Open Dialogue as a Human Rights-Aligned Approach

Throughout the last 20 years, the human rights perspective has increasingly developed into a paradigm against which to appraise and evaluate mental health care. This article investigates to what extent the Finnish open dialogue (OD) approach both aligns with human rights and may be qualified to strengthen compliance with human rights perspectives in global mental health care. Being a conceptual paper, the structural and therapeutic principles of OD are theoretically discussed against the background of human rights, as framed by the Universal Declaration of Human Rights, the UN Convention on the Rights of People with Disabilities, and the two recent annual reports of the Human Rights Council. It is shown that OD aligns well with discourses on human rights, being a largely non-institutional and non-medicalizing approach that both depends on and fosters local and context-bound forms of knowledge and practice. Its fundamental network perspective facilitates a contextual and relational understanding of mental well-being, as postulated by contemporary human rights approaches. OD opens the space for anyone to speak (out), for mutual respect and equality, for autonomy, and to address power differentials, making it well suited to preventing coercion and other forms of human rights violation. It is concluded that OD can be understood as a human rights-aligned approach.

Combatting Antibiotic Resistance Together: How Can We Enlist the Help of Industry?

The development of antibiotics needs to be supported through new financial stimuli, including help from the public sector. In exchange for public support, industry should be asked to do what is in their power to help curb the inappropriate use of antibiotics. This work discusses key areas through which industry has an important influence on antibiotic consumption and where agreements can be made alongside financial incentives, even those intended to stimulate very early research. As long as the traditional unit sale-based business model for antibiotics remains in place, profit-making incentives will likely undermine efforts to sell and utilize antibiotics in a sustainable manner. In the short-term, while we try to come to a consensus on how best to fix the market, we need measures to prevent major over-selling and inappropriate promotion—especially for new, badly needed antibiotics that reach the market. This paper explores ways in which the pharmaceutical industry could help buttress sustainable antibiotic use while we search for more long-term, constructive, mutually-beneficial ways to organize the market.

The evaluation of scholarship in academic promotion and tenure processes: Past, present, and future

Review, promotion, and tenure (RPT) processes significantly affect how faculty direct their own career and scholarly progression. Although RPT practices vary between and within institutions, and affect various disciplines, ranks, institution types, genders, and ethnicity in different ways, some consistent themes emerge when investigating what faculty would like to change about RPT. For instance, over the last few decades, RPT processes have generally increased the value placed on research, at the expense of teaching and service, which often results in an incongruity between how faculty actually spend their time vs. what is considered in their evaluation. Another issue relates to publication practices: most agree RPT requirements should encourage peer-reviewed works of high quality, but in practice, the value of publications is often assessed using shortcuts such as the prestige of the publication venue, rather than on the quality and rigor of peer review of each individual item. Open access and online publishing have made these issues even murkier due to misconceptions about peer review practices and concerns about predatory online publishers, which leaves traditional publishing formats the most desired despite their restricted circulation. And, efforts to replace journal-level measures such as the impact factor with more precise article-level metrics (e.g., citation counts and altmetrics) have been slow to integrate with the RPT process. Questions remain as to whether, or how, RPT practices should be changed to better reflect faculty work patterns and reduce pressure to publish in only the most prestigious traditional formats. To determine the most useful way to change RPT, we need to assess further the needs and perceptions of faculty and administrators, and gain a better understanding of the level of influence of written RPT guidelines and policy in an often vague process that is meant to allow for flexibility in assessing individuals.

P&T and Me

Very few occasions bring more stress to a faculty member than the promotion and/or tenure (P&T) process. In this commentary, two recent chairs of P&T committees give their advice to future petitioners. Subtopics of the editorial discuss knowing the expectations, finding mentors to guide you, understanding the role of peer reviewers and preparing your dossier.

A Focused Career Development Program for Women Faculty at an Academic Medical Center

Background: Within free-standing academic medical centers, women continue to be underrepresented at upper faculty ranks and in leadership positions. A career development program (CDP) at the Medical University of South Carolina (MUSC) was implemented with the goal of improving the number of women in the upper ranks and in leadership positions. The CDP was initiated in 2013 as a 2-day program. Beginning in 2015, a half-day promotion-focused program was offered alternating with the 2-day program. Materials and Methods: The CDP has served ∼200 women from 2013 to 2017 and was evaluated for reaction and learning through postprogram surveys. Promotion success of ∼160 women who attended at least one of the programs through 2016 was assessed through an additional survey. Promotion information for ∼3000 faculty members during the same 2013-2016 period (post-CDP), as well as a 4-year time period before implementation of the CDP (pre-CDP), was collected using university-level personnel data. Results: The majority of CDP attendees (94%) indicated overall satisfaction with the program and would recommend the program to a colleague. Of the 137 CDP attendees still employed at MUSC in 2017, 50 had applied for promotion and 42 (84%) were successfully promoted. Among all the MUSC faculty, overall and rank-sepcific promotion rates for women and men were similar during the post-CDP time period and there was a significant increase in the promotion rate of women to Full Professor from pre-CDP to post-CDP time periods. Conclusions: CDP attendees were overwhelmingly satisfied with the program and were highly successful in being promoted. Since the overall university promotion rates of women and men were similar during the post-CDP time period and women are currently underrepresented at the upper faculty ranks, parity between men and women will likely not be achievable without additional programs to retain and/or recruit women in the upper ranks.

Effectiveness of a Positive Parental Practices Training Program for Chilean Preschoolers' Families: A Randomized Controlled Trial

Background: Evidence for the effectiveness of parental training as a strategy for promotion of positive parental practices and prevention of child behavior problems in low and middle income countries is not conclusive. This study aims to assess the effectiveness of a universal positive parental training program designed for this context, “Día a Día” UdeC © (“Day by Day” University of Concepción), in Chilean preschoolers’ families (3–6 years old children).

Methods: A cluster randomized controlled trial (cRCT) was carried out in 19 preschool education centers. There were two treatment arms: 10 centers (including 178 families) were randomly assigned to the intervention group and nine centers (including 154 families) were assigned to the waiting list control condition. Intervention groups received Day by Day UdeC, a six group sessions program for parents, including two group sessions for preschool educators, focused in affective communication; daily and child-directed play; directed attention; routines and transitions; reinforcement and incentive programs; planned inattention-ignore and time out; and logical consequences. Parental practices, parental satisfaction, and presence of children behavioral problems were examined at two-time points: T1 (4 weeks before intervention) and T2 (5–6 weeks after intervention).

Results: Intention-to-treat analysis shows a reduction in physical punishment and an increase in parental involvement, as well as a reduction in children behavioral problems. A per-protocol analysis revealed an additional effect: increase in observed parental practices.

Conclusion: This cRCT provided evidence for the effectiveness of a parental training program for the promotion of positive parental practices in low and middle income countries. The observed effects of the program in decreasing physical punishment and children’s behavioral problems make it a promising strategy for prevention purposes.

Trial Registration: This study was registered under ISRCTN.com (ISRCTN90762146; https://doi.org/10.1186/ISRCTN90762146).

MicroRNA-146a-5p enhances ginsenoside Rh2-induced anti-proliferation and the apoptosis of the human liver cancer cell line HepG2

Liver cancer is one of the leading causes of malignancy-associated mortality worldwide and its clinical therapy remains very challenging. Ginsenoside Rh2 (Rh2) has been reported to have antitumor effects on some types of cancer, including liver cancer. However, its regulatory mechanism has not been extensively evaluated. In the present study, Rh2 increased the expression of microRNA (miR)-200b-5p, miR-224-3p and miR-146a-5p, and decreased the expression of miR-26b-3p and miR-29a-5p. Of the three upregulated miRs, miR-146a-5p exhibited the highest fold elevation. In accordance with a previous study, Rh2 effectively inhibited the survival of liver cancer cells in vitro and in a mouse model. In addition, it was observed that Rh2 markedly promoted liver cancer apoptosis and inhibited colony formation. Cell apoptosis and the inhibition of cell survival as well as colony formation induced by Rh2 were enhanced and weakened by miR-146a-5p overexpression and inhibition, respectively. The results of the present study provide further evidence of the antitumor effect of Rh2 in liver cancer and also demonstrate that this effect may be mediated via the regulation of miR-146a-5p expression in the liver cancer cell line HepG2. The results indicated that miR-146a-5p may be a promising regulatory factor in Rh2-mediated effects in liver cancer.

