Factors Associated with Caregivers’ Responses to Individuals Affected by Eating Disorders

Eating disorders can impact the whole family. Caregivers may engage in certain behaviours, termed accommodation and enabling behaviours, as an attempt to reduce conflict. Whilst understandable, the cognitive interpersonal maintenance model suggests that engaging in these behaviours may inadvertently maintain the eating disorder. This can become a vicious cycle. The emotional climate of families can be measured by the construct of expressed emotion (EE). High familial EE is associated with poorer treatment outcomes, as well as increased caregiver distress. It is therefore important to understand factors which are associated with accommodation and enabling behaviours, and EE, in families affected by eating disorders. Section One of this thesis is comprised of a systematic literature review, which explores the factors associated with/correlates of accommodation and enabling behaviours in caregivers of individuals affected by an eating disorder. Factors associated with both the caregiver and the person affected were identified, which can be used to identify caregivers who may be more vulnerable to engaging in accommodation. This provides valuable information regarding the targeting of support to relevant caregivers. Section Two reports an empirical study investigating the relationship between guilt, shame, blame, EE and self-compassion, in caregivers of those affected by eating disorders. It also examines whether self-compassion moderates the relationship between guilt/shame/blame and EE. Emotional overinvolvement (EOI), one component of EE, was positively associated with guilt and shame, and negatively associated with self-compassion. Guilt predicted EOI once other variables had been accounted for. Critical comments, a second component of EE, had a significant positive association with guilt, shame and blame. Blame was the only significant predictor of criticism when other factors had been accounted for. There were no significant moderating effects of self-compassion. Section Three considers the implications of these findings, and the importance of language when discussing these themes

Prevalence and outcomes of frailty in unplanned hospital admissions: a systematic review and meta-analysis of hospital-wide and general (internal) medicine cohorts

Background: Guidelines recommend routine frailty screening for all hospitalised older adults to inform care decisions, based mainly on studies in elective or speciality-specific settings. However, most hospital bed days are accounted for by acute non-elective admissions, in which the prevalence and prognostic value of frailty might differ, and uptake of screening is limited. We therefore did a systematic review and meta-analysis of frailty prevalence and outcomes in unplanned hospital admissions. Methods: We searched MEDLINE, EMBASE and CINAHL up to 31/01/2023 and included observational studies using validated frailty measures in adult hospital-wide or general medicine admissions. Summary data on the prevalence of frailty and associated outcomes, measurement tools, study setting (hospital-wide vs general medicine), and design (prospective vs retrospective) were extracted and risk of bias assessed (modified Joanna Briggs Institute checklists). Unadjusted relative risks (RR; moderate/severe frailty vs no/mild) for mortality (within one year), length of stay (LOS), discharge destination and readmission were calculated and pooled, where appropriate, using random-effects models. PROSPERO CRD42021235663. Findings: Among 45 cohorts (median/SD age = 80/5 years; n = 39,041,266 admissions, n = 22 measurement tools) moderate/severe frailty ranged from 14.3% to 79.6% overall (and in the 26 cohorts with low-moderate risk of bias) with considerable heterogeneity between studies (phet 8 days (RR range = 2.14–3.04; n = 6) and discharge to a location other than home (RR range = 1.97–2.82; n = 4) but was inconsistently related to 30-day readmission (RR range = 0.83–1.94; n = 12). Associations remained clinically significant after adjustment for age, sex and comorbidity where reported. Interpretation: Frailty is common in older patients with acute, non-elective hospital admission and remains predictive of mortality, LOS and discharge home with more severe frailty associated with greater risk, justifying more widespread implementation of screening using clinically administered tools

Delirium risk stratification in consecutive unselected admissions to acute medicine: validation of externally derived risk scores

Background: reliable delirium risk stratification will aid recognition, anticipation and prevention and will facilitate targeting of resources in clinical practice as well as identification of at-risk patients for research. Delirium risk scores have been derived for acute medicine, but none has been prospectively validated in external cohorts. We therefore aimed to determine the reliability of externally derived risk scores in a consecutive cohort of older acute medicine patients.// Methods: consecutive patients aged ≥65 over two 8-week periods (2010, 2012) were screened prospectively for delirium using the Confusion Assessment Method (CAM), and delirium was diagnosed using the DSM IV criteria. The reliability of existing delirium risk scores derived in acute medicine cohorts and simplified for use in routine clinical practice (USA, n = 2; Spain, n = 1; Indonesia, n = 1) was determined by the area under the receiver operating characteristic curve (AUC). Delirium was defined as prevalent (on admission), incident (occurring during admission) and any (prevalent + incident) delirium.// Results: among 308 consecutive patients aged ≥65 (mean age/SD = 81/8 years, 164 (54%) female), existing delirium risk scores had AUCs for delirium similar to those reported in their original internal validations ranging from 0.69 to 0.76 for any delirium and 0.73 to 0.83 for incident delirium. All scores performed better than chance but no one score was clearly superior.// Conclusions: externally derived delirium risk scores performed well in our independent acute medicine population with reliability unaffected by simplification and might therefore facilitate targeting of multicomponent interventions in routine clinical practice

An examination of perceptions of roles and responsibilities for health amongst the general public

