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The aim of this study is to assess General Practitioner (GP) trainees’ training experience, and confidence in assessing and managing children and adolescents with common mental health conditions in primary care in Ireland.
Methods:
An online anonymous questionnaire was distributed to third and fourth year GP registrars enrolled in the Irish College of General Practitioners training schemes. The online questionnaire evaluated participants’ training experiences and confidence levels in key areas of child and adolescent mental health in primary care.
Results:
Sixty participants completed the survey out of 406, yielding a response rate of 14.8%. The majority (88%) reported no formal training or experience working in Child and Adolescent Mental Healthcare Services (CAMHS) during their GP training scheme. Responses indicated that many participants rated their competency, skills, and knowledge in essential areas of Child and Adolescent Mental Health as needing improvement. Similarly, their awareness of referral pathways and specialty services was below expectations, with poor perceived access to services. A large proportion (91.7%) expressed a definite need for further training in child and adolescent mental health disorders.
Conclusion:
The results highlight the need for enhanced training and support for GP trainees in the field of Child and Adolescent Mental Health, ensuring their ability to effectively and confidently address these common issues in primary care.
Health and social care workers (HSCWs) are at risk of experiencing adverse mental health outcomes (e.g. higher levels of anxiety and depression) because of the COVID-19 pandemic. This can have a detrimental effect on quality of care, the national response to the pandemic and its aftermath.
Aims
A longitudinal design provided follow-up evidence on the mental health (changes in prevalence of disease over time) of NHS staff working at a remote health board in Scotland during the COVID-19 pandemic, and investigated the determinants of mental health outcomes over time.
Method
A two-wave longitudinal study was conducted from July to September 2020. Participants self-reported levels of depression (Patient Health Questionnaire-9), anxiety (Generalised Anxiety Disorder-7) and mental well-being (Warwick-Edinburgh Mental Well-being Scale) at baseline and 1.5 months later.
Results
The analytic sample of 169 participants, working in community (43%) and hospital (44%) settings, reported substantial levels of depression and anxiety, and low mental well-being at baseline (depression, 30.8%; anxiety, 20.1%; well-being, 31.9%). Although mental health remained mostly constant over time, the proportion of participants meeting the threshold for anxiety increased to 27.2% at follow-up. Multivariable modelling indicated that working with, and disruption because of, COVID-19 were associated with adverse mental health changes over time.
Conclusions
HSCWs working in a remote area with low COVID-19 prevalence reported substantial levels of anxiety and depression, similar to those working in areas with high COVID-19 prevalence. Efforts to support HSCW mental health must remain a priority, and should minimise the adverse effects of working with, and disruption caused by, the COVID-19 pandemic.
Policymakers in liberal welfare states like the UK have prioritised extending the reach of compulsory activation to target vulnerable jobseeker groups, such as lone parents. However, such interventions – especially when combined with intensified welfare conditionality – appear to have had limited positive effects on lone parents’ employability, while often negatively impacting wellbeing. This article argues that the problem is a disconnect between the complex barriers to employability faced by lone parents (including their need to balance work and caring) and the content of ‘work-first’ activation favoured by successive UK Governments. We report positive findings from in-depth interviews with lone parents and key stakeholders involved in more person-centred, non-compulsory local employability services. Multi-agency service delivery, collaborative governance and a clear role for user voice in programme design were important facilitators of positive experiences. Our analysis points to the need for services that empower lone parents to make choices to progress towards employment while supporting family life.
UK Biobank is a well-characterised cohort of over 500 000 participants including genetics, environmental data and imaging. An online mental health questionnaire was designed for UK Biobank participants to expand its potential.
Aims
Describe the development, implementation and results of this questionnaire.
Method
An expert working group designed the questionnaire, using established measures where possible, and consulting a patient group. Operational criteria were agreed for defining likely disorder and risk states, including lifetime depression, mania/hypomania, generalised anxiety disorder, unusual experiences and self-harm, and current post-traumatic stress and hazardous/harmful alcohol use.
