'Moving on and feeling good' : a feasibility study to explore the lifestyle behaviours of young adults with intellectual disabilities as they transition from school to adulthood—a study protocol

Background: The transition from adolescence to adulthood is a ‘high-risk’ period for weight gain in the general population. There is speculation that this may also be a risk period for adults with intellectual disabilities; however, there has been no research which has monitored change in health indicators. Since adults with intellectual disabilities have higher rates of obesity and engage in more sedentary behaviour and less physical activity than the general population, there is a need to understand more about the lifestyle behaviours of this population during the transition to adulthood. This protocol paper will provide details of the moving on and feeling good feasibility study, designed for young people with intellectual disabilities. Methods/design: A multi-point recruitment strategy will be used to recruit 30 participants with a mild-moderate level of intellectual disability. The aim of the feasibility study is to examine the feasibility of recruitment, participant retention and the measurement of relevant health behaviour outcomes. The study will assess the feasibility of monitoring weight, diet and physical activity levels in adolescents over a 12-month transitional period from school to adult life. This mixed method study will provide insight into the lives of young people with intellectual disabilities and will examine the use of Walker et al.’s social-ecological approach to promote self-determination specific to lifestyle behaviours, during this transition period. Baseline data will be collected during the final year of school, with follow-up data collection at 6 and 12 months. Anthropometric (weight, height, waist and hip circumference), objective physical activity measures (7-day accelerometer wear) and dietary and choice measures will be collected at each time point to assess the feasibility of measuring diet patterns, food frequency, physical activity and BMI. Furthermore, ten participants will be selected for short semi-structured scoping interviews at baseline and 12-month follow-up, to gain information on psychological, social and environmental factors which might affect behaviour change. Discussion: The outcomes from the feasibility study will aid the development and piloting of a sufficiently powered randomised controlled trial. This would allow us to evaluate the effectiveness and sustainability of a lifestyle behaviour intervention, over a 5-year transition period

The Role of the Solicitor in the Children's Hearings System : A Study Commissioned by the Scottish Legal Aid Board

In 2015, the Scottish Legal Aid Board (SLAB) commissioned the Centre for Excellence for Looked After Children in Scotland (CELCIS) to carry out a piece of research looking at the role of solicitors in the children’s hearings system. This research took place between July and December 2015, and was designed to address the following five topics: • Defining the ethos of the children’s hearings system and applying this to solicitors • The role and impact of solicitors in the modernised children’s hearings system • How to achieve a fair and consistent approach to monitoring compliance • How best to get feedback from professional and non-professional stakeholders • Training of solicitors on children’s hearings The role of solicitors in the children’s hearings system has taken on greater importance over the last five years, as the number of solicitors attending hearings proceedings is perceived to have increased since Part 19 of the Children’s Hearings (Scotland) Act 2011 (The Scottish Executive, 2011) enabled the provision of legal aid to both children and relevant others. In order to gather information, the study included nationwide surveys with solicitors, social workers, reporters, and panel members, followed by focus groups with these same groups. In addition, the study included key informant interviews with various professional stakeholders and interviews with three young people with experience of solicitors in the children’s hearing system

Development and feasibility testing of an intervention to support active lifestyles in youths with Type 1 diabetes - the ActivPals programme : a study protocol

Background/objective: The global incidence of Type 1 diabetes is rising and youths with Type 1 diabetes continue to suffer poorer health than peers without diabetes. Evidence suggests youths with Type 1 diabetes have Physical Activity (PA) levels well below the recommendations for health and have high levels of sedentary behavior. An active lifestyle is therefore recommended to improve health. There is limited research showing effective lifestyle behavior change in this population, therefore an evidence gap exists between the need to promote physical activity in Type 1 diabetes care and lack of understanding on how to do this. This protocol paper describes a feasibility and pilot study of the ActivPals programme – an intervention to support active lifestyles in youths with Type 1 diabetes. Methods and design: Key intervention components have been identified from preliminary work (individual and family focus, peer mentoring, technology integration and improved communication and understanding) and are being developed into a pragmatic randomised controlled trial (RCT) supported by recruitment pathways. A steering group of health care professionals and managers will refine the intervention to patient needs. A pilot trial is providing data on intervention implementation, acceptability and feasibility. 20 youths with Type 1 diabetes are being recruited and randomised into an intervention or control group. Physical activity is being measured objectively using the Actigraph GT3X+ monitor at baseline and one month follow-up. Contextual factors associated with intervention delivery are being explored. Conclusions: This study will contribute to the development of evidence based, user informed and pragmatic interventions leading to healthier lifestyles in youths with Type 1 diabetes

