Scottish Executive Health Department Research Articles

Long-term weight loss following a randomised controlled trial of a weight management programme for men delivered through professional football clubs: the Football Fans in Training follow-up study

Background Rising levels of obesity require interventions that support people in long-term weight loss. The Football Fans in Training (FFIT) programme uses loyalty to football teams to engage men in weight loss. In 2011/12, a randomised controlled trial (RCT) found that the FFIT programme was effective in helping men lose weight up to 12 months. Objectives To investigate the long-term weight, and other physical, behavioural and psychological outcomes up to 3.5 years after the start of the RCT; the predictors, mediators and men’s qualitative experiences of long-term weight loss; cost-effectiveness; and the potential for long-term follow-up via men’s medical records. Design A mixed-methods, longitudinal cohort study. Setting Thirteen professional Scottish football clubs from the RCT and 16 additional Scottish football clubs that delivered the FFIT programme in 2015/16. Participants A total of 665 men who were aged 35–65 years at the RCT baseline measures and who consented to follow-up after the RCT (intervention group, n = 316; comparison group, n = 349), and 511 men who took part in the 2015/16 deliveries of the FFIT programme. Interventions None as part of this study. Main outcome measures Objectively measured weight change from the RCT baseline to 3.5 years. Results In total, 488 out of 665 men (73.4%) attended 3.5-year measurements. Participants in the FFIT follow-up intervention group sustained a mean weight loss from baseline of 2.90 kg [95% confidence interval (CI) 1.78 to 4.02 kg; p < 0.001], and 32.2% (75/233) weighed ≥ 5% less than at baseline. Participants in the FFIT follow-up comparison group (who participated in routine deliveries of the FFIT programme after the RCT) lost a mean of 2.71 kg (95% CI 1.65 to 3.77 kg; p < 0.001), and 31.8% (81/255) achieved ≥ 5% weight loss. Both groups showed long-term improvements in body mass index, waist circumference, percentage body fat, blood pressure, self-reported physical activity (PA) (including walking), the consumption of fatty and sugary foods, fruit and vegetables and alcohol, portion sizes, self-esteem, positive and negative affect, and physical and mental health-related quality of life (HRQoL). Mediators included self-reported PA (including walking) and sitting time, the consumption of fatty and sugary foods and fruit and vegetables, portion sizes, self-esteem, positive affect, physical HRQoL, self-monitoring of weight, autonomous regulation, internal locus of control, perceived competence, and relatedness to other FFIT programme participants and family members. In qualitative interviews, men described continuing to self-monitor weight and PA. Many felt that PA was important for weight control, and walking remained popular; most were still aware of portion sizes and tried to eat fewer snacks. The FFIT programme was associated with an incremental cost-effectiveness of £10,700–15,300 per quality-adjusted life-year (QALY) gained at 3.5 years, and around £2000 per QALY gained in the lifetime analysis. Medical record linkage provided rich information about the clinical health outcomes of the FFIT RCT participants, and 90% of men (459/511) who took part in the 2015/16 FFIT programme gave permission for future linkage. Conclusions Participation in the FFIT programme under both research (during the FFIT RCT) and routine (after the FFIT RCT) delivery conditions led to significant long-term weight loss. Further research should investigate (1) how to design programmes to improve long-term weight loss maintenance, (2) longer-term follow-up of FFIT RCT participants and (3) very long-term follow-up via medical record linkage. Trial registration Current Controlled Trials ISRCTN32677491. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 6, No. 9. See the NIHR Journals Library website for further project information. The Scottish Executive Health Department Chief Scientist Office (CSO) funded the feasibility pilot that preceded the FFIT RCT (CZG/2/504). The Medical Research Council (MRC) funded Kate Hunt and additional developmental research through the MRC/CSO Social and Public Health Sciences Unit Gender and Health programme (5TK50/25605200-68094).

Prevalence of endocrine and genetic abnormalities in boys evaluated systematically for a disorder of sex development.

