show the most promise in promoting vegetable consumption and addressing the determinants of health. Health promotion efforts to encourage food security and healthy eating could be strengthened through collaborations within these new frontiers.

Objective Biomarkers are of increasing interest in dementia research. Studies describing favourable accuracy of various dementia tests have influenced research, guidelines and diagnostic criteria. Publication bias is known to compromise reports on efficacy of therapeutic interventions. Traditional methods of quantifying publication bias are not suited to reviews of diagnostic tests. We aimed to describe rates and predictors of publication of dementia test accuracy studies presented at scientific meetings. Methods We chose three exemplar scientific meetings from 2009. Two independent researchers assessed conference proceedings and selected all abstracts relating to dementia diagnostics. We recorded basic descriptors and dichotomised results as ‘positive’ or ‘neutral’. We assessed publication status using electronic literature databases and contacting lead authors. We described univariate and multivariate predictors of publication status using logistic regression modelling. Results From n = 2257 abstracts, we identified n = 250 (11%) abstracts relating to dementia diagnostics. The majority n = 209 (84%) reported positive results. Only 97 (39%) of these studies are published. Univariate predictors of publication status included positive result (p = 0.042), North American or European authors (p = 0.047), higher number of participants (p = 0.008) and use of a ‘biomarker’ test (p = 0.035). On multivariate analysis, only increasing number of participants was independently associated with publication (p = 0.034). Conclusions Our strategy did not prove or disprove a publication bias effect in dementia test accuracy studies. The substantial proportion of ‘positive’ studies may point to a downstream ‘submission bias’ effect on decision to submit data to meetings. Modest rate of publication of dementia test accuracy studies is concerning, and publication bias remains possible. Copyright © 2015 John Wiley & Sons, Ltd.

The design of hospital environments with an increased focus on incorporating nature and natural features has been reported to have multiple health and well-being benefits. This paper reports on three Australian case studies that each investigated the relationship between green spaces and people's mental health. The results suggest that gardens or other green spaces should be included within plans for future healthcare design. While we acknowledge that there are a range of considerations in the allocation of healthcare resources and programmes for maximum benefit, we believe that those programmes which highlight the beneficial outcomes for people with mental illness of ‘feeling blue and touching green’ are worth implementing.

Introduction This study aimed to assess training of Senior House Officer-grade equivalent doctors in postgraduate surgical training or service (SHO-DIPST) in surgical specialties across the United Kingdom (UK), against nationally agreed Joint Committee on Surgical Training Quality Indicators (JCST QIs). Specific recommendations are made, with a view to improving quality of training, workforce retention and recruitment to Higher Surgical Training. Method Prospective, observational, multicentre study conducted by the Association of Surgeons in Training, using the UK National Research Collaborative model. Any centres in the UK providing acute surgical services were eligible. SHO-DIPST with a permanent contract, on out-of-hours ‘on-call rota' were included across four, one-week data capture periods (September to October 2016, February to March 2017). Adherence to five quality indicators was reported using descriptive statistics. P-values were calculated using Student's t-test for continuous data, with a 5% level of significance. Results 2569 SHO-DIPST were included from all ten surgical specialties in 141 NHS trusts across all 16 Local Education and Training Boards in the UK. 960 SHO-DIPST were in registered ‘training' posts (37.3%). The median number of SHO-DIPST per rota was 7.0 (IQR 5.0–9.0). Adherence to the five included JCST QIs ranged from 6.0 to 53.1%. Only four SHO-DIPST posts across the study population met all five JCST QIs (0.3%). The total number of training sessions was higher for those in registered training posts (p Conclusions Only four early years postgraduate surgical training posts in the UK meet nationally approved minimum quality standards. Specific recommendations are made to improve training in this cohort and to bolster recruitment and retention into Higher Surgical Training.

Introduction Pre-treatment of the skin to remove scales and crusts prior to photodynamic therapy (PDT) is essential to enhance the uptake of topically applied methyl aminolevulinate (MAL) and to improve treatment efficacy. This study compared the effect of two different skin preparation pads on skin integrity in ex vivo human skin. Methods Ex vivo human skin samples from three donors were pre-treated in triplicates with PREPSTER™ (PR) skin preparation pad (6, 8, and 10 passages) or Ambu Unilect™ (A-UN) skin preparation pad (6, 8, and 10 passages). In addition, skin samples were pre-treated with tape strippings (10 adhesive tape strips) as a reference method for comparison. Transepidermal water loss (TEWL) was measured on intact skin and following skin barrier impairment using skin preparation pads and tape stripping. Histological analysis was performed to verify the impairment of the stratum corneum (SC) barrier function in samples from intact skin (control), 10 tape strippings (reference method), 10 passages of PR, and 10 passages of A-UN. Results TEWL increased with the increasing number of passages of skin preparation pads, with 2.4- and 3.3-fold increases following 10 passages of A-UN and PR, respectively, versus a 2.2-fold increase with 10 tape strippings (reference). Histological analysis showed only partial removal of the SC, with no damage observed on the epidermis, regardless of the procedure used. Conclusion Pre-treatment of skin using PR and A-UN skin preparation pads markedly increases TEWL, indicating slight impairment of the SC barrier function. Comparison of both skin preparation pads showed that PR pad consistently induced significantly higher TEWL than A-UN pad (p

