Exploring psychological distress in the lives of those affected by homelessness

This portfolio thesis is comprised of three parts and considers the experience of homelessness and psychological distress, from the perspectives of those with lived experience.Part one: Systematic Literature ReviewPart one contains a systematic literature review which explores the influences on homeless service users’ experience and perception of mental health services. A systematic search of six data bases retrieved ten suitable papers, the findings of which are presented using narrative synthesis. Three overarching influencing factors and ten sub-factors emerged. Conclusions and clinical implications for service development are discussed.Part two : Empirical paperPart two is a qualitative empirical study which explored how previously homeless White British males make sense of distressing unusual experiences and beliefs, by hearing their stories. A narrative oriented inquiry framework applied four analytic perspectives to analyse the stories’ content, form and identity positions. Conclusions and implications for practice are considered.Part three: AppendicesPart three consists of the appendices supporting both previous parts. A reflective and epistemological statement is included

Comparing dietary strategies to manage cardiovascular risk in primary care: a narrative review of systematic reviews

BACKGROUND: Nutrition care in general practice is crucial for cardiovascular disease (CVD) prevention and management, although comparison between dietary strategies is lacking.AIM: To compare the best available (most recent, relevant, and high-quality) evidence for six dietary strategies that are effective for primary prevention/absolute risk reduction of CVD.DESIGN AND SETTING: A pragmatic narrative review of systematic reviews of randomised trials focused on primary prevention of cardiovascular events.METHOD: Studies about: 1) adults without a history of cardiovascular events; 2) target dietary strategies postulated to reduce CVD risk; and 3) direct cardiovascular or all-cause mortality outcomes were included. Six dietary strategies were examined: energy deficit, Mediterranean-like diet, sodium reduction (salt reduction and substitution), the Dietary Approaches to Stop Hypertension (DASH) diet, alcohol reduction, and fish/fish oil consumption. Reviews were selected based on quality, recency, and relevance. Quality and certainty of evidence was assessed using GRADE.RESULTS: Twenty-five reviews met inclusion criteria; eight were selected as the highest quality, recent, and relevant. Three dietary strategies showed modest, significant reductions in cardiovascular events: energy deficit (relative risk reduction [RRR] 30%, 95% confidence interval [CI] = 13 to 43), Mediterranean-like diet (RRR 40%, 95% CI = 20 to 55), and salt substitution (RRR 30%, 95% CI = 7 to 48). Still, some caveats remain on the effectiveness of these dietary strategies. Salt reduction, DASH diet, and alcohol reduction showed small, significant reductions in blood pressure, but no reduction in cardiovascular events. Fish/fish oil consumption showed little or no effect; supplementation of fish oil alone showed small reductions in CVD events.CONCLUSION: For primary prevention, energy deficit, Mediterranean-like diets, and sodium substitution have modest evidence for risk reduction of CVD events. Strategies incorporated into clinical nutrition care should ensure guidance is person centred and tailored to clinical circumstances.</p

The role of specific amino acids in the regulation of food intake

It is well established that ingested protein has a greater satiating effect than other macronutrients. The mechanisms behind this effect are unknown, although it is believed that protein induces a greater increase in levels of anorectic gut hormones than carbohydrate or fat. Recent identification of a family of promiscuous L-amino acid receptors has provided a potential mechanism for the effects of protein on appetite. These amino acid receptors - the G-protein coupled receptor family C group 6 member A (GPRC6A), the Taste receptor type 1 member 1/Taste receptor type 1 member 3 (T1R1/T1R3) dimer and the calcium-sensing receptor (CaR) - are non-specific in their ligand binding but show preference for different families of amino acids. I assessed the effects of peripheral administration of a wide range of amino acids on food intake in rodents. My results demonstrate that the specific amino acids L-arginine, L-cysteine and L-lysine acutely reduce food intake following peripheral administration. The 0-1 hour food intake following both intraperitoneal (i.p.) and oral administration of amino acids in rats negatively correlated with the stimulatory efficacy of amino acids at the T1R1/T1R3. I subsequently investigated the mechanisms by which L-arginine, L-cysteine and L-lysine inhibit food intake. Oral administration, of L-arginine and L-lysine tended to increase levels of the anorectic hormones glucagon-like peptide 1 (GLP-1) and peptide YY (PYY). Intraperitoneal administration of L-cysteine reduced levels of circulating total and acyl-ghrelin. Conditioned taste aversion studies suggested that the anorectic effect of these amino acids is not secondary to visceral illness. Chronic administration of L-cysteine significantly reduces cumulative food intake. My studies suggest that specific amino acids can influence food intake, perhaps by altering circulating levels of gastrointestinal hormones. Altering dietary amino acid content may be helpful to prevent or treat obesity

Patient and public involvement in the development of clinical practice guidelines: a scoping review

