School-level factors associated with teacher connectedness: a multilevel analysis of the structural and relational school determinants of young people's health.

Background: Conducting research on the antecedents of teacher connectedness (TC) is key to inform intervention and policy that can leverage the public health potential of teachers for young people's well-being. As part of the EU-funded Teacher Connectedness Project, this study aims to examine the contribution of a variety of school-level factors (including type of school, school size, student-teacher ratio, students per class and teacher gender). Methods: Sample consisted of 5335 adolescents aged 11, 13 and 15 years that had participated in the HBSC study in England. Multilevel multinomial regression was used to examine the contributions of sociodemographic and school-level factors to TC. Results: TC was lower in older adolescents and those from less affluent families, but similar in boys and girls. Regarding school-level factors, it was not the size of the school but the ratio of students per teacher which was significantly associated to TC, with higher student-teacher ratio being significantly associated with lower odds of medium-to-high TC. Some differences between mixed and all-girls schools were also found. Conclusions: Health promotion strategies targeting student-teacher relationships need to consider how TC changes by age and SES and give attention to school-level factors, in particular the student-teacher ratio.

Management of metastatic spinal cord compression: awareness of NICE guidance.

OBJECTIVE: The spine is the most common site for bony metastases. It can lead to the development of significant complications and morbidity if appropriate treatment is not provided. National Institute for Health and Clinical Excellence (NICE) issued new guidance in 2008 with regard to the management of patient with metastatic spinal cord compression (MSCC) to assess the awareness of the NICE guidelines for MSCC. METHODS: We contacted doctors in oncology, trauma and orthopaedics, palliative care and general medicine and assessed their knowledge of MSCC using a questionnaire based on the salient points of the NICE guidance. This was a UK-wide questionnaire. RESULTS: We contacted 96 trainee doctors (oncology, palliative care, general medicine and orthopaedics) and found that 74 % felt adequately informed to diagnose metastatic cord compression although only 11 % considered a sensory level as a potential sign of cord compression. Neurological symptoms (91 %) were the main reason for referral to a tertiary spinal service. MRI was the investigation of choice. There was a poor knowledge of metastatic scoring systems and only 8 % would consider assessing the patient's fitness for surgery. Most of the respondents felt that they had been poorly taught at undergraduate and postgraduate level on MSSC. CONCLUSION: Our audit shows that MSCC is poorly understood in general and that greater understanding of the NICE guidance is required to allow for better management of these patients and more prompt referral for appropriate surgical assessment.

YouTube™ as a source of patient information for lumbar discectomy.

INTRODUCTION: YouTube™ contains more than 60% of all videos on the internet. Its popularity has increased, and it has now become a source of patient education and information. It is unregulated for the quality of its videos. This project was designed to assess the quality of videos on YouTube™ on lumbar discectomy. METHODS: A systematic search of YouTube™ was performed. The search terms used were 'lumbar' and 'discectomy'. The first ten pages were reviewed. Information was recorded relating to the date of publishing, the publisher and the number of viewings. The content was reviewed using criteria based on recommendations from the British Association of Spine Surgeons website. Content was assessed and points were awarded for information relating to management options, description of the procedure (including anaesthetic, likely recovery and outcome) and complications as well as information relating to the author and his or her institute. An overall rating of 'inadequate', 'poor', 'average' or 'good' was given. RESULTS: Overall, 81 videos were identified. The total number of viewings was 2,722,964 (range: 139-111,891), with an average number of 34,037 viewings per video. There were 16 with a rating of 'good', 25 with a rating of 'average' and 40 with a rating of 'poor' or 'inadequate'. The most common missing information related to anaesthesia or complications. Most videos (69/81) were broadcast by surgeons or surgical institutes. CONCLUSIONS: The quality of YouTube™ videos is variable and we believe this represents the unregulated nature of broadcasts on YouTube™. Thought should be given to information in videos prior to placement.

Adolescent multiple risk behaviour: an asset approach to the role of family, school and community.

BACKGROUND: Engagement in risk behaviours may pose a significant threat to health if involvement spans multiple behaviours. The asset model suggests that contextual aspects of young people's lives, such as factors related to family, school and community, serve as a protective function against health risk behaviours. METHODS: A risk-taking index was created from the English health behaviour in school-aged children study on 15 years olds, substance use and sexual activity. Using a multinomial regression, potential asset variables relating to school, family, peers, community and family affluence were tested for their association with levels of risk behaviours. RESULTS: Sense of neighbourhood belonging, strong school belonging and parental involvement in decision-making about leisure time were related to lower engagement in health risk behaviours. A weaker sense of family belonging was associated with increased risk behaviours if connectedness with teachers was also low. Factors related to school and community played a greater role in adolescent participation in health-related risk behaviours than family-related factors, including family affluence. CONCLUSIONS: Feelings of safety and belonging in the out-of-home settings of adolescents were positively associated with reduced risk behaviours, and indicate the importance of the wider community alongside parents and school as protective assets for health.