A Reappraisal of the Safety and Cost-Effectiveness of Statin Therapy in Primary Prevention

Statins are among the most investigated drugs of all time. There is now a wealth of evidence supporting their use in the primary and secondary prevention arenas. The reduction in event recurrence has since been demonstrated across all levels of risk and in elderly patients. As a result, it is now accepted practice for statins to be prescribed universally in secondary prevention unless contraindicated. The extension of this policy into the primary prevention setting is more problematic, with moral and financial issues arising from the long-term treatment of many young apparently healthy individuals. For these reasons it is necessary to prove not only the financial sustainability of such a strategy but also the long-term safety of statins and the degree of benefit that might be expected.

Sex Education in Northern Ireland Schools: a Critical Evaluation.

To date there has been little research on young people and sexuality in Northern Ireland. This paper draws on the first major study in this area to analyse the delivery of formal sex education in schools. Both quantitative and qualitative methods were used to access young people's opinions about the quality of the sex education they had received at school. Overall, they reported high levels of dissatisfaction, with notable variations in relation to both gender and religious affiliation. In one sense their opinions mesh well with those of young people in other parts of these islands. At the same time the specificity of sexuality in Ireland plays a key role in producing the moral system that underlies much of formal sex education in schools. Underpinned by a particularly traditional and conservative strain of Christian morality, sex education in Northern Ireland schools is marked by conservatism and silence and by the avoidance of opportunities for informed choice in relation to sexuality on the part of young people.

Secondary prevention of cardiovascular disease in different primary healthcare systems with and without pay-for-performance

Objective: To compare baseline cardiovascular risk management between people recruited from two different healthcare systems, to a research trial of an intervention to optimize secondary prevention. Design: Cross-sectional study. Setting: General practices, randomly selected: 16 in Northern Ireland (NI) (UK NHS, ‘strong’ infrastructure); 32 in Republic of Ireland (RoI) (mixed healthcare economy, less infrastructure). Patients: 903 (mean age 67.5 years; 69.9% male); randomly selected, known coronary heart disease. Main outcome measures: Blood pressure, cholesterol, medications; validated questionnaires for diet (DINE), exercise (Godin), quality of life (SF12); healthcare usage. Results: More RoI than NI participants had systolic BP>140 mmHg (37% v 28%, p=0.01) and cholesterol >5mmol/l (24% v 17%, p=0.02): RoI mean systolic BP was higher (139 v 132 mm Hg). More RoI participants reported a high fibre intake (35% v 23%), higher levels of physical activity (62% v 44%), and better physical and mental health (SF12); they had more GP (5.6 v 4.4) and fewer nurse visits (1.6 v 2.1) in the previous year. Fewer in RoI (55% v 70%) were prescribed B blockers. Both groups’ ACE inhibitor (41%; 48%) prescribing was similar; high proportions were prescribed statins (84%; 85%) and aspirin (83%; 77%). Conclusions Blood pressure and cholesterol are better controlled among patients in a primary healthcare system with a ‘strong’ infrastructure supporting computerization and rewarding measured performance but this is not associated with healthier lifestyle or better quality of life. Further exploration of differences in professionals’ and patients’ engagement in secondary prevention in different healthcare systems is needed.

Same sex attraction, homophobic bullying and mental health of young people in Northern Ireland

This article reports on the relationship between same-sex attraction, experience of bullying in school and mental health measured using the 12-item version of the General Health Questionnaire (GHQ12). A random sample of 16 year olds, drawn from the Child Benefit Register, was invited to take part in the 2005 Young Life and Times survey, which is a postal survey carried out in Northern Ireland every year. Eight hundred and nineteen 16 year olds responded, which represented a return rate of 40%. The results of the survey showed that respondents who said they had been attracted to a person of the same sex at least once were significantly more likely to report experiences of school bullying. Same-sex-attracted 16 year olds were significantly less likely than those attracted to persons of the opposite sex only to say that their school provided real help to those who are being bullied. The 2005 Young Life and Times data also indicated that same-sex-attracted respondents were more than twice as likely as respondents who were only attracted to people of the opposite sex to have higher levels of psychiatric disorder. (Contains 5 tables.)