Behind Closed Doors: The Priorities of the Alcohol Industry as Communicated in a Trade Magazine

Background: Efforts to reduce alcohol-related harm face strong resistance from the alcohol industry. It is important to monitor industry actions over time to assist in developing appropriate responses to this resistance. Monitoring can enable public health to identify industry positions on alcohol policy issues, stay abreast of current and emerging marketing tactics, and inform the development of possible counter-actions. One form of monitoring is the examination of industry trade publications where the industry converses with itself. The aim of this study was to assess industry strategic approaches as communicated in articles published in a leading Australian alcohol trade magazine to provide insights for policy makers and advocacy groups. Methods: Thematic analysis of 362 articles published in a trade magazine over a one-year period. Results: Three primary themes were evident in the articles: (1) the legitimization of alcohol as an important social and economic product, (2) the portrayal of the industry as trustworthy and benign, and (3) the strategic embedding of alcohol in various facets of everyday life. Conclusions: There was a general failure to acknowledge the substantial burden of disease caused by alcohol products, and instead much effort was expended on legitimizing the product and the companies responsible for its production, distribution, and promotion. The level of denial exhibited shows that additional regulation of the industry and its tactics will need to proceed without industry acceptance. Clear resistance to increasing consumer protections also points to the futility of inviting industry members to the policy table.

Is It Possible to "Find Space for Mental Health" in Young People? Effectiveness of a School-Based Mental Health Literacy Promotion Program

Lack of knowledge regarding, and the stigma associated with, mental disorders have been identified as major obstacles for the promotion of mental health and early intervention. The present study aimed to evaluate the effectiveness of a school-based intervention program focused on the promotion of mental health literacy (MHL) in young people (“Finding Space for Mental Health”). A sample of 543 students (22 classes), aged between 12 and 14 years old, participated in the study. Each class of students was randomly assigned to the control group (CG; n = 284; 11 classes) or the experimental group (EG; n = 259; 11 classes). MHL was assessed using the Mental Health Literacy questionnaire (MHLq), which is comprised of three dimensions—Knowledge/Stereotypes, First Aid Skills and Help Seeking, and Self-Help Strategies. The scores on these dimensions can also be combined to give an overall or total score. Participants from the EG attended the MHL promotion program (two sessions, 90 min each) delivered at one-week intervals. Sessions followed an interactive methodology, using group dynamics, music, and videos adapted to the target group. All participants responded to the MHLq at three points in time: pre-intervention assessment (one week prior to the intervention), post-intervention assessment (one week after the intervention) and follow-up assessment (six months after the intervention). The intervention effectiveness and the differential impact of sociodemographic variables on the effectiveness of the program were studied using a Generalized Estimation Equation (GEE). Results revealed that participants from the EG demonstrated, on average, significantly higher improvement in MHL from pre-intervention to follow-up when compared to participants from the CG. Different sociodemographic variables affected the effectiveness of the program on distinct dimensions of the MHLq. Overall, “Finding Space for Mental Health” showed efficacy as a short-term promotion program for improving MHL in schools.

Contents of Hopes and Duties: A Linguistic Analysis

People in a prevention focus tend to view their goals as duties and obligations, whereas people in a promotion focus tend to view their goals as hopes and aspirations. The current research suggests that people's attention goes to somewhat different experiences when they describe their hopes vs. duties. Two studies randomly assigned participants (N = 953) to describe a hope vs. duty. Specifically, Study 1 asked participants to describe a personal experience of pursuing a hope vs. duty, and Study 2 asked participants to describe a current hope vs. duty they had. I analyzed these descriptions with Linguistic Inquiry and Word Count (LIWC) 2015. Consistent with earlier research on regulatory focus, participants wrote more about positive outcomes when describing hopes and social relationships when describing duties. The current research suggests that the effectiveness of common regulatory focus and regulatory fit manipulations could depend on participants' freedom to choose the experiences they bring to mind when they describe their hopes and duties.

Urban regulatory focus: a new concept linking city size to human behaviour

Why do people in big cities behave differently to those living in small cities? To answer this question, in this paper a new concept of urban dynamics is presented that links city size to human behaviour. The concept has its origins in regulatory focus theory. According to the theory, goal-directed behaviour is regulated by two motivational systems, promotion and prevention. Individuals motivated by promotion goals (growth, accomplishment) focus on winning and tend to take risks, whereas those driven by prevention goals (safety, security) focus on not losing and try to avoid risk. Here we elaborate on the existing literature by linking the theory to the urban context. In our conceptualization, cities are powerful regulatory systems, and as such they impinge upon the way people regulate themselves in the urban space. Evidence from signal detection analysis is provided that supports this concept. The experience of a big-city context intensified both promotion-focused behaviour (a risky bias) for promotion-focused participants and prevention-focused behaviour (a conservative bias) for prevention-focused participants. The experience of a small-city context encouraged the opposite behavioural pattern in both cases. These findings suggest that the urban environment can influence the regulatory focus strategies of an individual in a way that cannot simply be explained by their personal regulatory focus. Specifically, the likelihood of one's behaving in a promotion- or prevention-oriented manner is dependent both on one's chronic regulatory focus and also on the urban context in which one lives. Based on this, we maintain that vibrant cities with a large population and a fast pace of life encourage extreme and polarized behaviours, whereas cities with a smaller population and a slower pace of life encourage more moderate and less polarized behavioural responses, which may explain why people in big cities take more risks, do more business, produce and spend more, and even walk faster.

Drug promotional activities in Nigeria: impact on the prescribing patterns and practices of medical practitioners and the implications

OBJECTIVE

Pharmaceutical companies spend significant amount of resources on promotion influencing the prescribing behavior of physicians. Drug promotion can negatively impact on rational prescribing, which may adversely affect the quality of patient care. However, little is known about these activities in Nigeria as the most populous country in Africa. We therefore aimed to explore the nature of encounters between Nigerian physicians and pharmaceutical sales representatives (PSRs), and how these encounters influence prescribing habits.

METHODS

Cross-sectional questionnaire-based study conducted among practicing physicians working in tertiary hospitals in four regions of Nigeria.

RESULTS

176 questionnaires were completed. 154 respondents (87.5%) had medicines promoted to them in the previous three months, with most encounters taking place in outpatients' clinics (60.2%), clinical meetings (46%) and new medicine launches (17.6%). Information about potential adverse effects and drug interactions was provided in 41.5%, and 27.3% of cases, respectively. Food, in the form of lunch or dinner, was the most common form of incentive (70.5%) given to physicians during promotional activities. 61% of physicians felt motivated to prescribe the drug promoted to them, with the quality of information provided being the driving factor. Most physicians (64.8%) would agree to some form of regulation of the relationship between medical doctors and the pharmaceutical industry.

CONCLUSION

Interaction between PSRs and physicians is a regular occurrence in Nigeria, influencing prescribing practices. Meals and cheap gifts were the most common items offered to physicians during their encounters with PSRs. The need for some form of regulation by professional organizations and the government was expressed by most respondents to address current concerns.

Evaluating Nonclinical Performance of the Academic Pathologist: A Comprehensive, Scalable, and Flexible System for Leadership Use

Academic pathologists perform clinical duties, as well as valuable nonclinical activities. Nonclinical activities may consist of research, teaching, and administrative management among many other important tasks. While clinical duties have many clear metrics to measure productivity, like the relative value units of Medicare reimbursement, nonclinical performance is often difficult to measure. Despite the difficulty of evaluating nonclinical activities, nonclinical productivity is used to determine promotion, funding, and inform professional evaluations of performance. In order to better evaluate the important nonclinical performance of academic pathologists, we present an evaluation system for leadership use. This system uses a Microsoft Excel workbook to provide academic pathologist respondents and reviewing leadership a transparent, easy-to-complete system that is both flexible and scalable. This system provides real-time feedback to academic pathologist respondents and a clear executive summary that allows for focused guidance of the respondent. This system may be adapted to fit practices of varying size, measure performance differently based on years of experience, and can work with many different institutional values.

