Modification of the Rosenberg Scale to Assess Self-Esteem in Children.

Rosenberg's scale (RSES) is widely used to assess global self-esteem (SE) in adults and adolescents but is not validated for children <12 years. This study assessed the internal consistency, convergent validity, and factor structure of a modified RSES for schoolchildren (CRSES) aged 7-12 years. A total of 711 children aged 9.0 ± 1.5 years completed the CRSES; a subset (n = 417) also completed a life satisfaction (LS) scale. Data were submitted for confirmatory factor analysis (CFA) and tests of factorial invariance by sex. Two-way ANOVA compared scores by age-group and sex; whilst Pearson's correlations examined the relationship between LS and SE. Following the use of modification indices the fit for the global SE model met the goodness of fit statistic criteria: χ(27, n = 711) = 77.22; χnormed = 2.860 CFI = 0.961; RMSEA = 0.051 with 90% CI = 0.038-0.065; SRMR = 0.037; and displayed respectable internal consistency (α = 0.79). The model was also factorially invariant by sex. SE scores did not vary sex (p > 0.05); but were significantly reduced in children aged 9-10 and 11-12 years compared to children aged 7-8 years. The global SE score was significantly correlated (r = 0.51; P < 0.001) with LS. The current version of the CRSES can reliably examine global SE in children aged 7-12 years; extending the use of the RSES to allow tracking across the life course.

Affective Outcomes of Group versus Lone Green Exercise Participation.

'Green exercise' (being physically active within a natural environment) research has examined the influence of environmental setting on health and wellbeing-related exercise outcomes. However, it is not known whether social exercise settings influence green exercise-associated changes in mood, self-esteem, and connection to nature. This study directly compared outcomes of participating in green exercise alone compared to in a group. Using repeated measures, counterbalanced and randomized-crossover design, participants (n = 40) completed two 3 km runs around sports fields. These fields had a relatively flat grass terrain, predominant view of trees, and open grassland. On one occasion participants ran alone and on the other they ran in a group of 4-5 participants. Questionnaire measures of mood, self-esteem, and connection to nature were completed immediately pre- and post-run. Across all of the measures, two-way mixed ANOVAs found that there were statistically significant effects for time but not for time-by-condition interactions. The simplest interpretation of this finding is that social setting does not influence individuals' attainment of the psychological outcomes of green exercise participation. However, we discuss the possibility that more complex processes might underpin this finding.

The effectiveness of Lee Silverman Voice Treatment therapy issued interactively through an iPad device: A non-inferiority study.

Introduction This study compared the differences in recorded speech variables between people treated with conventional 'in person' Lee Silverman Voice Treatment (LSVT) and those treated remotely via iPad-based 'Facetime'. Method Eight participants were selected for the iPad LSVT, and 21 similarly matched subjects were selected from existing data to form the 'in person' group. Participants in both groups had diagnosed idiopathic Parkinson's disease and moderate hypokinetic dysarthria. Eighteen sessions of prescribed LSVT comprising a pre-treatment assessment, 16 treatment sessions, and a six months' post-treatment assessment were administered for each person. In both groups, pre- and post-treatment assessments were conducted face-to-face. Performance measures were recorded during assessment and treatment. Average measures were determined for all tasks at all time points and a summary outcome variable was composed from across-task performance. Results Non-inferiority testing confirmed that iPad LSVT was non-inferior in treating all LSVT task 3 variables except generating words, with the 90% upper confidence intervals (CI) lying between the non-inferiority margin of ± 2.25 and zero. The iPad was superior in treating the task 3 rainbow reading passage and describing motor task variables with upper and lower 90% CI values being negative. The improvement in the summary outcome variable score was also superior in the iPad group. Discussion Non-inferiority testing implies that the iPad LSVT is non-inferior in treating task three variables when compared to traditional LSVT. The study supports further development of remote delivery solutions involving the Apple iPad and 'Facetime' system as a means of improving access to services and the participant's experience.

A case-control study of the health and well-being benefits of allotment gardening.

BACKGROUND: Allotments in the UK are popular and waiting lists long. There is, however, little evidence on the health benefits of allotment gardening. The aims of this study were to determine the impacts of a session of allotment gardening on self-esteem and mood and to compare the mental well-being of allotment gardeners with non-gardeners. METHODS: Self-esteem, mood and general health were measured in 136 allotment gardeners pre- and post- an allotment session, and 133 non-gardener controls. Allotment gardeners also detailed the time spent on their allotment in the current session and previous 7 days, and their length of tenure. RESULTS: Paired t-tests revealed a significant improvement in self-esteem (P < 0.05) and mood (P < 0.001) as a result of one allotment session. Linear regression revealed that neither the time spent on the allotment in the current session, the previous 7 days or the length of tenure affected the impacts on self-esteem and mood (P > 0.05). One-way ANCOVA revealed that allotment gardeners had a significantly better self-esteem, total mood disturbance and general health (P < 0.001), experiencing less depression and fatigue and more vigour (P < 0.0083). CONCLUSIONS: Allotment gardening can play a key role in promoting mental well-being and could be used as a preventive health measure.

