Existential Well-Being in Nature: A Cross-Cultural and Descriptive Phenomenological Approach

Exploring the putative role of nature in human well-being has typically been operationalized and measured within a quantitative paradigm of research. However, such approaches are limited in the extent to which they can capture the full range of how natural experiences support well-being. The aim of the study was to explore personal experiences in nature and consider how they might be important to human health and well-being. Based on a descriptive phenomenological analysis of fifty descriptions of memorable moments in nature from England, Indonesia, and Norway, our findings illustrate a common structure presented under three themes: 1. serenity that gives rise to a growing awareness of how the body is stimulated by the senses; 2. admiration and appreciation for the sensation of beauty; 3. an emerging sense of togetherness and deep emotional bonding. The findings are discussed using the concepts of ecological time and the ecological body, which foreground being in nature as constituted as an interdependent and dynamic human process. We conclude by understanding well-being in terms of human responsiveness to their surroundings and thus as rooted in the human condition.

Pasung: A qualitative study of shackling family members with mental illness in Indonesia

Use of coercion on people with mental illness is a deeply embedded practice around the world. Not only does the practice raise human rights issues, it also leads to further mental, physical, and emotional harms. In Indonesia, 'pasung' is a common practice of physical restraint, which involves lay people using a variety of illegal methods to tie a person. In this article, we explore the meanings families attach to their actions when using pasung by asking the question: to what extent does the use of pasung by families emerge from socioculturally prescribed norms and conventions? To explore this question, we conducted and analysed eight interviews with family members from Nias Island, Indonesia using Giorgi's descriptive phenomenological method. Our findings reveal that pasung emerges in the disjunction between sociocultural demands and the family's capacity to meet these demands. Struggling to understand the behaviour of a family member with mental illness, the family tries to cope with neighbourhood reactions to ever more visible behavioural signs alongside managing their everyday life. These struggles, in turn, make their social situation increasingly stressful, which initiates a process of depersonalization as a response. Moreover, the prevailing sociocultural values convey a need to act according to expected norms. As such, pasung materializes as a socioculturally accepted practice that allows families to take back control in stressful social situations. In sum, when families feel overwhelming emotional stress and a sense of powerlessness, they try to resolve their situation by using pasung to regain control and thus manage their lives.

Mapping the digital food environment: A systematic scoping review

Food environments are directly linked to diets and health outcomes such as overweight, obesity, and noncommunicable diseases. The digitalization of food environments is becoming a central issue in public health, yet little is known about this emerging field. We performed a systematic scoping review to map the research on the digital food environment and investigate how the eight dimensions of the food environment, according to an established framework (availability, prices, vendor and product properties, marketing and regulation, accessibility, affordability, convenience, and desirability), might be shifting in the context of a digital society. We searched MEDLINE, EMBASE, Scopus, and Web of Science for studies published between 2000 and 2019, using search terms covering digital technology and food environment, which yielded 13,580 unique records. Our analysis of 357 studies shows that digitalization is taking place in all dimensions of the food environment, and enabling the emergence of new forms of buying and selling food, such as online grocery shopping and online food delivery, which may be changing availability of foods and affecting the physical distance to shops and time allocated for shopping. Systematic reviews identified indicated that digital food marketing and social media can influence food choices, preferences and consumption. Our findings suggest that digital and physical food environments are interconnected and influencing one another, but the impact of the digital on health and nutrition is yet unclear.

The longitudinal association between objectively measured physical activity and mental health among Norwegian adolescents

Background

Mental health among young people in many countries, including Norway, seems to be deteriorating. Physical activity (PA) has been positively associated with mental health. However, methodological issues related to study design and measurement of PA and mental health outcomes currently limits our understanding of the relationship. The purpose of the present study is to explore the prospective relationship between objectively measured PA and mental health outcomes. More specifically, volume (total PA), intensity (moderate-to-vigorous PA [MVPA]) and sedentary behaviour (SED) were explored in relation to mental health problems (MHP) and mental wellbeing (MWB).

Methods

Data from 599 adolescents (54.4% female, mean age at baseline ±SD 13.3 ± 0.3 years) were collected annually during their 3 years (T1, T2 and T3) at lower secondary school. PA was measured using accelerometry. MWB was measured using the ‘Warwick-Edinburgh Mental Wellbeing Scale’ and MHP by the ‘Strengths and Difficulties Questionnaire’. Multiple linear regression was performed to explore relationships between changes in PA/SED (between T1-T3) and MWB/MHP (at T3). The term ‘movement categories’ was used to refer to components on the movement continuum and includes volume (total PA), intensity (MVPA) and SED.

Results

Among boys, any increase in SED was positively associated with MWB (β = 0.05, 95% CI: 0.01 to 0.10), whereas a small positive association between an increase in total PA (volume) and MWB was found among girls (β = 1.13, 95% CI: 0.05 to 2.21). There were no associations between changes in any movement categories [total PA (volume), MVPA, SED] and score on MHP at T3, neither for girls nor boys.

Conclusion

This study provided no clear evidence of any association between change in volume or intensity of PA and MHP among an overall healthy adolescent study sample. There was, however, evidence of a relationship between increased SED and MWB among boys and increased volume of PA and MWB among girls. The relationship between movement categories and mental health may depend on the measurement used to assess both PA/SED and variables of mental health. Future research would be strengthened by researchers clarifying what construct of mental health is being used and measured.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01211-x.

