Knowledge of vitamin D and practices of vitamin D supplementation in a Scottish adult population: A cross-sectional study.

Background: Vitamin D supplementation practices (dose and frequency) are relatively unknown in the Scottish population, with no recent up-to-date data available. Reassessing current knowledge, practices, and awareness of vitamin D supplementation following a national health campaign in 2020 by Food Standards Scotland on vitamin D is warranted. Aim: This article aims to present the knowledge and awareness of vitamin D, and current vitamin D supplementation practices in adults living in Scotland. Methods: A cross-sectional study was performed between June and July 2022 using an online survey adapted from previous work on assessing knowledge of vitamin D in adults. Participants aged 18+, living in Scotland for ≥6 months were eligible to participate. Scores for knowledge were calculated as a percentage. Univariate associations between demographic and supplement use were established by χ2-test and logistic regression performed to predict factors associated with daily vitamin D intake. Results: Four hundred and three participants (72.7% female), mean age 36.4 (±14.2 years), completed the study. Awareness of vitamin D was very high (99.5%) but the mean overall knowledge score was poor (31.4 ± 15.3%), with those with a university degree more likely to have knowledge scores at/above the mean compared with those with lower levels of education, χ2(1, N = 393) 10.7, p = 0.001, odds ratio (OR) = 2.1 (95% confidence interval (CI) 1.7-2.7). Finally, 64.3% took vitamin D supplements, of which 37.5% took them daily during winter months, with only 7.4% taking the recommended daily dose. Conclusion: The current study highlights the need to improve both knowledge of vitamin D and practices of vitamin D supplementation during the autumn and winter months in Scotland.

Pakistani orphanage caregivers' perspectives regarding their caregiving abilities, personal and orphan children's psychological wellbeing.

BACKGROUND: Pakistan is home to 4.6 million children who have been orphaned. Limited data on caregiving in orphanages suggests that caregivers do not have specialized training and experience heavy workloads and high-stress levels. Supporting these caregivers to provide responsive and consistent caregiving can improve their well-being along with the psychological and physical development of children who have been orphaned. This research explored the main caregiving-related challenges faced by caregivers in orphanage settings, their professional and personal needs and perceived emotional and behavioural problems manifesting in children under their care. METHOD: This research adopted a qualitative research design with a thematic analysis approach. Semi-structured interviews were conducted with 14 caregivers who were currently caring for four to 12-year-old children in Pakistani orphanages. RESULTS: Five main themes: (1) religiosity, (2) economic relief, (3) caregivers' needs and well-being, (4) caring for children who have been orphaned and (5) need for context specific training, emerged from the data, which included several subthemes. Findings revealed the presence of positive religious views regarding the upbringing and care of children who have been orphaned. Work-provided accommodation was an important economic relief. Caregivers' psychological, physiological and personal lives were affected by job-related stress and demands. Many helpful and unhelpful parenting practices were documented, and challenges such as children's verbal and physical aggression, stealing, non-cooperation and poor social skills were reported. The main professional issues included low salary, high numbers of children in care and lack of context specific professional caregiving training provided. CONCLUSION: This study established the need for a tailored programme that suits the context specific caregiving needs in Pakistani orphanages to support the training and professional growth of caregivers and promote their wellbeing along with positive developmental outcomes in the children under their care.

Scaling Up Parenting Interventions is Critical for Attaining the Sustainable Development Goals.

Of all the potentially modifiable influences affecting children's development and mental health across the life course, none is more important than the quality of parenting and family life. In this position paper, we argue that parenting is fundamentally linked to the development of life skills that children need in order to achieve the United Nations Sustainable Development Goals. We discuss key principles that should inform the development of a global research and implementation agenda related to scaling up evidence-based parenting support programs. Research over the past 50 years has shown that parenting support programs of varied intensity and delivery modality can improve a wide range of developmental, emotional, behavioral and health outcomes for parents and their children. Such findings have been replicated across culturally and socioeconomically diverse samples, albeit primarily in studies from Western countries. We highlight the evidence for the relevance of parenting interventions for attaining the SDGs globally, and identify the barriers to and strategies for achieving their scale-up. The implications of the global COVID-19 pandemic for the delivery of evidence-based parenting support are also discussed.

