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People with severe mental illness (SMI) have worse physical health than the general population. There is evidence that support from volunteers can help the mental health of people with SMI, but little evidence regarding the support they can give for physical health.
Aims
To evaluate the feasibility of an intervention where volunteer ‘Health Champions’ support people with SMI in managing their physical health.
Method
A feasibility hybrid randomised controlled trial conducted in mental health teams with people with SMI. Volunteers delivered the Health Champions intervention. We collected data on the feasibility of delivering the intervention, and clinical and cost-effectiveness. Participants were randomised by a statistician independent of the research team, to either having a Health Champion or treatment as usual. Blinding was not done.
Results
We recruited 48 participants: 27 to the intervention group and 21 to the control group. Data were analysed for 34 participants. No changes were found in clinical effectiveness for either group. Implementation outcomes measures showed high acceptability, feasibility and appropriateness, but with low response rates. No adverse events were identified in either group. Interviews with participants found they identified changes they had made to their physical health. The cost of implementing the intervention was £312 per participant.
Conclusions
The Health Champion intervention was feasible to implement, but the implementation of the study measures was problematic. Participants found the intervention acceptable, feasible and appropriate, and it led them to make changes in their physical health. A larger trial is recommended, with tailored implementation outcome measures.
Contemporary understanding of the mechanisms of disease increasingly points to examples of “genetic diseases” with an infectious component and of “infectious diseases” with a genetic component. Such blurred boundaries generate ethical, legal, and social issues and highlight historical contexts that must be examined when incorporating host genomic information into the prevention, outbreak control, and treatment of infectious diseases.
Online grocery shopping could improve access to healthy food, but it may not be equally accessible to all populations – especially those at higher risk for food insecurity. The current study aimed to compare the socio-demographic characteristics of families who ordered groceries online v. those who only shopped in-store.
Design:
We analysed enrollment survey and 44 weeks of individually linked grocery transaction data. We used univariate χ2 and t-tests and logistic regression to assess differences in socio-demographic characteristics between households that only shopped in-store and those that shopped online with curbside pickup (online only or online and in-store).
Setting:
Two Maine supermarkets.
Participants:
863 parents or caregivers of children under 18 years old enrolled in two fruit and vegetable incentive trials.
Results:
Participants had a total of 32 757 transactions. In univariate assessments, online shoppers had higher incomes (P < 0 0001), were less likely to participate in Special Supplemental Nutrition Program for Women, Infants, and Children or Supplemental Nutrition Assistance Program (SNAP; P < 0 0001) and were more likely to be female (P = 0·04). Most online shoppers were 30–39 years old, and few were 50 years or older (P = 0·003). After controlling for age, gender, race/ethnicity, number of children, number of adults, income and SNAP participation, female primary shoppers (OR = 2·75, P = 0·003), number of children (OR = 1·27, P = 0·04) and income (OR = 3·91 for 186–300 % federal poverty line (FPL) and OR = 6·92 for >300 % FPL, P < 0·0001) were significantly associated with likelihood of shopping online.
Conclusions:
In the current study of Maine families, low-income shoppers were significantly less likely to utilise online grocery ordering with curbside pickup. Future studies could focus on elucidating barriers and developing strategies to improve access.
The narrative of a second Gilded Age erroneously suggests that the current dynamics are repeating those of the late nineteenth century. Although they share certain important characteristics, these are profoundly different historical moments. Focusing on the history of capitalism and labor, and taking a global perspective, demonstrates that the two periods were bookends—the “before” and “after” to a lengthy period when the cruelest characteristics of corporate capitalism were temporarily constrained. The late nineteenth century saw the ascent of serious efforts to rein in the power of the new capitalism and force it to bow down to the needs of civil society. During the late twentieth and early twenty-first centuries, we are experiencing the decline of that effort as capitalists and their ideological and political supporters push to see how far they can go to ensure the unchallenged hegemony of corporate and property rights. The slow climb toward a more humane capitalism and the rapid descent away from it constitute two very different experiences.