An artificial intelligence deep learning model for identification of small bowel obstruction on plain abdominal radiographs

Objectives:

Small bowel obstruction is a common surgical emergency which can lead to bowel necrosis, perforation and death. Plain abdominal X-rays are frequently used as a first-line test but the availability of immediate expert radiological review is variable. The aim was to investigate the feasibility of using a deep learning model for automated identification of small bowel obstruction.

Methods:

A total of 990 plain abdominal radiographs were collected, 445 with normal findings and 445 demonstrating small bowel obstruction. The images were labelled using the radiology reports, subsequent CT scans, surgical operation notes and enhanced radiological review. The data were used to develop a predictive model comprising an ensemble of five convolutional neural networks trained using transfer learning.

Results:

The performance of the model was excellent with an area under the receiver operator curve (AUC) of 0.961, corresponding to sensitivity and specificity of 91 and 93% respectively.

Conclusion:

Deep learning can be used to identify small bowel obstruction on plain radiographs with a high degree of accuracy. A system such as this could be used to alert clinicians to the presence of urgent findings with the potential for expedited clinical review and improved patient outcomes.

Advances in knowledge:

This paper describes a novel labelling method using composite clinical follow-up and demonstrates that ensemble models can be used effectively in medical imaging tasks. It also provides evidence that deep learning methods can be used to identify small bowel obstruction with high accuracy.

Physical activity and academic achievement among Norwegian adolescents: Findings from a longitudinal study

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A longitudinal study of youth explored physical activity and academic achievement.

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Physical activity was assessed by accelerometry and academic achievement by school grades.

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Mediation through changes in waist circumference and sleep duration were explored.

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Changes in physical activity were not associated with changes in academic achievement.

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There was no mediation via changes in waist circumference or sleep duration.

Regular physical activity (PA) has been associated with academic achievement, but the evidence is mainly based on cross-sectional research and self-reported measures of PA. The purpose of the current study was to explore the longitudinal relationship between objectively measured PA and academic achievement among a cohort of adolescents in Norway between 2016 and 2018. As a secondary aim, an indirect relationship via waist circumference (WC) and sleep duration was assessed. Data from 599 adolescents (54.4% female, mean age at baseline ± SD 13.3 ± 0.3 years) were collected annually during their three years at lower secondary school. PA was measured objectively using accelerometry. Academic achievement was assessed using grade point average (GPA) from school records. Linear regression analysis was performed to explore associations between longitudinal changes in measures of PA (Total PA and moderate-to-vigorous PA [MVPA]) and academic achievement directly or via mediators. Results showed no significant associations between Total PA or MVPA and academic achievement, either in the main analyses or through mediation of WC and sleep duration. The results contribute to a growing evidence base of studies showing no association between objectively measured PA and academic achievement among adolescents.

Mapping the digital food environment: a scoping review protocol

INTRODUCTION

Food environments are the interface through which people interact with the broader food system. They are a key determinant of healthy and sustainable diets. The widespread use of digital technology in late modernity and the shift towards a digital society have posed new challenges for nutrition and health, with a concomitant surge in research on social media, digital health promotion interventions, and more recently, increasing interest in digital food marketing. While the literature is abundant on studies linking food, nutrition and digital technology, the effort to conceptualise and describe the digital food environment is new. This scoping review aims to support the development of a definition of the digital food environment and characterise it, along with key thematic research trends on this topic and potential consequences for nutrition and health.

METHODS AND ANALYSIS

The planned scoping review will be supported by the methodological framework proposed by Arksey and O'Malley and further developed by Levac et al. Development and reporting will follow the Preferred Reporting Items for Systematic Reviews and MetaAnalyses-Extension for Scoping Reviews (PRISMA-ScR) checklist and guidelines. The development of the search strategy was guided by the food environment conceptual framework developed by Turner et al. Four databases will be searched: MEDLINE, EMBASE, Scopus and Web of Science. Citation searching will be applied to identify additional studies, through checking of reference lists of primary studies and reviews. Studies in English, published from the year 2000 onwards, will be included. No geographical or population limits will be applied. Data will be extracted and analysed using a standardised charting tool.

ETHICS AND DISSEMINATION

No ethical approval is required for this study. The results will be submitted to an international peer-reviewed journal and scientific conferences. They will be disseminated through digital science communication platforms, including academic social media, to amplify its reach and usefulness.

Do "Girls Just Wanna Have Fun?" Participation Trends and Motivational Profiles of Women in the Birkebeiner Races, Norway's Ultimate Mass Participation Ski Event

Mass participation sporting events (MPSEs) are viewed as encouraging regular exercise in the population, but concerns have been expressed about the extent to which they are inclusive for women. This study focuses on an iconic cross-country skiing MPSE in Norway, the Birkebeiner race (BR), which includes different variants (main, Friday, half-distance, and women-only races). In order to shed light on women's participation in this specific MPSE, as well as add to the understanding of women's MPSEs participation in general, this study was set up to: (i) analyze trends in women's participation, (ii) examine the characteristics, and (iii) identify key factors characterizing the motivational profile of women in different BR races, with emphasis on the full-distance vs. the women-only races. Entries in the different races throughout the period 1996-2018 were analyzed using an autoregressive model. Information on women's sociodemographic characteristics, sport and exercise participation, and a range of psychological variables (motives, perceptions, overall satisfaction, and future participation intention) were extracted from a market survey and analyzed using a machine learning (ML) approach (n = 1,149). Additionally, qualitative information generated through open-ended questions was analyzed thematically (n = 116). The relative prevalence of women in the main BR was generally low (< 20%). While the other variants contributed to boosting women's participation in the overall event, a future increment of women in the main BR was predicted, with women's ratings possibly matching the men's by the year 2034. Across all races, most of the women were physically active, of medium-high income, and living in the most urbanized region of Norway. Satisfaction and future participation intention were relatively high, especially among the participants in the women-only races. "Exercise goal" was the predominant participation motive. The participants in women-only races assigned greater importance to social aspects, and perceived the race as a tradition, whereas those in the full-distance races were younger and gave more importance to performance aspects. These findings corroborate known trends and challenges in MPSE participation, but also contribute to greater understanding in this under-researched field. Further research is needed in order to gain more knowledge on how to foster women's participation in MPSEs.

