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Food is one of the basic necessities of life: a critical resource upon which we all rely for our survival, health and well-being. Ending hunger and ensuring access to safe, nutritious and sufficient food, is a global challenge. In working to address this challenge, the geography of our food has changed a lot in recent history, with the development of new methods of food production, complex food supply chains and changing customer demands and expectations. To explore this, we team up with geographers Dr Christopher Turner, Dr Catherine Oliver and Dr Kim Ward.

Food is one of the basic necessities of life: a critical resource upon which we all rely for our survival, health and well-being. Ending hunger and ensuring access to safe, nutritious and sufficient food, is a global challenge. In working to address this challenge, the geography of our food has changed a lot in recent history, with the development of new methods of food production, complex food supply chains and changing customer demands and expectations. To explore this, we team up with geographers Dr Christopher Turner, Dr Catherine Oliver and Dr Kim Ward.

BACKGROUND: People with bipolar disorder (BD) experience additional parenting challenges associated with mood driven fluctuations in communication, impulse control and motivation. This paper describes a novel web-based self-management approach (Integrated Bipolar Parenting Intervention; IBPI) to support parents with BD. METHOD: Parents with BD with children aged 3-10 years randomised to IBPI plus treatment as usual (TAU) or waitlist control (WL). IBPI offered 16 weeks access to interactive self-management information concerning BD and parenting issues. Feasibility was through recruitment, retention and web usage. Clinical outcomes were assessed at baseline, 16, 24, 36 and 48 weeks. TRIAL REGISTRATION NUMBER: ISRCTN75279027. RESULTS: Ninety seven participants were recruited with 98% retention to end of intervention and 90% to final follow-up (56%-94% data analysed of retained participants; higher rates for observer measures). 77% of IBPI participants accessed the website (53% accessed parenting modules). Child behaviour, parenting sense of competence and parenting stress improved significantly in IBPI compared to WL to end of intervention, sustained to 48 weeks. Impacts of IBPI on family functioning, parent mood and time to mood relapse were not significant. CONCLUSIONS: Online self-management support for parents with BD is feasible, with promising improvements in parenting and child behaviour outcomes. A definitive clinical and cost-effectiveness trial is required to confirm and extend these findings.

Background: Interventions that teach people with Bipolar Disorder (BD) to recognise and respond to early warning signs of relapse are NICE recommended but implementation in clinical practice is poor. Objective: This study tests the feasibility and acceptability of a randomised controlled trial to evaluate an online enhanced relapse prevention intervention (ERPonline), and reports preliminary evidence of effectiveness. Methods: Single blind, parallel primarily online randomised controlled trial (n=96) over 48 weeks comparing ERPonline plus usual treatment to waitlist (WL) control plus usual treatment for people with BD recruited through National Health Services, voluntary organisations, and media. Randomisation was independent, minimised on number of previous episodes (<8,8-20,21+). Primary outcomes were feasibility and acceptability assessed by rates of study recruitment and retention, levels of intervention use, adverse events and participant feedback. Process and clinical outcomes were assessed by telephone and online and compared using linear models with intention-to-treat analysis. Results: Two hundred and eighty people registered interest online, from which ninety-six met inclusion criteria, consented and were randomised (49 to WL, 47 to ERPonline) over seventeen months, with 80% retention in telephone and online follow up, except week 48 online (76%). Acceptability was high for both ERPonline and trial methods. ERPonline cost approximately £19,340 to create, and £2176 per year to host and maintain the site. Qualitative data highlighted the importance of the relationship users have with online interventions and how this is created as an extension of the relationship with the humans perceived as offering and supporting its use. Differences between the group means suggested that access to ERPonline was associated with: a more positive model of bipolar disorder at 24 (10.70 (0.90-20.5 95%CIs)) and 48 weeks (13.1 (2.44-23.93 95%CIs)); increased monitoring of early

BACKGROUND: People with bipolar disorder (BD) experience additional parenting challenges associated with mood driven fluctuations in communication, impulse control and motivation. This paper describes a novel web-based self-management approach (Integrated Bipolar Parenting Intervention; IBPI) to support parents with BD. METHOD: Parents with BD with children aged 3-10 years randomised to IBPI plus treatment as usual (TAU) or waitlist control (WL). IBPI offered 16 weeks access to interactive self-management information concerning BD and parenting issues. Feasibility was through recruitment, retention and web usage. Clinical outcomes were assessed at baseline, 16, 24, 36 and 48 weeks. TRIAL REGISTRATION NUMBER: ISRCTN75279027. RESULTS: Ninety seven participants were recruited with 98% retention to end of intervention and 90% to final follow-up (56%-94% data analysed of retained participants; higher rates for observer measures). 77% of IBPI participants accessed the website (53% accessed parenting modules). Child behaviour, parenting sense of competence and parenting stress improved significantly in IBPI compared to WL to end of intervention, sustained to 48 weeks. Impacts of IBPI on family functioning, parent mood and time to mood relapse were not significant. CONCLUSIONS: Online self-management support for parents with BD is feasible, with promising improvements in parenting and child behaviour outcomes. A definitive clinical and cost-effectiveness trial is required to confirm and extend these findings.

Background: Interventions that teach people with Bipolar Disorder (BD) to recognise and respond to early warning signs of relapse are NICE recommended but implementation in clinical practice is poor. Objective: This study tests the feasibility and acceptability of a randomised controlled trial to evaluate an online enhanced relapse prevention intervention (ERPonline), and reports preliminary evidence of effectiveness. Methods: Single blind, parallel primarily online randomised controlled trial (n=96) over 48 weeks comparing ERPonline plus usual treatment to waitlist (WL) control plus usual treatment for people with BD recruited through National Health Services, voluntary organisations, and media. Randomisation was independent, minimised on number of previous episodes (<8,8-20,21+). Primary outcomes were feasibility and acceptability assessed by rates of study recruitment and retention, levels of intervention use, adverse events and participant feedback. Process and clinical outcomes were assessed by telephone and online and compared using linear models with intention-to-treat analysis. Results: Two hundred and eighty people registered interest online, from which ninety-six met inclusion criteria, consented and were randomised (49 to WL, 47 to ERPonline) over seventeen months, with 80% retention in telephone and online follow up, except week 48 online (76%). Acceptability was high for both ERPonline and trial methods. ERPonline cost approximately £19,340 to create, and £2176 per year to host and maintain the site. Qualitative data highlighted the importance of the relationship users have with online interventions and how this is created as an extension of the relationship with the humans perceived as offering and supporting its use. Differences between the group means suggested that access to ERPonline was associated with: a more positive model of bipolar disorder at 24 (10.70 (0.90-20.5 95%CIs)) and 48 weeks (13.1 (2.44-23.93 95%CIs)); increased monitoring of early