Results
A total of 157 366 completed online questionnaires were available by August 2017. Participants were aged 45–82 (53% were ≥65 years) and 57% women. Comparison of self-reported diagnosed mental disorder with a contemporary study shows a similar prevalence, despite respondents being of higher average socioeconomic status. Lifetime depression was a common finding, with 24% (37 434) of participants meeting criteria and current hazardous/harmful alcohol use criteria were met by 21% (32 602), whereas other criteria were met by less than 8% of the participants. There was extensive comorbidity among the syndromes. Mental disorders were associated with a high neuroticism score, adverse life events and long-term illness; addiction and bipolar affective disorder in particular were associated with measures of deprivation.
Conclusions
The UK Biobank questionnaire represents a very large mental health survey in itself, and the results presented here show high face validity, although caution is needed because of selection bias. Built into UK Biobank, these data intersect with other health data to offer unparalleled potential for crosscutting biomedical research involving mental health.
A national need is to prepare for and respond to accidental or intentional disasters categorized as chemical, biological, radiological, nuclear, or explosive (CBRNE). These incidents require specific subject-matter expertise, yet have commonalities. We identify 7 core elements comprising CBRNE science that require integration for effective preparedness planning and public health and medical response and recovery. These core elements are (1) basic and clinical sciences, (2) modeling and systems management, (3) planning, (4) response and incident management, (5) recovery and resilience, (6) lessons learned, and (7) continuous improvement. A key feature is the ability of relevant subject matter experts to integrate information into response operations. We propose the CBRNE medical operations science support expert as a professional who (1) understands that CBRNE incidents require an integrated systems approach, (2) understands the key functions and contributions of CBRNE science practitioners, (3) helps direct strategic and tactical CBRNE planning and responses through first-hand experience, and (4) provides advice to senior decision-makers managing response activities. Recognition of both CBRNE science as a distinct competency and the establishment of the CBRNE medical operations science support expert informs the public of the enormous progress made, broadcasts opportunities for new talent, and enhances the sophistication and analytic expertise of senior managers planning for and responding to CBRNE incidents.
Policymakers in the UK have promised to deliver personalised employability services for vulnerable jobseekers. However, unemployed people often describe their engagement with state-funded services as defined by: the offer of low cost, standardised job search services; and pressure to accept any job, irrespective of quality or appropriateness. This article argues that more progressive, co-produced alternatives are possible. We draw on an evaluation of local, third sector-led services targeting lone parents (LPs) in five local government areas in Scotland. Our research involved more than 100 in-depth interviews with both service providers and LPs. We find that partnership-oriented co-governance mechanisms facilitated collaborative approaches to the management of services and processes of co-production. LPs expressed positive views of the personalised services that were co-produced. We conclude that a commitment to collaboration and co-production may be more effective in promoting personalised services that are responsive to the needs of vulnerable groups.
This paper reports on a funded summit, which convened a multidisciplinary group of experts to provide consensus on the research priorities necessary for improving long-term community integration of individuals with traumatic brain injury (TBI) and their caregivers.
Methods
The 2-day summit was directed using the World Café Methodology, to engage stakeholders and collaboratively arrive at a consensus on the problems to be targeted in research. Participants (n=54), drawn from two Canadian provinces, included an interdisciplinary group of researchers, clinicians, representatives from brain injury associations, individuals with TBI, and caregivers. In small groups, participants discussed challenges to long-term community integration and potential initiatives that would address these barriers. Field notes from the discussions were analyzed using qualitative content analysis.
Results
The consensus on prioritized research directions included developing interventions to optimize the functioning and participation of individuals with TBI, reducing caregiver burden, and evaluating how emerging technology can facilitate delivery of care.
Conclusions
The World Café Methodology was an effective method for developing research priorities. The breadth of expertise of participants and the collegial environment allowed for the identification of a broad perspective on important future research directions with potential to enhance the long-term community integration of individuals with brain injury.
