Exploring mechanisms and contexts in a Peer Education Project to improve mental health literacy in schools in England: a qualitative realist evaluation

Poor adolescent mental health calls for universal prevention. The Mental Health Foundation's 'Peer Education Project' equips older students ('peer educators') to teach younger students ('peer learners') about mental health. The peer-led lessons cover defining good and bad mental health, risk and protective factors, self-care, help-seeking and looking after one another. While previous pre-post evaluations have suggested effectiveness, the mechanisms through which the intervention improves mental health literacy remain unclear. We purposively recruited seven secondary schools across England from 2020 to 2022 and collected data through five observations, 12 staff interviews and 15 student focus groups (totalling 134 students; 46 peer educators aged 14-18 years and 88 peer learners aged 11-13 years). Our realist analysis adopted retroductive logic, intertwining deductive and inductive approaches to test the initial programme theory against insights arising from the data. We developed Context-Mechanisms-Outcome configurations related to four themes: (i) modelling behaviours and forming supportive relationships, (ii) relevant and appropriate content, (iii) peer educators feeling empowered and (iV) a school culture that prioritises mental health support. Our refined programme theory highlights key mechanisms, contexts conducive to achieving the outcomes and ways to improve training, recruitment and delivery to maximise effectiveness for similar peer-led initiatives.

The RESearch PARamedic Experience (RESPARE) study: a qualitative study exploring the experiences of research paramedics working in the United Kingdom

Background

The research paramedic position is a relatively niche role undertaken by a small number of paramedics who support, deliver and promote research. Research paramedic roles provide opportunities to develop talented researchers who are recognised as vital elements of developing a research culture within ambulance services. The benefits of research-active clinicians have been recognised at a national level. The aim of this study was to explore the experience of people who work, or have worked, as research paramedics.

Methods

A generic qualitative approach underpinned by phenomenological concepts was used. Volunteers were recruited via ambulance research leads and social media. Online focus groups allowed participants to discuss their roles with peers who may be geographically distant. Semi-structured interviews expanded on the focus group findings. Data were recorded, transcribed verbatim and analysed using framework analysis.

Results

Eighteen paramedics (66% female, median involvement in research six (interquartile range 2-7) years) representing eight English NHS ambulance trusts participated in three focus groups and five interviews lasting around one hour, in November and December 2021.Six key themes were identified: starting as a research paramedic; barriers and facilitators to working as a research paramedic; research careers; opportunities; the community (support and networking); and the value of a clinical identity.

Conclusions

Many research paramedics had similar experiences in terms of starting their career by delivering research for large studies, then building on this experience and the networks they create to develop their own research. There are common organisational and financial barriers to working as a research paramedic. Career progression in research beyond the research paramedic role is not well defined, but often involves building links outside of the ambulance service.

Major risk factors for sexual minority young people's mental and physical health: findings from a county-wide school-based health needs assessment

BACKGROUND

Childhood health is an important adult health predictor. Sexual orientation is increasingly recognized as influential on children and young people's (CYP) mental and physical health.

METHODS

Data came from a cross-sectional survey of year 9 children attending schools in two local authorities in the north-west of England, including mental and physical health indicators, and demographic characteristics including sexual orientation. The sample of 8058 represented 67.8% of the eligible population. Data were analysed by sexual orientation, sexual majority or sexual minority.

RESULTS

Children reporting their sexual orientation as sexual minority reported worse mental and physical health outcomes and behaviours than sexual majority peers; had higher odds of being lonely (odds ratios (OR) = 8.24, 95% C.I.: 6.56-10.37), having self-harmed (OR = 7.28, 95% C.I.: 5.78-9.15), being bullied (OR = 4.76, 95% C.I.: 3.74-6.05) or perceiving themselves as overweight (OR = 2.40, 95% C.I.: 1.89-3.06).

CONCLUSIONS

It is important to identify and support children in a sexual minority. Research is required to understand differences between children within sexual minorities and the impact on outcomes and rights. Health and social policy and services, should respond to the vulnerabilities of sexual minority CYP.

Bowel cancer screening in an English prison: a qualitative service evaluation

OBJECTIVES

Bowel cancer screening home-testing kits are offered every two years to individuals aged 60-74 years in the United Kingdom (UK), with prisoners eligible for screening in the same way as the general population. There are currently major changes planned to the bowel cancer screening programme in England, with the transition to the single-sample faecal immunochemical test (FIT) and the planned lowering of the age limit from 60 to 50 years. In this project, we aimed to explore processes and beliefs around bowel cancer screening in an English prison.

STUDY DESIGN

This is a qualitative study.

METHODS

Semistructured qualitative interviews were conducted with eight prisoners and four staff members in a male prison in North West England. Data were analysed via thematic analysis.

RESULTS

Promoting and impeding factors to screening were identified. There was high willingness amongst prisoners to be screened for bowel cancer, with screening seen as important and having benefits for the individual and healthcare system. However, there was often low awareness of screening and there were psychological challenges associated with screening. Prison healthcare staff were widely respected and were a motivator to accept screening, with prisoners viewing prison as a good opportunity to access health care. Despite this, prison life was characterised by competing priorities, with security taking precedence, and screening sometimes a low priority for staff and prisoners. There were also considerable logistical challenges to delivering bowel cancer screening in a prison, and the system was not comparable with that in the community. Providing good-quality understandable information, though challenging, was key.

