Associations between HbA1c Reduction and Change in Depressive Symptoms following Glucose-lowering Treatment in Adults: A Systematic Review of Intervention Studies.

INTRODUCTION: Hyperglycemia constitutes a likely pathway linking diabetes and depressive symptoms; lowering glycemic levels may help reduce diabetes-comorbid depressive symptoms. Since randomized controlled trials can help understand temporal associations, we systematically reviewed the evidence regarding the potential association of hemoglobin HbA1c lowering interventions with depressive symptoms. METHODS: PubMed, PsycINFO, CINAHL, and EMBASE databases were searched for randomized controlled trials evaluating HbA1c-lowering interventions and including assessment of depressive symptoms published between 01/2000-09/2020. Study quality was evaluated using the Cochrane Risk of Bias tool. PROSPERO registration: CRD42020215541. RESULTS: We retrieved 1,642 studies of which twelve met our inclusion criteria. Nine studies had high and three unclear risks of bias. Baseline depressive symptom scores suggest elevated depressive symptoms in five studies. Baseline HbA1c was <8.0% (<64 mmol/mol) in two, 8.0-9.0% (64-75 mmol/mol) in eight, and ≥10.0% (≥86 mmol/mol) in two studies. Five studies found greater HbA1c reduction in the treatment group; three of these found greater depressive symptom reduction in the treatment group. Of four studies analyzing whether the change in HbA1c was associated with the change in depressive symptoms, none found a significant association. The main limitation of these studies was relatively low levels of depressive symptoms at baseline, limiting the ability to show a lowering in depressive symptoms after HbA1c reduction. CONCLUSIONS: We found insufficient available data to estimate the association between HbA1c reduction and depressive symptom change following glucose-lowering treatment. Our findings point to an important gap in the diabetes treatment literature. Future clinical trials testing interventions to improve glycemic outcomes might consider measuring depressive symptoms as an outcome to enable analyses of this association.

"It's changed my life not to have the continual worry of being warm" - health and wellbeing impacts of a local fuel poverty programme: a mixed-methods evaluation.

BACKGROUND: Living in a cold home and being fuel poor can contribute to adverse physical and mental health. Energy efficiency interventions are considered the simplest ways of tackling fuel poverty and preventing associated negative health, wellbeing, and socio-economic consequences. The overall aim of the current study was to provide a greater understanding of the impact of a locally administered programme, which funded the installation of major heating/insulation measures in areas of high fuel poverty, on the health and wellbeing of beneficiaries of the programme. METHODS: A mixed-methods approach to explore the health and wellbeing impacts of a fuel poverty programme in East Sussex that took place between October 2016 and March 2018. Beneficiaries completed the Warwick-Edinburgh Mental Wellbeing Scale before and after any heating/insulation work had been completed in their home. Beneficiaries were also asked to retrospectively rate their health pre- and post-installation. Interviews with 23 beneficiaries of the programme were conducted to explore in-depth the impact of the programme on people's health and wellbeing and the wider social determinants of health. RESULTS: A major heating/insulation measure was installed in 149 homes. The majority of measures installed were boilers (57.7%) and new central heating systems (32.2%). Self-rated health and wellbeing were significantly higher post-installation. Interviewees described clear examples of the positive impacts on physical health and wellbeing such as fewer chest infections, reduced pain, feeling less anxious and depressed, and generally feeling happier and more relaxed. Interviews also highlighted broader areas of impact such as reduced social isolation and increased use of domestic space. Many of the beneficiaries also reported a reduction in their energy bills since their new heating systems had been installed. CONCLUSIONS: The findings from the evaluation suggest that the installation of major heating or insulation measures such as new boilers have substantial benefits for the health and wellbeing of beneficiaries. The findings also suggest that the programme had a positive impact on wider determinants of health including reduction in stress and isolation that are likely to be part of the pathways between fuel poverty interventions and mental and physical health outcomes.

The bidirectional longitudinal association between depressive symptoms and HbA1c : A systematic review and meta-analysis.

