Improving community health networks for people with severe mental illness : a case study investigation

Introduction Policy drivers in mental health to address personal recovery, stigma and poor physical health indicate that new service solutions are required. This study aimed to understand how connections to people, places and activities were utilised by individuals with severe mental illness (SMI) to benefit health and wellbeing. Methods A five-module mixed-methods design was undertaken in two study sites. Data were collected from 150 network-mapping interviews and 41 in-depth follow-up interviews with people with SMI; in-depth interviews with 30 organisation stakeholders and 12 organisation leaders; and 44 telephone interviews with practitioners. We undertook a three-stage synthesis process including independent lived experience feedback, and a patient and public involvement team participated in tool design, data collection, analysis and write-up. Results Three personal network types were found in our study using the community health network approach: diverse and active; family and stable; formal and sparse. Controlled for other factors we found only four variables significantly associated with which network type a participant had: living alone or not; housing status; formal education; long-term sickness or disability. Diagnosis was not a factor. These variables are challenging to address but they do point to potential for network change. The qualitative interviews with people with SMI provided further understanding of connection-building and resource utilisation. We explored individual agency across each network type, and identified recognition of the importance and value of social support and active connection management alongside the risks of isolation, even for those most affected by mental illness. We identified tensions in personal networks, be that relationships with practitioners or families, dealing with the impact of stigma, or frustrations of not being in employment, which all impact on network resources and well-being. The value of connectedness within personal networks of people, place and activity for supporting recovery was evident in shaping identity, providing meaning to life and sense of belonging, gaining access to new resources, structuring routines and helping individuals ‘move on’ in their recovery journey. Health-care practitioners recognised that social factors were important in recovery but reported system-level barriers (workload, administrative bureaucracy, limited contact time with clients) in addressing these issues fully. Even practitioners working in third-sector services whose remit involved increasing clients’ social connection faced restrictions due to being evaluated by outcome criteria that limited holistic recovery-focused practices. Service providers were keen to promote recovery-focused approaches. We found contrasts between recovery ideology within mental health policy and recovery practice on the ground. In particular, the social aspects of supporting people with SMI are often underprioritised in the health-care system. In a demanding and changing context, strategic multiagency working was seen as crucial but we found few examples of embedded multisector organisation partnerships. Conclusion While our exploratory study has limitations, findings suggest potential for people with SMI to be supported to become more active managers of their personal networks to support well-being regardless of current network type. The health and social care system does not currently deliver multiagency integrated solutions to support SMI and social recovery

Social networks in east Cleveland: a study of powerlessness and non-participation

This thesis is based on material gathered as part of a larger, multi-methodological study of public participation in Structure Planning in Cleveland County in the North East of England. The variations in local responses to planning policies were investigated through the use of the social networks approach, in which the interaction between individuals and sets of individuals was the main focus of the analysis. The case-study in this thesis covers an area in which there was little, if any, response to the Structure Plans. It is, therefore, primarily an explanation of non-participation. The former "ironstone mining settlements of the Skelton and Brotton area of East Cleveland are marked by declining employment opportunities, poor roads and facilities, and much old and obsolete housing. The image of dereliction, fragmentation and deprivation is reinforced by the planners' treatment of the area, both in the plans and in the way that public participation in the area was managed. Analysis of interaction in networks shows some inter- penetration of group membership, but no coherent, enduring involvement by participators from more than one village together, raising questions of cohesion and conflict. Within the context of fragmentation and competition between villages, the impact of major demolition and renovation schemes is assessed. The explanation of non-participation in a situation of clear inequality and disadvantage necessitates the use of power theory of a more radical type than that which has usually been applied to the inherently political process of planning. A theoretical frame work adequate to deal with the powerlessness of a population whose interests are adversely affected by those in power, is a modified version of Lukes' three-dimensional approach. Ideological factors such as deference can thus be related to the acquiescence found

The Empirical Development of a Preparation for Marriage Curriculum for Twelfth-Grade Students

Problem. The purpose of this project was to develop an instructional product that would enrich the student\u27s knowledge about dating and marriage, and teach specific relational skills. Method. A systematic procedure was undertaken in the development and validation of the product. First, the content of a pre-marriage course was identified through an examination of a large sample of family-life texts, a survey of teacher criticisms and recommendations pertaining to the text Marriage (Christensen, 1980), and an analysis of a group of 317 youth using the Search Institute instrument, Youth Research Survey (Strommen, 1977; see appendix E). Second, the proposed content subjects were divided into instructional units, arranged in a logical sequence, and introduced with behavioral objectives. Third, literature and research in the various unit content areas was reviewed and a prototype of the pre-marriage curriculum drafted. This prototype curriculum was taught to thirty-two seniors in a parochial academy in Hagerstown, Maryland. Validation of the instructional units was considered successful when 80 percent of the students achieved 80 percent mastery in each objective. Twenty four percent of the objectives failed to reach this level. Fourth, each of the instructional units were expanded, weaknesses exposed during the tryout stage were corrected, and a teacher\u27s manual was prepared. Finally, the instructional product was taught to class of seventeen twelfth-grade students at a parochial academy, Battle Creek, Michigan. Results. The instructional product met the validation criterion-- 80 percent of the students fulfilled each objective at or above the 80 percent mastery level. Conclusions. It was concluded that the instructional product was successful and, with some modification, ready for further use as an enrichment resource for pre-marriage courses. It was recommended that further systematic revision of the product take place based on student performance

