Listen and learn : engaging young people, their families and schools in early intervention research

Recent policy guidelines highlight the importance of increasing the identification of young people at risk of developing mental health problems in order to prevent their transition to longer-term problems, avoid crisis and remove the need for care through specialist mental health services or hospitalisation. Early awareness of the often insidious behavioural and cognitive changes associated with deteriorating mental wellbeing, however, is difficult, but it is vital if young people, their families and those who work with them are to be fully equipped with the skills to aid early help seeking. Our early intervention research continues to highlight the necessity of engaging with and listening to the voices of young people, families, and those who work with children and young people, not only in developing greater understanding of why some young people may be more be at-risk in terms of their mental health, but to provide children and young people with the best mental health support we can. Collaborative working with young people, their families and those who work with them has been an essential dimension of our youth mental health research in Birmingham, UK, enabling us to listen to the personal narratives of those with lived experience and to work alongside them. This paper highlights some of our key studies and how we have endeavored to make intra-agency working successful at each stage of the research process through increasing use of digital and youth informed resources to engage young people; a methodology which continues to inform, guide and develop our early intervention research and implementation

Decarbonising suburbia: Homeowners’ perspectives on home retrofits and travel mode shift in Perth, Scotland

Suburban neighbourhoods pose challenges to decarbonisation, due to high car-dependency and relatively large and energy inefficient homes. Home ownership dominates suburbia, thus putting responsibility on households to adopt measures to decarbonise their domestic lives and transportation. This paper examines household perspectives on the feasibility of such measures. We ran a survey and focus groups in Perth (Scotland) during the energy crisis. Whilst we found high levels of concern about climate change, energy costs, and growing engagement with cleaner technologies (e.g. heat pumps), most residents felt decarbonisation options were limited. Barriers like technologies’ up-front costs, worsened with the cost of living crisis. Participants had low familiarity with sharing economy approaches like car clubs. Despite high (non-electric) bike ownership and prevalence of storage space (garages), cycling was more perceived as a leisure activity than a regular transport mode. There were shared views that the state should take a stronger role in coordinating and implementing systemic changes required for energy transition, including measures affecting residents directly, like reducing car traffic into the city centre. We conclude that despite the economic privilege of high home and car ownership in suburbia, few felt financially able to decarbonise and most seem locked into high-carbon suburban lifestyles

Don’t turn your back on the symptoms of psychosis : a proof-of-principle, quasi-experimental public health trial to reduce the duration of untreated psychosis in Birmingham, UK

Background: Reducing the duration of untreated psychosis (DUP) is an aspiration of international guidelines for first episode psychosis; however, public health initiatives have met with mixed results. Systematic reviews suggest that greater focus on the sources of delay within care pathways, (which will vary between healthcare settings) is needed to achieve sustainable reductions in DUP (BJP 198: 256-263; 2011). Methods/Design: A quasi-experimental trial, comparing a targeted intervention area with a ‘detection as usual’ area in the same city. A proof-of–principle trial, no a priori assumptions are made regarding effect size; key outcome will be an estimate of the potential effect size for a definitive trial. DUP and number of new cases will be collected over an 18-month period in target and control areas and compared; historical data on DUP collected in both areas over the previous three years, will serve as a benchmark. The intervention will focus on reducing two significant DUP component delays within the overall care pathway: delays within the mental health service and help-seeking delay. Discussion: This pragmatic trial will be the first to target known delays within the care pathway for those with a first episode of psychosis. If successful, this will provide a generalizable methodology that can be implemented in a variety of healthcare contexts with differing sources of delay. Trial registration: http://www.controlled-trials.com/ISRCTN45058713 Keywords: Public mental health campaign, First-episode psychosis, Early detection, Duration of untreated psychosis, Youth mental healt

University students’ understanding and perceptions of schizophrenia in the UK:a qualitative study

Objective To explore lay understanding and perceptions of schizophrenia in university students. Design Qualitative study using semi-structured interviews and thematic analysis. Setting The University of Birmingham, West Midlands. Participants 20 UK home students of white British (n=5), Indian (n=5), Pakistani (n=5), African Caribbean (n=4) and dual white British and African Caribbean ethnicity (n=1). Results Findings revealed a lack of knowledge about schizophrenia, particularly the negative symptoms that were not mentioned. There were mixed ideas on the causes and sources of available help for schizophrenia; however, positively many said they would consult their general practitioner. While there was a general misconception among the students that schizophrenia caused multiple personalities and was a dangerous illness, there were some differences in perceptions and understanding between ethnic groups, with more Indian students perceiving upbringing as a causal factor in the development of the illness and more Pakistani students perceiving possession by a spirit as a cause. Conclusions The university students interviewed lacked knowledge about schizophrenia and stigma was widespread, both of which may delay help-seeking. Public health campaigns educating young people about schizophrenia are required to improve early identification and intervention and improve outcomes. Further research exploring ways to effectively tackle stigma is also required