The Well Organised Working Environment: A mixed methods study.

BACKGROUND: The English National Health Service Institute for Innovation and Improvement designed a series of programmes called The Productive Series. These are innovations designed to help healthcare staff reduce inefficiency and improve quality, and have been implemented in healthcare organisations in at least 14 different countries. This paper examines an implementation of the first module of the Productive Community Services programme called 'The Well Organised Working Environment'. OBJECTIVE: The quantitative component aims to identify the quantitative outcomes and impact of the implementation of the Well Organised Working Environment module. The qualitative component aims to describe the contexts, mechanisms and outcomes evident during the implementation, and to consider the implication of these findings for healthcare staff, commissioners and implementation teams. DESIGN: Mixed methods explanatory sequential design. SETTINGS: Community Healthcare Organisation in East Anglia, England. PARTICIPANTS: For the quantitative data, participants were 73 staff members that completed End of Module Assessments. Data from 25 services that carried out an inventory of stock items stored were also analysed. For the qualitative element, participants were 45 staff members working in the organisation during the implementation, and four members of the Productive Community Services Implementation Team. METHODS: Staff completed assessments at the end of the module implementation, and the value of items stored by clinical services was recorded. After the programme concluded, semi-structured interviews with staff and a focus group with members of the Productive Community Services implementation team were analysed using Framework Analysis employing the principles of Realist Evaluation. RESULTS: 62.5% respondents (n=45) to the module assessment reported an improvement in their working environment, 37.5% (n=27) reported that their working environment stayed the same or deteriorated. The reduction of the value of items stored by services ranged from £4 to £5039 across different services. Results of the qualitative analysis suggests explanations for why the programme worked in some contexts and not others, for instance due to varying levels of management support, and varying levels of resources allocated to carrying out or sustaining the improvement work. CONCLUSIONS: Quantitative analysis of data generated during healthcare improvement initiatives can give an impression of the benefits realised, but additional qualitative analysis also provides opportunity for learning to improve future implementations. Targets set by commissioners for innovation should focus on sustaining improvement rather demonstrating one-off benefits, and implementation teams should not let their preconceptions of what will and what will not work prevent them from trying interventions that may benefit staff.

Staff perceptions of a Productive Community Services implementation: A qualitative interview study.

BACKGROUND: The Productive Series is a collection of change programmes designed by the English National Health Service (NHS) Institute for Innovation and Improvement to help frontline healthcare staff improve quality and reduce wasted time, so that this time can be reinvested into time spent with patients. The programmes have been implemented in at least 14 countries around the world. This study examines an implementation of the Productive Community Services programme that took place in a Community healthcare organisation in England from July 2010 to March 2012. OBJECTIVES: To explore staff members' perceptions of a Productive Community Services implementation. DESIGN: Cross-sectional interview. SETTINGS: Community Healthcare Organisation in East Anglia, England. PARTICIPANTS: 45 participants were recruited using purposive, snowballing and opportunistic sampling methods to represent five main types of staff group in the organisation; clinical team members, administrative team members, service managers/team leaders, senior managers and software support staff. Team members were recruited on the basis that they had submitted data for at least one Productive Community Services module. METHODS: Semi-structured individual and group interviews were carried out after the programme concluded and analysed using thematic analysis. RESULTS: This report focuses on six of the themes identified. The analysis found that communication was not always effective, and there was a lack of awareness, knowledge and understanding of the programme. Many staff did not find the Productive Community Services work relevant, and although certain improvements were sustained, suboptimal practices crept back. Although negative outcomes were reported, such as the programme taking time away from patients initially, many benefits were described including improved stock control and work environments, and better use of the Electronic Patient Record system. CONCLUSIONS: One of the themes identified highlighted the positive perceptions of the programme, however a focus on five other themes indicate that important aspects of the implementation could have been improved. The innovation and implementation literature already addresses the issues identified, which suggests a gap between theory and practice for implementation teams. A lack of perceived relevance also suggests that similar programmes need to be made more easily adaptable for the varied specialisms found in Community Services. Further research on Productive Community Services implementations and knowledge transfer is required, and publication of studies focusing on the less positive aspects of implementations may accelerate this process.

Fixation failure in an isolated tibial eminence ACL traction avulsion fracture in a paratrooper: is there an association with vitamin D deficiency?

