A scoping study of interventions to increase the uptake of physical activity (PA) amongst individuals with mild-to-moderate depression (MMD).

BACKGROUND: Depression is the largest contributor to disease burden globally. The evidence favouring physical activity as a treatment for mild-to-moderate depression is extensive and relatively uncontested. It is unclear, however, how to increase an uptake of physical activity amongst individuals experiencing mild-to-moderate depression. This leaves professionals with no guidance on how to help people experiencing mild-to-moderate depression to take up physical activity. The purpose of this study was to scope the evidence on interventions to increase the uptake of physical activity amongst individuals experiencing mild-to-moderate depression, and to develop a model of the mechanisms by which they are hypothesised to work. METHODS: A scoping study was designed to include a review of primary studies, grey literature and six consultation exercises; two with individuals with experience of depression, two pre-project consultations with physical activity, mental health and literature review experts, one with public health experts, and one with community engagement experts. RESULTS: Ten papers met the inclusion criteria and were included in the review. Consultation exercises provided insights into the mechanisms of an uptake of physical activity amongst individuals experiencing mild-to-moderate depression; evidence concerning those mechanisms is (a) fragmented in terms of design and purpose; (b) of varied quality; (c) rarely explicit about the mechanisms through which the interventions are thought to work. Physical, environmental and social factors that may represent mediating variables in the uptake of physical activity amongst people experiencing mild-to-moderate depression are largely absent from studies. CONCLUSIONS: An explanatory model was developed. This represents mild-to-moderate depression as interfering with (a) the motivation to take part in physical activity and (b) the volition that it is required to take part in physical activity. Therefore, both motivational and volitional elements are important in any intervention to increase physical activity in people with mild-to-moderate depression. Furthermore, mild-to-moderate depression-specific factors need to be tackled in any physical activity initiative, via psychological treatments such as Cognitive Behavioural Therapy. We argue that the social and environmental contexts of interventions also need attention.

Survey of Beaver-related Restoration Practices in Rangeland Streams of the Western USA.

Poor condition of many streams and concerns about future droughts in the arid and semi-arid western USA have motivated novel restoration strategies aimed at accelerating recovery and increasing water resources. Translocation of beavers into formerly occupied habitats, restoration activities encouraging beaver recolonization, and instream structures mimicking the effects of beaver dams are restoration alternatives that have recently gained popularity because of their potential socioeconomic and ecological benefits. However, beaver dams and dam-like structures also harbor a history of social conflict. Hence, we identified a need to assess the use of beaver-related restoration projects in western rangelands to increase awareness and accountability, and identify gaps in scientific knowledge. We inventoried 97 projects implemented by 32 organizations, most in the last 10 years. We found that beaver-related stream restoration projects undertaken mostly involved the relocation of nuisance beavers. The most common goal was to store water, either with beaver dams or artificial structures. Beavers were often moved without regard to genetics, disease, or potential conflicts with nearby landowners. Few projects included post-implementation monitoring or planned for longer term issues, such as what happens when beavers abandon a site or when beaver dams or structures breach. Human dimensions were rarely considered and water rights and other issues were mostly unresolved or addressed through ad-hoc agreements. We conclude that the practice and implementation of beaver-related restoration has outpaced research on its efficacy and best practices. Further scientific research is necessary, especially research that informs the establishment of clear guidelines for best practices.

The Social Relations of a Health Walk Group: An Ethnographic Study.

It is already well established that regular walks are conducive to health and well-being. This article considers the production of social relations of regular, organized weekly group walks for older people. It is based on an ethnographic study of a Walking for Health group in a rural area of the United Kingdom. Different types of social relations are identified arising from the walk experience. The social relations generated are seen to be shaped by organizational factors that are constitutive of the walks; the resulting culture having implications for the sustainability of the experience. As there appears to be no single uniting theory linking group walk experiences to the production of social relations at this time, the findings are considered against therapeutic landscape, therapeutic mobility, and social capital theorizing. Finally, implications for the continuance of walking schemes for older people and for further research are considered.

Walking, sustainability and health: findings from a study of a Walking for Health group.