Leisure-time physical activity among adolescents and subsequent use of antidepressant and hypnotic drugs: a prospective register linkage study

In this prospective study, the association between physical activity and subsequent use of antidepressant and hypnotic drug use in adolescents aged 15-16 years was examined. This study is based on information retrieved from the Norwegian Youth Health Surveys (2000-2003) and linked to prescription data from the Norwegian Prescription Database (2004-2013). In total, the study included 10711 participants with a participation rate of 87%. Adolescents were asked how many hours per week they spent on physical activity that made them sweat and/or be out of breath outside of school. Incident psychotropic drug use (outcome measure) was defined as ≥ 1 prescription of one of the following psychotropic drugs: hypnotics and antidepressants registered in the Norwegian Prescription Database. In the crude model for the time period 2004-2007, the odds of incident hypnotic use were lower for those who were physically active 1-2 h per week (OR 0.48-0.64), compared to those who were physically inactive (< 1 h per week). However, the association become non-significant 4-year post-baseline (2008-2010 and 2011-2013). In the crude model for the time periods 2004-2007, 2008-2010 and 2011-2013, the odds of incident antidepressant use were lower for physically active adolescents (2004-2007: OR 0.46-0.71, 2008-2010: OR 0.40-0.67 and 2011-2013: OR 0.37-0.58, compared to those who were physically inactive < 1 h. However, after adjustment for confounders, the association became non-significant in all time periods except in physical activity 5-7 and 8-10 h in the period 2008-2010. Physical activity does not indicate any association with later use of antidepressants, and the significant association with incident hypnotic drug use was for short-term follow-up only and disappeared on longer term follow-up periods. Given the scarcity of longitudinal studies examining the association between physical activity and mental health as well as psychotropic drug use among young people, the current study adds to previous research.

The association between physical activity and symptoms of depression in different contexts - a cross-sectional study of Norwegian adolescents

BACKGROUND

The purpose was to analyse the association between physical activity taking place in different contexts (sports club, gym, exercise independently and other organized physical activities) and symptoms of depression.

METHODS

The study was based on self-reported cross-sectional data from the Ungdata survey, conducted in 2017 by the Norwegian Social Research (NOVA) institute in cooperation with regional centres for drug rehabilitation. The target group comprised 5531 15-16 years old adolescents (Grade 10 students) and 11,655 students in grades 8 and 9 in Norway. Based on Rasch analysis, six items on depressions symptoms were used to create a composite measure of depression. Binomial logistic regression was used to analyse the association between physical activities in different contexts and symptoms of depression.

RESULTS

In the crude model, the odds for symptoms of depression were lower for those who were physically active in a sports club (OR: 0.40, 95% CI: 0.30-0.53), in a sports club and gym (OR: 0.40, 95% CI: 0.28-0.56), in a sports club and exercise or keep fit independently (OR: 0.52, 95% CI: 0.38-0.72) and in a sports club, gym and exercise or keep fit independently (OR: 0.58, 95% CI: 0.41-0.81). After adjustment for potential confounders, the association became significant only for those who were physically active in a sports club (OR: 0.57, 95% CI: 0.40-0.81) and other organized physical activities, e.g. dance, martial arts (OR: 0.52, 95% CI: 0.31-0.86). Analysis for grade 8 and 9 showed the same patterns for the associations between sports club and symptoms of depression (grade 8: crude model, OR: 0.47, adjusted model, OR: 0.63, grade 9: crude model, OR: 0.44, adjusted model, OR: 0.49).

CONCLUSIONS

Physical activity in a sports club was associated with significantly lower odds for symptoms of depression, suggesting a possible role for social interaction in addition to physical activity per se. It is important, therefore, to consider in which types of contexts physical activities take place, not only focusing on physical activity frequency and volume when investigating the association between adolescents' physical activity and mental health. Additional research is needed to further explore these associations as well as measures of physical activity and mental health.

