Investigating geographical variation in the use of mental health services by area of England: a cross-sectional ecological study

BACKGROUND: There is evidence of geographical variation in the use of mental health services in the UK and in international settings. It is important to understand whether this variation reflects differences in the prevalence of mental disorders, or if there is evidence of variation related to other factors, such as population socioeconomic status and access to primary care services. METHODS: This is a cross-sectional ecological study using Public Health England data. The unit of analysis was the population served by clinical commissioning groups (CCGs), National Health Service (NHS) catchment areas. The analysis explored associations between area characteristics and the number of people in contact with mental health services using regression modelling. Explanatory variables included age, gender, prevalence of severe mental illness (SMI), prevalence of common mental disorder (CMD), index of multiple deprivation (IMD), unemployment, proportion of the population who are Black and Minority Ethnic (BAME), population density, access to and recovery in primary care psychological therapies. Unadjusted results are reported, as well as estimates adjusted for age, prevalence of CMD and prevalence of SMI. RESULTS: The populations of 194 CCGs were included, clustered within 62 trusts (NHS providers of mental health services). The number of people in contact with mental health services showed wide variation by area (range from 1131 to 5205 per 100,000 population). Unemployment (adjusted IRR 1.11; 95% CI 1.05 to 1.17; p < 0.001) and deprivation (adjusted IRR 1.02 95% CI 1.01 to 1.04; p < 0.001) were associated with more people being in contact with mental health services. Areas with a higher proportion of the population who are BAME (IRR 0.95 95% CI 0.92 to 0.99 p = 0.007) had lower service use per 100,000 population. There was no evidence for association with access to primary care psychological therapies. CONCLUSIONS: There is substantial variation in the use of mental health services by area of England. Social factors including deprivation, unemployment and population ethnicity continued to be associated with the outcome after controlling for the prevalence of mental illness. This suggests that there are factors that influence the local population use of mental health services in addition to the prevalence of mental disorder

Reconciling multiple societal objectives in cross-scale marine governance: Solomon Islands’ engagement in the Coral Triangle Initiative

This is the author accepted manuscript. The final version is available from the publisher via the DOI in this record.Environmental governance aims to reconcile an expanding set of societal objectives at ever-larger scales despite the challenges that remain in integrating conservation and development at smaller scales. We interrogate Solomon Islands’ engagement in the Coral Triangle Initiative on Coral Reefs, Fisheries and Food Security to contribute new insight on the scalar politics of multi-level marine governance. We show how regional objectives are re-interpreted and prioritized as they translate into national policy and practice. Our data suggest that enhanced coordination of finances and activities, integration of objectives in shared protocols and priority geographies, and a subtle shift in power relations between the state, donors, and implementation partners have resulted from processes of re-scaling. We discuss important procedural adjustments in cross-level and cross-scale governance across jurisdictional, institutional, and sectoral scales. We also reflect on the changing role of national governments in shifts toward large-scale, multi-national initiatives.LE acknowledges funding from the Australian Research Council Centre of Excellence for Coral Reef Studies. PJC and DB undertook this work as part of the CGIAR Research Program on Fish Agrifood Systems (FISH). Funding support for this study was provided by an Australian Centre for International Agricultural Research grant (FIS/2012/074)

Investigating reasoning with multiple integrated neuroscientific methods.

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Qualitative Environmental Health Research: An Analysis of the Literature, 1991-2008

BACKGROUND. Recent articles have advocated for the use of qualitative methods in environmental health research. Qualitative research uses nonnumeric data to understand people's opinions, motives, understanding, and beliefs about events or phenomena. OBJECTIVE. In this analysis of the literature, I report the use of qualitative methods and data in the study of the relationship between environmental exposures and human health. DATA SOURCES. A primary search on ISI Web of Knowledge/Web of Science for peer-reviewed journal articles dated from 1991 through 2008 included the following three terms: qualitative, environ*, and health. Inclusion and exclusion criteria are described. DATA EXTRACTION. Searches resulted in 3,155 records. Data were extracted and findings of articles analyzed to determine where and by whom qualitative environmental health research is conducted and published, the types of methods and analyses used in qualitative studies of environmental health, and the types of information qualitative data contribute to environmental health. DATA SYNTHESIS. Ninety-one articles met inclusion criteria. These articles were published in 58 different journals, with a maximum of eight for a single journal. The results highlight a diversity of disciplines and techniques among researchers who used qualitative methods to study environmental health, with most studies relying on one-on-one interviews. Details of the analyses were absent from a large number of studies. Nearly all of the studies identified increased scientific understanding of lay perceptions of environmental health exposures. DISCUSSION AND CONCLUSIONS. Qualitative data are published in traditionally quantitative environmental health studies to a limited extent. However, this analysis demonstrates the potential of qualitative data to improve understanding of complex exposure pathways, including the influence of social factors on environmental health, and health outcomes.National Institute of Environmental Health Sciences (R25 ES012084, P42ES007381

