The UK National Homicide Therapeutic Service: a retrospective naturalistic study among 929 bereaved individuals

Homicidal bereavement puts survivors at risk of developing a broad range of lasting and severe mental health problems. Previous research has often relied on relatively small and homogenous samples. Still, little is known about what factors influence the expression of symptoms following homicidal bereavement. Preventive and curative treatments often do not consider the complex coherence between the emotional, judicial, financial, and societal challenges that likely arise following a homicide. Despite the severity of its consequences on mental health, no gold standard for the preventative and curative treatment of mental health issues in homicide survivors exists. We aimed to introduce a time-limited, traumatic grief-focused outreaching model of care designed specifically for homicide survivors, and to examine its potential effectiveness. Furthermore, we aimed to investigate what factors influence the severity of mental health problems and response to treatment. In the current study, self-reported data on five different outcome measures, namely, symptoms of posttraumatic stress, prolonged grief, depression, anxiety, and functional impairment were available from 929 homicidally bereaved treatment receiving adults. We used Latent Growth Modeling to analyze our repeated measures data and to classify individuals into distinct groups based on individual response patterns. Results showed that the current model of care is likely to be effective in reducing mental health complaints following homicidal bereavement. Having a history of mental illness, being younger of age and female, and having lost either a child or spouse consistently predicted greater symptom severity and functional impairment at baseline. For change in symptom severity and functional impairment during treatment, having a history of mental illness was the only consistent predictor across all outcomes. This study was limited by its reliance on self-reported data and cross-sectional design without a control group. Future prospective, longitudinal research across different cultures is needed in order to replicate the current findings and enhance generalizability. That notwithstanding, findings provide a first step toward evaluating a novel service-delivery approach for homicide survivors and provide further insight in the development of mental health complaints following bereavement by homicide

Psychopathology in a treatment-seeking sample of homicidally bereaved individuals:Latent class analysis

Background: Violently bereaved individuals are at increased risk of developing severe and comorbid disorders. Comorbidity may increase psychiatric symptom severity and suicide risk and decrease psychosocial functioning compared with having one disorder. We aimed to identify subgroups of individuals with similar symptom patterns, describe prevalence rates and overall levels of prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD) per class, and explore associations between class membership and personal and homicide related variables. Methods: We investigated the comorbidity of symptoms of PGD, PTSD, MDD, and GAD in a sample of 923 treatment-seeking homicidally bereaved individuals by deploying latent class analysis. Results: Three subgroups were identified: (i) a moderate distress, low depression class (12.4%), (ii) a high distress, moderate depression class (42.7%), and (iii) a high distress and high depression class (45.0%). Prevalence rates and total scores of the questionnaires followed the pattern of iii ≥ ii ≥ i (ps ≤ .001). Being female and having experienced prior life stress distinguished between all classes (ps ≤ .05). Limitations: The data-driven analytic approach and reliance on self-reported routine outcome monitoring data limit the generalizability and validity of the study. Strengths include the large sample size and the inclusion of four measures in a treatment-seeking, violently bereaved sample. Conclusions: Classes were most clearly distinguishable based on symptom severity, indicating high comorbidity following bereavement by homicide. This argues for an integrated treatment that targets different complaints simultaneously rather than successively

Building blocks for social accountability: a conceptual framework to guide medical schools

