The impact of gardening on nutrition and physical health outcomes: a systematic review and meta-analysis.

Community gardening has been widely recognized as a multicomponent approach that has affected a broad range of health and well-being outcomes. The objective of this study was to investigate the association between community gardening and nutrition and physical health among adults. A systematic review and meta-analysis were conducted. Five electronic databases were searched systematically. Quality of included studies was appraised by several quality assessment tools related to the study design of each included article. Evidence from 19 articles was included (14 cross-sectional studies, 4 quasi-experimental studies and 1 case-control study). Although the majority of included studies appeared to have moderate quality, there existed weaknesses in the methods used, including low response rate and lack of confounder controls. Due to diversity in the measurement units, only body mass index (BMI) data could be pooled to perform meta-analysis. The results suggest that gardening had a significantly positive effect on BMI reduction. Subgroup analysis showed that quasi-experimental and case-control studies produced greater pooled effect size than those of cross-sectional design. Funnel plot and Egger's test showed no significant evidence of publication bias. As robust evidence for the effect of community gardening on BMI reduction was found, this intervention should be integrated in health promoting policy to improve population health.

Police Academy Training, Performance, and Learning.

We conducted empirical analyses of training at 3 large regional police academies in the United States. We objectively examined the performance and learning of 3 classes, a total of 115 cadets, across 3 representative training approaches to defensive and control tactics. Experiment 1 examined the content and effects of single-session or block training across 8 weeks during the academy. Experiment 2 examined the content and effects of spaced sessions with small-group practice and scenario-based feedback across 8 weeks during the academy. Experiment 3 examined the content and effect of block training with scenario-based feedback across 15 weeks during the academy. Experiment 3 also demonstrated the impact of performance feedback on instructor behavior and cadet performance during the academy and 16 weeks after graduation. We provide recommendations and a call for research based on the performance and learning literature, grounded in behavioral science.

Correction to: Police Academy Training, Performance, and Learning.

[This corrects the article DOI: 10.1007/s40617-018-00317-2.].

Perceptions of smoking cessation among Glasgow's Chinese community.

INTRODUCTION: Health related needs and services are stratified by ethnicity in UK. The Chinese community is Scotland's second-largest minority ethnic group but a relatively under-researched one. This study aimed to explore the views and experiences of smoking cessation and related services among Chinese community members in Glasgow and to inform them about smoking cessation interventions. METHODS: This cross-sectional study was conducted in 2016 using a qualitative research method. Purposive sampling methods were used to recruit 15 Chinese community members in Glasgow. Semi-structured interviews were audio-recorded and data transcribed, translated, and thematically analysed. RESULTS: Many factors influenced participants' smoking: concern for personal health, advice from medical professionals, expenditure, family pressure, tobacco-control policies, nicotine dependence, self-efficacy, and acculturation. Smoking initiation and relapse were influenced by interpersonal relations, emotional factors, Chinese social norms, and acculturation. Barriers reported to accessing and participating in cessation services included: excessive or inflexible working hours, low confidence in cessation services, language barriers, cultural barriers and unsuitability of cessation services for Chinese smokers. Employing community resources, improving language support, working with cultural values, and accommodating degrees of acculturation may improve services and their uptake. CONCLUSIONS: Smoking-cessation services should consider the culture of this ethnic minority population to improve cessation uptake. Further investigation of this community's needs and expectations is needed to tailor smoking-cessation interventions for Chinese immigrants in Glasgow.

Representativeness of the participants in the smoking Cessation in Pregnancy Incentives Trial (CPIT): a cross-sectional study.

