Surely not all experimental studies of bias need abandoning?

Cesario misrepresents experimental social psychology. The discipline encompasses significantly more than implicit bias research, including controlled decision making and real-world behavioral observations. Paradoxically, while critiquing popular implicit bias tasks, Cesario also describes task refinements that have significantly advanced their external validity and our contextual understanding of bias. Thus rather than abandonment, a call for "continued improvement" is a far more sensible proposition.

Depression predicts emotion acceptance beliefs in early adolescence: A longitudinal investigation.

OBJECTIVES: Adolescence is a time period which confers significant risk for the development of psychopathology. There is increasing consensus within the literature that beliefs about one's emotional experience are important and may present a unique risk factor during this time period. However, to date, there has been no longitudinal examination of the relationship between depression and specific beliefs regarding the acceptability of experiencing and expressing emotion in young people. DESIGN: The present study used a cross-lagged longitudinal design with questionnaires completed at two waves spaced 8 months apart. METHODS: 506 participants (50.60% female) aged 12-15 years completed the Beliefs about Emotion questionnaire to assess for beliefs regarding the acceptability of experiencing and expressing emotions, and the depression subscale of the DASS-21 to measure depressive symptoms. RESULTS: Greater depressive symptoms were associated with more negative beliefs about emotion at both time points. More negative beliefs about emotion at T1 did not significantly predict greater depressive symptoms at T2. However, greater depressive symptoms at T1 predicted significantly more negative beliefs about emotions at T2. CONCLUSIONS: Greater beliefs about the unacceptability of experiencing or expressing emotions do not appear to predispose young people to depression. Rather, these beliefs appear to emerge following earlier experiences of depressive symptoms. Further research is needed over multiple measurement waves to further elucidate the relationship between emotion acceptance beliefs and depressive symptoms across adolescence into adulthood and whether such beliefs may predict future depressive episodes indirectly via difficulties in emotion regulation. PRACTITIONER POINTS: Current findings suggest that more negative beliefs about emotion, specifically, beliefs about the unacceptability of experiencing or expressing emotions do not represent a key risk factor for the onset of depressive symptoms in early adolescence. Rather, current evidence suggests these beliefs emerge following depressive symptoms. Given these findings, universal prevention programmes targeting valuation beliefs regarding emotion acceptability are less likely to be effective for this developmental age group. It is important to assess for beliefs that an individual may hold regarding their emotional states alongside symptoms, as these beliefs are associated with greater clinical severity of depressive symptoms. Further research, over multiple measurement waves, is needed to clarify whether emotion acceptability beliefs may predict future depressive episodes indirectly via difficulties in emotion regulation.

Strategies for recruitment in general practice settings: the iSOLVE fall prevention pragmatic cluster randomised controlled trial.

BACKGROUND: Falls are common among older people, and General Practitioners (GPs) could play an important role in implementing strategies to manage fall risk. Despite this, fall prevention is not a routine activity in general practice settings. The iSOLVE cluster randomised controlled trial aimed to evaluate implementation of a fall prevention decision tool in general practice. This paper sought to describe the strategies used and reflect on the enablers and barriers relevant to successful recruitment of general practices, GPs and their patients. METHODS: Recruitment was conducted within the geographical area of a Primary Health Network in Northern Sydney, Australia. General practices and GPs were engaged via online surveys, mailed invitations to participate, educational workshops, practitioner networks and promotional practice visits. Patients 65 years or older were recruited via mailed invitations, incorporating the practice letterhead and the name(s) of participating GP(s). Observations of recruitment strategies, results and enabling factors were recorded in field notes as descriptive and narrative data, and analysed using mixed-methods. RESULTS: It took 19 months to complete recruitment of 27 general practices, 75 GPs and 560 patients. The multiple strategies used to engage general practices and GPs were collectively useful in reaching the targeted sample size. Practice visits were valuable in engaging GPs and staff, establishing interest in fall prevention and commitment to the trial. A mix of small, medium and large practices were recruited. While some were recruited as a whole-practice, other practices had few or half of the number of GPs recruited. The importance of preventing falls in older patients, simplicity of research design, provision of resources and logistic facilitation of patient recruitment appealed to GPs. Recruitment of older patients was successfully achieved by mailed invitations which was a strategy that was familiar to practice staff and patients. Patient response rates were above the expected 10% for most practices. Many practices (n = 17) achieved the targeted number of 20 or more patients. CONCLUSIONS: Recruitment in general practice settings can be successfully achieved through multiple recruitment strategies, effective communication and rapport building, ensuring research topic and design suit general practice needs, and using familiar communication strategies to engage patients. TRIAL REGISTRATION: The trial was prospectively registered on 29 April 2015 with the Australian New Zealand Clinical Trial Registry www.anzctr.org.au (trial ID: ACTRN12615000401550).