Cross sectional study of vitamin B12 supplementation in Slovak and Czech vegans

Background. The number of vegans in the world is growing and in Slovakia and the Czech Republic they make up 1% of the population. Vegan diet excludes all foods of animal origin and vegans who do not use vitamin B12 supplements are at risk of the vitamin B12 deficiency. Objective. The aim of this study was to determine what proportion of Czech and Slovak vegans use vitamin B12 supplements regularly, irregularly or not at all and what is their supplemental cobalamin intake. Materials and methods. The research involved 1337 self-identified vegans from Slovakia and the Czech Republic who were interviewed using the CAWI (Computer-Assisted Web Interview) method. Participants were recruited by posts in veganism-themed social media groups. Results. Out of 1337 vegans 55.5% supplemented cobalamin regularly, 32.54% irregularly and 11.97% were not supplementing. Rate of not supplementing individuals was 5.04% higher in Slovaks than in Czechs. Short-term vegans had a significantly higher rate of not supplementing individuals (17.99%) compared to medium-term (8.37%) and long-term vegans (7.50%). Mean weekly cobalamin intake from supplements was 2938.34±2566.60 μg in regularly supplementing vegans compared to 1630.31±1949.27 μg in irregularly supplementing vegans, particularly due to the lower weekly supplementation frequency among irregularly (2.93) compared to regularly supplementing vegans (5.27). Conclusions. The rate of supplementation in Slovak and particularly Czech vegans was higher than in other countries. The number of not supplementing individuals was significantly higher among short-term vegans, indicating that there is still a need for education on the importance of adequate and regular cobalamin supplementation, especially in new vegans. Our results support the hypothesis that the reason for higher rate of cobalamin deficiency in irregularly compared to regularly supplementing vegans is the lower cobalamin intake caused by lower supplementation frequency

Benzene health risk assessment for neurological disorders of gas station employees in Rayong Province, Thailand

Background. The main job of employees working in the area of fuel service stations is to provide refueling services to customers. Therefore, operators at petrol stations may be exposed to chemicals for long periods, potentially affecting their health in nervous system. Objectives. This study aims to assess the risk of benzene exposure to the nervous system in gas station operators. Data were collected from 100 fuel service personnel working at fuel dispensers and 100 employees working outside fuel dispensers, accounting to 200 cases. Material and methods. Data were collected using interview questionnaires. Urine samples were used for the analysis of t,t-muconic acid. Results. The results showed that t,t-muconic acid concentration is 431.23 ± 233.69 μg/g.cr (449.28 ± 213.32 μg/g.cr at fuel dispensers vs 413.18 ± 252.20 μg/g.cr outside fuel dispensers). The risk characterization results showed that most of the risks were at level 1 (low risk), as observed in 108 people (54.0%). The results of the analysis of the relationship between t,t-muconic acid concentrations classified by 3 levels of percentile and neurological disorders of the study group, the results showed that there was a statistically significant relationship (p-value <0.05). Conclusion. Therefore, the benzene neurotoxic risk assessment model could be utilized in field practice

In Memoriam: Professor Stanislaw Kafel (1927-2023)

Professor Stanisław Kafel passed away on March 23, 2023 in Warsaw, Poland. He was a distinguished employee of the Institute of Food and Nutrition (IŻŻ) in Warsaw, incorporated in 2020 into the structures of the National Institute of Public Health - National Institute of Hygiene. As an outstanding expert in meat hygiene, Professor Stanislaw Kafel, has also worked for the Food Agriculture Organisation(FAO) in Rome and the World Health Organisation (WHO) in Geneva

Consumption of food supplements in the Fes-Meknes region (Morocco); profiles and typology