Patient-oriented research: A qualitative study of research involvement of parents of children with neurodevelopmental disabilities.

Patient-oriented research engages patients and caregivers as partners contributing to all phases of the research process. This was the goal of the Strongest Families Institute Neurodevelopmental research, in Halifax, Nova Scotia, when they included a parent advisory committee, made up of parents and caregivers of children and adolescents with a neurodevelopmental condition, to complete their research project. The purpose of this qualitative research was to examine the experiences of researchers and parents of children with a neurodevelopmental condition who participated on a research study advisory committee for the Strongest Families Neurodevelopment research project. From interviews with both parents/caregivers and researchers that played a role on the advisory committee, four major themes emerged on how to negotiate and navigate their time on the committee and what worked well and what did not. This led to recommendations for future researchers and patients who may create or be a part of an advisory committee.

Comparing apples and pears: misleading conclusions about the population mental health impact of a parenting programme, a commentary on Marryat, Thompson and Wilson (2017).

BACKGROUND: The article by Marryat, Thompson and Wilson (2017) in BMC Pediatrics presents an evaluation of the implementation of the Triple P system as a public health intervention conducted by the Glasgow City Council and NHS Greater Glasgow and Clyde. DISCUSSION: Unfortunately, the conclusions drawn are questionable for multiple reasons. The lack of a controlled design precludes defensible conclusions about intervention effects free from routine threats to internal validity. There was a substantial mismatch between the intervention sample and the population sample assessed. The article's title and abstract leave readers with the mistaken impression that the children assessed for outcome were suitably representative of intervention families, when in fact many of the children in the intervention families were missing from the teacher-report outcome assessment (a single questionnaire), and many or most of the children in the teacher-report outcome assessment belonged to families who had never received the intervention. Although Triple P targets parent-child relations and child behavioural and emotional problems at home, Marryat et al. narrowly defined mental health impact as child difficulties in nursery or preschool, while not reporting data from practitioners and parents in the same evaluation that did not support the authors' conclusion. The paper was further diminished by a number of misleading statements and factual errors related for example to other research on Triple P. Studying the extent to which child mental health functioning at home can generalise to school settings is an important topic of inquiry in relation to parenting support interventions, but unfortunately the Marryat et al. article did not move this area forward.

Strongest Families™ Managing Our Mood (MOM): a randomized controlled trial of a distance intervention for women with postpartum depression.

The present study investigated whether a distance-delivered intervention could significantly decrease mild to moderate postpartum depression (PPD) in mothers as compared to usual care. Mothers with PPD (n = 62) were randomly assigned to the intervention or standard community care. Participants receiving the intervention followed a 12-session cognitive behavioural informed handbook supplemented with telephone-based coaching support. Diagnostic status and depressive symptoms were assessed at baseline and 3, 6 and 12 months postrandomization. Odds ratios indicated that intervention group participants were 1.5 times as likely to experience diagnostic remission at 3 months (mid-intervention) (p = 0.742), 1.54 times as likely at 6 months (p = 0.696) and 12.5 times as likely at 12 months (p = 0.009). Intervention 'dosage' significantly moderated this effect; for every additional coaching session completed, individuals had a 1.4 times greater chance of showing improvement at 3 and 6 months. Mothers reported high satisfaction with the intervention. Findings suggest positive outcomes at each time point and superior outcomes to the control condition at the long-term follow-up. Caution in interpreting these results is warranted due to small sample size and incomplete data; however, they support further investigation into the use of distance interventions as an accessible and effective solution for women with PPD.

Contributions of intrinsic mutation rate and selfish selection to levels of de novo HRAS mutations in the paternal germline.