Establishing ex ante public construction supply chain guidelines in the public procurement of Schools' estate

Purpose – The purpose of this study is to explore the formative development of construction supply chain guidelines or proposals in a UK region’s schools’ estates procurement process to more effectively address a forthcoming increase in investment.

Design/methodology/approach – The research approach is interpretive. Using an action research approach, repeated semi-structured interviews and focus groups with a range of stakeholders are conducted.

Findings – The current construction supply chain in schools’ estate procurement has many difficulties, not least given the highly fragmented and disconnected nature of the projects. Synergies are being missed and there is little or no continuous improvement. Drawing on these findings, the research iteratively develops a range of proposals and guidelines to address this situation.

Research limitations/implications – This research adds weight to the current focus on pressing for change in the construction industry. It presents potentially valuable insights into the benefits of partnering arrangements and how these might usefully be incorporated into schools’ estate supply chain.

Practical implications – A set of guidelines is developed to guide the public procurement of schools’ estate in a UK region. These guidelines are set within the context of the Modernising and Rethinking Construction agenda.

Originality/value – The action research approach enabled the researchers to gain a unique insight into how public procurement and contractor personnel interact and to establish effective practical guidelines.

Leadership for inclusion: Conceptualising and enacting inclusion in integrated schools in a troubled society

Inclusion is increasingly understood as an educational reform that responds to the diversity of all learners, challenging the marginalization, exclusion and underachievement which may result from all forms of ‘difference’. Leadership for inclusion is conceptualized here as driving a constant struggle to create shared meanings of inclusion and to build collaborative practice, an effort that needs to be rooted in critical practice lest it risk replicating existing patterns of disadvantage. In response to calls for further research that challenge how school leaders conceptualize inclusion and for research that investigates how leaders enact their understandings of inclusion, this paper aims to increase our understanding of the extent to which leadership vision can map onto a school’s culture and of the organizational conditions in schools that drive responses to diversity. We investigate the enactment of leadership for inclusion in the troubled context of Northern Ireland by looking at two schools that primarily aim to integrate Catholic and Protestant children but which are also sites for a range of other dimensions of student ‘difference’ to come together. Whilst the two schools express differing visions of the integration of Catholics and Protestants, leadership vision of inclusion is enacted by members of the school community with a consensus around this vision brought about by formal and informal aspects of school culture. Multiple and intersecting spheres of difference stimulate a concerted educational response in both schools but integration remains the primary focus. In this divided society, religious diversity poses a significant challenge to inclusion and further support is required from leaders to enable teachers to break through cultural restraints.

Evidence from a Baseline Study of Teachers and Young People in Northern Ireland: Implications for Peace Education.

Peace education initiatives in schools are often based on social psychological theories assuming that social identity affects ingroup and outgroup attitudes and, in turn, behaviors relating to relevant outgroups. However, research evidence on the role of young people’s social identity has often failed to take account of different social identity dimensions or to conceptualise outgroup behavior in the context of young people’s understandings of the social world. While recent research relating to bullying and bystander behavior amongst young people has addressed the latter point, this has rarely been considered in conjunction with a differentiated view of social identity. This paper is therefore distinctive as it will address the role of social identity dimensions with regards to behavior as captured in bystander scenarios relating to intergroup discrimination. This is particularly important in the context of divided societies, where peace education initiatives are crucial in promoting positive community relations for the future and where such initiative may be hampered by communities’ concerns about loss of identity and hardened intergroup attitudes. Furthermore, previous research frequently highlighted teachers’ fears to tackle outgroup attitudes in the classroom, especially in contexts where pupils and the wider school community are seen as entrenched in community divisions (Hughes, Donnelly, Hewstone, Gallagher & Carlisle, 2010). However, there is no research investigating the relationship between pupils’ attitudes and teacher confidence to talk about such issues in the classroom, which is explored in this paper.