Comparison of implementation strategies to influence adherence to the clinical pathway for screening, assessment and management of anxiety and depression in adult cancer patients (ADAPT CP): study protocol of a cluster randomised controlled trial.

BACKGROUND: Health service change is difficult to achieve. One strategy to facilitate such change is the clinical pathway, a guide for clinicians containing a defined set of evidence-based interventions for a specific condition. However, optimal strategies for implementing clinical pathways are not well understood. Building on a strong evidence-base, the Psycho-Oncology Co-operative Research Group (PoCoG) in Australia developed an evidence and consensus-based clinical pathway for screening, assessing and managing cancer-related anxiety and depression (ADAPT CP) and web-based resources to support it - staff training, patient education, cognitive-behavioural therapy and a management system (ADAPT Portal). The ADAPT Portal manages patient screening and prompts staff to follow the recommendations of the ADAPT CP. This study compares the clinical and cost effectiveness of two implementation strategies (varying in resource intensiveness), designed to encourage adherence to the ADAPT CP over a 12-month period. METHODS: This cluster randomised controlled trial will recruit 12 cancer service sites, stratified by size (large versus small), and randomised at site level to a standard (Core) versus supported (Enhanced) implementation strategy. After a 3-month period of site engagement, staff training and site tailoring of the ADAPT CP and Portal, each site will "Go-live", implementing the ADAPT CP for 12 months. During the implementation phase, all eligible patients will be introduced to the ADAPT CP as routine care. Patient participants will be registered on the ADAPT Portal to complete screening for anxiety and depression. Staff will be responsible for responding to prompts to follow the ADAPT CP. The primary outcome will be adherence to the ADAPT CP. Secondary outcomes include staff attitudes to and experiences of following the ADAPT CP, using the ADAPT Portal and being exposed to ADAPT implementation strategies, collected using quantitative and qualitative methods. Data will be collected at T0 (baseline, after site engagement), T1 (6 months post Go-live) and T2 (12 months post Go-live). DISCUSSION: This will be the first cluster randomised trial to establish optimal levels of implementation effort and associated costs to achieve successful uptake of a clinical pathway within cancer care. TRIAL REGISTRATION: The study was registered prospectively with the ANZCTR on 22/3/2017. Trial ID ACTRN12617000411347.

Time to diagnosis in young-onset dementia and its determinants: the INSPIRED study.

OBJECTIVE: The objective of this study is to identify factors determining the time to diagnosis for young-onset dementia (YOD), defined as dementia with symptom onset before age 65 years, by mapping the diagnostic pathways. METHODS: Participants were recruited via healthcare professionals, community support organisations or were self-referred. Information was obtained by interviews with the person with YOD and their carer, and medical record reviews. Clinical dementia diagnoses were independently ratified by consensus review. RESULTS: Participants included 88 people with YOD (mean age of onset = 55.4 years), due to Alzheimer's disease (AD) (53.4%, n = 47), frontotemporal dementia (FTD) (15.9%, n = 14) and other causes (30.7%, n = 27). Median time from symptom onset to first consultation was 2.3 years, to dementia diagnosis 3.2 years, to family awareness of dementia diagnosis 3.5 years and to final diagnosis of the type of dementia 4.7 years. Non-dementia diagnoses occurred in 48.9%, including depression (30.7%) and mild cognitive impairment (MCI) (17.0%). Participants with younger age of onset had significantly longer time to first consultation and family awareness of the dementia diagnosis. The time to dementia diagnosis was significantly longer when the participant presented with MCI or depression and when the dementia was other than AD or FTD. MCI was associated with significantly longer time to family awareness of dementia diagnosis. CONCLUSIONS: Factors impacting on time to diagnosis vary with the stage of diagnosis in YOD. Longer time to dementia diagnosis occurred in people who were younger at symptom onset, when MCI or depression was present, and in dementias other than AD and FTD. Copyright © 2016 John Wiley & Sons, Ltd.

