Publications by authors named "Julie Green"

76 Publications

Nursing and Midwifery Council's post-registration standards review: implications for district nursing.

Br J Community Nurs 2020 Dec;25(12):584

Executive Director of Nursing and Allied Health Professionals; Chair, District Nurse Apprenticeship Trailblazer Group; Leeds Community Healthcare and Leeds GP Confederation.

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http://dx.doi.org/10.12968/bjcn.2020.25.12.584DOI Listing
December 2020

Decolonising wound care teaching.

Authors:
Julie Green

Br J Community Nurs 2020 Sep;25(9):421

Dean of Education, Keele University; Chair, Royal College Nursing (RCN) District and Community Nursing Forum.

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http://dx.doi.org/10.12968/bjcn.2020.25.9.421DOI Listing
September 2020

Advance care planning and decision-making in dementia care: a literature review.

Nurs Older People 2020 Jul 15. Epub 2020 Jul 15.

Keele University, Keele, England.

Dementia is the leading cause of death in England and Wales, but traditionally it has not been considered a terminal or life-limiting condition. As a result, little significance may be placed on advance care planning (ACP) for people with dementia. Evidence suggests that most patients with advanced dementia have often not been given an opportunity to complete an advance care plan and have not had conversations with their families about their wishes and preferences at the end of life. This article reports on a literature review that aimed to explore the evidence on the introduction of ACP in achieving preferred place of care or death for people living with dementia, and reducing carer burden. The literature review found that ACP discussions have several benefits for people with dementia and their family carers, but that various factors can support or hinder such discussions. It concludes that these people and their families need to plan for end of life and suggests that ACP can increase the likelihood of achieving their preferred place of care and death and reducing decisional burden for carers.
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http://dx.doi.org/10.7748/nop.2020.e1238DOI Listing
July 2020

COVID-19 and district and community nursing.

Br J Community Nurs 2020 May;25(5):213

District Nurse Team Manager, Chiswick.

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http://dx.doi.org/10.12968/bjcn.2020.25.5.213DOI Listing
May 2020

Evaluating the impact of a coaching pilot on students and staff.

Br J Nurs 2019 Nov;28(21):1394-1398

Placement Quality Lead, Keele University, Staffordshire.

A coaching pilot was developed following the publication of a number of reports that recommended a review into how student nurses are taught in clinical practice. A bespoke version of the Collaborative Learning in Practice (CLiP) model was developed, which used both coaching and peer learning to encourage students to lead the delivery of care for a designated group of patients. A senior student led a team consisting of two junior students and they were given the responsibility of directing and coordinating the team in the manner expected of a registered nurse. A qualified nurse was responsible for the supervision of the students and used a coaching approach to teach. Findings from an evaluation revealed that the students benefitted from being able to work autonomously and were able to enhance their leadership and management skills.
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http://dx.doi.org/10.12968/bjon.2019.28.21.1394DOI Listing
November 2019

Challenges to concordance: theories that explain variations in patient responses.

Br J Community Nurs 2019 Oct;24(10):466-473

Professor of Nursing, Faculty of Education, Health and Wellbeing, Institute of Health, University of Wolverhampton.

To meet the challenges of an increasingly ageing and multimorbid population, patients must be fully engaged to work in partnership with their health professional (HP) in the management of their condition(s). The NHS Long Term Plan (2019) outlines goals to manage the increasing demands on the health service-hospital admission avoidance, shorter length of hospital stays through enhanced recovery pathways, increased management of patients within primary care and ensuring a person-centred approach to care provision. Meeting these goals is predicated on HPs being equipped to activate patients using the skills of motivational interviewing, person-centred care and a willingness to share decision making. This article presents a range of psychological theories that could explain the everyday challenges faced in care delivery. Awareness of these theories may help HPs target their approach to care delivery more effectively, to understand patient responses and, therefore, optimise the provision of person-centred care.
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http://dx.doi.org/10.12968/bjcn.2019.24.10.466DOI Listing
October 2019

District nurse apprenticeship standard-next steps for district nursing.

Br J Community Nurs 2019 May;24(5):205

Head of Practice Learning, Florence Nightingale Faculty of Nursing and Midwifery King's College, London, Chair Association of District Nurse Educators.

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http://dx.doi.org/10.12968/bjcn.2019.24.5.205DOI Listing
May 2019

One-step genome editing of elite crop germplasm during haploid induction.

Nat Biotechnol 2019 03 4;37(3):287-292. Epub 2019 Mar 4.

