Search

Introduction: Adolescents often have difficulty adjusting to their surroundings. Coping and family support are also associated with this adjustment. However, the relationship between the aforementioned factors and adjustment among adolescents with parents who work as migrant workers remains unclear. This study aimed to analyze the relationship between coping and family support with the adjustment of adolescents who have parents who work as migrant workers. Methods: This is a cross-sectional study. A total of 70 early adolescents with parents working as migrant workers were recruited from the total sample. In this study, coping strategies and family social support were assigned as independent variables, while the dependent variable was the adjustment of adolescents who had parents as migrant workers. The questionnaire was used to measure the outcome of interest and tested for validity and reliability. The data analysis in this study used Spearman Rho. Spearman’s Rho correlation with alpha, α set ≤ 0.05, was used to analyze the data. Results: The results indicate that Coping strategies (p = 0.018; r = 0.283) and family support (p = 0.001; r = 0.380) were associated with adolescent adjustment. Conclusions: Both coping strategies and family support contribute to the adjustment of adolescents whose parents work as migrant workers. There is a need to increase the priority of psychosocial counseling for adolescents who have parents working as migrant workers and educate their families to increase attention and support appropriate adolescent development.

Objective: To analyse the relationship of self-efficacy and social support with academic burnout of nursing students. Method: The correlational, cross-sectional study was conducted in August 2021 at the Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia, and comprised nursing students in the 4th and 6th semesters of their academic programme. Data was collected using self-efficacy and social support questionnaires as well as the Maslach Burnout Inventory-Student Survey. Results: Of the 184 subjects, 160(87%) were females and 24(13%) were males; 98(43.3%) were from the 4th semester and 86(46.7%) were from the 6th; 66(36.4%) were aged 20 years, followed by 65(35.9%) aged 21 years; and East Java was the hometown for 163(88.6%) students. Self-efficacy (p=0.005; r=-0.205) and social support (p=0.000; r=-0.265) were significantly associated with academic burnout. Conclusion: Higher self-efficacy and social support levels may lead to lower academic burnout among nursing students. Keywords: Self-efficacy, Burnout, Psychological, Social support, Nursing.

Background: Insulin-treated diabetes patients are at high risk of developing lipohypertrophy, which can negatively impact treatment outcomes. Early detection of lipohypertrophy is crucial to preventing blood glucose fluctuation. Unfortunately, this clinical issue is often overlooked by nurses, causing the development of vascular complications, which leads to an increase in the morbidity and mortality of the type 2 diabetes mellitus population. Objective: This study was conducted to identify lipohypertrophy prevalence and to establish the association between the presence of lipohypertrophy and its associated risk factors, including years on injection, total injection in a day, total insulin unit per day, often change needle, insulin injection site and move to a different area. Methods: This cross-sectional study included 128 patients with type 2 diabetes mellitus who received insulin therapy in an outpatient diabetic clinic. Questionnaires on socio-demographic and lipohypertrophy-associated risk factors were distributed among patients, and lipohypertrophy-assessment was done using a checklist. Descriptive statistics and Pearson Chi-square were used for statistical analysis. Results: The prevalence of lipohypertrophy was 51.6% (95% CI: 42.6, 60.5). Swelling on fatty tissue (46.1%) exhibited the highest percentage of lipohypertrophy features during the assessment. Pearson Chi-Square revealed a significant relationship between the presence of LH and BMI categories (χ2 = 10.059, df = 3, p = 0.018), duration of injection (χ2 = 15.001, df = 3, p = 0.002), frequency of needle replacement (χ2 = 9.525, df = 3, p = 0.023) and rotation of injection site (χ2 = 5.914, df = 1, p = 0.015). Conclusion: The high prevalence of lipohypertrophy indicates a need for a prevention strategy. Thus, nurses should play an important role in educating patients regarding the proper administration of insulin injections and performing a routine lipohypertrophy assessment and health education on the correct method of insulin injection.