Introduction: Lasagna’s Law, that the prevalence of a disease falls to 10% of your estimate the day you start recruitment , is relevant for stroke rehab trials. Data describing the problem are limited for very early trials (within 30 days) since most trials focus on more chronic survivors and moderate upper-extremity (UE) impairment (NIHSS motor arm > 0). Very early trials are important for rehab because animal data suggest very early intervention may improve recovery. We thus provide estimates on barriers to recruitment for very early rehabilitation trials in the US. Methods: We used screening data for the Phase II Critical Periods After Stroke Study RCT, designed to identify when after stroke patients are most responsive to motor training. Starting Aug 2014, 893 patients eventually admitted to inpatient rehab were screened (5 ±2 days post stroke). Results: We enrolled 4.3% of those screened, at 15.5 ±4.9 days post stroke. Participants had ischemic/hemorrhagic stroke within 28d, and moderate UE impairment (NIHSS motor arm > 0 and manual muscle test score >2- on shoulder flexion/abduction). The largest % were excluded for being “too mild” (35.7%, NIHSS motor arm = 0), or “too late” (18%, unable to receive first study-related treatment < 30 days of stroke). A smaller percentage were “too severe” (3.6%, UE motor assessment scale Conclusion: Frequent barriers to recruitment for inpatient rehab trials include persistent but too mild UE motor impairment and delayed admission to inpatient rehab. For early intervention studies, screening and treatment must begin in the acute hospital setting. Further, there is a patient subset whose motor impairment persists, but is too mild for most trials. These mildly affected individuals warrant more investigation.

Purpose – Neuropsychiatric disorders account for a substantial proportion of disease burden and disability in Africa. Despite this, mental health systems are under-resourced in Africa, as in most parts of the world, creating a “treatment gap” and denying the African population the right to mental health achieved through access to mental health services. The paper aims to discuss these issues. Design/methodology/approach – The mental health systems of African countries were compared with figures for all low- and middle-income countries (LAMICS) using data from the World Health Organization Assessment Instrument for Mental Health Systems. Comparable global figures were also available for some indicators from the WHO's World Mental Health Atlas 2011. Findings – Selected indicators of mental health systems are presented for 14 African countries and shows that they are lower as compared to figures for all other LAMICS and also global figures. The treatment gap for mental disorders is much higher in Africa than comparable global figures. For example, the treatment gap for mood disorders has been estimated from 95 to 100 per cent for some African countries. Originality/value – There is an imbalance between need and service provision in the area of mental health across the world but particularly in Africa. Despite this, there are a greater number of outpatient than inpatient services in Africa which provides an opportunity for development of community-based services. There are also many encouraging examples of effective approaches to reducing the burden of neuropsychiatic disease in Africa.

Background In the UK, early years policy emphasizes that all families should have access to support tailored to their individual needs. Knowledge of the determinants of health service use should help to inform rational and equitable planning and delivery of services to parents. Objectives We seek to investigate the determinants of primary care service use in families with preschool children. Methods Determinants of service use in two population cohorts (families with children aged 0-1 and 2-3 years) from the Growing Up in Scotland study are presented. Services related to use of the family doctor or health visitor for information on the child's health or behaviour in the last year. Results A range of socio-demographic determinants were significant predictors of service use on multivariate analysis. Determinants of service use differed between the health visitor and family doctor. Conclusions The analysis provides an insight into the determinants and patterns of health service use by families with young children at two stages of development. While some of our findings are expected or supported by previous research, others highlight areas that require further investigation.

