Supporting patients with a mental health diagnosis to use online services in primary care. A qualitative interview study.

Objective: The increase in reliance on online services for general practice has the potential to increase inequalities within some populations. Patients with a mental health condition are one such group. Digital facilitation is defined as a range of processes, procedures, and people, which seek to support NHS patients in using online services. This study aimed to examine the views and experiences of digital facilitation in primary care amongst patients living with a mental health condition. Methods: Semi-structured interviews were conducted with patients living with a mental health condition, recruited from general practices across England participating in the Di-Facto study. Thematic analysis was conducted on interview transcripts. Results: Interviews were conducted with ten participants with a mental health condition, recruited from five general practices. Three themes were identified: (1) familiarity with online services; (2) experiences of those using online services; (3) the need for digital facilitation. The need for digital facilitation was identified in the registration for online services, and in trusting online services. Conclusions: Online services offer convenience for patients, but registration for the use of such services remains a potential area of difficulty. Participants had difficulties with registering for online services and had concerns about trust in using them. Support offered by general practices in using online services needs to be varied and adaptable to meet the needs of individual patients.

Implementing mental health support teams in schools and colleges: the perspectives of programme implementers and service providers.

Background: Between 2018 and 2025, a national implementation programme is funding more than 500 new mental health support teams (MHSTs) in England, to work in education settings to deliver evidence-based interventions to children with mild to moderate mental health problems and support emotional wellbeing for all pupils. A new role, education mental health practitioner (EMHP), has been created for the programme.Aims: A national evaluation explored the development, implementation and early progress of 58 MHSTs in the programme's first 25 'Trailblazer' sites. This paper reports the views and experiences of people involved in MHST design, implementation and service delivery at a local, regional and national level.Methods: Data are reported from in-depth interviews with staff in five Trailblazer sites (n = 71), and the programme's regional (n = 52) and national leads (n = 21).Results: Interviewees universally welcomed the creation of MHSTs, but there was a lack of clarity about their purpose, concerns that the standardised CBT interventions being offered were not working well for some children, and challenges retaining EMHPs.Conclusions: This study raises questions about MHSTs' service scope, what role they should play in addressing remaining gaps in mental health provision, and how EMHPs can develop the skills to work effectively with diverse groups.

Early evaluation of the Children and Young People's Mental Health Trailblazer programme: a rapid mixed-methods study.

Background: The Children and Young People's Mental Health Trailblazer programme is funding the creation of new mental health support teams to work in schools and further education colleges. Mental health support teams directly support children and young people with 'mild to moderate' mental health problems and work with school and college staff to promote well-being for all. A new workforce of education mental health practitioners is being trained for the teams. Objective(s): The National Institute for Health and Care Research Birmingham, RAND and Cambridge Evaluation Rapid Evaluation Centre and Policy Innovation and Evaluation Research Unit undertook an early evaluation of the Trailblazer programme to examine the development, implementation and early progress of mental health support teams in the programme's first 25 'Trailblazer' sites. Design: A mixed-methods evaluation, comprising three work packages: 1. Establishing the baseline and understanding the development and early impacts of the Trailblazer sites, including two rounds of surveys with key informants and participating education settings in all 25 sites. 2. More detailed research in five purposively selected Trailblazer sites, including interviews with a range of stakeholders and focus groups with children and young people. 3. Scoping and developing options for a longer-term assessment of the programme's outcomes and impacts. Fieldwork was undertaken between November 2020 and February 2022. The University of Birmingham Institute for Mental Health Youth Advisory Group was involved throughout the study, including co-producing the focus groups with children and young people. Results: Substantial progress had been made implementing the programme, in challenging circumstances, and there was optimism about what it had the potential to achieve. The education mental health practitioner role had proven popular, but sites reported challenges in retaining education mental health practitioners, and turnover left mental health support teams short-staffed and needing to re-recruit. Education settings welcomed additional mental health support and reported positive early outcomes, including staff feeling more confident and having faster access to advice about mental health issues. At the same time, there were concerns about children who had mental health problems that were more serious than 'mild to moderate' but not serious enough to be accepted for specialist help, and that the interventions offered were not working well for some young people. Mental health support teams were generally spending more time supporting children with mental health problems than working with education settings to develop 'whole school' approaches to mental health and well-being, and service models in some sites appeared to be more clinically oriented, with a strong focus on mental health support teams' therapeutic functions. Limitations: Despite efforts to maximise participation, survey response rates were relatively low and some groups were less well represented than others. We were not able to gather sufficiently detailed data to develop a typology of Trailblazer sites, as was planned. Conclusions: Key lessons for future programme implementation include: - Whether mental health support teams should expand support to children and young people with more complex and serious mental health problems. - How to keep the twin aims of prevention and early intervention in balance. - How to retain education mental health practitioners once trained. Future work: The findings have important implications for the design of a longer-term impact evaluation of the programme, which is due to commence in summer 2023. Study registration: Ethical approval from the University of Birmingham (ERN_19-1400 - RG_19-190) and London School of Hygiene and Tropical Medicine (Ref: 18040) and Health Research Authority approval (IRAS 270760). Funding: The Birmingham, RAND and Cambridge Evaluation Rapid Evaluation Centre is funded by the National Institute for Health and Care Research Health Services and Delivery Research programme (HSDR 16/138/31). The Policy Innovation and Evaluation Research Unit is funded by the NIHR Policy Research Programme (PR-PRU-1217-20602).