An extensive programme of archaeological fieldwork between August 2006 and May 2008 in the area of the former New Street Gasworks and New Street Bus Depot, Canongate, Edinburgh revealed remains of one of the earliest and most significant gasworks in Britain. As well as patches of medieval and post-medieval backland soils and post-medieval structures that pre-dated the establishment of the New Street works in the first quarter of the 19th century, substantial structural remains of the various phases of this industrial undertaking were recorded, along with a suite of associated artefacts. These works have permitted the exploration of the industrial heritage of Edinburgh, as well as revealing important evidence of the medieval and post-medieval occupation of the Canongate. This is the first major excavation of an urban gasworks in Scotland and has enabled an examination of how these gasworks functioned and how they expanded with the introduction of more efficient systems and new technology.

A stoma is classified as either permanent or temporary depending on the time of anastomosis, and is referred to as a colostomy, ileostomy, or urostomy based on the organ to which it is anastomosed. The creation of a stoma poses many challenges to patients as they adapt to this profound life-changing event that affects fundamental aspects of quality of life. To reduce the risk of stoma and peristomal complications after discharge, telephone-based support (TBS) program which includes patient follow-up, counselling, and the benefits of group support activities including information sharing, health education and counselling, symptom management, early detection of problems, reassurance, and high-quality aftercare. This article narrates common stoma and peristomal complications as well as TBS program to support in reducing these complications.

Summary: Vascular adhesion protein-1 (VAP-1) also known as amino oxidase copper containing 3 (AOC3) is a pro-inflammatory and versatile molecule with adhesive and enzymatic properties. VAP-1 is a primary amine oxidase belonging to the semicarbazide-sensitive amine oxidase (SSAO) family, which catalyzes the oxidation of primary amines leading to the production of ammonium, formaldehyde, methylglyoxal, and hydrogen peroxide. VAP-1 is mainly expressed by endothelial cells, smooth muscle cells, adipocytes and pericytes. It is involved in a repertoire of biological functions, e.g., immune cell extravasation, angiogenesis, and vascularization. Research into VAP-1 has intensified within the last decade on its role as a novel clinical biomarker and as a potential therapeutic target of vascular inflammatory disorders such as atherosclerosis, stroke, diabetes, neurovascular disorders (e.g., Alzheimer’s Disease), hepatic disease (e.g., non-alcoholic steatohepatitis), and skin conditions (e.g., psoriasis). This is the most up-to-date and comprehensive review on VAP-1 focusing on the translational aspects of VAP-1. Compared to recent reviews, our review provides novel insights on VAP-1 and heart failure, stroke and frailty, diabetes, endometriosis, osteoarthritis, COVID-19, conjunctivitis associated systemic lupus erythematosus, hematopoietic stem cells, gliomas, treatment of colorectal cancer with a novel VAP-1 inhibitor (U-V269), promoting recovery of motor functions and habit learning with a novel VAP-1 inhibitor (PXS-4681A), and 68Ga-DOTA-Siglec-9, a labelled peptide of Siglec-9 (a VAP-1 ligand), which appears to be a safe PET tracer for inflammation in rheumatoid arthritis. Finally, we present the emerging role of VAP-1 in pregnancy as a gatekeeper of immune cells, which are critical for spiral arterial remodeling, the deficiency of which could lead to vascular disorders of pregnancy such as preeclampsia. Future research should prioritize clinical trials on VAP-1 small-molecule inhibitors and monoclonal antibodies, thus, maximizing the potential of VAP-1 targeted therapy as well as research into sVAP-1 as a clinical biomarker of diseases and its prognosis.

Syringes with attached needles (termed fixed low dead space syringes [LDSS]) retain less blood following injection than syringes with detachable needles, but evidence on them reducing blood-borne virus transmission among people who inject drugs (PWID) is lacking. Utilizing the UK Unlinked Anonymous Monitoring cross-sectional bio-behavioral surveys among PWID for 2016/18/19 (n = 1429), we showed that always using fixed LDSS was associated with 76% lower likelihood (adjusted odds ratio = 0.24, 95% confidence interval [CI]: .08–.67) of recent hepatitis C virus infection (RNA-positive and antibody-negative) among antibody-negative PWID compared to using any syringes with detachable needles.

