Explore the vast range of titles available.

Background Strokes are one of the leading causes of death worldwide. People with a lower socioeconomic position (SEP) (i.e. with regards to education, income and occupation) are at a higher risk of having a stroke and have worse clinical outcomes compared to the general population. Good knowledge levels about stroke risk factors and warning signs are key to prolonging life and reducing health issues caused by stroke. This systematic review examined differences in knowledge of stroke risk factors and warning signs with regards to SEP in the WHO European region. Methods MEDLINE, Embase, Web of Science, PsycINFO and CINAHL were systematically searched using appropriate Medical Subject Headings (MeSH) terms and free text, combining search terms with Boolean operators. Two independent reviewers selected studies in two stages (title and abstract, and full-text), and screened reference lists of included studies. Only studies in English and based in the WHO European region were included. Results Screening identified 2118 records. In the final review, 20 articles were included, with 67,309 study participants between them. Out of 17 studies that looked at stroke risk factors, 11 found increasing knowledge to be associated with higher SEP, four found no difference by SEP, one showed a mixed pattern and one outlier study found increasing knowledge of risk factors to be associated with a lower SEP. Out of 19 studies that looked at stroke warning signs or symptoms, 15 found there to be better knowledge of warning signs with a higher SEP, three found there to be no difference, and the same outlier study found increasing knowledge of warning signs with a lower SEP. Studies that seemed to have a higher quality rating found increasing knowledge of stroke with a higher SEP. A meta-analysis was not possible due to heterogeneity of studies. Conclusions In the WHO European region, better knowledge of stroke risk factors and warning signs is associated with a higher SEP. Public health campaigns and educational interventions aiming to increase stroke knowledge should be targeted at people with a lower SEP.

ObjectivesTo assess the longitudinal evidence of the relationships between sleep disturbances (of quantity and quality) and dyslipidaemia in the general population and to quantify such relationships.SettingSystematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.MethodsWe performed a systematic search of PubMed and Embase (up to 9 September 2017), complemented with manual searches, of prospective population studies describing the association between sleep duration and quality and the incidence of dyslipidaemias. Relative risks (95% CIs) were extracted and pooled using a random effects model. Subgroup analyses by lipid type were performed. Heterogeneity and publication bias were also assessed. Quality was assessed with Downs and Black score.ParticipantsStudies were included if they were prospective, had measured sleep quantity and/or quality at baseline and either incident cases of dyslipidaemia or changes in blood lipid fractions assessed prospectively.Primary outcome measuresRisk of of dyslipidaemia and changes in lipid fractions. Dyslipidaemia was defined as unfavorable lipid profile, such as high total cholesterol, triglycerides, low-density lipoprotein cholesterol or low high-density lipoprotein cholesterol.ResultsEleven studies were identified (seven using sleep duration, three sleep quality and one both). There was heterogeneity in the sleep quality aspects and types of lipids assessed. Classification of sleep duration (per hour/groups) also varied widely. In the pooled analysis of sleep duration (6 studies, 16 samples; 59945 participants; follow-up 2.6–10 years), short sleep was associated with a risk of 1.01 (95% CI 0.93 to 1.10) of developing dyslipidaemia, with moderate heterogeneity (I2=56%, P=0.003) and publication bias (P=0.035). Long sleep was associated with a risk of 0.98 (95% CI 0.87 to 1.10) for dyslipidaemia, with heterogeneity (I2=63%, P<0.001) and no significant publication bias (P=0.248).ConclusionThe present analysis was unable to find supportive evidence of a significant relationship between sleep duration and the development of dyslipidaemia. However, heterogeneity and small number of studies limit the interpretation.PROSPERO registration numberCRD42016045242.