Seeds Research, Syngenta Crop Protection, Research Triangle Park, North Carolina, United States.

Genome editing using CRISPR-Cas9 works efficiently in plant cells, but delivery of genome-editing machinery into the vast majority of crop varieties is not possible using established methods. We co-opted the aberrant reproductive process of haploid induction (HI) to induce edits in nascent seeds of diverse monocot and dicot species. Our method, named HI-Edit, enables direct genomic modification of commercial crop varieties. HI-Edit was tested in field and sweet corn using a native haploid-inducer line and extended to dicots using an engineered CENH3 HI system. We also recovered edited wheat embryos using Cas9 delivered by maize pollen. Our data indicate that a transient hybrid state precedes uniparental chromosome elimination in maize HI. Edited haploid plants lack both the haploid-inducer parental DNA and the editing machinery. Therefore, edited plants could be used in trait testing and directly integrated into commercial variety development.
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http://dx.doi.org/10.1038/s41587-019-0038-xDOI Listing
March 2019

What a difference a year makes: the impact of the district nursing specialist practice programme.

Authors:
Julie Green

Br J Community Nurs 2018 Sep;23(9):439-448

Queen's Nurse, RCN Professional Nursing Committee member, RCN District Nurse Forum Chair and member of the Association of District Nurse Educators.

District nursing has a long history as a service that provides care for patients in their home environment. Demographic changes and a need to optimise out of hospital care has impacted on the acuity of patients supported and the complexity of caseload management. District nurses, in order to effectively manage such increased demands on their busy service, need to possess excellent, assertive case management skills. This study explores and evaluates the impact of the Specialist Practice Qualification in district nursing on the assertiveness and leadership skills of students. A mixed methods approach was adopted, utilising a quantitative assertiveness questionnaire at three points during the programme across the 12 participating higher education institutions, alongside qualitative semi-structured interviews. Statistical analysis of assertiveness scores demonstrated a statistically significant increase in scores across the duration of the programmes, with no difference related to the academic level of programme studied. Qualitative analysis demonstrated wide ranging positive impacts of the programme, including the acquisition of knowledge of underpinning theory, enhanced leadership skills and the development of a voice to truly advocate for the patient. The Specialist Practice Qualification has a dramatic impact on the professional performance of students selected to undertake the programme. The programme is frequently at risk as a result of cuts in post-registration funding. This study effectively demonstrates the substantial impact of the programme; a programme that should remain an option for future district nurses.
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http://dx.doi.org/10.12968/bjcn.2018.23.9.439DOI Listing
September 2018

What a great opportunity.

Br J Community Nurs 2018 Jun;23(6):265

Deputy Director of Nursing and Quality, Leeds Community Healthcare NHS Trust, Leeds.

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http://dx.doi.org/10.12968/bjcn.2018.23.6.265DOI Listing
June 2018

Chronic venous leg ulcer care: Putting the patient at the heart of leg ulcer care Part 2: Development and evaluation of the consultation template.

Br J Community Nurs 2018 Jun;23(6):S20-S30

Lecturer, Director of Learning and Teaching, School of Nursing and Midwifery, Keele University, Staffordshire, ST4 6QG.

Part 2 in this article series summarises the final two phases of a study which explored the experiences of patients with leg ulcers and the impact of this condition on their quality of life. Early phases of the study revealed a mismatch between issues that affected a patient's quality of life and what they discussed during subsequent health care consultations. In light of this, a nominal group technique was employed to facilitate the development of a new leg ulcer consultation template with patient partners. The aim of this was to include many of the issues raised in phases 1. The new template was evaluated in terms of its utility, significance and clinical potential. The application of this template during routine consultations appears to encourage the patient to disclose issues that are important to them and may have otherwise been overlooked.
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http://dx.doi.org/10.12968/bjcn.2018.23.Sup6.S20DOI Listing
June 2018

What a great opportunity.

Br J Community Nurs 2018 Jun;23(6):213

Deputy Director of Nursing and Quality, Leeds Community Healthcare NHS Trust, Leeds.

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http://dx.doi.org/10.12968/bjcn.2018.23.6.213DOI Listing
June 2018

Non-disclosure of symptoms in primary care: an observational study.

Fam Pract 2018 12;35(6):706-711

Haywood Academic Rheumatology Centre, Staffordshire and Stoke-on-Trent Partnership Trust, Stoke-on-Trent, Staffordshire, UK.

