The experiences and perceptions of wellbeing provision among English ambulance services staff: a multi-method qualitative study.

BACKGROUND: NHS ambulance service staff are at risk of poor physical and mental wellbeing because of the likelihood of encountering stressful and traumatic incidents. While reducing sickness absence and improving wellbeing support to ambulance staff is a key NHS priority, few studies have empirically documented a national picture to inform policy and service re-design. The study aimed to understand how ambulance service trusts in England deal with staff health and wellbeing, as well as how the staff perceive and use wellbeing services. METHODS: To achieve our aim, we undertook semi-structured telephone interviews with health and wellbeing leads and patient-facing ambulance staff, as well as undertaking documentary analysis of ambulance trust policies on wellbeing. The study was conducted both before and during the UK first COVID-19 pandemic wave. The University of Lincoln ethics committee and the Health Research Authority (HRA) granted ethical approval. Overall, we analysed 57 staff wellbeing policy documents across all Trusts. Additionally, we interviewed a Health and Wellbeing Lead in eight Trusts as well as 25 ambulance and control room staff across three Trusts. RESULTS: The study highlighted clear variations between organisational and individual actions to support wellbeing across Trust policies. Wellbeing leads acknowledged real 'tensions' between individual and organisational responsibility for wellbeing. Behaviour changes around diet and exercise were perceived to have a positive effect on the overall mental health of their workforce. Wellbeing leads generally agreed that mental health was given primacy over other wellbeing initiatives. Variable experiences of health and wellbeing support were partly contingent on the levels of management support, impacted by organisational culture and service delivery challenges for staff. CONCLUSION: Ambulance service work can impact upon physical and mental health, which necessitates effective support for staff mental health and wellbeing. Increasing the knowledge of line managers around the availability of services could improve engagement.

The effect of ambient air pollution during early pregnancy on fetal ultrasonic measurements during mid-pregnancy.

BACKGROUND: Over the past decade there has been mounting evidence that ambient air pollution during pregnancy influences fetal growth. OBJECTIVES: This study was designed to examine possible associations between fetal ultrasonic measurements collected from 15,623 scans (13-26 weeks gestation) and ambient air pollution during early pregnancy. METHODS: We calculated mothers' average monthly exposures over the first 4 months of pregnancy for the following pollutants: particulate matter < 10 microm aerodynamic diameter (PM10), ozone, nitrogen dioxide, and sulfur dioxide. We examined associations with fetal femur length (FL), biparietal diameter (BPD), head circumference (HC), and abdominal circumference (AC). Final analyses included scans from only those women within 2 km of an air pollution monitoring site. We controlled for long-term trend, season, temperature, gestation, mother's age, socioeconomic status, and fetal sex. RESULTS: A reduction in fetal AC was associated with O3 during days 31-60 [-1.42 mm; 95% confidence interval (CI), -2.74 to -0.09], SO2 during days 61-90 (-1.67 mm; 95% CI, -2.94 to -0.40), and PM10 during days 91-120 (-0.78 mm; 95% CI, -1.49 to -0.08). Other results showed a reduction in BPD (-0.68 mm; 95% CI, -1.09 to -0.27) associated with SO2 during days 0-30, a reduction in HC (-1.02 mm; 95% CI, -1.78 to -0.26) associated with PM10 during days 91-120, and a reduction in FL associated with PM10 during days 0-30 (-0.28 mm; 95% CI, -0.48 to -0.08) and 91-120 (-0.23; 95% CI, -0.42 to -0.04). CONCLUSION: We found strong effects of ambient air pollution on ultrasound measures. Future research, including more individually detailed data, is needed to confirm our results.

The effect of chronic lorazepam administration in aging mice.

To assess benzodiazepine tolerance in aged animals, lorazepam or vehicle was administered chronically to male Crl: CD-1(ICR)BR mice. Pharmacodynamic and neurochemical endpoints were examined on days 1 and 14 of drug administration. There was no age-related significant difference in plasma lorazepam levels. Young and middle-aged animals demonstrated behavioral tolerance to lorazepam, while the aged animals showed a similar trend which failed to reach significance. In addition, aged animals also showed a trend toward tolerance to the anticonvulsant effects of lorazepam. There were no changes in alpha1 mRNA levels in cortex or hippocampus following administration of lorazepam when compared to vehicle-treated animals in any age group. Aged animals, however, had an initial increase in alpha1 mRNA expression in cortex and hippocampus on day 1 of vehicle treatment followed by decreased expression on day 14. These age-related changes were abolished by lorazepam administration. In summary, age-related sensitivity to the effects of lorazepam was not demonstrated in the present study. However, comparison of these data to other studies indicates that the effect of chronic benzodiazepine treatment may be specific to the benzodiazepine administered, the technique used to quantify mRNA expression changes, the subunits of the GABA(A) receptor investigated and the brain region analyzed. The phenomenon of benzodiazepine sensitivity in the elderly is an area of research which remains controversial and may well be compound specific. Determining benzodiazepines that do not produce pharmacodynamic sensitivity, such as lorazepam, may allow more careful prescribing and dosing of these drugs, and perhaps even the development of specific agents which could avoid this sensitivity.