Thalassophilia and marine identity: Drivers of ‘thick’ marine citizenship

This is the final version. Available on open access from Elsevier via the DOI in this recordData availability: The research data supporting this publication are openly available from the UK Data Service at: https://reshare.ukdataservice.ac.uk/855922/Changing humanity's relationship with the ocean is identified as one of ten key challenges in the UN Decade of Ocean Science for Sustainable Development (2021–2030). Marine citizenship is one potential policy approach for reducing anthropogenic harms to the ocean and promoting ocean recovery, and there is a need to better understand marine citizenship motivating factors and their interactions. To contribute to a more holistic understanding, we approached this problem using an interdisciplinary, mixed methodology, which prioritised the voices and experiences of active marine citizens. An online survey and semi-structured interviews were conducted to examine factors spanning environmental psychology (values, environmental identity) and human geography (place attachment and dependency). Our data uncovered a unique marine place attachment, or thalassophilia, which is a novel conceptualisation of the human capacity to bond with a type of place beyond human settlements or defined localities. It is the product of strong emotional responses to the sensorial experience of the ocean and shared social or cultural understanding of ocean place identifications. A key driver of deeper marine citizenship is marine place dependency, and it is positively influence by stimulation and non-conformity values, environmental identity, and thalassophilia. We map significant motivating factors to identity process theory and describe a novel marine identity concept. We propose this as an operational mechanism of marine citizenship action, potentially filling the value- and knowledge-action gaps in the context of marine environmental action. This research provides a cornerstone in marine citizenship research by analysing together in one study a multitude of variables, which cross human-ocean relationships and experiences. The identification and characterisation of thalassophilia and marine identity process theory will enable research and practice to move forwards with a clearer framework of the role of the ocean as a place in environmental action.Economic and Social Research Council (ESRC

Assessing trade-offs in large marine protected areas

This is the final version. Available on open access from Public Library of Science via the DOI in this recordData Availability: Data of coded case-studies can be viewed at: https://sesmad.dartmouth.edu/ses_casesLarge marine protected areas (LMPAs) are increasingly being established and have a high profile in marine conservation. LMPAs are expected to achieve multiple objectives, and because of their size are postulated to avoid trade-offs that are common in smaller MPAs. However, evaluations across multiple outcomes are lacking. We used a systematic approach to code several social and ecological outcomes of 12 LMPAs. We found evidence of three types of trade-offs: trade-offs between different ecological resources (supply trade-offs); trade-offs between ecological resource conditions and the well-being of resource users (supply-demand trade-offs); and trade-offs between the well-being outcomes of different resource users (demand trade-offs). We also found several divergent outcomes that were attributed to influences beyond the scope of the LMPA. We suggest that despite their size, trade-offs can develop in LMPAs and should be considered in planning and design. LMPAs may improve their performance across multiple social and ecological objectives if integrated with larger-scale conservation efforts.Social Science and Humanities Research Council of CanadaNatural Sciences and Engineering Research Council of Canad

Maxillary Changes Following Facial Bipartition – A Three-Dimensional Quantification

INTRODUCTION: Children with Apert syndrome have hypertelorism and midfacial hypoplasia, which can be treated with facial bipartition (FB), often aided by rigid external distraction. The technique involves a midline osteotomy that lateralizes the maxillary segments, resulting in posterior cross-bites and midline diastema. Varying degrees of spontaneous realignment of the dental arches occurs postoperatively. This study aims to quantify these movements and assess whether they occur as part of a wider skeletal relapse or as dental compensation. METHODS: Patients who underwent FB and had high quality computed tomography scans at the preoperative stage, immediately postsurgery, and later postoperatively were reviewed. DICOM files were converted to three-dimensional bone meshes and anatomical point-to-point displacements were quantified using nonrigid iterative closest point registration. Displacements were visualized using arrow maps, thereby providing an overview of the movements of the facial skeleton and dentition. RESULTS: Five patients with Apert syndrome were included. In all cases, the arrow maps demonstrated initial significant anterior movement of the frontofacial segment coupled with medial rotation of the orbits and transverse divergence of the maxillary arches. The bony position following initial surgery was shown to be largely stable, with primary dentoalveolar relapse correcting the dental alignment. CONCLUSIONS: This study showed that spontaneous dental compensation occurs following FB without compromising the surgical result. It may be appropriate to delay active orthodontic for 6-months postoperatively until completion of this early compensatory phase