Not only is it tacitly understood that walking is good for health and well-being but there is also now robust evidence to support this link. There is also growing evidence that regular short walks can be a protective factor for a range of long-term health conditions. Walking in the countryside can bring additional benefits, but access to the countryside brings complexities, especially for people with poorer material resources and from different ethnic communities. Reasons for people taking up walking as a physical activity are reasonably well understood, but factors linked to sustained walking, and therefore sustained benefit, are not. Based on an ethnographic study of a Walking for Health group in Lincolnshire, UK, this paper considers the motivations and rewards of group walks for older people. Nineteen members of the walking group, almost all with long-term conditions, took part in tape-recorded interviews about the personal benefits of walking. The paper provides insights into the links between walking as a sustainable activity and health, and why a combination of personal adaptive capacities, design elements of the walks and relational achievements of the walking group are important to this understanding. The paper concludes with some observations about the need to reframe conventional thinking about adherence to physical activity programmes.

Linking Hydroclimate to Fish Phenology and Habitat Use with Ichthyographs.

Streamflow and water temperature (hydroclimate) influence the life histories of aquatic biota. The relationship between streamflow and temperature varies with climate, hydrogeomorphic setting, and season. Life histories of native fishes reflect, in part, their adaptation to regional hydroclimate (flow and water temperature), local habitats, and natural disturbance regimes, all of which may be affected by water management. Alterations to natural hydroclimates, such as those caused by river regulation or climate change, can modify the suitability and variety of in-stream habitat for fishes throughout the year. Here, we present the ichthyograph, a new empirically-based graphical tool to help visualize relationships between hydroclimate and fish phenology. Generally, this graphical tool can be used to display a variety of phenotypic traits. We used long-term data sets of daily fish passage to examine linkages between hydroclimate and the expression of life-history phenology by native fishes. The ichthyograph may be used to characterize the environmental phenology for fishes across multiple spatio-temporal domains. We illustrate the ichthyograph in two applications to visualize: 1) river use for the community of fishes at a specific location; and 2) stream conditions at multiple locations within the river network for one species at different life-history stages. The novel, yet simple, ichthyograph offers a flexible framework to enable transformations in thinking regarding relationships between hydroclimate and aquatic species across space and time. The potential broad application of this innovative tool promotes synergism between assessments of physical characteristics and the biological needs of aquatic species.

Confirmation of Fructans biosynthesized in vitro from [1-13C]glucose in asparagus tissues using MALDI-TOF MS and ESI-MS.

Accumulation of Fructans was confirmed in asparagus tissues that had been cultured for 2 days on media supplemented with glucose. It is very common that Fructans are biosynthesized from sucrose. We hypothesized however that Fructans could also be biosynthesized from glucose. Stem tissues of in vitro-cultured asparagus were subcultured for 72 h on a medium containing 0.5M of [1-(13)C]glucose. A medium containing 0.5M of normal ((12)C) glucose was used as control. Carbohydrates were extracted from the tissues and analyzed using HPLC, MALDI-TOF MS and ESI-MS. HPLC results indicated that the accumulation of short-chain Fructans was similar in both (13)C-labelled and control samples. Short-chain Fructans of DP=3-7 were detected using MALDI-TOF MS. The molecular mass of each oligomer in the (13)C-labelled sample was higher than the mass of the natural sample by 1 m/z unit per sugar moiety. The results of ESI-MS on the HPLC fractions of neokestose and 1-kestose showed that these oligomers (DP=3) were biosynthesized from exogenous glucose added to the medium. We conclude that not only exogenous sucrose but glucose can induce Fructan biosynthesis; fructans of both inulin type and inulin neoseries are also biosynthesized from glucose accumulated in asparagus tissues; the glucose molecules (or its metabolic products) were incorporated into Fructans as structural monomers.

Coping strategies used by Pakistani parents living in the United Kingdom and caring for a severely disabled child.

PURPOSE: This study explores the coping strategies of Pakistani parents living in the UK and caring for children with severe learning disabilities. It examines factors that influenced participants' choice or ability to use the different strategies identified. METHOD: Qualitative design using in-depth interviews. RESULTS: Coping strategies included sharing care with others, using external support and recognizing and enjoying the rewards of caregiving. Parents used different strategies according to their appraisal of resources available and the perceived consequences of their action within their social milieu. CONCLUSIONS: Findings relating to cultural difference fit with a universalist approach. Coping strategies are not specific to the Pakistani population but certain characteristics of the strategies may be distinct to those used by parents with a different heritage. Antonovsky's work suggests that maintaining a sense of coherence makes a key difference to staying psychologically healthy in an apparently disordered world. Findings from this study fit with this theory. Parents derived meaning and a sense of purpose from the idea that their child's disability was from God. The rewards of caregiving and the strong moral imperative to care for one's own child contributed to understandings of caregiving as an activity worthy of investment.

