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People with non-communicable diseases (NCDs) have a higher prevalence of comorbid depression than the general population. While previous research has shown that behavioural activation is effective for general depression, its efficacy and safety in treating depression associated with NCDs remains unclear.
Aims
To compare the efficacy and safety of behavioural activation against comparators in reducing depression symptoms in people with NCDs.
Method
We searched six databases from inception until 30 March 2023 (updated 23 September 2024) for randomised controlled trials (RCTs) comparing behavioural activation with comparators for depression in people with NCDs. Risk of bias was assessed using the Cochrane Collaboration’s ‘risk-of-bias 2 tool’. We calculated a random-effects, inverse-variance weighting meta-analysis.
Results
Of the 21 386 initial studies, 12 RCTs (with 2144 patients) comparing behavioural activation with any comparator on treatment outcomes for depression with comorbid NCD met the inclusion criteria. Six studies rated as low risk of bias. For short-term follow-ups (up to 6 months), meta-analysis showed behavioural activation had little effect on depression symptom improvement in people with NCDs (Hedges’ g = −0.24; 95% CI, −0.62 to 0.15), compared to comparators, with high heterogeneity (I2 = 91.91%). Of the 12 included studies, three RCTs provided data on adverse events occurring during the trial.
Conclusions
Evidence from this systematic review is not sufficient to draw clear conclusions about the efficacy and safety of behavioural activation for reducing depression symptoms in people with NCDs. Future reviews need to include more high-quality, well-designed RCTs to better understand the potential benefits of behavioural activation for comorbid depression.
Working memory encompasses the limited incoming information that can be held in mind for cognitive processing. To date, we have little information on the effects of bilingualism on working memory because, absent evidence, working memory tasks cannot be assumed to measure the same constructs across language groups. To garner evidence regarding the measurement equivalence in Spanish and English, we examined second-grade children with typical development, including 80 bilingual Spanish–English speakers and 167 monolingual English speakers in the United States, using a test battery for which structural equation models have been tested – the Comprehensive Assessment Battery for Children – Working Memory (CABC-WM). Results established measurement invariance across groups up to the level of scalar invariance.
Review of social policies in the devolved countries of the UK during the Conservative– Liberal Democratic Coalition government at Westminster (2010– 15) indicates a clear shift towards a social democratic approach in Scotland and Wales, with growing divergence from key UK government social policies (for example, Birrell and Gray, 2016). In Northern Ireland (NI), the mandatory power-sharing arrangements made it more difficult to discern a distinct political approach.
In the period since 2015, politics and social policy in the UK have been dominated by two major influences, Brexit and the COVID-19 pandemic, as well as the most serious cost of living crisis for several decades. These have brought into sharp focus the increasing tensions between the UK government and each of the devolved parliaments.
Changes to constitutional and financial powers
Both the Scottish Parliament and the National Assembly for Wales (now called Senedd Cymru/Welsh Parliament) gained significantly expanded powers in the period since 2014. In the wake of the 2014 Scottish independence referendum, the Smith Commission was established to take forward the commitments made by the pro-Union parties regarding further devolution of powers to the Scottish Parliament. Pillar 2 of the ‘Smith Commission Agreement’ is ‘delivering prosperity, a healthy economy, jobs, and social justice’ (Smith Commission, 2014, p 12). The commission recommended devolution of significant areas of social security responsibility so that, for example, while the State Pension and the National Minimum Wage would remain reserved to Westminster, a wide range of benefits for carers, disabled people and those who are ill, plus benefits which comprised the Regulated Social Fund (including the Cold Weather Payment, Sure Start Maternity Grants, Winter Fuel Payment and Discretionary Housing Payments) should be devolved. Universal Credit was to remain a reserved benefit administered and delivered by the Department for Work and Pensions, but the Scottish Government would have the power to change the frequency of Universal Credit payments, vary the existing plans for single-household payments and the housing costs element of Universal Credit, and pay landlords direct for housing costs in Scotland.