Co-designing an online treatment decision aid for men with low-risk prostate cancer: Navigate.

Objectives: To develop an online treatment decision aid (OTDA) to assist patients with low-risk prostate cancer (LRPC) and their partners in making treatment decisions. Patients and methods: Navigate, an OTDA for LRPC, was rigorously co-designed by patients with a confirmed diagnosis or at risk of LRPC and their partners, clinicians, researchers and website designers/developers. A theoretical model guided the development process. A mixed methods approach was used incorporating (1) evidence for essential design elements for OTDAs; (2) evidence for treatment options for LRPC; (3) an iterative co-design process involving stakeholder workshops and prototype review; and (4) expert rating using the International Patient Decision Aid Standards (IPDAS). Three co-design workshops with potential users (n = 12) and research and web-design team members (n = 10) were conducted. Results from each workshop informed OTDA modifications to the OTDA for testing in the subsequent workshop. Clinician (n = 6) and consumer (n = 9) feedback on usability and content on the penultimate version was collected. Results: The initial workshops identified key content and design features that were incorporated into the draft OTDA, re-workshopped and incorporated into the penultimate OTDA. Expert feedback on usability and content was also incorporated into the final OTDA. The final OTDA was deemed comprehensive, clear and appropriate and met all IPDAS criteria. Conclusion: Navigate is an interactive and acceptable OTDA for Australian men with LRPC designed by men for men using a co-design methodology. The effectiveness of Navigate in assisting patient decision-making is currently being assessed in a randomised controlled trial with patients with LRPC and their partners.

Twice weekly dosing with Sebelipase alfa (Kanuma®) rescues severely ill infants with Wolman disease.

BACKGROUND: Sebelipase alfa (Kanuma®) is approved for patients with Wolman disease (WD) at a dosage of 3-5 mg/kg once weekly. Survival rates in the second of two clinical trials was greater, despite recruiting more severely ill patients, probably related to higher initial and maximal doses. We aimed to evaluate the effective pharmacokinetics and pharmacodynamics of Sebelipase alfa when administered to patients with severe WD at 5 mg/kg twice weekly, an intensive regimen which was not assessed in the trials. METHODS: We recruited 3 patients receiving Sebelipase alfa 5 mg/kg twice weekly. We measured LAL activity in leukocytes and plasma oxysterol concentration in two patients and LAL activity in fibroblasts in one patient. Clinical follow up was also assessed. RESULTS: Analyses of LAL activity and oxysterols demonstrate that there is short-lived enzyme activity post-dosing which is associated with the release of stored lipids. Clinical data demonstrate that 5 mg/kg twice weekly dosing is well tolerated and effective. CONCLUSION: 5 mg/kg twice weekly dosing with Sebelipase alfa rescues severely ill infants with WD by increasing substrate clearance. There is biologically relevant lipid accumulation in the 'trough' periods before the next dosing, even with this intensive regimen.

Emotion self-stigma as a unique predictor of help-seeking intentions: A comparative analysis of early adolescents and young adults.

OBJECTIVES: There has been limited consideration of the role emotion self-stigma (i.e. beliefs that experiencing and expressing so called 'negative' emotions are unacceptable) may play in help-seeking for emotional distress. This study is the first to investigate whether emotion self-stigma uniquely predicts help-seeking intentions across two key emotion vulnerability periods in development: (a) early adolescence and (b) young adulthood. METHODS AND DESIGN: Cross-sectional data were collected from secondary school (n = 510; M age = 13.96 years) and university students (n = 473; M age = 19.19 years) residing in Australia. Both samples completed measures online examining demographic characteristics, emotional competence, mental health and help-seeking stigma, emotion self-stigma, and help-seeking intentions. The Data were analysed using hierarchical multiple regression. RESULTS: Emotion self-stigma was a significant unique predictor of help-seeking intentions in young adults but not adolescents. The strength of the relationship between increased emotion self-stigma and lowered help-seeking intentions was similar for both males and females, regardless of developmental period. CONCLUSIONS: Addressing emotion self-stigma alongside mental illness and help-seeking stigma may be useful to improve help-seeking outcomes, particularly as young people transition into early adulthood.

Investigating the efficacy of a Dialectical behaviour therapy-based universal intervention on adolescent social and emotional well-being outcomes.

