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Helen Lewis

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Cardiff University

Rhiannon Whitaker

The University of Queensland, Australia

Helen Christensen

Gültürk Köroğlu

University of Bergen

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Papers by Helen Lewis

Folate Augmentation of Treatment – Evaluation for Depression (FolATED): protocol of a randomised controlled trial

by Rhiannon Whitaker, Helen Lewis, and David B Menkes

BMC Psychiatry, 2007

Background: Clinical depression is common, debilitating and treatable; one in four people experie... more Background: Clinical depression is common, debilitating and treatable; one in four people experience it during their lives. The majority of sufferers are treated in primary care and only half respond well to active treatment. Evidence suggests that folate may be a useful adjunct to antidepressant treatment: 1) patients with depression often have a functional folate deficiency; 2) the severity of such deficiency, indicated by elevated homocysteine, correlates with depression severity, 3) low folate is associated with poor antidepressant response, and 4) folate is required for the synthesis of neurotransmitters implicated in the pathogenesis and treatment of depression.

Diagnostic accuracy of the Whooley depression tool in older adults in UK primary care

by Kate Bosanquet, Della Bailey, Rhian Gabe, Helen Lewis, and Dean McMillan

Journal of Affective Disorders, 2015

To validate the Whooley questions as a screening tool for depression amongst a population of olde... more To validate the Whooley questions as a screening tool for depression amongst a population of older adults in UK primary care. To assess the diagnostic performance of the Whooley questions as a screening tool for depression amongst older adults in UK primary care. A cross-sectional validation study was conducted with 766 patients aged ≥75 from UK primary care, recruited via 17 general practices based in the North of England during the pilot phase of a randomized controlled trial. Sensitivity, specificity and likelihood ratios comparing the index test (two Whooley questions) with a diagnosis of major depressive disorder (MDD) ascertained by the reference standard Mini International Neuropsychiatric Interview (MINI). The two screening questions had a sensitivity of 94.3% (95% confidence interval, 80.8-99.3%) and specificity of 62.7% (95% confidence interval, 59.0-66.2%). The likelihood ratio for a positive test was 2.5 (95% confidence interval, 2.2-2.9) and the likelihood ratio for a negative test was 0.09 (95% confidence interval, 0.02-0.35). The two Whooley questions missed few cases of depression. However, they were responsible for a high rate of false positives. This creates additional burden on general practitioners, to conduct more detailed investigation on patients who screen positive, but many of whom turn out not to have MDD.

FINAL REPORT: The role of packaging in minimising food waste in the supply chain of the future

Food security is an emerging challenge for policy makers and companies in the food supply chain. ... more Food security is an emerging challenge for policy makers and companies in the food supply chain. The global population is expected to grow to 9 billion and demand for food by 77% by 2050. Over the same period food production will be under threat from climate change, competing land uses, erosion and diminishing supplies of clean water. One of the solutions to this dilemma is increased efficiency and waste reduction in the food supply chain. This report focuses on packaging opportunities that may help to reduce or recover food waste. Packaging has a vital role to play in containing and protecting food as it moves through the supply chain to the consumer. It already reduces food waste in transport and storage, and innovations in packaging materials, design and labelling provide new opportunities to improve efficiencies. Product protection needs to be the primary goal for packaging sustainability, and sometimes this requires trade-offs between packaging and food waste. The report draws ...

Implementing the Strategy

Packaging for Sustainability, 2012

Metacognition in the foundation phase: Using VSRD to help young children talk about their thinking

Welsh Journal of Education, 2011

Abstract: The extent to which children in the Foundation Phase are capable of metacognition is co... more

Using video‐stimulated reflective dialogue to learn from children about their learning with and without ICT

Technology, Pedagogy and Education, 2007

The Interactive Teaching and ICT project explored the process of interactive teaching and learnin... more The Interactive Teaching and ICT project explored the process of interactive teaching and learning with and without ICT. A key technique in our methodology was the use of videostimulated reflective dialogue to assist teachers to reflect on key episodes in their teaching. In this paper we discuss how this technique was extended to encourage pupils between the ages of 5 and 14 to reflect on their learning of mathematics. Analysis of the reflective dialogues indicates that even quite young children were able to articulate opinions about the ways in which they learned and the ways in which ICT supported this.