In the context of Northern Ireland, a divided society emerging from sectarian conflict, social identity, outgroup attitudes and outgroup behaviours have been key concepts addressed by peace educators for many years. Building on this work, this paper provides a detailed picture of young people’s strength of group identification and their willingness to explore ingroup perspectives, sectarian attitudes and their reported willingness to challenge sectarian bullying. Using data from a baseline survey, which forms part of a randomized control trial investigating the effect of an educational intervention aimed to promote reconciliation, the sample involved young people of different denominational backgrounds, attending separate school sectors. The baseline data will be used to compare with post intervention data. Therefore, the data and its findings would be of particular interest to educators and policy makers in other European countries who are working to develop peace education interventions in societies emerging from conflict. Additionally, this paper considers the results from a baseline teacher survey, collected before training and teaching of the intervention began. The teacher survey focused on confidence in tackling sectarian issues in the classroom, previous experience of teaching such issues and their hopes and concerns for the reconciliation intervention.

This paper therefore set out to investigate the relationship between dimensional concept of social identity, sectarian attitudes and pupils’ reported willingness to challenge sectarian bullying and to compare this with their teachers’ attitudes to teaching about sectarian issues in the classroom.



Method

The pupil sample included 35 primary and post-primary schools and about 800 pupils from 8-11 years old who completed an online questionnaire in December 2011 and January 2012. Main instruments for young people’s survey included an adapted version of the Multi-ethnic identity measure (Phinney, 1992) incorporating the dimensions identity affirmation and exploration, outgroup attitude scales, including an adaptation of the social distance measure (Bogardus, 1947), as well as a measure adapted from Palmer and Cameron (2011) involving scenarios to capture pupils’ intentions in bystander situations relating to intergroup discrimination. Results are analysed using regression analysis and take account of potential gender and religious differences. The teacher questionnaire was completed by the 35 primary and post-primary teachers who will deliver the intervention. Results are analysed in terms of how teachers’ responses compare with their pupil attitudes by considering their confidence in tackling sectarian issues in the classroom and how their previous experience and training relate to their hopes and concerns for the intervention.


Expected Outcomes

Results from the young people’s survey are discussed in the light of the role of social identity dimensions and their relationship to sectarian attitudes and reported bystander behaviour in sectarian school incidents. Furthermore, results related to pupils’ sectarian attitudes will be compared with teachers’ reported confidence in tackling sectarianism in the classroom. The teacher questionnaire also presents interesting findings in relation to teachers’ previous training and experience and how this may influence different perspectives on peace and reconciliation interventions and their expectations of what these could achieve. The paper concludes with potential implications for peace education initiatives and related teacher training in Northern Ireland and beyond. The implications will be of particular interest to policy makers, educators and those working in the area of peace education to design and implement interventions.


References

Bogardus, E. S. (1947) Measurement of Personal-Group Relations. Sociometry, 10: 4: 306–311. Hughes, J., Donnelly, C., Hewstone, M., Gallagher, T. & Carlisle, K. (2010) School partnerships and reconciliation: An evaluation of school collaboration in Northern Ireland. Belfast: Queen’s University Belfast. Available online: http://www.schoolsworkingtogether.com/documents/School%20collaboration%20in%20NI%202010.pdf. (accessed 27th Jan 2010) Palmer, S. & Cameron, L. (2011, May). What are the moderators and mediators of children’s bystander behaviour in the context of intergroup discrimination? Paper session presented at the UNA Global Biennial Conference 2011: Building Peaceable Communities: The Power of Early Childhood, Amsterdam, Holland. Phinney, J. S. (1992). The Multigroup Ethnic Identity Measure: A new scale for use with diverse groups. Journal of Adolescent Research, 7, 156–176.