Background: Symptoms form a major component of patient agendas, with the need for an explanation of symptoms being a prominent reason for consultation.

Objectives: To estimate the prevalence of different symptoms pre-consultation, to investigate whether intention to mention a symptom in the consultation varied between patients and across symptoms, and to determine how patients' intended agendas for mentioning symptoms compared with what was discussed.

Method: We videorecorded consultations of an unselected sample of people aged 45 and over consulting their GP in seven different practices in UK primary care. A pre-consultation questionnaire recorded the patient's agenda for the consultation, current symptoms and symptoms the patient intended to discuss with their GP. The videorecorded consultation was viewed and all patient agendas and 'symptoms with intention to discuss' were compared with the actual topics of discussion.

Results: Totally, 190 patients participated. Eighty-one (42.6%) were female and the mean age was 68 (range 46-93). Joint pain was the most commonly reported symptom. One hundred thirty-nine (81.8% of those reporting symptoms) patients reported intention to discuss a symptom. In 43 (22.6%) consultations, 67 symptoms (27.2%), where an intention to discuss had been expressed, remained undisclosed. Tiredness and sleeping difficulty were more likely to be withheld than other symptoms after an intention to discuss had been expressed. Of the more physically located symptoms, joint pain was the most likely to remain undisclosed.

Conclusion: This study suggests that the extent of symptom non-disclosure varies between patients, physicians and symptoms. Further work needs to explore the consequences of non-disclosure.
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http://dx.doi.org/10.1093/fampra/cmy023DOI Listing
December 2018

Using a modified Delphi methodology to gain consensus on the use of dressings in chronic wounds management.

J Wound Care 2018 03;27(3):156-165

Director of Research, Professor, Office of Health Economics, Victoria Street, London.

Objective: Managing chronic wounds is associated with a burden to patients, caregivers, health services and society and there is a lack of clarity regarding the role of dressings in improving outcomes. This study aimed to provide understanding on a range of topics, including: the definition of chronicity in wounds, the burden of illness, clinical outcomes of reducing healing time and the impact of early interventions on clinical and economic outcomes and the role of matrix metalloproteinases (MMPs) in wound healing.

Method: A systematic review of the literature was carried out on the role of dressings in diabetic foot ulcer (DFU), and venous leg ulcer (VLU) management strategies, their effectiveness, associated resource use/cost, and quality of life (QoL) impact on patients. From this evidence-base statements were written regarding chronicity in wounds, burden of illness, healing time, and the role of MMPs, early interventions and dressings. A modified Delphi methodology involving two iterations of email questionnaires followed by a face-to-face meeting was used to validate the statements, in order to arrive at a consensus for each. Clinical experts were selected, representing nurses, surgeons, podiatrists, academics, and policy experts.

Results: In the first round, 38/47 statements reached or exceeded the consensus threshold of 80% and none were rejected. According to the protocol, any statement not confirmed or rejected had to be modified using the comments from participants and resubmitted. In the second round, 5/9 remaining statements were confirmed and none rejected, leaving 4 to discuss at the meeting. All final statements were confirmed with at least 80% consensus.

Conclusion: This modified Delphi panel sought to gain clarity from clinical experts surrounding the use of dressings in the management of chronic wounds. A full consensus statement was developed to help clinicians and policy makers improve the management of patients with these conditions.
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http://dx.doi.org/10.12968/jowc.2018.27.3.156DOI Listing
March 2018

Chronic venous leg ulcer care: Putting the patient at the heart of leg ulcer care. Part 1: exploring the consultation.

Br J Community Nurs 2018 Mar;23(Sup3):S30-S38

Lecturer, Director of Learning and Teaching, School of Nursing and Midwifery, Keele University, Staffordshire, ST4 6QG.

This article, the first of two, summarises a study that explored the lived experiences of patients with leg ulcers and the impact of this condition on their quality of life. The study had four study phases; phases 1 and 2 employed qualitative methods and are reported here. Initially, unstructured interviews were held; these revealed significant issues for the patients including the dominance of pain, issues relating to exudate and odour, social isolation and psychological effects. A checklist based on these issues was completed by the researcher during observations of routine care for these same patients; this revealed the extent and depth to which these matters were addressed. On many occasions, significant issues were not disclosed or explored during consultations. These findings confirmed that participants with chronic venous leg ulcers have concerns far beyond wound care.
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http://dx.doi.org/10.12968/bjcn.2018.23.Sup3.S30DOI Listing
March 2018

Effectiveness of a patient education plan on knowledge of post-op venous thromboembolism survival skills.