BACKGROUND: The limited representativeness of trial samples may restrict external validity. The aim of this study was to ascertain the representativeness of the population enrolled in the Cessation in Pregnancy Incentives Trial (CPIT), a therapeutic exploratory study to examine the effectiveness of financial incentives for smoking cessation during pregnancy. METHODS: CPIT participants (n = 492) were compared with all self-reported smokers at maternity booking who did not participate in the trial (n = 1982). Both groups were drawn from the National Health Service (NHS) Greater Glasgow and Clyde area over a 1-year trial enrolment period. Variables used for comparison were age, area-based deprivation index, body mass index, gestation, and carbon monoxide (CO) breath test level. Chi-square and Mann-Whitney U tests were used to compare groups. RESULTS: From January to December 2012, 2474/13,945 (17.7 %) women, who booked for maternity care, self-reported as current smokers (at least one cigarette in the last week). Seven hundred and fifty-two were ineligible for trial participation because of a CO breath test level of less than 7 parts per million (ppm) used as a biochemical cut-off to corroborate self-report of current smoking. At telephone consent 301 could not be contacted, 11 had miscarried, 16 did not give consent and 3 opted out after randomisation, leaving 492 participants for analysis. There were no differences in demographic or clinical characteristics between trial participants, and self-reported smokers not enrolled in the trial in terms of CO breath test (as a measure of smoking level for those with a CO level of 7 ppm or higher), material deprivation (using an area-based measure), maternal age and maternal body mass index. Gestation at booking was statistically significantly lower for participants. CONCLUSIONS: To ensure that all trial participants were smokers, biochemical validation excluded self-reported smokers with a CO level of less than 7 ppm from taking part in the trial, which excluded 30 % of self-reported smokers who were 'lighter' smokers. The efficacy of financial incentives would not have been likely to decrease if 'lighter' smokers had been included in the trial population. Trial participants were slightly earlier in their pregnancy at maternity booking, but this difference would not clinically affect the provision of financial incentives if provided routinely. Overall, the trial population was representative of all self-reported smokers with regard to available routinely collected data. Appropriate comparison of trial and target populations, with detailed reporting of exclusion criteria would contribute to the understanding of the wider applicability of trial results. TRIAL REGISTRATION: Current Controlled Trials ISRCTN87508788 . Registered/Assigned on 1 September 2011.

An exploration of NHS staff views on tuberculosis service delivery in Scottish NHS boards.

Tuberculosis (TB) is a bacterial disease and major worldwide killer with an increased UK incidence rate. This study aimed to explore the views of National Health Service (NHS) staff on TB service delivery models of care in NHS boards across Scotland. Eighteen semi-structured interviews were conducted with 13 nurse specialists and five consultants in public health medicine (CPHM) across five Scottish NHS boards. Five main themes emerged and findings showed that: directly observed treatment (DOT) was provided only to patients assessed to be at high risk of poor treatment adherence; contact tracing was conducted by participating NHS boards but screening at ports was thought to be weak; all NHS boards implemented TB awareness campaigns for TB health professionals; three NHS boards conducted team meetings that monitored TB patient progress; participants believed that TB funding should be increased; contact tracing was routinely conducted by TB nurses. Improved TB screening at airports was recommended and a need for TB health education for high risk groups was identified.

Evaluation of an activity monitor for the objective measurement of free-living physical activity in children with cerebral palsy.

OBJECTIVE: To explore the use of an activity monitor (AM) to objectively characterize free-living physical activity (F-LPA) in children with mobility impairment resulting from cerebral palsy (CP). DESIGN: First, a validation study compared outcomes from the AM with video evidence. Second, multiday F-LPA was characterized. Relationships between laboratory measures and F-LPA were explored. SETTING: The evaluation study was conducted in a laboratory environment. F-LPA monitoring was conducted in the participants' free-living environment. PARTICIPANTS: Convenience sample of ambulatory children (N=15; 11 boys, 4 girls) aged 5 to 17 years with CP undergoing gait analysis. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Accuracy of the AM for sitting/lying time, upright time, stepping time, and strides taken. Daily volumes of F-LPA of children with CP. RESULTS: AM outcomes in comparison with video-based analysis were (mean ± SD) 97.4%±2.7%, 101.1%±1.5%, 99.5%±6.6%, 105.6%±15.8%, and 103.8%±10.1% for sitting/lying time, upright time, standing time, stepping time, and stride count, respectively. Participants' daily F-LPA demonstrated considerable variation: mean standing time ± SD, 2.33±.96h/d; mean stepping time ± SD, 1.68±.86h/d; mean steps per day ± SD, 8477±4528; and mean sit-to-stand transitions per day ± SD, 76±49. Laboratory-measured cadence and mobility level were related to F-LPA, but not directly. CONCLUSIONS: The AM demonstrated excellent ability to determine sitting/lying and upright times in children with CP. Stepping time and stride count had lower levels of agreement with video-based analysis but were comparable to findings in previous studies. Crouch gait and toe walking had an adverse effect on outcomes. The F-LPA data provided additional information on children's performance not related to laboratory measures, demonstrating the added value of using this objective measurement technique.

