A systematic review on the impact of financial insecurity on the physical and psychological well-being for people living with terminal illness.

BACKGROUND: People living with terminal illness are at higher risk of experiencing financial insecurity. The variance in definitions of financial insecurity, in addition to its impact on the well-being of this population has not yet been systematically analysed. AIM: To understand the definition, prevalence and impact of financial insecurity on the physical and psychological well-being of people living with terminal illness. DESIGN: A systematic review with a narrative synthesis (prospectively registered; CRD42023404516). DATA SOURCES: Medline, Embase, CINAHL, AMED, PsycINFO, ProQuest Central and Cochrane Central Register of Controlled Trials, from inception to May 2023. Included studies had to measure or describe the impact of financial insecurity on an aspect of participants' physical or mental well-being. Study quality was assessed using the Hawker tool. RESULTS: A total of 26 studies were included in the review. Financial insecurity was defined using many different definitions and terminology. Out of 4824 participants, 1126 (23%) reported experiencing high levels of financial insecurity. Nine studies reported 21 unique analyses across three domains of physical well-being. Out of those 21 analyses, 10 (48%) reported a negative result (an increase in financial insecurity was reported with a decrease in physical well-being). Twenty-one studies reported 51 unique analyses across nine domains of psychological well-being. Out of these analyses, 35 (69%) reported a negative result (an increase in financial insecurity was reported with a decrease in psychological well-being). CONCLUSIONS: People living with terminal illness require support with their financial situation to ensure their well-being is not negatively impacted by financial insecurity.

The Assessment of a Multifactorial Score for the Adaptability Evaluation of Six Poultry Genotypes to the Organic System.

This study aimed to develop an adaptability score (AS) for chicken strains, which includes behavioral, plumage conditions, and body lesion indicators through a multifactorial approach. A total of 600 male chickens from 6 poultry genotypes-Ranger Classic (R1), Ranger Gold (R2), Rowan Ranger (R3), Hubbard Red JA (A), CY Gen 5 × JA87 (CY), and M22 × JA87 (M)-were reared under organic conditions, fed ad libitum, and individually weighed weekly to calculate the daily weight gain (DWG). The behavioral observations consisted of the explorative attitude (EA), recorded at 21 days, and the behavioral patterns (BPs) recorded the week before the slaughter. The AS was established by a principal component analysis, and the AS of these genotypes was compared. Moreover, the effect of DWG and genotype on the AS was evaluated by univariable and multivariable regression models. Although the DWG and genotype were strictly dependent, genotype was the most important factor affecting the AS. In fact, its effect was significant both in univariable (p < 0.001) and multivariable models (p < 0.001). Conversely, the DWG was significant only in the univariable and lost significance when the effect of genotype was introduced in the model.

Changing lifestyle for dementia risk reduction: Inductive content analysis of a national UK survey.

OBJECTIVE: To explore what motivates individuals to change their behaviour to reduce their risk of dementia. METHODS: We conducted secondary qualitative analysis of a UK-based online survey on motivation to change lifestyle and health behaviour for dementia risk reduction. Participants were recruited through social media, the Join Dementia Research network and the National Institute for Health Research Portfolio. Free-text comments from people aged ≥50 years were analysed by two researchers independently using inductive content analysis. Inter-rater agreement was measured through Cohen's Kappa coefficient. RESULTS: Of the 3,948 participants completing the survey, 653 provided free text comments that were included in the analysis (Mean age = 64.1; SD = 8.3 years). The majority of the sample were women (n = 459; 70.3%), Caucasian (n = 625; 95.7%) and married/in partnership (n = 459; 70.3%). Three overarching themes were identified: (1) motivators to changing lifestyle; (2) barriers for lifestyle change; and, (3) quality of the information received. The inter-rater reliability of the coding was high (k = 0.7). Having a family history of dementia or feeling like they had a healthy lifestyle already were motivating factors for behaviour change. Having competing health priorities other than dementia and caring for someone acted as de-motivators as they reduced the time available to dedicate to one's own health. Evidence-based information around dementia prevention was a motivator, but commonly the information was not trusted. DISCUSSION: Aligned with the World Health Organisation (WHO) mandate on dementia prevention, community health campaigns targeting population awareness around behaviour change and dementia risk factor reduction are urgently needed. To be successful, such campaigns will need to be accompanied by individual approaches that can overcome age-related barriers and individual differences in motivation levels, personal barriers and trust in the information received.

