Self-reported alcohol consumption in doctors.

BACKGROUND: The UK government has prioritized reducing the harmful effects of excessive alcohol consumption on mental and physical well-being. AIMS: To assess self-reported alcohol consumption amongst doctors at an acute London Trust. METHODS: An opportunistic, anonymous, survey was conducted by Postgraduate Education Fellows over 2 weeks in December 2018. This included all grades of doctors from Foundation Year One to Consultant. The survey consisted of nine questions, modified from the alcohol use disorders identification test (AUDIT) and CAGE questionnaire. RESULTS: Of 446 doctors within our institution, 109 completed the survey (24%). Fourteen per cent of those surveyed abstained from alcohol, 21% drank monthly or less, 31% drank between two to four times per month, 25% drank two to three times per week and 9% drank greater than four times per week. In the preceding 2 years, 9% reported being unable to do what was expected of them on at least one occasion due to alcohol. Five per cent were concerned about alcohol affecting their performance. Two per cent were annoyed by criticism of their drinking, 9% felt guilty about drinking and 4% needed an eye-opener. Eighteen per cent wanted to reduce their alcohol consumption; however, 43% of the 109 doctors surveyed were uncertain where to seek help. CONCLUSIONS: Twenty per cent of surveyed doctors reported consuming potentially hazardous levels of alcohol and 18% of respondents wanted to cut down. Forty-three per cent were unaware of sources of support. Our findings suggest a role for collaboration between Occupational Health departments and Postgraduate Education teams to support doctors misusing alcohol.

Impact of improved observed hand hygiene on bloodstream infection rates in Ireland. A prospective segmented regression analysis, 2009-2016.

Participation in European surveillance for bloodstream infection (BSI) commenced in Ireland in 1999 with all laboratories (n = 39) participating by 2014. Observational hand hygiene auditing (OHHA) was implemented in 2011. The aim of this study was to evaluate the impact of OHHA on hand hygiene compliance, alcohol hand rub (AHR) procurement and the incidence of sensitive and resistant Staphylococcus aureus and Enterococcus faecium and faecalis BSI. A prospective segmented regression analysis was performed to determine the temporal association between OHHA and outcomes. Observed hand hygiene improved from 74.7% (73.7-75.6) in 2011 to 90.8% (90.1-91.3) in 2016. AHR procurement increased from 20.1 l/1000 bed days used (BDU) in 2009 to 33.2 l/1000 BDU in 2016. A pre-intervention reduction of 2% per quarter in the ratio of methicillin sensitive Staphylococcus aureus BSI/BDU stabilized in the time period after the intervention (P < 0.01). The ratio of Methicillin resistant Staphylococcus aureus (MRSA) BSI/BDU was decreasing by 5% per quarter pre-intervention, this slowed to 2% per quarter post intervention, (P < 0.01). There was no significant change in the ratio of vancomycin sensitive (P = 0.49) or vancomycin resistant (P = 0.90) Enterococcus sp. BSI/BDU post intervention. This study shows national OHHA increased observed hand hygiene compliance and AHR procurement, however there was no associated reduction in BSI.

A Positive Quadriceps Active Test, without the Quadriceps Being Active.

CASE: A 55-year-old male with a chronic isolated grade 3 PCL injury who demonstrates a positive quadriceps active test without activating his quadriceps musculature. CONCLUSION: Gravity and hamstring contraction posteriorly translate the tibia into a subluxed position. Subsequent gastrocnemius contraction with the knee flexed causes an anterior tibial translation by virtue of the mass enlargement of the gastrocnemius muscular bulk, the string of a bow effect, and the anterior origin of the gastrocnemius in relation to the posterior border of the subluxed tibia aided by the normal posterior tibial slope.

Economics of Early Warning Scores for identifying clinical deterioration-a systematic review.

