The coronavirus outbreak: the central role of primary care in emergency preparedness and response

On the last day of 2019, a cluster of cases of a pneumonia with unknown cause were reported by the Chinese authorities to the World Health Organization (WHO), believed to be connected to a seafood market in Wuhan, China. This market was closed the following day. On 7 January 2020, a novel coronavirus was isolated, and known pathogens were ruled out.1 Coronaviruses usually cause respiratory illness ranging from the common cold to severe acute respiratory syndrome (SARS). Clinical symptoms and signs of the Wuhan coronavirus include fever, with some sufferers experiencing difficulty breathing and bilateral pulmonary infiltrates seen on chest X-ray. WHO are referring to it as ‘2019-nCov’. At the time of writing, there have been over 4,500 confirmed cases and 106 deaths, including among healthcare workers. Over 98% of these cases are within mainland China, but cases have also been confirmed in tens of other countries

Building civic architecture in cyberspace: digital civic spaces and the people who create them

At the same time as we are seeing ever increasing numbers of people actively using social networking sites, and growing evidence of increased participation in campaigning and digital activism, we are seeing a decline in democratic participation in the UK at both a national and local level. This thesis examines these two contrasting effects within the context of Local Government in the UK and explores what the impact might be at the neighbourhood level. The work discusses the influence of place based online activity on democratic decision-making Local Government and the ways in which traditional processes of decision-making, democratic participation and community engagement practice may need to change to reflect the upward pressure that is being exerted by citizen use of new technologies and adjust the way in which Local Government facilitates citizen participation in decision-making. The work develops the concept of Digital civic space as an alternative to eParticipation platforms and discusses how such spaces are being used to connect online activity with democratic processes at present and how present experience may be used to inform future developments. Employing an Action Research method, the research analyses three projects in order to examine the nature of the pre-existing participation online and the impact of creating online civic spaces to connect the participants both to each other and to local decision-makers. Design criteria are proposed which describe the necessary qualities of public-ness, openness, co-production, definition of place and identity and the thesis reaches conclusions as to how these criteria might better connect local resident with the democratic decision-making processes for their communities

Long-term effects of the Active for Life Year 5 (AFLY5) school-based cluster randomised controlled trial

Objective: To investigate the long-term effectiveness of a school-based intervention to improve physical activity and diet in children. Design: Cluster-randomised controlled trial. Setting: 60 primary schools in the southwest of England. Participants: Primary school children who were aged 8-9 years at recruitment, 9-10 years during the intervention and 10-11 years at the long-term follow-up assessment. Intervention: Teacher training, provision of lesson and child-parent interactive homework plans and teaching materials. Main Outcome Measures: Primary outcomes were accelerometer-assessed minutes of moderate to vigorous physical activity (MVPA) per day, accelerometer-assessed minutes of sedentary behaviour per day and reported daily consumption of servings of fruit and vegetables. Results: 60 schools with 2221 eligible children were recruited. As in the previously published assessment immediately after the end of the intervention, none of the three primary outcomes differed between children in schools allocated to the intervention, compared with those in control schools at the end of the long-term follow-up (1 year after the end of the intervention). Differences in secondary outcomes were consistent with those at the immediate follow-up, with no evidence that these had diminished over time. Comparing intervention with control schools, the difference in mean child-reported screen viewing at the weekend was -16.03 min (95% CI -32.82 to 0.73), for servings of snacks per day, the difference was -0.11 (95% CI -0.39 to 0.06), in servings of high-energy drinks per day -0.20 (95% CI -0.39 to -0.01) and in servings of high-fat foods per day -0.12 (95% CI -0.39 to 0.00). None of these reached our predefined level of statistical significance, especially after accounting for multiple testing. Conclusions: School-based curriculum interventions alone are unlikely to have a major public health impact on children's diet and physical activity.Emma L Anderson, Laura D Howe, Ruth R Kipping, Rona Campbell, Russell Jago, Sian M Noble, Sian Wells, Catherine Chittleborough, Tim J Peters, Debbie A Lawlo

Dairy foods and dairy protein consumption is inversely related to markers of adiposity in obese men and women

A number of intervention studies have reported that the prevalence of obesity may be in part inversely related to dairy food consumption while others report no association. We sought to examine relationships between energy, protein and calcium consumption from dairy foods (milk, yoghurt, cheese, dairy spreads, ice-cream) and adiposity including body mass index (BMI), waist (WC) and hip circumference (HC), and direct measures of body composition using dual energy X-ray absorptiometry (% body fat and abdominal fat) in an opportunistic sample of 720 overweight/obese Australian men and women. Mean (SD) age, weight and BMI of the population were 51 ± 10 year, 94 ± 18 kg and 32.4 ± 5.7 kg/m2, respectively. Reduced fat milk was the most commonly consumed dairy product (235 ± 200 g/day), followed by whole milk (63 ± 128 g/day) and yoghurt (53 ± 66 g/day). Overall dairy food consumption (g/day) was inversely associated with BMI, % body fat and WC (all p < 0.05). Dairy protein and dairy calcium (g/day) were both inversely associated with all adiposity measures (all p < 0.05). Yoghurt consumption (g/day) was inversely associated with % body fat, abdominal fat, WC and HC (all p < 0.05), while reduced fat milk consumption was inversely associated with BMI, WC, HC and % body fat (all p < 0.05). Within a sample of obese adults, consumption of dairy products, dairy protein, and calcium was associated with more favourable body composition