The Virtual Interprofessional Education program is a multi-institutional consortium collaborative formed between five universities across the United States. As of January 2022, the collaborative includes over 60 universities in 30 countries. The consortium brings healthcare students together for a short-term immersive team experience that mimics the healthcare setting. The VIPE program has hosted over 5,000 students in healthcare training programs. The VIPE program expanded to a VIPE Security model to host students across multiple disciplines outside the field of healthcare to create a transdisciplinary approach to managing complex wicked problems.
Method:
Students receive asynchronous materials ahead of a synchronous virtual experience. VIPE uses the Interprofessional Education Competencies (IPEC) competencies (IPEC, 2016) and aligns with The Health Professions Accreditors Collaborative (HPAC) 2019 guidelines. VIPE uses an active teaching strategy, problem or case-based learning (PBL/CBL), which emphasizes creating an environment of psychological safety and its antecedents (Frazier et al., 2017 and Salas, 2019, Wiss, 2020). Following this model, VIPE Security explores whether the VIPE model can be tailored to work across multiple sectors to discuss management of complex wicked problems to include: climate change, disaster, cyber attacks, terrorism, pandemics, conflict, forced migration, food/water insecurity, human/narco trafficking etc. VIPE Security has hosted two events to include professionals in the health and security sectors to work through complex wicked problems to further understand their roles, ethical and responsible information sharing, and policy implications.
Results:
VIPE demonstrates statistically significant gains in knowledge towards interprofessional collaborative practice as a result of participation. VIPE Security results are currently being analyzed.
Conclusion:
This transdisciplinary approach to IPE allows for an all-hands-on-deck approach to security, fostering early education and communication of students across multiple sectors. The VIPE Security model has future implications to be utilized within multidisciplinary organizations for practitioners, governmental agencies, and the military.
To determine the safety and feasibility of over-expansion of right ventricle to pulmonary artery conduits during transcatheter pulmonary valve placement.
Background:
Transcatheter pulmonary valve placement is an alternative to surgical pulmonary valve replacement. Traditionally, it was thought to be unsafe to expand a conduit to >110% of its original size.
Methods:
This retrospective cohort study from two centers includes patients with right ventricle to pulmonary artery conduits with attempted transcatheter pulmonary valve placement from 2010 to 2017. Demographic, procedural, echocardiographic and follow-up data, and complications were evaluated in control and overdilation (to >110% original conduit size) groups.
Results:
One hundred and seventy-two patients (51 overdilation and 121 control) had attempted transcatheter pulmonary valve placement (98% successful). The overdilation group was younger (11.2 versus 16.7 years, p < 0.001) with smaller conduits (15 versus 22 mm, p < 0.001); however, the final valve size was not significantly different (19.7 versus 20.2 mm, p = 0.2). Baseline peak echocardiographic gradient was no different (51.8 versus 55.6 mmHg, p = 0.3). Procedural complications were more frequent in overdilation (18%) than control (7%) groups (most successfully addressed during the procedure). One patient from each group required urgent surgical intervention, with no procedural mortality. Follow-up echocardiographic peak gradients were similar (24.1 versus 26 mmHg, p = 0.5).
Conclusions:
Over-expansion of right ventricle to pulmonary artery conduits during transcatheter pulmonary valve placement can be performed successfully. Procedural complications are more frequent with conduit overdilation, but there was no difference in the rate of life-threatening complications. There was no difference in valve function at most recent follow-up, and no difference in rate of reintervention. The long-term outcomes of transcatheter pulmonary valve placement with conduit over-expansion requires further study.
Little is known about the relationship between sentence production and phonological working memory in school-age children. To fill this gap, we examined how strongly these constructs correlate. We also compared diagnostic groups’ working memory abilities to see if differences co-occurred with qualitative differences in their sentences.
Method
We conducted Bayesian analyses on data from seven- to nine-year-old children (n = 165 typical language, n = 81 dyslexia-only, n = 43 comorbid dyslexia and developmental language disorder). We correlated sentence production and working memory scores and conducted t tests between groups’ working memory scores and sentence length, lexical diversity, and complexity.