Putting coastal communities at the center of a sustainable blue economy: A review of risks, opportunities, and strategies

This is the final version. Available from Frontiers Media via the DOI in this record. New approaches to ocean governance for coastal communities are needed. With few exceptions, the status quo does not meet the diverse development aspirations of coastal communities or ensure healthy oceans for current and future generations. The blue economy is expected to grow to USD2.5–3 trillion by 2030, and there is particular interest in its potential to alleviate poverty in Least Developed Countries and Small Island Developing States, and to support a blue recovery from the COVID-19 pandemic. This paper presents a selective, thematic review of the blue economy literature to examine: (i) the opportunities and risks for coastal communities, (ii) the barriers and enablers that shape community engagement, and (iii) the strategies employed by communities and supporting organizations, which can be strengthened to deliver a ‘sustainable' blue economy and improve social justice for coastal communities. Our review finds that under business-as-usual and blue growth, industrial fisheries, large-scale aquaculture, land reclamation, mining, and oil and gas raise red flags for communities and marine ecosystems. Whereas, if managed sustainably, small-scale fisheries, coastal aquaculture, seaweed farming and eco-tourism are the most likely to deliver benefits to communities. Yet, these are also the sectors most vulnerable to negative and cumulative impacts from other sectors. Based on our evaluation of enablers, barriers and strategies, the paper argues that putting coastal communities at the center of a clear vision for an inclusive Sustainable Blue Economy and co-developing a shared and accessible language for communities, practitioners and policy-makers is essential for a more equitable ocean economy, alongside mainstreaming social justice principles and integrated governance that can bridge different scales of action and opportunity.WW

A Geographically-Restricted but Prevalent Mycobacterium tuberculosis Strain Identified in the West Midlands Region of the UK between 1995 and 2008

Background: We describe the identification of, and risk factors for, the single most prevalent Mycobacterium tuberculosis strain in the West Midlands region of the UK.Methodology/Principal Findings: Prospective 15-locus MIRU-VNTR genotyping of all M. tuberculosis isolates in the West Midlands between 2004 and 2008 was undertaken. Two retrospective epidemiological investigations were also undertaken using univariable and multivariable logistic regression analysis. The first study of all TB patients in the West Midlands between 2004 and 2008 identified a single prevalent strain in each of the study years (total 155/3,056 (5%) isolates). This prevalent MIRU-VNTR profile (32333 2432515314 434443183) remained clustered after typing with an additional 9-loci MIRU-VNTR and spoligotyping. The majority of these patients (122/155, 79%) resided in three major cities located within a 40 km radius. From the apparent geographical restriction, we have named this the "Mercian" strain. A multivariate analysis of all TB patients in the West Midlands identified that infection with a Mercian strain was significantly associated with being UK-born (OR = 9.03, 95% CI = 4.56-17.87, p 65 years old (OR = 0.25, 95% CI = 0.09-0.67, p < 0.01). A second more detailed investigation analyzed a cohort of 82 patients resident in Wolverhampton between 2003 and 2006. A significant association with being born in the UK remained after a multivariate analysis (OR = 9.68, 95% CI = 2.00-46.78, p < 0.01) and excess alcohol intake and cannabis use (OR = 6.26, 95% CI = 1.45-27.02, p = .01) were observed as social risk factors for infection.Conclusions/Significance: The continued consistent presence of the Mercian strain suggests ongoing community transmission. Whilst significant associations have been found, there may be other common risk factors yet to be identified. Future investigations should focus on targeting the relevant risk groups and elucidating the biological factors that mediate continued transmission of this strain

Impact of calcium on salivary α-amylase activity, starch paste apparent viscosity and thickness perception

Thickness perception of starch-thickened products during eating has been linked to starch viscosity and salivary amylase activity. Calcium is an essential cofactor for α-amylase and there is anecdotal evidence that adding extra calcium affects amylase activity in processes like mashing of beer. The aims of this paper were to (1) investigate the role of salivary calcium on α-amylase activity and (2) to measure the effect of calcium concentration on apparent viscosity and thickness perception when interacting with salivary α-amylase in starch-based samples. α-Amylase activity in saliva samples from 28 people was assessed using a typical starch pasting cycle (up to 95 °C). The activity of the enzyme (as measured by the change in starch apparent viscosity) was maintained by the presence of calcium, probably by protecting the enzyme from heat denaturation. Enhancement of α-amylase activity by calcium at 37 °C was also observed although to a smaller extent. Sensory analysis showed a general trend of decreased thickness perception in the presence of calcium, but the result was only significant for one pair of samples, suggesting a limited impact of calcium enhanced enzyme activity on perceived thickness