Anecdotal evidence suggests the use of bolus tube feeding is increasing in the long-term home enteral tube feed (HETF) patients. A cross-sectional survey to assess the prevalence of bolus tube feeding and to characterise these patients was undertaken. Dietitians from ten centres across the UK collected data on all adult HETF patients on the dietetic caseload receiving bolus tube feeding (n 604, 60 % male, age 58 years). Demographic data, reasons for tube and bolus feeding, tube and equipment types, feeding method and patients’ complete tube feeding regimens were recorded. Over a third of patients receiving HETF used bolus feeding (37 %). Patients were long-term tube fed (4·1 years tube feeding, 3·5 years bolus tube feeding), living at home (71 %) and sedentary (70 %). The majority were head and neck cancer patients (22 %) who were significantly more active (79 %) and lived at home (97 %), while those with cerebral palsy (12 %) were typically younger (age 31 years) but sedentary (94 %). Most patients used bolus feeding as their sole feeding method (46 %), because it was quick and easy to use, as a top-up to oral diet or to mimic mealtimes. Importantly, oral nutritional supplements (ONS) were used for bolus feeding in 85 % of patients, with 51 % of these being compact-style ONS (2·4 kcal (10·0 kJ)/ml, 125 ml). This survey shows that bolus tube feeding is common among UK HETF patients, is used by a wide variety of patient groups and can be adapted to meet the needs of a variety of patients, clinical conditions, nutritional requirements and lifestyles.
Edited in association with
Dawn Bessarab, University of Western Australia, Perth,Juli Coffin, Notre Dame University, Australia,Michael Wright, Curtin University, Perth
THIS CHAPTER'S CENTRAL focus is to demonstrate how Aboriginal constructs, such as the Coffin Cultural Security (CCS) Model and the Cultural Security Continuum (Coffin 2007), offer culturally secure ways forward for Aboriginal and Torres Strait Islander people engaged in and affected by community development processes. We do this by focusing on two community development projects undertaken in the health and local government sectors in rural and regional Western Australia. The motivation for community development practitioners to utilise tools such as the CCS Model and the Cultural Security Continuum is connected to the influence of colonial history and recognition of Aboriginal knowledge. In relation to colonial history, Australian community development processes are deeply entrenched within privileged Western paradigms that do not allow for processes to be developed and implemented from an Aboriginal perspective (Ife 2003). With regard to the relationship between Aboriginal knowledge and community development processes, views and experiences of Aboriginal communities have been historically excluded or not wholly embraced (Ife 2003; Sherwood 1999).
Situating ourselves
We would like to start this chapter by acknowledging the traditional owners of the Geraldton and Port Hedland areas. These very important areas of Western Australia are where Aboriginal knowledge production has occurred and the country that holds us as Aboriginal authors. We are researchers who both came to be working at the Telethon Kids Institute through similar pathways and are both attached to the ‘Working Towards Culturally Secure Health Service for Aboriginal Community’ research project. Juli Coffin is a Nyangumarta/Pilbara woman and Charmaine Green is a Wajarri/Badimaya Midwest woman.
Community development – five common principles in the Aboriginal context
As identified in Chapter 1 by Dawn Bessarab and Simon Forrest, community development is about social change within a community, which it facilitates by enabling communities to find solutions to identified community problems (Sherwood 1999). In writing this chapter, one of our initial tasks was to search existing community development literature from an Australian Aboriginal perspective. We wanted to understand the place of Aboriginal people in Australian community development frameworks and access Aboriginal experiences and perspectives in this context. We found that limited literature existed from an Aboriginal perspective, and the majority of Aboriginal community development projects were mostly evaluated and examined from a non-Aboriginal perspective (Campbell, Pyett, McCarthy, Whiteside & Tsey 2007; Higgins 2005; Ife 2003).
The acquisition of an empire that stretched across North America, the Caribbean, Central America, and the Pacific world transformed the United States during the Gilded Age and Progressive Era. While scholars have examined many aspects of U.S. expansionism, a neglected issue involved the imperial labor migrations it required. From across North America, the Caribbean, southern Europe, and Asia, men and women were recruited to labor in the service of building U.S. global power at the turn of the twentieth century. Officials saw recruiting and moving laborers from far away as necessary to ensure productivity and discipline. This required U.S. government and corporate leaders to experiment with labor management in ways that shaped the “long twentieth century” of U.S. history. Mobility was not only central to the logic of the U.S. Empire; when possible, workers also deployed it for their own ends. Therefore migration became a terrain of struggle between workers and government officials. This paper looks in particular at documents generated by two migrating groups important in the making of U.S. global power. Afro-Caribbeans who traveled to construct the Panama Canal; and soldiers who served in the War of 1898 and the Philippine-American War.