What you need to know Depression in pregnancy affects up to 10% of women, with higher rates in low and middle income countries, a rate only slightly lower than in the postpartum period.1 2 Yet, as few as 20% of pregnant women with depression receive adequate treatment.3 4 This is problematic because depression can profoundly affect a woman’s sense of wellbeing, relationships, and quality of life. Untreated or incompletely treated depression can also have adverse consequences for the offspring. Systematic reviews show an increase in markers of infant morbidity such as preterm birth, childhood emotional difficulties, behaviour problems, and, in some studies, poor cognitive development.5 6 Antenatal depression also is one of the strongest risk factors for postnatal depression, a condition linked to developmental problems in children.6 7 Severe depression can result in suicide, a major cause of maternal death.8 9 Perinatal suicides have been associated with lack of active treatment.10 Barriers to treatment include stigma, lack …

Background The Glasgow Parenting Support Framework is an intervention to support families with preschool children. It provides structured support through universal and targeted interventions. Two routine family visits by health visitors have been piloted, one involving a home assessment when the child is 13 months old. Aims To establish the need for parenting support in the population at 13 months and whether or not the home assessment improved the match of service provision to need. Methods Health visitors were asked to collect data on existing problems and service provision to families, the mental state of the child’s principal carer, an observation of the parent–child relationship and details of management plans. Data from the Child Health Surveillance System were also used. Results Data were obtained for 549 families. Nine families were noted to have problems in the parent–child relationship. Carers in these families had poorer mental health. In all, 20% of families had a revisit scheduled: they were also more likely to have poor mental health. All families with possible problems in the relationship had a revisit scheduled. Depression scores measured during the pilot were a significant predictor of revisiting and referral, with an odds ratio of 1.37 for every one point increase in score on the Adult Wellbeing Scale depression subscale. Conclusions Current service provision matches need to some extent but routine visits focused on parenting difficulties at 13 months, particularly parental depression, may help to identify families needing support who would not otherwise have received it.

The Australian Weed Risk Assessment system has been tested in a number of countries and geographical areas since its introduction in 1997, and is widely considered to be an accurate method of predicting the risk of invasiveness of new plant introductions. We evaluated the system against 152 plant species with at least a 50-year introduction history in Canada, including major and minor weeds and species which have not naturalized. Four questions that referred explicitly to Australian conditions were replaced with appropriate equivalent questions for Canada. The weediness of each species was independently rated by a panel of Canadian agricultural, botanical, and conservation experts. Using the standard cut-off scores, the system correctly rejected all major and 86% of minor weeds. However, it also incorrectly rejected 44% of non-weedy species. The diagnostic power of the system, as measured by the receiver operating characteristic curve, was similar to but somewhat lower than that found in other regions where the system has been evaluated. Answers to 23 of the 49 questions were not significantly associated with experts’ weediness ratings, indicating that a simplified system could give equally reliable results for Canada. Experts’ ratings were strongly related to cold-hardiness, suggesting that the system could be improved by making better use of data on climatic tolerances. We suggest that performance would also be improved by combining likelihood- and consequence-related scores in a multiplicative rather than additive way.

A 51 year old white homosexual man was admitted with cellulitis of the left leg. His medical history included psoriasis, for which he had received six years of methotrexate. The methotrexate was stopped 11 years before this presentation and he had not experienced any active psoriasis since then. Examination revealed multiple painless, indurated violaceous plaques and verrucous growths on the dorsal and plantar aspects of both feet (fig 1). Further questioning revealed that these lesions had been present for more than 10 months. There was no evidence of psoriasis on examination. What investigation would you request? Fig 1 Violaceous plaques and verrucous growths on both feet These lesions are characteristic of cutaneous Kaposi’s sarcoma. Methotrexate immunosuppression alone is unlikely to cause the condition, so an HIV …

This article focuses on the qualitative methodologies employed in a research project developed in collaboration with Aboriginal advisors and gaining an in‐depth understanding of Aboriginal Victorian peoples’1 connection to their ancestral lands. It outlines why qualitative methodologies were used and highlights the ethical dimensions of working with Aboriginal Victorian communities. A research partnership was developed between Aboriginal Victorian communities and the non‐Aboriginal researcher and this process was emphasised because in the past Australian Indigenous people have been grossly exploited in health research. The methods of semi‐structured interviews and focus groups were used to gain a better understanding of this topic. The novel point of this article is that it provides an honest reflection of the benefits and limitations of this qualitative research process from the perspectives of a non‐Aboriginal researcher and an Aboriginal participant, when emphasis is placed on a collaborative approach. The paper outlines what a successful qualitative research project looks like in Victorian Aboriginal communities. This can be used as a blueprint not only for working with Aboriginal Victorian communities, who have been marginalised within Australian society, but may also be relevant to other culturally diverse communities throughout the world.

This article focuses on three Victorian Aboriginal [1] groups (Bangerang, Boonwurrung and Yorta Yorta) to explore elements that provide or discourage development of land management projects. Results from this small qualitative study show that a number of distinct health, socio-political and economic factors need to be considered when developing Aboriginal land management projects. This study indicates that a greater involvement in Aboriginal land management projects - critical to Aboriginal peoples' health, economic and social structures - will only occur through increased community consultation, respect, training, consistency between all stakeholders involved, resources and the provision of employment opportunities. Further research is required to strengthen this evidence, allowing policy-makers to be progressive when developing land management projects for Aboriginal Victorian people as a health promoting tool.