Tibial eminence avulsion fracture at the ACL footprint may be caused by high-energy forces such as a fall, in which the ACL ligament proves stronger than the forces that hold the bone together. For reasons of bone maturity however, tibial spine avulsion fractures where the ACL remains intact, typically occur in children but are rare in adults. This case demonstrates a rare type of adult tibial avulsion fracture with intact ACL and subsequent fragment fixation failure in which vitamin D deficiency may have been contributory. Because there is a high rate of inadequate vitamin D levels in patients undergoing orthopaedic surgery and a known impact on bone healing complications, post-operative bone fixation failure may also occur. This case report may therefore prompt further awareness for considering pre-surgical vitamin D deficiency screening in adults presenting with rare avulsion fractures, and may further demonstrate its impact on surgical outcomes.

Comparing the Energy Expenditure of Wii Fit(™)-Based Therapy Versus Traditional Physiotherapy.

OBJECTIVE: Activity-promoting computer gaming systems, which encourage the use of the body to control game play, are commonly used in rehabilitation. However, the mechanisms by which improvements in clinical outcomes occur after using activity-promoting gaming systems are unknown. Therefore the aims of this study were to compare the physiological cost and enjoyment of Nintendo(®) (Kyoto, Japan) Wii Fit™-based therapy compared with traditional-based physiotherapy training. SUBJECTS AND METHODS: Young adults (n=35), 20.7±1.6 years old, carried out a traditional physiotherapy training program and a Wii Fit-based training program. Energy expenditure was assessed using indirect calorimetry while at rest and during training modes, and enjoyment was measured using a modified Physical Activity Enjoyment Scale. RESULTS: For the traditional physiotherapy-based program, all physiological measures (oxygen consumption [VO2], energy expenditure, and metabolic equivalents [METs]) were significantly greater (VO2, 0.64 versus 0.51 L/minute; energy expenditure, 186.0 versus 146.5 J/kg/minute; METs, 2.6 versus 2.1) than for the Wii Fit-based program. Enjoyment was rated statistically significantly higher for the Wii Fit-based program (76.0±13.7 percent) compared with the traditional program (67.5±14.8 percent). CONCLUSIONS: The lower physiological cost associated with the Wii Fit suggests that it is less demanding than the traditional therapy, even though this modality of training has been shown to elicit improvements in rehabilitative outcomes. This suggests that frailer individuals, whose energy levels are impaired, may benefit from using the Wii Fit as a rehabilitative tool because of the lower demand on energy.

Evaluation of a multicomponent intervention to improve weight status and fitness in children: Upstarts.

BACKGROUND: Many physical activity intervention programs are unable to sustain long-term improvements in activity levels and are often not cost-effective. The aim of this study was to determine if a low-cost school- and community-centered sports coaching program was able to improve health-related fitness in children. METHODS: Children from three schools in socially deprived areas took part in weekly coaching sessions over two 10 week periods during the school year. Coaching was provided by local community-based sports clubs. Body mass index (BMI), jump height, handgrip strength, and 20 m shuttle run test (20mSRT) performance were assessed before and after each of the two intervention periods, to determine short- and long-term changes in health-related fitness. Age- and sex-normalized z-scores were calculated using normative UK reference data for each measure. RESULTS: BMI z-score did not change in the short term, as expected, but importantly was significantly lower at the end of the study. Both handgrip and 20mSRT performance scores increased after the first 10 week period. Only improvements in handgrip were maintained for the whole study period. Jump height actually decreased over the entire study period. CONCLUSION: There were some notable benefits of this novel, cost-effective, naturalistic intervention but future studies should examine seasonal variation and motivational factors as potential confounding variables.

Visual color perception in green exercise: positive effects on mood and perceived exertion.

Positive effects of green exercise on physical and psychological wellbeing have been found, yet little is known about the underlying cognitive mechanisms responsible for such effects. The purpose of this visual sensation study was to establish the extent to which the color green, as a primitive visual feature of many natural environments, contributes to the green exercise effect. Fourteen participants performed three moderate-intensity 5-min cycling tasks (50% peak power output) while watching video footage of a rural cycling course that simulated cycling through a real natural environment. The three randomly counter-balanced video conditions were unedited (V(GREEN)), achromatic (V(GRAY)) or red filter (V(RED)). Lower total mood disturbance and ratings of perceived exertion were found during the V(GREEN) compared to V(GRAY) and V(RED). Feelings of anger were higher after V(RED) compared to the other conditions. Feelings of tension, depression, fatigue, vigor, and confusion did not differ among conditions. This is the first study to show that the color green, as a primitive feature of visual sensation, has a contributory effect toward positive green exercise outcomes.

Exercise-, nature- and socially interactive-based initiatives improve mood and self-esteem in the clinical population.

