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This article describes the first reported outcome evaluation of a family life/sexual health education program for elementary school students in Canada. The program, called Choices and Changes, was designed following concepts in the Canadian Guidelines for Sexual Health Education (Health Canada, 1994) and has been to presented to grade 4-7 students at a school in Whitehorse, Yukon, for the past four years (1998-2001). Parents/guardians provided input on program objectives and a parent component was added in 2000. Pooled scores for classroom evaluations of all grades in 1999-2001 showed modest increases in knowledge that remained at 3-4 month follow-up; notable increases in 3 of 5 measures of motivation and personal insight that also remained at follow-up; no change in selfassessed assertiveness skill at resisting pressure to do something they did not want to do; and slight change (but only at 3-4 month follow-up) in comfort talking with parents about puberty. The authors hope to stimulate dialogue on the appropriate outcome measures for sexual health education programs for this younger age group and to encourage further research. [ABSTRACT FROM AUTHOR]

This paper describes the development, implementation, and assessment of a theory-based, territory-wide social marketing campaign to reduce the high rates of Chlamydia trachomatis infection among young adults in the Yukon. Campaign messages focused on three key goals: increasing awareness of chlamydia among 15-29 year olds; reducing the probability of transmission (through regular condom use and safer sex practices); and reducing duration of infection (through increased testing for both sexes). The three month intensive campaign, called 'Style: doing the right thing', featured a visually arresting poster that became identified with the campaign, high profile radio spots, bus signs, and a widely distributed Style Kit (a brochure and condoms in a case designed to look like a rock CD). All resources featured messages focused on the three goals. Pre- and postcampaign questionnaires assessing both chlamydia-related knowledge and opinions about condom use were completed by over 650 high school and community college students. Increases in knowledge in this sample, and in the frequency of chlamydia tests within the entire community, are thought to be attributable to the campaign. Methodological challenges and limitations in implementing and assessing such an intervention are discussed. [ABSTRACT FROM AUTHOR]

Introduction: There are inconsistencies in outcome reporting for patients with necrotising soft tissue infections (NSTI). The aim of this study was to evaluate reported outcome measures in NSTI literature that could inform a core outcome set (COS) such as could be used in a study of hyperbaric oxygen in this indication., Methods: A systematic review of all NSTI literature identified from Cochrane, Ovid MEDLINE and Scopus databases as well as grey literature sources OpenGrey and the New York Academy of Medicine databases which met inclusion criteria and were published between 2010 and 2020 was performed. Studies were included if they reported on > 5 cases and presented clinical endpoints, patient related outcomes, or resource utilisation in NSTI patients. Studies did not have to include intervention. Two independent researchers then extracted reported outcome measures. Similar outcomes were grouped and classified into domains to produce a structured inventory. An attempt was made to identify trends in outcome measures over time and by study design., Results: Three hundred and seventy-five studies were identified and included a total of 311 outcome measures. Forty eight percent (150/311) of outcome measures were reported by two or more studies. The four most frequently reported outcome measures were mortality without time specified, length of hospital stay, amputation performed, and number of debridements, reported in 298 (79.5%), 260 (69.3%), 156 (41.6%) and 151 (40.3%) studies respectively. Mortality outcomes were reported in 23 different ways. Randomised controlled trials (RCTs) were more likely to report 28-day mortality or 90-day mortality. The second most frequent amputation related outcome was level of amputation, reported in 7.5% (28/375) of studies. The most commonly reported patient-centred outcome was the SF-36 which was reported in 1.6% (6/375) of all studies and in 2/10 RCTs., Conclusions: There was wide variance in outcome measures in NSTI studies, further highlighting the need for a COS., (Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.)

Background: Analyzing Twitter posts enables rapid access to how issues and experiences are socially shared and constructed among communities of health service users and providers, in ways that traditional qualitative methods may not., Objective: To enrich the understanding of mental health crisis care in the United Kingdom, this study explores views on crisis resolution teams (CRTs) expressed on Twitter. We aim to identify the similarities and differences among views expressed on Twitter compared with interviews and focus groups., Methods: We used Twitter's advanced search function to retrieve public tweets on CRTs. A thematic analysis was conducted on 500 randomly selected tweets. The principles of refutational synthesis were applied to compare themes with those identified in a multicenter qualitative interview study., Results: The most popular hashtag identified was #CrisisTeamFail, where posts were principally related to poor quality of care and access, particularly for people given a personality disorder diagnosis. Posts about CRTs giving unhelpful self-management advice were common, as were tweets about resource strains on mental health services. This was not identified in the research interviews. Although each source yielded unique themes, there were some overlaps with themes identified via interviews and focus groups, including the importance of rapid access to care. Views expressed on Twitter were generally more critical than those obtained via face-to-face methods., Conclusions: Traditional qualitative studies may underrepresent the views of more critical stakeholders by collecting data from participants accessed via mental health services. Research on social media content can complement traditional or face-to-face methods and ensure that a broad spectrum of viewpoints can inform service development and policy., (©Natasha Chilman, Nicola Morant, Brynmor Lloyd-Evans, Jane Wackett, Sonia Johnson. Originally published in JMIR Mental Health (https://mental.jmir.org), 29.06.2021.)