STUDY QUESTIONWhat is the likelihood of identifying genetic or endocrine abnormalities in a group of boys with 46, XY who present to a specialist clinic with a suspected disorder of sex development (DSD)?SUMMARY ANSWERAn endocrine abnormality of the gonadal axis may be present in a quarter of cases and copy number variants (CNVs) or single gene variants may be present in about half of the cases.WHAT IS KNOWN ALREADYEvaluation of 46, XY DSD requires a combination of endocrine and genetic tests but the prevalence of these abnormalities in a sufficiently large group of boys presenting to one specialist multidisciplinary service is unclear.STUDY, DESIGN, SIZE, DURATIONThis study was a retrospective review of investigations performed on 122 boys.PARTICIPANTS/MATERIALS, SETTING, METHODSAll boys who attended the Glasgow DSD clinic, between 2010 and 2015 were included in the study. The median external masculinization score (EMS) of this group was 9 (range 1–11). Details of phenotype, endocrine and genetic investigations were obtained from case records.MAIN RESULTS AND THE ROLE OF CHANCEAn endocrine abnormality of gonadal function was present in 28 (23%) with a median EMS of 8.3 (1–10.5) whilst the median EMS of boys with normal endocrine investigations was 9 (1.5–11) (P = 0.03). Endocrine abnormalities included a disorder of gonadal development in 19 (16%), LH deficiency in 5 (4%) and a disorder of androgen synthesis in 4 (3%) boys. Of 43 cases who had array-comparative genomic hybridization (array-CGH), CNVs were reported in 13 (30%) with a median EMS of 8.5 (1.5–11). Candidate gene analysis using a limited seven-gene panel in 64 boys identified variants in 9 (14%) with a median EMS of 8 (1–9). Of the 21 boys with a genetic abnormality, 11 (52%) had normal endocrine investigations.LIMITATIONS, REASONS FOR CAUTIONA selection bias for performing array-CGH in cases with multiple congenital malformations may have led to a high yield of CNVs. It is also possible that the yield of single gene variants may have been higher than reported if the investigators had used a more extended gene panel.WIDER IMPLICATIONS OF THE FINDINGSThe lack of a clear association between the extent of under-masculinization and presence of endocrine and genetic abnormalities suggests a role for parallel endocrine and genetic investigations in cases of suspected XY DSD.STUDY FUNDING/COMPETING INTEREST(S)RN was supported by the James Paterson Bursary and the Glasgow Children's Hospital Charity Summer Scholarship. SFA, RM and EST are supported by a Scottish Executive Health Department grant 74250/1 for the Scottish Genomes Partnership. EST is also supported by MRC/EPSRC Molecular Pathology Node and Wellcome Trust ISSF funding. There are no conflicts of interest.TRIAL REGISTRATION NUMBERNone.

The successful implementation of Scotland's Hepatitis C Action Plan: what can other European stakeholders learn from the experience? A Scottish voluntary sector perspective.

The successful implementation of Scotland's Hepatitis C Action Plan: what can other European stakeholders learn from the experience? A Scottish voluntary sector perspective.

Revised Guidelines on Chaplaincy and Spiritual Care in the NHS

The Working Party Report prepared for the Scottish Executive Health Department will form the basis of new guidelines for spiritual care and chaplaincy in the National Health Service (NHS) in Scotland. It, is summarised by the working party convener.

Spiritual Care in N.H.S.Scotland

A retired hospital physician considers the practical implications of the Scottish Executive Health Department (SEHD) Guidelines on Spiritual Care in the NHS Scotland. Whilst welcoming the move toward the recovery of a spiritual dimension in health care, and the recognition of the specialist role of hospital chaplains, he expresses two concerns. The first is the danger of too superficial and ill-defined an attitude to the spiritual need of patients. The other is whether the rank and file of healthcare workers will be prepared to give time to this additional burden, or feel equipped to do so.