IntroductionThe increasing prevalence of developmental disorders in early childhood poses a significant global health burden. Early detection of developmental problems is vital to ensure timely access to early intervention, and universal developmental surveillance is recommended best practice for identifying issues. Despite this, there is currently considerable variation in developmental surveillance and screening between Australian states and territories and low rates of developmental screening uptake by parents. This study aims to evaluate an innovative web-based developmental surveillance programme and a sustainable approach to referral and care pathways, linking primary care general practice (GP) services that fall under federal policy responsibility and state government-funded child health services.Methods and analysisThe proposed study describes a longitudinal cluster randomised controlled trial (c-RCT) comparing a ‘Watch Me Grow Integrated’ (WMG-I) approach for developmental screening, to Surveillance as Usual (SaU) in GPs. Forty practices will be recruited across New South Wales and Queensland, and randomly allocated into either the (1) WMG-I or (2) SaU group. A cohort of 2000 children will be recruited during their 18-month vaccination visit or opportunistic visit to GP. At the end of the c-RCT, a qualitative study using focus groups/interviews will evaluate parent and practitioner views of the WMG-I programme and inform national and state policy recommendations.Ethics and disseminationThe South Western Sydney Local Health District (2020/ETH01625), UNSW Sydney (2020/ETH01625) and University of Queensland (2021/HE000667) Human Research Ethics Committees independently reviewed and approved this study. Findings will be reported to the funding bodies, study institutes and partners; families and peer-reviewed conferences/publications.Trial registration numberANZCTR12621000680864.

BACKGROUND: The English schools-based human papillomavirus (HPV) vaccination programme is routinely offered to all young people aged 12-13 years, to prevent cancers affecting the cervix, vulva, vagina, penis, anus and oral cavity. Lower uptake among some population groups has been identified, in part, because of unmet information needs among young people. To address these unmet needs we report intervention planning and development processes to co-produce an educational package about the HPV vaccine.METHODS: We used co-production research methodologies and the ‘person-based approach’ involving the following iterative stages: (i) collating and analysing primary and secondary evidence, including HPV vaccine communication materials and interviews and workshops); (ii) developing guiding principles; (iii) undertaking a behavioural analysis informed by the Behaviour Change Wheel and the Behaviour Change Technique taxonomy; (iv) development of a preliminary logic model; (v) co-production of resources, and; (vi) refinement of resources informed by feedback from young people and key stakeholders. RESULTS: We co-produced EDUCATE, a theory-based educational package, that is designed to be delivered to young people prior to being offered the HPV vaccine to support uptake. Young people and key stakeholders identified the following key issues to include as content: (i) HPV-related information; (ii) how vaccines work; (iii) safety and side-effects of the HPV vaccine; (iii) eligibility for the HPV vaccination programme, and; (iv) preparation of young people to receive the HPV vaccine. A manual for professionals (e.g. immunisation nurses, school staff) delivering the intervention and a PowerPoint presentation, interspersed with five short films, were co-produced with young people and key stakeholders. Following feedback, the content of the EDUCATE package was refined to increase acceptability, engagement, and persuasiveness to the target users.CONCLUSION: Engagement with young people and key informants was integral to the development of our rigorously developed, theory-based intervention to address young people’s information needs about the HPV vaccination programme. The acceptability and persuasiveness of the package has been maximised by working closely with young people and key stakeholders to develop the content. Future studies to examine how the EDUCATE package is implemented in practice and the impact on uptake of the HPV vaccination programme are planned.TRIAL REGISTRATION: N/A