Background: This paper presents a conceptual framework developed from empirical evidence, to guide medical schools aspiring towards greater social accountability. Methods: Using a multiple case study approach, seventy-five staff, students, health sector representatives and community members, associated with four medical schools, participated in semi-structured interviews. Two schools were in Australia and two were in the Philippines. These schools were selected because they were aspiring to be socially accountable. Data was collected through on-site visits, field notes and a documentary review. Abductive analysis involved both deductive and inductive iterative theming of the data both within and across cases. Results: The conceptual framework for socially accountable medical education was built from analyzing the internal and external factors influencing the selected medical schools. These factors became the building blocks that might be necessary to assist movement to social accountability. The strongest factor was the demands of the local workforce situation leading to innovative educational programs established with or without government support. The values and professional experiences of leaders, staff and health sector representatives, influenced whether the organizational culture of a school was conducive to social accountability. The wider institutional environment and policies of their universities affected this culture and the resourcing of programs. Membership of a coalition of socially accountable medical schools created a community of learning and legitimized local practice. Communities may not have recognized their own importance but they were fundamental for socially accountable practices. The bedrock of social accountability, that is, the foundation for all building blocks, is shared values and aspirations congruent with social accountability. These values and aspirations are both a philosophical understanding for innovation and a practical application at the health systems and education levels. Conclusions: While many of these building blocks are similar to those conceptualized in social accountability theory, this conceptual framework is informed by what happens in practice - empirical evidence rather than prescriptions. Consequently it is valuable in that it puts some theoretical thinking around everyday practice in specific contexts; addressing a gap in the medical education literature. The building blocks framework includes guidelines for social accountable practice that can be applied at policy, school and individual levels

How can medical schools contribute to bringing about health equity?

The role of medical schools is in a process of change. The World Health Organization has declared that they can no longer be ivory towers whose primary focus is the production of specialist physicians and cutting edge laboratory research. They must also be socially accountable and direct their activities towards meeting the priority health concerns of the areas they serve. The agenda must be set in partnership with stakeholders including governments, health care organisations and the public.<p></p> The concept of social accountability has particular resonance for the Bar Ilan Faculty of Medicine in the Galilee, Israel’s newest medical school, which was established with a purpose of reducing health inequities in the Region. As a way of exploring and understanding the issues, discussions were held with international experts in the field who visited the Galilee. A symposium involving representatives from other medical schools in Israel was also held to extend the discourse. Deliberations that took place are reported here.<p></p> The meaning of social accountability was discussed, and how it could be achieved. Three forms of action were the principal foci – augmentation of the medical curriculum, direct action through community engagement and political advocacy. A platform was set for taking the social accountability agenda forward, with the hope that it will impact on health inequalities in Israel and contribute to discussions elsewhere

How do undergraduate medical students perceive social accountability?

Aim: The concept of social accountability within undergraduate training is embedded within the remit of medical schools. Little is known of how medical students perceive social accountability, recognize aspects of their training contributing to the development of this concept and cultivate the underpinning values. Methods: Students nearing graduation were recruited to participate in focus groups designed to explore their perceptions of social accountability, which curricular aspects had contributed to their understanding, and to investigate the implications of individual variations in training. Results: Students expressed limited appreciation of the concept of social accountability and acknowledged little explicit teaching around underpinning core concepts such as awareness of local health needs, advocacy and nurturing of altruism. However, participants recognized numerous aspects of the course and learning initiatives as impacting on their attitudes towards this concept implicitly. Conclusion: This study highlights areas of their undergraduate training that students recognize as having the greatest impact on their development into socially accountable professionals. It poses some significant challenges for health care educators in addressing unintended consequences, including an outcome-driven educational approach, in reducing students’ capacity or willingness to engage in curricular challenges often designed to embed this concept

The Long-term Loneliness of Widowhood: A Systematic Review of Marital Status Differences

Loneliness can be prominent in bereavement, possibly leading to compromised mental and physical health. We systematically reviewed the extent of loneliness across marital status groups, examining the prevalence, intensity, risk factors, and correlates of loneliness in widowhood, compared to other marital statuses. Studies that met predefined criteria as well as investigated marital status (comparisons) were included in the review. For reporting, we followed the PRISMA statement. Thirty-eight studies were included. Widowhood was associated with a greater likelihood and intensity of loneliness when compared to other marital statuses, and especially the divorced. Widowers were on average lonelier than widows. Findings suggest that , widowed persons are uniquely vulnerable to loneliness, and that, in the long-term, loneliness may be more pronounced among the widowed than the divorced. However, methodological shortcomings (e.g., heterogenous samples, different measures of loneliness) of available studies must be considered, and future research should aim to overcome these limitations

Human TSCM cell dynamics in vivo are compatible with long-lived immunological memory and stemness.