Sales promotion by wholesalers affects general practitioners' prescription behaviours in Japan

Background: One method for promoting drugs in Japan has been utilizing wholesalers for promotion; however, the effectiveness of the sales promotion has been brought into question. Methods: A total of 74,552 responses were collected from an internet survey of 511 prescribing doctors in hospitals with less than 19 beds, which recalled the visits by wholesalers' sales representatives (MS) in 2014. Each assessed the degree to which MS and/or sales representatives from a pharmaceutical company (MR) influenced a decision to prescribe each drug. The responses were analysed using the chi-square test and Goodman-Kruskal's gamma to evaluate the association between MS calls and doctors' prescription orders. Results: Results showed a significant effect of the MS calls on doctors' behaviours in terms of new drug prescriptions and subsequent behaviours. The results by therapeutic category showed a similar strong influence of the joint calls on new prescriptions on some therapeutic classes. The MS calls significantly influenced doctors to maintain and increase the prescription volume (p < 0.01). Conclusion: This paper demonstrates that sales promotion on the part of MSs and MRs adds value to the prescription decisions. Moreover, results suggest that MSs enhance prescription outcomes in competitive therapeutic categories.

Using Free Adoptions to Reduce Crowding and Euthanasia at Cat Shelters: An Australian Case Study

Simple Summary

Waiving adoption fees to encourage adoptions and reduce euthanasias of healthy adult cats in crowded shelters is controversial because of concerns that people attracted to free adoptions may be less responsible owners. An extremely busy kitten season in 2015 left no shelter or foster vacancies for incoming cats at Western Australia’s largest cat shelter. Instead of euthanasing healthy cats, the shelter held a three day adoption-drive where cats ≥1 year were free. Public response to the event was extremely high (weekly adoptions increased >5-fold). Post-adoption surveys were carried out and results compared with surveys of cat adopters who paid normal-fees during non-promotional periods. No differences were found between free and normal-fee adopter demographics, cat demographics, cat fate post-adoption, incidence of medical and behavioural issues, and likelihood of attaching collars, registering with local councils or allowing cats to roam freely. Mixed-media promotion of the adoption-drive attracted more first-time adopters compared with normal-fee adopters. Overall, we found no evidence for adverse outcomes associated with free adoptions. Animal shelters should not be dissuaded from occasional free adoption-drives during overflow periods.

Abstract

Many healthy adult cats are euthanised annually in shelters, and novel approaches are required to reduce euthanasia rates. Waiving adoption fees is one such approach. However, concerns that less responsible owners will be attracted to free events persist among welfare groups. We evaluated evidence for differences in cat fate, health, and adherence to husbandry legislation via a case-study of a free adoption-drive for cats ≥1 year at a Western Australian shelter. Post-adoption outcomes were compared between free adopters and a control group of normal-fee adopters. The free adoption-drive rehomed 137 cats, increasing average weekly adoptions by 533%. First-time adopters were a significantly larger portion of the free cohort, as a result of mixed-media promotions. Both adopter groups selected cats of similar age; sex and pelage. Post-adoption, both groups retained >90% cats, reporting near identical incidences of medical and behavioural problems. Adopters did not differ in legislative compliance regarding fitting collars, registering cats, or allowing cats to roam. The shelter reported satisfaction with the adoption-drive, because in addition to relieving crowding of healthy adults, adoption of full-fee kittens increased 381%. Overall, we found no evidence for adverse outcomes associated with free adoptions. Shelters should not be dissuaded from occasional free adoption-drives during overflow periods.

Interventions Designed to Promote Exclusive Breastfeeding in High-Income Countries: A Systematic Review Update

BACKGROUND

Worldwide, women seldom reach the recommended target of exclusive breastfeeding up to 6 months postpartum. The aim of the current study was to update a previously published review that presented a conceptual and methodological synthesis of interventions designed to promote exclusive breastfeeding up to 6 months in high-income countries.

MATERIALS AND METHODS

A systematic search of leading databases was conducted for scholarly, peer-reviewed, randomized controlled trials published from June 2013 to December 2016. Twelve new articles were identified as relevant; all were published in English and assessed exclusive breastfeeding with a follow-up period extending beyond 4 months postpartum. Articles were analyzed for overall quality of evidence in regard to duration of exclusive breastfeeding, using the Grading and Recommendations Assessment, Development, and Evaluation approach.

RESULTS

A significant increase in the duration of exclusive breastfeeding was found in 4 of the 12 studies. All four successful interventions had long-duration postpartum programs, implemented by telephone, text message, or through a website. Some of the successful interventions also included prenatal education or in-hospital breastfeeding support.

CONCLUSIONS

Results from this review update correspond closely with previous findings, in that all of the successful interventions had lengthy postnatal support or an education component. More studies assessed intervention fidelity than in the previous review; however, there was little discussion of maternal body-mass index. While a pattern of successful interventions is beginning to emerge, further research is needed to provide a robust evidence base to inform future interventions, particularly with overweight and obese women.

Introduction to a Follow-Up Symposium on "Am I Famous Yet?": Judging Scholarly Merit in Psychological Science

I introduce a follow-up symposium to "'Am I Famous Yet?' Judging Scholarly Merit in Psychological Science," which was published in Perspectives on Psychological Science in November 2016. The follow-up symposium is intended to increase the diversity of contributors and contributions and thereby to continue and expand the discussion of how scholarly merit can be usefully evaluated in psychological science.

Development and evaluation of the OHCITIES instrument: assessing alcohol urban environments in the Heart Healthy Hoods project

OBJECTIVES

To describe the development and test-retest reliability of OHCITIES, an instrument characterising alcohol urban environment in terms of availability, promotion and signs of consumption.

DESIGN

This study involved: (1) developing the conceptual framework for alcohol urban environment by means of literature reviewing and previous alcohol environment research experience; (2) pilot testing and redesigning the instrument; (3) instrument digitalisation; (4) instrument evaluation using test-retest reliability.

SETTING

Data for testing the reliability of the instrument were collected in seven census sections in Madrid in 2016 by two observers.

PRIMARY AND SECONDARY OUTCOME MEASURES

We computed per cent agreement and Cohen's kappa coefficients to estimate inter-rater and test-retest reliability for alcohol outlet environment measures. We calculated interclass coefficients and their 95% CIs to provide a measure of inter-rater reliability for signs of alcohol consumption measures.

RESULTS

We collected information on 92 on-premise and 24 off-premise alcohol outlets identified in the studied areas about availability, accessibility and promotion of alcohol. Most per cent-agreement values for alcohol measures in on-premise and off-premise alcohol outlets were greater than 80%, and inter-rater and test-retest reliability values were generally above 0.80. Observers identified 26 streets and 3 public squares with signs of alcohol consumption. Intraclass correlation coefficient between observers for any type of signs of alcohol consumption was 0.50 (95% CI -0.09 to 0.77). Few items promoting alcohol unrelated to alcohol outlets were found on public spaces.

CONCLUSIONS

The OHCITIES instrument is a reliable instrument to characterise alcohol urban environment. This instrument might be used to understand how alcohol environment associates with alcohol behaviours and its related health outcomes, and can help in the design and evaluation of policies to reduce the harm caused by alcohol.

Exposure to Tobacco Advertising, Promotion Among the Adult Population in Vietnam and Its Implications for Public Health

INTRODUCTION

The Law on Tobacco Control and the Law on Advertisement prohibit the advertising of any tobacco product in Vietnam. Tobacco promotion and marketing are alsostrictly prohibited. However, the violation of tobacco adverting and promotion is still common in Vietnam.

OBJECTIVES

This article aims at describing the exposure to tobacco advertising and promotion among the population aged 15+ years in Vietnam based on the data from the Global Adult Tobacco Survey 2015 from the view of the community, identifying any possible associations between the exposure to tobacco advertising and promotion and other individual factors, and discussing its possible public health implications.

METHOD

A cross-sectional study with the nationwide scale. Secondary data from the Global Adult Tobacco Survey 2015 was explored and analyzed. Chi-square test and multivariate logistic regressions were applied in the data analysis.