Experiencing Nature through Immersive Virtual Environments: Environmental Perceptions, Physical Engagement, and Affective Responses during a Simulated Nature Walk

By combining physical activity and exposure to nature, green exercise can provide additional health benefits compared to physical activity alone. Immersive Virtual Environments (IVE) have emerged as a potentially valuable supplement to environmental and behavioral research, and might also provide new approaches to green exercise promotion. However, it is unknown to what extent green exercise in IVE can provide psychophysiological responses similar to those experienced in real natural environments. In this study, 26 healthy adults underwent three experimental conditions: nature walk, sitting-IVE, and treadmill-IVE. The nature walk took place on a paved trail along a large river. In the IVE conditions, the participants wore a head-mounted display with headphones reproducing a 360° video and audio of the nature walk, either sitting on a chair or walking on a manually driven treadmill. Measurements included environmental perceptions (presence and perceived environmental restorativeness - PER), physical engagement (walking speed, heart rate, and perceived exertion), and affective responses (enjoyment and affect). Additionally, qualitative information was collected through open-ended questions. The participants rated the IVEs with satisfactory levels of 'being there' and 'sense of reality,' but also reported discomforts such as 'flatness,' 'movement lag' and 'cyber sickness.' With equivalent heart rate and walking speed, participants reported higher perceived exertion in the IVEs than in the nature walk. The nature walk was associated with high enjoyment and enhanced affect. However, despite equivalent ratings of PER in the nature walk and in the IVEs, the latter were perceived as less enjoyable and gave rise to a poorer affect. Presence and PER did not differ between the two IVEs, although in the treadmill-IVE the negative affective responses had slightly smaller magnitude than in the sitting-IVE. In both the IVEs, the negative affective responses were mainly associated with cyber sickness, whereas PER was positively associated with enjoyment. From the qualitative analysis, it emerged that poor postural control and lack of a holistic sensory experience can also hinder immersion in the IVE. The results indicate that IVE technology might in future be a useful instrument in green exercise research and promotion, but only if image quality and cyber sickness can be addressed.

Psychological distress among Norwegian adolescents: Changes between 2001 and 2009 and associations with leisure time physical activity and screen-based sedentary behaviour

AIMS

The aim of this work was to examine psychological distress among Norwegian adolescents in relation to changes over time and the associations with leisure time physical activity and screen-based sedentary behaviour.

METHODS

This cross-sectional study was based on data retrieved from the Norwegian Youth Health Surveys in 2001 and 2009 in Hedmark County. Adolescents aged 15-16 years old completed a questionnaire regarding physical activity, sedentary behaviour, psychological distress and other health and lifestyle variables. The self-report Hopkins Symptom Checklist-10 was used to assess psychological distress. Multinomial logistic regression was used to analyse the associations between psychological distress, physical activity and sedentary behaviour.

RESULTS

Self-reported psychological distress increased significantly from 2001 to 2009 (from 19.4 to 28.2%), with the proportion of girls reporting psychological distress being twice as large as the proportion of boys. The proportion of adolescents who were physically active for ⩾11 hours per week increased significantly over the same period (from 6.0 to 10.4%). Sedentary behaviour ⩾6 hours per school day increased significantly among both sexes between 2001 and 2009. Physical activity (⩾11 hours) and sedentary behaviour (⩾6 hours) were both significantly associated with psychological distress.

CONCLUSIONS

The association between physical activity, sedentary behaviour and psychological distress was weak; only high amounts of physical activity and high amounts of screen-based sedentary behaviour were associated with psychological distress. Longitudinal studies are needed to provide further insights into these associations and to understand the extent to which these variables might be causally related.

ELIXIR-UK role in bioinformatics training at the national level and across ELIXIR

ELIXIR-UK is the UK node of ELIXIR, the European infrastructure for life science data. Since its foundation in 2014, ELIXIR-UK has played a leading role in training both within the UK and in the ELIXIR Training Platform, which coordinates and delivers training across all ELIXIR members. ELIXIR-UK contributes to the Training Platform’s coordination and supports the development of training to address key skill gaps amongst UK scientists. As part of this work it acts as a conduit for nationally-important bioinformatics training resources to promote their activities to the ELIXIR community. ELIXIR-UK also leads ELIXIR’s flagship Training Portal, TeSS, which collects information about a diverse range of training and makes it easily accessible to the community. ELIXIR-UK also works with others to provide key digital skills training, partnering with the Software Sustainability Institute to provide Software Carpentry training to the ELIXIR community and to establish the Data Carpentry initiative, and taking a lead role amongst national stakeholders to deliver the StaTS project – a coordinated effort to drive engagement with training in statistics.

The NHS health check programme in England: a qualitative study

Despite an extensive evidence-base linking patterns of health with social determinants, recent public health policy has emphasized 'lifestyle diseases' and risk factor modification through behavioural and pharmacological intervention. In England, one manifestation of this has been the launch of the National Health Service Health Check programme. This paper reports findings from a small-scale qualitative study exploring experiences of engaging with a community-based health check in Knowsley, England, among 17 males and 19 females, with varying levels of risk for cardiovascular disease, who agreed to be contacted for the purpose of research at the time they underwent their check. Analysis revealed that the community-based nature of the checks provided opportunities for people to find out more about their health who might not otherwise have done so. Participants expressed a range of responses to the communication of the risk score, often revealing their confusion about its meaning. Changes in behaviour were identified, which participants connected with having had a check. This study raises questions about where, how and by whom health checks are delivered. Emphasis on health checks reflects the dominant individualist ideology, but this study also suggests that the process provides opportunities to enable and empower individuals, albeit in small ways. However, they remain a 'downstream' approach to public health, emphasizing medical and behavioural options for risk factor reduction rather than focussing on primary prevention through changes to the wider environment. Furthermore, although developed as a central feature of the UK's strategy to reduce health inequalities, health checks may widen them.

Fruit and vegetables on prescription: a brief intervention in primary care

BACKGROUND

Increasing fruit and vegetable consumption is a goal for the U.K. Therefore, the effectiveness of a fruit and vegetable voucher scheme coupled with key 'five-a-day' consumption messages as a brief intervention in primary care consultations was assessed in the present study.