Off the Edge? A Theological Assessment of Scott's "Peripheral Stance" of Chaplaincy

In the light of the recent Scottish Executive Health Department (SEHD) Guidelines, the author examines the validity of the late Tom Scott’s “peripheral stance” of institutional chaplaincy, with specific reference to contemporary healthcare chaplaincy. Scott’s views are discussed in the context of the premise of secularisation. By drawing on Gill’s critique of Hauerwas, the author cites recent events in the aftermath of the Alder Hey inquiry to claim that healthcare chaplaincy can be defined as a central activity: one that is socially significant and capable of influencing society. By redefining chaplaincy as a form of “community church” (Moltmann), the author concludes that the question of the precise locus of chaplaincy is transcended by adopting a “double strategy” that enables chaplaincy to maintain an authentic Christian presence but at the heart of the hospital community.

Relapse in long-term conditions: learning from mental health methods

Within the UK, health-related policy and legislation have supported a shift towards a more pluralistic provision of health care in order to meet the challenges associated with the shifting demographics in society (Scottish Executive Health Department, 2009). The management of long-term conditions such as diabetes, heart disease and asthma, is recognized as a priority (Department of Health, 2009), with recognition that these long-term disorders share many similarities with serious mental health problems (Loggernberg, 2008), and suggestions that interventions already applied within the mental health setting are transferable across heathcare settings (Fleming et al, 2010). The application of one such intervention is discussed in this article.

Practice-based learning: The role of practice education facilitators in supporting mentors

Central to the provision of high quality clinical placements for nursing and midwifery students are mentors who help engender a positive learning environment. In 2004 the Scottish Executive Health Department (now Scottish Government Health Directorates), NHS Scotland, NHS Education for Scotland, NHS Boards and Higher Education Institutions initiated and supported the establishment of the Practice Education Facilitator (PEF) role whose purpose is to ensure that the student experience, at both pre- and post-registration level, is of the highest quality, primarily through the support of mentors. A 3-year project evaluated the implementation and impact of the PEF role across Scotland. The study utilised both quantitative and qualitative data collection, with a sample comprising mentors, PEFs, students and other key stakeholders. This paper reports on selected findings from that study, specifically the perceived impact of the PEF in supporting mentors. Findings indicate that the PEF role has been accepted widely across Scotland and is seen as valuable to the development of quality clinical learning environments. PEFs provide support and guidance for mentors when dealing with 'failing' students, and encourage the identification of innovative learning opportunities. PEFs play an active part in student evaluation of their placements, but further work is needed in order that the feedback to clinical areas and mentors is timely.

Study Sheds Light on Relationship Between Debt, Mental Illness

Back to table of contents Previous article Next article Professional NewsFull AccessStudy Sheds Light on Relationship Between Debt, Mental IllnessJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:2 Jan 2009https://doi.org/10.1176/pn.44.1.0005aMillions of Americans have watched in dismay as their investments have plummeted in value during the country's economic downturn. Unemployment is growing. Countless people are struggling to pay their mortgage while those who can't have lost their homes. And what has now become a global financial crisis is taking its toll on people's mental health, not just on their pocketbooks.A study reported in the October 2008 Psychological Medicine, published by Cambridge University Press in England, found a strong link between debt and mental illness. Almost a quarter of all people with mental illness are in debt, compared with only 8 percent of people with no mental illness, the study found.The study, headed by Rachel Jenkins, M.D., a professor at the Institute of Psychiatry in London, was based on a nationally representative sample of people living in the United Kingdom—some 8,600 individuals. All were assessed for anxiety and depressive disorders, psychosis, alcohol abuse, and drug abuse. They were also asked detailed questions about their income and debt. Jenkins and her colleagues then looked to see whether there were any links between mental disorders and income or debt.The researchers found that those subjects with a low income were twice as likely to have a mental disorder as were those with a higher income. Also, the more debts they had, the more likely they were to have some form of mental disorder.The researchers then compared the relationship between income and mental disorders with the relationship between debt and mental disorders. The relationship between having a low income and having a mental disorder was weakened when debt was considered. In contrast, the relationship between having debt and having a mental disorder remained robust even when a low income was considered, and it was only slightly weakened when other sociodemographic variables were considered.In fact, even after adjusting for income and other variables, the more debts people had, the more likely they were to have a mental disorder overall, an anxiety or a depressive disorder, psychosis, alcohol dependence, or drug dependence. Also, people with six or more separate debts had a sixfold increase in mental disorder after adjusting for income.Thus, there may be a strong association not only between low income and mental illness, but also between debt and mental illness, Jenkins and her team concluded. But of the two associations, the latter seems to be more potent.The study was not designed to determine whether debt leads to mental illness or whether mental illness leads to debt. However, “Both are probably true,” Jenkins told Psychiatric News.Truly, some of the study data could be used to argue either case. For instance, that debt was found to be four times as prevalent among people with psychosis as among people in good mental health suggests that serious mental illness keeps people from holding down good jobs and thus puts them at risk of going into debt. In contrast, that debt was found to be three times as prevalent among people with an anxiety or a depressive disorder as among people in good mental health implies that the stress of being in debt can erode people's mental health.In any event, the implications for psychiatrists are the same in either case, Jenkins advised. They should assess the financial situations of their patients, she said, and if their patients are in considerable debt, they should refer them to a debt-management expert.The study was funded by England's Department of Health, the Scottish Executive Health Department, and the Welsh Assembly Government.An abstract of “Debt, Income, and Mental Disorder in the General Population” is posted at<http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=2178012>.▪ ISSUES NewArchived