J Clin Nurs 2018 Apr 21;27(7-8):e1485-e1493. Epub 2018 Feb 21.

Office of Nursing Research and Innovation, Cleveland Clinic, Cleveland, OH, USA.

Aims And Objectives: To investigate the effectiveness of a multimethod venous thromboembolism prevention patient education plan on participants' knowledge retention.

Background: A potential complication of surgery requiring general anaesthesia, worldwide, is the development of life-threatening venous thromboembolism. Patients need education on preventing, recognising and immediately responding to a suspected thromboembolism. Written instructional materials given to patients at discharge may be inadequate.

Design: A randomised controlled trial.

Methods: Setting was multiple general surgery units at a large Midwestern United States academic medical centre. Sample included patients recovering from surgery with general anaesthesia: (N = 66), 68% female, 34 = experimental, 32 = usual care. Prior to discharge, participants in the experimental group were given a multimethod venous thromboembolism prevention education plan including a video, pamphlet and verbal instruction; control group received usual instructional pamphlet. Both groups received a knowledge test immediately before instruction. Two weeks following discharge, a phone call was made to participants to complete the postinstruction test. The relevant EQUATOR guideline, CONSORT checklist, was used for reporting this study.

Conclusions: There were no statistically significant differences in age, gender, race, length of stay, surgery and history of venous thromboembolism among participants and group or test score results. No statistically significant difference in postinstruction score was found between groups. However, there was a trend in greater perception of importance in all groups and higher knowledge scores in the experimental group, with the percentage of participants in the experimental group answering all questions correctly rising from 38.2% correct to 73.5% correct.

Relevance To Clinical Practice: Teaching patients the importance of knowing venous thromboembolism signs and preventive/survival skills is potentially life-saving and nurses must know the importance of using the most effective methods for the learning needs of their patients. Further research including different education methods and testing is suggested.
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http://dx.doi.org/10.1111/jocn.14270DOI Listing
April 2018

What Influences Parents' Fear about Children's Independent Mobility? Evidence from a State-Wide Survey of Australian Parents.

Am J Health Promot 2018 03 22;32(3):667-676. Epub 2017 Nov 22.

1 Judith Lumley Centre, La Trobe University, Melbourne, Australia.

Purpose: To identify factors associated with generalized and stranger-specific parental fear (PF) about children's independent mobility (CIM), a critical aspect of physical activity.

Design: Cross-sectional survey; random sampling frame, minimum quotas of fathers, rural residents.

Setting: State of Victoria, Australia.

Subjects: Parents of children aged 9 to 15 years (n = 1779), 71% response rate.

Measures: Validated measures of PF and fear of strangers (FoS); parent, child, social, and environmental factors.

Analysis: Unadjusted and adjusted linear regression stratified by child age (9-10; 11-13; 14-15).

Results: Adjusted models explained a substantial proportion of variance across all age groups (PF: 33.6%-36.7%; FoS: 39.1%-44.0%). Perceived disapproval from others was consistently associated with both outcomes (PF: β =.11 to 23, p ≤ .05; FoS: β =.17-.21, p ≤ .001) as was parents' perception of children's competence to travel safely (PF: β = -.24 to -.11, p ≤ .05; FoS: β = -.16 to -.13, p ≤ .01). Factors associated with FoS included having a female child (β = -.21 to -.13, p ≤ .001), language other than English (β = .09 to.11, p ≤ .01), and low levels of parent education (β = -.14 to -08, p ≤ .05).

Conclusion: The current study suggests that social norms, child competence, and perceptions about the benefits of CIM underpin PF. This evidence informs the development of interventions to reduce PF and promote CIM and children's physical activity.
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http://dx.doi.org/10.1177/0890117117740442DOI Listing
March 2018

What's in a name? Is district nursing in danger of extinction?

Br J Community Nurs 2017 Nov;22(11):547-549

Deputy Director of Nursing and Quality, Leeds Community Healthcare NHS Trust.

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http://dx.doi.org/10.12968/bjcn.2017.22.11.547DOI Listing
November 2017

Cluster randomised trial of a school-community child health promotion and obesity prevention intervention: findings from the evaluation of fun 'n healthy in Moreland!

BMC Public Health 2017 08 3;18(1):92. Epub 2017 Aug 3.

School of Health and Social Development, Deakin University, Geelong, Australia.