METHODS

One thousand one hundred and eighty-eight vouchers as a prescription for fruits and vegetables were routinely distributed to patients attending a primary healthcare centre in a deprived area, and 124 volunteer patients routinely attending the centre were included. Telephone-based questionnaires were used to examine changes in consumption over the short and medium term. Other key aspects assessed in the evaluation related to fruit and vegetable purchasing behaviour, knowledge relating to what constitutes a portion size, the relationship between food and health, and barriers to consumption.

RESULTS

Although 76.2% of participants used the prescription vouchers when purchasing fruits and vegetables, a significant change in the consumption or purchasing behaviour was not observed (P > 0.05). Participants' level of knowledge relating to the number of portions recommended and the portion size of different fruits and vegetables showed a moderate increase from baseline over the short and medium term. The primary barriers to fruit and vegetable consumption were reported as 'the quality of fresh fruits and vegetables' and 'the money available to spend on food'.

CONCLUSIONS

The use of 'the fruit and vegetable on prescription' scheme was an effective method of engaging participants in improving awareness of key diet-related health messages. However, further intervention is required to produce a significant impact on the actual behaviour change.

Introduction of the primary care cancer nursing role in a GP practice

Nurses have always had an important role in the care of cancer patients and many specific nursing roles in cancer services have been developed. A qualitative research strategy using semi-structured interviews was adopted in this case-study of the implementation of a primary care cancer nurse (PCCN) role in a general practice. The implementation of the PCCN role is reported in order to shed light on the extent to which integration of the role into existing systems of care had taken place; and to explore facilitating factors and barriers to the implementation of a new primary care role. Three major themes emerged from the data: the management of change; systems of care; and the complexity of professional interfaces. It is evident that the effective implementation of innovative nursing roles in primary care can present many challenges to the role holder and to the health and social care professionals with whom they come into contact. The importance of communication and consultation in the role implementation are emphasized.

Meeting the sexual health care needs of young people: a model that works?

INTRODUCTION

In the UK, young people have been identified as a specific group who experience poor sexual health and there is scope for improving this if sexual health services are sensitive and relevant to their needs. This paper reports on the work of two services which were set up specifically for young people, exploring whether the model of service provision adopted was successful in engaging this group.

METHODS

Routine monitoring data (anonymous) in relation to all contacts with the services were collected. After the services had become established, short questionnaires were administered to young people using them.

RESULTS

For service one, 425 contacts were recorded over 34 service sessions. Of these, 149 were new clients: 52% young men (78) and 48% young women (71), with a mean age of 14 years. There were 259 repeat contacts: 74% with young men (191) and 26% with young women (68). For service two, 399 contacts were recorded over 61 service sessions. Of these, 118 were new clients: 32% young men (38) and 68% young women (80), with a mean age of 16.8 years. There were 274 repeat contacts: 40% with young men (108) and 60% (166) with young women. All of the young people were generally very satisfied with the services they received. The youngest young people were less likely to indicate that they would have accessed other sexual health services.

DISCUSSION AND CONCLUSIONS

This study indicates that young people of both sexes, between the ages of 11 and 19 years, can be engaged by sexual health services, if provision is modelled on 'best practice' and what is known about the sexual health service needs of young people. Engagement with such services is a prerequisite for addressing the diversity of sexual health needs young people are likely to have in contemporary society and the findings of this study in relation to gender and age are particularly pertinent.

Mainstreaming prevention: prescribing fruit and vegetables as a brief intervention in primary care

This paper examines a brief preventive intervention as a model for embedding public health action in primary care.

BACKGROUND

Low fruit and vegetable intake is a major risk factor for cancer, coronary heart disease and stroke. The recommended intake of five portions per day would reduce death rates from these causes by 20%. However, average daily consumption in the UK is under three portions, and it is significantly lower in men, young people and lower socio-economic groups. In order to tackle risk factors such as poor diet, the white paper Choosing Health promises action and funding to mainstream prevention and transform the NHS from a sickness service to a genuine health service.

THE INTERVENTION

To promote increased fruit and vegetable consumption, primary care professionals working in a deprived area issue prescriptions which offer the patient discounts on fruit and vegetable purchases. Hand over of each prescription to the patient is linked explicitly to key five a day messages. This brief intervention takes 1-2 min to deploy.

IMMEDIATE OUTCOMES

Evaluation is ongoing. However, early feedback suggests that the intervention of prescription plus key messages has a significant impact on patients in highlighting the connection between food and health. Clinicians express satisfaction at having a preventive intervention that can be deployed with confidence and consistency in routine primary care consultations.

DISCUSSION

This brief intervention is presented as a potential model for embedding prevention in the day-to-day work of health professionals. Primary care is a natural setting for the promotion of health, but despite success in implementing some public health programmes, it has a patchy record in primary prevention. The reasons for this are examined, the impact of new contractual and commissioning levers is explored, and a general framework for mainstreaming public health action in primary care is proposed.

The nurse practitioner in primary care: alleviating problems of access?

