How patients contribute to an online psychoeducation forum for bipolar disorder: a virtual participant observation study

Background: In a recent exploratory randomized controlled trial, an online psychoeducation intervention for bipolar disorder has been found to be feasible and acceptable to patients and may positively impact on their self-management behaviors and quality of life. Objective: The objective of the study was to investigate how these patients contribute to an online forum for bipolar disorder and the issues relevant for them. Methods: Participants in the intervention arm of the Bipolar Interactive PsychoEDucation (“BIPED”) trial were invited to contribute to the Beating Bipolar forum alongside receiving interactive online psychoeducation modules. Within this virtual participant observation study, forum posts were analyzed using thematic analysis, incorporating aspects of discourse analysis. Results: The key themes which arose from the forum posts included: medication, employment, stigma, social support, coping strategies, insight and acceptance, the life chart, and negative experiences of health care. Participants frequently provided personal narratives relating to their history of bipolar disorder, life experiences, and backgrounds, which often contained emotive language and humor. They regularly sought and offered advice, and expressed encouragement and empathy. The forum would have benefitted from more users to offer a greater support network with more diverse views and experiences. Conclusions: Online forums are inexpensive to provide and may offer peer support and the opportunity for patients to share their experiences and explore issues related to their illness anonymously. Future research should focus on how to enhance patient engagement with online health care forums

Stories of Children, Youth, and Families’ Adaptation to Community Living in the First Year after Involvement with Children’s Residential Mental Health Programs

Twenty-two youth between the ages of 14 and 18 years old who were involved with residential programs from participating children’s mental health organizations in Southern Ontario, Canada during 2015 to 2017 participated in a study of adaptation to community living in the first year following program exit. Youth, parents, child welfare workers, and mental health workers took part in qualitative interviews up to three times during the study period. Interview comments were used to construct a narrative or “story” of the year following program exit that integrated multiple informants’ perspectives of how each youth was functioning within that timeframe. Stories for youth who returned home to live with their families (12 youth) were examined together to explore any common experiences or processes that described the post-discharge daily living of this group of youth and their families. Similarly, the stories of youth who resided in the care of the Children’s Aid Society following program exit (10 youth) were explored for commonalities that could offer insight into their community adaptation experiences. Study findings underscore the need for proactive and flexible aftercare programming to improve community living outcomes for youth leaving residential mental health programs

Siege and Response: Families’ Everyday Lives and Experiences with Children’s Residential Mental Health Services (FULL REPORT)

