Translating Ultrasound into Clinical Practice for the Assessment of Swallowing and Laryngeal Function: A Speech and Language Pathology-Led Consensus Study.

Ultrasound (US) has an emerging evidence base for the assessment of swallowing and laryngeal function. Accessibility and technological advances support the use of US as a clinical assessment tool; however, there is insufficient evidence to support its translation into clinical practice. This study aimed to establish consensus on the priorities for translation of US into clinical practice for the assessment of swallowing and laryngeal function. Nominal Group Technique (NGT) was used as a formal method of consensus development. Clinicians and academics, all members of an international US working group, were invited to participate in the study. Two NGT meetings were held, where participants silently generated and then shared ideas. Participants anonymously ranked items. Rankings were aggregated before participants re-ranked items in order of priority. Discussions regarding rankings were recorded and transcribed to inform analysis. Member-checking with participants informed the final analysis. Participants (n = 15) were speech and language pathologists, physiotherapists and sonographers representing six countries. Fifteen items were identified and prioritised 1-13 (including two equally ranked items). Reliability, validity and normative data emerged as key areas for research while development of training protocols and engagement with stakeholders were considered vital to progressing US into practice. Analysis revealed common themes that might be addressed together in research, in addition to the ranked priority. A measured approach to the translation of US into clinical practice will enable effective implementation of this tool. Priorities may evolve as clinical and professional contexts shift, but this study provides a framework to advance research and clinical practice in this field.

A mixed methods analysis evaluating an alcohol health champion community intervention: How do newly trained champions perceive and understand their training and role?

Globally, alcohol harm is recognised as one of the greatest population risks and reducing alcohol harm is a key priority for the UK Government. The Communities in Charge of Alcohol (CICA) programme took an asset-based approach in training community members across nine areas to become alcohol health champions (AHCs); trained in how to have informal conversations about alcohol and get involved with alcohol licensing. This paper reports on the experiences of AHCs taking part in the training through the analysis of: questionnaires completed pre- and post-training (n = 93) and semi-structured interviews with a purposive sample of five AHCs who had started their role. Questionnaires explored: characteristics of AHCs, perceived importance of community action around alcohol and health, and confidence in undertaking their role. Following training AHCs felt more confident to talk about alcohol harms, give brief advice and get involved in licensing decisions. Interviews explored: AHCs' experiences of the training, barriers and facilitators to the adoption of their role, and how they made sense of their role. Four overarching themes were identified through thematic analysis taking a framework approach: (a) perceptions of AHC training; (b) applying knowledge and skills in the AHC role; (c) barriers and facilitators to undertaking the AHC role; and (d) sustaining the AHC role. Findings highlight the challenges in establishing AHC roles can be overcome by combining the motivation of volunteers with environmental assets in a community setting: the most important personal asset being the confidence to have conversations with people about a sensitive topic, such as alcohol.

Communities in charge of alcohol (CICA): a protocol for a stepped-wedge randomised control trial of an alcohol health champions programme.

BACKGROUND: Communities In Charge of Alcohol (CICA) takes an Asset Based Community Development (ABCD) approach to reducing alcohol harm. Through a cascade training model, supported by a designated local co-ordinator, local volunteers are trained to become accredited 'Alcohol Health Champions' to provide brief opportunistic advice at an individual level and mobilise action on alcohol availability at a community level. The CICA programme is the first time that a devolved UK region has attempted to coordinate an approach to building health champion capacity, presenting an opportunity to investigate its implementation and impact at scale. This paper describes the protocol for a stepped wedge randomised controlled trial of an Alcohol Health Champions programme in Greater Manchester which aims to strengthen the evidence base of ABCD approaches for health improvement and reducing alcohol-related harm. METHODS: A natural experiment that will examine the effect of CICA on area level alcohol-related hospital admissions, Accident and Emergency attendances, ambulance call outs, street-level crime and anti-social behaviour data. Using a stepped wedged randomised design (whereby the intervention is rolled out sequentially in a randomly assigned order), potential changes in health and criminal justice primary outcomes are analysed using mixed-effects log-rate models, differences-in-differences models and Bayesian structured time series models. An economic evaluation identifies the set-up and running costs of CICA using HM Treasury approved standardised methods and resolves cost-consequences by sector. A process evaluation explores the context, implementation and response to the intervention. Qualitative analyses utilise the Framework method to identify underlying themes. DISCUSSION: We will investigate: whether training lay people to offer brief advice and take action on licensing decisions has an impact on alcohol-related harm in local areas; the cost-consequences for health and criminal justice sectors, and; mechanisms that influence intervention outcomes. As well as providing evidence for the effectiveness of this intervention to reduce the harm from alcohol, this evaluation will contribute to broader understanding of asset based approaches to improve public health. TRIAL REGISTRATION: ISRCTN 81942890 , date of registration 12/09/2017.

Adolescents' health choices related rights, duties and responsibilities: An integrative review.

BACKGROUND: Although the link between adolescents' health choices in relation to rights, duties and responsibilities is acknowledged, little is studied in this subject. AIM: To identify, describe and synthesize previous studies on adolescents' health choices in relation to rights, duties and responsibilities. Ethical considerations: Ethical approval is not needed as it is an integrative review of published literature. METHOD: The integrative review was used to review and synthesize current knowledge. Electronic and manual searches from 2009 to March 2014 were used to systematically identify earlier studies. RESULTS: The review identified 13 studies. Adolescents' health choices were linked to unsuccessfully exercised rights, arising from questioned autonomy and freedom, and their duties were hardly mentioned. CONCLUSION: Research into adolescents' health choices in relation to their rights, duties and responsibilities is still methodologically fragmented. In future, more research is needed to support adolescents' health promotion initiatives and increase their involvement opportunities.