AIM: In 2013, a National Early Warning System (EWS) was implemented in Ireland. Whilst evidence exists to support the clinical effectiveness of EWS in the acute health care setting, there is a paucity of information on their cost and cost effectiveness. The objective of this systematic literature review was to critically evaluate the economic literature on the use of EWS in adult patients in acute health care settings for the timely detection of physiological deterioration. METHODS: A systematic literature review was conducted to accumulate the economic evidence on the use of EWS in adult patients in acute health care settings. RESULTS: The search yielded one health technology assessment, two budget impact analyses and two cost descriptions. Three of the studies were Irish, and considered the national EWS system. A Dutch study reported financial consequences of a single parameter EWS, as part of a rapid response system, in a surgical ward. The fifth study examined an advanced triage system in a medical emergency admission unit in Wales. CONCLUSIONS: The economic evidence on the use of EWS amongst adult patients in acute health care settings for the timely detection of physiological deterioration is limited. Further research is required to investigate the cost effectiveness of EWS, and the appropriateness of using standard methods to do so. The recent implementation of a national EWS in Ireland offers a unique opportunity to bridge this gap in the literature to examine the costs and cost effectiveness of a nationally implemented EWS system.

Can chronic disease be managed through integrated care cost-effectively? Evidence from a systematic review.

BACKGROUND: The increase in demand for integrated care models to manage chronic disease is a challenge for the Irish health system, which is traditionally organised around the acute hospital services. Implementing integrated care programmes requires significant investment, and thus, their economic impact requires consideration. AIMS: This paper updates the previous evidence on the cost-effectiveness of integrated care programmes to support the development of a cost-effective integrated care programme for chronic disease management. METHODS: A systematic review of economic evaluations of integrated care programmes for chronic diseases (respiratory, cardiovascular, diabetes and musculoskeletal diseases) was performed using methods guided by the principles of conducting systematic reviews. The evidence was combined and summarised using a narrative synthesis. A meta-analysis of the evidence was not performed due to the heterogeneity of interventions and associated outcomes. RESULTS: Six studies met the inclusion criteria; no study considered an integrated model of care that dealt with more than one chronic illness. Four chronic conditions were examined: stroke, diabetes, cardiovascular disease and COPD. Three studies were full economic evaluations, and three were partial economic evaluations. CONCLUSIONS: The economic evidence, examined within this review, suggests that integrated care programmes have the potential to be cost-effective, achieving greater health benefits and are less expensive than usual care. Across all the interventions considered, the reduction in inpatient and outpatient admissions was the main contributor to reducing costs.

Examining the role of socioeconomic deprivation in ethnic differences in sexually transmitted infection diagnosis rates in England: evidence from surveillance data.

Differences by ethnic group in STI diagnosis rates have long been recognized in England. We investigated whether these may be explained by ethnic disparities in socioeconomic deprivation (SED). Data on all diagnoses made in sexual health clinics in England in 2013 were obtained from the mandatory STI surveillance system. Poisson regression was used to calculate incidence rate ratios (IRRs) of STIs, by ethnicity, with and without adjustment for index of multiple deprivation (IMD) a measure of area-level deprivation. Unadjusted IRRs (95% confidence intervals) were highest for gonorrhoea [8·18 (7·77-8·61) and 5·76 (5·28-6·29)] and genital herpes [4·24 (3·99-4·51) and 3·58 (3·23-3·98)] for people of black Caribbean and non-Caribbean/non-African black ethnicity and IRRs were highest for syphilis [8·76 (7·97-9·63)] and genital warts [2·23 (2·17-2·29)] for people of non-British/non-Irish white ethnicity compared to white British ethnicity. After adjustment for IMD, IRRs for gonorrhoea [5·76 (5·47-6·07)] and genital herpes [3·73 (3·50-3·97)] declined but remained highest for black Caribbeans and IRRs for syphilis [7·35 (6·68-8·09)] and genital warts [2·10 (2·04-2·16)] declined but remained highest for non-British/non-Irish white compared to white British. In England, ethnic disparities in STI diagnosis rates are partially explained by SED, but behavioural and contextual factors likely contribute. Clinic and community-based interventions should involve social peer networks to ensure they are targeted and culturally sensitive.

Antagonism of the proinflammatory and pronociceptive actions of canonical and biased agonists of protease-activated receptor-2.