Biofilm formation by bacteria isolated from retrieved failed prosthetic hip implants in an in vitro model of hip arthroplasty antibiotic prophylaxis

Bacterial infection primarily with Staphylococcus spp. and Propionibacterium acnes remains a significant complication following total hip replacement. In this in vitro study, we investigated the efficacy of gentamicin loading of bone cement and pre- and postoperative administration of cefuroxime in the prevention of biofilm formation by clinical isolates. High and low initial inocula, representative of the number of bacteria that may be present at the operative site as a result of overt infection and skin contamination, respectively, were used. When a high initial inoculum was used, gentamicin loading of the cement did not prevent biofilm formation by the 10 Staphylococcus spp. and the 10 P. acnes isolates tested. Similarly, the use of cefuroxime in the fluid phase with gentamicin-loaded cement did not prevent biofilm formation by four Staphylococcus spp. and four P. acnes isolates tested. However, when a low bacterial inoculum was used, a combination of both gentamicin-loaded cement and cefuroxime prevented biofilm formation by these eight isolates. Our results indicate that this antibiotic combination may protect against infection after intra-operative challenge with bacteria present in low numbers as a result of contamination from the skin but would not protect against bacteria present in high numbers as a result of overt infection of an existing implant.

Demonstrating the merits of the peer research process: A Northern Ireland case study

This article discusses the benefits and challenges of involving peer researchers in social research projects. A research project on pupil participation in policy making on school bullying in Northern Ireland’s schools was commissioned by the Office of the Northern Ireland Commissioner for Children and Young People and undertaken by the National Children’s Bureau in conjunction with researchers from Queen’s University Belfast in fourteen schools across Northern Ireland, utilizing a mixed methods approach. We trained and employed nine 15–18-year-old peer researchers to support them in this project. After the project’s completion, we conducted interviews with six of the peer researchers to investigate how they experienced their involvement in the research. We discuss the findings from these interviews and contextualize in a review
of literature on research involving children and young people.

Intimate Mixing - Bridging the Gap? Catholic-Protestant Relationships in Northern Ireland

For many years Northern Ireland has been a divided society where members of the two main religious groups, Catholics and Protestants, have limited opportunities to interact due to segregation in their social lives. Attempts have been made to encourage religious mixing through integration in schools, housing and workplaces predicated on the theory that bringing people together can improve community relations and remove prejudices – known as the ‘contact hypothesis’. However, little is known about those who enter into mixed-religion partnerships often against the wishes of their families and communities. This paper examines the characteristics and attitudes of mixed-religion couples and suggests that they differ in their socio-demographic characteristics and in their attitudes from those who marry within their own religion. These findings add to the weight of evidence from other countries in conflict suggesting that intermarriage has a role to play in contributing to less sectarian views and improved community relations.

In vitro isoflavone supplementation reduces hydrogen peroxide-induced DNA damage in sperm

Isoflavones are plant compounds, proposed to have health benefits in a variety of human diseases, including coronary heart disease and endocrine-responsive cancers. Their physiological effects include possible antioxidant activity, therefore suggesting a role for isoflavones in the prevention of male infertility. The aim of this study was to test the antioxidant effects of the isoflavones genistein and equol on sperm DNA integrity, assessed in vitro after hydrogen peroxide-mediated damage, using the cornet assay. Pre-treatment with genistein or equol at doses of 0.01-100 mumol/l significantly protected sperm DNA against oxidative damage. Both ascorbic acid (10-600 mumol/l) and alpha-tocopherol (1-100 mumol/l) also protected. Compared with ascorbic acid and alpha-tocopherol, added at physiological concentrations, genistein was the most potent antioxidant, followed by equol, ascorbic acid, and alpha-tocopherol. Genistein and equol added in combination were more protective than when added singly. Based on these preliminary data, which are similar to those observed previously in lymphocytes, these compounds may have a role to play in antioxidant protection against male infertility.

