Reflections from the forgotten frontline: ‘The reality for children and staff in residential care’ during COVID-19

Currently, 78,150 children are in care in England, with 11% of the most vulnerable living in 2,460 residential homes due to multitype traumas. These children require safe and secure trauma-informed therapeutic care. However, the children's residential care workforce delivering this vital care is an unrepresented, under-researched and largely unsupported professional group. The workforce undertakes physically and emotionally challenging work in difficult conditions, exacerbated by the COVID-19 pandemic. Practitioner wellbeing is directly associated with outcomes for children. Therefore, we sought to understand how experiences within the workforce could improve overall working conditions, and thus outcomes for staff and children. Thirty participants took part in a survey, providing feedback on their experiences and the situations they faced during the English lockdown April-June 2020. Two participants also opted to take part in a teleconference interview, rather than survey, although were asked the same questions. Data were analysed through thematic analysis. A stakeholder advisory board supported the project, including frontline staff, care leavers, service managers and policy researchers. The advisory board assisted in reflecting on the data from the survey and interviews to generate a complete analysis. Overall, staff require facilitated safe spaces for peer-support, reflective and emotionally supportive supervision. An organisational awareness that staff wellbeing is intrinsically connected to the wellbeing and therapeutic outcomes of the children they care for is essential. Further, staff require a sense of belongingness to feel safe and competent in their role due to a lack of external recognition and professional representation or validation. Based on the findings of the study and an iterative process with the stakeholder advisory board, we created a Wellbeing Charter for adoption within organisations to promote and protect the wellbeing of this vital workforce. The COVID-19 pandemic has exposed professional, financial and environmental inequalities that affect these frontline workers. Implementing organisational, statutory and policy-driven initiatives to prioritise their wellbeing are essential for the vulnerable children they care for.     

Antioxidants and physical performance in elderly persons: the Invecchiare in Chianti (InCHIANTI) study

BACKGROUND: Muscle strength and physical performance in old age might be related to the oxidative damage caused by free radicals. OBJECTIVE: The objective was to assess the correlation of plasma concentrations and daily dietary intakes of antioxidants with skeletal muscle strength and physical performance in elderly persons. DESIGN: This study is part of the Invecchiare in Chianti (InCHIANTI) study, which was conducted in 986 Italians aged > or = 65 y. Physical performance was assessed on the basis of walking speed, ability to rise from a chair, and standing balance. Knee extension strength was assessed with a hand-held dynamometer. The European Prospective Investigation into Cancer and Nutrition (EPIC) questionnaire was used to evaluate the daily dietary intakes of vitamin C, vitamin E, beta-carotene, and retinol. Plasma alpha- and gamma-tocopherol concentrations were measured. Adjusted linear regression analyses were used to calculate regression coefficients per SD increase in plasma concentrations and daily dietary intakes. RESULTS: In adjusted analyses, plasma alpha-tocopherol was significantly correlated with knee extension (beta = 0.566, P = 0.003) and the summary physical performance score (beta = 0.044, P = 0.008). Plasma gamma-tocopherol was associated only with knee extension strength (beta = 0.327, P = 0.04). Of the daily dietary intake measures, vitamin C and beta-carotene were significantly correlated with knee extension strength, and vitamin C was significantly associated with physical performance (beta = 0.029, P = 0.04). CONCLUSIONS: Plasma antioxidant concentrations correlate positively with physical performance and strength. Higher dietary intakes of most antioxidants, especially vitamin C, appear to be associated with higher skeletal muscular strength in elderly persons.     

An integrated method to determine meaningful changes in health-related quality of life

OBJECTIVE: We describe an integrated method for determining meaningful change in health-related quality of life (HRQOL) that combines information from anchor-based and distribution-based methods and illustrate this method using data aggregated from weight loss studies. STUDY DESIGN AND SETTING: A total of 1476 participants in weight loss studies were evaluated at baseline and at 6 months using the Impact of Weight on Quality of Life-Lite (IWQOL-Lite). Severity of baseline impairment was determined by comparing scores with those obtained from a normative sample of 534 normal/overweight individuals. The precision of the IWQOL-Lite was evaluated using standard error of measurement corrected for regression to the mean. Weight loss was used as an anchor for evaluating changes in IWQOL-Lite scores. RESULTS: Change in HRQOL varied as a function of weight loss and baseline severity of HRQOL. Using this integrated method, an improvement of 7.7 to 12 points (depending on baseline severity) on IWQOL-Lite total score is considered meaningful. CONCLUSION: Meaningful change in HRQOL can be determined using an integrated method that (1) combines information from anchor-based and distribution-based methods, (2) reconciles discrepancies between these two methods, and (3) adjusts for baseline severity and regression to the mean. This method may be applied to other types of HRQOL measures and conditions.     

Fiber contamination of vermiculites: a potential occupational and environmental health hazard

Vermiculite ores from Montana, Virginia, and South Africa have been analyzed for the presence of amphibole contamination. Fibrous actinolite was found in unexpanded Montana vermiculite ore at a maximum concentration of 2.0%. The fibers persisted in the expanded ore at a maximum concentration of 0.6%. Actinolite was also found in the Virginia vermiculite ore but at a lower concentration and mostly as cleavage fragments with low length-to-width ratios. South African ore contained rare anthophyllite fibers also with low length-to-width ratios. Vermiculite ores have the potential for amphibole contamination and can represent potential health hazards without proper occupational and environmental control measures.     

Hypertension in the coloured population of the Cape Peninsula

In a random sample of 976 coloured people 17.2% of men and 18.4% of women were hypertensive (greater than or equal to 160/95 mmHg or receiving medication). In the same population 35.6% of men and 24.7% of women suffered from total hypertension (greater than or equal to 140/90 mmHg). Men between 25 and 44 years had a markedly higher prevalence of hypertension than women of the same age. Above this age the situation was reversed. Correcting for under- and over-cuffing increased the mean pressures in men and decreased them in older women. Only 42.2% of hypertensive men and 69.9% of women were aware of their condition. Only 41.3% were on medication for it and a mere 16% had blood pressures below 160/95 mmHg. Hypertensives had significantly lower intakes of potassium, calcium, magnesium and saturated fat than normotensive subjects. Young hypertensives consumed more salt than older hypertensives. Both systolic and diastolic blood pressures were positively associated with alcohol consumption, smoking (in men), total serum cholesterol, low-density lipoprotein cholesterol, non-fasting triglyceride and uric acid levels. Hypertensive subjects were less educated and showed more type A coronary-prone behaviour than normotensives. A comparison of the prevalence of hypertension in the four South African ethnic groups is given.