AIM: To investigate whether there is a bidirectional longitudinal association of depression with HbA1c . METHODS: We conducted a systematic literature search in PubMed, PsycINFO, CINAHL and EMBASE for observational, longitudinal studies published from January 2000 to September 2020, assessing the association between depression and HbA1c in adults. We assessed study quality with the Newcastle-Ottawa-Scale. Pooled effect estimates were reported as partial correlation coefficients (rp ) or odds ratios (OR). RESULTS: We retrieved 1642 studies; 26 studies were included in the systematic review and eleven in the meta-analysis. Most studies (16/26) focused on type 2 diabetes. Study quality was rated as good (n = 19), fair (n = 2) and poor (n = 5). Of the meta-analysed studies, six investigated the longitudinal association between self-reported depressive symptoms and HbA1c and five the reverse longitudinal association, with a combined sample size of n = 48,793 and a mean follow-up of 2 years. Higher levels of baseline depressive symptoms were associated with subsequent higher levels of HbA1c (partial r = 0.07; [95% CI 0.03, 0.12]; I2 38%). Higher baseline HbA1c values were also associated with 18% increased risk of (probable) depression (OR = 1.18; [95% CI 1.12,1.25]; I2 0.0%). CONCLUSIONS: Our findings support a bidirectional longitudinal association between depressive symptoms and HbA1c . However, the observed effect sizes were small and future research in large-scale longitudinal studies is needed to confirm this association. Future studies should investigate the role of type of diabetes and depression, diabetes distress and diabetes self-management behaviours. Our results may have clinical implications, as depressive symptoms and HbA1c levels could be targeted concurrently in the prevention and treatment of diabetes and depression. REGISTRATION: PROSPERO ID CRD42019147551.

Estimating the percentage of European MSM eligible for PrEP: insights from a bio-behavioural survey in thirteen cities.

OBJECTIVES: This paper aims to estimate the percentage of European men who have sex with men (MSM) who may benefit from pre-exposure prophylaxis (PrEP), applying the three most widely used HIV risk indices for MSM (MSM Risk Index, Menza score, San Diego Early Test (SDET) score) and drawing on a large-scale multisite bio-behavioural survey (Sialon II). METHODS: The Sialon II study was a bio-behavioural survey among MSM implemented in 13 European cities using either time-location sampling or respondent-driven sampling. Biological and behavioural data from 4901 MSM were collected. Only behavioural data of HIV-negative individuals were considered. Three widely used risk indices to assess HIV acquisition risk among MSM were used to estimate individual HIV risk scores and PrEP eligibility criteria. RESULTS: 4219 HIV-negative MSM were considered. Regardless the HIV risk score used and the city, percentages of MSM eligible for PrEP were found to range between 5.19% and 73.84%. Overall, the MSM Risk Index and the Menza score yielded broadly similar percentages, whereas the SDET Index provided estimates constantly lower across all cities. Although all the three scores correlated positively (r>0.6), their concordance was highly variable (0.01

Parent-child conversations associated with alcohol-related risk behaviours in young people (13-17 years) in the UK: a cross-sectional study.