Faecal microbiota transplantation for recurrent C. difficile infections: challenges and improvement opportunities for clinical practice and healthcare systems.

BACKGROUND: There is growing interest in faecal microbiota transplantation (FMT) as a treatment for recurrent Clostridioides difficile infection (CDI), but evidence on the diverse requirements for safe, effective and accessible services is fragmented and limited. AIMS: To identify key components of FMT provision relating to the patient care pathway, stool donor pathway and wider healthcare system, and to explore variation in practice METHODS: We conducted a narrative review of the literature and consultations with key clinical experts in the field. Evidence is drawn from high-income country contexts, with an emphasis on Australia, Canada, Italy and the United Kingdom as case example countries. RESULTS: We identify and discuss key challenges to do with healthcare capacity (workforce, FMT and stool banking facilities), donors and donations, patient access and choice of FMT delivery routes, regulation, costs and reimbursement. We also identify improvement opportunities to increase awareness of FMT and referral processes, physician training, maintaining patient registries and outcome monitoring metrics, in-country regulatory harmonisation and tackling reimbursement challenges and discuss future research needs. CONCLUSION: Effectively bringing FMT to patients in a healthcare system requires much more than just the existence of a clinically effective procedure. With FMT being a potentially effective treatment option for recurrent CDI for many patients, a well-rounded understanding of how appropriate FMT capacity can be built and nurtured is important for both healthcare providers and policymakers seeking to improve patient care.

The Burden of Respiratory Syncytial Virus: Understanding Impacts on the NHS, Society and Economy.

Respiratory syncytial virus (RSV) is a common respiratory virus that affects large numbers, mainly of children younger than five. The burden of RSV includes not only ill health for the children with the virus, which in severe cases results in hospitalisation, intensive care and even death; but also the emotional and practical burden on the affected families and carers; and the impact that has on productivity in the economy; alongside the costs of providing healthcare. We reviewed recent literature and published data relevant to the UK and used this information to model the costs to the healthcare system and to the wider UK economy in terms of productivity losses of parents/carers. We found healthcare costs and productivity losses in the UK resulting from RSV in children younger than five total approximately £80 million annually. These costs are the consequence, in part, of an estimated 467,000 GP visits per year in the UK for children aged under five with RSV and 34,000 hospitalisations. Our study also presents additional material, identified in the literature review, on the health impacts on affected children and the nature of the burden on parents and families of caring for a young child with RSV. The consequences of RSV are short-term for the majority of cases, but for some there are long term sequelae including poorer respiratory health in later life. RSV is also responsible for the deaths each year in the UK of an estimated 33 children under five.

Improving care for patients with Clostridioides difficile infection: A clinical practice and healthcare systems perspective.

Introduction: Arriving at a C. difficile infection (CDI) diagnosis, treating patients and dealing with recurrences is not straightforward, but a comprehensive and well-rounded understanding of what is needed to improve patient care is lacking. This manuscript addresses the paucity of multidisciplinary perspectives that consider clinical practice related and healthcare system-related challenges to optimizing care delivery. Methods: We draw on narrative review, consultations with clinical experts and patient representatives, and a survey of 95 clinical and microbiology experts from the UK, France, Italy, Australia and Canada, adding novel multi-method evidence to the knowledge base. Results and discussion: We examine the patient pathway and variations in clinical practice and identify, synthesize insights on and discuss associated challenges. Examples of key challenges include the need to conduct multiple tests for a conclusive diagnosis, treatment side-effects, the cost of some antibiotics and barriers to access of fecal microbiota transplantation, difficulties in distinguishing recurrence from new infection, workforce capacity constraints to effective monitoring of patients on treatment and of recurrence, and ascertaining whether a patient has been cured. We also identify key opportunities and priorities for improving patient care that target both clinical practice and the wider healthcare system. While there is some variety across surveyed countries' healthcare systems, there is also strong agreement on some priorities. Key improvement actions seen as priorities by at least half of survey respondents in at least three of the five surveyed countries include: developing innovative products for both preventing (Canada, Australia, UK, Italy, and France) and treating (Canada, Australia, and Italy) recurrences; facilitating more multidisciplinary patient care (UK, Australia, and France); updating diagnosis and treatment guidelines (Australia, Canada, and UK); and educating and supporting professionals in primary care (Italy, UK, Canada, and Australia) and those in secondary care who are not CDI experts (Italy, Australia, and France) on identifying symptoms and managing patients. Finally, we discuss key evidence gaps for a future research agenda.