Frequency and preventative interventions for non-suicidal self-injury and suicidal behaviour in primary school-age children : a scoping review protocol

Introduction: Non-suicidal self-injury (NSSI) and suicidal behaviour have been witnessed in children as young as 6–7 years of age, but while there are many reviews of preventative interventions for NSSI and suicide in adolescents, few have explored its prevalence in younger children and the potential impact of preventative interventions at this stage of life. NSSI and suicidal behaviour are an increasing concern in schools but school-based programmes can improve knowledge, attitudes and help-seeking behaviours and help prevent escalation of NSSI and later suicide. This scoping review will aim to explore the nature and extent of the evidence on the magnitude of NSSI and suicidal behaviour in primary school children, and to examine whether there are any primary school-based interventions available for the prevention of this phenomenon in 5 to 11-year-olds. Methods and analysis: A scoping review will be conducted using established methodology by Arksey and O’Malley and the Joanna Briggs Institute. Multiple bibliographic and indexing databases and grey literature will be searched using a combination of text words and index terms relating to NSSI, suicide, primary schools, frequency and intervention. Two reviewers will independently screen eligible studies for study selection and extract relevant data from included studies. A narrative summary of evidence will be conducted for all included studies with results presented in tables and/or diagrams. Inductive content analysis will be used to understand any narrative findings within the included studies. Ethics and dissemination: Ethical approval is not required for this scoping review. The results of this review will be disseminated though publication in a peer-reviewed journal and presented at relevant conferences

Overlaps and disjunctures : a cultural case study of a British Indian young woman’s experiences of Bulimia Nervosa

Eating disorder diagnoses are characterised by a pattern of disordered eating behaviour alongside symptoms such as body dissatisfaction and preoccupation with food, weight or shape (APA in Diagnostic and statistical manual of mental disorders, DSM-5, APA, Washington, DC, 2013). Incidence rates for eating disorders have increased during the last 50 years. However, epidemiological studies have suggested that such trends may not be a true representation of the occurrence of these illnesses in the general population, with figures underestimated due to reduced help seeking and poor access to care, particularly amongst ethnic minorities. This case study explores the experiences of a young British Indian woman with bulimia nervosa. Arising from an in-depth semi-structured interview, analysed with interpretative phenomenological analysis, her narrative offers a critical lens onto how diverse fragments of cultural practices and meanings come together to produce the clinical category of ‘bulimia.’ It thereby offers an alternative portrait of relationships between eating disorders and ‘culture,’ one that goes beyond a framing of these illnesses as culture inscribed on the body. Interrogating relationships between culture and the development, expression and maintenance of bulimia is suggested to be key to forging culturally-sensitive understandings of this illness; this paper begins to provide the evidence base for the design and development of appropriate support services, thereby aiming to contribute to a reduction in health inequalities and barriers to treatment

Le Companion curriculum : la perception des étudiants en médecine de l’intégration des sciences humaines dans l’enseignement médical