OBJECTIVES: Organisations that develop clinical practice guidelines (CPGs) encourage involvement of patients and the publics in their development, however, there are no standard methodologies for doing so. To examine how CPGs report patient and public involvement (PPI), we conducted a scoping review of the evidence addressing the following four questions: (1) who are the patients and publics involved in developing the CPG?; (2) from where and how are the patients and publics recruited?; (3) at what stage in the CPG development process are the patients and publics involved? and (4) how do the patients and publics contribute their views? We also extracted data on the use of PPI reporting checklists by the included studies. DESIGN: We used the methodology developed by Arksey and O’Malley and refined by the Joanna Briggs Institute. We searched PubMed, Embase, CINAHL and PsycINFO, websites of national guideline bodies from the UK, Canada, Australia and the USA, and conducted a forward citation search. No language, date or participant demographics restrictions were applied. Data were synthesised narratively. RESULTS: We included 47 studies addressing 1 or more of the 4 questions. All included studies reported who the patient and publics involved (PPI members) were, and several studies reported PPI members from different groups. Patients were reported in 43/47 studies, advocates were reported in 22/47 studies, patients and advocates reported in 17/47 studies, and general public reported in 2/47 studies. Thirty-four studies reported from where the patients and publics were recruited, with patient groups being the most common (20/34). Stage of involvement was reported by 42/47 studies, most commonly at question identification (26/42) and draft review (18/42) stages. Forty-two studies reported how the patients contributed, most commonly via group meetings (18/42) or individual interviews. Ten studies cited or used a reporting checklist to report findings. CONCLUSIONS: Our scoping review has revealed knowledge gaps to inform future research in several ways: replication, terminology and inclusion. First, no standard approach to PPI in CPG development could be inferred from the research. Second, inconsistent terminology to describe patients and publics reduces clarity around which patients and publics have been involved in developing CPGs. Finally, the under-representation of research describing PPI in the development of screening, as opposed to treatment, CPGs warrants further attention

Hourly historical and near-future weather and climate variables for energy system modelling

Energy systems are becoming increasingly exposed to the impacts of weather and climate due to the uptake of renewable generation and the electrification of the heat and transport sectors. The need for high-quality meteorological data to manage present and near-future risks is urgent. This paper provides a comprehensive set of multi-decadal, time series of hourly meteorological variables and weather-dependent power system components for use in the energy systems modelling community. Despite the growing interest in the impacts of climate variability and climate change on energy systems over the last decade, it remains rare for multi-decadal simulations of meteorological data to be used within detailed simulations. This is partly due to computational constraints, but also due to technical barriers limiting the use of meteorological data by non-specialists. This paper presents a new European-level dataset which can be used to investigate the impacts of climate variability and climate change on multiple aspects of near-future energy systems. The datasets correspond to a suite of well-documented, easy-to-use, self-consistent, hourly- and nationally aggregated, and sub-national time series for 2 m temperature, 10 m wind speed, 100 m wind speed, surface solar irradiance, wind power capacity factor, solar power factor, and degree days spanning over 30 European countries. This dataset is available for the historical period 1950–2020 and is accessible from https://doi.org/10.17864/1947.000321 (Bloomfield and Brayshaw, 2021a). As well as this a companion dataset is created where the ERA5 reanalysis is adjusted to represent the impacts of near-term climate change (centred on the year 2035) based on five high-resolution climate model simulations. These data are available for a 70-year period for central and northern Europe. The data are accessible from https://doi.org/10.17864/1947.000331 (Bloomfield and Brayshaw, 2021b). To the authors’ knowledge, this is the first time a comprehensive set of high-quality hourly time series relating to future climate projections has been published, which is specifically designed to support the energy sector. The purpose of this paper is to detail the methods required for processing the climate model data and illustrate the importance of accounting for climate variability and climate change within energy system modelling from the sub-national to European scale. While this study is therefore not intended to be an exhaustive analysis of climate impacts, it is hoped that publishing these data will promote greater use of climate data within energy system modelling.</p

Attitudes, beliefs, behaviours and perspectives on barriers and enablers of Australian general practitioners towards non-drug interventions: A national survey