Background: Acute Day Units (ADUs) provide intensive, non-residential, short-term treatment for adults in mental health crisis. They currently exist in approximately 30% of health localities in England, but there is little research into their functioning or effectiveness, and how this form of crisis care is experienced by service users. This qualitative study explores the views and experiences of stakeholders who use and work in ADUs., Methods: We conducted 36 semi-structured interviews with service users, staff and carers at four ADUs in England. Data were analysed using thematic analysis. Peer researchers collected data and contributed to analysis, and a Lived Experience Advisory Panel (LEAP) provided perspectives across the whole project., Results: Both service users and staff provided generally positive accounts of using or working in ADUs. Valued features were structured programmes that provide routine, meaningful group activities, and opportunities for peer contact and emotional, practical and peer support, within an environment that felt safe. Aspects of ADU care were often described as enabling personal and social connections that contribute to shifting from crisis to recovery. ADUs were compared favourably to other forms of home- and hospital-based acute care, particularly in providing more therapeutic input and social contact. Some service users and staff thought ADU lengths of stay should be extended slightly, and staff described some ADUs being under-utilised or poorly-understood by referrers in local acute care systems., Conclusions: Multi-site qualitative data suggests that ADUs provide a distinctive and valued contribution to acute care systems, and can avoid known problems associated with other forms of acute care, such as low user satisfaction, stressful ward environments, and little therapeutic input or positive peer contact. Findings suggest there may be grounds for recommending further development and more widespread implementation of ADUs to increase choice and effective support within local acute care systems.

Intraoperative magnetic resonance imaging (MRI) has been proposed as a method to optimize intracerebral targeting and for tracking infusate distribution in gene therapy trials for nervous system disorders. We thus investigated possible effects of two MRI contrast agents, gadoteridol (Gd) and galbumin (Gab), on the distribution and levels of transgene expression in the rat striatum and their effect on integrity and stability of recombinant adeno-associated virus (rAAV) particles. MRI studies showed that contrast agent distribution did not predict rAAV distribution. However, green fluorescent protein (GFP) immunoreactivity revealed an increase in distribution of rAAV5-GFP, but not rAAV2-GFP, in the presence of Gd when compared with viral vector injected alone. In contrast, Gab increased the distribution of rAAV2-GFP not rAAV5-GFP. These observations pointed to a direct effect of infused contrast agent on the rAAV particles. Negative-stain electron microscopy (EM), DNAase treatment, and differential scanning calorimetry (DSC) were used to monitor rAAV2 and rAAV5 particle integrity and stability following contrast agent incubation. EMs of rAAV2-GFP and rAAV5-GFP particles pretreated with Gd appear morphologically similar to the untreated sample; however, Gab treatment resulted in surface morphology changes and aggregation. A compromise of particle integrity was suggested by sensitivity of the packaged genome to DNAase treatment following Gab incubation but not Gd for both vectors. However, neither agent significantly affected particle stability when analyzed by DSC. An increase in T m was observed for AAV2 in lactated Ringer's buffer. These results thus highlight potential interactions between MRI contrast agents and AAV that might affect vector distribution and stability, as well as the stabilizing effect of lactated Ringer's solution on AAV2.

Iatrogenic Horner syndrome is a rare complication of chest tube insertion, with little information available on this topic in the pediatric literature. We present a case of a 13-month-old boy with a left-sided pneumonia and an associated pleural effusion for which a chest tube was inserted. His respiratory and septic parameters improved, but he was noted to have ptosis, miosis, and anhydrosis of the left side. These resolved in the days after chest tube removal. Although tube thoracostomy is a common procedure in surgical practice, little is written about the potential for injury to the ipsilateral sympathetic chain. This report reviews the available literature, with an emphasis on complication avoidance.

Teen pregnancy has declined throughout North America in the 1990s. In Yukon Territory, Canada, teen pregnancy in the late 1990s was almost 40% lower than in the early 1990s. This rate of decline is significantly greater than most recently reported national rates of teen pregnancy decline in Canada and United States. Identifying possible causes of the Yukon decline may help policy makers and program managers plan and implement teen pregnancy prevention strategies. Data on Yukon teen pregnancy prevention initiatives were collected through numerous discussions and interviews with Yukon service providers, teens, and the general public between 1994 and 2001. Analysis of data demonstrates that multiple new initiatives spanning many sectors were implemented in the mid and late 1990s that could have contributed to the decline in Yukon teen pregnancy. A multi-dimensional approach to teen pregnancy prevention that included researching and evaluating family planning programs and policies before, during, and after implementation, increasing access to longer-acting hormonal contraceptives, providing continuing family planning medical education to health care providers and other youth service providers, subsidization of contraceptives, delivery of innovative family planning mass media campaigns, and delivery of ongoing sexual health education programs may have significantly contributed to the decline in Yukon teen pregnancy. Collaboration among service providers across many service sectors (clinical, public health, education, First Nations, government communication and policy, grassroots) facilitated coordination of the multi-dimensional approach.