There is increasing research interest as to whether Dialectical Behaviour Therapy (DBT), specifically the group skills training component, is an effective early intervention approach when delivered universally in schools. The current study aimed to provide the first large-scale examination of a universal DBT-based intervention and to also determine the extent to which home practice of DBT skills predicted changes in social and emotional outcomes over time. A non-randomised controlled trial design was employed whereby 1071 participants (51.30% Male; M age = 13.48 years) completed either an adapted eight-session DBT skills-training intervention ('WISE Teens) (n = 563) or class-as-per-usual (n = 508). On average, the 'WISE Teens' intervention did not improve outcomes with significant deteriorations or null effects observed across outcomes relative to class-as-per-usual immediately post-intervention. The largest deteriorations were observed for depressive (d = -0.22; 95% CI = -0.35, -0.08) and anxiety symptoms (d = -0.28; 95%CI - = -0.41, -0.14). Applying Bonferroni corrections, most group differences in outcomes had dissipated at follow-up, however, 'WISE Teens' participants continued to report significantly poorer quality of parent-child relationships relative to control (d = .16 for mother (95% CI = 0.01, 0.31); d = 0.17 for father (95% CI = 0.02, 0.33). While home practice was modest on average, further exploratory analyses nevertheless revealed that greater home practice was generally associated with more positive outcomes both immediately post-intervention and at follow-up. Based on these findings, the DBT-based 'WISE Teens' intervention is not recommended in its current format for universal dissemination amongst early adolescents in schools. Further research is needed to determine how to improve engagement and feasibility of delivery of DBT-based interventions universally in this context.

Advancing E-contact to Reduce Intergroup Anxiety and Increase Positive Attitudes Towards Individuals Who Identify as Bisexual.

Bisexual individuals are invisible sexual minorities, who face prejudice and "double discrimination" from both heterosexual and sexual minority communities. Despite this, little empirical research has examined bisexual prejudice reduction. To address this, the current study tested an E-contact intervention - a highly structured, text-based, online interaction tool - to reduce bisexual prejudice. Heterosexual participants (N = 170) were randomly allocated to an intergroup (E-contact) or intragroup (control) interaction, with either a male or female interaction partner. Findings indicated that intergroup E-contact resulted in less intergroup anxiety compared to an intragroup interaction, and that this effect was more pronounced when the bisexual interaction partner was male for heterosexual men, but not for heterosexual women. Although E-contact had no direct effect on tolerance toward bisexual individuals or the perceived stability of bisexuality as a sexual orientation, findings revealed that reduced intergroup anxiety mediated the effect of E-contact on these outcome variables. This result was found in the intergroup dynamic of heterosexual men interacting with bisexual men, providing an important experimental demonstration of the potential for harnessing an E-contact intervention to reduce affective prejudice toward bisexual individuals.

The use of continuous glucose monitoring in the practical management of glycogen storage disorders.

Continuous glucose monitoring systems (CGMS) are now in widespread use in diabetes management with an increasing evidence base. There are few reports of their use in GSD. Liver glycogen storage disorders (GSDs) are most often managed by intensive dietary regimens. Risks of over and under-treatment remain. We describe our use of CGMS in a cohort of GSD patients, the results obtained and the frequency of complications. Our experience is that CGM is a reliable, well accepted and valid tool in the monitoring of GSD patients and allows for assessment of blood sugar control in the 'real-life' setting, unlike hospital admissions. Combining CGM with urine ketone and / or blood lactate measurements, again at home, improves the investigation yet further. It is possible to perform CGM for periods including both schooldays and weekends, and also to change the dietary regimen during the period of monitoring to reduce the frequency of assessments. Risks of decreased reliability in the low range of blood sugars may be outweighed by the increased validity of the patient being in the home environment, with a normal diet and activity schedule.

The natural history of glycogen storage disease type Ib in England: A multisite survey.

Glycogen storage disease type Ib (GSDIb) is characterized by hepatomegaly and fasting hypoglycaemia as well as neutropaenia and recurrent infections. We conducted a retrospective observational study on a cohort of patients with GSDIb across England. A total of 35 patients, with a median age of 9.1 years (range 1-39 years), were included in the study. We examined the genotype and phenotype of all patients and reported 14 novel alleles. The phenotype of GSDIb in England involves a short fasting tolerance that extends into adulthood and a high prevalence of gastrointestinal symptoms. Growth is difficult to manage and neutropaenia and recurrent infections persist throughout life. Liver transplantation was performed in nine patients, which normalized fasting tolerance but did not correct neutropaenia. This is the first natural history study on the cohort of GSDIb patients in England.