The RAS proto-oncogene Harvey rat sarcoma viral oncogene homolog (HRAS) encodes a small GTPase that transduces signals from cell surface receptors to intracellular effectors to control cellular behavior. Although somatic HRAS mutations have been described in many cancers, germline mutations cause Costello syndrome (CS), a congenital disorder associated with predisposition to malignancy. Based on the epidemiology of CS and the occurrence of HRAS mutations in spermatocytic seminoma, we proposed that activating HRAS mutations become enriched in sperm through a process akin to tumorigenesis, termed selfish spermatogonial selection. To test this hypothesis, we quantified the levels, in blood and sperm samples, of HRAS mutations at the p.G12 codon and compared the results to changes at the p.A11 codon, at which activating mutations do not occur. The data strongly support the role of selection in determining HRAS mutation levels in sperm, and hence the occurrence of CS, but we also found differences from the mutation pattern in tumorigenesis. First, the relative prevalence of mutations in sperm correlates weakly with their in vitro activating properties and occurrence in cancers. Second, specific tandem base substitutions (predominantly GC>TT/AA) occur in sperm but not in cancers; genomewide analysis showed that this same mutation is also overrepresented in constitutional pathogenic and polymorphic variants, suggesting a heightened vulnerability to these mutations in the germline. We developed a statistical model to show how both intrinsic mutation rate and selfish selection contribute to the mutational burden borne by the paternal germline.

Sustained Implementation of Evidence-based Programs in Disadvantaged Communities: A Conceptual Framework of Supporting Factors.

This paper presents a review of the empirical literature for studies evaluating factors that facilitate and create barriers to sustained program implementation in disadvantaged communities. It outlines study methodology and sustainment outcomes and proposes a conceptual model that involves implementation sustainment support for providers delivering evidence-based health and family services in disadvantaged communities. Sustained program implementation in the community setting is a significant issue as only 43% of studies reported successfully sustained programs. The review identified 18 factors that facilitate success and create barriers to program sustainment. The factors are synthesized into three themes; program characteristics, workplace capacity, and process and interaction factors. The majority of factors map onto commonly cited sustainability influences in implementation science. However, there was an additional focus for studies included in this review on the importance of factors such as program burden, program familiarity and perceived competence in program skills, workplace support for the program, staff mobility and turnover, supervision and peer support, and ongoing technical assistance. The need to use a conceptual framework and develop measures to guide and evaluate capacity building in EBP implementation and sustainment in low-resource community settings is highlighted.

'I am actually doing something to keep well. That feels really good': Experiences of exercise within hospice care.

Background: Patients with advanced cancer frequently experience functional impairment and reduced quality of life. Therapeutic exercise can provide benefit and be made accessible through the use of tailored programmes. Most studies examining exercise programmes for people with advanced cancer have used quantitative outcome measures and focussed on objective physical function, therefore offer a limited perspective on the experience of exercise participation. Methods: This qualitative study explored patients' experiences of an exercise programme within a palliative care setting. The interviews focussed on the perceived impact on all aspects of quality of life. Results: Nine people with advanced cancer, attending a hospice-based exercise programme, completed a one-to-one interview with a senior physiotherapist to explore the physical, emotional, and social impacts of their participation. Interviews were audiotaped, transcribed verbatim and analysed using interpretive phenomenological analysis. Patients reported an awareness of the positive physical, psychological, and social consequences of exercising. Their experiences reflected on all dimensions of quality of life, the impact of others and the sense of meaning gained through participation in exercise. Conclusion: Our findings highlight that exercise in palliative care should not be viewed solely a physical intervention, but one that has potential to enhance many aspects of patients' quality of life.

Erratum to: Reducing Preschoolers' Disruptive Behavior in Public with a Brief Parent Discussion Group.

CONFLICT OF INTEREST: The Triple P-Positive Parenting Program is owned by the University of Queensland (UQ). The University through its main technology transfer company UniQuest Pty Limited has licensed Triple P International Pty Ltd to disseminate the program worldwide. Royalties stemming from this dissemination activity are distributed to the Parenting and Family Support Centre, School of Psychology, UQ; Faculty of Health and Behavioural Sciences at UQ; and contributory authors. No author has any share or ownership in Triple P International Pty Ltd. Matthew Sanders is the founder and an author on various Triple P programs and a consultant to Triple P International. Karen Turner is an author of various Triple P programs.