Clinical and cost effectiveness of staff training in the delivery of Positive Behaviour Support (PBS) for adults with intellectual disabilities, autism spectrum disorder and challenging behaviour - randomised trial.

BACKGROUND: Although Positive Behaviour Support (PBS) is a widely used intervention for ameliorating challenging behaviour (CB), evidence for its use in adults with intellectual disability (ID) and comorbid autism (ASD) is lacking. We report a planned subsidiary analysis of adults with both ASD and ID who participated in a randomised trial of PBS delivered by health professionals. METHODS: The study was a multicentre, cluster randomised trial conducted in 23 community ID services in England, participants were randomly allocated to either the delivery of PBS (n = 11 clusters) or to treatment as usual (TAU; n = 12). One-hundred and thirteen participants (46% of all participants in the trial) had a diagnosis of ID, autism spectrum disorder and CB (ASD+); (47 allocated to the intervention arm, and 66 to the control). CB (primary outcome) was measured with the Aberrant Behaviour Checklist total score (ABC-CT). Secondary outcomes included mental health status, psychotropic medication use, health and social care costs and quality adjusted life years (QALYs) over 12 months. RESULTS: There were no statistically significant differences in ABC-CT between ASD+ groups randomised to the two arms over 12 months (adjusted mean difference = - 2.10, 95% CI: - 11.3 7.13, p = 0.655) or other measures. The mean incremental cost of the intervention per participant was £628 (95% CI -£1004 to £2013). There was a difference of 0.039 (95% CI - 0.028 to 0.103) for QALYs and a cost per QALY gained of £16,080. CONCLUSIONS: Results suggest lack of clinical effectiveness for PBS delivered by specialist ID clinical teams. Further evidence is needed from larger trials, and development of improved interventions. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01680276.

The social value of the arts for care home residents in England: A Social Return on Investment (SROI) analysis of the Imagine Arts programme.

BACKGROUND: Direct involvement in creative activities can have benefits in terms of improved attention and positive engagement for older people. We used the social return on investment (SROI) approach to explore the social and economic benefits of arts activities for older people living in residential homes in England. METHODS: We complied with the CHEERS checklist and followed the six stages of SROI as reported in the literature. RESULTS: We identified three main stakeholders: care home residents, care home personnel, and activity co-ordinators. For residents, the outcomes of interest were: community inclusion, mental and physical health, improved cognition and decreased social isolation. For care home personnel and activity co-ordinators the outcomes were: improved skills in caring for older people and increased confidence in using arts interventions. The analysis yielded an SROI of £1.20 for every £1 of expenditure. The sensitivity analysis revealed that when we consider a displacement rate of 15% for all the outcomes of all participating stakeholders, the Imagine study is unlikely to report a ratio that is less than £1.02 for every £1.00 invested. CONCLUSIONS: Findings could inform policy decisions about investment in the arts and health or social care.

Mobile Poultry Processing Unit as a Resource for Small Poultry Farms: Planning and Economic Efficiency, Animal Welfare, Meat Quality and Sanitary Implications.