CONCLUSIONS

This is the first project to explore entering the bowel cancer screening programme in UK prisons, and promoting and impeding factors to the take-up of screening have been identified. This information could be practically used by local commissioners and policymakers to aid the design of staff and prisoner interventions to maximise uptake of bowel cancer screening in prisons. As the planned changes to bowel cancer screening in England are likely to increase the number of eligible prisoners, this work could also be used to inform any service reconfiguration required to accommodate these changes.

Phytoscreening as an efficient tool to delineate chlorinated solvent sources at a chlor-alkali facility

Chlorinated ethenes (CE) are among the most common volatile organic compounds (VOC) that contaminate groundwater, currently representing a major source of pollution worldwide. Phytoscreening has been developed and employed through different applications at numerous sites, where it was generally useful for detection of subsurface chlorinated solvents. We aimed at delineating subsurface CE contamination at a chlor-alkali facility using tree core data that we compared with soil data. For this investigation a total of 170 trees from experimental zones was sampled and analyzed for perchloroethene (PCE) and trichloroethene (TCE) concentrations, measured by solid phase microextraction gas chromatography coupled to mass spectrometry. Within the panel of tree genera sampled, Quercus and Ulmus appeared to be efficient biomonitors of subjacent TCE and PCE contamination, in addition to the well known and widely used Populus and Salix genera. Among the 28 trees located above the dense non-aqueous phase liquid (DNAPL) phase zone, 19 tree cores contained detectable amounts of CE, with concentrations ranging from 3 to 3000 μg L^-1. Our tree core dataset was found to be well related to soil gas sampling results, although the tree coring data were more informative. Our data further emphasized the need for choosing the relevant tree species and sampling periods, as well as taking into consideration the nature of the soil and its heterogeneity. Overall, this low-invasive screening method appeared useful to delineate contaminants at a small-scale site impacted by multiple sources of chlorinated solvents.

Phytovolatilization of Organic Contaminants

Plants can interact with a variety of organic compounds, and thereby affect the fate and transport of many environmental contaminants. Volatile organic compounds may be volatilized from stems or leaves (direct phytovolatilization) or from soil due to plant root activities (indirect phytovolatilization). Fluxes of contaminants volatilizing from plants are important across scales ranging from local contaminant spills to global fluxes of methane emanating from ecosystems biochemically reducing organic carbon. In this article past studies are reviewed to clearly differentiate between direct- and indirect-phytovolatilization and we discuss the plant physiology driving phytovolatilization in different ecosystems. Current measurement techniques are also described, including common difficulties in experimental design. We also discuss reports of phytovolatilization in the literature, finding that compounds with low octanol-air partitioning coefficients are more likely to be phytovolatilized (log KOA < 5). Reports of direct phytovolatilization at field sites compare favorably to model predictions. Finally, future research needs are presented that could better quantify phytovolatilization fluxes at field scale.

Plants as bio-indicators of subsurface conditions: impact of groundwater level on BTEX concentrations in trees

Numerous studies have demonstrated trees' ability to extract and translocate moderately hydrophobic contaminants, and sampling trees for compounds such as BTEX can help delineate plumes in the field. However, when BTEX is detected in the groundwater, detection in nearby trees is not as reliable an indicator of subsurface contamination as other compounds such as chlorinated solvents. Aerobic rhizospheric and bulk soil degradation is a potential explanation for the observed variability of BTEX in trees as compared to groundwater concentrations. The goal of this study was to determine the effect of groundwater level on BTEX concentrations in tree tissue. The central hypothesis was increased vadose zone thickness promotes biodegradation of BTEX leading to lower BTEX concentrations in overlying trees. Storage methods for tree core samples were also investigated as a possible reason for tree cores revealing lower than expected BTEX levels in some sampling efforts. The water level hypothesis was supported in a greenhouse study, where water table level was found to significantly affect tree BTEX concentrations, indicating that the influx of oxygen coupled with the presence of the tree facilitates aerobic biodegradation of BTEX in the vadose zone.

Plants as bio-indicators of subsurface conditions: impact of groundwater level on BTEX concentrations in trees

Numerous studies have demonstrated trees' ability to extract and translocate moderately hydrophobic contaminants, and sampling trees for compounds such as BTEX can help delineate plumes in the field. However, when BTEX is detected in the groundwater, detection in nearby trees is not as reliable an indicator of subsurface contamination as other compounds such as chlorinated solvents. Aerobic rhizospheric and bulk soil degradation is a potential explanation for the observed variability of BTEX in trees as compared to groundwater concentrations. The goal of this study was to determine the effect of groundwater level on BTEX concentrations in tree tissue. The central hypothesis was increased vadose zone thickness promotes biodegradation of BTEX leading to lower BTEX concentrations in overlying trees. Storage methods for tree core samples were also investigated as a possible reason for tree cores revealing lower than expected BTEX levels in some sampling efforts. The water level hypothesis was supported in a greenhouse study, where water table level was found to significantly affect tree BTEX concentrations, indicating that the influx of oxygen coupled with the presence of the tree facilitates aerobic biodegradation of BTEX in the vadose zone.

A new HLA-A*02 null allele, HLA-A*9213N

A novel HLA-A*02 null allele, differing from HLA-A*02010101 at codon 60 (TGG tryptophan-->TAG stop), is described.