Surviving the Stigma: Incorporating Mental Health Literacy to Increase Help-Seeking in California First Responders

First responders are at risk of developing mental health problems due to repeated exposure to traumatic incidents, increasing their chance of developing Post Traumatic Stress Disorder, substance abuse, suicidal ideation, and suicide. Unfortunately, first responders do not recognize that they may have a mental illness and are reluctant to seek help. This paper will discuss the prevalence of mental health problems among first responders and the barriers to their help-seeking. These barriers include the stigma around mental illness within the culture, the assessability of professional help, and the lack of mental health literacy regarding their well-being. Further discussion will focus on California prehospital medical care personnel, which includes emergency medical technicians, paramedics, and firefighters. Current interventions for these first responders will be explained at policy, organizational, interpersonal, and individual levels. Recommendations to improve the intervention will follow. Increasing mental health literacy through education from the start of first responders\u27 training and throughout their careers will reduce stigma, manage mental issues, and increase help-seeking

Smarter choices ?changing the way we travel. Case study reports

This report accompanies the following volume:Cairns S, Sloman L, Newson C, Anable J, Kirkbride A and Goodwin P (2004)Smarter Choices ? Changing the Way We Travel. Report published by theDepartment for Transport, London, available via the ?Sustainable Travel? section ofwww.dft.gov.uk, and from http://eprints.ucl.ac.uk/archive/00001224/

Smarter choices - changing the way we travel

Summary: In recent years, there has been growing interest in a range of initiatives, which are now widelydescribed as 'soft' transport policy measures. These seek to give better information and opportunities,aimed at helping people to choose to reduce their car use while enhancing the attractiveness ofalternatives. They are fairly new as part of mainstream transport policy, mostly relativelyuncontroversial, and often popular. They include:. Workplace and school travel plans;. Personalised travel planning, travel awareness campaigns, and public transport information andmarketing;. Car clubs and car sharing schemes;. Teleworking, teleconferencing and home shopping.This report draws on earlier studies of the impact of soft measures, new evidence from the UK andabroad, case study interviews relating to 24 specific initiatives, and the experience of commercial,public and voluntary stakeholders involved in organising such schemes. Each of the soft factors isanalysed separately, followed by an assessment of their combined potential impact.The assessment focuses on two different policy scenarios for the next ten years. The 'high intensity'scenario identifies the potential provided by a significant expansion of activity to a much morewidespread implementation of present good practice, albeit to a realistic level which still recognisesthe constraints of money and other resources, and variation in the suitability and effectiveness of softfactors according to local circumstances. The 'low intensity' scenario is broadly defined as aprojection of the present (2003-4) levels of local and national activity on soft measures.The main features of the high intensity scenario would be. A reduction in peak period urban traffic of about 21% (off-peak 13%);. A reduction of peak period non-urban traffic of about 14% (off-peak 7%);. A nationwide reduction in all traffic of about 11%.These projected changes in traffic levels are quite large (though consistent with other evidence onbehavioural change at the individual level), and would produce substantial reductions in congestion.However, this would tend to attract more car use, by other people, which could offset the impact ofthose who reduce their car use unless there are measures in place to prevent this. Therefore, thoseexperienced in the implementation of soft factors locally usually emphasise that success depends onsome or all of such supportive policies as re-allocation of road capacity and other measures toimprove public transport service levels, parking control, traffic calming, pedestrianisation, cyclenetworks, congestion charging or other traffic restraint, other use of transport prices and fares, speedregulation, or stronger legal enforcement levels. The report also records a number of suggestionsabout local and national policy measures that could facilitate the expansion of soft measures.The effects of the low intensity scenario, in which soft factors are not given increased policy prioritycompared with present practice, are estimated to be considerably less than those of the high intensityscenario, including a reduction in peak period urban traffic of about 5%, and a nationwide reductionin all traffic of 2%-3%. These smaller figures also assume that sufficient other supporting policies areused to prevent induced traffic from eroding the effects, notably at peak periods and in congestedconditions. Without these supportive measures, the effects could be lower, temporary, and perhapsinvisible.Previous advice given by the Department for Transport in relation to multi-modal studies was that softfactors might achieve a nationwide traffic reduction of about 5%. The policy assumptionsunderpinning this advice were similar to those used in our low intensity scenario: our estimate isslightly less, but the difference is probably within the range of error of such projections.The public expenditure cost of achieving reduced car use by soft measures, on average, is estimated atabout 1.5 pence per car kilometre, i.e. £15 for removing each 1000 vehicle kilometres of traffic.Current official practice calculates the benefit of reduced traffic congestion, on average, to be about15p per car kilometre removed, and more than three times this level in congested urban conditions.Thus every £1 spent on well-designed soft measures could bring about £10 of benefit in reducedcongestion alone, more in the most congested conditions, and with further potential gains fromenvironmental improvements and other effects, provided that the tendency of induced traffic to erodesuch benefits is controlled. There are also opportunities for private business expenditure on some softmeasures, which can result in offsetting cost savings.Much of the experience of implementing soft factors is recent, and the evidence is of variable quality.Therefore, there are inevitably uncertainties in the results. With this caveat, the main conclusion isthat, provided they are implemented within a supportive policy context, soft measures can besufficiently effective in facilitating choices to reduce car use, and offer sufficiently good value formoney, that they merit serious consideration for an expanded role in local and national transportstrategy.AcknowledgementsWe gratefully acknowledge the many contributions made by organisations and individuals consultedas part of the research, and by the authors of previous studies and literature reviews which we havecited. Specific acknowledgements are given at the end of each chapter.We have made extensive use of our own previous work including research by Lynn Sloman funded bythe Royal Commission for the Exhibition of 1851 on the traffic impact of soft factors and localtransport schemes (in part previously published as 'Less Traffic Where People Live'); and by SallyCairns and Phil Goodwin as part of the research programme of TSU supported by the Economic andSocial Research Council, and particularly research on school and workplace travel plans funded bythe DfT (and managed by Transport 2000 Trust), on car dependence funded by the RAC Foundation,on travel demand analysis funded by DfT and its predecessors, and on home shopping funded byEUCAR. Case studies to accompany this report are available at: http://eprints.ucl.ac.uk/archive/00001233