This paper reports on a research project undertaken with members of a community garden in Port Melbourne, Australia, to investigate the ways in which such a facility contributes to the enhancement of health, wellbeing and contact with nature for urban dwellers. Ten members from an urban community garden were interviewed using qualitative semi‐structured questions exploring perceptions of health and wellbeing benefits associated with membership. The garden was felt by members to be a sanctuary where people could come together and escape daily pressures, a source of advice and social support, and a place which gave them a sense of worth and involvement. Members also identified spiritual, fitness and nutritional benefits arising from participation in the community garden. It is evident even from this small qualitative study that community gardening offers many health and wellbeing benefits to members. This study provides a basis for the benefits of community gardens in Australia to be taken into account by p...

This article highlights contributions that can be made to the public health field by incorporating “ecosystem approaches to health” to tackle future environmental and health challenges at a regional level. This qualitative research reviews attitudes and understandings of the relationship between public health and the environment and the priorities, aspirations and challenges of a newly established group (the Oceania EcoHealth Chapter) who are attempting to promote these principles. Ten semi-structured interviews with Oceania EcoHealth Chapter members highlighted the important role such groups can play in informing organisations working in the Oceania region to improve both public health and environmental outcomes simultaneously. Participants of this study emphasise the need to elevate Indigenous knowledge in Oceania and the role regional groups play in this regard. They also emphasis that regional advocacy and ecosystem approaches to health could bypass silos in knowledge and disciplinary divides, with groups like the Oceania EcoHealth Chapter acting as a mechanism for knowledge exchange, engagement, and action at a regional level with its ability to bridge the gap between environmental stewardship and public health.

Whilst a growing body of evidence demonstrates people derive a range of health and wellbeing benefits from visiting parks, only a limited number of attempts have been made to provide a complementary economic assessment of parks. The aim of this exploratory study was to directly estimate the perceived health and wellbeing benefits attained from parks and the economic value assigned to parks by park users in Victoria, Australia. The research employed a mixed methods approach (survey and interviews) to collect primary data from a selection of 140 park users: 100 from two metropolitan parks in Melbourne and 40 from a park on the urban fringe of Melbourne, Victoria. Our findings suggest that park users derive a range of perceived physical, mental/spiritual, and social health benefits, but park use was predominantly associated with physical health benefits. Overall, our exploratory study findings suggest that park users are willing to pay for parks, as they highly value them as places for exercising, socialising, and relaxing. Importantly, most people would miss parks if they did not exist. The findings aim to provide park managers, public health advocates, and urban policy makers with evidence about the perceived health and wellbeing benefits of park usage and the economic value park visitors place on parks.

Date Presented 4/8/2016 Development of treatments based on client-centered principles is a challenge. Use of meaningful activities and individualized treatment plans support translation of studies of neuroplasticity after stroke into human treatment trials. Occupation-based paradigms will yield better treatment outcomes. Primary Author and Speaker: Jessica Barth Additional Authors and Speakers: Kathaleen Brady, Dorothy Edwards, Claire Wilson, Margot Gianetti, Alexander Dromerick

Firstly, we agree with Braillon and Bewley that more is needed to support education in this area at the point of care,1 2 and our teams have been working on developing an online patient decision aid that aims to help women make decisions about drugs during pregnancy in collaboration with their providers.3 This tool is currently being evaluated, and one main advantage is that its electronic nature will enable timely updating when new evidence emerges and broad access. Because of the rapidly changing literature, with the harms and benefits of antidepressant use in pregnancy being inconsistently reported, we would also argue that printed …

Substance abuse by the late 1980s had already become a prominent, out-of-control sector of health care. Some of the reasons for this crisis, as well as more recent changes in this specialty field, are explicated in this chapter.

It is estimated that half of the world’s population now live in urban environments. Urban living necessitates a removal from nature, yet evidence indicates that contact with nature is beneficial for human health. In fact, everyday urban places, such as where people live, study, and work, provide opportunities to bring nature back into cities to contribute to positive, healthy environments for people and to foster the human–nature connection. The inclusion of more nature in cities could have additional environmental benefits, such as habitat provision and improving the environmental performance of built environments. In the context of climate change, outcomes such as these assume further importance. This article explores how common urban places can foster links between people and nature, and generate positive health and well-being outcomes. We achieve this by exploring nature in the everyday settings of schools and residential housing.