: Nowadays there is an increasing demand for poultry products from alternative rearing systems. These systems, commonly named pastured poultry production (PPP), are more expensive than intensive rearing system but sustain biodiversity, local economies and farm multi-functionality besides providing meat to which consumers attribute high ethical value and quality. PPP generally uses large outdoor runs, small number of animals and requires chickens adapted to natural environment. One of the most relevant obstacles to further development of PPP systems is related to the slaughtering of animals economically and at the same time complying with the sanitary regulations to maintain food safety standards. A possible solution could be represented by a Mobile Poultry Processing Unit (MPPU), which directly reaches the poultry farms. MPPU can consider a good compromise for the niche production providing an opportunity to small farmers to exploit the full potential of their production system. The aim of this review is to analyse the essential requisites and MPPU economic viability in an Italian system. Qualitative, societal aspects are discussed together with bird welfare and hygiene implications. The case study indicates the viability of MPPUs but notes that up scaling to medium sized operations would not be permissible under current EU regulations.

Use of olive leaves (whether or not fortified with sodium selenate) in rabbit feeding: Effect on performance, carcass and meat characteristics, and estimated indexes of fatty acid metabolism.

Sixty New Zealand White weaned rabbits were divided into three groups and subjected to different dietary treatments: a standard diet for the control (C), a standard feed supplemented with 10% of plain olive leaves (OL) and a standard feed supplemented with 10% of selenium-fortified olive leaves (100 mg/L of foliar spray sodium selenate solution; SeOL). The productive performance was recorded at the time of slaughter (after 35 days); the carcass and meat traits were determined and estimated indexes of fatty acid metabolism were calculated. No significant differences were found on the rabbit productive performance and the physical-chemical characteristics of the meat. Both group of rabbits on the enriched diet showed leaner and thinner carcasses and a higher meat concentration of oleic acid. The estimated index of Δ5 + Δ6-desaturase, starting from n-6 fatty acids, was lower in both groups supplemented with leaves. The use of selenium-fortified olive leaves, positively affected the lipid oxidative stability of rabbit meat.

Effect of diet and packaging system on the oxidative status and polyunsaturated fatty acid content of rabbit meat during retail display.

The aim of this study was to evaluate the combined effect of two dietary lipid sources (sunflower vs. linseed oil) and three packaging methods (PVC film - BAG vs. modified atmosphere CO2 20% + 80% O2 - MAP vs. and vacuum - VAC) on the oxidative status and polyunsaturated fatty acid content of rabbit loins (Longissimus thoracis et lumborum muscle), at days 1, 4 and 10 of simulated retail display. The diet, storage time and packaging method affected the oxidative status of rabbit meat under retail display. As expected, storage time, independently on the other factors, significantly reduced the antioxidant content of loin meat. Accordingly, TBARs values significantly increased during storage, as well as the dietary supplementation of linseed. The fatty acid profile of the fresh loin closely respected that of the diets. At day 10, oxidative status and fatty acid profile of MAP samples could be yet considered optimal.

Positive behaviour support training for staff for treating challenging behaviour in people with intellectual disabilities: a cluster RCT.

