Development of a Scale to Assess the Attitudes of Paediatric Staff to Caring for Children with Medically Unexplained Symptoms: Implications for the Role of CAMHS in Paediatric Care

Background:  Children with medically unexplained symptoms (MUS) represent a challenge for paediatricians and typically undergo extensive in-patient investigations for symptoms such as abdominal pain. This can delay access to psychological services. This study aims to develop and evaluate a scale to assess the attitudes of paediatric staff to caring for children with MUS and to explore factors influencing those attitudes.
Method:  In this cross-sectional survey, 118 health professionals at one UK hospital with experience of caring for children with MUS completed an attitude questionnaire developed for the study.
Results:  Factor analysis identified four factors that explained significant variance in staff perceptions of care: rewarding nature of care; demanding nature of care; parental influence; children's need for skilled support. The combined subscales formed the MUS-Q.
Conclusion:  Paediatric staff found caring for children with MUS difficult and would welcome more support from CAMHS. The MUS-Q proved a reliable tool to evaluate staff attitudes.     

The association between substance misuse and first-episode psychosis in a defined UK geographical area during the 1990s

Objective  

The aim of this study was to examine the prevalence of all substance use disorders (SUD) and cannabis-specific SUDs reported in two first-episode epidemiological studies, conducted in the same catchment area, 5 years apart.     

Spectrum of Chronic Complications Related to Silicone Leakage and Migration

Background

Medical silicone is widely used as implants and free injections, but the spectrum of complications related to migration or embolization of silicone remains unclear.

Longitudinal migration and inducible displacement of the Mobility Total Ankle System

Background and purpose RSA can be used for early detection of unstable implants. We assessed the micromotion of the Mobility Total Ankle System over 2 years, to evaluate the stability of the bone-implant interface using radiostereometric analysis measurements of longitudinal migration and inducible displacement. Patients and methods 23 patients were implanted with the Mobility system. Median age was 62 (28-75) years and median BMI was 28.8 (26.0-34.5). Supine radiostereometric analysis examinations were done from postoperatively to the 2-year follow-up. Standing examinations were taken from the 3-month to the 2-year follow-up. Migrations and displacements were assessed using model-based RSA software (v. 3.2). Results The median maximum total point motion (MTPM) for the implants at 2 years was 1.19 (0.39-1.95) mm for the talar component and 0.90 (0.17-2.28) mm for the spherical tip of the tibial component. The general pattern for all patients was that the slope of the migration curves decreased over time. The main direction of motion for both components was that of subsidence. The median 2-year MTPM inducible displacement for the talar component was 0.49 (0.27-1.15) mm, and it was 0.07 (0.03-0.68) mm for the tibial component tip. Interpretation The implants subside into the bone over time and under load. This corresponds to the direction of primary loading during standing or walking. This statistically significant motion may become a clinically significant finding that would correspond with premature implant failure.     

Lumbar Spinal Stenosis and Lower Extremity Motor Control: The Impact of Walking-Induced Strain on a Performance-Based Outcome Measure

Objective

The primary objective of this study was to quantify the lower extremity movements and capabilities of a population with lumbar spinal stenosis (LSS) compared with healthy age-matched controls under conditions of strain and no strain. The secondary objective was to identify challenging movement conditions for a population with LSS, on a lower limb aiming task with different levels of difficulty, compared with healthy age-matched controls under conditions of strain and no strain.

Methods

Using a nonrandomized, controlled, before-and-after design, LSS patients (n = 16) and healthy controls (n = 16) performed 2 blocks of great toe–pointing movements to a series of projected squares. Following block 1, participants completed a 12-minute progressive exercise treadmill test. Pointing movements were analyzed using 3D motion analysis. Behavioral and kinematic measures evaluated performance.

Results

Both groups' reaction times (RTs) lengthened as task difficulty increased. An interaction revealed that LSS patients were more adversely impacted by task difficulty, F (3,372) = 4.207; P = .006. The progressive exercise treadmill test facilitated RT for both groups, F (1,124) = 5.105; P = .026. Control participants showed less variability in time-to-peak velocity poststrain, a benefit not shared by LSS patients, t (31) = 2.149; P = .040.

Conclusion

A lower extremity movement task captured differences under strain between healthy and LSS populations. The lower extremity Fitts' Law task accurately measured differences between healthy and LSS participants. For the subjects in this study, strain was sufficient to prevent LSS patients from demonstrating improvement in the variability of the ballistic phase of movement execution, whereas LSS patients' movement performance remained unchanged. This study also showed that regardless of strain, as task difficulty increased, LSS patients were more adversely impacted in the planning and execution of their lower limb movements than healthy control participants. The lower extremity motor control task (Fitts' task) can be used as a performance-based outcome measure to measure differences between healthy and LSS populations.     

Talking about obesity with clients: Preferred terms and communication styles of UK pre-registration dieticians,doctors, and nurses

Objective

To describe trainee healthcare professionals’ preferred terms when talking about obesity, their beliefs about initiating discussions about weight, and their confidence about consulting with obese people.

Methods

A self-completed questionnaire collected data on demographics, preferred terms, beliefs about initiation of discussions, confidence and training needs from 1036 pre-registration dieticians, nurses and doctors.

Results

Participants’ preferred terms when raising the issue of obesity with clients were BMI (mean = .96), weight (mean = .71) and unhealthy BMI (mean = .43). When defining a client's bodyweight, students endorsed the euphemism ‘your weight may be damaging your health’ (67.6%). A proactive, collaborative communication style was preferred by 34.9% of participants. 58.2% of participants felt confident about discussing obesity with clients and 95.1% felt that that more training would be useful.

Conclusion

It is reassuring that UK trainee healthcare professionals avoid value-laden terms and broadly endorse words preferred by people with obesity. It is, however, concerning that the majority of participants did not favor a proactive, collaborative communication style.

Practice implications

Educators of tomorrow's healthcare professionals could take advantage of students’ desire for more training on how to effectively talk to clients with obesity about their weight. Such training would, however, require the development of clear guidelines on terminology and communication styles.     

Isolation of phytoalexin-deficient mutants of Arabidopsis thaliana and characterization of their interactions with bacterial pathogens.

A genetic approach was used to assess the extent to which a particular plant defense response, phytoalexin biosynthesis, contributes to Arabidopsis thaliana resistance to Pseudomonas syringae pathogens. The A. thaliana phytoalexin, camalexin, accumulated in response to infection by various P. syringae strains. No correlation between pathogen avirulence and camalexin accumulation was observed. A biochemical screen was used to isolate three mutants of A. thaliana ecotype Columbia that were phytoalexin deficient (pad mutants). The mutations pad1, pad2, and pad3 were found to be recessive alleles of three different genes. pad1 and pad2 were mapped to chromosome IV and pad3 was mapped to chromosome III. Infection of pad mutant plants with strains carrying cloned avirulence genes revealed that the pad mutations did not affect the plants' ability to restrict the growth of these strains. This result strongly suggests that in A. thaliana, phytoalexin biosynthesis is not required for resistance to avirulent P. syringae pathogens. Two of the pad mutants displayed enhanced sensitivity to isogenic virulent P. syringae pathogens, suggesting that camalexin may serve to limit the growth of virulent bacteria.