Statins for the prevention of dementia

Background: This is an update of a Cochrane review first published in 2001. At that stage there was insufficient evidence to recommend statins for the prevention of Alzheimer's disease (AD). The scope of this review has been expanded to include all forms of dementia.
Objectives: To assess the effects of statins in the prevention of dementia.
Search strategy: The Specialized Register of the Cochrane Dementia and Cognitive Improvement Group, The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL and LILACS were searched on 10 October 2007 using the terms statin*, lovastatin*, pravastatin*, simvastatin*, fluvastatin*, atorvastatin* and rosuvastatin*. The CDCIG Register contains records from many healthcare databases, SIGLE, LILACS as well as many trials databases and is updated regularly.
Selection criteria: Double-blind randomized placebo-controlled trials of statins in people at risk of AD and dementia.
Data collection and analysis: Two independent reviewers extracted and assessed data independently and agreement was reached after discussion. Adverse effects were noted.
Main results: Two trials were identified with 26,340 participants; HPS 2002 and PROSPER 2002. Age range was 40-82 years across the two studies, PROSPER 2002 included 5804 patients aged 70-82 years and HPS included 20,536 patients with 5806 at least 70 years old at study entry. Mean total cholesterol 5.9 mmol/l, LDL cholesterol 3.4 mmol/l at study entry with mean reduction in LDL cholesterol of 1.0mmol/l in simvastatin treated patients compared to placebo in HPS 2002. Mean total cholesterol 5.7 mmol/l, LDL cholesterol 3.8 mmol/l at study entry with mean reduction in LDL cholesterol of 1.02 mmol/l in pravastatin treated patients compared to placebo in PROSPER 2002. Mean follow-up 3.2 years in PROSPER, 5 years in HPS 2002. Cognition was measured at different times and with different scales so could not be combined in a meta-analysis. There was no difference in incidence of dementia in HPS 2002 (31 cases in simvastatin group, 31 cases in placebo group) nor in performance on the modified Telephone Interview for Cognitive Status at final follow-up (23.7% simvastatin group cognitively impaired vs 24.2% in placebo group). There was no difference in cognition between groups either in relation to age at study entry or previous history of cerebrovascular disease. Cognitive function declined at the same rate in both treatment groups in PROSPER 2002, there was no significant difference between pravastatin treated and placebo groups in performance on letter digit codes, picture word learning test, Stroop and Mini Mental State Examination. There was no evidence that statins were detrimental to cognition.
Authors' conclusions : There is good evidence from RCTs that statins given in late life to individuals at risk of vascular disease have no effect in preventing AD or dementia. Biologically it seems feasible that statins could prevent dementia due to their role in cholesterol reduction and initial evidence from observational studies was very promising. Indication bias may have been a factor in these studies however and the evidence from subsequent RCTs has been negative.

The effect of teachers trained in a fundamental movement skills programme on children’s self-perceptions and motor competence

Perceived and actual motor competence are hypothesized to have potential links to children and young people’s physical activity (PA) levels with a potential consequential link to long-term health. In this cross-sectional study, Harter’s (1985, Manual for the Self-perception Profile for Children. Denver, CO: University of Denver) Competency Motivation-based framework was used to explore whether a group of children taught, during curriculum time, by teachers trained in the Fundamental Movement Skills (FMS) programme, scored higher on self-perception and on core motor competencies when compared to children whose teachers had not been so trained. One hundred and seventy seven children aged 7–8 years participated in the study. One hundred and seven were taught by FMS-trained teachers (FMS) and the remaining 70 were taught by teachers not trained in the programme (non-FMS). The Harter Self-Perception Profile for Children assessed athletic competence, scholastic competence, global self-worth and social acceptance. Three core components of motor competence (body management, object control and locomotor skills) were assessed via child observation. The FMS group scored higher on all the self-perception domains (p < 0.05). Statistically significant differences were found between the schools on all of the motor tasks (p < 0.05). The relationships between motor performance and self-perception were generally weak and non-significant. Future research in schools and with teachers should explore the FMS programme’s effect on children’s motor competence via a longitudinal approach.

Does prophylactic endoscopic sphincterotomy prevent recurrent biliary problems in patients with gallstones and a normal cholangiogram?

Endoscopic sphincterotomy (ES) is indicated in patients with confirmed bile duct stones at endoscopic retrograde cholangiopancreatography (ERCP). The role of ES in patients with suspected bile duct stones but a normal cholangiogram, in the prevention of recurrent biliary symptoms, when cholecystectomy is not planned, is unclear.