The views of stakeholders on the role of the primary school in preventing childhood obesity: a qualitative systematic review

Schools are increasingly recognized as an ideal setting for interventions to tackle childhood obesity. A better understanding of the views of key stakeholders would help to engage schools and inform the feasibility of such interventions in practice. This meta‐synthesis of 18 qualitative studies explores the views of parents, school staff, school governors, school nurses and students on the role of the primary school in preventing childhood obesity. Six categories emerged: ‘School as a key setting’; ‘What schools should be doing to promote healthy eating (HE)’; ‘What schools should be doing to promote physical activity (PA)’; ‘General barriers’; ‘Barriers to promoting HE at school’; and ‘Barriers to promoting PA at school’. Thirty‐seven finer‐level themes emerged within these categories. Stakeholders agreed on the key role of the primary school as a setting for obesity prevention, the importance of schools providing and promoting opportunities for HE and PA, and the need for schools to work with parents. Some perceived barriers could be overcome at school level, e.g. using unhealthy foods as rewards/fundraisers or withholding PA for bad behaviour. Leadership and guidance from government were considered to be needed to counteract other observed barriers, particularly regarding school canteens, support for parents and time for PA.     

Towards the Prevention of Behavioural and Psychiatric Disorders in People with Intellectual Disabilities

Intervention for behavioural and psychiatric disorders in people with intellectual disabilities often only takes place once these conditions are well established and more resistant to change. As an alternative, this paper promotes a public health prevention model and maps out opportunities for intervention at primary, secondary and tertiary levels. The resulting model is partly derived from generic research into these issues and partly on specific evidence on interventions for people with intellectual disabilities; it also contains more theoretical considerations. The additional research that is necessary to demonstrate the efficacy of the interventions identified is also considered. Central to this proposal is a greater integration of issues for people with intellectual disabilities within much broader policy and research agendas.     

Touch, Caring, and Cancer: randomized controlled trial of a multimedia caregiver education program

Purpose

A randomized controlled trial was conducted to evaluate outcomes of a multimedia instructional program for family caregivers in simple touch-based techniques to provide comfort to cancer patients at home.

Methods

A multilingual 78-min DVD and 66-page manual were produced for homebased instruction. Content addresses attitudes and communication about touch in cancer, psychological preparation for giving and receiving touch, safety precautions, massage techniques for comfort and relaxation, acupressure for specific cancer-related symptoms, and practice in the home setting. Materials were produced in English, Spanish, and Chinese versions. A community-based multiethnic sample of 97 adult patient/caregiver dyads was randomized to experimental (massage) or attention control (reading) groups for 4 weeks. Massage dyads received the program and instructions to practice at least three times per week, while control caregivers read to their patients for the same frequency. Self-report instruments assessed change in symptom severity, quality of life, perceived stress, and caregiver attitudes.

Results

Significant reductions in all symptoms occurred for patients after both activities: 12–28 % reductions after reading vs. 29–44 % after massage. Massage caregivers showed significant gains in confidence, comfort, and self-efficacy using touch and massage as forms of caregiving.

Conclusions

Multimedia instruction in touch and massage methods may offer family members a viable means of enhancing self-efficacy and satisfaction in caregiving while decreasing patient pain, depression, and other symptoms. Family members may be able to learn and apply safe and simple methods that increase patient comfort and reduce distress.     

Investigation of malignant hyperthermia in Sweden

One hundred and thirty patients from 52 families were investigated for susceptibility to malignant hyperthermia (MH). The diagnosis of MH susceptibility (MHS) was made by in vitro exposure of muscle to halothane and to caffeine, according to the protocol established by the European malignant hyperpyrexia group. In addition, 13 normal control biopsies were obtained from the same muscle and with the same anaesthesia as in the MH patients. These control results agree with and confirm the criteria formulated in the European MH group. The results are compared with our first 85 investigations performed prior to the establishment of the protocol. The main difference compared to the earlier material is the addition of an equivocal group (MHE), whose muscle reacted in vitro to either halothane or caffeine, but not both. All the families referred because of a fulminant MH reaction contained MHS or MHE members. There was a greater incidence of MH-negative families, suggesting an increased suspicion of MH amongst the clinicians.     

Biliary stricture dilatation: multicenter review of clinical management in 73 patients

Eighty-nine biliary strictures in 73 patients who had undergone percutaneous balloon dilatation were reviewed to determine long-term patency rates and clinical management problems. The majority of dilatations were performed in patients with anastomotic strictures (n = 44), iatrogenic strictures (n = 28), and strictures associated with sclerosing cholangitis (n = 17). Patency rates after 36 months or more were 67%, 76%, and 42%, respectively. Complications, mostly minor, occurred in less than 7% of patients. Of patients with significant biliary obstruction, 15% had little or no intrahepatic biliary duct dilatation demonstrated by cross-sectional imaging and/or direct cholangiography. No definite conclusions could be drawn about the utility of long-term internal/external stenting.     

Malignant uveal melanoma and simulating lesions: MR imaging evaluation

Twenty-one patients with intraocular disease were studied by magnetic resonance (MR) imaging and computed tomography (CT). In 13 cases, malignant uveal melanoma was considered the likely diagnosis. Both imaging methods were accurate in determining the location and size of uveal melanomas. MR imaging was superior for the assessment of possible associated retinal detachment, for assessment of vitreous change, and for differentiating uveal melanoma from choroidal hemangioma and choroidal detachment. A case of retinal gliosis could not be differentiated from uveal melanoma by either technique. Uveal melanomas appeared as hyperintense lesions on T1-weighted images and as hypointense lesions on T2-weighted images. High signal intensity of the vitreous was observed in patients with vitritis and in those who were thought to have protein leaking into the vitreous as a result of impairment of the retinal-blood barrier.     

Spontaneous rupture of the spleen in pregnancy with splenic conservation

Spontaneous rupture of the spleen in pregnancy is rare. It presents with severe internal haemorrhage with a high perinatal and maternal mortality. Splenic preservation is now a well-known option in dealing with splenic damage, and is recommended where possible to avoid diminished immunological competence. This is the first reported case of splenic preservation following splenic damage in pregnancy.     

The anorectic action of peripheral 5-HT examined in the runway: evidence for an action on satiation

The hypothesis that systemically administered 5-hydroxytryptamine (5-HT) reduces feeding by a specific action on satiation and satiety processes was examined using a food-rewarded runway task. Over the course of 15 successive trials, with food available for 2 min on each trial, the development of satiation was monitored following treatment with 5-HT (1 and 2 mg/kg SC) and saline. The 5-HT failed to alter runway performance over the early trials, but then induced marked decrements in running speed and food intake. Analysis of cumulative food intake curves showed that 5-HT significantly reduced food intake beginning at the point where a decline in the rate of feeding was observed under control conditions. These results indicate that 5-HT exerts its anorectic effect only after some food has been ingested, and support the hypothesis that 5-HT accelerates the development of satiation and satiety.