Changes in Ciliary Muscle Thickness During Accommodation in Children

Optometry and Vision Science, 2012

Purpose-To investigate the morphology of the ciliary muscle during the act of accommodation in a ... more

ATP2A2 Mutations in Darier's Disease: Variant Cutaneous Phenotypes Are Associated with Missense Mutations, But Neuropsychiatry Features Are Independent of Mutation Class

Human Molecular Genetics, 1999

Darier's disease (DD) is an autosomal dominant skin disorder characterized clinically by multiple... more Darier's disease (DD) is an autosomal dominant skin disorder characterized clinically by multiple keratotic papules, and histologically by focal loss of adhesion between epidermal cells (acantholysis) and by abnormal keratinization. Variant forms of cutaneous phenotype, sometimes familial, have been described. Associated neuropsychiatric features, including mental handicap, schizophrenia, bipolar disorder and epilepsy, have also been reported. The cause of DD was shown recently to be mutation in the ATP2A2 gene at 12q24.1, which encodes the sarco-endoplasmic reticulum calcium ATPase type 2 (SERCA2). Here, we show that while both common isoforms of SERCA2 are expressed in the cytoplasm of cultured keratinocytes and fibroblasts, in adult skin sections only the longer isoform, SERCA2b, was expressed abundantly in epidermal structures. Extended mutation analysis in European DD patients using single-strand conformation polymorphism and/or direct sequencing identified 40 different patient-specific mutations in 47 families. The majority (23/40) were likely to result in nonsense-mediated RNA decay. The remaining 17 were missense mutations distributed throughout the protein and were associated significantly with atypical clinical features. The clearest association was with the familial haemorrhagic variant where all four families tested had a missense mutation. Three of the families (one Scottish family and two unrelated Italian families) exhibited the same N767S substitution in the M5 transmembrane domain, and a fourth family, from Sweden, had a C268F substitution in the M3 transmembrane domain. Neuropsychiatric features did not appear to be associated with a specific class of mutation and may be an intrinsic, but inconsistent, effect of defective ATP2A2 expression.

Altered cell-mediated immunity to group A haemolytic streptococcal antigens in chronic plaque psoriasis

British Journal of Dermatology, 1991

The proliferative lymphocyte response to sonicated group A, )?-haemolytic streptococci (Strep-A) ... more The proliferative lymphocyte response to sonicated group A, )?-haemolytic streptococci (Strep-A) was measured by thymidine incorporation in 78 patients with psoriasis (guttate, chronic plaque or both). Lymphocytes from 72 of these patients were also cultured with streptokinase/streptodornase (SK/SD), and 20 ofthe patients with chronic plaque psoriasis were further tested with PPD, Candida albicans and sonicated Streptococcus mutans. a bacteriai type not associated ciinicaiiy with psoriasis. The median stimulation index (SI) of the psoriasis group to the Strep-A preparation was significantiy higher than that of a group of 27 non-psoriatic individuais (P<0'05), Within this group, oniy the patients with chronic plaque psoriasis (n = 42) showed a significantiy increased proiiferative response compared to the non-psoriatic controls (median SI= 123-8 and 31-9, respectiveiy, P<0-01), Although the lymphocyte response ofthe chronic plaque group to SK/SD was also markedly higher than that ofthe control group, this difference did not reach statistical significance. In addition, these patients did not show significantiy increased responses to any of the other antigens tested, inciuding S, mutatis.