Influenza A (H1N1) pdm09 became the predominant circulating strain in the United States during the 2013–2014 influenza season. Little is known about the epidemiology of severe influenza during this season.
METHODS
A retrospective cohort study of severely ill patients with influenza infection in intensive care units in 33 US hospitals from September 1, 2013, through April 1, 2014, was conducted to determine risk factors for mortality present on intensive care unit admission and to describe patient characteristics, spectrum of disease, management, and outcomes.
RESULTS
A total of 444 adults and 63 children were admitted to an intensive care unit in a study hospital; 93 adults (20.9%) and 4 children (6.3%) died. By logistic regression analysis, the following factors were significantly associated with mortality among adult patients: older age (>65 years, odds ratio, 3.1 [95% CI, 1.4–6.9], P=.006 and 50–64 years, 2.5 [1.3–4.9], P=.007; reference age 18–49 years), male sex (1.9 [1.1–3.3], P=.031), history of malignant tumor with chemotherapy administered within the prior 6 months (12.1 [3.9–37.0], P<.001), and a higher Sequential Organ Failure Assessment score (for each increase by 1 in score, 1.3 [1.2–1.4], P<.001).
CONCLUSION
Risk factors for death among US patients with severe influenza during the 2013–2014 season, when influenza A (H1N1) pdm09 was the predominant circulating strain type, shifted in the first postpandemic season in which it predominated toward those of a more typical epidemic influenza season.
Infect. Control Hosp. Epidemiol. 2015;36(11):1251–1260
To compare commonly used dietary screeners for fat intake and fruit and vegetable intake with 24 h dietary recalls among low-income, overweight and obese African-American women.
Design
Three telephone interviews were completed; measures included two 24 h dietary recalls (a weekday and weekend day) using the Nutrition Data System for Research software, the Behavioral Risk Factor Surveillance System’s (BRFSS) Fruit and Vegetable Consumption Module and the National Cancer Institute’s (NCI) Percentage Energy from Fat Screener.
Setting
Participants were recruited from three federally qualified health centres in south-west Georgia, USA.
Subjects
Participants (n 260) were African-American women ranging in age from 35 to 65 years. About half were unemployed (49·6 %) and 58·7 % had a high-school education or less. Most were obese (88·5 %), with 39·6 % reporting a BMI≥40·0 kg/m2.
Results
Mean fruit and vegetable intake reported from the 24 h dietary recall was 2·66 servings/d compared with 2·79 servings/d with the BRFSS measure. The deattenuated Pearson correlation was 0·22, with notable variation by weight status, education level and age. Mean percentage of energy from fat was 35·5 % as reported from the 24 h dietary recall, compared with 33·0 % as measured by the NCI fat screener. The deattenuated Pearson correlation was 0·38, also with notable variation by weight status, education level and age.
Conclusions
Validity of brief dietary intake measures may vary by demographic characteristics of the sample. Additional measurement work may be needed to accurately measure dietary intake in obese African-American women.
Mindfulness-based interventions and mindfulness techniques have become increasingly popular in psychosocial care. These interventions have also been increasingly used with cancer patients and survivors. However, more attention is due to issues such as how these techniques may be specifically relevant for an oncology population and whether the religious derivation of mindfulness should be considered by frontline psychosocial clinicians. This article provides a history and overview of the use of mindfulness in psychosocial cancer care.
Scholarship on American labor politics has been dominated by the view that the American Federation of Labor, the dominant labor organization, rejected political action in favor of economic strategies. Based upon extensive research into labor and political party records, this study demonstrates that, despite the common belief, the AFL devoted great attention to political activity. The organization's main strategy, however, which Julie Greene terms 'pure and simple politics', dictated that trade unionists alone should shape American labor politics. Exploring the period from 1881 to 1917, Pure and Simple Politics focuses on the quandaries this approach generated for American trade unionists. Politics for AFL members became a highly contested terrain, as leaders attempted to implement a strategy which many rank-and-file workers rejected. Furthermore, its drive to achieve political efficacy increasingly exposed the AFL to forces beyond its control, as party politicians and other individuals began seeking to influence labor's political strategy and tactics.