Improving access to primary care services is an essential component of the NHS modernization plan and the advent of independent nurse practitioners in primary care has focused attention on the extent to which this group of nurses can effectively substitute for GPs. This study was designed to explore the role of a nurse practitioner in primary care, particularly whether the provision of a nurse practitioner facilitated access to care that met the needs of patients. Semistructured interviews were conducted with 14 patients who had consulted with the nurse practitioner, 10 staff within the practice who had knowledge of the role, and the nurse practitioner herself. With the permission of interviewees, interviews were audiotaped, the tapes transcribed verbatim, and the data were coded by theme. It was perceived by both groups of interviewees that access to care had been improved in that there were more appointments available, appointments were longer than they had been previously and were available at different times of the day. However, some areas in which access was 'restricted' were articulated by staff interviewees, such as limitations to the nurse practitioner's prescribing and problems with referring patients to secondary care. Additionally, while access to a member of the primary healthcare team was improved for many patients, access to a specific member of the team, such as a GP, was not always improved. Concerns were also expressed about how the role of the nurse practitioner needed to be developed in the practice. It can be concluded from this study that, potentially, the role of nurse practitioner has much to offer in terms of addressing problems of access in primary care for some patients. However, this is not a straightforward solution and in order for the role to be effective several issues highlighted in this study require addressing.

Adherence to exercise in later life: how can exercise on prescription programmes be made more effective?

A broad consensus has emerged in relation to the desirability of promoting exercise among a variety of 'at risk' groups via 'exercise on prescription' (EoP) schemes, as an alternative to orthodox, biomedical approaches to the management of health problems. Underpinning the rationale for such schemes is the notion that they can act as vehicles for encouraging long-term adherence to exercise. Whilst there is a common sense appeal to using EoP schemes to promote exercise, research to date suggests that evidence of their impact is limited. This paper attempts to make sense of these findings in the light of recent debates about adult lifestyles and exercise. More specifically, it brings work in the sociology of leisure to bear on the topic, on the premise that any study of adults' propensity towards sustainable physical activity needs to be viewed as an aspect of their lives 'in the round'. Such an analysis points up the value of synthesizing perspectives from across the disciplinary divide in order to shed light on particular 'problems', which obviate the necessity for further empirical work. The paper concludes by identifying a number of implications for public health policy and practice with respect to the matter of encouraging lifelong participation in sport and exercise in general, and via EoP schemes in particular. One such implication is the development of a model for understanding participation that shifts the emphasis away from a focus on motivation and behaviour change per se towards satisfaction and enjoyment through the development of skills and relationships. Reconceptualizing the matter of participation in this way is likely to lead not only to a more realistic appreciation of what can be expected from EoP schemes, but also a more adequate understanding of adherence to exercise in later life.

Involvement and detachment in researching sexuality: reflections on the process of semistructured interviewing

In this article, the authors reflect on the utility of the concept of involvement-detachment for researchers involved in a study of the lifeworlds of gay, lesbian, and bisexual young people where one of the researchers was lesbian. They focus in particular on the process of semistructured interviewing in qualitative research and the analysis of material generated by the interviews, noting that complete detachment from the subject of study is neither achievable nor desirable. They discuss the benefit of teamwork in supporting researchers and enhancing the integrity of the research, particularly when the subject is sensitive, the importance of researchers' active management of their own ideological leanings, and the understanding of project management as a conceptual and cognitive process that is fundamental to enhancing research rigor.

SDZ ASM 981: an emerging safe and effective treatment for atopic dermatitis

BACKGROUND

SDZ ASM 981 is a selective inhibitor of the production of pro-inflammatory cytokines from T cells and mast cells in vitro. It is the first ascomycin macrolactam derivative under development for the treatment of inflammatory skin diseases.

OBJECTIVES

This study was designed to determine the safety and efficacy of SDZ ASM 981 cream at concentrations of 0.05%, 0.2%, 0.6% and 1.0% in the treatment of patients with atopic dermatitis and to select the concentration to be used in phase III studies.

METHODS

This was a double-blind, randomized, parallel-group, multicentre dose-finding study. A total of 260 patients were randomly assigned to treatment with SDZ ASM 981 cream at concentrations of 0.05%, 0.2%, 0.6%, or 1.0%, matching vehicle cream, or the internal control 0.1% betamethasone-17-valerate cream (BMV). Treatment was given twice daily for up to 3 weeks.

RESULTS

A clear dose-response relationship for SDZ ASM 981 was evident, with 0.2%, 0.6% and 1.0% SDZ ASM 981 creams all being significantly more effective than vehicle (P = 0.041, 0.001 and 0.008, respectively) in terms of baseline to end-point changes in the Eczema Area Severity Index (EASI) and pruritus score. The 1.0% cream was the most effective SDZ ASM 981 concentration. BMV was more effective than the SDZ ASM 981 creams tested in this study. It appears that the efficacy plateau was not reached with the SDZ ASM 981 creams within 3 weeks treatment. SDZ ASM 981 was well tolerated. Burning or a feeling of warmth were the only adverse events reported more frequently in the 0.6% and 1.0% SDZ ASM 981 treatment groups than in the vehicle treatment group (42.9%, 48.9% and 34.9%, respectively). Few systemic adverse events were reported during the study (headache was the most frequent systemic event reported by 15 of 252 patients) and none was considered to be related to treatment. The local tolerability profile of the 1.0% cream was similar to that of the lower concentrations.

CONCLUSIONS

1.0% SDZ ASM 981 cream, which was shown to be safe, well tolerated and the most effective concentration in this study, was selected as the concentration to be further developed in phase III studies.

The eczema area and severity index (EASI): assessment of reliability in atopic dermatitis. EASI Evaluator Group

OBJECTIVE

To test the reliability of the eczema area and severity index (EASI) scoring system by assessing inter- and intra-observer consistency.

