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Many countries now offer support to teenage mothers to help them to achieve long-term socioeconomic stability and to give a successful start to their children. The Family Nurse Partnership (FNP) is a licensed intensive home-visiting intervention developed in the USA and introduced into practice in England that involves up to 64 structured home visits from early pregnancy until the child's second birthday by specially recruited and trained family nurses. We aimed to assess the effectiveness of giving the programme to teenage first-time mothers on infant and maternal outcomes up to 24 months after birth. We did a pragmatic, non-blinded, randomised controlled, parallel-group trial in community midwifery settings at 18 partnerships between local authorities and primary and secondary care organisations in England. Eligible participants were nulliparous and aged 19 years or younger, and were recruited at less than 25 weeks' gestation. Field-based researchers randomly allocated mothers (1:1) via remote randomisation (telephone and web) to FNP plus usual care (publicly funded health and social care) or to usual care alone. Allocation was stratified by site and minimised by gestation (<16 weeks vs ≥16 weeks), smoking status (yes vs no), and preferred language of data collection (English vs non-English). Mothers and assessors (local researchers at baseline and 24 months' follow-up) were not masked to group allocation, but telephone interviewers were blinded. Primary endpoints were biomarker-calibrated self-reported tobacco use by the mother at late pregnancy, birthweight of the baby, the proportion of women with a second pregnancy within 24 months post-partum, and emergency attendances and hospital admissions for the child within 24 months post-partum. Analyses were by intention to treat. This trial is registered with ISRCTN, number ISRCTN23019866. Between June 16, 2009, and July 28, 2010, we screened 3251 women. After enrolment, 823 women were randomly assigned to receive FNP and 822 to usual care. All follow-up data were retrieved by April 25, 2014. 304 (56%) of 547 women assigned to FNP and 306 (56%) of 545 assigned to usual care smoked at late pregnancy (adjusted odds ratio [AOR] 0·90, 97·5% CI 0·64–1·28). Mean birthweight of 742 babies with mothers assigned to FNP was 3217·4 g (SD 618·0), whereas birthweight of 768 babies assigned to usual care was 3197·5 g (SD 581·5; adjusted mean difference 20·75 g, 97·5% CI −47·73 to 89·23. 587 (81%) of 725 assessed children with mothers assigned to FNP and 577 (77%) of 753 assessed children assigned to usual care attended an emergency department or were admitted to hospital at least once before their second birthday (AOR 1·32, 97·5% CI 0·99–1·76). 426 (66%) of 643 assessed women assigned to FNP and 427 (66%) 646 assigned to usual care had a second pregnancy within 2 years (AOR 1·01, 0·77–1·33). At least one serious adverse event (mainly clinical events associated with pregnancy and infancy period) was reported for 310 (38%) of 808 participants (mother–child) in the usual care group and 357 (44%) of 810 in the FNP group, none of which were considered related to the intervention. Adding FNP to the usually provided health and social care provided no additional short-term benefit to our primary outcomes. Programme continuation is not justified on the basis of available evidence, but could be reconsidered should supportive longer-term evidence emerge. Department of Health Policy Research Programme.

Pyrolysis–gas chromatography mass spectrometry (py-GC/MS) allows the characterisation of complex macromolecular organic matter. In lakes and wetlands this can potentially be used to assess the preservation/diagenesis and provenance of sediment organic matter. It can complement palaeoenvironmental investigations utilising ‘bulk’ sediment variables such as total organic carbon (TOC) and TOC/total nitrogen ratios. We applied py-GC/MS analyses to a ~32,000-year sediment record from the southern Cape coastline of South Africa. We used the results to evaluate the sources and extent of degradation of organic matter in this semi-arid environment. Marked down-core changes in the relative abundance of multiple pyrolysis products were observed. Correspondence analysis revealed that the major driver of this down-core variability in OM composition was selective preservation/degradation. Samples comprising highly degraded OM are primarily confined to the lower half of the core, older than ~12,000 years, and are characterised by suites of low-molecular-weight aromatic pyrolysis products. Samples rich in organic matter, e.g. surface sediments, are characterised by products derived from fresh emergent or terrestrial vegetation, which include lignin monomers, plant-derived fatty acids and long-chain n -alkanes. Pyrolysates from the late glacial-early Holocene period, approximately mid-way down the core are characterised by distinct suites of long-chain n -alkene/ n -alkane doublets, which may reflect the selective preservation of recalcitrant aliphatic macromolecules and/or enhanced inputs of the algal macromolecule algaenan/polymerised algal lipids. Increased TOC, lower δ 13 C and increased abundance of more labile lignin and fatty acid products at the same depths suggest this period was associated with increased lake primary productivity and enhanced inputs of terrestrial OM. TOC is the only ‘bulk’ parameter correlated with the correspondence analysis axes extracted from the py-GC/MS data. Distinct fluctuations in TOC/total nitrogen ratio are not explained by variation in organo-nitrogen pyrolysis products. Notwithstanding, the study suggests that py-GC/MS has potential to complement palaeolimnological investigations, particularly in regions such as southern Africa, where other paleoenvironmental proxy variables in sediments may be lacking or equivocal.