Understanding students’ experiences in a PE, health and well-being context:a self-determination theory perspective

Framed by Self-Determination Theory, this investigation explored student experience as they engaged in their physical education (PE), health and well-being (HWB) curriculum in Scotland for the first time. We aimed to uncover the features of various learning environments that appeared to impact upon student motivation in PE over the period one academic year. We carried out focus group interviews with students from one state secondary school (secondary 1 and 2; ages 12–14) and its feeder primary schools (primary 7; age 11 years) immediately after a selection of PE lessons throughout the year. Furthermore, to provide some additional context for our analysis, the students in each year completed a questionnaire (pre–post) to identify and understand their motivation for PE over time. The results from the interviews indicated that students had a number of positive and negative PE experiences. However, the results from the questionnaire demonstrate that the students’ experiences during the first year of this ‘new’ curriculum had little impact on their motivation for PE. The findings highlight the importance of mixed methods research to provide context-specific account of student experience. This detail may be critical for the development of informed and effective pedagogy that supports student learning, health and well-being

Acute abdomen caused by bladder rupture attributable to neurogenic bladder dysfunction following a stroke: a case report.

INTRODUCTION: Spontaneous bladder rupture is a rare and serious event with high mortality. It is not often considered in the patient presenting with peritonitis. This often leads to delays in diagnosis. There are very few case reports of true spontaneous rupture in the literature. This is the first such reported case in which bladder rupture was attributable to neurogenic bladder dysfunction following a stroke. CASE PRESENTATION: We report the case of a 67-year-old Caucasian man who presented with lower abdominal pain and a peritonitic abdomen. He had a long-term urethral catheter because of urinary retention following a previous stroke. He was treated conservatively with antibiotics before a surgical opinion was sought. Exploratory laparotomy confirmed the diagnosis of spontaneous bladder rupture. After repair of the defect, he eventually made a full recovery. CONCLUSION: In this unusual case report, we describe an example of a serious event in which delays in diagnosis may lead to increased morbidity and mortality. To date, no unifying theory explaining why rupture occurs has been postulated. We conducted a thorough literature search to examine the etiological factors in other published cases. These etiological factors either increase intra-vesical pressure or decrease the strength of the bladder wall. We hope that by increasing awareness of these etiological factors, spontaneous bladder rupture may be diagnosed earlier and appropriate therapy started

Correlates of objectively measured sedentary time in adults with intellectual disabilities

Sedentary behaviour is an independent risk factor for adverse health conditions. Adults with intellectual disabilities spend a high proportion of their day engaged in sedentary behaviour, however, there is limited evidence on potential correlates of objectively measured sedentary behaviour in this population group. In Glasgow, UK from July to September 2017, a secondary analysis of pooled baseline accelerometer data from two randomised controlled trials of lifestyle behaviour change programmes was conducted. Backwards linear regression was used to investigate the associations between demographic, biological, and environmental correlates and objective measure of sedentary behaviour (percentage of time spent sedentary). One-hundred and forty-three participants provided valid accelerometer data. Mean percentage time spent sedentary (adjusted for wear time) was 72.9% [Standard Deviation (SD) = 8.7] per day. In the final model, physical and mental health problems were significantly (p < 0.05) associated with increased percentage time spent sedentary. This is the first study to provide evidence on multi-level, demographic, biological, and environmental correlates of objectively measured sedentary behaviour in adults with intellectual disabilities. To inform the development of interventions to modify sedentary behaviours in adults with intellectual disabilities, further research is required including a wide range of socio-ecological correlates

Process evaluation of the Walk Well study : a cluster-randomised controlled trial of a community based walking programme for adults with intellectual disabilities