Does intermediate care exist in Scotland?

The term 'intermediate care' has not been widely used in NHS Scotland. That is not tosay that the types of services associated with intermediate care in England and Wales do not exist in Scotland, it is just that the old Scottish Executive Health Department (SEHD) was wary of using the term because it had previously been used to re-label and reinvent existing services ( SEHD 2006 ). However, in the past 18 months, the term has started to become more common. For example, the Joint Improvement Team (established in late 2004 to work directly with local health and social care partnerships across Scotland) has an Intermediate Care Learning Network.

Commentary on Paley J (2008) Spirituality and secularization: nursing and the sociology of religion. Journal of Clinical Nursing17, 175–186

included study Cortazzi et al. (2001) reported on the use of both incidental, anecdotal and formal peer teaching and learning strategies, as reported in the outcomes ‘Narratives mediate learning by re-telling experience, students learn by reflection’ (Secomb 2008). In health science education literature many learning outcomes are self reported, peer evaluated, client reported or clinician evaluated, therefore level of evidence is considered but not central to the investigation (Secomb 2008). The inclusion of this type of information can highlight significant factors and further research responsibilities and possibilities (Secomb 2008), but the research design needs to clear (Altman 2002), and the meaning contextualised within existing literature, and evaluation and inclusion strategies outlined. As with this review, not all the outcomes discussed in the main text as relevant to the research question made the final reporting, in Table 2 ‘The significant findings for clinical practice from this systematic review of literature’ (Secomb 2008). When it became evident that statistical meta-analysis was unachievable, a meta-synthesis which provided consistency and comparability between studies their designs and results was used. Jacinta Secomb PhD candidate University of South Australia E-mail: secomb@chariot.net.au

Co‐proxamol withdrawal has reduced suicide from drugs in Scotland

To determine what effect the withdrawal of co-proxamol from the UK market has had on mortality from poisoning in Scotland. This was a retrospective, observational study of mortality relating to poisoning by single agents in Scotland for the period 2000-2006. Mortality data were obtained from the General Register Office Scotland, and primary care prescribing data from the Information and Statistics Division of the Scottish Executive Health Department. A significant reduction in the proportion of poisoning deaths due to co-proxamol was observed following legislation [mean 2000-2004, 37 deaths (21.8% of total poisoning deaths); 2006, 10 (7.8%); P < 0.0001]. The most significant reduction was seen in male out-of-hospital deaths [mean 2000-2004, 17 (21.8%); 2006, two (2.9%); P < 0.0001]. This was associated with a decline in prescriptions by 60% within 6 months of legislation. The total number of poisoning deaths also fell, slightly earlier than the full impact on co-proxamol deaths (mean 2000-2004, 171.2; mean 2005-2006, 129.5; P = 0.005). Legislation has resulted in a major reduction in the number of deaths associated with co-proxamol poisoning in Scotland, with no compensatory rise in mortality from poisonings from other common analgesics. We estimate from this study that a minimum of 300 lives across the UK will have been saved by the withdrawal of co-proxamol.