RESULTS

The most common type of adults' exposure to tobacco advertising and promotion was points of sale (8.6%); 9.8% adults exposure to one source of tobacco advertising and 4.0% of them exposed to one source of tobacco promotion. Around 13.3% of Vietnamese adults were exposed to tobacco advertisement, while 2.0% were exposed to tobacco promotion, 5.3% were exposed to both tobacco advertising and promotion, and 16.6% were exposed to tobacco advertising or promotion. Gender, educational level, age, occupation, marital status, socioeconomic status, location (urban, rural), and current smoking status were associated with the exposure to tobacco advertising, tobacco promotion, tobacco advertising and promotion, and tobacco advertising or promotion.

CONCLUSION AND RECOMMENDATION

Although there are comprehensive bans on tobacco advertising and promotion in Vietnam, adults aged 15+ years still reported their exposure to tobacco advertising and promotion. There should be a strict enforcement of the ban on tobacco advertising and promotion in Vietnam.

A cluster randomised controlled trial to evaluate the effectiveness and cost-effectiveness of the GoActive intervention to increase physical activity among adolescents aged 13-14 years

INTRODUCTION

Adolescent physical activity promotion is rarely effective, despite adolescence being critical for preventing physical activity decline. Low adolescent physical activity is likely to last into adulthood, increasing health risks. The Get Others Active (GoActive) intervention is evidence-based and was developed iteratively with adolescents and teachers. This intervention aims to increase physical activity through increased peer support, self-efficacy, group cohesion, self-esteem and friendship quality, and is implemented using a tiered-leadership system. We previously established feasibility in one school and conducted a pilot randomised controlled trial (RCT) in three schools.

METHODS AND ANALYSIS

We will conduct a school-based cluster RCT (CRCT) in 16 secondary schools targeting all year 9 students (n=2400). In eight schools, GoActive will run for two terms: weekly facilitation support from a council-funded intervention facilitator will be offered in term 1, with more distant support in term 2. Tutor groups choose two weekly activities, encouraged by older adolescent mentors and weekly peer leaders. Students gain points for trying new activities; points are entered into a between-class competition. Outcomes will be assessed at baseline, interim (week 6), postintervention (week 14-16) and 10-month follow-up (main outcome). The primary outcome will be change from baseline in daily accelerometer-assessed moderate-to-vigorous physical activity. Secondary outcomes include accelerometer-assessed activity intensities on weekdays/weekends; self-reported physical activity and psychosocial outcomes; cost-effectiveness and cost-utility analyses; mixed-methods process evaluation integrating information from focus groups and participation logs/questionnaires.

ETHICS AND DISSEMINATION

Ethical approval for the conduct of the study was gained from the University of Cambridge Psychology Research Ethics Committee. Given the lack of rigorously evaluated interventions, and the inclusion of objective measurement of physical activity, long-term follow-up and testing of causal pathways, the results of a CRCT of the effectiveness and cost-effectiveness of GoActive are expected to add substantially to the limited evidence on adolescent physical activity promotion. Workshops will be held with key stakeholders including students, parents, teachers, school governors and government representatives to discuss plans for wider dissemination of the intervention.

TRIAL REGISTRATION NUMBER

ISRCTN31583496.

Attitudes, Beliefs and Predictors of Male Circumcision Promotion among Medical University Students in a Traditionally Non-Circumcising Region

Objective: To evaluate the beliefs of medical university students regarding male circumcision (MC), as well as attitudes and the predictors of its promotion in the case of adults at risk of HIV. Methods: A cross-sectional survey was conducted between 2013–2016 at the Medical University in Szczecin, Poland, among final year Polish/foreign students from Northern Europe, using a standardized questionnaire. Results: There were 539 participants, median age 25 years, 40.8% males, and 66.8% were Polish nationals. The MC rate was 16.7%. Regarding HIV/AIDS knowledge, 66.6% of the students scored more than 75%; and, 34.2% knew that MC reduces the risk of HIV infection. One in eleven respondents (9.1%) believed that circumcised men felt more intense sexual pleasure. More than half of the respondents (54.8%) declared that they would recommend MC to adult patients at risk for HIV. The belief that circumcised men felt more intense sexual pleasure, and knowledge on MC regarding HIV risk reduction was associated with greater odds of recommending adult MC (OR = 3.35 and OR = 2.13, respectively). Conclusions: Poor knowledge of its benefits and a low willingness to promote the procedure—strongly dependent on personal beliefs—suggest that medical students may need additional training to help them to discuss MC more openly with adult men at risk for HIV infection. Knowledge may be an effective tool when making decisions regarding MC promotion.

[Promoting the code of ethics for nurses]

The publication of the code of ethics for nurses requires the French National Order of Nurses' structures to undertake initiatives with the aim of promoting it as well as implementing the public service missions which have now been attributed to the Order. Each regional and departmental body has its role to play in raising awareness of this code and its application in the field.

Effective Approach to Promoting the Proton Conductivity of Metal-Organic Frameworks by Exposure to Aqua-Ammonia Vapor

We explored the proton conductivities of two 3D Co^II metal-organic frameworks (MOFs), {[Co₃(m-ClPhIDC)₂(H₂O)₆]·2H₂O}_n [1; m-ClPhH₃IDC = 2-(m-chlorophenyl)imidazole-4,5-dicarboxylic acid] and {[Co₃(p-ClPhHIDC)₃(H₂O)₃]·6H₂O}_n (2; p-ClPhH₃IDC = 2-(p-chlorophenyl)imidazole-4,5-dicarboxylic acid), under water and aqua-ammonia vapors, respectively. The experimental results revealed that the proton conductivities of 1 and 2 at aqua-ammonia vapor were 2.89 × 10^-2 and 4.25 × 10^-2 S/cm, respectively, and approximately 2 orders of magnitude greater than those at water vapor. On the basis of the activation energy, water and ammonia vapor absorption, and powder X-ray diffraction patterns, their proton-conduction mechanisms have been discussed. We believe that this is a novel approach to drastically improving the proton conductivity of MOFs.

Languaje: what makes us humans

Pediatrician carry out the surveillance of language in preschool children as one of the components of child development (language, fine and gross motor skills, etc.). However, language is more than that. The process of transformation of the magic meaning on the word present in the initial stages of human evolution (Myth period) into a new, symbolic meaning as representative of the object (Logos period) took around 40,000 years. With the mastering of language, man was capable of thinking; from then onwards, these two functions, thought and language, became inextricably linked, the evolved hand in hand. But this achievement had a high price : the alienation of man from nature. Hence, language became a social construction which, far from representing the objects of nature, was capable of assigning attributes and meaning to the objects themselves. Language can be used as a commercial strategy (making the words value and cost indistinguishable). According to Lacan, language is also a part of the subject, we are constructed by language. By promoting language in children we contribute to the promotion of the child as a person, as an individual and as a social being.

Lentinan dose dependence between immunoprophylaxis and promotion of the murine liver cancer

Lentinan could exhibit significant biological activity favorable for human health and disease control such as the recovery of patients with liver cancer. In order to investigate the effect of lentinan dose dependence between immunoprophylaxis and promotion of cancer cell proliferation of the murine liver cancer, different concentrations of lentinan were prepared for the test in vitro (MTT assay) and in vivo (cumulative survival assay, spleen lymphocyte proliferation tests and peritoneal macrophage phagocytosis assays). New emerging proteins of the H22 cell incubated with lentinan was demonstrated by MS analysis and protein database searching. Lentinan was non-toxic for HL7702 cells but inhibited H22 cells proliferation obviously in a dose-dependent manner. In vivo, the proliferation of H22 hepatocarcinoma cells was inhibited by lentinan 0.4mg/kg body weight (L2, survival rate, 20%, PPP<0.01). Six proteins 60Sacidic ribosomal protein P2, Peroxiredoxin-2, Annexin A5, PDZ and LIM domain protein 1, Src substrate cortactin and Moesin were found as emerging proteins of the H22 cell incubated with high dose lentinan which related to cancer promotion closely. In conclusion, Thelentinan was relatively safe and could inhibit the proliferation of H22 cancer cells through immunity improvement when it's intake was in proper quantity.

Special attention to women experiencing high-risk pregnancy: Delivery, care assistance and neonatal outcomes in two Brazilian maternity wards

BACKGROUND

To compare two care models of high-risk pregnant women--a House for Pregnant Women, staffed by nurse-midwives, versus a traditional care model in a hospital maternity ward.