BACKGROUND: Preliminary studies have indicated that training staff in Positive Behaviour Support (PBS) may help to reduce challenging behaviour among people with intellectual disability (ID). OBJECTIVE: To evaluate whether or not such training is clinically effective in reducing challenging behaviour in routine care. The study also included longer-term follow-up (approximately 36 months). DESIGN: A multicentre, single-blind, two-arm, parallel-cluster randomised controlled trial. The unit of randomisation was the community ID service using an independent web-based randomisation system and random permuted blocks on a 1 : 1 allocation stratified by a staff-to-patient ratio for each cluster. SETTING: Community ID services in England. PARTICIPANTS: Adults (aged > 18 years) across the range of ID with challenging behaviour [≥ 15 Aberrant Behaviour Checklist - Community total score (ABC-CT)]. INTERVENTIONS: Manual-assisted face-to-face PBS training to therapists and treatment as usual (TAU) compared with TAU only in the control arm. MAIN OUTCOME MEASURES: Carer-reported changes in challenging behaviour as measured by the ABC-CT over 12 months. Secondary outcomes included psychopathology, community participation, family and paid carer burden, family carer psychopathology, costs of care and quality-adjusted life-years (QALYs). Data on main outcome, service use and health-related quality of life were collected for the 36-month follow-up. RESULTS: A total of 246 participants were recruited from 23 teams, of whom 109 were in the intervention arm (11 teams) and 137 were in the control arm (12 teams). The difference in ABC-CT between the intervention and control arms [mean difference -2.14, 95% confidence interval (CI) -8.79 to 4.51; p = 0.528] was not statistically significant. No treatment effects were found for any of the secondary outcomes. The mean cost per participant in the intervention arm was £1201. Over 12 months, there was a difference in QALYs of 0.076 in favour of the intervention (95% CI 0.011 to 0.140 QALYs) and a 60% chance that the intervention is cost-effective compared with TAU from a health and social care cost perspective at the threshold of £20,000 per QALY gained. Twenty-nine participants experienced 45 serious adverse events (intervention arm, n = 19; control arm, n = 26). PBS plans were available for 33 participants. An independent assessment of the quality of these plans found that all were less than optimal. Forty-six qualitative interviews were conducted with service users, family carers, paid carers and service managers as part of the process evaluation. Service users reported that they had learned to manage difficult situations and had gained new skills, and carers reported a positive relationship with therapists. At 36 months' follow-up (n = 184), the mean ABC-CT difference between arms was not significant (-3.70, 95% CI -9.25 to 1.85; p = 0.191). The initial cost-effectiveness of the intervention dissipated over time. LIMITATIONS: The main limitations were low treatment fidelity and reach of the intervention. CONCLUSIONS: Findings from the main study and the naturalistic follow-up suggest that staff training in PBS as delivered in this study is insufficient to achieve significant clinical gains beyond TAU in community ID services. Although there is an indication that training in PBS is potentially cost-effective, this is not maintained in the longer term. There is increased scope to develop new approaches to challenging behaviour as well as optimising the delivery of PBS in routine clinical practice. TRIAL REGISTRATION: This study is registered as NCT01680276. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 15. See the NIHR Journals Library website for further project information.

A feasibility randomised controlled trial of extended brief intervention for alcohol misuse in adults with mild to moderate intellectual disabilities living in the community; The EBI-LD study.

BACKGROUND: Extended brief interventions (EBIs) are effective in targeting alcohol misuse in the general population. However, little is known of the effects of EBI in adults with intellectual (also known as learning) disabilities. In this feasibility trial we compared EBI with usual care for alcohol misuse in adults with mild to moderate Intellectual Disability (ID). METHODS: The study took place in three community ID networks of services in England. Participants aged 18-65 years with reported alcohol problems, a score ≥8 on the Alcohol Use Disorder Identification Test (AUDIT), and IQ <70 (+/5%CI) were recruited and were randomly allocated to either EBI (five weekly sessions and one follow-up at 8 weeks) and usual care or usual care alone. Research assistants were blind to arm allocation. Research assessments took place at baseline, 2 and 3 months. The primary outcome was reduction in alcohol consumption measured by the AUDIT. Preliminary health economic analysis was performed to investigate the costs of delivering EBI and the feasibility of a cost-effectiveness analysis in a full trial. The trial is closed. RESULTS: Participants were recruited from January 2014 to August 2015. Thirty individuals were randomised (15 in each arm) and provided primary outcome data. In regard to harmful drinking, at baseline, all the participants exceeded the relevant threshold. At 8 weeks, the proportion of participants with harmful drinking had decreased to 60% for both groups, and at 12 weeks it had decreased by 66°7% and 46°7% for the intervention and the control groups, respectively. The unit cost for the delivery of EBI is £430. CONCLUSIONS: Recruitment to this trial has been proven challenging as prevalence of alcohol misuse in the targeted population was lower than anticipated. EBI may provide an effective low-intensity treatment for this population. Participants' and carers' feedback on their experience was overall positive. Further work needs to be undertaken to ascertain the group of participants that should be participating in a future definitive trial. TRIAL REGISTRATION: Psychological Intervention Alcohol Misuse Learning Disability; isrctn.com, identifier: ISRCTN58783633 . Registered on 17 December 2013.