Changes in physical activity and sedentary behaviours from before to during the COVID-19 pandemic lockdown: a systematic review.

OBJECTIVE: In March 2020, several countries banned unnecessary outdoor activities during COVID-19, commonly called 'lockdowns. These lockdowns have the potential to impact associated levels of physical activity and sedentary behaviour. Given the numerous health outcomes associated with physical activity and sedentary behaviour, the aim of this review was to summarise literature that investigated differences in physical activity and sedentary behaviour before vs during the COVID-19 lockdown. DESIGN DATA SOURCES AND ELIGIBILITY CRITERIA: Electronic databases were searched from November 2019 to October 2020 using terms and synonyms relating to physical activity, sedentary behaviour and COVID-19. The coprimary outcomes were changes in physical activity and/or sedentary behaviour captured via device-based measures or self-report tools. Risk of bias was measured using the Newcastle-Ottawa Scale. RESULTS: Sixty six articles met the inclusion criteria and were included in the review (total n=86 981). Changes in physical activity were reported in 64 studies, with the majority of studies reporting decreases in physical activity and increases in sedentary behaviours during their respective lockdowns across several populations, including children and patients with a variety of medical conditions. CONCLUSION: Given the numerous physical and mental benefits of increased physical activity and decreased sedentary behaviour, public health strategies should include the creation and implementation of interventions that promote safe physical activity and reduce sedentary behaviour should other lockdowns occur.

Associations of Sitting Behavior Patterns With Cardiometabolic Risk in Children: The Sit Less for Health Cross-Sectional Study.

BACKGROUND: The objective of this study was to investigate the associations between sedentary behavior patterns and cardiometabolic risk in children using a monitor that accurately distinguishes between different postures. METHODS: In this cross-sectional study, 118 children (67 girls) aged 11-12 years had adiposity, blood pressure, lipids, and glucose measured, and then they wore an activPAL device to record sitting, standing, and stepping for 7 consecutive days. Data were analyzed using multiple linear regression. RESULTS: After adjustment for potential confounders and moderate to vigorous physical activity, the number of breaks in sitting was significantly negatively associated with adiposity (standardized ß ≥ -0.546; P ≤ .001) and significantly positively associated with high-density lipoprotein cholesterol (ß = 0.415; P ≤ .01). Time in prolonged sitting bouts was significantly negatively associated with adiposity (ß ≥ -0.577; P ≤ .001) and significantly positively associated with high-density lipoprotein cholesterol (ß = 0.432; P ≤ .05). Standing time was significantly negatively associated with adiposity (ß ≥ -0.270; P ≤ .05) and significantly positively associated with high-density lipoprotein cholesterol (ß = 0.312; P ≤ .05). CONCLUSIONS: This study suggests that increasing the number of breaks in sitting and increasing standing time are beneficially associated with cardiometabolic risk and should be considered in health promotion interventions in children.

Digital behavior change interventions to promote physical activity and/or reduce sedentary behavior in older adults: A systematic review and meta-analysis.

BACKGROUND: Physical activity and sedentary behavior are modifiable risk factors for non-communicable disease and healthy ageing, however the majority of older adults remain insufficiently active. Digital behavior change interventions (DBCI) have the potential to reach many older adults to promote physical activity and reduce sedentary time. This study aims to assess the efficacy of DBCI interventions in older adults (≥50 years) on physical activity and sedentary behavior. METHODS: A systematic review of major databases from inception to 03/2018 was undertaken. Randomized controlled trials (RCT) or pre-post interventions assessing effects of DBCI on physical activity and/or sedentary behavior in older adults (≥50 years) were included. Random effects meta-analyses were carried out. RESULTS: Twenty-two studies were included, including 1757 older adults (mean age = 67 years, %male = 41), 68% showed moderate-high risk of bias. Meta-analyses suggested that DBCI increased total physical activity among RCT studies (n = 8) (SMD = 0.28; 95%CI 0.01, 0.56; p = 0.04) and pre-post studies (n = 6) (SMD = 0.25; 95%CI 0.09, 0.41; p = 0.002), increased moderate-to-vigorous physical activity (SMD = 0.47; 95%CI 0.32, 0.62, p < 0.001; MD = 52 min/week) and reduced sedentary time (SMD = -0.45; 95%CI -0.69, -0.19; p < 0.001; MD = 58 min/day). Reductions in systolic blood pressure (-11 bpm; p = 0.04) and improvements in physical functioning (p = 0.03) were also observed. CONCLUSIONS: DBCI may increase physical activity and physical functioning, and reduce sedentary time and systolic blood pressure in older adults, however more high-quality studies are required.