Background: Multi-level, longer-term obesity prevention interventions that focus on inequalities are scarce. Fun 'n healthy in Moreland! aimed to improve child adiposity, school policies and environments, parent engagement, health behaviours and child wellbeing.

Methods: All children from primary schools in an inner urban, culturally diverse and economically disadvantaged area in Victoria, Australia were eligible for participation. The intervention, fun 'n healthy in Moreland!, used a Health Promoting Schools Framework and provided schools with evidence, school research data and part time support from a Community Development Worker to develop health promoting strategies. Comparison schools continued as normal. Participants were not blinded to intervention status. The primary outcome was change in adiposity. Repeated cross-sectional design with nested longitudinal subsample.

Results: Students from twenty-four primary schools (clusters) were randomised (aged 5-12 years at baseline). 1426 students from 12 intervention schools and 1539 students from 10 comparison schools consented to follow up measurements. Despite increased prevalence of healthy weight across all schools, after 3.5 years of intervention there was no statistically significant difference between trial arms in BMI z score post-intervention (Mean (sd): Intervention 0.68(1.16); Comparison: 0.72(1.12); Adjusted mean difference (AMD): -0.05, CI: -0.19 to 0.08, p = 0.44). Children from intervention schools consumed more daily fruit serves (AMD: 0.19, CI:0.00 to 0.37, p = 0.10), were more likely to have water (AOR: 1.71, CI:1.05 to 2.78, p = 0.03) and vegetables (AOR: 1.23, CI: 0.99 to 1.55, p = 0.07), and less likely to have fruit juice/cordial (AOR: 0.58, CI:0.36 to 0.93, p = 0.02) in school lunch compared to children in comparison schools. More intervention schools (8/11) had healthy eating and physical activity policies compared with comparison schools (2/9). Principals and schools highly valued the approach as a catalyst for broader positive school changes. The cost of the intervention per child was $65 per year.

Conclusion: The fun n healthy in Moreland! intervention did not result in statistically significant differences in BMI z score across trial arms but did result in greater policy implementation, increased parent engagement and resources, improved child self-rated health, increased fruit, vegetable and water consumption, and reduction in sweet drinks. A longer-term follow up evaluation may be needed to demonstrate whether these changes are sustainable and impact on childhood overweight and obesity.

Clinical Trial Registration: ACTRN12607000385448 (Date submitted 31/05/2007; Date registered 23/07/2007; Date last updated 15/12/2009).
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http://dx.doi.org/10.1186/s12889-017-4625-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5543738PMC
August 2017

Exploring Factors Influencing Childhood Obesity Prevention Among Migrant Communities in Victoria, Australia: A Qualitative Study.

J Immigr Minor Health 2018 Aug;20(4):865-883

Dept. of Marketing, Deakin Business School, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia.

Despite the availability of numerous obesity prevention initiatives in developed countries including Australia, rising childhood obesity levels have been found among migrant communities which contribute to widening obesity-related disparities in these countries. We sought to understand the factors influencing the participation of migrant communities in childhood obesity prevention initiatives. We conducted a qualitative study using semi-structured interviews among 48 migrant parents from African, Middle Eastern, Indian and Vietnamese origins living in disadvantaged areas of Victoria, Australia to explore their views on childhood obesity and its prevention. Thematic analysis showed low obesity literacy among migrant communities, cultural influences negatively impacting their healthy lifestyle behaviours and cultural, family-level and community-level barriers impacting their participation in childhood obesity prevention initiatives. There is an urgent need to improve obesity literacy among migrant communities using bicultural workers in order to improve their responsiveness to childhood obesity prevention initiatives. Health interventionists are urged to incorporate culturally-mediated influences in the design of obesity prevention programs to achieve energy balance and maintain healthy weight among migrants. Such culturally appropriate approaches have the potential of reducing the widening ethnic-related obesity disparities in Australia.
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http://dx.doi.org/10.1007/s10903-017-0620-6DOI Listing
August 2018

MATRILINEAL, a sperm-specific phospholipase, triggers maize haploid induction.

Nature 2017 02 23;542(7639):105-109. Epub 2017 Jan 23.

Seeds Research, Syngenta Crop Protection, 9 Davis Drive, Research Triangle Park, North Carolina 27709, USA.