Clinical Ethics Support in Contemporary Health Care

This chapter concerns current initiatives to create and maintain specialized services to help respond to ethical issues that arise in the practice of health care. These initiatives, the obstacles they face, and the controversies they engender should be of considerable interest to those concerned with the management of health care organizations. This is because ethics is and should be intrinsic to routine health care practice. Also, no less, it is because ethical disputes and controversies, even if they seldom occur, can severely disrupt the complex organizations that deliver health care in modern societies. Clinical ethics support services (CES services) are comprised of an individual or group, usually in an organization, who can provide a suite of services to support all stakeholders in identifying and managing the ethical issues that inevitably arise in the design and delivery of health care. While there is a degree of consensus about the potential value of such services, they are also the focus of ongoing theoretical, methodological and political debates. This chapter does not aim to resolve these debates. Rather, our aim is to provide health care managers with an account of how and why CES services are becoming a part of the contemporary organizational landscape of health care, and describe the concerns that bioethicists and observers and critics of bioethics have raised regarding their role, function, and dissemination. We first describe the origins of CES services, to provide a context for the following discussion about the goals, functions and models of support that exist across this discipline—drawing on some relevant examples. We then describe how CES services can be evaluated. Third, we discuss initiatives that aim to optimise quality of CES services and some of the criticisms and suspicions that these initiatives have engendered. Finally, we offer some reflections on the direction that CES services may take in the future

Exploring gender differences within forest schools as a physical activity intervention

This study investigated whether children engaged in more physical activity (PA) on school days that included Forest School (FS) sessions than a regular school day or a school day with a Physical Education (PE) lesson. How FS sessions influenced children’s general levels of PA and wellbeing was also explored across gender. A mixed-methods study followed a sample of 59 child participants aged 7 to 9 years old, from four primary schools, whilst taking part in twelve weekly FS sessions. Measures included the PA Questionnaire for Older Children and accelerometry data together with an individual Write and Draw task to inform focus groups. Children had significantly greater levels of light PA on a FS day and a PE school day compared to a regular school day and children reported feeling both happier and relaxed as a consequence of the intervention. From the qualitative data, boys and girls reported different likes of the FS interventions, whereas their dislikes of FS were comparable. Findings from this research provide evidence for such outdoor, nature-based learning within the school curriculum contributing to daily PA in children

A qualitative exploration of the experiences of pregnant women living with obesity and accessing antenatal care