Enzyme replacement therapy and hematopoietic stem cell transplant: a new paradigm of treatment in Wolman disease.

BACKGROUND: Wolman disease is a rare, lysosomal storage disorder in which biallelic variants in the LIPA gene result in reduced or complete lack of lysosomal acid lipase. The accumulation of the substrates; cholesterol esters and triglycerides, significantly impacts cellular function. Untreated patients die within the first 12 months of life. Clinically, patients present severely malnourished, with diarrhoea and hepatosplenomegaly, many have an inflammatory phenotype, including with hemophagocytic lymphohistiocytosis (HLH). Hematopoietic stem cell transplant (HCT) had been historically the only treatment available but has a high procedure-related mortality because of disease progression and disease-associated morbidities. More recently, enzyme replacement therapy (ERT) with dietary substrate reduction (DSR) has significantly improved patient survival. However, ERT is life long, expensive and its utility is limited by anti-drug antibodies (ADA) and the need for central venous access. RESULTS: We describe five Wolman disease patients diagnosed in infancy that were treated at Royal Manchester Children's Hospital receiving ERT with DSR then HCT-multimodal therapy. In 3/5 an initial response to ERT was attenuated by ADA with associated clinical and laboratory features of deterioration. 1/5 developed anaphylaxis to ERT and the other patient died post HCT with ongoing HLH. All patients received allogeneic HCT. 4/5 patients are alive, and both disease phenotype and laboratory parameters are improved compared to when they were on ERT alone. The gastrointestinal symptoms are particularly improved after HCT, with reduced diarrhoea and vomiting. This allows gradual structured normalisation of diet with improved tolerance of dietary fat. Histologically there are reduced cholesterol clefts, fewer foamy macrophages and an improved villous structure. Disease biomarkers also show improvement with ERT, immunotherapy and HCT. Three patients have mixed chimerism after HCT, indicating a likely engraftment-defect in this condition. CONCLUSION: We describe combined ERT, DSR and HCT, multimodal treatment for Wolman disease. ERT and DSR stabilises the sick infant and reduces the formerly described prohibitively high, transplant-associated mortality in this condition. HCT abrogates the problems of ERT, namely attenuating ADA, the need for continuing venous access, and continuing high cost drug treatment. HCT also brings improved efficacy, particularly evident in improved gastrointestinal function and histology. Multimodal therapy should be considered a new paradigm of treatment for Wolman disease patients where there is an attenuated response to ERT, and for all patients where there is a well-matched transplant donor, in order to improve long term gut function, tolerance of a normal diet and quality of life.

Special Low Protein Foods Prescribed in England for PKU Patients: An Analysis of Prescribing Patterns and Cost.

Patients with phenylketonuria (PKU) are reliant on special low protein foods (SLPFs) as part of their dietary treatment. In England, several issues regarding the accessibility of SLPFs through the national prescribing system have been highlighted. Therefore, prescribing patterns and expenditure on all SLPFs available on prescription in England (n = 142) were examined. Their costs in comparison to regular protein-containing (n = 182) and 'free-from' products (n = 135) were also analysed. Similar foods were grouped into subgroups (n = 40). The number of units and costs of SLPFs prescribed in total and per subgroup from January to December 2020 were calculated using National Health Service (NHS) Business Service Authority (NHSBSA) ePACT2 (electronic Prescribing Analysis and Cost Tool) for England. Monthly patient SLPF units prescribed were calculated using patient numbers with PKU and non-PKU inherited metabolic disorders (IMD) consuming SLPFs. This was compared to the National Society for PKU (NSPKU) prescribing guidance. Ninety-eight percent of SLPF subgroups (n = 39/40) were more expensive than regular and 'free-from' food subgroups. However, costs to prescribe SLPFs are significantly less than theoretical calculations. From January to December 2020, 208,932 units of SLPFs were prescribed (excluding milk replacers), costing the NHS £2,151,973 (including milk replacers). This equates to £962 per patient annually, and prescribed amounts are well below the upper limits suggested by the NSPKU, indicating under prescribing of SLPFs. It is recommended that a simpler and improved system should be implemented. Ideally, specialist metabolic dietitians should have responsibility for prescribing SLPFs. This would ensure that patients with PKU have the necessary access to their essential dietary treatment, which, in turn, should help promote dietary adherence and improve metabolic control.

