Relevance or Excellence? Setting Research Priorities for Mental Health and Psychosocial Support in Humanitarian Settings

Background: Humanitarian crises are associated with an increase in mental disorders and psychological distress. Despite the emerging consensus on intervention strategies in humanitarian settings, the field of mental health and psychosocial support (MHPSS) in humanitarian settings lacks a consensus-based research agenda. Methods: From August 2009 to February 2010, we contacted policymakers, academic researchers, and humanitarian aid workers, and conducted nine semistructured focus group discussions with 114 participants in three locations (Peru, Uganda, and Nepal), in both the capitals and remote humanitarian settings. Local stakeholders representing a range of academic expertise (psychiatry, psychology, social work, child protection, and medical anthropology) and organizations (governments, universities, nongovernmental organizations, and UN agencies) were asked to identify priority questions for MHPSS research in humanitarian settings, and to discuss factors that hamper and facilitate research. Results: Thematic analyses of transcripts show that participants broadly agreed on prioritized research themes in the following order: (1) the prevalence and burden of mental health and psychosocial difficulties in humanitarian settings, (2) how MHPSS implementation can be improved, (3) evaluation of specific MHPSS interventions, (4) the determinants of mental health and psychological distress, and (5) improved research methods and processes. Rather than differences in research themes across countries, what emerged was a disconnect between different groups of stakeholders regarding research processes: the perceived lack of translation of research findings into actual policy and programs; misunderstanding of research methods by aid workers; different appreciation of the time needed to conduct research; and disputed universality of research constructs. Conclusions: To advance a collaborative research agenda, actors in this field need to bridge the perceived disconnect between the goals of “relevance” and “excellence.” Research needs to be more sensitive to questions and concerns arising from humanitarian interventions, and practitioners need to take research findings into account in designing interventions. (Harv Rev Psychiatry 2012;20:25–36.

Political opportunity structures, democracy, and civil war

Theories of mobilization suggest that groups are more likely to resort to violence in the presence of political opportunity structures that afford greater prospects for extracting concessions from the government or better opportunities to topple ruling governments. However, existing efforts to consider the possible influences of political opportunity structures on incentives for violence and civil war empirically have almost invariably relied upon measures of democracy to proxy for the hypothesized mechanisms, most notably the argument that the opposing effects of political accommodation and repression will give rise to an inverted U-shaped relationship between democracy and the risk of civil war. The authors detail a number of problems with measures of democracy as proxies for political opportunity structures and develop alternative measures based on the likely risks that political leaders will lose power in irregular challenges and their implications for the incentives for resort to violence. The authors evaluate empirically how the security with which leaders hold office influences the prospects of violent civil conflict. The findings indicate that recent irregular leader entry and transitions indeed increase the risk of conflict onset, while democratic institutions are found to decrease the risk of civil war, after controlling for the new measures of state weakness. </jats:p

Evaluation of the role of ImplantMovement Analysis in diagnosing asepticloosening of total hip arthroplasty

Introduction: Aseptic loosening is the most common indication for revision surgery of hipimplants. However, sometimes diagnosis from planar radiography is uncertain, makingdecision regarding revision surgery problematic. Implant Movement Analysis (IMA) is anewly introduced method of analysing uncertain aseptic loosening of hip prostheses. It usescomputer tomography with rotational provocation to expose movement of the implantrelatively to the surrounding bone. Aim: To evaluate the role of IMA as a complementary method to planar radiography indiagnosing aseptic loosening of total hip artroplasty (THA) at Lindesberg Hospital. 1) HasIMA improved diagnosing of uncertain cases of aseptic loosening? 2) Has IMA reduced thenumber of unnecessary THA revision surgeries? Methods: Retrospective cohort study analysing 43 cases of uncertain aseptic looseningexamined with IMA at Lindesberg Hospital. Paired results from planar radiography and IMAwere statistically compared with McNemar’s test, IMA held as the reference. Additional datawas also collected (i.e. age and symptoms). Results: Planar radiography had 70 % sensitivity and 65 % specificity compared to certainresults from IMA. IMA provided diagnoses in 84 % of the cases and changed the diagnosisfor 33 % compared to planar radiography. Eight cases got their diagnosis changed from looseto not loose. Conclusions: IMA has improved diagnosing cases of uncertain aseptic loosening and cantherefore be seen as a good complementary method to planar radiography in these cases.However, as it is a new method further evaluation is needed

Young adults’ experience of a multimodal pain rehabilitation programme. An interview study.