An exploration of Traditional Chinese Medicine practitioners' perceptions of Evidence Based Medicine.

OBJECTIVES: To explore understanding of Evidence Based Medicine (EBM) and use of evidence by Traditional Chinese Medicine (TCM) practitioners, practising in Scotland. DESIGN: Qualitative study incorporating semi-structured interviewing of 12 TCM practitioners practising TCM in Scotland. SETTING: TCM practitioners' premises in an urban area of Scotland, UK. RESULTS: Few participants were aware of the process of EBM but all reported importance of learning from a range of sources including patients and practice. Participants reported no involvement in the wider demands of the EBM process. CONCLUSIONS: TCM practice here was informed by a range of sources but many barriers to full engagement with the EBM process were evident and the small business model of service delivery seemed important here. Participants' prioritisation of classical books and practice as evidence sources poses some cause for concern at a time of rapid growth in well evidenced western biomedical and TCM knowledge and practice.

Towards a definition: what does 'health promotion' mean to speech and language therapists?

BACKGROUND: As UK healthcare moves towards the ideals of prevention and enablement, health promotion is more commonly cited as an area of practice. In comparison with its allied health profession peers, physiotherapy and occupational therapy, the speech and language therapy profession has little evidence to demonstrate that it has explored what its members understand health promotion to mean or how they describe their current and future practice in relation to it. AIMS: To explore how speech and language therapists define health promotion and how they describe their current and future practice in relation to it. METHODS & PROCEDURES: Individual, semi-structured interviews were conducted with 15 community-based speech and language therapists. Interviews were transcribed verbatim and analysed using inductive coding. OUTCOMES & RESULTS: Participants viewed health promotion as a complex entity representing the processes of education and enablement in relation to responsibility for speech, language and communication skills. Participants viewed health promotion as a means of maximizing the scarce resource they represented. The vast majority of activities described as being illustrative of health promotion in a speech and language therapy context were examples of educational interventions, e.g. training, information provision. Participants believed that the speech and language therapist's role will continue to develop in relation to health promotion and that this will have implications for future workforce preparation. CONCLUSIONS & IMPLICATIONS: Participants viewed health promotion as both an educational, enabling process and as a strategy that maximizes the potential of speech and language therapy resources. Further research is indicated to develop professional consensus regarding the meaning of health promotion and to support a cohesive approach to workforce development in this area.

Validity of method to quantify transtibial amputees' free-living prosthetic wearing times and physical activity levels when using suction suspension sockets.

Prostheses are prescribed to restore the mobility of people with amputated lower limbs. Monitoring the prosthesis wearing times and physical activity of prosthesis users would provide invaluable information regarding rehabilitation progress and suitability of the prosthesis. The validation of a method to determine wearing times and physical activity state, as well as strides taken, of amputees wearing suction suspension sockets is reported. Eight participants with transtibial amputation were fitted with custom-made suction sockets. Analysis algorithms were used to automatically characterize physical activity based on the pressure at the socket's relief valve. The algorithms were validated in a laboratory-based protocol that included walking, stair climbing, standing, sitting, donning, and doffing. Intraclass correlation coefficient (2,1) values of >0.98 were achieved with mean differences of - 2.0%, 0.3%, 1.3%, and 0.7% for agreement between "off," "static," and "dynamic" times and stride count, respectively, as determined by the analysis algorithms and a concurrent video analysis. This study demonstrates that an interpretation of the pressure at the pressure-relief valve of suction suspension sockets can be used to determine wearing times and activity state.

Cultivation of a learning culture in general practice: an educational intervention.