Sexual reproduction in flowering plants involves double fertilization, the union of two sperm from pollen with two sex cells in the female embryo sac. Modern plant breeders increasingly seek to circumvent this process to produce doubled haploid individuals, which derive from the chromosome-doubled cells of the haploid gametophyte. Doubled haploid production fixes recombinant haploid genomes in inbred lines, shaving years off the breeding process. Costly, genotype-dependent tissue culture methods are used in many crops, while seed-based in vivo doubled haploid systems are rare in nature and difficult to manage in breeding programmes. The multi-billion-dollar maize hybrid seed business, however, is supported by industrial doubled haploid pipelines using intraspecific crosses to in vivo haploid inducer males derived from Stock 6, first reported in 1959 (ref. 5), followed by colchicine treatment. Despite decades of use, the mode of action remains controversial. Here we establish, through fine mapping, genome sequencing, genetic complementation, and gene editing, that haploid induction in maize (Zea mays) is triggered by a frame-shift mutation in MATRILINEAL (MTL), a pollen-specific phospholipase, and that novel edits in MTL lead to a 6.7% haploid induction rate (the percentage of haploid progeny versus total progeny). Wild-type MTL protein localizes exclusively to sperm cytoplasm, and pollen RNA-sequence profiling identifies a suite of pollen-specific genes overexpressed during haploid induction, some of which may mediate the formation of haploid seed. These findings highlight the importance of male gamete cytoplasmic components to reproductive success and male genome transmittance. Given the conservation of MTL in the cereals, this discovery may enable development of in vivo haploid induction systems to accelerate breeding in crop plants.
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http://dx.doi.org/10.1038/nature20827DOI Listing
February 2017

Exploring Service Providers' Perspectives in Improving Childhood Obesity Prevention among CALD Communities in Victoria, Australia.

PLoS One 2016 13;11(10):e0162184. Epub 2016 Oct 13.

School of Social Sciences and Psychology, Western Sydney University, Locked Bag 1797, Penrith, New South Wales, Australia.

Background: Childhood obesity rates have been increasing disproportionately among disadvantaged communities including culturally and linguistically diverse (CALD) migrant groups in Australia due to their poor participation in the available obesity prevention initiatives. We sought to explore service providers' perceptions of the key factors influencing the participation of CALD communities in the existing obesity prevention services and the service requirements needed to improve CALD communities' participation in these services.

Methods: We conducted a qualitative study using focus group discussions involving fifty-nine service providers from a range of services, who are involved in the health and wellbeing of children from CALD groups living in four socioeconomically disadvantaged areas in Victoria, Australia.

Results: Thematic analysis of the data showed three major themes including community-level barriers to CALD engagement in childhood obesity prevention services; service-level barriers to the delivery of these services; and proposed changes to current childhood obesity prevention approaches. Integrating obesity prevention messages within existing programs, better coordination between prevention and treatment services and the establishment of a childhood obesity surveillance system, were some of the important changes suggested by service providers.

Conclusion: This study has found that low CALD health literacy, lack of knowledge of cultural barriers among service providers and co-existing deficiencies in the structure and delivery of obesity prevention services negatively impacted the participation of CALD communities in obesity prevention services. Cultural competency training of service providers would improve their understanding of the cultural influences of childhood obesity and incorporate them into the design and development of obesity prevention initiatives. Service providers need to be educated on the pre-migratory health service experiences and health conditions of CALD communities to ensure equitable delivery of care. Collaborative approaches between health systems, immigrant services, early years' services and community health services are urgently needed to address obesity-related disparities in Australia.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0162184PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5063376PMC
May 2017

Enhancing assertiveness in district nurse specialist practice.

Authors:
Julie Green

Br J Community Nurs 2016 Aug;21(8):400-3

Director of Postgraduate Studies, Lecturer in Nursing and Award Lead for Specialist Community Nursing (District Nursing), School of Nursing and Midwifery, Keele University.

District nurse (DN) care delivery has undergone substantial change in recent years due to changing demographics and service delivery demands that have called for a move of care delivery from secondary to primary care. The title District Nurse is recorded with the Nursing and Midwifery Council (NMC) on completion of the Specialist Practice Qualification in District Nursing (SPQ DN), which purports to be a 'transformational' course that prepares future caseload holders to manage their team and prioritise care delivery effectively. This article explores the need for assertiveness skills in this role in response to Australian research, and outlines the pedagogic interventions implemented during the SPQ DN course to enhance this skill. Assertiveness scores were monitored for the duration of the course and demonstrated a significant increase-a topic that is now the subject of a future, funded study.
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http://dx.doi.org/10.12968/bjcn.2016.21.8.400DOI Listing
August 2016

Readiness of communities to engage with childhood obesity prevention initiatives in disadvantaged areas of Victoria, Australia.

