Weight management interventions for adults living with overweight or obesity and severe mental illness: a systematic review and meta-analysis.

When compared with the general population, people living with severe mental illness (SMI) are 1·8 times more likely to have obesity while in adult mental health secure units, rates of obesity are 20 % higher than the general population. In England, there are currently 490 000 people living with SMI. The aim of this systematic review was to collate and synthesise the available quantitative and qualitative evidence on a broad range of weight management interventions for adults living with SMI and overweight or obesity. Primary outcomes were reductions in BMI and body weight. Following sifting, eighteen papers were included in the final review, which detailed the results of nineteen different interventions; however, there was a lack of qualitative evidence. Pooled results for three studies (MD - 3·49, 95 % CI - 6·85, -0·13, P = 0·04) indicated a small effect in terms of body weight reduction but no effect on BMI for four studies (MD - 0·42, 95 % CI - 1·27, 0·44, P = 0·34). Key recommendations for future research included integration of qualitative methodology into experimental study design, a review of outcome measures and for study authors to follow standardised guidelines for reporting to facilitate complete and transparent reporting.

Characterising and monitoring preconception health in England: a review of national population-level indicators and core data sources.

Initiatives to optimise preconception health are emerging following growing recognition that this may improve the health and well-being of women and men of reproductive age and optimise health in their children. To inform and evaluate such initiatives, guidance is required on indicators that describe and monitor population-level preconception health. We searched relevant databases and websites (March 2021) to identify national and international preconception guidelines, recommendations and policy reports. These were reviewed to identify preconception indicators. Indicators were aligned with a measure describing the prevalence of the indicator as recorded in national population-based data sources in England. From 22 documents reviewed, we identified 66 indicators across 12 domains. Domains included wider (social/economic) determinants of health; health care; reproductive health and family planning; health behaviours; environmental exposures; cervical screening; immunisation and infections; mental health, physical health; medication and genetic risk. Sixty-five of the 66 indicators were reported in at least one national routine health data set, survey or cohort study. A measure of preconception health assessment and care was not identified in any current national data source. Perspectives from three (healthcare) professionals described how indicator assessment and monitoring may influence patient care and inform awareness campaign development. This review forms the foundation for developing a national surveillance system for preconception health in England. The identified indicators can be assessed using national data sources to determine the population's preconception needs, improve patient care, inform and evaluate new campaigns and interventions and enhance accountability from responsible agencies to improve preconception health.

Explaining the relation between early mind-mindedness and children's mentalizing abilities: The development of an observational preschool assessment.

The aim of this research was to develop a new observation-based measure for assessing caregivers' mind-mindedness in the preschool years and investigate whether this measure could explain the link between mothers' early appropriate mind-related comments and children's later mentalizing abilities. The new measure was developed using a sample of mothers and 44-month-olds (N = 171), characterizing mind-mindedness in terms of (a) solicited child involvement, (b) adaptive communication, and (c) internal state talk. These indices were positively related to established assessments of mind-mindedness at 8, 44, and 61 months. Positive associations were also observed with children's later mentalizing abilities. The new measure of mind-mindedness did not, however, mediate the relation between mind-mindedness in the first year of life and children's mentalizing abilities. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Protein-creatinine ratio and albumin-creatinine ratio for the diagnosis of significant proteinuria in pregnant women with hypertension: Systematic review and meta-analysis of diagnostic test accuracy.

BACKGROUND: The gold standard for assessment and diagnosis of significant proteinuria in pregnancy has been by 24-hour urine collection and analysis. Determining fast, accurate methods to identify clinically significant proteinuria would aid diagnosis of pre-eclampsia. The objective of this study was to determine the accuracy of spot protein-creatinine ratio (PCR) and albumin-creatinine ratio (ACR) measurements compared with 24-hour urine collection for the identification of clinically significant proteinuria in women with hypertensive disorders of pregnancy. METHODS: Search strategies were developed for electronic databases from inception to 1st October 2020. Data were assessed for methodological quality using the QUADAS-II checklist for risk of bias and quality of the evidence using GRADE. Meta-analysis was performed where there were at least four studies presenting data for the same comparison (test and threshold). This is an update of the review for NICE guideline NG133 (published June 2019) and includes additional data. RESULTS: Twenty-nine studies were included. PCR measurements (28 studies) showed high sensitivity (91%) and specificity (89%) at a threshold of 30 mg/mmol (n = 3577). Higher thresholds (>60 mg/mmol) increased specificity, but reduced sensitivity. At a threshold of PCR 30 mg/mmol, diagnostic accuracy improved for sensitivity and specificity (93% for both) in studies where the first morning void was excluded (n = 1868). Data available (4 studies) for ACR supports ruling out of significant proteinuria at less than 2 mg/mmol, though evidence was limited by paucity of data and wide confidence intervals around the result. CONCLUSIONS: PCR and ACR have high accuracy compared to the gold standard 24-hour urine collection.

Mind-mindedness in parents of looked-after children.

The studies reported here aimed to test the proposal that mind-mindedness is a quality of personal relationships by assessing mind-mindedness in caregiver-child dyads in which the relationship has not spanned the child's life or in which the relationship has been judged dysfunctional. Studies 1 and 2 investigated differences in mind-mindedness between adoptive parents (ns = 89, 36) and biological parents from the general population (ns = 54, 114). Both studies found lower mind-mindedness in adoptive compared with biological parents. The results of Study 2 showed that this group difference was independent of parental mental health and could not fully be explained in terms of children's behavioral difficulties. Study 3 investigated differences in mind-mindedness in foster carers (n = 122), parents whose children had been the subject of a child protection plan (n = 172), and a community sample of biological parents (n = 128). The level of mind-mindedness in foster carers and parents who were involved with child protection services was identical and lower than that in the community sample; children's behavioral difficulties could not account for the difference between the 2 groups of biological parents. In all 3 studies, nonbiological carers' tendency to describe their children with reference to preadoption or placement experiences was negatively related to mind-mindedness. These findings are in line with mind-mindedness being a relational construct. (PsycINFO Database Record

Pelvic girdle pain: updating current practice.

Traditionally, pelvic girdle pain (PGP) was viewed as a hormonal problem, untreatable during pregnancy and exacerbated by the weight of the baby. Customary advice was for rest, support belts and to await recovery following the baby's birth. However, the outcome of this management resulted in many women experiencing short or long-term physical disability, as well as the psychological impact of pain and immobility. Recent research links an asymmetry of the pelvic joints to the incidence and severity of PGP and shows the cause is biomechanical and not due to pregnancy hormones. Evidence supports manual therapy as the effective way to resolve PGP quickly during pregnancy through a realignment and restoration of symmetry of movement in the pelvic joints, thereby avoiding the adverse long-term consequences of the condition.

Maternal mind-mindedness and children's behavioral difficulties: mitigating the impact of low socioeconomic status.

Relations between mothers' tendency to comment appropriately on their 8-month-olds' internal states (mind-mindedness) and children's behavioral difficulties (Strengths and Difficulties Questionnaire) at ages 44 and 61 months were investigated in a socially diverse sample (N = 171, 88 boys). Controlling for maternal depressive symptoms, perceived social support, sensitivity, child language ability, and child gender, maternal mind-mindedness was negatively related to children's externalizing and internalizing behaviors specifically in low socioeconomic status (SES) families. Furthermore, behavioral difficulties at age 44 months mediated the relation between maternal mind-mindedness and behavioral difficulties at age 61 months, but only for low SES families. These findings are discussed with reference to possible ways in which mind-mindedness could inform interventions targeted at at-risk groups.