Evaluating standards in cross-language research: a critique of Squires' criteria.

Innovative methods to conduct cross-language research continue to evolve. There is a need to evaluate the processes involved in cross-language research to assess the extent to which they are fit for purpose from an epistemological point of view, and the subsequent impact on quality of resultant findings. Debate continues about the application of evaluative criteria to qualitative research, not least because of the multiplicity of worldviews and perspectives associated with different qualitative research paradigms. In this article we use two of the authors' studies to discuss how we assess whether methodologies underpinning cross-language research and the choice of methods used are 'fit for purpose'. We use Squires' (2009) 14 criteria to evaluate cross-language nursing and health sciences research based around conceptual equivalence, translator credentials, translator role/competence and study methods, and consider their value as an heuristic or a guide to encourage reflexivity and fuller accounting of the justifications for the approaches taken.

Polymer-free biolimus a9-coated stent demonstrates more sustained intimal inhibition, improved healing, and reduced inflammation compared with a polymer-coated sirolimus-eluting cypher stent in a porcine model.

BACKGROUND: Drug-eluting stents effectively reduce restenosis but may increase late thrombosis and delayed restenosis. Persistent polymer, the drug, or a combination of both could be responsible. Local delivery of Biolimus A9, a rapamycin derivative, from a polymer-free BioFreedom stent (Biosensors International) may prevent these complications. METHODS AND RESULTS: We compared high-dose (HD) (225 microg/14 mm Biolimus A9) and low-dose (LD) (112 microg/14 mm Biolimus A9) BioFreedom stents with a polymer-coated sirolimus-eluting Cypher stent (SES) and a bare-metal stent (BMS) at 28 days and 180 days in an overstretch coronary mini-swine model with histomorphometric and histological analysis. At 28 days, there was a reduction in neointimal proliferation by HD, LD, and SES compared with BMS (neointimal thickness: HD, 0.080+/-0.032; LD, 0.085+/-0.038; SES, 0.064+/-0.037; BMS, 0.19+/-0.111 mm; P<0.001; BMS > HD/LD/SES). At 180 days, both BioFreedom stents were associated with reduced neointimal proliferation, whereas SES exhibited increased neointima (neointimal thickness: HD, 0.12+/-0.034; LD, 0.10+/-0.040; SES, 0.20+/-0.111; BMS, 0.17+/-0.099 mm; P<0.001; SES > HD/LD; BMS > LD). At 180 days, BioFreedom stents showed decreased fibrin and inflammation, including granuloma and giant cells, compared with SES. CONCLUSIONS: The polymer-free Biolimus A9-coated stent demonstrates equivalent early and superior late reduction of intimal proliferation compared with SES in a porcine model. After implantation of BioFreedom stent, delayed arterial healing was minimal, and there was no increased inflammation at 180 days compared with SES implantation. The use of polymer-free stents may have a potential long-term benefit over traditional polymeric-coated drug-eluting stents.

Using narratives to understand older people's decision-making processes.

Despite the availability of health and social care services designed to support people in their own homes, older people often underuse or refuse these services. It is now acknowledged that this phenomenon contributes to older people being admitted to hospital and long-term care in circumstances that could be avoided. To understand how the uptake of supportive and preventative services can be improved, the first author, supervised by the second and third authors, developed a constructivist inquiry to explore what factors enhance or bar service use. This article describes how narratives were used not only to help identify decision- and choice-making influences, but also as a way of enhancing the hermeneutic processes associated with constructivism.

Young people supporting parents with mental health problems: experiences of assessment and support.

The explosion of interest in young people as carers over the last decade and a half conceals the fact that there are still no reliable estimates of the number of young people with caregiving responsibilities. This is even more problematic in circumstances where the 'looked after' person has a mental health problem. In this study, we reflect on what can be done to identify, assess and support young people in these circumstances. We draw on selected findings from a study that has been examining the constituents of good assessment practice in work with family carers supporting relatives with mental health problems. The study embraces different carer groups but this paper concentrates on the experiences of young carers at one study site where Barnardo's and partner organisations had developed a joint initiative targeting young people who are looking after parents and relatives with mental health problems. Following a review of the literature about young people as carers, the paper describes how Barnardo's worked to support them through its young carers projects. Based on face-to-face interviews with the young people (N = 10) caring for a mother with mental health problems, the main part of the paper provides an account of how they talk about, make sense of and evaluate the support they have received through this combined initiative. The findings underscore the value of one particular young carers project, and provide clues about what lessons may be transferable to other similar projects.