Background The Nurse Family Partnership programme was developed in the USA where it is made available to pregnant young mothers in some socially deprived geographic areas. The related Family Nurse Partnership programme was introduced in England by the Department of Health in 2006 with the aim of improving outcomes for the health, wellbeing and social circumstances of young first-time mothers and their children. Methods / design This multi-centre individually randomised controlled trial will recruit 1600 participants from 18 Primary Care Trusts in England, United Kingdom. The trial will evaluate the effectiveness of Family Nurse Partnership programme and usual care versus usual care for nulliparous pregnant women aged 19 or under, recruited by 24 weeks gestation and followed until the child’s second birthday. Data will be collected from participants at baseline, 34-36 weeks gestation, 6, 12, 18 and 24 months following birth. Routine clinical data will be collected from maternity, primary care and hospital episodes statistics. Four primary outcomes are to be reported from the trial: birth weight; prenatal tobacco use; child emergency attendances and/or admissions within two years of birth; second pregnancy within two years of first birth. Discussion This trial will evaluate the effectiveness and cost effectiveness of the Family Nurse Partnership in England. The findings will provide evidence on pregnancy and early childhood programme outcomes for policy makers, health professionals and potential recipients in three domains (pregnancy and birth, child health and development, and parental life course and self-sufficiency) up to the child’s second birthday. Trial registration Trial registration number: ISRCTN 23019866

ObjectivesThe Strengthening Families Programme 10–14 (SFP10-14) is a USA-developed universal group-based intervention aiming to prevent substance misuse by strengthening protective factors within the family. This study evaluated a proportionate universal implementation of the adapted UK version (SFP10-14UK) which brought together families identified as likely/not likely to experience/present challenges within a group setting.DesignPragmatic cluster-randomised controlled effectiveness trial, with families as the unit of randomisation and embedded process and economic evaluations.SettingThe study took place in seven counties of Wales, UK.Participants715 families (919 parents/carers, 931 young people) were randomised.InterventionsFamilies randomised to the intervention arm received the SFP10-14 comprising seven weekly sessions. Families in intervention and control arms received existing services as normal.Outcome measuresPrimary outcomes were the number of occasions young people reported drinking alcohol in the last 30 days; and drunkenness during the same period, dichotomised as ‘never’ and ‘1–2 times or more’. Secondary outcomes examined alcohol/tobacco/substance behaviours including: cannabis use; weekly smoking (validated by salivary cotinine measures); age of alcohol initiation; frequency of drinking >5 drinks in a row; frequency of different types of alcoholic drinks; alcohol-related problems. Retention: primary analysis included 746 young people (80.1%) (alcohol consumption) and 732 young people (78.6%) (drunkenness).ResultsThere was no evidence of statistically significant between-group differences 2 years after randomisation for primary outcomes (young people’s alcohol consumption in the last 30 days adjusted OR=1.11, 95% CI 0.72 to 1.71, p=0.646; drunkenness in the last 30 days adjusted OR=1.46, 95% CI 0.83 to 2.55, p=0.185). There were no statistically significant between-group differences for other substance use outcomes, or those relating to well-being/stress, and emotional/behavioural problems.ConclusionsPrevious evidence of effectiveness was not replicated. Findings highlight the importance of evaluating interventions when they are adapted for new settings.Trial registration numberISRCTN63550893.Cite Now