Folate Augmentation of Treatment – Evaluation for Depression (FolATED): protocol of a randomised controlled trial

by Helen Lewis and Nefyn Williams

BMC Psychiatry, 2007

Background: Clinical depression is common, debilitating and treatable; one in four people experie... more Background: Clinical depression is common, debilitating and treatable; one in four people experience it during their lives. The majority of sufferers are treated in primary care and only half respond well to active treatment. Evidence suggests that folate may be a useful adjunct to antidepressant treatment: 1) patients with depression often have a functional folate deficiency; 2) the severity of such deficiency, indicated by elevated homocysteine, correlates with depression severity, 3) low folate is associated with poor antidepressant response, and 4) folate is required for the synthesis of neurotransmitters implicated in the pathogenesis and treatment of depression.

An Investigation of the Affordances of ICT for the Development of Effective Pedagogy In Mathematics and Science Classrooms the I-Ped Project

Welsh Journal of …, 2009

ABSTRACT Recent research indicates that the use of ICT to support traditional forms of classroom ... more ABSTRACT Recent research indicates that the use of ICT to support traditional forms of classroom interaction is ineffective in improving learning and attainment. Instead, teachers are being encouraged to develop more dialogic pedagogies. This paper reports on a project which investigated the efficacy of Video Stimulated Reflective Dialogue (VSRD) as a school-based professional development tool for improving pedagogy in the use of ICT to support dialogic teaching. Parallels are drawn between the nature of the classroom interactions in dialogic teaching and the teacher/researcher interactions during the VSRD process. Distinctions are made between interactions which were dialectic rather than dialogic in character. Developing teachers&#39; pedagogies requires complex changes and it is argued that such changes are best supported by more dialogic forms of VSRD.

Training of public health workforce at the National School of Public Health: Meeting Africa's needs

CASPER plus (CollAborative care in Screen-Positive EldeRs with major depressive disorder): study protocol for a randomised controlled trial

by Karen Overend, shaista meer, John Holmes, Helen Lewis, Rebecca Woodhouse, Dean McMillan, Carolyn Chew-graham, Della Bailey, Dominic Trépel, Kate Bosanquet, and Gemma Traviss

Trials, 2014

Background: Depression accounts for the greatest disease burden of all mental health disorders, c... more Background: Depression accounts for the greatest disease burden of all mental health disorders, contributes heavily to healthcare costs, and by 2020 is set to become the second largest cause of global disability. Although 10% to 16% of people aged 65 years and over are likely to experience depressive symptoms, the condition is under-diagnosed and often inadequately treated in primary care. Later-life depression is associated with chronic illness and disability, cognitive impairment and social isolation. With a progressively ageing population it becomes increasingly important to refine strategies to identity and manage depression in older people. Currently, management may be limited to the prescription of antidepressants where there may be poor concordance; older people may lack awareness of psychosocial interventions and general practitioners may neglect to offer this treatment option. Methods/design: CASPER Plus is a multi-centre, randomised controlled trial of a collaborative care intervention for individuals aged 65 years and over experiencing moderate to severe depression. Selected practices in the North of England identify potentially eligible patients and invite them to participate in the study. A diagnostic interview is carried out and participants with major depressive disorder are randomised to either collaborative care or usual care. The recruitment target is 450 participants. The intervention, behavioural activation and medication management in a collaborative care framework, has been adapted to meet the complex needs of older people. It is delivered over eight to 10 weekly sessions by a case manager liaising with general practitioners. The trial aims to evaluate the clinical and cost effectiveness of collaborative care in addition to usual GP care versus usual GP care alone. The primary clinical outcome, depression severity, will be measured with the Patient Health Questionnaire-9 (PHQ-9) at baseline, 4, 12 and 18 months. Cost effectiveness analysis will assess health-related quality of life using the SF-12 and EQ-5D and will examine cost-consequences of collaborative care. A qualitative process evaluation will be undertaken to explore acceptability, gauge the extent to which the intervention is implemented and to explore sustainability beyond the clinical trial. Discussion: Results will add to existing evidence and a positive outcome may lead to the commissioning of this model of service in primary care.