Aust Health Rev 2017 Jul;41(3):297-307

School of Social Sciences and Psychology, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia. Email.

Objective Disadvantaged communities bear a disproportionate burden of childhood obesity and show low participation in childhood obesity prevention initiatives. This study aims to examine the level of readiness of disadvantaged communities to engage with childhood obesity prevention initiatives. Methods Using the community readiness model, 95 semi-structured interviews were conducted among communities in four disadvantaged areas of Victoria, Australia. Community readiness analysis and paired t-tests were performed to assess the readiness levels of disadvantaged communities to engage with childhood obesity prevention initiatives. Results The results showed that disadvantaged communities demonstrated low levels of readiness (readiness score=4/9, 44%) to engage with the existing childhood obesity prevention initiatives, lacked knowledge of childhood obesity and its prevention, and reported facing challenges in initiating and sustaining participation in obesity prevention initiatives. Conclusion This study highlights the need to improve community readiness by addressing low obesity-related literacy levels among disadvantaged communities and by facilitating the capacity-building of bicultural workers to deliver obesity prevention messages to these communities. Integrating these needs into existing Australian health policy and practice is of paramount importance for reducing obesity-related disparities currently prevailing in Australia. What is known about the topic? Childhood obesity prevalence is plateauing in developed countries including Australia; however, obesity-related inequalities continue to exist in Australia especially among communities living in disadvantaged areas, which experience poor engagement in childhood obesity prevention initiatives. Studies in the USA have found that assessing disadvantaged communities' readiness to participate in health programs is a critical initial step in reducing the disproportionate obesity burden among these communities. However, no studies in Australia have assessed disadvantaged communities' readiness to engage in obesity prevention initiatives. What does this paper add? This paper addresses the current gap in the knowledge of disadvantaged communities' level of readiness to engage in childhood obesity prevention initiatives in Australia. The study also identified the key factors responsible for low readiness of disadvantaged communities to participate in current childhood obesity prevention services. By using the Community Readiness model this study shows the readiness levels specific to the various dimensions of the model; Understanding dimension-specific readiness allows us to identify strategies that are tailored to each dimension, as guided by the model. What are the implications for practitioners? With the increasing burden of childhood obesity on disadvantaged communities, policymakers and health practitioners are facing a crisis in obesity prevention and management. Almost every year, new interventions are being planned and implemented. However if the target communities are not ready to participate in the available interventions these efforts are futile. This study exposes the key factors responsible for low readiness to participate in current obesity prevention services by disadvantaged communities. Addressing these key factors and improving readiness before designing new interventions will improve the participation of disadvantaged communities in those interventions. The study findings ultimately have the potential of reducing obesity-related disparities in Australia.
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http://dx.doi.org/10.1071/AH16069DOI Listing
July 2017

Comparison of methods for recruiting and engaging parents in online interventions: study protocol for the Cry Baby infant sleep and settling program.

BMC Pediatr 2015 Nov 10;15:174. Epub 2015 Nov 10.

Murdoch Childrens Research Institute, Royal Children's Hospital, Flemington Road, Parkville, 3052, VIC, Australia.

Background: Anticipatory guidance around the management of sleep and crying problems in early infancy has been shown to improve both infant behaviour and parent symptoms of postnatal depression. Digital technology offers platforms for making such programs widely available in a cost-efficient manner. However, it remains unclear who accesses online parenting advice and in particular, whether the parents who would most benefit are represented amongst users. It is also unknown whether the uptake of online programs can be improved by health professional recommendations, or whether parents require additional prompts and reminders to use the program. In this study we aim to: (1) determine whether weekly email prompts increase engagement with and use of a brief online program about infant sleeping and crying, (2) determine whether encouragement from a maternal and child health nurse promotes greater engagement with and use of the program, (3) examine who uses a brief online program about infant sleeping and crying; and, (4) examine the psychosocial characteristics of participants.

Methods/design: This study is a randomised, parallel group, superiority trial, with all participating primary carers of infants aged 2 to 12 weeks, receiving access to the online program. Two modes of recruitment will be compared: recruitment via an online notice published on a non-commercial, highly credible and evidence-based website for parents and carers and via the parent's Maternal and Child Health nurse. After baseline assessment, parents will be randomised to one of two support conditions: online program alone or online program plus weekly email prompts. Follow up data will be collected at 4 months of infant age.