ObjectivesTo review outcomes of young people, identified through screening of ‘red flag’ presentations, discussed at an Emergency Department (ED)-focussed Adolescent Safeguarding meetingBackgroundAt the University Hospital of Wales (UHW) in Cardiff, young people aged 16 & 17 years presenting to the ED will be seen and managed within the adult unit, unless under ongoing care of a Paediatrician.In September 2018, focus groups were set up during the participation phase of the Trust’s Children’s Charter, where users of the service gave feedback on their ED experience. The results, and a subsequent snapshot audit assessing safeguarding (SG) issues arising within this transitional age group, highlighted a significant need to offer equity of safety-net processes, reflecting those afforded to younger children attending the Paediatric ED.A multi-agency task group convened to understand the issues and address the shortcomings. A series of changes followed, including adolescent specific paperwork, incorporating the HEADS screening tool and associated pathway, plus the introduction of a bi-weekly ‘Adolescent Safeguarding’ meeting. Here, ‘red flag’ cases* are reviewed by representatives from Violence Prevention, Emergency Medicine, Safeguarding, Department of Sexual Health (DOSH), Child & Adolescent Mental Health Services (CAMHS), Frequent Attenders (FA), Childs Rights Advocate and Looked After Children (LAC) teams, gaps identified and relevant referrals made.MethodsA retrospective review of the cases discussed at the Adolescent Safeguarding meeting from 01.03.2021 until 28.02.22 was undertaken. Outcomes were reviewed, primarily to assess the frequency of onward referrals.* red flag attendances include:assault/punch injuriesmental health (e.g Overdose/DSH)UTI/genitourinaryPregnancy/sexual healthAbdominal painDrugs/alcoholLooked after young personResultsSixteen & seventeen year-olds made up 2968 attendances during the year, with 727 (24%) requiring discussion at the SG meeting, flagged from their presenting complaint (average 30 cases per meeting). Of those discussed, 305 (42%) required referral to another service with an average of 12 referrals made per meeting.Referrals includedOnward referrals Total Number % of total Violence Prevention team 25 8 Childrens Services 206 68 DOSH 4 1 CAMHS 30 10 School Nurse 28 9 LAC team 12 4 ConclusionsAlmost a quarter of 16 & 17 year olds attending the adult ED at a large tertiary hospital presented with potentially high risk complaints. Of these, almost half were felt retrospectively to require further support by way of onward referral, with the majority to Children’s Services.Whilst the processes are largely in place locally to support, educate and inform at time of presentation, this age group continue to slip through the gap. The adult service remains overwhelmed, ‘child-specific’ legislation may be overlooked and frequently only physical symptoms are identified and treated.Much work is being done to address these challenges, including education of staff, digitalised referral processes and consideration of recruiting allied professionals, such as Youth Workers, to work within the ED.Making every contact count at point of presentation is clearly the gold standard, however, the Adolescent Safeguarding meeting provides some reassurance of safety netting for this vulnerable group of patients.

The importance of stakeholder engagement in ocean observation and in particular the realization of economic and societal benefits is discussed, introducing a number of overarching principles such as the convergence on common goals, effective communication, co-production of information and knowledge and the need for innovation. A series of case studies examine the role of coordinating frameworks such as the US’s Interagency Ocean Observing System (IOOS®), and the European Ocean Observing System (EOOS), public-private partnerships such as Project Azul and the Coastal Data Information Program (CDIP) and finally the role of the “third” or voluntary sector. The paper explores the value that stakeholder engagement can bring as well as making recommendations for the future.