UK Biobank is a well-characterised cohort of over 500 000 participants that offers unique opportunities to investigate multiple diseases and risk factors.
Aims
An online mental health questionnaire completed by UK Biobank participants was expected to expand the potential for research into mental disorders.
Method
An expert working group designed the questionnaire, using established measures where possible, and consulting with a patient group regarding acceptability. Case definitions were defined using operational criteria for lifetime depression, mania, anxiety disorder, psychotic-like experiences and self-harm, as well as current post-traumatic stress and alcohol use disorders.
Results
157 366 completed online questionnaires were available by August 2017. Comparison of self-reported diagnosed mental disorder with a contemporary study shows a similar prevalence, despite respondents being of higher average socioeconomic status than the general population across a range of indicators. Thirty-five per cent (55 750) of participants had at least one defined syndrome, of which lifetime depression was the most common at 24% (37 434). There was extensive comorbidity among the syndromes. Mental disorders were associated with high neuroticism score, adverse life events and long-term illness; addiction and bipolar affective disorder in particular were associated with measures of deprivation.
Conclusions
The questionnaire represents a very large mental health survey in itself, and the results presented here show high face validity, although caution is needed owing to selection bias. Built into UK Biobank, these data intersect with other health data to offer unparalleled potential for crosscutting biomedical research involving mental health.
Declaration of interest
G.B. received grants from the National Institute for Health Research during the study; and support from Illumina Ltd. and the European Commission outside the submitted work. B.C. received grants from the Scottish Executive Chief Scientist Office and from The Dr Mortimer and Theresa Sackler Foundation during the study. C.S. received grants from the Medical Research Council and Wellcome Trust during the study, and is the Chief Scientist for UK Biobank. M.H. received grants from the Innovative Medicines Initiative via the RADAR-CNS programme and personal fees as an expert witness outside the submitted work.
Most large carnivores are secretive and threatened, and these characteristics pose problems for research on, and monitoring of, these species across extensive areas. Participatory monitoring, however, can be a useful tool for obtaining long-term data across large areas. Pumas Puma concolor and jaguars Panthera onca are the largest predators in the threatened Upper Paraná Atlantic Forest. To survey the presence of these two species we established a participatory network of volunteers and a partnership with researchers in the three countries that share the Upper Paraná Atlantic Forest (Argentina, Brazil and Paraguay). We trained participants in simple methods of collecting faeces and track imprints of large felids. Between 2002 and 2008 > 100 volunteers helped with monitoring, obtaining 1,633 records identified as pumas or jaguars across c. 92,890 km2. We confirmed jaguar presence in a large section of the Misiones Green Corridor in Argentina and in the largest protected areas of Brazil and Paraguay. Pumas exhibited a wider distribution, being recorded throughout Misiones province in Argentina and in some areas of Brazil and Paraguay where jaguars were not detected. Both species, and especially jaguars, were detected mainly in the few remaining medium and large forest fragments in this Forest. Although these carnivores are often in conflict with local people, their charisma and cultural significance makes them flagship species that motivated the participation of volunteers and institutions. Participatory monitoring allowed coverage of a vast area at relatively low cost whilst enhancing collaborative management policies among people and institutions from three countries.
This study, reporting a ten-year investigation of suicide in Kildare, found that the suicide rate based on clinical assessment of coroner's records was very close to the Central Statistics Office (CSO) figure for Kildare and for Ireland as a whole for the same period. Dublin data for 1977–1981 confirmed these findings. Since in the 1960s similar clinical assessment concluded that CSO rates underestimated suicide by a factor of two or over, we believe that changes in CSO coding procedures whereby more deaths are now coded to suicide than was the case in the past have resulted in current CSO data reflecting accurately the rate of clinical suicide. There has been more than a three-fold increase in CSO suicide rates in Ireland between 1968 and 1987. Even allowing for improved CSO practices there still remains a considerable excess of suicide deaths which indicates a doubling of ‘real’ suicide in Ireland over these twenty years.