An evaluation of a storybook targeting parental attitudes, intention, and self-efficacy to change their child's oral health behavior.

OBJECTIVE: Methods for reducing dental disease have traditionally focused on health education rather than targeting psychosocial determinants of the core behaviors through behavior change strategies. This study tested a novel intervention in the form of a children's story (Kitten's First Tooth) embedded with behavior change techniques (Abraham & Michie, 2008) with the aim of investigating how effective the intervention was at improving parents' efficacy and intention to enact oral health behaviors for their child. METHOD: A controlled before and after study conducted in a deprived area of England (n = 149; child mean age 4 years) with an intervention and control group. Changes in task specific parental self-efficacy (PSE) and intention were measured using the Oral Health Behaviors Questionnaire (OHBQ; Adair et al., 2004) at baseline and 3 months following intervention. RESULTS: Of the 149 participants, 129 returned both baseline and evaluation questionnaires (retention 86.6%), 125 of these pairs of questionnaires were used in the analysis (83.4%). The OHBQ was analyzed using a general linear model (ANCOVA). A significant difference was found in favor of the intervention group for PSE related to child tooth brushing behaviors, F(1,1) = 12.04, p = .001, however no change was observed for PSE related to control of dietary sugars. CONCLUSIONS: A theorized children's story can be effective as an oral health promotion intervention by supporting parents to improve their child's oral health-related behavior. Change was observed for child tooth brushing but not sugar control. This may reflect story contents or may be indicative of difficulties of changing dietary behavior. (PsycINFO Database Record

Barriers and facilitators to extended working lives in Europe: a gender focus.

BACKGROUND: There is a global imperative to respond to the challenge of a growing 'old-age dependency ratio' by ensuring the workforce is healthy enough to remain in work for longer. Currently more than half of older workers leave before the default retirement age, and in some countries (e.g. the UK), the time spent in retirement is increasing. At the same time across Europe, there is a gender employment gap, with 14.5% fewer female workers between 55-64 years old, and a large variation in the participation of older women in the workforce (ranging from 30-75%). As older women are under-represented in the workforce, increasing employment in this group has the propensity to go some way towards reducing the old-age dependency ratio to ensure continued economic growth. OBJECTIVES: This review explores the barriers and facilitators to extended working lives in Europe, particularly those that impact on women. METHODS: A systematic mapping review process was undertaken using four electronic databases, MEDLINE, PsychoINFO, PsychEXTRA via Ovid and AgeLine via EBSCO, using the terms, 'work', 'ageing', 'retirement', 'pension', 'old', 'barrier', 'extended working life', 'gender' and 'health and well-being'. Hand searching was also carried out in the International Journal of Aging and Human Development and the International Journal of Aging and Society. RESULTS: The search resulted in 15 English language studies published from 1st January 2005 to the current date that met the inclusion criteria. KEY FINDINGS: The key factors that influenced decisions to retire or extend working lives in Europe were health, social factors, workplace factors, and financial security and pension arrangements. CONCLUSIONS AND IMPLICATIONS OF THE KEY FINDINGS: Health was found to be the most commonly cited barrier to extended working lives in Europe, and a number of social inequalities to work exist by gender. Structural factors exist, such as the gender pay gap, which disadvantages women, while the nature of work itself differs by gender and can have a negative impact on health. Currently, women tend to exit the labour market earlier than men; however, changes in the state pension age are resulting in women being required to work for as long as men, in most countries. For women to remain healthy at work, workplaces need to consider a range of interventions, including flexible arrangements to both work and retirement to enable women to balance the demands of work with domestic and caring responsibilities that particularly impact on them.

Identifying the participant characteristics that predict recruitment and retention of participants to randomised controlled trials involving children: a systematic review.

BACKGROUND: Randomised controlled trials (RCTs) are recommended as the 'gold standard' in evaluating health care interventions. The conduct of RCTs is often impacted by difficulties surrounding recruitment and retention of participants in both adult and child populations. Factors influencing recruitment and retention of children to RCTs can be more complex than in adults. There is little synthesised evidence of what influences participation in research involving parents and children. AIM: To identify predictors of recruitment and retention in RCTs involving children. METHODS: A systematic review of RCTs was conducted to synthesise the available evidence. An electronic search strategy was applied to four databases and restricted to English language publications. Quantitative studies reporting participant predictors of recruitment and retention in RCTs involving children aged 0-12 were identified. Data was extracted and synthesised narratively. Quality assessment of articles was conducted using a structured tool developed from two existing quality evaluation checklists. RESULTS: Twenty-eight studies were included in the review. Of the 154 participant factors reported, 66 were found to be significant predictors of recruitment and retention in at least one study. These were classified as parent, child, family and neighbourhood characteristics. Parent characteristics (e.g. ethnicity, age, education, socioeconomic status (SES)) were the most commonly reported predictors of participation for both recruitment and retention. Being young, less educated, of an ethnic minority and having low SES appear to be barriers to participation in RCTs although there was little agreement between studies. When analysed according to setting and severity of the child's illness there appeared to be little variation between groups. The quality of the studies varied. Articles adhered well to reporting guidelines around provision of a scientific rationale for the study and background information as well as displaying good internal consistency of results. However, few studies discussed the external validity of the results or provided recommendations for future research. CONCLUSION: Parent characteristics may predict participation of children and their families to RCTs; however, there was a lack of consensus. Whilst sociodemographic variables may be useful in identifying which groups are least likely to participate they do not provide insight into the processes and barriers to participation for children and families. Further studies that explore variables that can be influenced are warranted. Reporting of studies in this field need greater clarity as well as agreed definitions of what is meant by retention.