DESIGN

Training of evaluators, application, and assessment over 2 consecutive days.

SETTING

An academic center.

PATIENTS

Twenty adults and children with atopic dermatitis (AD); cohort 1 (10 patients > or = 8 years) and cohort 2 (10 patients < 8 years).

INTERVENTIONS

None.

MAIN OUTCOME MEASURE

The EASI was used by 15 dermatologist evaluators to assess atopic dermatitis in cohort 1 and cohort 2 on 2 consecutive days. Inter- and intraobserver reliability were analyzed.

RESULTS

Overall intra-evaluator reliability of the EASI was in the fair-to-good range. Inter-evaluator reliability analyses indicated that the evaluators assessed the patients consistently across both study days.

CONCLUSIONS

This study demonstrated that the EASI can be learned quickly and utilized reliably in the assessment of severity and extent of AD. There was consistency among the evaluators between consecutive days of evaluation. These results support the use of the EASI in clinical trials of therapeutic agents for AD.

The novel ascomycin derivative SDZ ASM 981 is effective for psoriasis when used topically under occlusion

Topical SDZ ASM 981 has been found to be highly effective in preclinical models of T-cell-mediated skin disease. T cell activation is crucial in the pathogenesis of psoriasis. It has been hypothesized that SDZ ASM 981 may prove to be an effective treatment for chronic plaque psoriasis. Therefore, the study objective was to determine the efficacy, tolerability and safety of the new topical macrolactam, SDZ ASM 981, for chronic plaque psoriasis. Ten patients with chronic plaque-type psoriasis were treated with SDZ ASM 981 (0.3% and 1.0%), the corresponding ointment base (placebo) and open-labelled clobetasol-17-propionate ointment (0.05%) in a randomized, double-blind, within-subject comparison for 2 weeks using the microplaque assay. Evaluation was performed by daily determination of clinical scores for erythema and induration. The results of the study showed that, after 2 weeks of treatment, total scores described by 92% for clobetasol, by 82% for 1 SDZ ASM 981, by 63% for 0.3% SDZ ASM 981 and by 18% for the ointment base (placebo). No adverse drug effects were seen in any patient throughout the study. We conclude from our results that the new macrolactam SDZ ASM 981 (1%) is similar to clobetasol-17-propionate (0.05%) in plaque-type psoriasis when applied topically under occlusion for 2 weeks using the microplaque assay.

The novel ascomycin derivative SDZ ASM 981 is effective for psoriasis when used topically under occlusion

Topical SDZ ASM 981 has been found to be highly effective in preclinical models of T-cell-mediated skin disease. T cell activation is crucial in the pathogenesis of psoriasis. It has been hypothesized that SDZ ASM 981 may prove to be an effective treatment for chronic plaque psoriasis. Therefore, the study objective was to determine the efficacy, tolerability and safety of the new topical macrolactam, SDZ ASM 981, for chronic plaque psoriasis. Ten patients with chronic plaque-type psoriasis were treated with SDZ ASM 981 (0.3% and 1.0%), the corresponding ointment base (placebo) and open-labelled clobetasol-17-propionate ointment (0.05%) in a randomized, double-blind, within-subject comparison for 2 weeks using the microplaque assay. Evaluation was performed by daily determination of clinical scores for erythema and induration. The results of the study showed that, after 2 weeks of treatment, total scores described by 92% for clobetasol, by 82% for 1 SDZ ASM 981, by 63% for 0.3% SDZ ASM 981 and by 18% for the ointment base (placebo). No adverse drug effects were seen in any patient throughout the study. We conclude from our results that the new macrolactam SDZ ASM 981 (1%) is similar to clobetasol-17-propionate (0.05%) in plaque-type psoriasis when applied topically under occlusion for 2 weeks using the microplaque assay.

Effectiveness of the ascomycin macrolactam SDZ ASM 981 in the topical treatment of atopic dermatitis

OBJECTIVE

To compare the safety and efficacy of 1% SDZ ASM 981 cream and a matching placebo cream in the treatment of patients with moderate atopic dermatitis.

DESIGN

A randomized, double-blind, placebo-controlled, right-and-left comparison study.

SETTING

Academic referral center.

PATIENTS

Thirty-four adult patients with moderate atopic dermatitis.

INTERVENTION

Topical 1% SDZ ASM 981 cream was applied twice daily (n=16) or once daily (n=18) and compared with a corresponding placebo cream base.

MAIN OUTCOME MEASURES

Efficacy was measured using a 4-point (0-3) scale for erythema, pruritus, exudation, excoriation, and lichenification (Atopic Dermatitis Severity Index [ADSI]). The ADSI score was defined as the sum of these 5 ratings (range, 0-15) and was determined on the pretreatment day (1 to 14 days before day 0) and on days 0, 2, 4, 7, 9, 11, 14, 16, 18, and 21. The percentage change from baseline (day 0) in the ADSI score was calculated on each of these days. Safety was evaluated by monitoring of adverse events, physical examination, hematologic examination, clinical chemistry studies, urinalysis, and measurement of blood levels of SDZ ASM 981.