The provision of assistive technology products and services for people with dementia in the United Kingdom.

In this review we explore the provision of assistive technology products and services currently available for people with dementia within the United Kingdom. A scoping review of assistive technology products and services currently available highlighted 171 products or product types and 331 services. In addition, we assimilated data on the amount and quality of information provided by assistive technology services alongside assistive technology costs. We identify a range of products available across three areas: assistive technology used 'by', 'with' and 'on' people with dementia. Assistive technology provision is dominated by 'telecare' provided by local authorities, with services being subject to major variations in pricing and information provision; few currently used available resources for assistive technology in dementia. We argue that greater attention should be paid to information provision about assistive technology services across an increasingly mixed economy of dementia care providers, including primary care, local authorities, private companies and local/national assistive technology resources.

Separation of craniopagus joined at the occiput. Case report.

Siamese or conjoined twins have intrigued both the physician and layperson for centuries. The craniopagus type (joined at the head) is exceedingly rare, with an incidence of one in 2.5 million births. Most clinicians never see a case of craniopagus, and those who do rarely see more than one. The authors present a case of the craniopagus type of conjoined twins born and recently separated in Brisbane, Australia. The prenatal diagnosis, subsequent investigations, separation, and outcome are presented.

Mid trimester sonographic findings for the prediction of Down syndrome in a sonographically screened population.

OBJECTIVE: The purpose of this study was to report the adjusted effect sizes of mid trimester sonographic findings that are associated with Down syndrome in a sonographically screened population. STUDY DESIGN: A large prospective single-center cohort study was conducted between March 1993 and December 2002 in South-East Queensland with women who were first scanned between 15 to 22 weeks of gestation. Univariate and multivariable logistic regression modeling was used to relate karyotypically ascertained Down syndrome fetuses and their control counterparts against routinely collected demographic and sonographic findings. RESULTS: Data were available for 73 Down-affected and 16,891 unaffected pregnancies. Strong colinearity existed between short humerus and short femurs that necessitated the removal of FL in pursuant multivariable models. In the most parsimonious model, which was adjusted for maternal age and gestational age, pregnancies with thick nuchal skinfold (regression coefficient beta [+/- SE], 2.100 +/- 0.545), short humerus length (regression coefficient beta, 2.304 +/- 0.314), presence of echogenic bowel (regression coefficient beta, 1.602 +/- 0.412), presence of echogenic intracardiac focus (regression coefficient beta, 1.975 +/- 0.308), presence of renal pelvic dilation (regression coefficient beta, 1.281 +/- 0.420), presence of aneuploid associated anomalies (regression coefficient beta, 4.473 +/- 0.535), the interaction between gestational age and thick nuchal skinfold (regression coefficient beta, 0.465 +/- 0.210), and the interaction between short humerus length and the presence of aneuploid associated anomalies (regression coefficient beta, -1.693 +/- 0.811) all were associated significantly with Down syndrome risk (all P < .05). Adjusted relative risk estimates were substantially different from their crude estimates. CONCLUSION: Routinely collected mid trimester sonographic findings are associated significantly with Down syndrome risk in a sonographically screened population after accounting for maternal age and gestational age. Because of dependencies between ultrasonic findings, risk estimates should be derived from appropriate multivariable models.

A second case of intrauterine growth retardation and primary hypospadias associated with a trisomy 22 placenta but with biparental inheritance of chromosome 22 in the fetus.

We report a case of severe intrauterine growth retardation (IUGR) and hypospadias in association with trisomy 22 diagnosed following chorionic villus sampling (CVS). Subsequent analysis of amniotic fluid cultures showed a normal male karyotype, 46,XY. As a previous case had been reported with similar abnormalities, in association with maternal uniparental disomy (UPD) 22, molecular studies were also performed. Microsatellite marker studies showed biparental inheritance. Follow-up studies after delivery showed a normal cell line in lymphocytes with the trisomy appearing to be confined to the placenta. The present case concurs with other earlier reports that maternal UPD for chromosome 22 has no impact on the phenotype. The features seen in the fetus are most likely the result of placental dysfunction due to trisomy, tissue-specific mosaicism and/or the effects of local growth restriction.