Objective To provide an overview of the types of wound debridement and update the available scientific consensus on the effect of wound debridement. Methods The articles were searched through CINAHL, PubMed, Cochrane Library, and Medline database for relevant articles on all types of wound debridement. Articles included were all systematic review on the effectiveness of wound debridement-related outcome, published within the year 2017 until Aug 2021, in English. Results A total of seven scientific articles had been selected for review out of 318 screened. The authors reviewed a total of 318 titles and abstracts related to wound debridement effectiveness. Seven articles that were selected were narratively reviewed by two authors. The findings of the review were organized into autolytic, enzymatic, sharp, surgical, biological, and mechanical debridement methods and includes the advantages and disadvantages of each. The author further explored on the role of wound debridement according to wound bed preparation model. Articles were synthesized and organized based on the authors, year, total studies included in the systematic review, study range of year, total sample, debridement method, wound types, and findings. Conclusion Maggot debridement therapy showed a consistent finding in terms of effectiveness in debriding chronic wounds. The newer debridement method includes hydro-surgery, low-frequency ultrasonic and enzymatic collagenase debridement were getting more attention due to faster wound bed preparation and less painful. However, these newer method of debridements showed inconclusive findings and the patient safety was not clearly defined. A higher level of review is warranted in the future study., Highlight • Maggot debridement therapy (MDT) showed a consistent positive effect in treating chronic wounds. • New debridement methods that gaining more attention includes hydro-surgery, low-frequency ultrasonic and enzymatic collagenase debridement. • Newer debridement method reported faster wound bed preparation and deemed to be less pain. • Patient safety was not clearly defined in these newer debridement methods.

Unnecessarily delayed discharges from hospital of older people living with frailty can have negative consequences for their health and add significant costs to health services. We report on an ethnographic study at two English hospitals and their respective health and social care systems where we followed 37 patient journeys. The study aim was to understand why delays occur. Our findings indicate that working practices in the study hospitals may have inadvertently contributed to delays. While many pieces of patients’ clinical and social information were collected, recorded and accessed in different ways by different professionals, to facilitate a discharge, these pieces needed to be re-found, integrated and re-constructed. A key component of this process was information related to patients’ social, family and functional background. This was often missing, not accessed or perceived to be of low value compared to other more readily available clinical information. Patients’ re-construction was thus often incomplete, or insufficient to reduce the clinical and prognostic uncertainty associated with frailty and to manage risks inherent in older people's discharge. Where this key component was present and integrated into decision-making in multi-disciplinary team working, uncertainty and risk were managed more constructively and sometimes avoided an escalation of care needs.

AimTo co-produce with young people an educational package about the human papillomavirus (HPV) vaccine that is tailored to increase vaccine uptake in schools and populations with lower uptake.IntroductionPersistent infection with HPV can result in cancers affecting men and especially women. From September 2019, the English-schools-based HPV vaccination programme was expanded to include young men (in addition to young women) aged 12–13 years. Some young people attending schools with lower uptake of the vaccine have unmet information needs. We hypothesise that mechanisms to address information needs and increase young people’s autonomy in consent procedures will result in higher uptake.Methods and analysisThe Medical Research Council’s framework for development and evaluation of complex interventions will inform intervention development. Recruitment of young people aged 12–15 years and key stakeholders (National Health Service commissioners, school staff, immunisation nurses and youth workers/practitioners) will be facilitated through existing links with healthcare organisations, schools and youth organisations in areas with lower uptake of the HPV vaccination programme. The proposed research will comprise three phases: (1) a rapid review of adolescent immunisation materials and preliminary qualitative interviews with young people and key stakeholders, (2) theory development and co-production of HPV vaccine communication materials through an iterative process with young people and (iii) testing delivery mechanisms and acceptability of the educational package in four schools with lower uptake.Ethics and disseminationThe University of Bristol’s Faculty of Health Sciences and London School of Hygiene and Tropical Medicine's Research Ethics Committees provided approvals for the study. A dissemination event for young people and key stakeholders and webinar with the National Immunisation Network will be organised. The study findings will be published in peer-reviewed journals and presented at conferences. Recommendations for a future larger scale study will be made.