Results
Correlations were positive but weak. The dyslexic and typical groups had dissimilar working memory and comparable sentence quality. The dyslexic and comorbid groups had comparable working memory but dissimilar sentence quality.
Conclusion
Contrary to literature-based predictions, phonological working memory and sentence production are weakly related in school-age children.
The Southern dietary pattern, derived within the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort, is characterised by high consumption of added fats, fried food, organ meats, processed meats and sugar-sweetened beverages and is associated with increased risk of several chronic diseases. The aim of the present study was to identify characteristics of individuals with high adherence to this dietary pattern. We analysed data from REGARDS, a national cohort of 30 239 black and white adults ≥45 years of age living in the USA. Dietary data were collected using the Block 98 FFQ. Multivariable linear regression was used to calculate standardised beta coefficients across all covariates for the entire sample and stratified by race and region. We included 16 781 participants with complete dietary data. Among these, 34·6 % were black, 45·6 % male, 55·2 % resided in stroke belt region and the average age was 65 years. Black race was the factor with the largest magnitude of association with the Southern dietary pattern (Δ = 0·76 sd, P < 0·0001). Large differences in Southern dietary pattern adherence were observed between black participants and white participants in the stroke belt and non-belt (stroke belt Δ = 0·75 sd, non-belt Δ = 0·77 sd). There was a high consumption of the Southern dietary pattern in the US black population, regardless of other factors, underlying our previous findings showing the substantial contribution of this dietary pattern to racial disparities in incident hypertension and stroke.
This chapter explores the relationship between human rights and health and social care. It begins by setting out the main international mechanisms and the obligations that these place on governments. It then discusses the impact of international and domestic human rights instruments through an examination of developments in social care policy, and with regard to reproductive healthcare rights in Northern Ireland. It also highlights issues relating to devolution and the implementation of human rights in the UK.
International mechanism relating to the right to health and social care
In 2015, the principles of a human rights-based approach to health were endorsed in the United Nations 2030 Agenda for Sustainable Development (United Nations, 2015), including the target of universal health coverage. However, the right to the highest attainable standard of health has long been internationally recognised as a fundamental human right. In 1946, the constitution of the World Health Organization (WHO) set out the principles which it described as basic to happiness, harmonious relations and the security of all peoples. These included the statement that: ‘The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition’ (WHO, 1946: 1). The Universal Declaration of Human Rights, adopted by the United Nations in 1948, for example, refers to the:
right to a standard of living adequate for the health and wellbeing of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control. (Article 25)
Since then, a number of other human rights treaties have recognised the right to health. The most authoritative statement of the right to health is set out in the International Covenant on Economic, Social and Cultural Rights (ICESCR) (United Nations, 1966). Article 12 of the Covenant recognises ‘the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’.
A relatively new common feature of the devolved administrations has been the emergence of outcome-based frameworks as key components of their policy-making processes. This trend has received comparatively little analysis or comment in academic work on devolved policy-making, and existing work has tended to focus mainly on other policy dimensions (Birrell, 2009; Cairney, 2011; Birrell and Gormley-Heenan, 2016; Cole and Stafford, 2015; Cairney et al, 2016). Coverage in more specialist forms in reports or articles is limited, as is any comparative analysis. There are a range of different outcomes-based models or frameworks (Penna and Williams, 2005) rooted in different methodological positions, including in England specific NHS, adult social care and public health outcomes frameworks. Therefore the use of the generic term ‘outcomesbased approaches’ in government narratives in all three countries has not helped provide clarity.