Purpose Our purpose in interviewing parents with a child placed in residential mental health treatment was threefold: (1) to understand the functioning of children requiring residential mental health treatment before, during, and after treatment; (2) to characterize parents’ perceptions of their families’ involvement with residential treatment; and, (3) to address the popular notion that children requiring residential treatment come from highly dysfunctional and potentially harmful families by describing prevalent family functioning patterns. Methodology|This report is based on information obtained by interviewing 29 primary caregivers who had a child placed in residential care at one of two Ontario children’s mental health agencies. Parents were visited in their homes by an interviewer to engage in one-on-one dialogue to explore dimensions of their everyday lives and reflect on their service experiences. Interviews consisted of a series of open ended questions and were approximately 1 ½ to 2 hours in length. Because of the labour intensive nature of qualitative investigations, there are limitations to the number of cases that can practically be included in a study; however, what is lost in generalizability is compensated for by a richer sense of the struggles facing these families. Parents’ Perceptions of Residential Services Parents were generally pleased with their child’s placement in a residential treatment center. Parents feel respected, valued, and understood by service providers. They experience staff as competent, compassionate, and helpful. Residential services offered respite for families and containment for focal children. Many parents reported gains made for themselves and their children. Yet only 17% of parents felt that sufficient gains had been made to warrant the discharge of their child from the center. Parents tended not to blame the residential center for the lack of progress. The also seemed unable to articulate what the residential center could have done differently. Yet these parents, extremely hopeful when they first had their child placed in residence, had to come to terms with the realization that service outcomes had not matched their hopes. These stories highlight both the complexity and the tenacious nature of these children’s mental health difficulties. They also provide a challenge to service providers. What do we do when good is not good enough? Changes in Child Functioning Before, During and After Residential CareThese stories provide dramatic testimony that most of the older cohort children in this study leaving residential care had very serious ongoing problems in daily living. Problems which in many cases rivaled or exceeded the challenges faced prior to entering residential care. About one-third of these children had left home and many had unstable living arrangements or were “on the streets”. With the exception of living on their own and involvement in delinquent activities, and notwithstanding moderately more evidence of “successful” or partially “successful” adaptations, the after care daily living portraits of younger cohort residential care graduates were not notably more encouraging. About half of these younger children did not return to their original homes 6 after residential care. Serious areas of concern shared by both groups of children include continuing major adaptation problems at school and continued high levels of pressure on the parents and siblings of many of these children. Parent and Family FunctioningCaring for the focal child permeates every facet of daily life for these families including work, health, and relationships. Parents experience prolonged elevated levels of daily stress trying to juggle work schedules, appointments with professionals, household activities, and the needs of family members with caring for the focal child. Family climate is markedly tense and frequently involves conflict, particularly with the focal child. Relationships among other family members suffer as well, with parents reporting increased marital strain and little time to devote to siblings of the focal child. Caring for the focal child is taxing on parents’ own physical and mental health. Most families (70%) reported experiencing substantial relief, at least for a short period of time, from tensions within the home when the focal child entered residential care. Child Functioning Over Three Selected Developmental PeriodsOne of the interpretative challenges inherent in these stories is understanding the connection between the behaviour of these children, which is strikingly similar, and evidence suggestive of these children having a variety of problems, life histories and family environments. It can be argued that these children arrive at a similar point from many different trajectories. Who are the children represented in this sample? How are we to understand their difficulties? When it comes to understanding the behaviour of the focal children, both its presentation and its genesis, these stories raise as many questions as they answer. These stories challenge the notion of a single or root cause of extreme unmanageable behaviour. Instead they offer a complex and unsettling portrayal of these children, their familial and social environments, life histories, their strengths and challenges. These stories caution against the use of blanket or catch-all interpretations to help us understand the problematic behaviour of these children. ConclusionDespite the positive view of residential treatment held by parents long after treatment ends, the data suggest relatively poor outcome patterns for children leaving residential care. Serious areas of concern shared by both groups of children include continuing major adaptation problems at school and continued high levels of pressure on the parents and siblings of many of these children. The clearest area of benefit from these residential placements, at least in the short run, is for family members other than the focal child. This is an important consideration, given the incredible pressures families manage when the focal child is at home, and the extreme disruptions in family life described in these stories. An obvious question emanating from these stories is what can be expected for these children - in school, employment and relationships - over the years ahead. There is almost no support in our study for helping strategies predicated on “curing” or changing the focal child through short-term or medium-term interventions so that he or she can prosper in everyday life. Variations in living arrangements, enhancing school and employment opportunities, and continuing support to these children and their families with the challenges of daily living merit serious attention

Chronic venous leg ulcer care: Putting the patient at the heart of leg ulcer care Part 2: Development and evaluation of the consultation template

This is an accepted manuscript of an article published by MA Healthcare Ltd in British Journal of Community Nursing on 25/05/2018, available online: https://doi.org/10.12968/bjcn.2018.23.Sup6.S20 The accepted version of the publication may differ from the final published version.Part 2 in this article series summarises the final two phases of a study which explored the experiences of patients with leg ulcers and the impact of this condition on their quality of life. Early phases of the study revealed a mismatch between issues that affected a patient's quality of life and what they discussed during subsequent health care consultations. In light of this, a nominal group technique was employed to facilitate the development of a new leg ulcer consultation template with patient partners. The aim of this was to include many of the issues raised in phases 1. The new template was evaluated in terms of its utility, significance and clinical potential. The application of this template during routine consultations appears to encourage the patient to disclose issues that are important to them and may have otherwise been overlooked