OBJECTIVE: To investigate different types of parent-child conversations associated with young people's (13-17 years) alcohol-related risk behaviours. DESIGN: Secondary analysis of the 2016 Drinkaware Monitor Survey. This survey employed a cross-sectional design and collected data using self-completion questionnaires. SETTING: UK-wide. PARTICIPANTS: 561 parent-child pairs were included in the analysis. The nationally representative quota sample was weighted by reference to the UK population. METHODOLOGY: Data were analysed using purposeful selection modelling (adjusted OR (AOR), 95% CIs). RISK BEHAVIOURS: 'Whether have ever drank' and 'whether vomited as a result of alcohol'. RESULTS: 50% (277/553) of young people reported drinking a whole alcoholic drink, and 22% (60/277) of these experienced vomiting as a result. After adjusting for age and gender, the likelihood of ever having drank alcohol was significantly increased among the following young people: those whose parents believed they knew a little about how much they drink (AOR 1.80, 95% CI 1.04 to 3.13) or that some/most/all friends drink (AOR 3.82, 95% CI 2.40 to 6.08); those given gentle reminders about taking care when drinking alcohol (AOR 1.82, 95% CI 1.15 to 2.88), practical advice (AOR 2.09, 95% CI 1.20 to 3.64) or designated time, led by the parent, to instil care around alcohol through a formal sit-down (AOR 1.79, 95% CI 1.07 to 2.99). The likelihood was reduced for parents aged 40-49 years (AOR 0.52, 95% CI 0.31 to 0.89) and conversations providing information (AOR 0.53, 95% CI 0.29 to 0.98). Vomiting was significantly associated with some/most/all friends drinking alcohol (AOR 3.65, 95% CI 1.08 to 12.30), parent's beliefs about child's frequency of drinking alcohol (AOR 1.26, 95% CI 1.02 to 1.54), parental harmful/dependency drinking (AOR 3.75, 95% CI 1.13 to 12.50) and having a formal sit-down conversation (AOR 2.15, 95% CI 0.99 to 4.66). CONCLUSIONS: We found evidence of mostly negative associations between young people's risk behaviours and different types of parent-child conversations. Conversations providing information were linked to a reduced tendency to have ever drunk alcohol. All other types of conversations were negatively associated with risk behaviours. Psychological reactance and conversation quality possibly explain these findings.

The role of interpersonal style in aggression and its containment in a forensic mental health setting: A correlational and pseudoprospective study of patients and nursing staff.

Inpatient aggression on mental health wards is common and staff-patient interactions are frequently reported antecedents to aggression. However, relatively little is known about the precise relationship between aggression and these interactions, or their relationships with aggression and staff containment responses such as restraint and seclusion. This study aimed to determine the roles of anger and interpersonal style among mental health nurses and between nurses and patients in the occurrence of aggression and its containment. A correlational, pseudoprospective study design was employed. n = 85 inpatients and n = 65 nurses were recruited from adult, low- and medium-secure wards of a secure forensic mental health service. Participants completed validated self-report anger and transactional interpersonal style measures. Inpatient aggression and containment incident data for a 3-month follow-up period were extracted from clinical records. Dyadic nurse-patient relationships were anticomplementary. Patients' self-reported anger and staff-rated hostile interpersonal style were significantly positively correlated; staff self-reported anger and patient-rated dominant interpersonal style were also positively correlated. Patient anger predicted aggression and their interpersonal style predicted being subject to containment in the form of restraint and seclusion. There were no statistically significant differences identified on measures between staff who were and were not involved in containment. More targeted intervention for patients' anger may have a positive impact on interpersonal style and lead to the reduction of incidents. Staff education and skills training programmes should emphasize the importance of interpersonal styles which could help to promote and enhance positive interactions.

Mental health nurses' emotions, exposure to patient aggression, attitudes to and use of coercive measures: Cross sectional questionnaire survey.

BACKGROUND: Mental health nurses are exposed to patient aggression, and required to manage and de-escalate aggressive incidents; coercive measures such as restraint and seclusion should only be used as a last resort. An improved understanding of links between nurses' exposure to aggression, attitudes to, and actual involvement in, coercive measures, and their emotions (anger, guilt, fear, fatigue, sadness), could inform preparation and education for prevention and management of violence. OBJECTIVES: To identify relationships between mental health nurses' exposure to patient aggression, their emotions, their attitudes towards coercive containment measures, and their involvement in incidents involving seclusion and restraint. DESIGN: Cross-sectional, correlational, observational study. SETTINGS: Low and medium secure wards for men and women with mental disorder in three secure mental health hospitals in England. PARTICIPANTS: N=Sixty eight mental health nurses who were designated keyworkers for patients enrolled into a related study. METHODS: Participants completed a questionnaire battery comprising measures of their exposure to various types of aggression, their attitudes towards seclusion and restraint, and their emotions. Information about their involvement in restraint and/or restraint plus seclusion incidents was gathered for the three-month period pre- and post- their participation. Linear and logistic regression analyses were performed to test study hypotheses. RESULTS: Nurses who reported greater exposure to a related set of aggressive behaviours, mostly verbal in nature, which seemed personally derogatory, targeted, or humiliating, also reported higher levels of anger-related provocation. Exposure to mild and severe physical aggression was unrelated to nurses' emotions. Nurses' reported anger was significantly positively correlated with their endorsement of restraint as a management technique, but not with their actual involvement in restraint episodes. Significant differences in scores related to anger and fatigue, and to fatigue and guilt, between those involved/not involved in physical restraint and in physical restraint plus seclusion respectively were detected. In regression analyses, models comprising significant variables, but not the variables themselves, predicted involvement/non-involvement in coercive measures. CONCLUSIONS: Verbal aggression which appears targeted, demeaning or humiliating is associated with higher experienced anger provocation. Nurses may benefit from interventions which aim to improve their skills and coping strategies for dealing with this specific aggressive behaviour. Nurse-reported anger predicted approval of coercive violence management interventions; this may have implications for staff deployment and support. However, anger did not predict actual involvement in such incidents. Possible explanations are that nurses experiencing anger are sufficiently self-aware to avoid involvement or that teams are successful in supporting colleagues who they perceive to be 'at risk'. Future research priorities are considered.

