Farming struggles and triumphs: recommendations from Australian farming families

The farming and grazing industry is an industry where there is a constant evolution of stressors, impacting on the farming families ability to remain resilient to these challenges, which is evident through the steady decline in the number of farming families in the past twenty years. Yet despite the growing number of adversities within the industry (i.e. climate change), some farming families still continue to persevere on the farm. However, due to limited research, little is known about the influence that the farming working lifestyle has upon farming families' well-being. It is important to identify factors that affect farming family well-being as this industry is a vital industry for the Australian economy and needs to be supported. Therefore, the determinants of farming families well-being and the identification of factors which buffer stress and assist in the perseverance of farming families was investigated. Interviews across Queensland and New South Wales were conducted with 53 members of farming families (M=28, F=25). As an outcome, themes were identified in relation to what skills and values farming families perceived farmers needed in order to be a successful farmer (Men = managing for the future, respect for land; Women = adaptability). Furthermore, informants reported how they identified with farming (Men & Women = it's who I am) and why they continued to farm (Men = lifestyle, pride in product; Women = lifestyle). As a result, it was proposed that those who had higher levels of commitment to farming and identified more closely with farming were more likely to be satisfied with their life and work and would be able to buffer stress more effectively

Within-treatment changes in a novel addiction treatment program using traditional Amazonian medicine

Aims: The therapeutic use of psychedelics is regaining scientific momentum, but similarly psychoactive ethnobotanical substances have a long history of medical (and other) uses in indigenous contexts. Here we aimed to evaluate patient outcomes in a residential addiction treatment center that employs a novel combination of Western and traditional Amazonian methods. Methods: The study was observational, with repeated measures applied throughout treatment. All tests were administered in the center, which is located in Tarapoto, Peru. Data were collected between 2014 and 2015, and the study sample consisted of 36 male inpatients who were motivated to seek treatment and who entered into treatment voluntarily. Around 58% of the sample was from South America, 28% from Europe, and the remaining 14% from North America. We primarily employed repeated measures on a psychological test battery administered throughout treatment, measuring perceived stress, craving frequency, mental illness symptoms, spiritual well-being, and physical and emotional health. Addiction severity was measured on intake, and neuropsychological performance was assessed in a subsample from intake to at least 2 months into treatment. Results: Statistically significant and clinically positive changes were found across all repeated measures. These changes appeared early in the treatment and were maintained over time. Significant improvements were also found for neuropsychological functioning. Conclusion: These results provide evidence for treatment safety in a highly novel addiction treatment setting, while also suggesting positive therapeutic effects

Targeted Prevention in Bulimic Eating Disorders: Randomized Controlled Trials of a Mental Health Literacy and Self-Help Intervention

[Extract] Eating disorders (EDs) in the community are associated with high burden and poor quality of life (Mathers et al., 2000, Hay & Mond, 2005). It is also known that people with EDs have frequent chronic medical complications (Mehler, 2003), increased risk of obesity especially for the more common bulimic EDs such as binge eating disorder (Neumark-Sztainer et al., 2006; Hudson et al., 2007)) and high levels of co-morbidity with both depression and anxiety (Hudson et al., 2007). However, there is a wide gap between the presence of a disorder and its identification and treatment. It is well-documented that the overwhelming majority of people in the community with an ED do not seek help for their eating behaviours (Hart et al., in press; Welch & Fairburn 1994), and that even fewer access appropriate or evidencebased treatments (Cachelin & Striegel-Moore,2006; Mond et al., 2009). This is problematic as many randomised controlled trials support the efficacy of treatments, such as cognitivebehaviour therapy for bulimic EDs (Hay et al., 2004) and unmet treatment needs likely add to the general community burden from psychiatric disorders (Andrews et al., 2000). In addition, these disorders often become chronic with longitudinal studies indicating persistence of symptoms over many years (Fairburn et al., 2000, Evans et al., 2011)

Grounded theory - a lens to understanding clinical reasoning

Clinical reasoning is fundamental to medical education and clinical practice (Schmidt & Mamede, 2015). Despite its centrality, clinical reasoning is often regarded as difficult to conceptualise and teach (Charlin, 2012; Pinnock & Welch, 2014). The pivotal role of clinical reasoning constitutes a compelling case for better understanding, more efficient teaching and practice that is more systematic and evidence-based. Clinical reasoning has been regarded as an art rather than a science (Braude, 2012) and has attracted less research effort than befits its important function. The authors examined the suitability of grounded theory methodology to provide a more complete understanding of the clinical reasoning process. Grounded theory and clinical reasoning are processes which both qualitatively evaluate and analyse information from an interview subject as well as additional sources and arrive at a robust, defensible theory to explain their findings. Grounded theory offers considerable utility for (i) understanding and modelling clinical reasoning, (ii) researching clinical reasoning and (iii) as a heuristic for teaching clinical reasoning skills. This paper explores the parallels between grounded theory methodology and clinical reasoning, as well as the suitability of grounded theory as a framework for informing and transforming our understanding of clinical reasoning.