Leaving a solitary life behind: Evolutionary processes leading to sociality in animals

Die Entwicklung stabiler Tiergruppen ist ein wichtiger Übergang in der Evolution, der aufgrund des selektiven Drucks, der mit sozialen Interaktionen verbunden ist, Veränderungen in der Populationsstruktur und in den aufkommenden Eigenschaften mit sich bringt. Die Sozialität basiert auf Kooperation, ein evolutionäres Puzzle in der darwinistischen Theorie, das auf der Konkurrenz um begrenzte Ressourcen beruht. Im ersten Kapitel stellen wir die Bedeutung der Verwandtschaftsselektion (i.e. Nepotismus) in Frage, um das Auftreten von Tiergruppen zu erklären, das das aktuelle Paradigma darstellt. Diese Theorie legt nahe, dass genetische Ähnlichkeit notwendig ist, um die Konkurrenz zwischen Individuen zu reduzieren, die eine Kooperation ermöglichen. Wir schlagen einen alternativen Rahmen vor, der die zahlreichen und unterschiedlichen Arten berücksichtigt, in denen die elterliche Fürsorge die Entwicklung des Gruppenlebens katalysiert haben könnte. Wir betonen die Bedeutung koevolutiver Prozesse zwischen Parasiten und Raubtieren mit elterlichen Investitionsstrategien, lange bevor ein Übergang zur Sozialität stattfinden kann. Aufbauend auf empirischen und theoretischen Erkenntnissen aus einem breiten Spektrum von Taxa, einschließlich Wirbeltieren und wirbellosen Tieren, schlagen wir vor, dass direkte Fitnessvorteile, die sich aus dem selektiven Druck ergeben, der mit der Evolution der elterlichen Fürsorge verbunden ist, die Kraft hinter dem Auftreten von Tiergruppen sind. In diesem Rahmen ist die Verwandtenselektion eher ein Verstärker oder sogar ein Nebenprodukt aus evolutionären Prozessen, die mit der elterlichen Fürsorge in Verbindung stehen, und nicht die Hauptvoraussetzung für die Entwicklung der Zusammenarbeit. Im zweiten Kapitel konzentrieren wir uns auf die Untersuchung fakultativ sozialer Spezies, um die Prozesse zu verstehen, die eine einsame Spezies zu einem Gruppenleben führen. In diesem Sinne beschreiben wir das Sozialsystem eines fakultativ sozialen Primaten mit gemeinschaftlicher Zucht, Microcebus murinus, anhand von Daten über mehr als 200 Individuen aus einer Wildpopulation. Durch die Untersuchung der gemeinsamen Schlafplatznutzung bei dieser einsamen Futtersuche wollen wir die soziale Flexibilität sowohl auf der Ebene der Art als auch auf der Ebene des Individuums charakterisieren. Wir finden Belege für die soziale Flexibilität bei philopatrischen Weibchen und zerstreuenden Männchen. Darüber hinaus zeigen wir, im Gegensatz zu früheren Ergebnissen, eine höhere Fähigkeit zur Sozialität und sozialen Flexibilität bei den Männchen. Unsere Ergebnisse deuten also darauf hin, dass die weibliche Gemeinschaftszucht möglicherweise nicht die einzige treibende Kraft für die Sozialität bei dieser Art ist, was den in Kapitel 1 dargelegten Rahmen kritisiert; und dass nicht verwandte Männchen genauso anfällig für die Bildung sozialer Gruppen sind wie verwandte Weibchen, was darauf hindeutet, dass die Verwandtschaftsauswahl auch nicht in der Lage ist, die Entwicklung der sozialen Systeme des Mausmakis zu erklären. Während wir in den ersten beiden Kapiteln die Übergänge zur Sozialität aus einer anpassungsorientierten Perspektive diskutiert haben, untersuchen wir in Kapitel 3.1 die Möglichkeit, dass die Sozialität bei Microcebus murinus ein passives Ergebnis der heterogenen Verteilung von Nahrungsressourcen und Schlafplätzen sein könnte. Wir finden keine Belege für einen Effekt der Verfügbarkeit von Nahrungsressourcen oder der Einschränkung der Nistplätze auf individuelle Sozialstrategien. Daher könnten die intrinsischen Vorteile, die mit dem gemeinsamen Schlafen und der gemeinsamen Nutzung eines Heimbereichs mit anderen verbunden sind, bei dieser Art im Spiel sein. In Kapitel 3.2 entwickeln wir die in Kapitel 3.1 angewandte Methode zur Beurteilung der Zuverlässigkeit der für jedes Individuum gesammelten Informationen, um mit Hilfe der Michaelis-Menten-Modellierung Heimatorte zu bauen. Wir glauben, dass dies ein potenziell nützliches