Diurnal Time-Activity Budgets Of Schoolmaster Snapper (Lutjanus Apodus) In South Water Caye Marine Reserve (Belize)

Diurnal time-activity budgets from a sample of 588 schoolmaster snapper (Lu^\u27anus apodus. Family Lutjanidae) were recorded over a period of two and a half weeks in the South Water Caye Marine Reserve (Belize) during May and June of 2010. Each fish was observed for a 20-second time period, and the amount of time they spent swimming, stationaiy (resting), foraging, and performing “other” (less common activities) behaviors was recorded. The specific objectives of my study were to: (1) quantitatively describe the behavior of schoolmaster with time-activity budgets, (2) assess differences in schoolmaster size distribution by location (habitat type), and (3) analyze differences in activity budgets within and among varying size classes. Lutjanus apodus spent significantly more time resting (54%) and swimming (44%), than foraging or performing “other” activities (e.g., aggression, and being cleaned). Foraging behavior was rarely observed during daylight observations, which corroborated previous investigations and local knowledge that this species feeds noctumally. Larger schoolmaster dominated reef habitats, whereas the smaller specimens favored shallow intertidal and mangrove habitats. There were significant differences spent in behaviors for all size classes, when size class was used as a criterion. L apodus spent significantly more time swimming during mornings than later in the day, and those observed in the shallowest habitats spent more time swimming than those in deeper habitats

The Active for Life Year 5 (AFLY5) school based cluster randomised controlled trial: study protocol for a randomized controlled trial

Abstract Background Low levels of physical activity, high levels of sedentary behaviour and low levels of fruit and vegetable consumption are common in children and are associated with adverse health outcomes. The aim of this paper is to describe the protocol for a cluster randomised controlled trial (RCT) designed to evaluate a school-based intervention that aims to increase levels of physical activity, decrease sedentary behaviour and increase consumption of fruit and vegetables in school children. Methods/design The Active for Life Year 5 (AFLY5) study is a school-based, cluster RCT that targets school children in Year 5 (age 9-10 years). All state junior/primary schools in the area covered by Bristol City and North Somerset Council are invited to participate; special schools are excluded. Eligible schools are randomised to one of two arms: intervention arm (receive the intervention 2011-2012) and control arm (receive the intervention after the final follow-up assessment, 2013-2014). The primary outcomes of the trial are levels of accelerometer assessed physical activity and sedentary behaviour and questionnaire assessed fruit and vegetable consumption. A number of secondary outcomes will also be measured, including body mass index, waist circumference and overweight/obesity. Outcomes will be assessed at baseline (prior to intervention when the children are in Year 4), at the end of intervention 'immediate follow-up' and '12 months long-term' follow-up. We will use random effects linear and logistic regression models to compare outcomes by randomised arm. The economic evaluation from a societal perspective will take the form of a cost consequence analysis. Data from focus groups and interviews with pupils, parents and teachers will be used to increase understanding of how the intervention has any effect and is integrated into normal school activity. Discussion The results of the trial will provide information about the public health effectiveness of a school-based intervention aimed at improving levels of physical activity, sedentary behaviour and diet in children. Trial registration ISRCTN50133740</p

Effects of n-3 fatty acids, EPA v. DHA, on depressive symptoms, quality of life, memory and executive function in older adults with mild cognitive impairment: a 6-month randomised controlled trial

