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Abstract Background Emotional problems such as anxiety and low mood in children are common, impair everyday functioning and increase the risk of severe mental health disorders in adulthood. Relatively few children with emotional health problems are identified and referred for treatment indicating the need to investigate preventive approaches. Methods/Design The study is designed to be a pragmatic cluster randomized controlled trial evaluating the effectiveness of an efficacious school-based cognitive behavior therapy (CBT) prevention program (FRIENDS) on symptoms of anxiety and low mood in children 9 to 10 years of age. The unit of allocation is schools which are assigned to one of three conditions: school-led FRIENDS, health-led FRIENDS or treatment as usual. Assessments will be undertaken at baseline, 6 months and 12 months. The primary outcome measure is change on the Revised Child Anxiety and Depression Scale. Secondary outcome measures assess changes in self-esteem, worries, bullying and life satisfaction. An economic evaluation will be undertaken. Discussion As of September 2011, 41 schools have been recruited and randomized. Final 12-month assessments are scheduled to be completed by May 2013. Trial Registration ISRCTN23563048

Abstract Background School-based interventions and campaigns are used to promote health and address a wide variety of public health problems. Schools are considered to be key sites for the implementation of health promotion programmes for their potential to reach the whole population in particular age-groups and instil healthy patterns of behavior early in life. However, evidence for the effectiveness of school-based health promotion interventions is highly variable. Systematic reviews of the evidence of school-based interventions tend to be highly problem- or intervention- specific, thereby missing potential generic insights into implementation and effectiveness of such programmes across problems. Methods/design A realist systematic review will be undertaken to explain how, why and in what circumstances schools can provide feasible settings for effective health promotion programmes in the United Kingdom (UK). The review will be conducted in two phases. Phase 1 will identify programme theories about implementation (ideas about what enables or inhibits effective health promotion to be delivered in a school setting). Phase 2 will test the programme theories so that they can be challenged, endorsed and/or refined. A Review Advisory Group of education and health professionals will be convened to help identify and choose potential programme theories, provide a ‘reality check’ on the clarity and explanatory strength of the mechanisms to be tested, and help shape the presentation of findings to be usable by practitioners and decision-makers. Review findings will be disseminated through liaison with decision-makers, and voluntary and professional groups in the fields of education and health.

Abstract Background Depression in adolescents is a significant problem that impairs everyday functioning and increases the risk of severe mental health disorders in adulthood. Relatively few adolescents with depression are identified and referred for treatment indicating the need to investigate alternative preventive approaches. Study Design A pragmatic cluster randomised controlled trial evaluating the effectiveness of a school based prevention programme on symptoms of depression in "high risk" adolescents (aged 12-16). The unit of allocation is year groups (n = 28) which are assigned to one of three conditions: an active intervention based upon cognitive behaviour therapy, attention control or treatment as usual. Assessments will be undertaken at screening, baseline, 6 months and 12 months. The primary outcome measure is change on the Short Mood and Feeling Questionnaire at 12 months. Secondary outcome measures will assess changes in negative thoughts, self esteem, anxiety, school connectedness, peer attachment, alcohol and substance misuse, bullying and self harm. Discussion As of August 2010, all 28 year groups (n = 5023) had been recruited and the assigned interventions delivered. Final 12 month assessments are scheduled to be completed by March 2011. Trial Registration ISRCTN19083628

Abstract Background The use of neonatal screening for cystic fibrosis is widely debated in the United Kingdom and elsewhere, but the evidence available to inform policy is limited. This paper explores the cost-effectiveness of adding screening for cystic fibrosis to an existing routine neonatal screening programme for congenital hypothyroidism and phenylketonuria, under alternative scenarios and assumptions. Methods The study is based on a decision model comparing screening to no screening in terms of a number of outcome measures, including diagnosis of cystic fibrosis, life-time treatment costs, life years and QALYs gained. The setting is a hypothetical UK health region without an existing neonatal screening programme for cystic fibrosis. Results Under initial assumptions, neonatal screening (using an immunoreactive trypsin/DNA two stage screening protocol) costs £5,387 per infant diagnosed, or £1.83 per infant screened (1998 costs). Neonatal screening for cystic fibrosis produces an incremental cost-effectiveness of £6,864 per QALY gained, in our base case scenario (an assumed benefit of a 6 month delay in the emergence of symptoms). A difference of 11 months or more in the emergence of symptoms (and mean survival) means neonatal screening is both less costly and produces better outcomes than no screening. Conclusion Neonatal screening is expensive as a method of diagnosis. Neonatal screening may be a cost-effective intervention if the hypothesised delays in the onset of symptoms are confirmed. Implementing both antenatal and neonatal screening would undermine potential economic benefits, since a reduction in the birth incidence of cystic fibrosis would reduce the cost-effectiveness of neonatal screening.