Instrument für Studien in der freien Natur sein könnte, wo sowohl die Knappheit der Daten als auch die individuellen Unterschiede in der Menge der gesammelten Daten bewegungsökologische Analysen erschweren können. Abschließend betonen wir, dass die soziale Evolution ein vielfältiger Prozess ist, der mehrere Ebenen der Lebenskomplexität in sich birgt und miteinander verflochten ist und sich den Versuchen einer einheitlichen Erklärung ihrer Ursprünge widersetzt.The evolution of stable animal groups is a major transition in evolution entailing changes in population structure and emerging properties due to the selective pressures associated with social interactions. Sociality is based on cooperation, an evolutionary puzzle in Darwinian theory that is grounded on competition for limited resources. In the first chapter, we challenge the importance of kin selection (i.e. nepotism) to explain the appearance of animal groups, which is the current paradigm. This theory suggests that genetic similarity is needed to reduce competition between individuals allowing cooperation to be selected. We propose an alternative framework that takes into account the numerous and diverse ways in which parental care may have catalyzed the evolution of group living. We emphasize the importance of coevolutionary processes between parasites and predators with parental investment strategies long before transitions to sociality may occur. Building on empirical and theoretical evidence from a wide range of taxa, including vertebrates and invertebrates, we suggest that direct fitness benefits arising from selective pressures associated with parental care evolution are the force behind the appearance of animal groups. Under this framework, kin-selection is rather an enhancer or even a by-product derived from evolutionary processes related to parental care and not the main prerequisite for cooperation to evolve. In the second chapter, we focus on studying facultatively social species to understand the processes that lead a solitary species to become group-living. In this sense, we describe the social system of a facultatively social primate with communal breeding, Microcebus murinus, using data on more than 200 individuals from a wild population. By studying sleeping site sharing in this solitary foraging species, we aim to characterize the social flexibility both at the species as well as at the individual levels. We find evidence for social flexibility in philopatric females and dispersing males. Moreover, contrary to previous findings, we show a higher capacity for sociality and social flexibility in males. Thus, our results suggest that female communal breeding may not be the only force driving sociality in this species, criticizing the framework exposed in chapter 1; and that unrelated males may be as prone as related females to form social groups, which suggests that kin-selection is also unable to explain the evolution of mouse lemurs’ social systems. While in the first two chapters, we discussed transitions to sociality from an adaptationist perspective, in Chapter 3.1, we examine the possibility that sociality in Microcebus murinus may be a passive result of heterogeneous distribution of food resources and sleeping sites. We find no evidence for an effect of food resource availability or nesting limitation on individual social strategies. Thus, intrinsic benefits associated with sleeping together and sharing a home range with others may be at play in this species. In chapter 3.2, we develop the method used in chapter 3.1 to assess the reliability of information gathered per individual to construct home ranges using Michaelis-Menten modeling. We believe this might be a potentially useful tool for studies in the wild where scarcity of data as well as between-individual variation in the amount of data collected may hamper movement ecology analyses. We end by emphasizing that social evolution is a manifold process that embeds and intertwines several layers of life complexity, resisting attempts for unitary explanations of its origins