This article examines the experiences of Spanish workers during the construction of the Panama Canal by the United States from 1904 to 1914. Spaniards engaged in a wide range of protest actions during the construction years, from strikes to food riots to anarchist politics. Employing Victor Turner's concept of liminality, the article highlights the mutability of the Spaniards' position and identity and examines several factors that shaped their experiences: the US government's policies of racial segregation and the injustices Spaniards experienced; the political and racial identities they brought with them from Spain; and their complex racial and imperial status in the Canal Zone. Spaniards possessed a remarkably fluid racial identity, considered white or nonwhite depending on circumstances, and that shifting status fueled their racial animosities as well as their protests.
A combination of on- and off-site palaeo-environmental and archaeological investigations of the upper Allen valley of Dorset conducted in 1998–2000 has begun to reveal a different model of landscape development than those previously put forward. A combination of off-site geoarchaeological and aerial photographic survey and palynological analyses of two relict palaeochannel systems, and sample investigations of four Bronze Age round barrows and a Neolithic enclosure, have been combined with inter-regional summaries of the archaeological and molluscan records to re-examine the prehistoric landscape dynamics in the study area. Preliminary results suggest that woodland development in the earlier Holocene appears to have been more patchy than the presumed model of full climax deciduous woodland. With open areas still present in the Mesolithic, the area witnessed its first exploitation of the chalk downs, thus slowing and altering soil development of the downlands. Consequently, many areas perhaps never developed thick, well structured, clay-enriched soils (or argillic brown earths), but rather thin brown earths. By the later Neolithic these under-developed soils had become thin rendzinas, largely as a consequence of human exploitation. The presence of thinner and less well-developed soils over large areas of downland removes the necessity for envisaging extensive soil erosion and thick aggraded deposits in the valley bottom in later prehistory. The investigations have suggested that, if there were major changes in vegetation and soil complexes, these had already occurred by the Neolithic rather than in the Bronze Age as suggested by previous researchers, and the area has remained relatively stable since.
Many factors influence the type and quantity of services received by patients and, thus, the total cost of care. Knowledge of these factors can aid budgetary and service-planning decisions.
Aims
To investigate factors that influence the cost of caring for patients with severe psychotic illness.
Method
Univariate and multivariate analyses were used to examine associations between baseline characteristics and subsequent 2-year total direct costs in 667 patients from the UK700 case management trial.
Results
Significantly more money was spent on younger patients, those with longer duration of illness, those who had spent less time living independently and those who had spent longer in hospital for psychiatric reasons.
Conclusions
Total costs of caring for patients with severe psychotic illness appear to be influenced to a large extent by age, duration of illness and past levels of dependence on statutory services. The strength of these relationships is greater than the impact of illness severity.
After 1912, a growing consensus that the government must do more to correct the evils of industrial capitalism took hold through much of the United States, helping to recast political relationships and strategies along the way. Woodrow Wilson had won the presidency in 1912 by articulating a vision of only very modest state action. Poised between Theodore Roosevelt, who advocated a more interventionist state, and William Taft, who celebrated the virtues of laissez-faire relationships and viewed the government's role negatively, Wilson took the middle road. More government was needed, he seemed to say, but not much more. When campaigning among workers that year, Wilson sounded remarkably like Samuel Gompers, warning that a powerful government could turn virtuous workingmen into dependent wards of the state.
Once elected, Wilson found his vision difficult to implement because numerous pressures encouraged him to use his power in more positive ways. Both the Progressive and Socialist movements enjoyed great vitality during these years, and activists from both movements clamored for expanded governmental responsibilities, demanding everything from free schoolbooks for children, to pensions for mothers, to laws regulating child or female labor. Wilson's own actions, and especially his role in forming the Commission on Industrial Relations in 1913, helped focus public attention on the government. Organized labor continued fighting to win anti-injunction legislation and exemption from the Sherman Anti-Trust Act.