Emerald ash borer (EAB) (Agrilus planipennis Fairmaire), an invasive forest insect first identified in southeastern Michigan in 2002, is established in at least 32 US states and three Canadian provinces. Ash (Fraxinus spp.) mortality rates in some forested areas exceed 90%, but to date, little is known about the potential effects of EAB-caused ash mortality on hydrological processes. More broadly, there is a need for information on the timing and magnitude of soil moisture response to species-specific mortality of overstory vegetation in deciduous forest systems. Soil moisture was examined in 28 forested sites where 0–100% of the white ash basal area (Fraxinus americana L.) was killed by EAB. Synoptic measurements of near-surface (0–6 cm depth) soil moisture were collected from 112 plots (18 m radius) within the sites. Three plots were also instrumented with soil moisture sensors at 10 and 25 cm depth to log hourly measurements from May to October. Synoptic data showing white ash mortality and soil moisture were positively correlated in the 34 plots with ≥ 5% mortality (by total basal area). In the intensively monitored plots, volumetric soil moisture declined from 37 to 16% between July and September where white ash mortality was low (0.6% of basal area killed), but remained near field capacity (~ 30%) throughout the monitoring period in the high mortality plot (8.6% of basal area killed), meriting further investigation to assess effects of white ash mortality on evapotranspiration and soil moisture dynamics in heterogeneous upland forests. Altered soil moisture may have implications for regrowth dynamics, infiltration/runoff partitioning, and nutrient cycling, but additional study to quantify the extent and duration of EAB-related ash mortality on hydrology at the plot and watershed scale is necessary.

Background Local-level analysis of ethnic inequalities in health is lacking, prohibiting a comprehensive understanding of the health needs of local populations and the design of effective health services. Knowledge of ethnic disparities in child weight status is particularly limited by overlooking both the heterogeneity within ethnic groupings; and the complex ecological contexts in which obesity arises. This study aimed to establish whether there was variation in childhood BMI across ethnic groups in Coventry, and the influence of individual, school and neighbourhood contexts, using routinely collected local data. Methods National Child Measurement Programme data were compiled for the period 2007/8–2014/15 and combined with routinely collected local data reflecting school performance and demographics, and school and neighbourhood physical environments. Multi-level modelling using Monte Carlo Markov Chain methods was used to account for the clustering of children within schools and neighbourhoods. Ethnic group differences in BMI z-score (zBMI) were explored at 4–5 years and 10–11 years for girls and boys alongside individual, school and neighbourhood covariates. Results At age 4–5 years ( n  = 28,407), ethnic group differences were similar for boys and girls, with children from South Asian, White other, Chinese and ‘any other’ ethnic groups having a significantly lower zBMI, and Black African children having a higher zBMI, versus White British (WB) children. Patterns differed considerably at age 10–11 years ( n  = 25,763) with marked sex differences. Boys from White other, Bangladeshi and Black African groups had a significantly higher zBMI than WB boys. For girls, only children from Black ethnic groups showed a significantly higher zBMI. Area-level deprivation was the only important school or neighbourhood covariate, but its inclusion did not explain ethnic group differences in child zBMI. Conclusion This analysis contributes to the existing literature by identifying nuanced patterns of ethnic disparities in childhood adiposity in Coventry, supporting the targeting of early obesity prevention for children from Black African groups, as well as girls from Black Caribbean and Black other ethnic backgrounds; and boys from Bangladeshi and White other ethnic backgrounds. It also demonstrates the utility of exploring routinely collected local data sets in building a comprehensive understanding of local population needs.

Objective The Eat Well Move More (EWMM) family and child weight management service is a 12-week intervention integrating healthy eating and physical activity education and activities for families and children aged 4–16. EWMM service providers identified low uptake 12 months prior to the evaluation. The aims of this study were to describe referral practices and pathways into the service to identify potential reasons for low referral and uptake rates. Results We conducted interviews and focus groups with general practitioners (GPs) (n = 4), school nurses, and nursing assistants (n = 12). Data were analysed using thematic analysis. School nurses highlighted three main barriers to making a referral: parent engagement, child autonomy, and concerns over the National Child Measurement Programme letter. GPs highlighted that addressing obesity among children is a ‘difficult conversation’ with several complex issues related to and sustaining that difficulty. In conclusion, referral into weight management services in the community may persistently lag if a larger and more complex tangle of barriers lie at the point of school nurse and GP decision-making. The national prevalence of, and factors associated with this hesitation to discuss weight management issues with parents and children remains largely unknown.