The need to develop our understanding of public perceptions of roles and responsibilities for health underpins a number of key policy developments in the UK (Wanless, 2004; Welsh Assembly Government, 2003), particularly in light of an increased focus on the relationship between the state and the individual in health improvement action (Halpern, 2003). Research was commissioned by the Welsh Assembly Government to explore perceptions of responsibility at different levels including individual, organisational and state roles and responsibilities for health improvement amongst the general public and key stake holders. This report focuses on the focus group study with member of the general public across Wales in 2005. Participants (n = 101) included a range of age groups and family backgrounds, with 57% female. A broad range of socio-economic backgrounds were represented. A semi structured schedule, newspaper headline prompts and a prioritisation task were used to guide the discussion. Group discussions were audio taped and transcriptions were analysed with main themes identified and validated by a second researcher. Areas of consent and disagreement within groups were identified and key areas of similarity and difference between socio-economic groups identified. Participant’s understandings of personal responsibility for health were associated with socio-economic position and, to a lesser extent, with age. Issues associated with health communication, family processes, social capital, instrumentation, individualisation, social values and personal morality were used to explain and justify health protective and risk behaviours. The tension between what were seen as the responsibilities of the state and maintaining personal freedoms highlighted further differences between these groups. These results raise a number of implications for public health practice, with lay perceptions reflecting current policy debates

Organisational roles and responsibilities for health: interviews with representatives from the statutory and non-statutory sectors

The idea of organisations taking responsibilities for health has both theoretical and political relevance. However, there is a need to develop a clearer understanding of how organisations conceptualise and respond to such policy initiatives across a range of sectors. Research was commissioned by the Welsh Assembly Government to explore perceptions of responsibility at different levels including individual, organisational and state roles and responsibilities for health improvement amongst the general public and key stake holders. This report focuses on the in-depth interviews with representatives across the health, local government, education, voluntary and community, business and media sectors in Wales. This study provided further insights into who is acting to improve health and well-being, why these actions are being taken, how health improvement is being enacted and who organisations are working with to achieve this. Although overall, responsibility for improving health is largely taken and enacted by the statutory sector, there is a spectrum of more and less active organisations within all of the sectors. This study has highlighted a number of good examples of work undertaken within different spheres of influence but there are policy implications for the way in which the more active organisations could be better supported. Also, developing an evidence base on what works in terms of health improvement could quickly be put into motion across different sectors and the effectiveness of this would be optimised by building in an element of good practice sharing and peer support between local level organisations. In terms of ongoing research priorities there is still a need to understand more fully the drivers behind the actions of more active organisations, understand the nature of corporate responsibility in the less active organisations and unpack influences on management perspectives

Organisational roles and responsibilities for health: a pilot survey of businesses, primary and secondary schools and local government

The idea of organisations taking responsibilities for health has both theoretical and political relevance. However, there is a need to develop a clearer understanding of how organisations conceptualise and respond to such policy initiatives across a range of sectors. Research was commissioned by the Welsh Assembly Government to explore perceptions of responsibility at different levels including individual, organisational and state roles and responsibilities for health improvement amongst the general public and key stakeholders. This report focuses on the results of a pilot survey conducted with 688 representatives across the business, education and local government sectors in Wales. The overall response rate was 31%, with 14.3% for local authorities, 14.9% for business, 38.8% for secondary schools and 52.0% for primary schools. Follow-up stages appeared to be effective in increasing the response but samples were very small, and the response rate was too low to justify an extensive statistical analysis. Data from the questionnaires are presented as a description of a non-representative group subject to potential measurement error. Results from business respondents suggest that they accept some degree of responsibility for the health of employees and customers in the area of accidents and injuries. Otherwise they take very little action to promote health and most do not want to do any more. Reasons given included a lack of resources, training and information, a lack of need and individuals being responsible for their own health. Results for both primary and secondary schools suggest that schools accept a high degree of responsibility for promoting the health of pupils. All report participation in more than one health-promotion initiative and many say they would like to do more. The report also includes resource and methodological implications for future survey work of this kind

The impact of the economic downturn on health in Wales: a review and case study

The current economic downturn and the austerity measures currently being decided with regard to public spending are likely to impact on people’s lives in a number of different ways. The test of how well political administrations respond to such crises will be the extent to which the health and well being of its populations are protected. The lesson of previous downturns is that the social and associated health impacts can lag long after what can be a relatively short period of economic recession. These effects can also be uneven and affect particular groups in the population and people living in particular places more than others. However in order for Governments, local authorities and services to respond appropriately we need to learn from the past whilst acknowledging the unique character of this particular social and economic crisis. In South Wales people are still dealing with the emotional and physical wounds which are the legacy of rapid re‐industrialisation in the 1980s and we need to be prepared this time round. This is report comprises a literature review of what is known about the health impact of past recessions and their aftermaths, a qualitative case study of perceived current and potential health impacts on relevant statutory and voluntary services in two contrasting local authority areas, and a policy dialogue to discuss the findings with a small group of policy makers and service leads with national and local responsibilities. The report concludes with a number of broad recommendations to support and guide decisions at national and local government levels

Demonstration of quantum volume 64 on a superconducting quantum computing system

We improve the quality of quantum circuits on superconducting quantum computing systems, as measured by the quantum volume, with a combination of dynamical decoupling, compiler optimizations, shorter two-qubit gates, and excited state promoted readout. This result shows that the path to larger quantum volume systems requires the simultaneous increase of coherence, control gate fidelities, measurement fidelities, and smarter software which takes into account hardware details, thereby demonstrating the need to continue to co-design the software and hardware stack for the foreseeable future.Comment: Fixed typo in author list. Added references [38], [49] and [52