Objective Following paediatric burn injury, dressings are initially changed in outpatient clinics, necessitating regular visits with substantial burden for parents, children and services. This can potentially be lessened if some parents go on to administer dressing changes for their child at home. However, there is a lack of data regarding support for parent-administered dressing changes. The aim of this study was to describe current practice and views regarding at-home parent-administered dressing changes (PAD) in the UK. Methods An online survey was distributed to 20 paediatric burns services in England and Wales. The survey used fixed and free-text responses to collect data on whether PAD is offered and the reasons for this; patient and parent eligibility criteria; training and support; and respondents’ views on the advantages and disadvantages of PAD. Analysis comprised simple descriptive statistics and simple content analysis of free-text responses. Results Thirteen responses were received (response rate = 65%). Eleven respondents indicated their service offers PAD. Two respondents reported their service does not offer PAD due to alternative nurse outreach appointments (n = 1), and service resource limitations (n = 1), though another respondent indicated service cost savings. Twelve respondents regard PAD positively (n = 8) or very positively (n = 4). Most respondents reported that 10% or fewer parents refuse PAD when offered (n = 7). Perceived advantages of PAD included reduced travel burden (n = 9), patient better able to cope with dressing changes (n = 8), better school and work attendance for child and parent respectively (n = 6), and reduced financial impact on families (n = 4). There are no formal eligibility criteria for PAD, though 5 respondents described informal criteria in place in their service, predominantly involving dressing frequency (n = 5), and size or complexity of wound (n = 4). Conclusion The survey indicates that most paediatric burns services support PAD. However, the absence of formal eligibility criteria, and informal criteria open to interpretation, risks inequity of support received by children and their families. Further research should evaluate whether this inequity extends to variable clinical outcomes to determine what works for who and under what circumstances when supporting parents in paediatric burns aftercare.

Objective Paediatric burn injuries present physical and psychosocial effects for children and their parents, including disruption to family life. Some burns services in the UK enable parents to administer dressing changes at home to reduce the number of hospital visits. To date, there is no research on parents’ experiences of administering dressing changes. The aim of this study was to describe parents’ experiences of administering dressing changes in paediatric burns aftercare. Methods Semi-structured research interviews were conducted with a purposive sample of parents recruited from a paediatric burns centre in the UK. The interview addressed the initial offer of at-home dressing changes by clinicians; parental decision-making in relation to dressing changes; training and support received; and the experience of administering dressing changes, including practical and emotional considerations. Thematic analysis of the data was informed by the framework approach, including associative analysis using demographic and clinical characteristics. Results Seventeen participants were interviewed. Three themes of parents’ experiences of administering dressing changes were identified including (1) Parental Identity concerning the newly undertaken responsibility and the impact on the parental role; (2) Challenges, physical or emotional, confronted or lessened by administering dressing changes; and (3) Reassurance provided by healthcare professionals and others to support parents to adopt and maintain parent-administered dressing changes. Conclusion The qualitative data reported here indicates that parents want to be involved in their child’s care by administering dressing changes at home, provided they receive sufficient reassurance that they are able to manage the severity of their child’s burn. Parents’ concerns about the effectiveness of their dressing changes lacks empirical basis, and this study provides preliminary data to support the development and evaluation of best practice guidance for parent-administered dressing changes in paediatric burns aftercare.