Folate Augmentation of Treatment – Evaluation for Depression (FolATED): protocol of a randomised controlled trial

by Rhiannon Whitaker, Helen Lewis, and David B Menkes

BMC Psychiatry, 2007

Background: Clinical depression is common, debilitating and treatable; one in four people experie... more Background: Clinical depression is common, debilitating and treatable; one in four people experience it during their lives. The majority of sufferers are treated in primary care and only half respond well to active treatment. Evidence suggests that folate may be a useful adjunct to antidepressant treatment: 1) patients with depression often have a functional folate deficiency; 2) the severity of such deficiency, indicated by elevated homocysteine, correlates with depression severity, 3) low folate is associated with poor antidepressant response, and 4) folate is required for the synthesis of neurotransmitters implicated in the pathogenesis and treatment of depression.

Diagnostic accuracy of the Whooley depression tool in older adults in UK primary care

by Kate Bosanquet, Della Bailey, Rhian Gabe, Helen Lewis, and Dean McMillan

Journal of Affective Disorders, 2015

To validate the Whooley questions as a screening tool for depression amongst a population of olde... more To validate the Whooley questions as a screening tool for depression amongst a population of older adults in UK primary care. To assess the diagnostic performance of the Whooley questions as a screening tool for depression amongst older adults in UK primary care. A cross-sectional validation study was conducted with 766 patients aged ≥75 from UK primary care, recruited via 17 general practices based in the North of England during the pilot phase of a randomized controlled trial. Sensitivity, specificity and likelihood ratios comparing the index test (two Whooley questions) with a diagnosis of major depressive disorder (MDD) ascertained by the reference standard Mini International Neuropsychiatric Interview (MINI). The two screening questions had a sensitivity of 94.3% (95% confidence interval, 80.8-99.3%) and specificity of 62.7% (95% confidence interval, 59.0-66.2%). The likelihood ratio for a positive test was 2.5 (95% confidence interval, 2.2-2.9) and the likelihood ratio for a negative test was 0.09 (95% confidence interval, 0.02-0.35). The two Whooley questions missed few cases of depression. However, they were responsible for a high rate of false positives. This creates additional burden on general practitioners, to conduct more detailed investigation on patients who screen positive, but many of whom turn out not to have MDD.

FINAL REPORT: The role of packaging in minimising food waste in the supply chain of the future

Food security is an emerging challenge for policy makers and companies in the food supply chain. ... more Food security is an emerging challenge for policy makers and companies in the food supply chain. The global population is expected to grow to 9 billion and demand for food by 77% by 2050. Over the same period food production will be under threat from climate change, competing land uses, erosion and diminishing supplies of clean water. One of the solutions to this dilemma is increased efficiency and waste reduction in the food supply chain. This report focuses on packaging opportunities that may help to reduce or recover food waste. Packaging has a vital role to play in containing and protecting food as it moves through the supply chain to the consumer. It already reduces food waste in transport and storage, and innovations in packaging materials, design and labelling provide new opportunities to improve efficiencies. Product protection needs to be the primary goal for packaging sustainability, and sometimes this requires trade-offs between packaging and food waste. The report draws ...

Implementing the Strategy

Packaging for Sustainability, 2012

Metacognition in the foundation phase: Using VSRD to help young children talk about their thinking

Welsh Journal of Education, 2011

Abstract: The extent to which children in the Foundation Phase are capable of metacognition is co... more

Using video‐stimulated reflective dialogue to learn from children about their learning with and without ICT

Technology, Pedagogy and Education, 2007

The Interactive Teaching and ICT project explored the process of interactive teaching and learnin... more The Interactive Teaching and ICT project explored the process of interactive teaching and learning with and without ICT. A key technique in our methodology was the use of videostimulated reflective dialogue to assist teachers to reflect on key episodes in their teaching. In this paper we discuss how this technique was extended to encourage pupils between the ages of 5 and 14 to reflect on their learning of mathematics. Analysis of the reflective dialogues indicates that even quite young children were able to articulate opinions about the ways in which they learned and the ways in which ICT supported this.