233: Resource-Neutral Performance Improvement in an Urban General Hospital Emergency Department

The Scottish Executive Health Department has introduced a mandatory target of 98% of all emergency department (ED) patients being treated and discharged within 4 hours from registration time by December 2007. We aimed to reduce exit block within the emergency department and reduce total ED waiting times utilising a process-led resource-neutral initiative towards meeting this target.

An evaluation, at the 1-year stage, of a 3-year project to introduce practice education facilitators to NHS Tayside and Fife

As a result of the Scottish Executive Health Department (SEHD) initiative, Facing the Future [Scottish Executive Health Department, 2002. Facing the Future. SEHD, Edinburgh], a need was identified for a group of experienced nurses and midwives to help support students and mentors within practice settings. It was agreed to fund one hundred "G" grade posts across NHS Scotland for an initial period of three years. As a result of this initiative, in 2004 a group of fifteen Practice Education Facilitators (PEFs) were employed by NHS Tayside and NHS Fife in Scotland. Their brief was to maintain and improve learning environments within the practice setting. This paper describes an evaluation of this new role as carried out at key stages within the first year of the project. A combination of focus groups and questionnaires were used, both to analyse the perceptions of the NHS staff that PEFs would be working with and to explore the lived experience of the PEFs during their first year in post. There was a general welcome for the role across all groups. Perceptions varied on the PEF role itself, most staff groups expecting PEFs to work mainly with students. The PEFs, however, saw the main thrust of their work with mentors, their associates and other staff.

New role, new country: introducing US physician assistants to Scotland.

This paper draws from research commissioned by the Scottish Executive Health Department (SEHD). It provides a case study in the introduction of a new health care worker role into an already well established and "mature" workforce configuration It assesses the role of US style physician assistants (PAs), as a precursor to planned "piloting" of the PA role within the National Health Service (NHS) in Scotland.The evidence base for the use of PAs is examined, and ways in which an established role in one health system (the USA) could be introduced to another country, where the role is "new" and unfamiliar, are explored.The history of the development of the PA role in the US also highlights a sometimes somewhat problematic relationship between P nursing profession. The paper highlights that the concept of the PA role as a 'dependent practitioner' is not well understood or developed in the NHS, where autonomous practice within regulated professions is the norm. In the PA model, responsibility is shared, but accountability rests with the supervising physician. Clarity of role definition, and engendering mutual respect based on fair treatment and effective management of multi-disciplinary teams will be pre-requisites for effective deployment of this new role in the NHS in Scotland.

Identity Dynamics as a Barrier to Organizational Change

This article seeks to explore the construction of group and professional identities in situations of organizational change. It considers empirical material drawn from a health demonstration project funded by the Scottish Executive Health Department, and uses insights from this project to discuss issues that arise from identity construction(s) and organizational change. In the course of the project studied here, a new organizational form was developed which involved a network arrangement with a voluntary sector organization and the employment of “lay-workers” in what had traditionally been a professional setting. Our analysis of the way actors made sense of their identities reveals that characterizations of both self and other became barriers to the change process. These identity dynamics were significant in determining the way people interpreted and responded to change within this project and which may relate to other change-oriented situations.