Action research--a necessary complement to traditional health science?

There is continuing interest in action research in health care. This is despite action researchers facing major problems getting support for their projects from mainstream sources of R&D funds partly because its validity is disputed and partly because it is difficult to predict or evaluate and is therefore seen as risky. In contrast traditional health science dominates and relies on compliance with strictly defined scientific method and rules of accountability. Critics of scientific health care have highlighted many problems including a perpetual quality gap between what is publicly expected and what is deliverable in the face of rising costs and the cultural variability of scientific medicine. Political demand to close the quality gap led to what can be seen as an elitist reform of policy on UK health research by concentrating more resources on better fewer centres and this may also have reduced support for action research. However, incompetent, unethical or criminal clinical practice in the UK has shifted policy towards greater patient and public involvement in health care and research. This highlights complementarity between health science and action research because action research can, as UK health policy requires, involve patients and public in priority setting, defining research outcomes, selecting research methodology, patient recruitment, and interpretation of findings and dissemination of results. However action research will remain marginalised unless either scientific research is transformed generally into a more reflective cycle or there is increased representation of action research enthusiasts within the establishment of health R&D or current peer review and public accountability arrangements are modified. None of these seem likely at this time. The case for complementarity is illustrated with two case studies.

Invisible contributions in families with children and adults with intellectual disabilities.

For many years there has been an underlying pathology within the literature about families with children and adults with intellectual disabilities (Helff & Glidden, 1998). This literature has emphasized stress and burden, incapacity and dependency, leading to negative stereotyping of families in this context. Over the last 2 decades research has led to some important reconceptualizations of how families approach their caring, affording an improved understanding of how they deploy strengths and resources, and who benefits. This paper reviews this thinking, arguing that it provides a suitable context for understanding the scope and form of family caregiving contributions that are less visible, and therefore less recognized. An attempt is therefore made to chart invisible contributions. It is suggested that invisible contributions have implications for thinking about human and social capital (Putnam, 2000) as well as for practice in supporting families.

Heterobifunctional multivalent inhibitor-adaptor mediates specific aggregation between Shiga toxin and a pentraxin.

[reaction: see text] The first example of a multivalent heterofunctional inhibitor-adaptor, called "BAIT", is described. This multivalent inhibitor-adaptor is able to capture a "target" receptor (Shiga toxin) through its recognition of one ligand of a heterobivalent headgroup while the other ligand binds to an endogenous "trap" protein (serum amyloid P component, SAP). BAIT showed markedly enhanced inhibition of toxin activity. An efficient synthesis of this multivalent cluster containing heterobifunctional ligands was accomplished by chemical and chemoenzymatic approaches.

Defining 'people-centredness': making the implicit explicit.

This paper examines the emerging concept of 'people-centredness' in relation to health care. It raises issues resulting from debates about consumerism within health care to set the parameters for the ensuing analysis. The particular context for the analysis is Welsh health care policy which proclaimed 'health gain', 'resource effectiveness' and 'people-centredness' as the three core objectives of the health service re-focus. Illustrations about the range of meanings of 'people-centredness' are drawn from one of the author's (BW) studies in the field of community mental health. The analysis posits different relationships between 'health gain' and 'people-centredness' and considers the implications for a re-definition and re-working of ideas about people-centredness in health services.

Stress and job satisfaction among social workers, community nurses and community psychiatric nurses: implications for the care management model.

The introduction in April 1993 of new arrangements for assessment and care management following the NHS and Community Care Act 1990 (Department of Health 1990a) heralded a period of major transition for front-line workers in the health and social services. Policy expectations for the development of the purchaser/provider split and the 'new managerialism' have posed unprecedented ideological, organizational and professional challenges. Two years after the full implementation of the reforms a postal survey of the experiences of care managers about policy and practice changes was undertaken in Wales. This paper focuses on the stresses and satisfactions of care management practice among three distinct groups of front-line workers: social workers, community nurses and community psychiatric nurses. The results of multiple regression analyses, corroborated by qualitative data, implicate an increased workload in general and administrative work in particular, combined with reduced opportunities for client contact, as the main sources of stress. Being able to control or shape those factors impinging on the experience of stress and job satisfaction appears to lie at the heart of the dilemma. Practice and policy implications are considered.