Discussion: Results from this trial will indicate whether involvement from a health professional, and/or ongoing email contact is necessary to engage parents in a brief online intervention, and promote parental use of strategies suggested within the program. Results of this trial will inform the development of recruitment and engagement strategies for other online interventions.

Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12613001098729. Registered 01 October 2013.
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http://dx.doi.org/10.1186/s12887-015-0502-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4640160PMC
November 2015

Connecting parents with the right information at the right time.

Authors:
Julie Green

Aust Nurs Midwifery J 2015 Apr;22(9):41

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April 2015

The Healthy Migrant Families Initiative: development of a culturally competent obesity prevention intervention for African migrants.

BMC Public Health 2015 Mar 19;15:272. Epub 2015 Mar 19.

Raising Children Network, Parenting Research Centre Level 5, 232 Victoria Parade, East Melbourne, VIC, 3002, Australia.

Background: Although obesity among immigrants remains an important area of study given the increasing migrant population in Australia and other developed countries, research on factors amenable to intervention is sparse. The aim of the study was to develop a culturally-competent obesity prevention program for sub-Saharan African (SSA) families with children aged 12-17 years using a community-partnered participatory approach.

Methods: A community-partnered participatory approach that allowed the intervention to be developed in collaborative partnership with communities was used. Three pilot studies were carried out in 2008 and 2009 which included focus groups, interviews, and workshops with SSA parents, teenagers and health professionals, and emerging themes were used to inform the intervention content. A cultural competence framework containing 10 strategies was developed to inform the development of the program. Using findings from our scoping research, together with community consultations through the African Review Panel, a draft program outline (skeleton) was developed and presented in two separate community forums with SSA community members and health professionals working with SSA communities in Melbourne.

Results: The 'Healthy Migrant Families Initiative (HMFI): Challenges and Choices' program was developed and designed to assist African families in their transition to life in a new country. The program consists of nine sessions, each approximately 1 1/2 hours in length, which are divided into two modules based on the topic. The first module 'Healthy lifestyles in a new culture' (5 sessions) focuses on healthy eating, active living and healthy body weight. The second module 'Healthy families in a new culture' (4 sessions) focuses on parenting, communication and problem solving. The sessions are designed for a group setting (6-12 people per group), as many of the program activities are discussion-based, supported by session materials and program resources.

Conclusion: Strong partnerships and participation by SSA migrant communities enabled the design of a culturally competent and evidence-based intervention that addresses obesity prevention through a focus on healthy lifestyles and healthy families. Program implementation and evaluation will further inform obesity prevention interventions for ethnic minorities and disadvantaged communities.
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http://dx.doi.org/10.1186/s12889-015-1628-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4372278PMC
March 2015

Adenosine signaling promotes hematopoietic stem and progenitor cell emergence.

J Exp Med 2015 May 13;212(5):649-63. Epub 2015 Apr 13.

Stem Cell Program, Division of Hematology/Oncology, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, MA 02115 Harvard Stem Cell Institute, Howard Hughes Medical Institute, and Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA 02138 Harvard Stem Cell Institute, Howard Hughes Medical Institute, and Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA 02138 Harvard Stem Cell Institute, Howard Hughes Medical Institute, and Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA 02138

Hematopoietic stem cells (HSCs) emerge from aortic endothelium via the endothelial-to-hematopoietic transition (EHT). The molecular mechanisms that initiate and regulate EHT remain poorly understood. Here, we show that adenosine signaling regulates hematopoietic stem and progenitor cell (HSPC) development in zebrafish embryos. The adenosine receptor A2b is expressed in the vascular endothelium before HSPC emergence. Elevated adenosine levels increased runx1(+)/cmyb(+) HSPCs in the dorsal aorta, whereas blocking the adenosine pathway decreased HSPCs. Knockdown of A2b adenosine receptor disrupted scl(+) hemogenic vascular endothelium and the subsequent EHT process. A2b adenosine receptor activation induced CXCL8 via cAMP-protein kinase A (PKA) and mediated hematopoiesis. We further show that adenosine increased multipotent progenitors in a mouse embryonic stem cell colony-forming assay and in embryonic day 10.5 aorta-gonad-mesonephros explants. Our results demonstrate that adenosine signaling plays an evolutionary conserved role in the first steps of HSPC formation in vertebrates.
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http://dx.doi.org/10.1084/jem.20141528DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419349PMC
May 2015