BACKGROUND AND PURPOSE: Diverse proteases cleave protease-activated receptor-2 (PAR2) on primary sensory neurons and epithelial cells to evoke pain and inflammation. Trypsin and tryptase activate PAR2 by a canonical mechanism that entails cleavage within the extracellular N-terminus revealing a tethered ligand that activates the cleaved receptor. Cathepsin-S and elastase are biased agonists that cleave PAR2 at different sites to activate distinct signalling pathways. Although PAR2 is a therapeutic target for inflammatory and painful diseases, the divergent mechanisms of proteolytic activation complicate the development of therapeutically useful antagonists. EXPERIMENTAL APPROACH: We investigated whether the PAR2 antagonist GB88 inhibits protease-evoked activation of nociceptors and protease-stimulated oedema and hyperalgesia in rodents. KEY RESULTS: Intraplantar injection of trypsin, cathespsin-S or elastase stimulated mechanical and thermal hyperalgesia and oedema in mice. Oral GB88 or par2 deletion inhibited the algesic and proinflammatory actions of all three proteases, but did not affect basal responses. GB88 also prevented pronociceptive and proinflammatory effects of the PAR2-selective agonists 2-furoyl-LIGRLO-NH2 and AC264613. GB88 did not affect capsaicin-evoked hyperalgesia or inflammation. Trypsin, cathepsin-S and elastase increased [Ca(2+) ]i in rat nociceptors, which expressed PAR2. GB88 inhibited this activation of nociceptors by all three proteases, but did not affect capsaicin-evoked activation of nociceptors or inhibit the catalytic activity of the three proteases. CONCLUSIONS AND IMPLICATIONS: GB88 inhibits the capacity of canonical and biased protease agonists of PAR2 to cause nociception and inflammation.

Effects of stress early in gestation on hippocampal neurogenesis and glucocorticoid receptor density in pregnant rats.

Pregnancy is a time of marked neural, physiological and behavioral plasticity in the female and is often a time when women are more vulnerable to stress and stress-related diseases, such as depression and anxiety. Unfortunately the impact of stress during gestation on neurobiological processes of the mother has yet to be fully determined, particularly with regard to changes in the hippocampus; a brain area that plays an important role in stress-related diseases. The present study aimed to determine how stress early in pregnancy may affect hippocampal plasticity in the pregnant female and whether these effects differ from those in virgin females. For this purpose, adult age-matched pregnant and virgin female Sprague-Dawley rats were divided into two conditions: (1) Control and (2) Stress. Females in the stress condition were restrained during days 5-11 of gestation and at matched time-points in virgin females. All pregnant females received an injection of bromodeoxyuridine (BrdU) on day 1 of gestation and were sacrificed 21 days later. The same procedure was carried out at matched time points in virgin females. Results show that for number of Ki67-immunoreactive (ir) cells and doublecortin (DCX)-ir cells, there were significant interactions between reproductive state (pregnant/virgin) and stress exposure (p=.05, p=.04, respectively) with control virgin and stressed pregnant females having more Ki67-ir cells than control pregnant females and more DCX-ir cells than stressed virgin females. Results also show that pregnant females had significantly greater glucocorticoid receptor (GR) density in the CA1, CA3 and granule cell layer compared to virgin females. In addition, there was a main effect of stress on GR density in the CA3 region, with stressed females having significantly lower GR density compared to control females (p=.01). This work adds to our understanding of how stress and reproductive state affect plasticity in the female hippocampus.

Does rheumatoid arthritis disease activity correlate with weather conditions?

To determine whether rheumatoid arthritis disease activity correlates with changing weather conditions. A longitudinal analysis of 133 patients attending the Department of Rheumatology, Musgrave Park Hospital, Belfast was performed. Participants had a diagnosis of rheumatoid arthritis and were receiving subcutaneous anti-TNF therapy (Adalimumab or Etanercept) for a period of >6 months. Data were collected at five time points. This included tender joint count, swollen joint count, patient visual analogue score (VAS), erythrocyte sedimentation rate, C-reactive protein, VAS, and DAS-28 (Disease Activity Score). Each weather factor (maximum, minimum temperature, pressure, rainfall, sunshine, humidity, and wind-speed) was analysed against each patients' DAS-28 score at five time points, using an analysis of covariance. A significant correlation was noted between low DAS-28 and increased hours of sunshine (p < 0.001). Sunny conditions were associated with a DAS-28 reduction of 0.037 (95 % CI -0.059, -0.016) p < 0.001. A significant correlation between humidity and DAS-28 was also noted (p = 0.016). Increased humidity was associated with an increased DAS-28 of 0.007 (95 % CI 0.001, 0.013) p = 0.016. Higher temperatures were associated with a non-significant decrease in DAS-28 (p = 0.16). In this study, rheumatoid arthritis disease activity (as measured by DAS-28) was significantly lower in both more sunny and less humid conditions.