The short time frame associated with rapid reviews can be challenging for researchers conducting qualitative evidence synthesis. In these circumstances a Best-Fit Framework Synthesis, drawing upon existing theory and/or research, may be conducted to rapidly make sense of qualitative evidence. This article discusses a "Rapid Best-Fit" approach to conducting Framework Synthesis within an 6-week rapid systematic review of qualitative evidence. In the absence of a suitable theoretical model to inform the synthesis, we drew upon our research objectives to structure a framework, and to identify the studies which contained the most relevant data. Themes from these studies were used to revise the initial framework before inductive thematic synthesis finalized theme content. This "Rapid Best-Fit" approach yielded results aligned with the needs of the commissioners of the review and is a useful addition to qualitative synthesis methods, allowing for the incorporation of diverse views and experiences into fast-paced decision making scenarios.

Damage to building envelopes, roofing, and wall cladding systems remains a major concern during high wind speed events such as hurricanes and tornadoes. Roofing systems are particularly vulnerable to wind damage, which can lead to extensive water leakage and damage to building contents, even when the structural system remains intact. Hence, ongoing research to improve the wind resistance of roofing materials is of great importance. This paper focuses on the wind load resistance of discontinuous metal roofing (DMR) systems, which are cladding systems assembled with individual panels that have numerous joints that facilitate air flow into and out of the cavity space between the roofing system and structural deck. Experimental research was conducted to establish whether DMR systems are air-permeable, and if so, to develop procedures that evaluate appropriate net wind pressures and pressure equalization factor (PEF) values for their design. First, wind tunnel tests were conducted on 6 by 8 ft DMR roofing specimens to measure the net wind uplift pressure coefficients on DMR systems located in simulated wind flow reattachment zones of the roof. A second experiment sought to measure the net wind pressure and PEF value across a single DMR panel subjected to suction in an air pressure chamber. Both experimental results were compared to PEF values obtained from full-scale tests conducted at the Insurance Institute for Business & Home Safety. The results showed that air permeable DMR systems experience net surface pressures related to the magnitude of external wind pressure by a PEF and so accurate determination of the PEF can only be achieved by reproducing the appropriate spatial pressure distribution on a test specimen during tests. Ultimately, this research highlights inaccuracies in current testing methodologies and the importance of importance of ongoing efforts to enhance the wind resistance of roofing materials and mitigate damage during high wind speed events. [ABSTRACT FROM AUTHOR]

Purpose: Schools are an important setting for a wide variety of activities to promote health. The purpose of this paper is to map the different types of health promotion programmes and activities in schools, to estimate the amount of published evaluations of health promotion within UK schools, and to identify any provisional "candidate programme theories" to inform a planned theory-driven systematic review. Design/methodology/approach: Review of reviews: in total, 67 published systematic reviews of health promotion in schools were identified, from which a sub-sample of 28 systematic reviews (on 14 health topics) were retrieved for more detailed reading. Findings: Key dimensions of programme design and delivery fell mainly under the following categories: the problem and age-group of children targeted, who delivers the programme and how, and the scale and theoretical underpinning of the programme. Candidate programme theories spanned both effectiveness factors and aspects of programme implementation. Research limitations/implications: Few detailed "candidate theories" emerged for explaining how and why health promotion can more successfully implemented in different schools. Practical implications: There are five or more systematic reviews of studies of health promotion programmes in schools which target: smoking prevention; physical activity; sexual health; emotional and behavioural health and well-being; mental health; substance abuse; obesity/overweight. This suggests probable duplication of health problem-specific systematic reviews. Originality/value: The findings highlight the considerable diversity of health promotion in schools, and specifies key dimensions of this diversity. They underline the need to understand better how, why, and in what circumstances health promotion can be successfully implemented in different schools and education systems.

Background: A substantial minority of adolescents suffer from depression and it is associated with increased risk of suicide, social and educational impairment, and mental health problems in adulthood. A recently conducted randomized controlled trial in England evaluated the effectiveness of a manualized universally delivered age-appropriate CBT programme in school classrooms. The cost-effectiveness of the programme for preventing low mood and depression for all participants from a health and social care sector perspective needs to be determined. Methods: A trial-based cost-effectiveness analysis based on a cluster-randomized controlled trial (trial registration--ISRCTN 19083628) comparing classroom-based CBT with usual school provision of Personal Social and Health Education. Per-student cost of intervention was estimated from programme records. The study was undertaken in eight mixed-sex UK secondary schools, and included 3,357 school children aged 12 to 16 years (in the two trial arms evaluated in the cost-effectiveness analysis). The main outcome measures were individual self-reported data on care costs, Quality-Adjusted Life-Years (QALYs, based on the EQ-5D health-related quality-of-life instrument) and symptoms of depression (Short Mood and Feelings Questionnaire) at baseline, 6 and 12 months. Results: Although there was lower quality-adjusted life-years over 12 months (-0.05 QALYs per person, 95% confidence interval -0.09 to -0.005, p = 0.03) with CBT, this is a "clinically" negligible difference, which was not found in the complete case analyses. There was little evidence of any between-arm differences in SMFQ scores (0.19, 95% CI -0.57 to 0.95, p = 0.62), or costs (£142, 95% CI -£132 to £415, p = 0.31) per person for CBT versus usual school provision. Conclusions: Our analysis suggests that the universal provision of classroom-based CBT is unlikely to be either more effective or less costly than usual school provision.