Bakgrund: Långvarig smärta är ett vanligt förekommande tillstånd, även bland unga vuxna. Smärtproblematik leder ofta till inskränkningar i det dagliga livet, till exempel genom minskad fysisk aktivitet vilket kan leda till försämrad funktionsförmåga. Vid komplex långvarig smärta rekommenderas ofta multimodala smärtrehabiliteringsprogram i syfte att förbättra funktionsförmågan. Det saknas dock i dagsläget kunskap om hur dessa program upplevs av unga vuxna patienter. Syfte: Att undersöka hur unga vuxna med långvarig smärta upplever ett multimodalt smärtrehabiliteringsprogram och hur de upplevt att deltagande i programmet påverkat deras fysiska funktionsförmåga och tankar om fysisk aktivitet Metod: En kvalitativ, semistrukturerad intervjustudie. Tio deltagare rekryterades utifrån ett bekvämlighetsurval. Databearbetning skedde med hjälp av kvalitativ innehållsanalys. Resultat: Deltagarna i studien upplevde att de under smärtrehabiliteringsprogrammet var i en trygg miljö där de blev förstådda. De hittade nya förhållningssätt med ökad acceptans och tilltro till den egna förmågan. Många beskrev ett nytt sätt att se på att vara fysiskt aktiv trots smärta, där viktiga faktorer var att lyssna på kroppen och anpassa aktiviteten efter dagsformen. Flera deltagare önskade att rehabiliteringsprogrammet hade haft ett större fokus på fysisk aktivitet. Slutsats: Studien visade att unga vuxna patienter med långvarig smärta som genomgick ett smärtrehabiliteringsprogram upplevde sig vara i ett sammanhang där de blev förstådda och bekräftade. Programmet resulterade i nya kunskaper som underlättade vardagen och nya förhållningssätt till ett liv med smärta och till att vara fysiskt aktiv. Fortsatt forskning inom området är av vikt för att säkerställa att patientgruppen erbjuds väl utformad rehabiliteringBackground: Chronic pain is a common diagnosis, also among young adults. Pain conditions often have an impact on daily life by causing patients to be less physically active and hence affecting their functional capacity. In order to improve functional capacity, multimodal rehabilitation programmes are often recommended. However, there is a significant knowledge gap in how young adults with chronic pain experience such programmes. Objective: To examine young adults’ experience of participating in a multimodal pain rehabilitation programme, and how they consider the programme having affected their functional capacity and thoughts about being physically active. Method: A qualitative, semi structured interview study. Ten participants were recruited based on convenience sampling. The data analysis was performed using qualitative content analysis. Results: The participants described the rehabilitation programme as a safe and validating environment. They were helped to develop a new, more accepting, approach to life with pain. Many participants described a new attitude towards physical activity, which involved paying attention to signals from the body and adjusting activities accordingly. Several participants wished for the programme to have a greater focus on physical activity. Conclusion: The study shows that young adults with chronic pain experienced being understood and validated when attending a rehabilitation programme. The programme provided new skills that improved daily life, and gave rise to new attitudes towards a life with pain and the possibility of being physically active. More research on the subject is important in order to ensure that young adults with chronic pain are offered well suited rehabilitation programmes

Young adults’ experience of a multimodal pain rehabilitation programme. An interview study.