UK Biobank is a prospective study of half a million subjects, almost all aged 40-69 years, identified in 22 centres across the UK during 2006-2010. A healthy lifestyle has been described as 'better than any pill, and no side effects [5]. We therefore examined the relationships between healthy behaviours: low alcohol intake, non-smoking, healthy BMI, physical activity and a healthy diet, and the risk of all cancers, colon, breast and prostate cancers in a large dataset. Data on lifestyle behaviours were provided by 343,150 subjects, and height and weight were measured at recruitment. 14,285 subjects were diagnosed with cancer during a median of 5.1 years of follow-up. Compared with subjects who followed none or a single healthy behaviour, a healthy lifestyle based on all five behaviours was associated with a reduction of about one-third in incident cancer (hazard ratio [HR] 0.68; 95% confidence intervals [CI] 0.63-0.74). Colorectal cancer was reduced in subjects following the five behaviours by about one-quarter (HR 0.75; 95% CI 0.58-0.97), and breast cancer by about one-third (HR 0.65; 95% CI 0.52-0.83). The association between a healthy lifestyle and prostate cancer suggested a significant increase in risk, but this can be attributed to bias consequent on inequalities in the uptake of the prostate specific antigen screening test. Taken together with reported reductions in diabetes, vascular disease and dementia, it is clearly important that every effort is taken to promote healthy lifestyles throughout the population, and it is pointed out that cancer and other screening clinics afford 'teachable moments' for the promotion of a healthy lifestyle.

BackgroundBleeding per rectum in infants and children is often an alarming symptom for caregivers. The differential diagnosis is wide, from the benign to life-threatening. The current literature is limited on the description of this undifferentiated population in the UK. We aimed to describe the frequency of this presentation, the most common diagnoses and current management in the Paediatric Emergency Department (PED).Method and resultsRetrospective case note review of all patients presenting to a tertiary PED within a two year period from April 2017 to March 2019, with blood in stool/per rectum. Cases were identified by reviewing all presenting complaints including the words ‘blood’ or ‘bleed’. Data was collected using a standardised data collection form for the following variables; age, sex, diagnosis in PED, urgent intervention required, diagnosis on follow-up, diagnostic concordance between PED and follow-up diagnosis, investigation (stool, blood, imaging), admission, outpatient referral and reattendance during thestudy period.ConclusionsA total of 90 cases were identified, 10 were excluded as they did not meet inclusion criteria (n=80). This made up 0.14% of all presentations to the PED within the two year period. Mean age was 5 years (3 months - 15 years) with 51% female and 49% male. Collectively constipation and gastroenteritis accounted for 76% of diagnoses. 24% of patients were admitted the same day and 38% referred for outpatient follow up. There was agreement between PED diagnosis and outpatient diagnosis in 87% of cases. 5% of cases required urgent intervention.Bleeding per rectum is an infrequent presentation to the PED. The most common diagnoses are benign and many cases may be managed without need of admission or outpatient follow up. A high index of suspicion remains necessary to identify infrequent but serious pathology. There is currently limited evidence to guide practice and therefore further work is required.

See Nagpal v. IBM Canada Ltd. Frustration of a contract occurs when an employee becomes ill to the point of being temporarily or permanently incapacitated and, therefore, unable to return to work to perform their regular duties or when the length of the employee's illness means that it would be unreasonable for the employer to wait any longer for the employee to recover and return to work - as established by the Ontario Superior Court General Division in its 1999 decision Skopitz v. Intercorp Excelle Foods Inc. The onus rests on the employer to establish that the contract of employment has been frustrated. The doctrine of frustration of contract is not likely to apply in a situation where an employer must lay off or downsize employees due to decreased revenue or a recession - see the Ontario Court of Appeal decision ACT Greenwood Ltd. v. Desjardins-McLeod - particularly if the layoff or economic disruption is not permanent. Court decisions will likely be made on a case-by-case basis, depending on the specific facts of each termination.

\"Essential\" employees, such as hospital workers, ambulance drivers and police officers cannot refuse work when: * the likely endangerment is inherent in the employee's work or is a normal condition of the employee's employment; or * the employee's refusal to work would directly endanger the life, health or safety of another person. Work refusals during the pandemic During the COVID-19 crisis, it is possible that employees could refuse work in the following circumstances: * When there is a confirmed or presumptive case of COVID-19 in the workplace; * If the employee is considered \"high risk\" for contracting COVID-19 due to their age or a pre-existing condition; * If the employee works in an essential service - for example, a grocery store - and is concerned about the increased risk of exposure due to close proximity with the general public and colleagues. The employee may also be given \"other directions\" by their employer during the Ministry of Labour's investigation, which could likely include paid or unpaid leave depending on the length of time required to determine the risk.