The benefit of contact for prejudice-prone individuals: The type of stigmatized outgroup matters.

Intergroup contact reduces prejudice against a variety of social outgroups and seems to be particularly effective at reducing prejudice in individuals most prone to it-those high in right-wing authoritarianism (RWA) and social dominance orientation (SDO). The present study examines the moderating roles of RWA and SDO in the contact-prejudice relationship, targeting dissident, dangerous, and derogated outgroups: lesbians and gay men, people with schizophrenia, and Indigenous Australians, respectively. In total, 234 participants self-reported contact and prejudice against these outgroups and completed RWA and SDO scales. Contact predicted less prejudice against lesbians and gay men and Indigenous Australians in participants high in RWA and participants high in SDO. However, contact only predicted less prejudice against people with schizophrenia in participants low in RWA or SDO. The results suggest that the ability for intergroup contact to reduce prejudice in prejudice-prone individuals may depend on the outgroup targeted, specifically the threat they pose and the level of prejudice held against them.

Testing Consultation Recordings in a Clinical Setting With the SecondEars Smartphone App: Mixed Methods Implementation Study.

BACKGROUND: Health care systems are increasingly looking to mobile device technologies (mobile health) to improve patient experience and health outcomes. SecondEars is a smartphone app designed to allow patients to audio-record medical consultations to improve recall, understanding, and health care self-management. Novel health interventions such as SecondEars often fail to be implemented post pilot-testing owing to inadequate user experience (UX) assessment, a key component of a comprehensive implementation strategy. OBJECTIVE: This study aimed to pilot the SecondEars app within an active clinical setting to identify factors necessary for optimal implementation. Objectives were to (1) investigate patient UX and acceptability, utility, and satisfaction with the SecondEars app, and (2) understand health professional perspectives on issues, solutions, and strategies for effective implementation of SecondEars. METHODS: A mixed methods implementation study was employed. Patients were invited to test the app to record consultations with participating oncology health professionals. Follow-up interviews were conducted with all participating patients (or carers) and health professionals, regarding uptake and extent of app use. Responses to the Mobile App Rating Scale (MARS) were also collected. Interviews were analyzed using interpretive descriptive methodology; all quantitative data were analyzed descriptively. RESULTS: A total of 24 patients used SecondEars to record consultations with 10 multidisciplinary health professionals. In all, 22 of these patients used SecondEars to listen to all or part of the recording, either alone or with family. All 100% of patient participants reported in the MARS that they would use SecondEars again and recommend it to others. A total of 3 themes were identified from the patient interviews relating to the UX of SecondEars: empowerment, facilitating support in cancer care, and usability. Further, 5 themes were identified from the health professional interviews relating to implementation of SecondEars: changing hospital culture, mitigating medico-legal concerns, improving patient care, communication, and practical implementation solutions. CONCLUSIONS: Data collected during pilot testing regarding recording use, UX, and health professional and patient perspectives will be important for designing an effective implementation strategy for SecondEars. Those testing the app found it useful and felt that it could facilitate the benefits of consultation recordings, along with providing patient empowerment and support. Potential issues regarding implementation were discussed, and solutions were generated. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Registry ACTRN12618000730202; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373915&isClinicalTrial=False.

Uniformity of Food Protein Interpretation Amongst Dietitians for Patients with Phenylketonuria (PKU): 2020 UK National Consensus Statements.