Background. The consumption of food supplements is increasing. This evolution is due to several factors, including nutritional deficiencies in the population, a sedentary lifestyle, and a decrease in physical activity. In addition, stress and an active lifestyle led to several dysfunctions (fatigue, deconcentration) that food supplements can help to overcome. Objective. This study aimed to determine the profiles of food supplement consumers in the Fes-Meknes region (Morocco), distribution, and production of these products. In addition, this survey aimed to evaluate consumers’ knowledge of food supplements as part of their self-medication. Material and methods. The present study was conducted in the form of a survey using a questionnaire composed of two parts. The first part provides information on the socio-demographic status of respondents, including gender, age, and level of education. The second part concerned various information on the consumption of food supplements. Results. The results obtained showed that of the 498 subjects, 68.88% declared that they had already consumed the food supplements. The study revealed the predominance of the female gender at 69.68% and the age group 21-30 years (80.32%). Among the reasons for consumption, improving general health comes first with 56.29%. Our results also showed high consumption of vitamins (44.04%) and minerals (24.79%), next come proteins and plant extracts at 16.62% and 14.54% respectively. The consumption of food supplements is most often done on the advice of a doctor or dietician with 43.60%, and the pharmacy and para-pharmacy remains the main distribution channel at 75.78%. Conclusion. The present survey allowed us to update the current situation of food supplement consumption and a way of regulatory monitoring and more control for an organization of the sector

Prevalence and predictors of depression, anxiety, and stress among recovered COVID-19 patients in Vietnam

Background. During the COVID-19 pandemic, a high prevalence of mental health distress has been reported among people who have recovered from the disease. Objectives. To assess the prevalence of depression, anxiety, and stress as well as identify predictors among recovered COVID-19 patients after more than six months of being discharged in Dong Thap Province, Vietnam. Material and methods. The cross-sectional study was conducted among 549 eligible participants recruited by stratified sampling. Data was collected using the depression, anxiety and stress scale – 21 items had Content Validity Index = 0.9, and Cronbach’s alpha for depression, anxiety and stress sub-scales were 0.95, 0.81, and 0.86, respectively. Descriptive statistics were used to measure the prevalence levels and distribution of characteristics of the participant, while factors influencing depression, anxiety, and stress were predicted using binary logistic regression. Results. The overall prevalence of depression, anxiety, and stress were 24.8% (95% CI: 21.2-28.6), 41.5% (95% CI: 37.4-45.8), and 25.3% (95% CI: 21.7-29.2), respectively. The predictors of depression were living in urban area (OR = 1.97; 95% CI: 1.27-3.08), holding a bachelor’s degree (OR:3.51; 95% CI: 1.13-10.8), having a high monthly income (OR: 2.57; 95% CI: 1.03-6.38), diabetes (OR: 2.21; 95% CI: 1.04-4.68), heart disease (OR: 3.83; 95% CI: 1.79-8.17), respiratory disease (OR: 3.49; 95% CI: 1.24-9.84), and diarrhea (OR: 4.07; 95% CI: 1.06-15.6). Living in the urban area (OR: 1.57; 95% CI: 1.07-2.29), having sleep disturbance (OR: 2.32; 95% CI: 1.56-3.46), and fatigue (OR: 1.57; 95% CI: 1.03-2.39) were predictors for anxiety. Having respiratory disease (OR: 3.75; 95% CI: 1.47-9.60) or diarrhea (OR: 4.34; 95% CI: 1.18-15.9) were predictors of stress. Conclusion. People who have recovered from COVID-19 should be assessed for symptoms of depression, anxiety, and stress. Primary healthcare providers should develop interventions to support their recovery

Energy expenditure during training and official league match in professional female soccer players - a pilot study

Background. The most important component of a well-balanced diet is the proper energetic value. However, adequate estimation of the body’s energy needs is difficult for professional athletes, including soccer players. There is little research showing energy expenditure during training and lack of studies on the energy expenditure of professional female soccer players during a match. Objective. The aim of our study was to estimate energy expenditure during training and official league match in female soccer players and comparing it. Material and methods. Seven Polish professionally practicing soccer females (23.4±6,6 years old; 63.5±7.8 kg; 168.5±5.8 cm; 46±4.4 kg fat-free mass) participated in the study. The participants had their height and body mass measured. Energy expenditure during activities was measured by means of a SenseWear Pro3 Armband device. Body composition was assessed with Akern BIA 101 Anniversary Sport Edition device. Results. Statistically higher energy expenditure was achieved in the study group during the match hour (452±55 kcal/hour) compared to the training hour (353±28 kcal/ hour) as well as in the case of energy expenditure per hour of activity per kg of fat-free mass (match: 9.94±1.75 kcal/kg fat-free mass/hour; training: 7.71±0.8 kcal/kg fat-free mass/hour). During one hour of training, more time was spent on sedentary, light, and moderate activities, but the difference was statistically significant only for light activities. More time during the match hour than during the training hour was spent on vigorous and very vigorous activities. Conclusions. In conclusion, the energy expenditure of the players during the match was greater than in the case of the planned intensive training, which was caused by the timeshare of more intense physical activities and going a longer distance during match