Changes in Ciliary Muscle Thickness During Accommodation in Children

Optometry and Vision Science, 2012

Purpose-To investigate the morphology of the ciliary muscle during the act of accommodation in a ... more

ATP2A2 Mutations in Darier's Disease: Variant Cutaneous Phenotypes Are Associated with Missense Mutations, But Neuropsychiatry Features Are Independent of Mutation Class

Human Molecular Genetics, 1999

Darier's disease (DD) is an autosomal dominant skin disorder characterized clinically by multiple... more Darier's disease (DD) is an autosomal dominant skin disorder characterized clinically by multiple keratotic papules, and histologically by focal loss of adhesion between epidermal cells (acantholysis) and by abnormal keratinization. Variant forms of cutaneous phenotype, sometimes familial, have been described. Associated neuropsychiatric features, including mental handicap, schizophrenia, bipolar disorder and epilepsy, have also been reported. The cause of DD was shown recently to be mutation in the ATP2A2 gene at 12q24.1, which encodes the sarco-endoplasmic reticulum calcium ATPase type 2 (SERCA2). Here, we show that while both common isoforms of SERCA2 are expressed in the cytoplasm of cultured keratinocytes and fibroblasts, in adult skin sections only the longer isoform, SERCA2b, was expressed abundantly in epidermal structures. Extended mutation analysis in European DD patients using single-strand conformation polymorphism and/or direct sequencing identified 40 different patient-specific mutations in 47 families. The majority (23/40) were likely to result in nonsense-mediated RNA decay. The remaining 17 were missense mutations distributed throughout the protein and were associated significantly with atypical clinical features. The clearest association was with the familial haemorrhagic variant where all four families tested had a missense mutation. Three of the families (one Scottish family and two unrelated Italian families) exhibited the same N767S substitution in the M5 transmembrane domain, and a fourth family, from Sweden, had a C268F substitution in the M3 transmembrane domain. Neuropsychiatric features did not appear to be associated with a specific class of mutation and may be an intrinsic, but inconsistent, effect of defective ATP2A2 expression.

Altered cell-mediated immunity to group A haemolytic streptococcal antigens in chronic plaque psoriasis

British Journal of Dermatology, 1991

The proliferative lymphocyte response to sonicated group A, )?-haemolytic streptococci (Strep-A) ... more The proliferative lymphocyte response to sonicated group A, )?-haemolytic streptococci (Strep-A) was measured by thymidine incorporation in 78 patients with psoriasis (guttate, chronic plaque or both). Lymphocytes from 72 of these patients were also cultured with streptokinase/streptodornase (SK/SD), and 20 ofthe patients with chronic plaque psoriasis were further tested with PPD, Candida albicans and sonicated Streptococcus mutans. a bacteriai type not associated ciinicaiiy with psoriasis. The median stimulation index (SI) of the psoriasis group to the Strep-A preparation was significantiy higher than that of a group of 27 non-psoriatic individuais (P<0'05), Within this group, oniy the patients with chronic plaque psoriasis (n = 42) showed a significantiy increased proiiferative response compared to the non-psoriatic controls (median SI= 123-8 and 31-9, respectiveiy, P<0-01), Although the lymphocyte response ofthe chronic plaque group to SK/SD was also markedly higher than that ofthe control group, this difference did not reach statistical significance. In addition, these patients did not show significantiy increased responses to any of the other antigens tested, inciuding S, mutatis.