Research report: "Using what you have to get what you want": Vulnerability to HIV and prevention needs of female post‐secondary students engaged in transactional sex in Kumasi, Ghana

This study was implemented by Boston University in collaboration with the Kwame Nkrumah University of Science and Technology with support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 2010. The content and views expressed here are the authors’ and do not necessarily reflect the opinion or policy of USAID or the U.S. Government.This report presents findings from a qualitative study examining vulnerability to HIV of female post‐secondary students engaged in transactional sex in Kumasi, Ghana and their prevention needs. The study was conducted by Boston University’s Center for Global and Health and Development (CGHD) and the Kwame Nkrumah University of Science and Technology (KNUST) as part of Project SEARCH funded by the United States Agency for International Development Ghana. Participants were recruited from five post‐secondary institutions in the greater Kumasi area. Our objective is to provide academic institutions, the Ghana AIDS Commission (GAC), the National AIDS Control Program, donors, and other stakeholders with rich data to inform research and programmatic efforts in Kumasi specifically, as well as academic institutions in general. We set out to document what forms of transactional sex female students are engaging in, who their partners are, and what motivates them to participate. We asked students about the individual and structural vulnerabilities for HIV reported by female post‐secondary students involved in transactional sex and what their prevention needs are. We also interviewed a small sample of faculty, residence hall matrons, and hotel staff to get their perspective on the behavior of female students practicing transactional sex that might put them at risk for HIV. The findings of this study can be used as well to inform the design of future studies of young women engaging in transactional sex in Ghana. With such limited understanding of HIV transmission among young female post‐secondary students engaged in transactional sex, research is needed to determine how this group contributes to the overall HIV epidemic. The Ghana AIDS Commission has recognized the need for further research among communities engaged in less well‐defined risky sex practices in the National Strategic Plan for Most‐at – Risk Populations (MARP) 2011‐2015.4 This study attempts to fill in gaps in the research regarding transactional sex, taking into account the complexities and nuances of the practice, in addition to examining the needs of female students for targeted HIV prevention programs.Support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 201

Turning Point Scotland's Housing First Project Evaluation: Final Report

GIS maps are one kind of complex display in which people search for targets. Recent studies have shown that the choice of colour-scales when displaying these maps has important implications for people's strategies in searching these displays (Donnelly, Cave, Welland & Menneer, 2006). The current study follows up on this research. Observers searched for multiple targets in each display. Two targets were red and two were blue, and targets were not very salient. Observers searched until all targets were found. This often took several seconds and many fixations. The order in hich observers found targets suggested that they were more reliant on search for particular colours under some color-scales than under others. What will be presented here is a number of oculomotor measures used to explore how search was guided in the displays: the degree to which fixations clustered around targets, the image characteristics of regions of the display that were fixated, and goodness of fit to fixation distributions of Itti & Koch saliency maps, where the features used to compute saliency were varied. The goal was to see which measures would best pick up on differences in what guided search through complex display

Honey, I’ll Be Working Late Tonight. The Effect of Individual Work Routines on Leisure Time Synchronization of Couples

German time use data for 2001/02 are used to assess the impact of workplace characteristics on the private life of couples. The major aim is to solve the endogeneity resulting from individual preferences for work and leisure to identify the pure effects of the workplace independent from other diluting personal influences in a cross-sectional setting when no appropriate instruments are available. I propose a repeated random assignment of people into pseudo couples as a solution. By this approach, I am able to uncover additional marriage inherent mechanisms that result in a (de-)synchronization of joint time that are still family friendly.Time Use, Time Allocation, Family Economics, Flexibility, Synchronization, Leisure, Endogeneity