Supporting Families Affected by Adversity: An Open Feasibility Trial of Family Life Skills Triple P.

This pilot feasibility study examined the effects of a new trauma-informed parenting program, Family Life Skills Triple P (FLSTP), in an open uncontrolled trial conducted in a regular service delivery context via video conferencing. FLSTP was trialed as a group-delivered 10-session intervention. Program modules target positive parenting skills (4 sessions) and adult life skills including coping with emotions, taking care of relationships, self-care, dealing with the past, healthy living, and planning for the future. Participants were 50 parents with multiple vulnerabilities, due to social disadvantage or adverse childhood experiences, who had children aged 3-9 with early onset behavior problems. Outcomes were assessed across four data collection points: baseline, mid-intervention (after Session 4), post-intervention, and 3-month follow up. Findings show moderate to large intra-group effect sizes for changes in child behavior problems, parenting practices and risk of child maltreatment, and medium effect sizes for parental distress, emotion regulation and self-compassion. Parents and practitioners reported high levels of consumer satisfaction with the program. Parents with lower levels of parental self-efficacy, lower personal agency and higher baseline scores on a measure of child abuse potential were at greater risk of not completing the program. The strength of these preliminary findings indicates that a more rigorous evaluation using a randomized clinical trial is warranted.

Tead4 and Tfap2c generate bipotency and a bistable switch in totipotent embryos to promote robust lineage diversification.

The mouse and human embryo gradually loses totipotency before diversifying into the inner cell mass (ICM, future organism) and trophectoderm (TE, future placenta). The transcription factors TFAP2C and TEAD4 with activated RHOA accelerate embryo polarization. Here we show that these factors also accelerate the loss of totipotency. TFAP2C and TEAD4 paradoxically promote and inhibit Hippo signaling before lineage diversification: they drive expression of multiple Hippo regulators while also promoting apical domain formation, which inactivates Hippo. Each factor activates TE specifiers in bipotent cells, while TFAP2C also activates specifiers of the ICM fate. Asymmetric segregation of the apical domain reconciles the opposing regulation of Hippo signaling into Hippo OFF and the TE fate, or Hippo ON and the ICM fate. We propose that the bistable switch established by TFAP2C and TEAD4 is exploited to trigger robust lineage diversification in the developing embryo.

Exploring Indigenous Community Conceptions of Parent Wellbeing: A Qualitative Analysis.

Using non-Indigenous perspectives of parental social and emotional wellbeing in the design and application of parent support programs can undermine program effectiveness as it may not account for Indigenous family structures and community values. With a clearer understanding of Indigenous parent wellbeing and its determinants, parenting interventions can be more appropriately designed and tailored to provide support for Indigenous families. This study utilised a community-based participatory action research approach involving collaboration between the research team, participants, and community advisory groups to explore Indigenous parents' and carers' conceptions of wellbeing. Participants' cultural perspectives on parent wellbeing were collected through semi-structured focus groups and in-depth interviews (N = 20). Thematic analysis was undertaken using theory-driven and interpretative phenomenological analysis. Eleven themes emerged as risk and protective factors across three domains: child domain (i.e., school attendance and education, respect, routine, development), parent domain (i.e., role modelling, self-regulation of body, self-regulation of mind and emotions, parenting strategies), and context domain (i.e., connections to family and kinship, community, access to services). It is noteworthy that parents reported three super-ordinate intersecting themes across all domains: connection to culture, Country, and spirituality. In addition, Indigenous parents' and carers' conception of their own wellbeing is closely linked to their children's wellbeing, their lived community context, and expected personal indicators. In recognising and working with this holistic view of Indigenous parent wellbeing, parent support programs can be optimally designed and implemented in Indigenous communities.

A commentary on evidenced-based parenting programs: redressing misconceptions of the empirical support for Triple P.