Background: BATHE is a brief psychosocial intervention designed for physician use in patient consultations. The technique has gained some international recognition, but there is currently limited research evidence to demonstrate its acceptability and benefits to patient care. We conducted a pilot cluster randomised controlled trial and feasibility study to explore the use of BATHE as a key component of a person-focused intervention to improve the care of frequent attending patients in UK primary care. Methods: A nested qualitative interview study conducted within a pilot trial. The trial took place in six general practices in the South West of England. Eligible patients had been identified as being in the top 3% of attenders in the previous 12 months. General practitioners (GPs) were trained to use BATHE during a one-hour initial training session, and two top-up trainings which included feedback on implementation fidelity. GPs were asked to use BATHE with their study patients for a period of 12 months. 34 GPs were trained and documented using BATHE in a total of 577 consultations with eligible patients during the intervention period. At the end of the intervention period, GPs and study patients from the intervention practices were invited to take part in an interview. Interviews were semi-structured, audio-recorded and transcribed. Thematic analysis was used. Results: Eleven GPs and 16 patients took part in post-intervention interviews. Benefits of using BATHE included making consultations more person-centred, challenging assumptions that the GP knew what was going on for the patient and their main concerns, and supporting self-management. Difficulties reported included changing existing consultation habits, identifying appropriate consultations in which to use BATHE, and organisational constraints. Conclusions: The study suggests that using BATHE is both acceptable and beneficial but also highlighted some of the difficulties GPs had incorporating BATHE into routine practice. Strategies to reduce these difficulties are needed before the extent of the potential benefits of BATHE can be fully assessed.Trial Registration: ISRCTN62939408 Prospectively registered on 24/06/2015

Despite many countries having physical activity guidelines, there have been few concerted efforts to mobilize this information to the public. The aim of this study was to understand the preferences of under-served community groups about how the benefits of physical activity, and associated guidelines, can be better communicated to the public. Participatory workshops, co-developed between researchers, a local charity, and a community artist, were used to gather data from four groups in Bristol, UK: young people (n = 17), adults (n = 11), older adults (n = 5), and Somali women (n = 15). Workshop content was structured around the study aims. The community artist and/or the local charity delivered the workshops, with researchers gathering data via observation, photos, and audio-recordings, which were analysed using the framework method. All four groups noted that the benefits of physical activity should be included within any communications efforts, though not restricted to health-related benefits. Language used should be simple and jargon-free, terms such as &ldquo, sedentary&rdquo, &ldquo, vigorous&rdquo, and &ldquo, intensity&rdquo, were deemed inaccessible, however all groups liked the message &ldquo, some is good, more is better&rdquo, Views about preferred mechanisms, and messenger, for delivering physical activity messages varied both between, and within, groups. Recommendations for those working in physical activity communications, research, and policy are provided.

Introduction: Creating an educational climate that engages the students in the digital era is crucial as it prepares them for the future.Objectives: The aim of this multiple case study is to highlight the impact of creative educational environment on the students’ awareness of digital era tools.Methods: In this study three activities were organized. Firstly, a brain storming seminar titled “Medical Practice in Artificial Intelligence Era” was held. The second event was E-poster competitions which challenged the students’ curiosity to address the health problems and to introduce innovative solutions to solve it. Medical and nursing students presented 32 posters. Third activity was MeDuino, a hands-on workshop to familiarize the students with arduino technology in medical practice.Results: Around 260 participants attended the seminar. In their feedback, 72% of students found the topics attractive and more than 60% found its theme relevant and beneficial. E-poster competition was evaluated using a modified rubric scale. The data was analysed by SPSS showed that only “creativity” and “practicality” merits scored little above the mean range. There was no statistically significant difference in the mean score of ‘creativity’ and ‘practicality’ between medical students and nursing students. However, in general medical students’ scores were higher compared to nursing students. 90% of students said that they improved cognitively and 85% found it fascinating. In Meduino workshop (Robotics), The 30 participants practiced mini projects. 86 % found it attractive, 81% expressed that it improve d their cognitive about technology as noted in comparing the pre and post- event questionnaires. The students’ concerns included the time constraints short time and lack of lecturers’ guidance during posters’ preparation.Conclusion(s): Transforming educational environment physically, emotionally and socially managed to address few aspects digital era. Allocating more time, facilities and training in the informal curriculum could enhance health-care students mastering of future tools.International Journal of Human and Health Sciences Supplementary Issue: 2019 Page: 31