Definitions of advanced multimorbidity : a scoping review

Funding: Wellcome Trust (223499/Z/21/Z) (SB).Background Increasing numbers of people are living with and dying from multimorbidity (the presence of two or more physical or mental health conditions). However, it has been seen as challenging to identify when people with multiple health conditions may be approaching the end of life (so-called advanced multimorbidity). Aims & Objectives This scoping review aims to comprehensively detail how advanced multimorbidity are currently defined in research, policy and clinical practice. Methods This scoping review is reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). A search strategy was developed and implemented into Medline, EMBASE, CINAHL, Scopus and PsychINFO. A further grey literature search was undertaken. Title and abstract then full text screening was undertaken by three co-reviewers. The study’s Public Advisory Group have been instrumental in shaping the research question and summarising our findings. Results From 13,758 initial studies 9499 titles and abstracts screened 760 full texts screened approximately 50 full texts included. There were no studies found from low-middle income countries. Various study designs were utilised, most were retrospective observational studies. Definitions of advanced multimorbidity were often study-specific however a few used a validated prognostic tool e.g. NECPAL. Very few end-of-life care policies were specific to people with advanced multimorbidity. Conclusion The results of this scoping review will enable researchers, policy makers, clinicians and patients to better understand ways to identify when people with multimorbidity may be approaching the end of life.Publisher PDFPeer reviewe

Current definitions of advanced multimorbidity: a protocol for a scoping review

INTRODUCTION: People living with and dying from multimorbidity are increasing in number, and ensuring quality care for this population is one of the major challenges facing healthcare providers. People with multimorbidity often have a high burden of palliative and end-of-life care needs, though they do not always access specialist palliative care services. A key reason for this is that they are often not identified as being in the last stages of their life by current healthcare providers and systems.This scoping review aims to identify and present the available evidence on how people with multimorbidity are currently included in research, policy and clinical practice.METHODS AND ANALYSIS: Scoping review methodology, based on Arksey and O'Malley's framework, will be undertaken and presented using the Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews. Search terms have been generated using the key themes of 'multimorbidity', 'end of life' and 'palliative care'. Peer-reviewed research will be obtained through systematic searching of Medline, EMBASE, CINAHL, Scopus and PsycINFO. Grey literature will be searched in a systematic manner. Literature containing a definition for adults with multimorbidity in a terminal phase of their illness experience will be included. After screening studies for eligibility, included studies will be described in terms of setting and characteristics as well as using inductive content analysis to highlight the commonalities in definitions.ETHICS AND DISSEMINATION: Ethical approval is not required for this scoping review. The findings of the scoping review will be used internally as part of SPB's PhD thesis at the University of St Andrews through the Multimorbidity Doctoral Training Programme for Health Professionals, which is supported by the Wellcome Trust (223499/Z/21/Z) and published in an open access, peer-reviewed journal for wider dissemination.</p

A Community-Based Study of Enduring Eating Features in Young Women

We conducted a prospective exploration of the temporal course of eating disorder (ED) symptoms in two cohorts of community women. One hundred and twenty-two young women (Cohort 1) identified in a general population based survey with ED symptoms of clinical severity agreed to participate in a 5-year follow-up study. A comparative sample (Cohort 2) of 706 similar aged self-selected college women (221 with disordered eating) was recruited one year later. Both ED groups were given a health literacy package in the first year. ED symptoms, health related quality of life, and psychological distress were assessed annually with the Eating Disorder Examination Questionnaire, the Short Form—12 Health Survey and the Kessler Psychological Distress Scale, respectively. Forty percent (Cohort 1) and 30.3% (Cohort 2) completed questionnaires at each year of follow-up. In both groups, there was early improvement in ED symptoms which plateaued after the first year, and participants retained high EDE-Q scores at 5 years. BMI increased as expected. Mental health related quality of life scores did not change but there were small improvements in psychological distress scores. The findings suggest little likelihood of spontaneous remission of ED problems in community women

Obesity and nutrition behaviours in Western and Palestinian outpatients with severe mental illness