Background: The contributions of arts and humanities to medical education are known in the medical education community, but medical schools’ offerings vary. The Companion Curriculum (CC) is a student-curated set of optional humanities content for medical students at the University of Toronto. This study evaluates integration of the CC to identify key enabling conditions for medical humanities engagement. Methods: A mixed-methods evaluation gauged usage and perceptions of integration of the CC among medical students using an online survey and focus groups. Narrative data underwent thematic analysis, supported by summary statistics of quantitative data. Results: Half of survey respondents were aware of the CC (n = 67/130; 52%), and, once prompted with a description, 14% had discussed it in their tutorial groups. Of students using the CC, 80% reported learning something new regarding their roles as communicators and health advocates. Themes were the perceived value of the humanities, internal student barriers, institutional neglect of the humanities, and student critiques and recommendations. Conclusion: Despite participants’ interest in medical humanities, our CC remains underused. To improve humanities’ visibility in the MD curriculum, our results indicate that greater institutional support, including faculty development and early curricular integration, is required. Further study should explore reasons for gaps between interest and participation.Contexte : L’apport des arts et des sciences humaines à l’éducation médicale est bien connu du milieu de l’enseignement médical, mais l’offre des programmes à cet égard varie d’une faculté à l’autre. Le Companion curriculum (CC) est un recueil de contenu facultatif en sciences humaines, préparé par des étudiants et destiné aux étudiants en médecine de l’Université de Toronto. En évaluant l’intégration du CC au programme, cette étude vise à dégager les conditions principales qui favorisent l’enseignement des humanités médicales. Méthodes : Une évaluation à méthode mixte a permis de mesurer l’utilisation du CC par les étudiants en médecine et leur perception quant à l’intégration de cet outil, à l’aide d’un sondage en ligne et de groupes de discussion. Les données narratives ont fait l’objet d’une analyse thématique, étayée par des statistiques sommaires de données quantitatives. Résultats : La moitié des répondants à l’enquête connaissaient le CC (n=67/130 ; 52%) et 14 % en avaient discuté dans leurs groupes de tutorat. Parmi les étudiants qui l’avaient utilisé, 80 % ont déclaré avoir appris quelque chose de nouveau concernant leurs rôles de communicateurs et de promoteurs de la santé. Les thèmes abordés étaient la valeur perçue des sciences humaines, les freins internes des étudiants, la méconnaissance des sciences humaines au sein des établissements d’enseignement médical, ainsi que les critiques et les recommandations des étudiants. Conclusion : Malgré l’intérêt des participants pour les humanités médicales, notre CC demeure sous-utilisé. Nos résultats indiquent que le renforcement de la visibilité des sciences humaines dans le programme d’études médicales nécessite plus de soutien de la part des établissements, y compris par la formation des enseignants et par l’intégration des sciences humaines plus tôt dans le cursus du programme. Une étude plus approfondie permettrait d’explorer les raisons de l’écart entre l’intérêt et la participation

Learning Graph Models for Retrosynthesis Prediction

Retrosynthesis prediction is a fundamental problem in organic synthesis, where the task is to identify precursor molecules that can be used to synthesize a target molecule. A key consideration in building neural models for this task is aligning model design with strategies adopted by chemists. Building on this viewpoint, this paper introduces a graph-based approach that capitalizes on the idea that the graph topology of precursor molecules is largely unaltered during a chemical reaction. The model first predicts the set of graph edits transforming the target into incomplete molecules called synthons. Next, the model learns to expand synthons into complete molecules by attaching relevant leaving groups. This decomposition simplifies the architecture, making its predictions more interpretable, and also amenable to manual correction. Our model achieves a top-1 accuracy of $53.7\%$, outperforming previous template-free and semi-template-based methods

Don’t turn your back on the symptoms of psychosis : the results of a proof-of-principle, quasi-experimental intervention to reduce duration of untreated psychosis

Background No evidence based approach to reduce duration of untreated psychosis (DUP) has been effective in the UK. Existing interventions have many components and have been difficult to replicate. The majority of DUP in Birmingham, UK is accounted for by delays within mental health services (MHS) followed by help-seeking delay and, we hypothesise, these require explicit targeting. This study examined the feasibility and impact of an intervention to reduce DUP, targeting help-seeking and MHSs delays. Methods A dual-component intervention, comprising a direct care pathway, for 16-25 year olds, and a community psychosis awareness campaign, using our youth-friendly website as the central hub, was implemented, targeting the primary sources of care pathway delays experienced by those with long DUP. Evaluation, using a quasi-experimental, design compared DUP of cases in two areas of the city receiving early detection vs detection as usual, controlling for baseline DUP in each area. Results DUP in the intervention area was reduced from a median 71 days (mean 285) to 39 days (mean 104) following the intervention, with no change in the control area. Relative risk for the reduction in DUP was 0.74 (95 % CI 0.35 to 0.89; p = .004). Delays in MHSs and help-seeking were also reduced. Conclusions Our targeted approach appears to be successful in reducing DUP and could provide a generalizable methodology applicable in a variety of healthcare contexts with differing sources of delay. More research is needed, however, to establish whether our approach is truly effective

Derivation of a prediction model for a diagnosis of depression in young adults: a matched case-control study using electronic primary care records.

Background: Approximately 80 000 children and young people in the UK suffer from depression, but many are untreated because of poor identification of early warning signs and risk factors. Aims: This study aimed to derive and to investigate discrimination characteristics of a prediction model for a first recorded diagnosis of depression in young people aged 15–24 years. Method: This study used a matched case–control method using electronic primary care records. Stepwise conditional logistic regression modelling investigated 42 potential predictors including symptoms, co‐morbidities, social factors and drug and alcohol misuse. Results: Of the socio‐economic and symptomatic predictors identified, the strongest associations were with depression symptoms and other psychological conditions. School problems and social services involvement were prominent predictors in men aged 15–18 years, work stress in women aged 19–24 years. Conclusion: Our model is a first step in the development of a predictive model identifying early warning signs of depression in young people in primary care