A Progressive Reading, Writing, and Artistic Module to Support Scientific Literacy.

Scientific literacy, marked by the ability and willingness to engage with scientific information, is supported through a new genre of citizen science-course-based research in association with undergraduate laboratories. A three-phased progressive learning module was developed to enhance student engagement in such contexts while supporting three learning outcomes: I) present an argument based on evidence, II) analyze science and scientists within a social context, and III) experience, reflect upon, and communicate the nature of scientific discovery. Phase I entails guided reading and reflection of citizen science-themed texts. In Phase II, students write, peer-review, and edit position and counterpoint papers inspired by the following prompt, "Nonscientists should do scientific research." Phase III involves two creative assignments intended to communicate the true nature of science. Students work collaboratively to develop public service announcement-like poster campaigns to debunk a common misconception about the nature of science or scientists. Individually, they create a work of art to communicate a specific message about the raw experience of performing scientific research. Suggestions for implementation and modifications are provided. Strengths of the module include the development of transferable skills, temporal distribution of grading demands, minimal in-class time needed for implementation, and the inclusion of artistic projects to support affective learning domains. This citizen science-themed learning module is an excellent complement to laboratory coursework, as it serves to surprise, challenge, and inspire students while promoting disciplinary values.

Genomic characterization and comparison of seven Myoviridae bacteriophage infecting Bacillus thuringiensis.

Bacillus thuringiensis Kurstaki, a bacterium that is a source of biopesticides and a safe simulant for pathogenic Bacillus species, was used to isolate seven unique bacteriophages. The phage genomes were sequenced and ranged in size from 158,100 to 163,019 bp encoding 290-299 genes, and the GC content of ~38% was similar to that of the host bacterium. All phages had terminal repeats 2-3 kb long. Three of the phages encoded tRNAs and three contained a self-splicing intron in the DNA polymerase gene. They were categorized as a single cluster (>60% nucleotide conservation) containing three subclusters (>80% nucleotide conservation), supported by genomic synteny and phylogenetic analysis. Considering the published genomes of phages that infect the genus Bacillus and noting the ability of many of the Bacillus cereus group phages to infect multiple species, a clustering system based on gene content is proposed.

Bordetella avium antibiotic resistance, novel enrichment culture, and antigenic characterization.

Bordetella avium continues to be an economic issue in the turkey industry as the causative agent of bordetellosis, which often leads to serious secondary infections. This study presents a broad characterization of the antibiotic resistance patterns in this diverse collection of B. avium strains collected over the past thirty years. In addition, the plasmid basis for the antibiotic resistance was characterized. The antibiotic resistance pattern allowed the development of a novel enrichment culture method that was subsequently employed to gather new isolates from diseased turkeys and a healthy sawhet owl. While a healthy turkey flock was shown to seroconvert by four weeks-of-age, attempts to culture B. avium from healthy turkey poults were unsuccessful. Western blot of B. avium strains using pooled serum from diseased and healthy commercial turkey flocks revealed both antigenic similarities and differences between strains. In sum, the work documents the continued exposure of commercial turkey flocks to B. avium and the need for development of an effective, inexpensive vaccine to control spread of the disease.

Bordetella avium causes induction of apoptosis and nitric oxide synthase in turkey tracheal explant cultures.

Bordetellosis is an upper respiratory disease of turkeys caused by Bordetella avium in which the bacteria attach specifically to ciliated respiratory epithelial cells. Little is known about the mechanisms of pathogenesis of this disease, which has a negative impact in the commercial turkey industry. In this study, we produced a novel explant organ culture system that was able to successfully reproduce pathogenesis of B. avium in vitro, using tracheal tissue derived from 26 day-old turkey embryos. Treatment of the explants with whole cells of B. avium virulent strain 197N and culture supernatant, but not lipopolysaccharide (LPS) or tracheal cytotoxin (TCT), specifically induced apoptosis in ciliated cells, as shown by annexin V and TUNEL staining. LPS and TCT are known virulence factors of Bordetella pertussis, the causative agent of whooping cough. Treatment with whole cells of B. avium and LPS specifically induced NO response in ciliated cells, shown by uNOS staining and diaphorase activity. The explant system is being used as a model to elucidate specific molecules responsible for the symptoms of bordetellosis.