A meta-analytic review of the Triple P-Positive Parenting program by Wilson et al., recently published in BMC Medicine, claimed to demonstrate that although Triple P is widely disseminated and adopted, the evidence attesting to the effectiveness of the program is not as convincing as it may appear. Although this review addresses the important issue of evaluation and reporting methods within evidence-based interventions, we contend that the Wilson et al. review contains a number of significant conceptual, methodological and interpretational inadequacies that render the key conclusions of their review problematic.

Motile sperm organelle morphology evaluation-selected globozoospermic human sperm with an acrosomal bud exhibits novel patterns and higher levels of phospholipase C zeta.

STUDY QUESTION: Does motile sperm organelle morphology examination (MSOME) affect levels and localization patterns of the oocyte activation factor phospholipase C zeta (PLCζ) in globozoospermic sperm with and without an acrosomal bud? SUMMARY ANSWER: MSOME identified round-headed globozoospermic sperm with increased levels of PLCζ relative to sperm from the same sample that did not undergo MSOME, and identified novel patterns of PLCζ localization in sperm exhibiting an acrosomal bud. WHAT IS KNOWN ALREADY: Absence or reduction in the level of PLCζ in the sperm head, abnormal localization patterning, or defective functional ability as a result of PLCζ gene mutation, have been linked to certain types of human male factor infertility in which oocyte activation is deficient. It has been determined that a subpopulation of sperm (1%) from a patient exhibiting 100% globozoospermia presented with an acrosome bud upon MSOME. A cycle of intracytoplasmic morphologically selected sperm injection, carried out with sperm exhibiting an acrosomal bud led to pregnancy and birth of a healthy baby boy, without the use of assisted oocyte activation (AOA). STUDY DESIGN, SIZE, DURATION: Immunofluorescent analysis of PLCζ in globozoospermic sperm from three patients, before and after MSOME. PARTICIPANTS/MATERIALS, SETTING, METHODS: Quantitative immunofluorescence was used to investigate PLCζ levels and localization patterns in individual sperm (n = 1 patient) identified by MSOME and isolated by micromanipulation, and presenting with and without the acrosomal bud. A secondary aim was to investigate levels and localization patterns of PLCζ in sperm before and after MSOME from two other globozoospermic men. MAIN RESULTS AND THE ROLE OF CHANCE: Non-globozoospermic control sperm exhibited characteristic localization patterns of PLCζ immunofluorescence. Completely round-headed globozoospermic sperm from patients 1-3 were either devoid of PLCζ immunofluorescence, or exhibited an abnormal, punctate, pattern of PLCζ localization. PLCζ immunofluorescence in sperm exhibiting an acrosomal bud was observed in the midpiece with varying fluorescent intensity and was detected in 28.5% of such sperm. The majority of sperm with an acrosomal bud (43.0%) exhibited punctate patterns of PLCζ localization within the sperm head. A further 28.5% of sperm exhibited PLCζ in both the head and the midpiece. Total levels of PLCζ, and the proportions of sperm exhibiting PLCζ immunoreactivity, showed significant variance (P ≤ 0.05) amongst control [45.8 arbitrary units (a.u.) and 95.7%, respectively], non-MSOME-selected (25.9 a.u. and 46.1%, respectively) and MSOME-selected globozoospermic sperm (33.4 a.u. and 65.0%, respectively). Total levels of PLCζ immunofluorescence, and proportions of sperm exhibiting PLCζ immunoreactivity, in control sperm was significantly higher (P≤ 0.05) compared with non-MSOME-selected sperm, but not significantly different from MSOME-selected sperm. LIMITATIONS, REASONS FOR CAUTION: The low numbers of sperm analysed may not be ideal for conclusive statistical analysis. Evaluation of the effects of MSOME on morphologically normal sperm would confirm conclusions. WIDER IMPLICATIONS OF THE FINDINGS: The present findings provide hope for the future treatment of globozoospermia without the need for AOA, and provide further evidence for the clinical application of PLCζ as a therapeutic and prognostic tool. STUDY FUNDING/COMPETING INTEREST(S): The research described herein was funded by the Nuffield Department of Obstetrics and Gynaecology, University of Oxford. The authors report no conflict of interest.

Asking the Question 'What Matters to You?' in a London Intensive Care Unit.