Improving surveillance of sexually transmitted infections using mandatory electronic clinical reporting: the genitourinary medicine clinic activity dataset, England, 2009 to 2013.

A new electronic surveillance system for sexually transmitted infections (STIs) was introduced in England in 2009. The genitourinary medicine clinic activity dataset (GUMCAD) is a mandatory, disaggregated, pseudo-anonymised data return submitted by all STI clinics across England. The dataset includes information on all STI diagnoses made and services provided alongside demographic characteristics for every patient attendance at a clinic. The new system enables the timely analysis and publication of routine STI data, detailed analyses of risk groups and longitudinal analyses of clinic attendees. The system offers flexibility so new codes can be introduced to help monitor outbreaks or unusual STI activity. From January 2009 to December 2013 inclusive, over twenty-five million records from a total of 6,668,648 patients of STI clinics have been submitted. This article describes the successful implementation of this new surveillance system and the types of epidemiological outputs and analyses that GUMCAD enables. The challenges faced are discussed and forthcoming developments in STI surveillance in England are described.

As I see it: a study of African American pastors' views on health and health education in the black church.

The Black Church is the only institution that has consistently served the interest of African Americans, and there is no other institution in the African American community that rivals its influence (Camara, 2004). The spiritual well-fare, social support, health, and well-being of its people have been one of its main goals. With health disparities of African Americans still at an alarming rate, the Black Church has used informal education as a means to impart knowledge on health, as well as other non-religious and religious topics. One of the avenues least researched within the Black Church is the pastor's perception of its educational role in health and wellness and its efforts to reduce health discrimination and health disparities between African American and European Americans in the U.S. Since social justice appears as a theme and concern in the traditions of many churches, it is only appropriate that, among other things, the Black Church should address the issue of health education and interventions. The purpose of this study was to explore African American pastors' perceptions of the role of the Black Church in providing health care, health education, and wellness opportunities to African Americans. Many pastors reported their church provided some form of health education and/or health screenings. Their perceptions about the important issues facing their congregants versus African Americans in general were quite similar.

Motivators to engage in health promotion activities by low-income black fathers.

There has been increasing concern about the health status of low-income Black fathers. Little is known about their motivators to participate in health promotion activities. This descriptive qualitative research study explored these motivators. Focus groups were used to gather the data. Themes included avoiding specific diseases, helping others, a personal desire to learn, and modeling positive behaviors. These findings provide baseline data that might be used to develop community interventions targeting this group. Additional work will focus on validating these results and further exploration of some of the motivators verbalized by these participants.

Motivators and barriers to participating in health promotion behaviors in Black men.

There is limited research examining the health promotion behaviors (HPBs) of low-income Black men. This study examined the relationship between HPBs, and motivators and barriers to participating in these behaviors in Black men (N = 107), aged 21 to 56. Using descriptive statistics, more than 96% of the participants reported they were motivated because of the desire to be healthy. Canonical correlation analysis and conditional random forest were used to determine the importance of individual motivators and barriers. Canonical correlation analysis yielded one interpretable canonical variate that explained 39.5% of the variance in sets of motivators and barriers, and health promotion lifestyle variables. Men with fewer motivators and more barriers took less responsibility for their health, participated in less physical activity, and reported less spiritual growth. Having too many things to do and not knowing what to do best predicted participation in HPBs.

Rapid increase in gonorrhoea and syphilis diagnoses in England in 2011.

There has been a rapid rise in the number of gonorrhoea and syphilis diagnoses in England during 2011, an increase of 25% and 10% respectively. Large increases of both gonorrhoea (61%) and syphilis (28%) were observed among men who have sex with men. Although these rises can partly be attributed to increased testing, ongoing high-levels of unsafe sexual behaviour probably contributed to the rise. The rise in gonorrhoea rates is worrying in an era of decreased susceptibility to treatments.

Effects of fillet weight on sensory descriptive flavor and texture profiles of broiler breast meat.