DESIGN

This was across-sectional study conducted in two reference maternity hospitals for high-risk pregnancies, in Belo Horizonte, Minas Gerais, Brazil. The sample consisted of 312 high-risk pregnant women consecutively admitted from January 1st to December 31^st, 2010, either to the House for Pregnant Women (n=247), or the hospital maternity ward (n=65). Gestational ages varied from 22 weeks to 36 weeks and six days. We measured individual, demographic, obstetric, labour and delivery variables, and newborn characteristics. For data analysis, we used descriptive, bivariate and multivariate statistics using Poisson regression, with a 5% significance level.

FINDINGS

At the conventional hospital maternity ward, more women had six or more antenatal exams, greater frequencies of diagnosis related to blood pressure, and a greater number of women underwent either a C-section or a vaginal delivery with an episiotomy and analgesia. At the House for Pregnant Women, the majority of the hospitalizations were related to preterm labour and premature rupture of membranes. There were no statistical differences in the newborn characteristics.

KEY CONCLUSIONS

The House for Pregnant Women care model, utilizing midwives was less interventionist, yet with results as favorable as in a conventional maternity hospital setting.

Body Shape and Weight Loss as Motivators for Breastfeeding Initiation and Continuation

Breastfeeding rates in the UK are low. Efforts to promote breastfeeding typically include the known health benefits for mother and child, many of which are not immediate. Gaining immediate benefits can be effective motivators of behaviour. Body-related changes resulting from breastfeeding could be an immediate benefit. This study explored breastfeeding mothers’ reports of body-related changes as benefits of breastfeeding. Mothers (N = 182) who currently, or had recently, breastfed an infant completed a survey detailing their infant feeding choices and the perceived benefits of breastfeeding on their bodies. Half of the mothers felt that breastfeeding had a positive effect on their body. Benefits were grouped into five themes: (1) Returning to pre-pregnancy body shape; (2) Health benefits; (3) Physical benefits; (4) Eating benefits; (5) Psychological benefits. These themes highlight the numerous body-related benefits that mothers identified as resulting from breastfeeding and suggest that immediate, personal, and appearance-related gains of breastfeeding are highly valued. These findings indicate that interventions would likely benefit from emphasising the more immediate physical and psychological benefits of breastfeeding, alongside the health and bonding benefits, as a way to promote breastfeeding initiation and continuation in more women. This may be particularly effective for groups such as young mothers, where breastfeeding rates are low and whose emphasis on body image may be greater.

Mental health provision in schools: approaches and interventions in 10 European countries

BACKGROUND

The role of schools in providing community-based support for children's mental health and well-being is widely accepted and encouraged. Research has mainly focused on designing and evaluating specific interventions and there is little data available regarding what provision is available, the focus and priorities of schools and the professionals involved in providing this support. The current study presents these data from schools in 10 European countries.

METHODS

Online survey of 1466 schools in France, Germany, Ireland, Netherlands, Poland, Serbia, Spain, Sweden, UK and Ukraine. The participating countries were chosen based on their geographical spread, diversity of political and economic systems, and convenience in terms of access to the research group and presence of collaborators.

RESULTS

Schools reported having more universal provision than targeted provision and there was greater reported focus on children who already have difficulties compared with prevention of problems and promotion of student well-being. The most common interventions implemented related to social and emotional skills development and anti-bullying programmes. Learning and educational support professionals were present in many schools with fewer schools reporting involvement of a clinical specialist. Responses varied by country with 7.4-33.5% between-country variation across study outcomes. Secondary schools reported less support for parents and more for staff compared with primary schools, with private schools also indicating more staff support. Schools in rural locations reported less student support and professionals involved than schools in urban locations.

CONCLUSION

The current study provides up-to-date and cross-country insight into the approaches, priorities and provision available for mental health support in schools; highlighting what schools prioritise in providing mental health support and where coverage of provision is lacking.

Effects of Promotion and Compunction Interventions on Real Intergroup Interactions: Promotion Helps but High Compunction Hurts

HIGHLIGHTS  We show the promotion intervention has positive effects during intergroup contact, but that high levels of compunction can have negative effects. Intergroup contact is probably the longest standing and most comprehensively researched intervention to reduce discrimination. It is also part of ordinary social experience, and a key context in which discrimination is played out. In this paper, we explore two additional interventions which are also designed to reduce discrimination, but which have not yet been applied to real intergroup interactions. The promotion intervention encourages participants to relax and enjoy an interaction, while the compunction intervention motivates participants to avoid discrimination. Across two studies, we tested the separate effects of promotion (Study 1) and then compunction (Study 2) on participants' interactions with a confederate whom they believed to have a history of schizophrenia. In Study 1, participants received either a promotion intervention to "relax and have an enjoyable dialogue" or no intervention (control; n = 67). In Study 2, participants completed a Single-Category Implicit Attitude Test before being told that they were high in prejudice (high compunction condition) or low in prejudice (low compunction condition; n = 62). Results indicated that promotion was associated with broadly positive effects: participants reported more positive experience of the interaction (enjoyment and interest in a future interaction), and more positive evaluations of their contact partner (increased friendliness and reduced stereotyping). There were no effects on participants' reported intergroup anxiety. In contrast, high compunction had broadly negative effects: participants reported more negative experiences of the interaction and more negative evaluations of their contact partner (using the same dependent measures outlined above). In addition, participants in the high compunction condition reported increased intergroup anxiety and increased self-anxiety (anxiety around thinking or doing something that is prejudiced). Participants in the high compunction condition also reported reduced expectancies of self-efficacy (i.e., they were less confident that they would be able to make a good impression).

Effects of Physician-directed Pharmaceutical Promotion on Prescription Behaviors: Longitudinal Evidence

Spending on prescription drugs (Rx) represents one of the fastest growing components of US healthcare spending and has coincided with an expansion of pharmaceutical promotional spending. Most (83%) of Rx promotion is directed at physicians in the form of visits by pharmaceutical representatives (known as detailing) and drug samples provided to physicians' offices. Such promotion has come under increased public scrutiny, with critics contending that physician-directed promotion may play a role in raising healthcare costs and may unduly affect physicians' prescribing habits towards more expensive, and possibly less cost-effective, drugs. In this study, we bring longitudinal evidence to bear upon the question of how detailing impacts physicians' prescribing behaviors. Specifically, we examine prescriptions and promotion for a particular drug class based on a nationally representative sample of 150,000 physicians spanning 24 months. The use of longitudinal physician-level data allows us to tackle some of the empirical concerns in the extant literature, virtually all of which have relied on aggregate national data. We estimate fixed-effects specifications that bypass stable unobserved physician-specific heterogeneity and address potential targeting bias. In addition, we also assess differential effects at both the extensive and intensive margins of prescribing behaviors and differential effects across physician-level and market-level characteristics, questions that have not been explored in prior work. The estimates suggest that detailing has a significant and positive effect on the number of new scripts written for the detailed drug, with an elasticity magnitude of 0.06. This effect is substantially smaller than those in the literature based on aggregate information, suggesting that most of the observed relationship between physician-directed promotion and drug sales is driven by selection bias. We find that detailing impacts selective brand-specific demand but does not have any substantial effects on class-level demand. The increase in brand-specific demand appears to crowd out demand for the substitute branded drug although not for the generic alternative. Results also indicate that most of the detailing response may operate at the extensive margin; detailing affects the probability of prescribing the drug more than it affects the number of prescriptions conditional on any prescribing. We draw some implications from these estimates with respect to effects on healthcare costs and public health. Copyright © 2016 John Wiley & Sons, Ltd.

Structured Annual Faculty Review Program Accelerates Professional Development and Promotion: Long-Term Experience of the Duke University Medical Center's Pathology Department

This retrospective observational study on faculty development analyzes the Duke University Pathology Department's 18-year experience with a structured mentoring program involving 51 junior faculty members. The majority had MD degrees only (55%). The percentage of young women faculty hires before 1998 was 25%, increasing to 72% after 2005. Diversity also broadened from 9% with varied heritages before 1998 to 37% since then. The mentoring process pivoted on an annual review process. The reviews generally helped candidates focus much earlier, identified impediments they individually felt, and provided new avenues to gain a national reputation for academic excellence. National committee membership effectively helped gain national exposure. Thirty-eight percent of the mentees served on College of American Pathologists (CAP) committees, exponential multiples of any other national society. Some used CAP resources to develop major programs, some becoming nationally and internationally recognized for their academic activities. Several faculty gained national recognition as thought leaders for publishing about work initiated to serve administrative needs in the Department. The review process identified the need for more protected time for research, issues with time constraints, and avoiding exploitation when collaborating with other departments. This review identified a rigorous faculty mentoring and review process that included annual career counseling, goal-oriented academic careers, monitored advancement to promotion, higher salaries, and national recognition. All contributed to high faculty satisfaction and low faculty turnover. We conclude that a rigorous annual faculty review program and its natural sequence, promotion, can greatly foster faculty satisfaction.