In the devolved jurisdictions there has been much attention on the influence of the outcomes- or results-based accountability methodology developed and promoted by Friedman (2005). Based on population measures and indicators, the Friedman model has been used in performance management, particularly in the US. Key features of the approach include working backwards from a set of desired outcomes and the use of three performance categories: ‘How much did we do?’, ‘How well did we do it?’ and ‘Is anyone better off?’ Although not extensively adopted by the Westminster government, the outcomesbased accountability (OBA) approach has been used by some local authorities in England, particularly with regard to children's services and education. This chapter is mainly concerned with the introduction and use of OBA in policy-making in the three devolved administrations where there has been divergence in its use and in the nature and scope of approaches. It examines the emergence of outcomes-based approaches in Scotland, Wales and Northern Ireland, the rationale for their adoption and arguments about benefits and criticisms. Conceptual and definitional issues associated with OBA are considered as are the choice and use of indicators and the policy implications arising from its use.
Development of outcomes-based approaches in the devolved Administrations
Scotland led the way in using an outcomes-based approach that has come to be associated with a Scottish approach to public sector performance (Cook, 2017a).
The referendum vote for Remain in Scotland and Northern Ireland and the small majority for Leave in Wales immediately attracted much attention to the position of the devolved governments on Brexit negotiations and to the impact of Brexit on their jurisdictions. As the core of devolved powers relate to social policy, identifying the impact of leaving the EU on aspects of social policy is highly significant. This article examines the impact of EU programmes, funding, directives and regulations as delivered in recent years, noting the nature of the participation of the devolved administrations in EU decision making. The post-referendum concerns of the devolved governments and their approaches to Brexit and Brexit negotiations are explained. Also discussed are the likely major changes as well as possible changes that will take place in the operation of devolution after Brexit.
Typhoon Haiyan hit the Philippines in November 2013 and left a trail of destruction. As part of its emergency response, Médecins Sans Frontières distributed materials for reconstructing houses and boats as standardized kits to be shared between households. Community engagement was sought and communities were empowered in deciding how to make the distributions. We aimed to answer, Was this effective and what lessons were learned?
Methods
A cross-sectional survey using a semi-structured questionnaire was conducted in May 2014 and included all community leaders and 269 households in 22 barangays (community administrative areas).
Results
All houses were affected by the typhoon, of which 182 (68%) were totally damaged. All households reported having received and used the housing material. However, in 238 (88%) house repair was incomplete because the materials provided were insufficient or inappropriate for the required repairs.
Conclusion
This experience of emergency mass distribution of reconstruction or repair materials of houses and boats led by the local community was encouraging. The use of “standardized kits” resulted in equity issues, because households were subjected to variable degrees of damage. A possible way out is to follow up the emergency distribution with a needs assessment and a tailored distribution. (Disaster Med Public Health Preparedness. 2017;11:285–289)
Since the establishment of devolution for Scotland, Wales and Northern Ireland in 1999, a major feature has been the prominence of social policy in terms of the nature of devolved powers and in terms of devolved expenditure (Chaney and Drakeford, 2004; Mooney et al, 2006; Birrell, 2009). This was again demonstrated in the various programmes for government published following the 2011 elections for the devolved assemblies and the Scottish Parliament. There was originally a degree of policy continuity from the previous administrations, produced by rather similar electoral outcomes. In Scotland, the Scottish National Party (SNP) moved from a position as a minority government to forming the government with a majority (Cairney, 2011). In Wales, a Labour–Plaid Cymru coalition changed to a Labour administration, but with only 50% of the Assembly members. Northern Ireland continued with its form of compulsory coalition or power-sharing, consisting of a four-party executive, later a five-party executive, although with two parties, the Democratic Unionists and Sinn Fein, in a dominant position. The establishment of a UK Conservative–Liberal Democratic coalition brought an incongruence to the party and ideological alignments between the UK and the devolved governments and the increased possibility of major policy divergence. Three other debates were to have an important influence on the development of social policy. First, there was a debate on the future of devolution under the coalition government: this was to mean that a settled direction for the future of devolved policies and the meaning of the union was not clear (Jeffery et al, 2010). Second, there was a debate on the enhancements and changes in devolved powers: in Scotland, the debate on the powers of a Scottish government related to the campaign for independence for Scotland and the referendum; a major debate also commenced in Wales on the extension of legislative powers; while completing the devolution of justice and policing and some other limited extensions dominated the Northern Ireland debate. Third, there was an extensive debate on the financial arrangements and increasing fiscal devolution and responsibilities.