Four replications were conducted to compare sensory descriptive profiles of cooked boneless skinless chicken breast categorized by fillet (pectoralis major) weight or size. In each replication, 20 heavy fillets, 20 medium fillets, and 20 light fillets (deboned at 6-8 h postmortem) were obtained from a commercial processing plant. Fillets were trimmed and weighed before chosen for each of 3 size categories based on their weight as follows: light, average weight 112 g; medium, average weight 153 g; and heavy, average weight 204 g. Descriptive sensory texture and flavor attributes were measured after the frozen samples were thawed for 24 h at a refrigerated temperature (2°C) and cooked to an endpoint temperature of 78°C. Sensory evaluations were performed by trained descriptive panelists using 0 to 15 universal intensity scales for 8 texture and 10 flavor attributes. Our results show that there were differences (P < 0.05) in intensity scores of sensory descriptive texture and flavor attributes cohesiveness, hardness, juiciness, cardboardy, and sourness, among the 3 weight categories. The average cohesiveness, hardness, and sourness scores of the heavy and light fillets were higher than the medium fillets. The juiciness score of the heavy fillets was higher than that of the light fillets, and the cardboardy score of the light fillets was higher than those of the medium and heavy fillets. The juiciness score of the medium fillets did not differ from that of either the light or heavy fillets, and there was no difference for cardboardy scores between the medium and heavy fillets. These results indicate that fillet weight or size in the range (95-230 g) assessed in this study may influence sensory descriptive flavor and texture profiles of cooked broiler breast fillets deboned 6 to 8 h postmortem. Current genetic selection of broiler lines based on growth rate and feed efficiency may sacrifice breast meat quality. However, it remains to be determined if the differences in the sensory descriptive evaluation can be perceived by consumers.

Postmortem aging and freezing and thawing storage enhance ability of early deboned chicken pectoralis major muscle to hold added salt water.

The effects of postdeboning aging and frozen storage on water-holding capacity (WHC) of chicken breast pectoralis major muscle were investigated. Broiler breast muscle was removed from carcasses either early postmortem (2 h) or later postmortem (24 h). Treatments included: no postdeboning aging; 1-d postdeboning aging at 2°C, 7-d postdeboning aging (2-h deboned meat only), and 6-d storage at -20°C plus 1-d thawing at 2°C (freezing and thawing treatment, 2-h deboned meat only). The WHC was determined by cooking loss, drip loss, a filter paper press method (results were presented as expressible fluid), and a salt-induced swelling and centrifugation method (results were presented as percentage of salt-induced water gain). There were no differences for WHC estimated by cooking loss and expressible fluid between the treatments. Only the freezing and thawing treatment resulted in a significant increase in drip loss. The average percentage of salt-induced water gains by the 24-h deboned samples, postdeboning aged 2 h samples, and frozen 2 h sample, which did not differ from each other, were significantly higher than that by the 2-h deboned sample. These results indicate that regardless of method (carcass aging vs. postdeboning aging) and time (aging for 1 d vs. for 7 d), postmortem aging more than 1 d does not affect WHC of the early deboned samples measured by dripping, cooking, and pressing. However, postmortem carcass aging, postdeboning aging, and freezing and thawing storage can significantly enhance the ability of chicken breast meat to hold added salt water or WHC measured by the salt-induced swelling and centrifuge method.

Survival gains needed to offset persistent adverse treatment effects in localised prostate cancer.

BACKGROUND: Men diagnosed with localised prostate cancer (LPC) face difficult choices between treatment options that can cause persistent problems with sexual, urinary and bowel function. Controlled trial evidence about the survival benefits of the full range of treatment alternatives is limited, and patients' views on the survival gains that might justify these problems have not been quantified. METHODS: A discrete choice experiment (DCE) was administered in a random subsample (n=357, stratified by treatment) of a population-based sample (n=1381) of men, recurrence-free 3 years after diagnosis of LPC, and 65 age-matched controls (without prostate cancer). Survival gains needed to justify persistent problems were estimated by substituting side effect and survival parameters from the DCE into an equation for compensating variation (adapted from welfare economics). RESULTS: Median (2.5, 97.5 centiles) survival benefits needed to justify severe erectile dysfunction and severe loss of libido were 4.0 (3.4, 4.6) and 5.0 (4.9, 5.2) months. These problems were common, particularly after androgen deprivation therapy (ADT): 40 and 41% overall (n=1381) and 88 and 78% in the ADT group (n=33). Urinary leakage (most prevalent after radical prostatectomy (n=839, mild 41%, severe 18%)) needed 4.2 (4.1, 4.3) and 27.7 (26.9, 28.5) months survival benefit, respectively. Mild bowel problems (most prevalent (30%) after external beam radiotherapy (n=106)) needed 6.2 (6.1, 6.4) months survival benefit. CONCLUSION: Emerging evidence about survival benefits can be assessed against these patient-based benchmarks. Considerable variation in trade-offs among individuals underlines the need to inform patients of long-term consequences and incorporate patient preferences into treatment decisions.