A clear understanding of climate change and its impacts on society is an integral component of scientific literacy today. However, college students in introductory and lower division science courses often struggle to connect with this material in a meaningful way when they do not see how it is relevant to their daily lives. To address this challenge, we have developed a role-playing game in which students act out a fictitious meeting of the Seattle City Council in which they select an action plan in response to impending sea-level rise. They are given roles and form factions to develop proposals, lobbying for either climate change prevention, mitigation, or adaptation. Students focus on using scientific literature and evidence to support their arguments and work as teams to get their action plans approved by the city council. The game takes approximately two class periods, during which the teams research and prepare action plans, the council hears proposals and questions the lobbying citizens, and an action plan is selected. Quantitative and qualitative data from introductory Earth and atmospheric science courses demonstrate improved learning outcomes for game-relevant course content and student perceptions of increased learning.

The benefits of physical activity in young people are well documented. Understanding of young people's physical activity behaviours is therefore important in promotion of participation in this group. Objective measures are increasingly used to quantify the amount and intensity of physical activity, and accelerometers are currently the favoured device. Previous studies have found some parents reporting their children as unwilling to wear accelerometers at school and during sports because of the risk of stigma and bullying. There is however, little evidence for how young people themselves feel about wearing accelerometers for physical activity research. We aimed to investigate young people's views on accelerometer use. We undertook a user-involvement qualitative study, involving five focus group discussions with young people aged 7–18 years (n=35). Participants were members of two Medicines for Children Research Network (MCRN) young person's advisory groups and pupils from two local primary schools. Focus groups allowed for differences between participants to be revealed. Young people's views were analysed by thematic analysis. Five broad themes emerged from the focus group discussions: first impressions, how it feels to wear an accelerometer, best time to wear an accelerometer, disadvantages of wearing an accelerometer, and how accelerometers can be made more appealing or incentives for use. First impressions of accelerometers were often negative, with issues related to size and comfort reported. In particular, participants felt that the accelerometer could be too bulky and that the elastic waistband used to attach it could be uncomfortable. Unwanted attention from wearing the device and the risk of bullying were also noted. Other disadvantages included feeling embarrassed and not being able to wear the device for certain activities (eg, swimming or contact sports). Many young people felt that they would find it difficult to keep an activity diary alongside their accelerometer use. Positive aspects included feeling special or having increased attention or curiosity from friends. Views on the best time to wear accelerometers (eg, term time or holidays) were mixed. Young people offered advice on how to make wearing accelerometers more appealing, including presenting the device in a positive way, using a clip rather than an elastic band to attach it, personalising the device, and being able to see activity levels via feedback afterwards. There has been little focus on young people's views on wearing accelerometers in physical activity research. This small-scale user-involvement study provides initial data and provides practical issues for researchers to consider when embarking on accelerometer research in this group. Young people's views on accelerometer use are varied. Judgments over the way in which accelerometers are used should be made at the study development stage, and based on the individual population, to increase compliance. This study presents practical ideas for researchers to help to increase acceptability of accelerometer use in young people. This is a small-scale study within a specific group of young people in the West Midlands, UK, but initial findings are revealing and certainly warrant further exploration. National Institute for Health Research Health Technology Assessment.

ObjectiveTo examine whether care provided by general practitioners (GPs) to non-urgent patients in the emergency department differs significantly from care provided by usual accident and emergency (A&E) staff in terms of process outcomes and A&E clinical quality indicators.DesignPropensity score matched cohort study.SettingGPs in A&E colocated within the University Hospitals Coventry and Warwickshire NHS Trust between May 2015 and March 2016.ParticipantsNon-urgent attendances visits to the A&E department.Main outcomesProcess outcomes (any investigation, any blood investigation, any radiological investigation, any intervention, admission and referrals) and A&E clinical indicators (spent 4 hours plus, left without being seen and 7-day reattendance).ResultsA total of 5426 patients seen by GPs in A&E were matched with 10 852 patients seen by emergency physicians (ratio 1:2). Compared with standard care in A&E, GPs in A&E significantly: admitted fewer patients (risk ratio (RR) 0.28, 95% CI 0.25 to 0.31), referred fewer patients to other specialists (RR 0.31, 95% CI 0.24 to 0.40), ordered fewer radiological investigations (RR 0.38, 95% CI 0.34 to 0.42), ordered fewer blood tests (0.57, 95% CI 0.52 to 0.61) and ordered fewer investigations (0.93, 95% CI 0.90 to 0.96). However, they intervened more, offered more primary care follow-up (RR 1.78, 95% CI 1.67 to 1.89) and referred more patients to outpatient and other A&E clinics (RR 2.29, 95% CI 2.10 to 2.49). Patients seen by GPs in A&E were on average less likely to spend 4 hours plus in A&E (RR 0.37, 95% CI 0.30 to 0.45) compared with standard care in A&E. There was no difference in reattendance after 7 days (RR 0.96, 95% CI 0.84 to 1.09).ConclusionGPs in A&E tended to manage self-reporting minor cases with fewer resources than standard care in A&E, without increasing reattendance rates.

