Review objective/question The objective of this umbrella review is to examine the effectiveness of different types of weight management, smoking cessation and alcohol reduction interventions in producing explicitly measured behavior change or proxy measures of behavior change in pregnant women. Specifically the review question is: are weight management, smoking cessation and alcohol reduction interventions effective in producing behavior change in pregnant women?
Seasonal influenza viruses are a common cause of acute respiratory illness worldwide and generate a significant socioeconomic burden. Influenza viruses mutate rapidly, necessitating annual vaccine reformulation because traditional vaccines do not typically induce broad-spectrum immunity. In addition to seasonal infections, emerging pandemic influenza viruses present a continued threat to global public health. Pandemic influenza viruses have consistently higher attack rates and are typically associated with greater mortality compared with seasonal strains. Ongoing strategies to improve vaccine efficacy typically focus on providing broad-spectrum immunity; although B and T cells can mediate heterosubtypic responses, typical vaccine development will augment either humoral or cellular immunity. However, multipronged approaches that target several Ags may limit the generation of viral escape mutants. There are few vaccine platforms that can deliver multiple Ags and generate robust cellular and humoral immunity. In this article, we describe a novel vaccination strategy, tested preclinically in mice, for the delivery of novel bivalent viral-vectored vaccines. We show this strategy elicits potent T cell responses toward highly conserved internal Ags while simultaneously inducing high levels of Abs toward hemagglutinin. Importantly, these humoral responses generate long-lived plasma cells and generate Abs capable of neutralizing variant hemagglutinin-expressing pseudotyped lentiviruses. Significantly, these novel viral-vectored vaccines induce strong immune responses capable of conferring protection in a stringent influenza A virus challenge. Thus, this vaccination regimen induces lasting efficacy toward influenza. Importantly, the simultaneous delivery of dual Ags may alleviate the selective pressure that is thought to potentiate antigenic diversity in avian influenza viruses.
Abstract This paper begins by reviewing several of the ways in which social inclusion has been conceptualized in the literature. The paper then explores these approaches in the context of the provision of preschool education in rural Scotland. Preschool education is viewed by government as a powerful weapon in the fight against social exclusion, but higher per capita costs in rural areas as well as the availability and cost of transport are major problems, raising questions in turn about inclusive models of provision. Moreover, many parents are sceptical about their ability to access preschool education for their children while also continuing their own engagement in the labour market (a central pillar of social inclusion policy). Issues of choice, quality and governance arise and these are discussed in depth. The paper concludes with some reflections on the concept of social inclusion in the light of this case study.
This paper draws on evidence from a study that explored patient compliance with the Department of Health’s (DH) NHS Health Check (NHSHC)Programme. In 2009 the DH introduced a national screening programme for adults aged 40-74 for risk of cardiovascular disease. The success of the NHSHC
programme is reliant on sustained patient compliance with drug treatments and lifestyle advice offered to those with a greater than 20% chance of having ‘an adverse event’ in the next ten years. Thus, unusually for a screening programme, it facilitates the identification of potential risk rather than existing conditions.
This has serious implications in terms of patient understanding and compliance.
Sociology offers tools to frame thinking around how patients take on board information about their health and evaluate their risk of illness. This paper presents findings from qualitative interviews with patients (N=30) across the Tees Valley, who were identified as ‘high risk’, had been given lifestyle advice and in many cases prescribed medication to reduce risk factors. In order to engage with the NHSHC programme patients need to interpret risk so that they will perceive a problem that they want to address. In this paper we will explore the views and experiences of patients as they engage with the concept of risk. We will discuss how patients perceive risk in relation to their everyday lives, self-identity and how they understand risk in the context of their current health status. We will explore how patients use lay epidemiology to frame their understanding of risk.