Bakgrund: Långvarig smärta är ett vanligt förekommande tillstånd, även bland unga vuxna. Smärtproblematik leder ofta till inskränkningar i det dagliga livet, till exempel genom minskad fysisk aktivitet vilket kan leda till försämrad funktionsförmåga. Vid komplex långvarig smärta rekommenderas ofta multimodala smärtrehabiliteringsprogram i syfte att förbättra funktionsförmågan. Det saknas dock i dagsläget kunskap om hur dessa program upplevs av unga vuxna patienter. Syfte: Att undersöka hur unga vuxna med långvarig smärta upplever ett multimodalt smärtrehabiliteringsprogram och hur de upplevt att deltagande i programmet påverkat deras fysiska funktionsförmåga och tankar om fysisk aktivitet Metod: En kvalitativ, semistrukturerad intervjustudie. Tio deltagare rekryterades utifrån ett bekvämlighetsurval. Databearbetning skedde med hjälp av kvalitativ innehållsanalys. Resultat: Deltagarna i studien upplevde att de under smärtrehabiliteringsprogrammet var i en trygg miljö där de blev förstådda. De hittade nya förhållningssätt med ökad acceptans och tilltro till den egna förmågan. Många beskrev ett nytt sätt att se på att vara fysiskt aktiv trots smärta, där viktiga faktorer var att lyssna på kroppen och anpassa aktiviteten efter dagsformen. Flera deltagare önskade att rehabiliteringsprogrammet hade haft ett större fokus på fysisk aktivitet. Slutsats: Studien visade att unga vuxna patienter med långvarig smärta som genomgick ett smärtrehabiliteringsprogram upplevde sig vara i ett sammanhang där de blev förstådda och bekräftade. Programmet resulterade i nya kunskaper som underlättade vardagen och nya förhållningssätt till ett liv med smärta och till att vara fysiskt aktiv. Fortsatt forskning inom området är av vikt för att säkerställa att patientgruppen erbjuds väl utformad rehabiliteringBackground: Chronic pain is a common diagnosis, also among young adults. Pain conditions often have an impact on daily life by causing patients to be less physically active and hence affecting their functional capacity. In order to improve functional capacity, multimodal rehabilitation programmes are often recommended. However, there is a significant knowledge gap in how young adults with chronic pain experience such programmes. Objective: To examine young adults’ experience of participating in a multimodal pain rehabilitation programme, and how they consider the programme having affected their functional capacity and thoughts about being physically active. Method: A qualitative, semi structured interview study. Ten participants were recruited based on convenience sampling. The data analysis was performed using qualitative content analysis. Results: The participants described the rehabilitation programme as a safe and validating environment. They were helped to develop a new, more accepting, approach to life with pain. Many participants described a new attitude towards physical activity, which involved paying attention to signals from the body and adjusting activities accordingly. Several participants wished for the programme to have a greater focus on physical activity. Conclusion: The study shows that young adults with chronic pain experienced being understood and validated when attending a rehabilitation programme. The programme provided new skills that improved daily life, and gave rise to new attitudes towards a life with pain and the possibility of being physically active. More research on the subject is important in order to ensure that young adults with chronic pain are offered well suited rehabilitation programmes

Process improvement of brushdeburring

During the milling of Sandvik Coromant’s world leading Drill with replaceable inserts,the CoroDrill880©, burrs appear around the milled surfaces. The burrs are removedusing different methods, one of which is deburring with special brushing machines thatare integrated into milling cells. The machines of the type Sinjet, use a Siemensguidance system. The deburring results are not satisfying and manual deburring isrequired afterwards. The manual deburring may cause damage to important edges andmeasurements of the product and is also very time consuming for the machineoperators.As almost no engineering work has been done with the process, it has to be evaluatedand improved. The objective is to present a proposition of an improved process,where no manual deburring is required and also to present an instruction manual ofhow the implementation should be carried out.The evaluation of the deburring process revealed some flaws that lead to themachines bad performance. The greatest flaw was that many dimensions of theproducts use the same recipe, where few parameters are adapted to the differentdimensions, which gives an uneven performance. Another problem was the generallack of knowledge about the guidance system.Many experiments were carried out to find which adjustable parameters that had themost influence on the machines performance. The tests showed that the brushingangle against the part and the brushes in feed depth had the most effect. By designinga new program that was better adapted to the problematic areas of the part, as wellas making better use of the parameters that gave the best results, a significantimprovement was achieved.An instruction manual was made in order to explain the changes in the program andthe different parameters contribution to the performance of the machines. Theimplementation process was also thoroughly explained to make the work easier forthe ones doing it