Adaptive immunity relies on the generation and maintenance of memory T cells to provide protection against repeated antigen exposure. It has been hypothesised that a self-renewing population of T cells, named stem cell-like memory T (TSCM) cells, are responsible for maintaining memory. However, it is not clear if the dynamics of TSCM cells in vivo are compatible with this hypothesis. To address this issue, we investigated the dynamics of TSCM cells under physiological conditions in humans in vivo using a multidisciplinary approach that combines mathematical modelling, stable isotope labelling, telomere length analysis, and cross-sectional data from vaccine recipients. We show that, unexpectedly, the average longevity of a TSCM clone is very short (half-life < 1 year, degree of self-renewal = 430 days): far too short to constitute a stem cell population. However, we also find that the TSCM population is comprised of at least 2 kinetically distinct subpopulations that turn over at different rates. Whilst one subpopulation is rapidly replaced (half-life = 5 months) and explains the rapid average turnover of the bulk TSCM population, the half-life of the other TSCM subpopulation is approximately 9 years, consistent with the longevity of the recall response. We also show that this latter population exhibited a high degree of self-renewal, with a cell residing without dying or differentiating for 15% of our lifetime. Finally, although small, the population was not subject to excessive stochasticity. We conclude that the majority of TSCM cells are not stem cell-like but that there is a subpopulation of TSCM cells whose dynamics are compatible with their putative role in the maintenance of T cell memory

Comparison of knowledge scores of medical students in problem-based learning and traditional curriculum on public health topics

BACKGROUND: The purpose of the study was to compare the knowledge scores of medical students in Problem-based Learning and traditional curriculum on public health topics. METHODS: We planned a cross-sectional study including the fifth and sixth year medical students of Dokuz Eylul University in Turkey. The fifth year students (PBL group, n = 56) were the pioneers educated with PBL curriculum since the 1997–1998 academic year. The sixth year students (traditional education group, n = 78) were the last students educated with traditional education methods. We prepared 25 multiple-choice questions in order to assess knowledge scores of students on selected subjects of Public Health. Our data were collected in year 2002. RESULTS: Mean test scores achieved in PBL and traditional groups were 65.0 and 60.5 respectively. PBL students were significantly more successful in the knowledge test (p = 0.01). The knowledge scores of two topics were statistically higher among PBL students. These topics were health management and chronic diseases. CONCLUSION: We found that mean total evaluation score in the PBL group was 4.5 points higher than in the traditional group in our study. Focusing only on the knowledge scores of students is the main limitation of our study. Upon the graduation of the first PBL students in the 2002–2003 academic year, we are planning additional studies regarding the other functions of a physician such as skill, behaviour and attitude

Addressing health workforce inequities in the Mindanao regions of the Philippines: tracer study of graduates from a socially-accountable, community-engaged medical school and graduates from a conventional medical school

Developing and retaining a high-quality medical workforce in low-resource countries is a worldwide challenge. The Filipino Ateneo de Zamboanga University–School of Medicine (ADZU-SOM) has adopted a strong focus on socially accountable health professional education (SAHPE) in order to address the shortage of physicians across rural and urban communities in the Western Mindanao region. A cross-sectional survey of graduates from two Philippines medical schools: ADZU-SOM in the Mindanao region and a medical school with a more conventional curriculum, found ADZU-SOM graduates were more likely to have joined the medical profession due to a desire to help others (p=0.002), came from lower socioeconomic strata (p¼0.001) and had significantly (p<0.05) more positive attitudes to community service. ADZU graduates were also more likely to currently work in Government Rural Health Units (p<0.001) or be generalist Medical Officers (p<0.001) or Rural/Municipal Health Officers (p=0.003). ADZU graduates were also less likely to work in private or specialist Government hospitals (p=0.033 and p=0.040, respectively) and be surgical or medical specialists (p=0.010 and p<0.001, respectively). The findings suggest ADZU-SOM’s SAHPE philosophy manifests in the practice choices of its graduates and that the ADZUSOM can meet the rural and urban health workforce needs of the Western Mindanao region