Pervasive promotion of breastmilk substitutes in Phnom Penh, Cambodia, and high usage by mothers for infant and young child feeding

In 2005, Cambodia passed the Sub-Decree on Marketing of Products for Infant and Young Child Feeding (no. 133) to regulate promotion of commercial infant and young child food products, including breastmilk substitutes. Helen Keller International assessed mothers' exposure to commercial promotions for breastmilk substitutes and use of these products through a cross-sectional survey among 294 mothers of children less than 24 months of age. Eighty-six per cent of mothers reported observing commercial promotions for breastmilk substitutes, 19.0% reported observing infant and young child food product brands/logos on health facility equipment and 18.4% reported receiving a recommendation from a health professional to use a breastmilk substitute. Consumption of breastmilk substitutes was high, occurring among 43.1% of children 0-5 months and 29.3% of children 6-23 months of age. Findings also indicated a need to improve breastfeeding practices among Phnom Penh mothers. Only 36.1% of infants 0-5 months of age were exclusively breastfed, and 12.5% of children 20-23 months of age were still breastfed. Children that received a breastmilk substitute as a prelacteal feed were 3.9 times more likely to be currently consuming a breastmilk substitute than those who did not. Despite restriction of commercial promotions for breastmilk substitutes without government approval, occurrence of promotions is high and use is common among Phnom Penh mothers. In a country with high rates of child malnutrition and pervasive promotions in spite of restrictive national law, full implementation of Cambodia's Sub-Decree 133 is necessary, as are policies and interventions to support exclusive and continued breastfeeding.

KEY MESSAGES

Despite prohibition without specific approval by the national government, companies are pervasively promoting breast-milk substitutes in Phnom Penh, particularly on television and at points of sale. Strengthened implementation and enforcement of Cambodia's subdecree 133 are needed to better regulate promotion in order to protect breastfeeding for the nutrition and health of infants and young children in Cambodia. Mothers who used a breast-milk substitute as a prelacteal feed were 3.9 times more likely to currently feed this same child a breast-milk substitute, as compared with mothers who did not provide breast-milk substitute as a prelacteal feed. Supporting breastfeeding among mothers after delivery is critical to establish and sustain optimal breastfeeding practices. Use of breast-milk substitutes is also very common among mothers of children under 2 years of age in Phnom Penh. We recommend promoting exclusive and continued breastfeeding as beneficial to children's health and development, and supporting policy and workplace environments that enable breastfeeding up to and beyond 24 months of age.

Research productivity of doctor of physical therapy faculty promoted in the southeastern United States

BACKGROUND

Little information exists on the research productivity of successfully promoted tenure-track Doctor of Physical Therapy (DPT) faculty.

OBJECTIVE

To determine the research productivity that typically results in successful promotion.

DESIGN

We collected publicly available curriculum vitae (CVs) from faculty currently in accredited DPT programs and who had been successfully promoted from an institution in the southeastern USA from 2000 through 2016. Total publication count, journal impact factor, funding, citations, and other metrics were analysed from 45 subjects of 22 of the 64 CAPTE-accredited DPT programs in the southeast.

RESULTS

None of the studied metrics were normally distributed with time to promotion as determined by a Shapiro-Wilk test. These faculty exhibited a median publication count of 4, range 0 to 43; median of average citation count of 12.4, range 0 to 87.25; median of average journal impact factor of 2.866, range 0 to 6.280; median external funding received of $9910, range $0.00 to $19 543 198; and median author h-index of 3, range 0 to 17. The median number of years before promotion was 6, ranging from 3 to 13 years. Linear regression analysis indicates a poor fit with no significant correlation between years before promotion and any of the studied metrics. No correlation between journal impact factor and number of citations was observed (m = -0.22, p = 0.728, R² = 0.0003). Prior to promotion 31% (14 of 45) did not receive external funding and 24% (11 of 45) had a 0 h-index. The Carnegie Classification of the institution did not significantly correlate with research productivity metrics in this dataset (p = 0.213).

CONCLUSION

While faculty unsuccessful in promotion were not identifiable using this method, this research can be used by faculty and committees to evaluate research productivity against regional data and promote competitive standards with peer institutions.

ABBREVIATIONS

CAPTE: Commission on Accreditation in Physical Therapist Education; DPT: Doctor of Physical Therapy.

Social impact of participatory health research: collaborative non-linear processes of knowledge mobilization

Social impact, defined as an effect on society, culture, quality of life, community services, or public policy beyond academia, is widely considered as a relevant requirement for scientific research, especially in the field of health care. Traditionally, in health research, the process of knowledge transfer is rather linear and one-sided and has not recognized and integrated the expertise of practitioners and those who use services. This can lead to discrimination or disqualification of knowledge and epistemic injustice. Epidemic injustice is a situation wherein certain kinds of knowers and knowledge are not taken seriously into account to define a situation. The purpose of our article is to explore how health researchers can achieve social impact for a wide audience, involving them in a non-linear process of joint learning on urgent problems recognized by the various stakeholders in public health. In participatory health research impact is not preordained by one group of stakeholders, but the result of a process of reflection and dialog with multiple stakeholders on what counts as valuable outcomes. This knowledge mobilization and winding pathway embarked upon during such research have the potential for impact along the way as opposed to the expectation that impact will occur merely at the end of a research project. We will discuss and illustrate the merits of taking a negotiated, discursive and flexible pathway in the area of community-based health promotion.

Effective self-regulation change techniques to promote mental wellbeing among adolescents: a meta-analysis

Mental wellbeing is influenced by self-regulation processes. However, little is known on the efficacy of change techniques based on self-regulation to promote mental wellbeing. The aim of this meta-analysis is to identify effective self-regulation techniques (SRTs) in primary and secondary prevention interventions on mental wellbeing in adolescents. Forty interventions were included in the analyses. Techniques were coded into nine categories of SRTs. Meta-analyses were conducted to identify the effectiveness of SRTs, examining three different outcomes: internalising behaviour, externalising behaviour, and self-esteem. Primary interventions had a small-to-medium ([Formula: see text] = 0.16-0.29) on self-esteem and internalising behaviour. Secondary interventions had a medium-to-large short-term effect (average [Formula: see text] = 0.56) on internalising behaviour and self-esteem. In secondary interventions, interventions including asking for social support [Formula: see text] 95% confidence interval, CI = 1.11-1.98) had a great effect on internalising behaviour. Interventions including monitoring and evaluation had a greater effect on self-esteem [Formula: see text] 95% CI = 0.21-0.57). For primary interventions, there was not a single SRT that was associated with a greater intervention effect on internalising behaviour or self-esteem. No effects were found for externalising behaviours. Self-regulation interventions are moderately effective at improving mental wellbeing among adolescents. Secondary interventions promoting 'asking for social support' and promoting 'monitoring and evaluation' were associated with improved outcomes. More research is needed to identify other SRTs or combinations of SRTs that could improve understanding or optimise mental wellbeing interventions.

Feasibility study and pilot cluster-randomised controlled trial of the GoActive intervention aiming to promote physical activity among adolescents: outcomes and lessons learnt

OBJECTIVES

Assess the feasibility of implementing the GoActive intervention in secondary schools, to identify improvements, test study procedures, determine preliminary effectiveness to increase moderate-to-vigorous physical activity (MVPA), and inform power calculations to establish programme effectiveness.

SETTING

Feasibility study (1 school) and pilot cluster-randomised controlled trial (CRCT; 2 intervention; 1 control school(s)).

PARTICIPANTS

460 participants (46.6% female; 13.2 (0.4) years old).

INTERVENTIONS

8-week intervention (2013) involved: classes choosing weekly activities encouraged by mentors (older adolescents) and in-class peer leaders. Students gain points for trying activities which are entered into an intramural competition.