BACKGROUND: Increasing challenges are faced in primary care, including the increase in chronic disease and its management in the community. This paper describes an educational initiative developed to help local general practitioners (GPs) and primary care teams manage chronic conditions and address referral behaviour. The purpose of this study was to evaluate the initiative through the exploration of the experiences of the participants and providers. METHODS: A variety of methods was used to collect data for the evaluation. These included feedback from participants in the form of workshop evaluation questionnaires, semi-structured interviews of both participants and presenters and focus groups involving participants. RESULTS: Following analysis of the data, five themes were identified across all the methods used. This paper focuses on the key themes of 'practice change' and 'referral behaviour' as they relate to the specific aims and objectives of the initiative. The data indicated that participants had identified actual changes in practice following their participation in the educational initiative, including changes in individual practice and prescribing behaviour as well as in the provision of healthcare in the community. Changes identified in referral behaviour were evident in feedback from both participants and presenters in secondary care. Participants indicated proposed changes, including an anticipated reduction in referrals for dermatology with greater management of conditions in primary care, as well as a greater awareness of indications for early referral. The use of guidelines in aiding referral decisions was identified and the content and information required from referral letters was also a key area. CONCLUSION: The evaluation of this educational initiative has identified changes in practice in primary care and demonstrates how educational interventions can support and enhance future developments in primary care.

The characterisation of gait patterns of people with multiple sclerosis.

BACKGROUND: There are relatively few reports describing gait patterns in multiple sclerosis (MS) and most are confined to the analysis of temporal distance parameters with some assessment of joint range of motion. The aim of this study was to perform a biomechanical characterisation of gait patterns among people with MS across a wide range of severity of ambulatory impairment. METHODS: Sixteen patients with MS were recruited for this study. Initially, the spasticity of lower limb muscle groups was measured and ambulatory ability was graded. Patients were then placed in two groups based on the level of severity of ambulatory ability. Kinematic, kinetic and EMG gait data from both MS groups were then compared to a control group of 10 healthy subjects. RESULTS: Patients with MS in both groups were found to walk with reduced gait speed, reduced maximum hip and knee extension, ankle plantarflexion angle and propulsive force compared to the control group. In general, the same gait impairments were found in both MS groups compared to the control group, and were greater for the more severely affected MS patient group. INTERPRETATION: This study highlights typical gait patterns of people with MS and provides an indication of common pathways in the degeneration of ambulatory ability as a consequence of disease progression. This information should enable improved clinical treatment of ambulation, as well as the prescription, or even design, of appropriate assistive devices.

An investigation of teaching staff members' and parents' views on the current state of adaptive seating technology and provision.

PURPOSE: It is recognized that for children with poor postural control, a comfortable adaptive seating system which provides them with the support needed to maintain a sitting position can be essential for raising their overall level of well being. The purpose of this study was to investigate the views of teaching staff members at special needs schools and of the parents of children who attended these schools on the provision and current technology of seating systems. METHOD: Two similar questionnaires intended to elicit the views of teaching staff and the parents of children attending these schools were designed and distributed to these groups. RESULTS: Dissatisfaction exists with reliability of these systems and the time it takes for replacement systems to be issued. The perceived importance of adaptive seating role in the user being accepted by peers was found to be statistically different between the two groups. Time spent per day transferring the child to and from seating systems was found to be greater than 1 h for both groups. CONCLUSION: Scope remains for improvements to be made in adaptive seating provision and technology. Although mainly descriptive, these results could be of use when developing newer systems and improving services.

Ambulatory rehabilitation in multiple sclerosis.

Multiple sclerosis (MS) is an autoimmunogenic disease involving demyelination within the central nervous system. Many of the typical impairments associated with MS can affect gait patterns. With walking ability being one of the most decisive factors when assessing quality of life and independent living, this review focuses on matters, which are considered of significance for maintaining and supporting ambulation. This article is an attempt to describe current research and available interventions that the caring healthcare professional can avail of and to review the present trends in research to further these available options. Evidence-based rehabilitation techniques are of interest in the care of patients with MS, given the various existing modalities of treatment. In this review, we summarise the primary factors affecting ambulation and highlight available treatment methods. We review studies that have attempted to characterise gait deficits within this patient population. Finally, as ambulatory rehabilitation requires multidisciplinary interventions, we examine approaches, which may serve to support and maintain ambulation within this patient group for as long as possible.

The potential for actigraphy to be used as an indicator of sitting discomfort.