Care planning for aggression management in a specialist secure mental health service: An audit of user involvement.

This paper describes an audit of prevention and management of violence and aggression care plans and incident reporting forms which aimed to: (i) report the compliance rate of completion of care plans; (ii) identify the extent to which patients contribute to and agree with their care plan; (iii) describe de-escalation methods documented in care plans; and (iv) ascertain the extent to which the de-escalation methods described in the care plan are recorded as having been attempted in the event of an incident. Care plans and incident report forms were examined for all patients in men's and women's mental health care pathways who were involved in aggressive incidents between May and October 2012. In total, 539 incidents were examined, involving 147 patients and 121 care plans. There was no care plan in place at the time of 151 incidents giving a compliance rate of 72%. It was documented that 40% of patients had contributed to their care plans. Thematic analysis of de-escalation methods documented in the care plans revealed five de-escalation themes: staff interventions, interactions, space/quiet, activities and patient strategies/skills. A sixth category, coercive strategies, was also documented. Evidence of adherence to de-escalation elements of the care plan was documented in 58% of incidents. The reasons for the low compliance rate and very low documentation of patient involvement need further investigation. The inclusion of coercive strategies within de-escalation documentation suggests that some staff fundamentally misunderstand de-escalation.

Experimental manipulation of breakfast in normal and overweight/obese participants is associated with changes to nutrient and energy intake consumption patterns.

The effect of breakfast and breakfast omission on daily food intake in normal and overweight participants was investigated. 37 participants were recruited for this experimental study and assigned to one of four groups on the basis of their body mass index (BMI) (normal weight BMI <25 kg/m(2) or overweight/obese BMI >25 kg/m(2)) and breakfast habits (breakfast eater or breakfast omitter). All participants were requested to eat breakfast for an entire week, and then following a washout period, omit breakfast for an entire week, or vice versa. Seven-day food diaries reporting what was consumed and the timing of consumption were completed for each breakfast condition. Overall more energy was consumed during the breakfast than the no breakfast week. The present study revealed significant effects of timing on energy intakes; more energy was consumed during the afternoon in the no breakfast week compared to the breakfast week. Overweight participants consumed greater amounts of energy than normal weight participants in the early evening. Breakfast omitters consumed more than did breakfast eaters later in the evening. All groups consumed significantly less energy, carbohydrate and fibre in the no breakfast week; however, overweight participants increased their sugar intakes. Consumption of the micronutrients iron and folate was reduced in the no breakfast week. The findings highlight that the timing of food intake and habitual breakfast eating behaviour are important factors when investigating why breakfast consumption may be associated with BMI.

Implementing the National Service Framework for Long-Term (Neurological) Conditions: service user and service provider experiences.