AIMS: This study evaluated two existing group-based health promotion initiatives (a social club and a swimming group) and compared these to a new green exercise programme (weekly countryside and urban park walks). METHODS: Participants represented a clinical population (N = 53) and were all experiencing a range of mental health problems. They only attended one of the three programmes and sessions were held once a week for six weeks in all initiatives. Composite questionnaires incorporating two standardized measures to analyse changes in self-esteem and mood were completed before and after all sessions. RESULTS: A significant main effect for self-esteem and mood pre and post activity (p < 0.001) was reported after participating in a single session. The change in self-esteem was significantly greater in the green exercise group compared with the social activities club (p < 0.001). Dose responses showed that both self-esteem and mood levels improved over the six-week period and improvements were related to attendance in the green exercise group. CONCLUSIONS: Green exercise as a health-promoting initiative for people experiencing mental ill health is equally as effective as existing programmes. Combining exercise, nature and social components in future initiatives may play a key role in managing and supporting recovery from mental ill health, suggesting a potential 'green' approach to mental healthcare and promotion.

Endometrial hyperplasia - the dilemma of management remains: a retrospective observational study of 280 women.

OBJECTIVE: To quantify the rate of inconsistency in histopathological reporting between endometrial biopsy specimens (obtained by Pipelle endometrial sampler or curettage) and hysterectomy specimens using the World Health Organization classification criteria. STUDY DESIGN: A retrospective review of the records of 280 women with a histopathological diagnosis of endometrial hyperplasia treated in Ipswich Hospital NHS Trust, UK from 1 January 1998 to 31 May 2009. RESULTS: Discrepancy was found between the histopathological results of endometrial samples and hysterectomy specimens. The discrepancy was doubled for specimens obtained using a Pipelle endometrial sampler, with false-positive (i.e. overdiagnosis when the hysterectomy specimen showed a better diagnosis) and false-negative (i.e. underdiagnosis when the hysterectomy specimen showed a worse diagnosis) rates of 5.3% and 22.6%, respectively. For curettage specimens, the false-positive and false-negative rates were 1.8% and 13.2%, respectively. All cases of curettage were performed under general or regional anaesthesia, and were preceded by hysteroscopy. Apart from age, no risk factors were associated with a worse diagnosis. The association of age differed between types of endometrial hyperplasia and cancer; the strongest association was seen for cancer and the weakest association was seen for simple hyperplasia. CONCLUSION: Hysteroscopy and curettage may be considered when simple or complex hyperplasia is diagnosed from a specimen obtained with a Pipelle endometrial sampler. When a diagnosis of atypical hyperplasia is made, irrespective of the method of endometrial sampling, the gynaecologist must be concerned that endometrial carcinoma exists concomitantly within the uterus.

Activity-promoting gaming systems in exercise and rehabilitation.

Commercial activity-promoting gaming systems provide a potentially attractive means to facilitate exercise and rehabilitation. The Nintendo Wii, Sony EyeToy, Dance Dance Revolution, and Xbox Kinect are examples of gaming systems that use the movement of the player to control gameplay. Activity-promoting gaming systems can be used as a tool to increase activity levels in otherwise sedentary gamers and also be an effective tool to aid rehabilitation in clinical settings. Therefore, the aim of this current work is to review the growing area of activity-promoting gaming in the context of exercise, injury, and rehabilitation.

The mental and physical health outcomes of green exercise.

Both physical activity and exposure to nature are known separately to have positive effects on physical and mental health. We have investigated whether there is a synergistic benefit in adopting physical activities whilst being directly exposed to nature ('green exercise'). Five groups of 20 subjects were exposed to a sequence of 30 scenes projected on a wall whilst exercising on a treadmill. Four categories of scenes were tested: rural pleasant, rural unpleasant, urban pleasant and urban unpleasant. The control was running without exposure to images. Blood pressure and two psychological measures (self-esteem and mood) were measured before and after the intervention. There was a clear effect of both exercise and different scenes on blood pressure, self-esteem and mood. Exercise alone significantly reduced blood pressure, increased self-esteem, and had a positive significant effect on 4 of 6 mood measures. Both rural and urban pleasant scenes produced a significantly greater positive effect on self-esteem than the exercise-only control. This shows the synergistic effect of green exercise in both rural and urban environments. By contrast, both rural and urban unpleasant scenes reduced the positive effects of exercise on self-esteem. The rural unpleasant scenes had the most dramatic effect, depressing the beneficial effects of exercise on three different measures of mood. It appears that threats to the countryside depicted in rural unpleasant scenes have a greater negative effect on mood than already urban unpleasant scenes. We conclude that green exercise has important public and environmental health consequences.