The study aim was to assess implementation fidelity (i.e., adherence) to a talk-based primary care intervention using Conversation Analytic (CA) methods. The context was a UK feasibility trial where General Practitioners (GPs) were trained to use “BATHE” (Background, Affect, Trouble, Handling, Empathy) – a technique to screen for psychosocial issues during consultations – with frequently attending patients. 35 GPs received BATHE training between July–October 2015. 15 GPs across six practices self-selected to record a sample of their consultations with study patients at three and six months. 31 consultations were recorded. 21/26 patients in four intervention practices gave permission for analysis. The recordings were transcribed and initially coded for the presence or absence of the five BATHE components. CA methods were applied to assess delivery, focusing on position and composition of each component, and patients’ responses. Initial coding showed most of the BATHE components to be present in most contacts. However the CA analysis revealed unplanned deviations in position and adaptations in composition. Frequently the intervention was initiated too early in the consultation, and the BATHE questions misunderstood by patients as pertaining to their presenting problems rather than the psychosocial context for their problems. Often these deviations resulted in reducing theoretical fidelity of the intervention as a whole. A CA approach enabled a dynamic assessment of the delivery and receipt of BATHE in situ revealing common pitfalls in delivery and provided valuable examples of more and less efficacious implementations. During the trial this evidence was used in top-up trainings to address problems in delivery and to improve GP engagement. Using CA methods enabled a more accurate assessment of implementation fidelity, a fuller description of the intervention itself, and enhanced resources for future training. When positioned appropriately, BATHE can be a useful tool for eliciting information about the wider context of the medical visit.

Objective To assess whether non-clinical staff can effectively manage people at high risk of cardiovascular disease using digital health technologies. Design Pragmatic, multicentre, randomised controlled trial. Setting 42 general practices in three areas of England. Participants Between 3 December 2012 and 23 July 2013 we recruited 641 adults aged 40 to 74 years with a 10 year cardiovascular disease risk of 20% or more, no previous cardiovascular event, at least one modifiable risk factor (systolic blood pressure ≥140 mm Hg, body mass index ≥30, current smoker), and access to a telephone, the internet, and email. Participants were individually allocated to intervention (n=325) or control (n=316) groups using automated randomisation stratified by site, minimised by practice and baseline risk score. Interventions Intervention was the Healthlines service (alongside usual care), comprising regular telephone calls from trained lay health advisors following scripts generated by interactive software. Advisors facilitated self management by supporting participants to use online resources to reduce risk factors, and sought to optimise drug use, improve treatment adherence, and encourage healthier lifestyles. The control group comprised usual care alone. Main outcome measures The primary outcome was the proportion of participants responding to treatment, defined as maintaining or reducing their cardiovascular risk after 12 months. Outcomes were collected six and 12 months after randomisation and analysed masked. Participants were not masked. Results 50% (148/295) of participants in the intervention group responded to treatment compared with 43% (124/291) in the control group (adjusted odds ratio 1.3, 95% confidence interval 1.0 to 1.9; number needed to treat=13); a difference possibly due to chance (P=0.08). The intervention was associated with reductions in blood pressure (difference in mean systolic −2.7 mm Hg (95% confidence interval −4.7 to −0.6 mm Hg), mean diastolic −2.8 (−4.0 to −1.6 mm Hg); weight −1.0 kg (−1.8 to −0.3 kg), and body mass index −0.4 ( −0.6 to −0.1) but not cholesterol −0.1 (−0.2 to 0.0), smoking status (adjusted odds ratio 0.4, 0.2 to 1.0), or overall cardiovascular risk as a continuous measure (−0.4, −1.2 to 0.3)). The intervention was associated with improvements in diet, physical activity, drug adherence, and satisfaction with access to care, treatment received, and care coordination. One serious related adverse event occurred, when a participant was admitted to hospital with low blood pressure. Conclusions This evidence based telehealth approach was associated with small clinical benefits for a minority of people with high cardiovascular risk, and there was no overall improvement in average risk. The Healthlines service was, however, associated with improvements in some risk behaviours, and in perceptions of support and access to care. Trial registration Current Controlled Trials ISRCTN 27508731.