This paper draws on an analysis of case studies from the line of research that examines contractual and working relationships in the aerospace industry (Cullen, Keast and Simpson, 2002; Cullen, Hickman, 2001; Cullen, 2005). These studies found a divergence between the parties’ intended working relationship and the agenda prescribed by formal contracts. The paper proposes that the ramifications of the contractual arrangements engender strains between the dynamic nature of collaborative transactions and the laissez-faire presumption of conflictual relations that underpins western commercial contract law, which in turn influences contractual relations and formal agreements.
The porphyrias are a group of rare hereditary metabolic disorders where there is an excess formation and excretion of porphyrins or their precursors. Type IIA, acute intermittent porphyria (AIP), has an estimated prevalence of one to eight per 100,000 in the general population but is thought to have a higher prevalence in psychiatric patients. AIP can present with a variety of psychiatric symptoms, often misdiagnosed. Associated neuropathological changes including focal cerebral ischaemic lesions have been found. However, to our knowledge, no case of dementia and AIP has been described. We present the case of a 56 year old man with a five-year history of progressive cognitive decline, diagnosed with AIP at an advanced stage of dementia. Whether AIP contributed to the dementia or is a coincidental finding is unknown. However treatment of AIP in this case resulted in some improvement in the patient's cognitive state.
Objectives: To determine to what extent official suicide rates in counties Kildare and Mayo underestimate the rates as clinically determined, and to examine and compare the association between the sociodemographic characteristics of the two Irish counties and trends in the suicide rates.
Method: Populations for the two counties for the years 1988-1994 were calculated. Official suicide mortality data was obtained from the Central Statistics Office. Following examination of the coroners' files for both counties the number of suicides was estimated using clinical criteria.
Results: Neither county showed a significant change in suicide mortality over time from 1988-1994. Suicide was underestimated in official mortality data for each county. There were significant differences in the choice of method of suicide with an excess of drowning in Mayo and of shooting in Kildare. Mayo suicides were more likely to be single and unemployed.
Conclusions: Much local research is needed before implementing suicide prevention programmes due to the many demographic differences and differences in traditions and choice of method of suicide that exist between counties.
Objectives: To ascertain whether or not there had been any improvement in the registration of deaths in Co. Mayo, Ireland, since 1970. At the time is was shown that 7.5% of deaths, in a sample of parishes in the west of Ireland had not been registered.
Method: A list of all those who died and were buried in Co. Mayo in 1992, was obtained and compared with a list of deaths registered in that and subsequent years.
Results: One hundred and twenty eight deaths (11.5%) occurring in the county in 1992 had not been registered by the time of this study in 1997.
Conclusions: Non-registration of deaths continues to pose serious problems for research and for the planning of health services. It is suggested that the government introduce legislation to address the issue. Registration of deaths should be standardised throughout the EU.
For many years after its publication in 1912 Berthold Laufer's book Jade: a study in Chinese archaeologh and religion remained a standard reference work for Western scholars. In his third chapter Laufer discusses certain three-lobed jade discs (pl. I); he is in general agreement with the theories of the late-nineteenth-century Chinese scholar Wu Ta-ch'eng , who named the discs hsüan chi and suggested that they were originally intended to be used for astronomical purposes. After Laufer the discussion was taken up by other writers on jade, and was carried a stage further in a series of papers by Henri Michel, beginning in 1947, in which he presented a considerable amount of literary and scientific evidence in support of his interpretation of the astronomical purpose of the discs. Michel's theories were lent additional weight and given a wide circulation by their inclusion in Joseph Needham's survey of Chinese astronomy. Since Michel, those writers who have doubted the astronomical connexions of the discs have nevertheless tended to retain the name huüan chi, which now seems to have become established as the standard term for this particular jade form on museum labels and in archaeological reports in China as well as in the West.
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