In phenylketonuria (PKU), variable dietary advice provided by health professionals and social media leads to uncertainty for patients/caregivers reliant on accurate, evidence based dietary information. Over four years, 112 consensus statements concerning the allocation of foods in a low phenylalanine diet for PKU were developed by the British Inherited Metabolic Disease Dietitians Group (BIMDG-DG) from 34 PKU treatment centres, utilising 10 rounds of Delphi consultation to gain a majority (≥75%) decision. A mean of 29 UK dietitians (range: 18-40) and 18 treatment centres (range: 13-23) contributed in each round. Statements encompassed all foods/food groups divided into four categories based on defined protein/phenylalanine content: (1) foods high in protein/phenylalanine (best avoided); (2) foods allowed without restriction including fruit/vegetables containing phenylalanine ≤75 mg/100 g and most foods containing protein ≤0.5 g/100 g; (3) foods that should be calculated/weighed as an exchange food if they contain protein exchange ingredients (categorized into foods with a protein content of: >0.1 g/100 g (milk/plant milks only), >0.5 g/100 g (bread/pasta/cereal/flours), >1 g/100 g (cook-in/table-top sauces/dressings), >1.5 g/100 g (soya sauces)); and (4) fruit/vegetables containing phenylalanine >75 mg/100 g allocated as part of the protein/phenylalanine exchange system. These statements have been endorsed and translated into practical dietary management advice by the medical advisory dietitians for the National Society for PKU (NSPKU).

Awareness and pharmacotherapy of hypertension in a rural community.

OBJECTIVE: To determine the level of awareness of hypertension and pharmacological management in patients from a rural community of Australia. SUBJECTS AND METHODS: A total of 665 patients were studied. The patients were recruited from Albury-Wodonga and surrounding districts, which are located in a rural area of south-eastern Australia. Demographic information and medical history were recorded for all patients. Clinical data were also recorded. RESULTS: Of the 665 patients, 449 (75%) were hypertensive, and of these 449 hypertensive patients, 195 (43.4%) were aware that they had hypertension. Blood pressure was inadequately controlled in 399 of the hypertensive patients (88.9%) according to the management guidelines of the National Heart Foundation of Australia. Of all the patients who had hypertension, 247 (55.0%) were not receiving antihypertensive therapy. Of those receiving therapy, 132 (65.3%) were being administered only one antihypertensive (monotherapy). The most commonly prescribed antihypertensive classes were angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, diuretics, beta-blockers and calcium channel blockers. CONCLUSION: The level of awareness of hypertension and its management appeared to be poor in hypertensive patients living in this rural Australian community. Actual hypertension control was extremely poor, and a major potential cause of this may be the poor use of anti-hypertensive medications in these patients. Strategies to improve the awareness of hypertension and its required management in patients residing in rural communities are recommended.

Intergroup contact and mental health stigma: A comparative effectiveness meta-analysis.

Mental health stigma is a substantial problem all over the world. Although many interventions to reduce stigma exist, there is considerable methodological variability, making it difficult for decision-makers to determine what strategies are the most effective and what characteristics make them so. To this end, we conducted a meta-analysis on intergroup contact strategies and examined several potential moderators. We searched 5 databases for published and unpublished studies and retrieved 101 studies from 24 countries that could be included in the analyses. Ninety studies assessed outcomes immediately after the intervention (n = 15,826), 33 in the short-term (n = 3,697), and 7 in the medium-term (n = 842). The effect of contact was significant and small-to-medium in size at all three timepoints, d = -0.384, -0.334, and -0.526, respectively. Intervention effectiveness did not differ between contact with or without an educational component, different contact mediums, or the mental illness of the outgroup member. However, the effect of contact was stronger in non-Western countries and in university students and health professionals compared to community members. These results may inform policy-makers of the most effective and suitable stigma-reduction initiatives to invest in and can guide researchers towards important avenues for future research.

Using Electronic Contact to Reduce Homonegative Attitudes, Emotions, and Behavioral Intentions Among Heterosexual Women and Men: A Contemporary Extension of the Contact Hypothesis.

The current study experimentally examined the potential for a contemporary extension of the contact hypothesis, known as electronic contact, or E-contact, to reduce sexual prejudice, intergroup anxiety, and avoidant behavioral intentions among heterosexuals. It also extended the sexual minority contact literature by examining the role of participant and interaction partner sex as a possible boundary condition of this contact-prejudice relationship. To test our hypotheses, 140 heterosexual female and male university students were randomly allocated to interact with a homosexual or heterosexual, female or male E-contact partner, in a collaborative and text-only online interaction before completing the outcome measures. Overall, the results demonstrated that interacting online with a female, as opposed to a male, homosexual E-contact partner reduced heterosexual men's feelings of intergroup anxiety, which in turn was associated with lower sexual prejudice and outgroup avoidance. For heterosexual women, however, E-contact did not influence the outcome variables. In the context of sexual prejudice, these results suggest that E-contact may be particularly useful as a prejudice-reduction strategy among individuals who typically require it most: heterosexual men.