PURPOSE: This research explored the experiences of service users and providers during the implementation of the National Service Framework (NSF) for Long-Term (Neurological) Conditions (LTNCs). METHOD: A participatory qualitative research design was employed. Data were collected using 50 semi-structured interviews with service users, 25 of whom were re-interviewed on three occasions. Forty-five semi-structured interviews were also conducted with service providers who worked with individuals with LTNCs. Interviews focused on health, well-being and quality of life in relation to service provision, access and delivery. Data were thematically analysed individually and collaboratively during two data analysis workshops. RESULTS: Three major themes were identified that related to the implementation of the NSF: "Diagnosis and treatment", "Better connected services" and "On-going rehabilitation". Service users reported that effective care was provided when in hospital settings but such treatments often terminated on return to their communities despite on-going need. In hospital and community settings, service providers indicated that they lacked the support and resources to provide continuous care, with patients reaching a crisis point before referral to specialist care. CONCLUSION: This research highlighted a range of issues concerning the recent UK-drive towards patient-centred approaches within healthcare, as service users were disempowered within the LTNC care pathway. Moreover, service providers indicated that resource constraints limited their ability to provide long-term, intensive and integrated service provision. IMPLICATIONS FOR REHABILITATION: Our research suggests that many service users with long-term neurological conditions experienced disconnections between services within their National Service Framework care pathway. For health and social care practitioners, a lack of continuity within a care pathway was suggested to be most pertinent following immediate care and moving to rehabilitative care. Our findings also indicate that service providers lack the necessary financial resources and staffing capacity to provide on-going and comprehensive rehabilitation. This article aims to help practitioners better understand particular issues during the implementation of the National Service Framework for long-term neurological conditions from the perspectives of service users and service providers.

Breakfast habits, beliefs and measures of health and wellbeing in a nationally representative UK sample.

The aim of this study was to report UK adult breakfasting habits, beliefs and the relationship of both with measures of personality, health and wellbeing including physical activity and body mass index (BMI). A nationally representative sample of 1068 adults completed a web-based survey, combining standardised scales and self-designed questionnaire statements. Sixty-four percent of respondents consumed breakfast daily whilst 6% never ate breakfast. Breakfasting frequency was found to correlate with conscientiousness, wellbeing and age and general health. The survey found that breakfast eaters strongly believe that breakfast helps weight control and weight loss. Breakfast eaters were more likely to partake in vigorous exercise, although there was no significant difference in BMI. Multi-variate analysis identified conscientiousness, cognitive restraint and age as making unique contributions to predicting breakfast frequency. This study provides further support for the view that breakfast eating is likely to be a proxy-variable for a healthy lifestyle. The role of breakfast and related beliefs should be taken into consideration in breakfast behaviour research, interventions and health and wellbeing campaigns.

Does consuming breakfast influence activity levels? An experiment into the effect of breakfast consumption on eating habits and energy expenditure.

OBJECTIVE: To experimentally compare the effects of eating or skipping breakfast on energy expenditure, activity levels and dietary habits. DESIGN: A randomised cross-over trial, lasting 2 weeks. Participants were provided breakfast during one week and were required to fast until mid-day during the other week. SETTING: University campus. SUBJECTS: Forty-nine participants (twenty-six female and twenty-three male participants) were recruited. Food intake was monitored using food diaries, and energy expenditure was assessed using pedometers and heart rate monitors. Morningness-eveningness, physical activity and health were assessed using validated questionnaires. RESULTS: Across all participants, daily energy expenditure did not differ between the two experimental conditions. Total energy intake over 24 h did not vary with condition (male participants: 8134 (sd 447) kJ/d and 7514 (sd 368) kJ/d; female participants: 7778 (sd 410) kJ/d and 7531 (sd 535) kJ/d, for the breakfast and no-breakfast conditions, respectively). However, when comparing habitual breakfast eaters with those with irregular or breakfast-skipping habits, it was found that male non-habitual breakfast eaters consumed significantly (P = 0·029) more energy during the breakfast condition. Furthermore, female participants who were habitual breakfast eaters were found to eat significantly (P = 0·005) more and later in the day under the no-breakfast condition. CONCLUSIONS: Although the suggestion that breakfast is a behavioural marker for appropriate dietary and physical activity patterns is not refuted by the present findings, our data suggest that the effect of breakfast may vary as a function of gender and morning eating habits, and thus there may be other mechanisms that link BMI and breakfast consumption behaviour.