BACKGROUND: Many guidelines recommend non-drug interventions (NDIs) for managing common conditions in primary care. However, compared with drug interventions, NDIs are less widely known, promoted and used. We aim to (1) examine general practitioners' (GPs') knowledge, attitudes and practices for NDIs, including their use of the Royal Australian College of General Practitioners (RACGP) Handbook of Non-Drug Interventions (HANDI), and (2) identify factors influencing their use of NDIs and HANDI.METHODS: We conducted a web-based cross-sectional survey of practicing GP members in Australia during October-November 2022. The survey contained five sections: characteristics of GP; knowledge and use of NDIs; attitudes towards NDIs; barriers and enablers to using HANDI; and suggestions of NDIs and ideas to improve the uptake of NDIs in primary care.RESULTS: Of the 366 GPs who completed the survey, 242 (66%) were female, and 248 (74%) were ≥45 years old. One in three GPs reported that they regularly ('always') recommend NDIs to their patients when appropriate (34%), whereas one-third of GPs were unaware of HANDI (39%). GPs identified several factors that improve the uptake of HANDI, including 'access and integration of HANDI in clinical practice', 'content and support to use in practice' and 'awareness and training'.CONCLUSIONS: While many GPs are aware of the effectiveness of NDIs and often endorse their use, obstacles still prevent widespread adoption in primary care. The results of this survey can serve as a foundation for developing implementation strategies to improve the uptake of effective evidence-based NDIs in primary care.</p

Age-related trends in the trabecular micro-architecture of the medial clavicle: is it of use in forensic science?

The mechanical and structural properties of bone are known to change significantly with age. Within forensic and archaeological investigations, the medial end of the clavicle is typically used for estimating the age-at-death of an unknown individual. Although, this region of the skeleton is of interest to forensic and clinical domains, alterations beyond the macro-scale have not been fully explored. For this study, non-destructive micro-computed tomography (µ-CT) was employed to characterize structural alterations to the cancellous bone of the medial clavicle. Fresh human cadaveric specimens (12-59 years) obtained at autopsy were utilized for this study, and were scanned with a voxel size of ∼83µm. Morphometric properties were quantified and indicated that the bone volume, connectivity density, mineral density, and number of trabeculae decreased with age, while the spacing between the trabeculae increased with age. In contrast to other sub-regions of the skeleton, trabecular thickness, and degree of anisotropy did not correlate with age. Collectively, this could suggest that the network is becoming increasingly perforated with age rather than exhibiting trabecular thinning. These results are used in the context of deriving a potential protocol for forensic investigations by using this particular and largely unexplored region of the skeleton, and provide inspiration for future experiments concerning micro-architectural and small scale changes in other regions of the human skeleton

Telehealth Versus Face-to-face Psychotherapy for Less Common Mental Health Conditions: Systematic Review and Meta-analysis of Randomized Controlled Trials

BACKGROUND: Mental disorders are a leading cause of distress and disability worldwide. To meet patient demand, there is a need for increased access to high-quality, evidence-based mental health care. Telehealth has become well established in the treatment of illnesses, including mental health conditions. OBJECTIVE: This study aims to conduct a robust evidence synthesis to assess whether there is evidence of differences between telehealth and face-to-face care for the management of less common mental and physical health conditions requiring psychotherapy. METHODS: In this systematic review, we included randomized controlled trials comparing telehealth (telephone, video, or both) versus the face-to-face delivery of psychotherapy for less common mental health conditions and physical health conditions requiring psychotherapy. The psychotherapy delivered had to be comparable between the telehealth and face-to-face groups, and it had to be delivered by general practitioners, primary care nurses, or allied health staff (such as psychologists and counselors). Patient (symptom severity, overall improvement in psychological symptoms, and function), process (working alliance and client satisfaction), and financial (cost) outcomes were included. RESULTS: A total of 12 randomized controlled trials were included, with 931 patients in aggregate; therapies included cognitive behavioral and family therapies delivered in populations encompassing addiction disorders, eating disorders, childhood mental health problems, and chronic conditions. Telehealth was delivered by video in 7 trials, by telephone in 3 trials, and by both in 1 trial, and the delivery mode was unclear in 1 trial. The risk of bias for the 12 trials was low or unclear for most domains, except for the lack of the blinding of participants, owing to the nature of the comparison. There were no significant differences in symptom severity between telehealth and face-to-face therapy immediately after treatment (standardized mean difference [SMD] 0.05, 95% CI −0.17 to 0.27) or at any other follow-up time point. Similarly, there were no significant differences immediately after treatment between telehealth and face-to-face care delivery on any of the other outcomes meta-analyzed, including overall improvement (SMD 0.00, 95% CI −0.40 to 0.39), function (SMD 0.13, 95% CI −0.16 to 0.42), working alliance client (SMD 0.11, 95% CI −0.34 to 0.57), working alliance therapist (SMD −0.16, 95% CI −0.91 to 0.59), and client satisfaction (SMD 0.12, 95% CI −0.30 to 0.53), or at any other time point (3, 6, and 12 months). CONCLUSIONS: With regard to effectively treating less common mental health conditions and physical conditions requiring psychological support, there is insufficient evidence of a difference between psychotherapy delivered via telehealth and the same therapy delivered face-to-face. However, there was no includable evidence in this review for some serious mental health conditions, such as schizophrenia and bipolar disorders, and further high-quality research is needed to determine whether telehealth is a viable, equivalent treatment option for these conditions