PRIMARY AND SECONDARY OUTCOME MEASURES

Planned quantitative (questionnaire) and qualitative (focus groups) process evaluation addressed enjoyment, confidence, participation, suggested improvements. Outcomes were assessed at baseline and follow-up (week 8) in pilot CRCT and included accelerometer-assessed MVPA; adolescent-reported activity type, well-being, peer support, shyness, sociability. Analysis of covariance was used to assess preliminary effectiveness as change in MVPA adjusted for baseline.

RESULTS

All year 9 students in intervention schools were exposed to the intervention; over all schools 77% of eligible students were measured. 71% boys and 74% girls found GoActive 'fun'; 38% boys and 32% girls said it increased confidence, and 64% boys and 59% girls said they would continue with a GoActive activity. Suggested improvements included more mentorship; improved training; streamlined points recording. Pilot results indicated potential effectiveness ((adjusted mean difference (95% CI) p value; MVPA mins; 5.1 (1.1 to 9.2) p=0.014)) and suggest recruitment of 16 schools (2400 adolescents) for a full trial. Compared with control, intervention students reported greater peer support 0.5 (0.1 to 0.9) p=0.03, well-being 1.8 (0.1 to 3.4) p=0.04 but no difference in shyness/sociability. Participation in activity types approached significance (intervention group 2.3 (-0.2 to 4.7) p=0.07 more activity types).

CONCLUSIONS

Results suggest feasibility and indicate potential effectiveness of GoActive to increase MVPA and support a fully powered evaluation of effectiveness and cost-effectiveness. Process evaluation data were used to refine GoActive prior to a full trial.

TRIAL REGISTRATION NUMBER

ISRCTN31583496; pre-results.

Debating the Effectiveness and Necessity of Tenure in Pharmacy Education

Academic tenure is a controversial and highly debated topic. Is tenure truly outdated or does it simply need to be reformed? On one hand, the tenure system has shortcomings including deincentivizing productive faculty members, inconsistent application of tenure policies and procedures, and the potential for discrimination during tenure decisions. On the other hand, the tenure system is a long held tradition in the academy, essential in higher education to ensure academic standards and values are upheld in the best interest of students. It provides faculty members with the academic freedom to try innovative teaching strategies and conduct research and assists with faculty retention and recruitment. Regardless of one's opinion, the tenure debate is not going away and warrants further discussion. This paper represents the work of a group of academic leaders participating in the 2014-2015 AACP Academic Leadership Fellowship Program. This work was presented as a debate at the 2015 AACP Interim Meeting in Austin, TX in February 2015.

Effectiveness of Social Marketing Interventions to Promote Physical Activity Among Adults: A Systematic Review

BACKGROUND

Social marketing managers promote desired behaviors to an audience by making them tangible in the form of environmental opportunities to enhance benefits and reduce barriers. This study proposed "benchmarks," modified from those found in the past literature, that would match important concepts of the social marketing framework and the inclusion of which would ensure behavior change effectiveness. In addition, we analyzed behavior change interventions on a "social marketing continuum" to assess whether the number of benchmarks and the role of specific benchmarks influence the effectiveness of physical activity promotion efforts.

METHODS

A systematic review of social marketing interventions available in academic studies published between 1997 and 2013 revealed 173 conditions in 92 interventions.

RESULTS

Findings based on χ², Mallows' Cp, and Logical Analysis of Data tests revealed that the presence of more benchmarks in interventions increased the likelihood of success in promoting physical activity. The presence of more than 3 benchmarks improved the success of the interventions; specifically, all interventions were successful when more than 7.5 benchmarks were present. Further, primary formative research, core product, actual product, augmented product, promotion, and behavioral competition all had a significant influence on the effectiveness of interventions.

CONCLUSIONS

Social marketing is an effective approach in promoting physical activity among adults when a substantial number of benchmarks are used and when managers understand the audience, make the desired behavior tangible, and promote the desired behavior persuasively.

An examination of envy and jealousy in nursing academia

AIM

To discuss envy and jealousy and how their positive and negative aspects among nurse academics affect the workplace.

BACKGROUND

In nursing academia, jealousy and envy are common emotions, engendered by demands for high productivity, intense competition for limited resources, preferences for particular assignments and opportunities for promotions. When these feelings are moderate and part of everyday rivalry, competition and ambition benefit the organisation. However, jealousy and envy can have serious consequences including damaged relationships and communication, and the undermining of colleagues' performance.

DISCUSSION

Strategies are recommended to provide opportunities for self-reflection and consideration of how the workplace affects nursing academics' wellbeing and professional performance.

CONCLUSION

Jealousy and envy can be damaging emotions in the workplace. The embittered, hostile person can undermine and damage relationships, disrupt teams and communication, and undermine organisational performance. Discussing the positive and negative effects of envy and jealousy provides an opportunity for nursing academics to self-reflect and to consider others and their own personal and professional performance.

IMPLICATIONS FOR PRACTICE

Understanding how jealousy and envy impact on the work environment, workplace relationships and individual/team performance is important especially for early career and seasoned nursing academics alike.

Does Academic Blogging Enhance Promotion and Tenure? A Survey of US and Canadian Medicine and Pediatric Department Chairs

BACKGROUND

Electronic educational (e-learning) technology usage continues to grow. Many medical journals operate companion blogs (an application of e-learning technology) that enable rapid dissemination of scientific knowledge and discourse. Faculty members participating in promotion and tenure academic tracks spend valuable time and effort contributing, editing, and directing these medical journal blogs.

OBJECTIVE

We sought to understand whether chairs of medicine and pediatric departments acknowledge blog authorship as academic achievement.

METHODS

The authors surveyed 267 chairs of US and Canadian medicine and pediatric departments regarding their attitudes toward the role of faculty participation in e-learning and blogging in the promotion and tenure process. The survey completion rate was 22.8% (61/267).

RESULTS

A majority of respondents (87%, 53/61) viewed educational scholarship as either important or very important for promotion. However, only 23% (14/61) perceived importance to faculty effort in producing content for journal-based blogs. If faculty were to participate in blog authorship, 72% (44/61) of surveyed chairs favored involvement in a journal-based versus a society-based or a personal (nonaffiliated) blog. We identified a "favorable group" of chairs (19/59, 32%), who rated leadership roles in e-learning tools as important or very important, and an "unfavorable group" of chairs (40/59, 68%), who rated leadership roles in e-learning tools as somewhat important or not important. The favorable group were more likely to be aware of faculty bloggers within their departments (58%, 11/19 vs 25%, 10/40), viewed serving on editorial boards of e-learning tools more favorably (79%, 15/19 vs 31%, 12/39), and were more likely to value effort spent contributing to journal-based blogs (53%, 10/19 vs 10%, 4/40).

CONCLUSIONS

Our findings demonstrate that although the majority of department chairs value educational scholarship, only a minority perceive value in faculty blogging effort.

Making connections and promoting the profession: Social media use by World Federation of Occupational Therapists member organisations

Background

World Federation of Occupational Therapists (WFOT) member organisations comprise 77 national occupational therapy organisations across the world. Each national organisation interacts with its members and the public using diverse methods. Increasingly, national organisations are broadening their communication methods.

Objective

The objective of this study was to examine if and how occupational therapy organisations are using social media for communication, and if so, the types of concerns or barriers they experience and what role they anticipate social media might play in the near future.

Methods

An online survey was developed; 57 of 77 WFOT member organisations responded.

Findings

This study identified that WFOT national organisations are using social media, to varying degrees, with or without an individual formally assigned to manage social media. Respondents reported that they used social media to: communicate with members, promote the organisation and promote the profession. Commonly expressed needs included assistance with guidelines for ethical social media use, developing technical expertise, and recognition of limits of time and competing priorities. Recommendations arising from this research are at the global, national, local and individual levels and incorporate active dissemination and pure diffusion approaches. Taking steps to increase the use of social media could indirectly impact occupational therapy practice through enhancing organisations’ abilities to support practitioners to enhance their practice.

Limitations and recommendations for further research

Although 57% of WFOT member organisations returned usable responses, there may be some additional perspectives that were not captured. It would be helpful to contact non-responding organisations to explore their social media use and plans. Further research could examine how future initiatives put in place by WFOT impact social media use by member organisations.