Context for proposals and action on financial and constitutional powers
A number of contextual factors were important for the operation of devolution under the coalition government in relation to social policy.
There is an emerging evidence base about best practice in supporting
recovery. This is usually framed in relation to general principles, and
specific pro-recovery interventions are lacking.
Aims
To develop a theoretically based and empirically defensible new
pro-recovery manualised intervention – called the REFOCUS
intervention.
Method
Seven systematic and two narrative reviews were undertaken. Identified
evidence gaps were addressed in three qualitative studies. The findings
were synthesised to produce the REFOCUS intervention, manual and
model.
Results
The REFOCUS intervention comprises two components: recovery-promoting
relationships and working practices. Approaches to supporting
relationships comprise coaching skills training for staff, developing a
shared team understanding of recovery, exploring staff values, a
Partnership Project with people who use the service and raising patient
expectations. Working practices comprise the following: understanding
values and treatment preferences; assessing strengths; and supporting
goal-striving. The REFOCUS model describes the causal pathway from the
REFOCUS intervention to improved recovery.
Conclusions
The REFOCUS intervention is an empirically supported pro-recovery
intervention for use in mental health services. It will be evaluated in a
multisite cluster randomised controlled trial (ISRCTN02507940).
In analysing governance and social policy in Northern Ireland in the period of devolution 1999–2002 Eithne McLaughlin described and predicted the dominance of a lowest common denominator approach to the formulation of social policies. This paper examines the period of restored devolution 2007–11 using this thesis. It identifies the trends in the development of social policies after 2007 and examines social policy-making by the government under five categories. Having established the reasons for this complex approach to social policy formulation, consideration is also given to the outcomes of the policy process.
How does the demand for lobbying reflected by government policy activity influence the use of lobbying strategies and tactics? The authors examine this question by assessing how the complexity of the policy space affects the political action committee (PAC) system. They hypothesize that the complexity of the policy space indirectly affects the size and activity of the PAC system through its direct effect on interest organization density. The authors test this hypothesis within the health sector using a unique data set that connects individual interest organizations registered to lobby U.S. state legislatures with active PACs in the state. It appears that social, economic, and political measures of policy space complexity influence the size of the lobbying community, which in turn influences the size and activity of the PAC community.
1. This paper confirms and extends several observations during the past 20 years that, despite many reports to the contrary, the rat is not unduly resistant to initial infection with tubercle bacilli provided they lodge in the lungs.
2. The pattern of pathogenesis in the rat is probably closest to the now classical picture in the mouse, i.e. the response of a species with a low hypersensitivity potential. The pathology of the lesions agreed closely with the descriptions of Wessels (1941) and Kumashiro (1958b) resembling the mouse in most respects but, unlike the mouse, including the production of giant cells.
3. When tested by footpad inoculation with 1/3·5 Old Tuberculin a positive reaction was demonstrated, commencing between 2 and 5 weeks after infection and persisting for several weeks. A fatal systemic reaction could often be induced with large doses of tuberculin given intraperitoneally.
4. In a few cases loss of allergy was shown to be associated with a terminal anergic flare of the type observed previously in mice and guinea-pigs.
Working within a large geographic area, McDonald Observatory lacks the resources to send staff to present professional development workshops to teachers – and only limited numbers of teachers have the resources to attend workshops at our observatory. Our solution is the development of a new program to bring the workshop to teachers in their own communities through videoconferencing. Each workshop location has a co-facilitator who prepared for his/her duties through an orientation/training session held at McDonald Observatory. At the observatory, they experienced a variety of activities and selected the ones most suitable for the grade-levels of the teachers in their region; they recruit the teachers for the local workshop. Each videoconference session includes pre/post assessment of the participants, an interactive videoconference with an expert presenter, and assistance from the co-facilitator who manages the materials and assists with the activities. Through use of this technology, we expect to reach 500 teachers. An independent evaluator is preparing formative and summative evaluation for the project.