Progressing the action plan in Scotland – an educational perspective

In March 2005 the Scottish Executive Health Department published the 'Action plan for improving oral health and modernising NHS dental services in Scotland'. Six areas required major new educational input: pre-qualification education, workforce supply, career development, dental practice and team development, clinical effectiveness/quality improvement and support for the oral health strategy. Targets from the action plan that have been fully achieved include: 1) undergraduate student numbers have reached the target output of 135 per year; 2) vocational training numbers match graduate numbers; 3) a vocational training scheme for dental therapists has been developed and numbers of VT places will match the number of qualifying therapists; 4) a new strategy to support dental nurse training will allow an additional 200 dental nurse training places by 2007; and 5) a clinical effectiveness programme has developed a rolling programme of guidelines, the first one of which, on conscious sedation, was released in May. The dental action plan has provided Scotland with the best opportunity for modernising dental services since the NHS was established. This paper describes some of the educational developments that will ensure NHS dental services in Scotland are 'fit for the future' and 'delivering for health'.

Model Infection Control Policies – A National Resource for Scotland

ISSUE: Following a mandate from the Scottish Executive Health Department and reports stating that standards within hospitals and home care settings in Scotland required improvement, model infection control policies were requested to support implementation of infection prevention and control programs. Our Infection Control Team were tasked with developing these policies in conjunction with stakeholers, as part of our responsibility to facilitate knowledge management. The first policies identified for development, due to a lack of consistency and currency of those policies already in place in Scotland, were on standard precautions. PROJECT: The policies developed were based on the standard precautions described by Garner in the Guideline for Isolation Precautions in Hospitals in 1996 and as recommended to be adopted by all healthcare settings in the Scottish Infection Manual in 1997. A novel approach to developing model infection control policies was used to ensure relevance to all settings: A Steering Group, consisting of representatives from all settings and a member of the public, was set up to oversee the work. A web based forum was made accessible to the Group to allow consultation and to facilitate version control of documents. A project management approach was applied to facilitate progress and quality assurance. It was established early in the project from other national initiatives, that utilising questions and answers to format the policies was the most appropriate. Critical appraisal of the literature was conducted, to underpin each of the policies, as well as consideration of expert infection control opinion to ensure relevance to settings within Scotland. Policy content was also mapped to existing audit tools. Autoalerts were set up within the <i>e</i>.library at this time to ensure any new, relevant literature would be highlighted in a timely fashion. The policies and literature reviews were sent out for wide consultation around the UK, with returned comments collated, categorised and ratified by an external assessor. Materials to support implementation of the policies, e.g. audit tools, example training materials, were also compiled and made available alongside the policy documents. RESULTS: The Team produced nine model policies and associated literature reviews and published them on the internet. These will be reviewed annually.The process used to produce these documents was evaluated in order to inform further model policy development. LESSONS LEARNED: The process to develop these policies proved essential in ensuring a high standard of work, in line with international standards. It has proven to be a resource intense excercise, however, duplication of policy development in Scotland has been prevented. The response to the policies has been very positive, which has highlighted the importance of producing such resources to facilitate knowledge management throughout Scotland.

The president of the GMC

Professor Sir Graeme Catto qualified from the University of Aberdeen in 1969. He won a Harkness Fellowship to Harvard University to work in renal medicine. He became dean and vice principal at Aberdeen and then at King9s College London, and pro vice chancellor at the University of London. In the 1990s he was the chief scientist at the Scottish Executive Health Department and chairman of the GMC Education Committee. He has been president of the GMC since 2002, and is also professor of medicine at the University of Aberdeen

Nursing and midwifery research in Scotland: from partnership to collaboration

Nurses and midwives form the workforce that provides the greatest proportion of direct care to service users. They have the ability to make a significant impact not only on the quality and outcomes of patient care, but also on service users' and carers' perceptions of the care experience. It is therefore vital that nursing and midwifery practice has a robust knowledge and evidence base. The Scottish Executive Health Department, in partnership with other key stakeholders, launched in 2004 an 8 million pounds funding package for research and development capacity and capability initiatives for nursing, midwifery and the allied health professions. This article seeks to describe the process of engagement and partnership building that enabled this scheme to be developed. It will attempt to illustrate how the convergence of political, policy and professional agendas has provided the opportunity for nurses and midwives to set a direction of travel for research and development that will enable them to become key players within multidisciplinary research at United Kingdom and international levels.