Women are advised to optimise weight before pregnancy. However, many are either already living with overweight or obesity prior to becoming pregnant, increasing the risks for adverse outcomes. Health care professionals (HCP) are responsible for advising women of risks throughout and following pregnancy. However, midwives find broaching the conversation around maternal obesity difficult. This difficulty may be due to insufficient knowledge regarding the management of obesity during pregnancy or because they do not wish to offend. This study explored the experiences of accessing antenatal care in pregnant women living with obesity. Seventeen women completed a semi-structuredinterview. Transcripts were analysed thematically. Four themes were developed:1) antenatal care is inconsistent, 2)additional support is needed, 3) women feel judged about their weight, and 4) weight cycling is highly prevalent. Findings suggest that pregnant women living with obesity often experience weight bias from HCPs, feel judged because of their weight and are left feeling confused andoverlooked. Women reported inconsistencies in advice and care offered,and acknowledged a lack of continuity of care throughout pregnancy. We call for an urgent need for further multidisciplinary training to address the concerns, experiences and needs of pregnant women living with obesity

Smarter Choices : Assessing the Potential to Achieve Traffic Reduction Using 'Soft Measures'

Peer reviewedPostprin

EEG Frequency Bands in Psychiatric Disorders: A Review of Resting State Studies

A significant proportion of the electroencephalography (EEG) literature focuses on differences in historically pre-defined frequency bands in the power spectrum that are typically referred to as alpha, beta, gamma, theta and delta waves. Here, we review 184 EEG studies that report differences in frequency bands in the resting state condition (eyes open and closed) across a spectrum of psychiatric disorders including depression, attention deficit-hyperactivity disorder (ADHD), autism, addiction, bipolar disorder, anxiety, panic disorder, post-traumatic stress disorder (PTSD), obsessive compulsive disorder (OCD) and schizophrenia to determine patterns across disorders. Aggregating across all reported results we demonstrate that characteristic patterns of power change within specific frequency bands are not necessarily unique to any one disorder but show substantial overlap across disorders as well as variability within disorders. In particular, we show that the most dominant pattern of change, across several disorder types including ADHD, schizophrenia and OCD, is power increases across lower frequencies (delta and theta) and decreases across higher frequencies (alpha, beta and gamma). However, a considerable number of disorders, such as PTSD, addiction and autism show no dominant trend for spectral change in any direction. We report consistency and validation scores across the disorders and conditions showing that the dominant result across all disorders is typically only 2.2 times as likely to occur in the literature as alternate results, and typically with less than 250 study participants when summed across all studies reporting this result. Furthermore, the magnitudes of the results were infrequently reported and were typically small at between 20% and 30% and correlated weakly with symptom severity scores. Finally, we discuss the many methodological challenges and limitations relating to such frequency band analysis across the literature. These results caution any interpretation of results from studies that consider only one disorder in isolation, and for the overall potential of this approach for delivering valuable insights in the field of mental health

Breeding ground correlates of the distribution and decline of the Common Cuckoo Cuculus canorus at two spatial scales

This is the author accepted manuscript. The final version is available from the publisher via the DOI in this recordMany migratory bird species are undergoing population declines as a result of potentially multiple, interacting mechanisms. Understanding the environmental associations of spatial variation in population change can help tease out the likely mechanisms involved. Common Cuckoo Cuculus canorus populations have declined by 69% in England but increased by 33% in Scotland. The declines have mainly occurred in lowland agricultural landscapes, but their mechanisms are unknown. At both the local scale within the county of Devon (SE England) and at the national (UK) scale, we analysed the breeding season distribution of Cuckoos in relation to habitat variation, the abundance of host species and the abundance of moth species whose caterpillars are a key food of adult Cuckoos. At the local scale, we found that Cuckoos were more likely to be detected in areas with more semi-natural habitat, more Meadow Pipits Anthus pratensis (but fewer Dunnocks Prunella modularis) and where, later in the summer, higher numbers of moths were captured whose larvae are Cuckoo prey. Nationally, Cuckoos have become more associated with upland heath characterized by the presence of Meadow Pipit hosts, and with wetland habitats occupied by Eurasian Reed Warbler Acrocephalus scirpaceus hosts. The core distribution of Cuckoos has shifted from south to north within the UK. By the end of 2009, the abundance of macro-moth species identified as prey had also declined four times faster than that of species not known to be taken by Cuckoos. The abundance of these moths has shown the sharpest declines in grassland, arable and woodland habitats and has increased in semi-natural habitats (heaths and rough grassland). Our study suggests that Cuckoos are likely to remain a very scarce bird in lowland agricultural landscapes without large-scale changes in agricultural practices.Biotechnology and Biological Sciences Research Council (BBSRC)Royal Society for the Protection of Birds and Natural Englan