Extent: 7p.Background: While people with severe mental illness have been found to be more overweight and obese in Western nations, it is unknown to what extent this occurs in Middle Eastern nations and which eating behaviours contribute to obesity in Middle Eastern nations. Method: A total of 665 responses were obtained from patients with serious mental illness attending out-patient clinics in Western developed countries (Germany, UK and Australia; n = 518) and Palestine (n = 147). Patients were evaluated by ICD-10 clinical diagnosis, anthropometric measurements and completed a self-report measure of frequencies of consuming different food items and reasons for eating. Nutritional habits were compared against a Western normative group. Results: More participants from Palestine were overweight or obese (62%) compared to Western countries (47%). In the Western sample, obese patients reported consuming more low-fat products (OR 2.54, 95% CI 1.02-6.33) but also greater eating due to negative emotions (OR 1.84, 95% CI 1.31-2.60) than patients with a healthy body-mass index. In contrast, obese patients from Palestine reported increased consumption of unhealthy snacks (OR 3.73 95% CI 1.16-12.00). Conclusion: Patients with mental illness have poorer nutritional habits than the general population, particularly in Western nations. Separate interventions to improve nutritional habits and reduce obesity are warranted between Western nations and Palestine.David Jakabek, Frances Quirk, Martin Driessen, Yousef Aljeesh and Bernhard T Baun

Neuropsychiatric Symptoms in Patients with Aortic Aneurysms

BACKGROUND: Emerging evidence suggests that vascular disease confers vulnerability to a late-onset of depressive illness and the impairment of specific cognitive functions, most notably in the domains of memory storage and retrieval. Lower limb athero-thrombosis and abdominal aortic aneurysm (AAA) have both been previously associated with neuropsychiatric symptoms possibly due to associated intracerebral vascular disease or systemic inflammation, hence suggesting that these illnesses may be regarded as models to investigate the vascular genesis of neuropsychiatric symptoms. The aim of this study was to compare neuropsychiatric symptoms such as depression, anxiety and a variety of cognitive domains in patients who had symptoms of peripheral athero-thrombosis (intermittent claudication) and those who had an asymptomatic abdominal aortic aneurysm AAA. METHODOLOGY/PRINCIPAL FINDINGS: In a cross-sectional study, 26 participants with either intermittent claudication or AAA were assessed using a detailed neuropsychiatric assessment battery for various cognitive domains and depression and anxiety symptoms (Hamilton Depression and Anxiety Scales). Student t test and linear regression analyses were applied to compare neuropsychiatric symptoms between patient groups. AAA participants showed greater levels of cognitive impairment in the domains of immediate and delayed memory as compared to patients who had intermittent claudication. Cognitive dysfunction was best predicted by increasing aortic diameter. CRP was positively related to AAA diameter, but not to cognitive function. AAA and aortic diameter in particular were associated with cognitive dysfunction in this study. CONCLUSIONS/SIGNIFICANCE: AAA patients are at a higher risk for cognitive impairment than intermittent claudication patients. Validation of this finding is required in a larger study, but if confirmed could suggest that systemic factors peculiar to AAA may impact on cognitive function.Bernhard T. Baune, Steven J. Unwin, Frances Quirk and Jonathan Golledg

Mother, Monster, Mrs, I:A critical evaluation of gendered naming strategies in English sentencing remarks of women who kill

In this article, we take a novel approach to analysing English sentencing remarks in cases of women who kill. We apply computational, quantitative, and qualitative methods from corpus linguistics to analyse recurrent patterns in a collection of English Crown Court sentencing remarks from 2012 to 2015, where a female defendant was convicted of a homicide offence. We detail the ways in which women who kill are referred to by judges in the sentencing remarks, providing frequency information on pronominal, nominative, and categorising naming strategies. In discussion of the various patterns of preference both across and within these categories (e.g. pronoun vs. nomination, title + surname vs. forename + surname), we remark upon the identities constructed through the references provided. In so doing, we: (1) quantify the extent to which members of the judiciary invoke patriarchal values and gender stereotypes within their sentencing remarks to construct female defendants, and (2) identify particular identities and narratives that emerge within sentencing remarks for women who kill. We find that judges refer to women who kill in a number of ways that systematically create dichotomous narratives of degraded victims or dehumanised monsters. We also identify marked absences in naming strategies, notably: physical identification normally associated with narrativization of women’s experiences; and the first person pronoun, reflecting omissions of women’s own voices and narratives of their lived experiences in the courtroom