Women's experiences of how their recovery process is promoted after a first myocardial infarction: Implications for cardiac rehabilitation care

BACKGROUND

A rapid improvement in the care of myocardial infarction (MI) in the emergency services has been witnessed in recent years. There is, however, a lack of understanding of the factors involved in a successful recovery process, after the initial stages of emergency care among patients, and in particular those who are women. Both preventive and promotive perspectives should be taken into consideration for facilitating the recovery process of women after a MI.

AIM

To explore how women's recovery processes are promoted after a first MI.

METHODS

A qualitative content analysis was used.

FINDINGS

The women's recovery process is a multidirectional process with a desire to develop and approach a new perspective on life. The women's possibility to approach new perspectives on life incorporates how they handle the three dimensions: behaviour, that is, women's acting and engaging in various activities; social, that is, how women receive and give support in their social environment; and psychological, that is, their way of thinking, reflecting, and appreciating life.

CONCLUSIONS

The personal recovery of women is a multidirectional process with a desire to develop and approach a new perspective on life. It is important for cardiac rehabilitation nurses to not only focus on lifestyle changes and social support but also on working actively with the women's inner strength in order to promote the recovery of the women.

Faculty Promotion and Attrition: The Importance of Coauthor Network Reach at an Academic Medical Center

BACKGROUND

Business literature has demonstrated the importance of networking and connections in career advancement. This is a little-studied area in academic medicine.

OBJECTIVE

To examine predictors of intra-organizational connections, as measured by network reach (the number of first- and second-degree coauthors), and their association with probability of promotion and attrition.

DESIGN

Prospective cohort study between 2008 and 2012.

SETTING

Academic medical center.

PARTICIPANTS

A total of 5787 Harvard Medical School (HMS) faculty with a rank of assistant professor or full-time instructor as of January 1, 2008.

MAIN MEASURES

Using negative binomial models, multivariable-adjusted predictors of continuous network reach were assessed according to rank. Poisson regression was used to compute relative risk (RR) and 95 % confidence intervals (CI) for the association between network reach (in four categories) and two outcomes: promotion or attrition. Models were adjusted for demographic, professional and productivity metrics.

KEY RESULTS

Network reach was positively associated with number of first-, last- and middle-author publications and h-index. Among assistant professors, men and whites had greater network reach than women and underrepresented minorities (p < 0.001). Compared to those in the lowest category of network reach in 2008, instructors in the highest category were three times as likely to have been promoted to assistant professor by 2012 (RR: 3.16, 95 % CI: 2.60, 3.86; p-trend <0.001) after adjustment for covariates. Network reach was positively associated with promotion from assistant to associate professor (RR: 1.82, 95 % CI: 1.32, 2.50; p-trend <0.001). Those in the highest category of network reach in 2008 were 17 % less likely to have left HMS by 2012 (RR: 0.83, 95 % CI 0.70, 0.98) compared to those in the lowest category.

CONCLUSIONS

These results demonstrate that coauthor network metrics can provide useful information for understanding faculty advancement and retention in academic medicine. They can and should be investigated at other institutions.

Promotion of the Transition of Adult Patients with Childhood-Onset Chronic Diseases among Pediatricians in Japan

The transition of adult patients with childhood-onset chronic diseases (APCCD) from pediatric to adult health-care systems has recently received worldwide attention. However, Japan is lagging behind European countries and North America as this concept of health-care transition was introduced only 10 years ago. In Japan, before the introduction of this concept, APCCD were referred to as "carryover patients," who were often considered a burden in pediatric practice. In the late 1990s, groups composed of pediatric nephrologists, developmental and behavioral pediatricians, pediatric nurses, and special education teachers researching the quality of life of adult patients with chronic kidney disease began to discuss the physical and psychosocial problems of APCCD. In 2006, a group of pediatricians first introduced the term "transition" in a Japanese journal. By 2010, a group of adolescent nurses had begun a specialized training program aimed at supporting patients during the transitional period. In 2013, the Ministry of Health, Labour and Welfare in Japan convened a research committee, focusing on issues related to social, educational, and medical support for APCCD, and the Japan Pediatric Society established a committee for the health-care transition of APCCD and summarized their statements. Moreover, in 2013, the Tokyo Metropolitan Children's Medical Center initiated ambulatory services for APCCD managed by specialized nurses. The concept of health-care transition has rapidly spread over these past 10 years. The purpose of this article is to describe how this concept of health-care transition has advanced in Japan, such that APCCD now experience a positive pediatric to adult health-care transition.

Off-Label Promotion of Prescription Medicine: Is It Ever Justifiable?

Off-label promotion has attracted intense scrutiny from regulators in recent decades, resulting in many pharmaceutical companies paying hefty penalties for illegal marketing practices. At the same time, the pharmaceutical industry has accused governments of applying double standards by encouraging the use of cheaper off-label alternatives to registered treatments, and defended their "right" to promote off-label drugs on freedom of speech grounds. However, the debate about off-label promotion and the prescribing that results has largely failed to address the issue that really matters-what impact does off-label promotion and prescribing have on patients and the health system? This paper explores the benefits and problems with off-label prescribing to determine whether off-label promotion is ever justified and, if so, under what conditions.

Previously inactive rural adults' experiences of commencing and maintaining a walking routine following participation in a walking intervention

OBJECTIVE

This study aimed to richly describe previously inactive Riverland adults' experiences of commencing and maintaining a walking routine following participation in a walking intervention.

DESIGN

Qualitative description using semi-structured in-depth interviews and thematic analysis.

SETTING

Riverland, South Australia.

PARTICIPANTS

Nine adults (four men and five women) aged between 40 and 65 years.

INTERVENTION

Six-week walking intervention included issuing of pedometers, setting goals, completing logs and weekly emails to remind participants to wear their pedometers, recording of steps and provision of strategies for increasing daily steps.

MAIN OUTCOME MEASURES

Rich description of participants' experiences represented by four themes and a number of subthemes, supported by direct quotes.

RESULTS

Four themes: taking care of me through my walk, pedometers and accountability as motivators, fitting walking in and commencing and maintaining a walking routine.

CONCLUSIONS

The participants' experience of commencing a walking routine differed from maintaining a walking routine. Future attempts to support maintenance of a walking routine may be strengthened through identifying and including ways to provide accountability for walking to others beyond the intervention as well as strategies that support the integration of walking into every activity. Furthermore, future walking interventions should enable participants to tailor their walks to their own preferences and mental health benefits of walking should be promoted at least as much as the physical benefits.

Phosphorylation of TGB1 by protein kinase CK2 promotes barley stripe mosaic virus movement in monocots and dicots

The barley stripe mosaic virus (BSMV) triple gene block 1 (TGB1) protein is required for virus cell-to-cell movement. However, little information is available about how these activities are regulated by post-translational modifications. In this study, we showed that the BSMV Xinjiang strain TGB1 (XJTGB1) is phosphorylated in vivo and in vitro by protein kinase CK2 from barley and Nicotiana benthamiana. Liquid chromatography tandem mass spectrometry analysis and in vitro phosphorylation assays demonstrated that Thr-401 is the major phosphorylation site of the XJTGB1 protein, and suggested that a Thr-395 kinase docking site supports Thr-401 phosphorylation. Substitution of Thr-395 with alanine (T395A) only moderately impaired virus cell-to-cell movement and systemic infection. In contrast, the Thr-401 alanine (T401A) virus mutant was unable to systemically infect N. benthamiana but had only minor effects in monocot hosts. Substitution of Thr-395 or Thr-401 with aspartic acid interfered with monocot and dicot cell-to-cell movement and the plants failed to develop systemic infections. However, virus derivatives with single glutamic acid substitutions at Thr-395 and Thr-401 developed nearly normal systemic infections in the monocot hosts but were unable to infect N. benthamiana systemically, and none of the double mutants was able to infect dicot and monocot hosts. The mutant XJTGB1T395A/T401A weakened in vitro interactions between XJTGB1 and XJTGB3 proteins but had little effect on XJTGB1 RNA-binding ability. Taken together, our results support a critical role of CK2 phosphorylation in the movement of BSMV in monocots and dicots, and provide new insights into the roles of phosphorylation in TGB protein functions.