Mental health nurses’ attitudes, behaviour, experience and knowledge regarding adults with a diagnosis of borderline personality disorder: systematic, integrative literature review

Aims and objectives To establish whether mental health nurses responses to people with borderline personality disorder are problematic and, if so, to inform solutions to support change. Background There is some evidence that people diagnosed with borderline personality disorder are unpopular among mental health nurses who respond to them in ways which could be counter-therapeutic. Interventions to improve nurses’ attitudes have had limited success. Design Systematic, integrative literature review. Methods Computerised databases were searched from inception to April 2015 for papers describing primary research focused on mental health nurses’ attitudes, behaviour, experience, and knowledge regarding adults diagnosed with borderline personality disorder. Analysis of qualitative studies employed metasynthesis; analysis of quantitative studies was informed by the theory of planned behaviour. Results Forty studies were included. Only one used direct observation of clinical practice. Nurses’ knowledge and experiences vary widely. They find the group very challenging to work with, report having many training needs, and, objectively, their attitudes are poorer than other professionals’ and poorer than towards other diagnostic groups. Nurses say they need a coherent therapeutic framework to guide their practice, and their experience of caregiving seems improved where this exists. Conclusions Mental health nurses’ responses to people with borderline personality disorder are sometimes counter-therapeutic. As interventions to change them have had limited success there is a need for fresh thinking. Observational research to better understand the link between attitudes and clinical practice is required. Evidence-based education about borderline personality disorder is necessary, but developing nurses to lead in the design, implementation and teaching of coherent therapeutic frameworks may have greater benefits. Relevance to clinical practice There should be greater focus on development and implementation of a team-wide approach, with nurses as equal partners, when working with patients with borderline personality disorder.

Effects of a 12-week aerobic exercise intervention on eating behaviour, food cravings and 7-day energy intake and energy expenditure in inactive men

This study examined effects of 12 weeks of moderate-intensity aerobic exercise on eating behaviour, food cravings and weekly energy intake and expenditure in inactive men. Eleven healthy men (mean ± SD: age, 26 ± 5 years; body mass index, 24.6 ± 3.8 kg/m2; maximum oxygen uptake, 43.1 ± 7.4 mL/kg/min) completed the 12-week supervised exercise programme. Body composition, health markers (e.g. blood pressure), eating behaviour, food cravings and weekly energy intake and expenditure were assessed before and after the exercise intervention. There were no intervention effects on weekly free-living energy intake (p=0.326, d=-0.12) and expenditure (p=0.799, d=0.04), or uncontrolled eating and emotional eating scores (p>0.05). However, there was a trend with a medium effect size (p=0.058, d=0.68) for cognitive restraint to be greater after the exercise intervention. Total food cravings (p=0.009, d=-1.19) and specific cravings of high-fat foods (p=0.023, d=-0.90), fast-food fats (p=0.009, d=-0.71) and carbohydrates/starches (p=0.009, d=-0.56) decreased from baseline to 12 weeks. Moreover, there was a trend with a large effect size for cravings of sweets (p=0.052, d=-0.86) to be lower after the exercise intervention. In summary, 12 weeks of moderate-intensity aerobic exercise reduced food cravings and increased cognitive restraint, however, these were not accompanied by changes in other eating behaviours and weekly energy intake and expenditure. The results indicate the importance of exercising for health improvements even when reductions in body mass are modest.

Health assets and active lifestyles during preadolescence and adolescence: highlights from the HBSC/WHO health survey and implications for health promotion

The present chapter discusses the assets model as a theoretical approach to the study of health behavior and health promotion. The model emphasizes people’s talents, competences, and resources. In this chapter, a health asset is defined as any factor or resource that maximizes the opportunities for individuals, local communities, and populations to attain and maintain health and well-being. This perspective expands and complements the current medical model as it focuses on the development of a sense of empowerment in community members to prevent and manage their own health. Therefore, in this chapter we address the concepts of salutogenesis, social support, resilience, coping, self-regulation, social capital, and personal and social competence, which are central to the development of individuals’ potential to manage and savor their own health, creating the conditions for self-fulfillment. Additionally, we demonstrate how the assets model guides the study of children’s and adolescents’ health in the Portuguese Health Behaviour in School-aged Children study (www.hbsc.org), concentrating on areas such as active lifestyles and quality-of-life perception. Finally, we present a roadmap for action that emphasizes the need to identify the factors that make children and adolescents happy and healthy individuals, while minimizing risks and problems they naturally encounter throughout their development. We also argue for the need to involve young people in discussions concerning their health and health promotion practices, focusing on the development of talents, capabilities, and positive expectations for the future.

Navigating uncertain waters: a critical review of inferring foraging behaviour from location and dive data in pinnipeds

In the last thirty years, the emergence and progression of biologging technology has led to great advances in marine predator ecology. Large databases of location and dive observations from biologging devices have been compiled for an increasing number of diving predator species (such as pinnipeds, sea turtles, seabirds and cetaceans), enabling complex questions about animal activity budgets and habitat use to be addressed. Central to answering these questions is our ability to correctly identify and quantify the frequency of essential behaviours, such as foraging. Despite technological advances that have increased the quality and resolution of location and dive data, accurately interpreting behaviour from such data remains a challenge, and analytical methods are only beginning to unlock the full potential of existing datasets. This review evaluates both traditional and emerging methods and presents a starting platform of options for future studies of marine predator foraging ecology, particularly from location and two-dimensional (time-depth) dive data. We outline the different devices and data types available, discuss the limitations and advantages of commonly-used analytical techniques, and highlight key areas for future research. We focus our review on pinnipeds - one of the most studied taxa of marine predators - but offer insights that will be applicable to other air-breathing marine predator tracking studies. We highlight that traditionally-used methods for inferring foraging from location and dive data, such as first-passage time and dive shape analysis, have important caveats and limitations depending on the nature of the data and the research question. We suggest that more holistic statistical techniques, such as state-space models, which can synthesise multiple track, dive and environmental metrics whilst simultaneously accounting for measurement error, offer more robust alternatives. Finally, we identify a need for more research to elucidate the role of physical oceanography, device effects, study animal selection, and developmental stages in predator behaviour and data interpretation.

Some problems and errors in cytogenetic biodosimetry

Human radiosensitivity is a quantitative trait that is generally subject to binomial distribution. Individual radiosensitivity, however, may deviate significantly from the mean (by 2-3 standard deviations). Thus, the same dose of radiation may result in different levels of genotoxic damage (commonly measured as chromosome aberration rates) in different individuals. There is significant genetic component in individual radiosensitivity. It is related to carriership of variant alleles of various single-nucleotide polymorphisms (most of these in genes coding for proteins functioning in DNA damage identification and repair); carriership of different number of alleles producing cumulative effects; amplification of gene copies coding for proteins responsible for radioresistance, mobile genetic elements, and others. Among the other factors influencing individual radioresistance are: radioadaptive response; bystander effect; levels of endogenous substances with radioprotective and antimutagenic properties and environmental factors such as lifestyle and diet, physical activity, psychoemotional state, hormonal state, certain drugs, infections and others. These factors may have radioprotective or sensibilising effects. Apparently, there are too many factors that may significantly modulate the biological effects of ionising radiation. Thus, conventional methodologies for biodosimetry (specifically, cytogenetic methods) may produce significant errors if personal traits that may affect radioresistance are not accounted for.