ObjectiveEvaluating effectiveness and cost-effectiveness of ‘Families for Health V2′ (FFH) compared with usual care (UC).DesignMulticentre randomised controlled trial (RCT) (investigators blinded, families unblinded) and economic evaluation. Stratified randomisation by family; target of 120 families.SettingThree National Health Service Primary Care Trusts in West Midlands, England.ParticipantsOverweight or obese (≥91st or ≥98th centile body mass index (BMI)) children aged 6–11 years and their parents/carers, recruited March 2012–February 2014.InterventionsFFH; a 10-week community-based family programme addressing parenting, lifestyle change and social and emotional development. UC; usual support for childhood obesity at each site.Main outcome measuresPrimary outcomes were 12-months change in children's BMI z-score and incremental cost per quality-adjusted life-year gained (QALY). Secondary outcomes included changes in children's physical activity, fruit and vegetable consumption and quality of life, parents' BMI and mental well-being, family eating/activity, parent-child relationships and parenting style.Results115 families (128 children) were randomised to FFH (n=56) or UC (n=59). There was no significant difference in BMI z-score 12-months change (0.114, 95% CI −0.001 to 0.229, p=0.053; p=0.026 in favour of UC with missing value multiple imputation). One secondary outcome, change in children's waist z-score, was significantly different between groups in favour of UC (0.15, 95% CI 0.00 to 0.29). Economic evaluation showed that mean costs were significantly higher for FFH than UC (£998 vs £548, p<0.001). Mean incremental cost-effectiveness of FFH was estimated at £552 175 per QALY.ConclusionsFFH was neither effective nor cost-effective for the management of obesity compared with UC.Trial registration numberISRCTN45032201.

Objective:To develop and evaluate “Families for Health”, a new community based family intervention for childhood obesity.Design:Programme development, pilot study and evaluation using intention-to-treat analysis.Setting:Coventry, England.Participants:27 overweight or obese children aged 7–13 years (18 girls, 9 boys) and their parents, from 21 families.Intervention:Families for Health is a 12-week programme with parallel groups for parents and children, addressing parenting, lifestyle change and social and emotional development.Main outcome measures:Change in baseline BMI z score at the end of the programme (3 months) and 9-month follow-up. Attendance, drop-out, parents’ perception of the programme, child’s quality of life and self-esteem, parental mental health, parent–child relationships and lifestyle changes were also measured.Results:Attendance rate was 62%, with 18 of the 27 (67%) children completing the programme. For the 22 children with follow-up data (including four who dropped out), BMI z score was reduced by −0.18 (95% CI −0.30 to −0.05) at 3 months and −0.21 (−0.35 to −0.07) at 9 months. Statistically significant improvements were observed in children’s quality of life and lifestyle (reduced sedentary behaviour, increased steps and reduced exposure to unhealthy foods), child–parent relationships and parents’ mental health. Fruit and vegetable consumption, participation in moderate/vigorous exercise and children’s self-esteem did not change significantly. Topics on parenting skills, activity and food were rated as helpful and used with confidence by most parents.Conclusions:Families for Health is a promising new childhood obesity intervention. Definitive evaluation of its clinical effectiveness by randomised controlled trial is now required.