Objectives Sex and relationship education (SRE) is regarded as vital to improving young people’s sexual health, but a third of schools in England lacks good SRE and government guidance is outdated. We aimed to identify what makes SRE programmes effective, acceptable, sustainable and capable of faithful implementation. Design This is a synthesis of findings from five research packages that we conducted (practitioner interviews, case study investigation, National Survey of Sexual Attitudes and Lifestyles, review of reviews and qualitative synthesis). We also gained feedback on our research from stakeholder consultations. Settings Primary research and stakeholder consultations were conducted in the UK. Secondary research draws on studies worldwide. Results Our findings indicate that school-based SRE and school-linked sexual health services can be effective at improving sexual health. We found professional consensus that good programmes start in primary school. Professionals and young people agreed that good programmes are age-appropriate, interactive and take place in a safe environment. Some young women reported preferring single-sex classes, but young men appeared to want mixed classes. Young people and professionals agreed that SRE should take a ‘life skills’ approach and not focus on abstinence. Young people advocated a ‘sex-positive’ approach but reported this was lacking. Young people and professionals agreed that SRE should discuss risks, but young people indicated that approaches to risk need revising. Professionals felt teachers should be involved in SRE delivery, but many young people reported disliking having their teachers deliver SRE and we found that key messages could become lost when interpreted by teachers. The divergence between young people and professionals was echoed by stakeholders. We developed criteria for best practice based on the evidence. Conclusions We identified key features of effective and acceptable SRE. Our best practice criteria can be used to evaluate existing programmes, contribute to the development of new programmes and inform consultations around statutory SRE.
This chapter takes up the boundary metaphor through an exploration of the relationships between families and education services. It explores the ‘push and pull’ around the boundaries between families and professional educators. The study involved 19 adult members of working-class families. Based on the study, this chapter considers how boundaries between school and home have shifted seemingly in respect of the school's power to dictate aspects of childrearing, domestic timetables and parenting practices. However, parents still reserved a space around the boundary where they felt free to demand appropriate standards of care and concern for their child; for example, on issues of bullying or healthcare. Boundaries between families and school have often been identified as crucial elements in educational and related social policies.
In this paper the development of askFuse is used as a case study to illustrate contextual and system barriers to universities providing useful, usable and timely research evidence in response to local practice and policy partners’ stated public health research needs. Entrenched systems (research excellence framework, academic career pathways, procurement processes) proved to be considerable obstacles. Issues discussed in the successful operationalising of askFuse included: reputational risks, uncertainty; working round system barriers; dilemmas in costing the research; and an opportunity to re-think what counts as valuable research, effective public health research methods, and the creation of a new evidence base.
Drawing from a Scottish study, this article examines ways in which the school environment can impact upon the well‐being of pupils and their associated behaviour. It identifies tensions between existing school structures and cultures and the promotion of positive mental health, particularly in relation to the curriculum, pastoral care, discipline and teacher/pupil relationships. In many cases, schools attempt to address mental well‐being by bolting fragmented initiatives onto existing systems, and we argue that a more fundamental review of values, policies and practices throughout the school is needed. This paper also looks at the roles of interagency workers in schools, and reports that, in most cases, these workers are seen as offering a parallel service to the mainstream school, targeted at the most troubled or troublesome pupils. We suggest that schools should draw on the skills and understandings of these workers to help build new cultures throughout the school for the benefit of all children and young people.
Maternal obesity is associated with risks to mother and infant, and has implications for healthcare costs. United Kingdom (UK) levels of maternal obesity are rising, with higher prevalence in North East (NE) England, where this study was set. Pregnancy is often seen as an opportune time for intervention – a 'teachable moment' - which is ripe for promoting behaviour change. In response to rising obesity levels, a National Health Service (NHS) Foundation Trust in NE England implemented three maternal obesity care pathways contingent on Body Mass Index (BMI) at time of booking: pathway 1 for those with BMI ≥30 kg/m2; pathway 2 for BMI ≥35 kg/m2; and pathway 3 for BMI ≥40 kg/m2. These incorporated relevant antenatal, intrapartum and postnatal clinical requirements, and included a focus on weight management intervention. This evaluation explored the accounts of postnatal women who had been through one of these pathways in pregnancy. The study used a generic qualitative approach. Semi-structured interviews were carried out to explore the views and experiences of 24 recent mothers (aged 20–42), living in NE England, who had commenced on one of the pathways during pregnancy. Interviews explored experiences of weight management support during and after pregnancy, and perceived gaps in this support. Data were analysed using thematic content analysis. Three main themes emerged reflecting women's views and experiences of the pathways: communication about the pathways; treating obese pregnant women with sensitivity and respect; and appropriate and accessible lifestyle services and information for women during and after pregnancy. An overarching theme: differences in care, support and advice, was evident when comparing the experiences of women on pathways 1 or 2 with those on pathway 3. This study indicated that women were not averse to risk management and weight management intervention during and after pregnancy. However, in order to improve reach and effectiveness, such interventions need to be well communicated and offer constructive, individualised advice and support. The postnatal phase may also offer an opportune moment for intervention, suggesting that the simple notion of seeing pregnancy alone as a window of opportunity or a 'teachable moment' should be reconsidered.
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