RESULTS

Of the 38 patients recruited, 34 started and 28 completed treatment according to the protocol. Sixteen patients used the cream twice daily, with significant improvement after 2 days of treatment. Within 3 weeks of topical therapy with 1% SDZ ASM 981 cream twice daily, a mean reduction of 71.9% in the ADSI score was observed at the actively treated test sites compared with a mean reduction of 10.3% at the placebo-treated test sites (P<.001). Efficacy was significantly less in the group treated once daily (n=18), with mean reductions of 37.7% and 6.2%, respectively. The efficacy was especially apparent for pruritus and excoriation. There were no clinically relevant drug-related adverse effects.

CONCLUSIONS

Treatment with 1% SDZ ASM 981 cream was well tolerated. Twice-daily application of 1% SDZ ASM 981 cream was significantly more effective than use of the corresponding placebo and more effective than once-daily treatment. The new macrolactam ascomycin derivative SDZ ASM 981 is a promising agent for the treatment of patients with atopic dermatitis. More elaborate phase 2 and 3 trials are under way to fully investigate the potential of this medication.

Genomic regions regulating imprinting and insulin-like growth factor-II promoter 3 activity in transgenics: novel enhancer and silencer elements

Transgenic lines (89) were made with constructs containing eight different combinations of candidate regulatory elements from the insulin-like growth factor-II (Igf2)-H19 region of mouse chromosome 7. In all constructs, promoter 3 of Igf2 was attached to a firefly luciferase reporter gene. Promoter 3 was the common element that imposed a decrease in reporter activity similar to that of endogenous Igf2 after birth. The specific activity of the reporter was measured on the day of birth in the liver and the brain, after each transgene had been transmitted by either the father or the mother. This procedure demonstrated that the quantity and organ distribution of expression from this promoter can be regulated by each element. The following new information was obtained. (a) The 5' differentially methylated region of Igf2 inhibits promoter 3 in the liver. (b) The conserved DNase I-hypersensitive Middle region between Igf2 and H19 is an enhancer of promoter 3 in the brain. (c) The H19 promoter inhibits Igf2 promoter 3 in the brain. The results confirmed that the H19 enhancer is a strong enhancer of promoter 3 in the liver. A new finding was that one genomic region regularly imposed imprinted gene expression. This was the H19 enhancer, and this region was sufficient to give higher expression on maternal transmission in the majority of transgenic lines. The full data are reported in Supplementary Publication SUP 50180 (8 pages), which has been deposited at the British Library Document Supply Centre, Boston Spa, Wetherby, West Yorkshire LS23 7BQ, U.K., from whom copies can be obtained on the terms indicated in Biochem. J. (1997) 21, 8-10.

Gamma-detecting probe and autoradiographic studies of radiolabeled antibody B72.3 in CX-1 colon xenografts

Nude mice bearing CX-1 colon tumors were injected with 50 microCi 125I-labeled monoclonal antibody (MAb) B72.3. Radioactivity in tumors was studied with the gamma detecting probe (GDP) on days 1, 3, 7, and 10 after MAb injection. On each day, two mice were sacrificed and sections were examined with autoradiography (ARG), immunoperoxidase methods (IMP), and routine stains. Mean probe counts showed increasing tumor to background ratios and ARG demonstrated a progressive increase in radionuclide in the tumors. The distribution of 125I was primarily around the vascular spaces on day 1, but by day 3 and progressively it appeared in tumor gland lumina and necrotic areas. A regional correlation was shown between radionuclide in vascular spaces and its sequestration in tumor elements.

Intraoperative radioimmunodetection of colorectal tumor with a hand-held radiation detector

A hand-held gamma detection probe was used intraoperatively to localize primary and recurrent colorectal tumors in 28 patients 48 to 72 hours after they received an intravenous injection of 2.2 mCi of iodine-131 labeled anticarcinoembryonic antigen polyclonal baboon antibody. Preoperative evaluation included determination of serum carcinoembryonic antigen, barium enema, colonoscopy, chest film, computerized axial tomography, liver, spleen, and bone scans, and endoscopy when indicated. Preoperative whole-body imaging correctly localized primary tumors in only 33 percent of the patients, whereas it correctly demonstrated tumor in 64 percent of those with recurrent disease. Intraoperative tumor-to-background ratios derived from the detector probe were elevated in all patients, averaging 3.97:1 in primary lesions and 4.18:1 in recurrent tumors. Postoperatively, carcinoembryonic antigen was localized in tissues with the avidin-biotin peroxidase staining technique to confirm intraoperative readings. Variations in stain uptake in a patient could be correlated with variations in radiation detector readings in the same patient. Results support our previous work in nude mice, demonstrating the improved sensitivity and specificity of the hand-held gamma detection device over whole-body imaging for intraoperative localization of immunoradiolabeled tumors.

Bedside haemodynamic monitoring: experience in a general hospital

Bedside right heart haemodynamic monitoring was carried out on 55 occasions over 18 months in the cardiac care unit of a district general hospital. The technique was used to assist in the management of 27 patients with acute heart failure by helping to select appropriate treatment. Although the catheters were flow guided, insertion and positioning were facilitated by fluoroscopy. The procedure was safe, with one complication arising; technical difficulties occurred in eight cases. Prediction of cardiac output and left ventricular filling pressure by clinical assessment proved to be accurate in only 55% of cases: in patients with acute heart failure there was a tendency to underestimate the cardiac output (25%) and overestimate the left ventricular filling pressure (37%), whereas in patients with chronic heart failure the filling pressure was more accurately estimated (71%). Haemodynamic measurement was often invaluable in selecting and adjusting treatment, particularly in critically ill patients.