PhD Away Days: a component of PhD supervision.

AIM: This paper describes a peer-to-peer and supervisor support and mentoring process that was implemented in one PhD programme in nursing in the Republic of Ireland. BACKGROUND: PhD Away Days are held once per year and attended by all enrolled PhD students and their academic supervisors. Positive evaluations were obtained both from students and supervisors as collective learning occurred and group cohesiveness developed. All participants expressed interest in continuing the PhD Away Days as they learned from others' experiences. In addition, the range of topics provided learning on topics of concern across content areas, e.g. conceptual and theoretical developments, research design, challenges in data collection, and analysis and publication plans. Most importantly, there was a feeling of togetherness among students, thus decreasing the feeling of being alone with the challenges of PhD work. CONCLUSIONS: Plans for the future include the need to have the PhD Away Days continued structured around key topics of concern to both students and supervisors, and to implement content-specific modules in the PhD programme.

Effect of 3 postmortem electrical stimulation treatments on the quality of early deboned broiler breast meat.

The present experiment was carried out to evaluate the effects of electrical stimulation (ES) immediately prescalding (PS), ES immediately postdefeathering (PD), or PS combined with PD (PSPD) on the quality of early deboned (2 h) broiler breast muscles, pectoralis major (fillets), and pectoralis minor (tenders). No stimulation, early-deboned (2 h), and 24-h deboned (24 h) fillets were used for the comparison. The 42-d-old broiler carcasses were electrically stimulated with pulsed current at 200 V for 30 s over a 90-s time interval (total of 1 min over 180 s for PSPD), and breast meat was deboned 2 h postmortem. Quality indicators evaluated were CIE L*, a*, and b* color and pH of the raw fillets and cook yields and Warner-Bratzler (WB) shear force of the fillets and tenders. There were no differences in raw fillet color, pH, and cook yields of both the fillets and tenders between the 3 ES treatments. Effects of different ES treatments on meat WB shear force values varied with breast muscles. For the fillets, the average WB shear force values of both the PS and PSPD samples, which were not different from each other, were significantly lower than those of the PD samples. For the tenders, there were no differences in the average shear force values between the 3 ES treatments. Regardless of ES treatment and breast muscle, early deboned broiler breast meat from ES carcasses required significantly less force to shear than the 2-h control. These results indicate that ES can tenderize early deboned poultry breast muscles; however, the effectiveness of ES tenderization varies with ES treatments for the fillets. The PS treatment is more effective in reducing fillet shear values than PD, and there is no further reduction in shear values with PSPD compared with the PS treatment.

Cultural perspectives of interventions for managing diabetes and asthma in children and adolescents from ethnic minority groups.

Both diabetes and asthma are increasingly being recognized as health problems for ethnic groups. Because of cultural differences, ethnicity is reported to be a risk factor for poorer quality in health care, disease management and disease control. Ethnic groups are at risk for poorer quality of life and increased disease complications when compared with non-ethnic counterparts living in the same country. There is little known about how culture is addressed in interventions developed for ethnic groups. The aim of this paper is to systematically review the cultural perspectives of interventions for managing diabetes and asthma in children, adolescents and/or their families from ethnic minority groups. A total of 92 records were identified that were potentially relevant to this review following which, 61 papers were excluded. The full texts of remaining papers (n= 31) were then read independently by both authors, and agreement was reached to exclude a further 27 papers that did not meet inclusion criteria. A total of four papers were eligible for inclusion in this review. Findings indicate that despite growing concerns about health disparities between ethnic and non-ethnic groups in relation to both asthma and diabetes in childhood, there has been little effort to develop cultural specific interventions for ethnic groups. By systematically reviewing asthma and diabetes interventions we have highlighted that few interventions have been developed from a cultural perspective. There are a limited number of interventions published that add knowledge on the specific elements of intervention that is needed to effectively and sensitively educate other cultures. More work is required into identifying which strategies or components of cultural interventions are most effective in achieving positive health outcomes for children, adolescents and/or their families from ethnic groups.