OBJECTIVE: A novel technique that uses actigraphy, the study of activity involving the use of body-mounted accelerometers, to detect the discomfort-related movements of a sitting individual has been proposed as a potential indicator of sitting discomfort, and the purpose of this study was to test its validity. BACKGROUND: Objective measurement of sitting discomfort has always been challenging for researchers. Electromyographic measurements, pressure mapping, and a wide range of other techniques have all been investigated with limited success. METHOD: The activity monitor's ability to detect and measure seated movement was assessed, and 12 participants were tested on four different chairs (100-min sessions for each). RESULTS: The activity monitor was able to detect participants' sitting movements (Pearson coefficients > 0.9). The chairs were shown to have significantly different subjective discomfort ratings, all of which increased over time. The movements detected by the activity monitor also increased significantly with time, and the amount measured was greater in the chairs rated as most uncomfortable. Regression analysis indicated that the actigraphy data were able to account for 29.6% of the variation in perceived discomfort ratings. CONCLUSION: Actigraphy can reliably detect sitting movements and may be of use in measuring sitting discomfort. APPLICATION: Potential applications of this technique exist for seating research in the automotive industry, health care, and office and leisure chairs.

A preliminary investigation into the development of 3-D printing of prosthetic sockets.

The socket is considered an element of major importance in the makeup of a prosthesis. Each socket is a tailor-made device, designed to fit the unique geometry of the patient's residual limb. The design and manufacture of a prosthetic socket traditionally has been a manual process that relies on the use of plaster of Paris casts to capture the shape of the patient's residual limb and then artisan fabrication techniques to manufacture the socket. Computer-aided design and manufacturing technologies have overcome some of the shortcomings of the traditional process, but the final manufacture of the prosthetic socket is still performed manually. Rapid prototyping (RP), a relatively new class of manufacturing technologies, creates physical models directly from three-dimensional (3-D) computer data. Previous research into the application of RP systems to the manufacture of prosthetic sockets has focused on expensive, high-end technologies that have proven too expensive. This paper investigates the use of a cheaper, low-end RP technology known as 3-D printing. Our investigation was an initial approach to using a technology that is normally associated with producing prototypes quickly, some of which could not be manufactured by alternative means. Under normal circumstances, these printed components are weak and relatively fragile. However, comfortable prosthetic sockets manufactured with 3-D printing have been used in preliminary fittings with patients.

Portfolio assessment: practice teachers' early experience.

Experience was recognised to be a vital source of learning as long ago as 1762 [Emile, Everyman, London, 1993] and reflection on practice experience may be one way forward in addressing nursing's anxieties concerning the practice theory gap. However, despite the acceptance that subjectivity in the process seems inevitable and potentially important, little is understood of the practitioner's experience of practice assessment. Two questionnaires sought the views of specialist community nursing practitioner (SCNP) programme (United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) 2001) practice teachers (PTs) on the introduction of the portfolio approach to practice assessment. These were distributed to 62 and 76 PTs and the response rates were 32% and 50%, respectively. Responses of those PTs from the three specialisms participating in the piloting of the portfolio approach were compared with those using an existing approach. An action research method was adopted which attempted to use established theory to explain the challenges presented by the introduction of this approach and ultimately to raise the PT group's awareness of assessment issues. Both qualitative and quantitative data were collected and the findings support the use of the portfolio approach to practice assessment. The PT experience of portfolio use was found to be a largely positive one. PTs reported the utility of the portfolio in prompting student self-evaluation of learning. Concerns were expressed by PTs around the quality of portfolio evidence although many felt that it had promoted students' reflection on practice. Inter-PT reliability in practice assessment was identified as a topic for PT continuing professional development. Many sources of evidence, including patient feedback, were used by PTs in their assessment of students although PTs using the portfolio approach used less first-hand experience of students' practice in their assessments of competence, relying more on written evidence, than those PTs using a traditional approach to practice assessment.

Ultrasound imaging in lower limb prosthetics.

The biomechanical interaction between the residual limb and the prosthetic socket determines the quality of fit of the socket in lower limb prosthetics. An understanding of this interaction and the development of quantitative measures to predict the quality of fit of the socket are important for optimal socket design. Finite-element modeling is used widely for biomechanical modeling of the limb/socket interaction and requires information on the internal and external geometry of the residual limb. Volumetric imaging methods such as X-ray computed tomography, magnetic resonance imaging, and ultrasound have been used to obtain residual limb shape information. Of these modalities, ultrasound has been introduced most recently and its development for visualization in prosthetics is the least mature. This paper reviews ultrasound image acquisition and processing methods as they have been applied in lower limb prosthetics.