First published online 20 September 2011Depressive symptoms may increase the risk of progressing from mild cognitive impairment (MCI) to dementia. Consumption of n-3 PUFA may alleviate both cognitive decline and depression. The aim of the present study was to investigate the benefits of supplementing a diet with n-3 PUFA, DHA and EPA, for depressive symptoms, quality of life (QOL) and cognition in elderly people with MCI. We conducted a 6-month double-blind, randomised controlled trial. A total of fifty people aged >65 years with MCI were allocated to receive a supplement rich in EPA (1·67 g EPA + 0·16 g DHA/d; n 17), DHA (1·55 g DHA + 0·40 g EPA/d; n 18) or the n-6 PUFA linoleic acid (LA; 2·2 g/d; n 15). Treatment allocation was by minimisation based on age, sex and depressive symptoms (Geriatric Depression Scale, GDS). Physiological and cognitive assessments, questionnaires and fatty acid composition of erythrocytes were obtained at baseline and 6 months (completers: n 40; EPA n 13, DHA n 16, LA n 11). Compared with the LA group, GDS scores improved in the EPA (P=0·04) and DHA (P=0·01) groups and verbal fluency (Initial Letter Fluency) in the DHA group (P=0·04). Improved GDS scores were correlated with increased DHA plus EPA (r 0·39, P=0·02). Improved self-reported physical health was associated with increased DHA. There were no treatment effects on other cognitive or QOL parameters. Increased intakes of DHA and EPA benefited mental health in older people with MCI. Increasing n-3 PUFA intakes may reduce depressive symptoms and the risk of progressing to dementia. This needs to be investigated in larger, depressed samples with MCI.Natalie Sinn, Catherine M. Milte, Steven J. Street, Jonathan D. Buckley, Alison M. Coates, John Petkov, and Peter R. C. How

Differentiated Instruction

This study wanted to prove that using differentiated instruction in the classroom would improve students\u27 comprehension and learning. It is obvious that it does. Differentiated instruction has so many wonderful ideas and strategies that teachers can, and have used. Teachers need to have an understanding of their students, and then teach in response to student readiness, interest, or learning profile. This undoubtedly takes extra time and a commitment from the classroom teacher, but studies have shown that it is definitely worth the extra effort. Students learn better when they are taught as the individual that they are, rather than the old fashioned lecture hall

A literature review of factors that influence sexually transmitted infection risk in resource-extraction communities: implications for the Marcellus Shale industry in Southwestern Pennsylvania

Pennsylvania has experienced rapid in-migration of workers in response to the "boom" in the Marcellus Shale gas industry throughout many counties in the state. Large-scale natural resource extraction activities can have significant impacts on the health and well-being of communities living in surrounding areas. A comprehensive literature review was conducted on the impact of industry on increases in disease. It was found that the population influx can affect communicable disease patterns as seen in Canadian communities, where the increase in oil and gas extraction was accompanied by a rise in sexually transmitted infection (STI) rates exceeding the provincial average by 22%. Despite being largely preventable and treatable, STIs continue to be a significant public health problem in the US. This essay is a literature review of the effect of resource extraction on STI rates in resource extraction areas and the implications for Marcellus Shale gas extraction in the rural United States (US). STI increases have coincided with the substantial increase of Marcellus Shale drilling activities, but there is currently no direct evidence to link the two phenomena. However, there has been a 56.9% increase in STIs in the Pennsylvania drilling counties in the last six years, compared to a statewide increase of 21.7%. More research is needed to assess the direct impact resource extraction has on communities in the US. The current research on the public health impacts of Marcellus Shale gas extraction has mainly focused on the environmental and occupational effects. However, little has been done to explore the effects on sexual health and related issues that impact the welfare of a community. Specific public health recommendations are needed to develop innovative outreach strategies to address gas workers' health risks which include STI awareness campaigns, condom distribution and onsite STI testing. This review is a critical step in understanding the correlation between gas resource extraction and STIs rates by examining other resource-extraction contexts in order to design prevention and control strategies that can be applied to similar communities in this emerging industry in rural areas of the US

The Relationship Between Socioeconomic Status and CV Risk Factors: The CRONICAS Cohort Study of Peruvian Adults.

BACKGROUND: Variations in the distribution of cardiovascular disease and risk factors by socioeconomic status (SES) have been described in affluent societies, yet a better understanding of these patterns is needed for most low- and middle-income countries. OBJECTIVE: This study sought to describe the relationship between cardiovascular risk factors and SES using monthly family income, educational attainment, and assets index, in 4 Peruvian sites. METHODS: Baseline data from an age- and sex-stratified random sample of participants, ages ≥35 years, from 4 Peruvian sites (CRONICAS Cohort Study, 2010) were used. The SES indicators considered were monthly family income (n = 3,220), educational attainment (n = 3,598), and assets index (n = 3,601). Behavioral risk factors included current tobacco use, alcohol drinking, physical activity, daily intake of fruits and vegetables, and no control of salt intake. Cardiometabolic risk factors included obesity, elevated waist circumference, hypertension, insulin resistance, diabetes mellitus, low high-density lipoprotein cholesterol, and high triglyceride levels. RESULTS: In the overall population, 41.6% reported a monthly family income <US$198, and 45.6% had none or primary education. Important differences were noted between the socioeconomic indicators: for example, higher income and higher scores on an asset index were associated with greater risk of obesity, whereas higher levels of education were associated with lower risk of obesity. In contrast, higher SES according to all 3 indicators was associated with higher levels of triglycerides. CONCLUSIONS: The association between SES and cardiometabolic risk factors varies depending on the SES indicator used. These results highlight the need to contextualize risk factors by socioeconomic groups in Latin American settings