Purpose: At the heart of the paradigm shift in approach to patient care from paternalism toward shared decision-making lies the international "What Matters To You?" (WMTY) movement. However, WMTY principles are not frequently applied to the critical care setting. The aim of this quality improvement project work was to design and integrate a tool for all patients admitted to the intensive care unit (ICU) that helped answer WMTY. Methods: Using Plan-Do-Study-Act (PDSA) methodology across 8 cycles, a multidisciplinary team designed and integrated a bedside poster into the ICU. Quantitative and qualitative data were collected via a bedside audit process on a regular basis during each of the study phases comprising PDSA cycles. Results: Project results confirmed that the introduction of this poster/tool, alongside resource- and staff engagement-focused interventions, enabled the ICU to offer more than 50% of patients a WMTY conversation, as compared to zero at the start of the project. Consistently, 100% of staff surveyed (n=46 over all cycles) felt the posters were a useful addition to the ICU and confirmed they learned something new about their patients that they didn't know already. Conclusions: This novel poster design successfully summarized patients' responses to the question "What matters to you?" for ICU staff and would be transferable to other ICUs.

A review of Australian Government funding of parenting intervention research.

OBJECTIVES: Parenting is central to children's optimal development and accounts for a substantial proportion of the variance in child outcomes, including up to 40% of child mental health. Parenting is also one of the most modifiable, proximal, and direct factors for preventing and treating a range of children's problems and enhancing wellbeing. To determine the effectiveness of new approaches to parenting intervention, and to evaluate how to optimise reach and uptake, sufficient funding must be allocated for high quality research. METHOD: We reviewed funding awarded by the National Health and Medical Research Council (NHMRC) and Australian Research Council (ARC) for parenting intervention research during 2011-2020. RESULTS: Parenting intervention research received 0.25% of the NHMRC and ARC research budgets. CONCLUSIONS: There is a substantial mismatch between the funding of parenting intervention research and the impact of improved parenting on short- and long-term child outcomes. To rectify this, it is critical that Australian Government funding schemes include parenting interventions as priority areas for funding. IMPLICATIONS FOR PUBLIC HEALTH: Changes in allocation of funding to parenting research will support the establishment of evidence for the effective development, implementation and dissemination of parenting interventions to maximise health outcomes for children and their families.

Effects of cryopreservation and density-gradient washing on phospholipase C zeta concentrations in human spermatozoa.

Cryopreservation and density-gradient washing (DGW) are routinely used in infertility treatment. This study used quantitative immunofluorescence analysis to report how these techniques affect concentrations of the oocyte activation factor, phospholipase C zeta (PLCζ) in spermatozoa from fertile men. DGW significantly elevated the proportion of spermatozoa in which PLCζ could be detected (by 25­81%; P < 0.0001). In contrast, in four donors, cryopreservation significantly reduced PLCζ concentrations (by 20­56%; P < 0.0001). These findings indicate that while DGW positively selects spermatozoa with detectable PLCζ, cryopreservation has significant detrimental effects upon PLCζ concentrations. Since reduced PLCζ concentrations have been implicated in deficient oocyte activation and infertility, further study is highly warranted.

The role of practitioner self-efficacy, training, program and workplace factors on the implementation of an evidence-based parenting intervention in primary care.

This study examines factors affecting the implementation by primary care practitioners (nursing, education, allied health, and medical) of a brief parenting and family support intervention (the Primary Care Triple P-Positive Parenting Program) following professional training. It assesses the impact of prior experience, self-efficacy, program supports, program barriers, satisfaction with training, and workplace characteristics on reported extent of program use. The majority of practitioners (97%) reported using Triple P following training. Implementation was assessed as the proportion of cases seen who received the full program. Program supports (quality of format and materials) and barriers (management difficulties and lack of fit) impacted on practitioner self-efficacy, and higher self-efficacy was positively associated with implementation. Prior professional experience, satisfaction with training, and workplace factors were not significant predictors. These results highlight the importance of promoting practitioners' sense of competence or mastery of a program for facilitating the implementation of evidence-based programs in primary care settings.