Folate Augmentation of Treatment – Evaluation for Depression (FolATED): protocol of a randomised controlled trial

by Helen Lewis and Nefyn Williams

BMC Psychiatry, 2007

Background: Clinical depression is common, debilitating and treatable; one in four people experie... more Background: Clinical depression is common, debilitating and treatable; one in four people experience it during their lives. The majority of sufferers are treated in primary care and only half respond well to active treatment. Evidence suggests that folate may be a useful adjunct to antidepressant treatment: 1) patients with depression often have a functional folate deficiency; 2) the severity of such deficiency, indicated by elevated homocysteine, correlates with depression severity, 3) low folate is associated with poor antidepressant response, and 4) folate is required for the synthesis of neurotransmitters implicated in the pathogenesis and treatment of depression.

An Investigation of the Affordances of ICT for the Development of Effective Pedagogy In Mathematics and Science Classrooms the I-Ped Project

Welsh Journal of …, 2009

ABSTRACT Recent research indicates that the use of ICT to support traditional forms of classroom ... more ABSTRACT Recent research indicates that the use of ICT to support traditional forms of classroom interaction is ineffective in improving learning and attainment. Instead, teachers are being encouraged to develop more dialogic pedagogies. This paper reports on a project which investigated the efficacy of Video Stimulated Reflective Dialogue (VSRD) as a school-based professional development tool for improving pedagogy in the use of ICT to support dialogic teaching. Parallels are drawn between the nature of the classroom interactions in dialogic teaching and the teacher/researcher interactions during the VSRD process. Distinctions are made between interactions which were dialectic rather than dialogic in character. Developing teachers&#39; pedagogies requires complex changes and it is argued that such changes are best supported by more dialogic forms of VSRD.

Training of public health workforce at the National School of Public Health: Meeting Africa's needs

CASPER plus (CollAborative care in Screen-Positive EldeRs with major depressive disorder): study protocol for a randomised controlled trial

by Karen Overend, shaista meer, John Holmes, Helen Lewis, Rebecca Woodhouse, Dean McMillan, Carolyn Chew-graham, Della Bailey, Dominic Trépel, Kate Bosanquet, and Gemma Traviss

Trials, 2014

Background: Depression accounts for the greatest disease burden of all mental health disorders, c... more Background: Depression accounts for the greatest disease burden of all mental health disorders, contributes heavily to healthcare costs, and by 2020 is set to become the second largest cause of global disability. Although 10% to 16% of people aged 65 years and over are likely to experience depressive symptoms, the condition is under-diagnosed and often inadequately treated in primary care. Later-life depression is associated with chronic illness and disability, cognitive impairment and social isolation. With a progressively ageing population it becomes increasingly important to refine strategies to identity and manage depression in older people. Currently, management may be limited to the prescription of antidepressants where there may be poor concordance; older people may lack awareness of psychosocial interventions and general practitioners may neglect to offer this treatment option. Methods/design: CASPER Plus is a multi-centre, randomised controlled trial of a collaborative care intervention for individuals aged 65 years and over experiencing moderate to severe depression. Selected practices in the North of England identify potentially eligible patients and invite them to participate in the study. A diagnostic interview is carried out and participants with major depressive disorder are randomised to either collaborative care or usual care. The recruitment target is 450 participants. The intervention, behavioural activation and medication management in a collaborative care framework, has been adapted to meet the complex needs of older people. It is delivered over eight to 10 weekly sessions by a case manager liaising with general practitioners. The trial aims to evaluate the clinical and cost effectiveness of collaborative care in addition to usual GP care versus usual GP care alone. The primary clinical outcome, depression severity, will be measured with the Patient Health Questionnaire-9 (PHQ-9) at baseline, 4, 12 and 18 months. Cost effectiveness analysis will assess health-related quality of life using the SF-12 and EQ-5D and will examine cost-consequences of collaborative care. A qualitative process evaluation will be undertaken to explore acceptability, gauge the extent to which the intervention is implemented and to explore sustainability beyond the clinical trial. Discussion: Results will add to existing evidence and a positive outcome may lead to the commissioning of this model of service in primary care.