Background: Walking interventions can be effective in encouraging sedentary populations to become more active; however, limited research has explored the effectiveness of walking interventions for adults with intellectual disabilities. This process evaluation explored the delivery of a community based walking intervention for adults with intellectual disabilities. Methods: Walk Well was a single-blind cluster randomised controlled trial of a 12-week physical activity consultation-led walking intervention. 102 participants were randomised to the Walk Well intervention or a waiting list control group. Participants in the intervention group received three physical activity consultations with a walking advisor at baseline, 6 & 12-weeks. They were encouraged to use a pedometer to set goals and monitor their daily step count. Primary outcome was change in daily step count at 12-weeks. Process evaluation measures included qualitative interviews with key stakeholders (n = 6) and quantifiable data collected as part of the intervention. Additional process data were extracted from a sub-set of qualitative interviews with participants and carers (n = 20). Data were analysed for process information related to context, recruitment and retention, reach, implementation, and fidelity. Results: Walk Well was not effective in significantly increasing levels of physical activity. The process evaluation did, however, highlight several important areas for consideration in future studies, including: a successful recruitment and retention strategy reaching a representative sample of adults with intellectual disabilities in the community; feasible and (for most) enjoyable methods of engaging adults with intellectual disabilities in activities to support behaviour change; potential need for greater intervention duration and frequency of contact; advantages and disadvantages of using pedometers as a behaviour change tool; the need for strategies which engage carers in supporting participants; and the complex issue of ‘freedom of choice’ in relation to lifestyle behaviours and study participation. Conclusions: Walking interventions for adults with intellectual disabilities can be feasibly delivered in the community in relation to reach, recruitment, retention and intervention fidelity. More intensive intervention methods need to be explored as well as strategies to engage and motivate carers in their support of participants

Comparison of the two most commonly used treatments for pyoderma gangrenosum: results of the STOP GAP randomised controlled trial

Objective To determine whether ciclosporin is superior to prednisolone for the treatment of pyoderma gangrenosum, a painful, ulcerating skin disease with a poor evidence base for management. Design Multicentre, parallel group, observer blind, randomised controlled trial. Setting 39 UK hospitals, recruiting from June 2009 to November 2012. Participants 121 patients (73 women, mean age 54 years) with clinician diagnosed pyoderma gangrenosum. Clinical diagnosis was revised in nine participants after randomisation, leaving 112 participants in the analysis set (59 ciclosporin; 53 rednisolone). Intervention Oral prednisolone 0.75 mg/kg/day compared with ciclosporin 4 mg/kg/day, to a maximum dose of 75 and 400 mg/day, respectively. Main outcome measures The primary outcome was speed of healing over six weeks, captured using digital images and assessed by blinded investigators. Secondary outcomes were time to healing, global treatment response, resolution of inflammation, self reported pain, quality of life, number of treatment failures, adverse reactions, and time to recurrence. Outcomes were assessed at baseline and six weeks and when the ulcer had healed (to a maximum of six months). Results Of the 112 participants, 108 had complete primary outcome data at baseline and six weeks (57 ciclosporin; 51 rednisolone). Groups were balanced at baseline. The mean (SD) speed of healing at six weeks was −0.21 (1.00) cm2/day in the ciclosporin group compared with −0.14 (0.42) cm2/day in the prednisolone group. The adjusted mean difference showed no between group difference (0.003 cm2/day, 95% confidence interval −0.20 to 0.21; P=0.97). By six months, ulcers had healed in 28/59 (47%) participants in the ciclosporin group compared with 25/53 (47%) in the prednisolone group. In those with healed ulcers, eight (30%) receiving ciclosporin and seven (28%) receiving prednisolone had a recurrence. Adverse reactions were similar for the two groups (68% ciclosporin and 66% prednisolone), but serious adverse reactions, especially infections, were more common in the prednisolone group. Conclusion Prednisolone and ciclosporin did not differ across a range of objective and patient reported outcomes. Treatment decisions for individual patients may be guided by the different side effect profiles of the two drugs and patient preference. Trial registration Current Controlled Trials ISRCTN35898459

Improving the Quality of Dentistry (IQuaD):a cluster factorial randomised controlled trial comparing the effectiveness and cost-benefit of oral hygiene advice and/or periodontal instrumentation with routine care for the prevention and management of periodontal disease in dentate adults attending dental primary care

Acknowledgements The authors wish to thank Mark Forrest and the programming team at CHaRT; Cynthia Fraser, our information specialist, for assistance with referencing; Moira Swan, who was the dental research nurse and part of the OA team in Newcastle upon Tyne; Louise Campbell for secretarial support and data management; our original statistician in the group, Andy Elders; senior IT manager Gladys Macpherson; senior trial administrator at the TCOD Marilyn Laird; Luke Vale for his involvement with the design of the health economic analysis at the inception of the trial; Maria Dimitrova, who assisted the health economists in the collection of unit costs; staff of the Scottish Primary Care Research Network, who assisted with screening eligible patients at dental practices; staff of the North East Commissioning Support Unit who assisted with research payments to dental practices in the north-east; members of the TMC and Periodontal Advisory Group for their ongoing advice and support of the trial; the independent members of the TSC and DMC; and the staff at recruitment sites who facilitated recruitment, treatment and follow-up of trial participants. The Health Services Research Unit and the Health Economics Research Unit is core funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorate.Peer reviewedPublisher PD