Beyond recovery: sense of self and psychosocial change following recent onset psychosis

Background: The experience of a Recent Onset Psychosis (ROP) can be traumatic. Framing psychosis using a trauma model has implications for understanding recovery. That psychosis can precipitate Post Traumatic Stress Disorder (PTSD) has been demonstrated. However, little research has explored constructive changes that may occur as a result of the struggle to overcome the traumatic experience. Aim: This study sought to explore Post-traumatic Growth (PTG) following a ROP and the relationship of this to the re-construction of the self, which is regarded as central to the recovery process. Method: The study used a constructivist grounded theory approach. Eight individuals who had experienced a recent onset of psychosis, were recruited through NHS and third sector organisations. The participants engaged in semi-structured interviews about their experience of recovery from psychosis and associated perceptions of change (e.g., PTG and Post-traumatic Depreciation (PTD)). Results: The theme ‘the immediate crisis and aftermath’ epitomised the trauma of psychosis and ongoing struggle. The remaining themes ‘making sense’ and ‘finding a sense of value and purpose’ represented strategies employed by the participants to regain a sense of self. Making sense involved creating a ‘narrative of the crisis’ and of the future ‘recovered self’. ‘Re-gaining trust’ was central to the development of reinstating a perception of self as having value and purpose alongside ‘social participation’. Through participants’ engagement in these strategies the core category ‘Post-traumatic Growth’ emerged reflecting positive change, which included the categories: ‘increased self-awareness’; ‘increased empathy for others’; ‘deeper relationships’; and ‘reassessing priorities’. Conclusions: The findings have numerous clinical implications for clinical psychology and more widely for service delivery. The study recommends fruitful research endeavours in the topic of PTG and ROP

Developing novel evidence-based interventions to promote asthma action plan use: a cross-study synthesis of evidence from randomised controlled trials and qualitative studies

Background: Long-standing randomised controlled trial (RCT) evidence indicates that asthma action plans can improve patient outcomes. Internationally, however, these plans are seldom issued by professionals or used by patients/carers. To understand how the benefits of such plans might be realised clinically, we previouslyinvestigated barriers and facilitators to their implementation in a systematic review of relevant RCTs and synthesised qualitative studies exploring professional and patient/carer views. Our final step was to integrate these two separate studies.Methods: First, a theoretical model of action plan implementation was proposed, derived from our synthesis of 19 qualitative studies, identifying elements which, if incorporated into future interventions, could promote their use. Second, 14 RCTs included in the quantitative synthesis were re-analysed to assess the extent to which these elements were present within their interventions (that is, ‘strong’, ‘weak’ or ‘no’ presence) and with what effect. Matrices charted each element’s presence and strength, facilitating analysis of element presence and action plan implementation.Results: Four elements (professional education, patient/carer education, (patient/carer and professional) partnership working and communication) were identified in our model as likely to promote asthma plan use. Thirteen interventions reporting increased action plan implementation contained all four elements, with two or morestrongly present. One intervention reporting no effect on action plan implementation contained only weakly present elements. Intervention effectiveness was reported using a narrow range of criteria which did not fully reflect the four elements. For example, no study assessed whether jointly developed action plans increased use.Whilst important from the professional and patient/carer perspectives, the integral role of these elements in intervention delivery and their effect on study outcomes was under acknowledged in these RCTs.Conclusions: Our novel approach provides an evidence-base for future action plan interventions. Such interventions need to ensure all elements in our implementation model (patient/carer and professional education to support development of effective partnership working and communication) are strongly present within them and a wider range of criteria better reflecting the realities of clinical practice and living with asthma are used to measure their effectiveness. We now intend to test such a complex intervention using a cluster trial design

A family history of breast cancer will not predict female early onset breast cancer in a population-based setting

ABSTRACT: BACKGROUND: An increased risk of breast cancer for relatives of breast cancer patients has been demonstrated in many studies, and having a relative diagnosed with breast cancer at an early age is an indication for breast cancer screening. This indication has been derived from estimates based on data from cancer-prone families or from BRCA1/2 mutation families, and might be biased because BRCA1/2 mutations explain only a small proportion of the familial clustering of breast cancer. The aim of the current study was to determine the predictive value of a family history of cancer with regard to early onset of female breast cancer in a population based setting. METHODS: An unselected sample of 1,987 women with and without breast cancer was studied with regard to the age of diagnosis of breast cancer. RESULTS: The risk of early-onset breast cancer was increased when there were: (1) at least 2 cases of female breast cancer in first-degree relatives (yes/no; HR at age 30: 3.09; 95% CI: 128-7.44), (2) at least 2 cases of female breast cancer in first or second-degree relatives under the age of 50 (yes/no; HR at age 30: 3.36; 95% CI: 1.12-10.08), (3) at least 1 case of female breast cancer under the age of 40 in a first- or second-degree relative (yes/no; HR at age 30: 2.06; 95% CI: 0.83-5.12) and (4) any case of bilateral breast cancer (yes/no; HR at age 30: 3.47; 95%: 1.33-9.05). The positive predictive value of having 2 or more of these characteristics was 13% for breast cancer before the age of 70, 11% for breast cancer before the age of 50, and 1% for breast cancer before the age of 30. CONCLUSION: Applying family history related criteria in an unselected population could result in the screening of many women who will not develop breast cancer at an early age

The benefits of protected areas for bird population trends may depend on their condition

The Post-2020 Global Biodiversity Framework calls for at least 30% of land and sea to be protected by 2030. Whilst there is growing evidence that protected areas can benefit biodiversity, to achieve the greatest possible gains from their expansion, we must understand how protected area quality impacts upon biodiversity metrics. We used UK BTO/JNCC/RSPB Breeding Bird Survey data and protected areas condition data from national Common Standards Monitoring, to test whether improving site condition (for which there are UK policy targets) would contribute to stated policy targets to increase species' abundance. After controlling for differences in climate, land cover, and elevation, we found a positive association between the proportion of favourable habitat and bird abundance trends in the UK, while in Wales, Scotland and Northern Ireland combined, the positive effect was also significantly greater than in unfavourable habitat. Conversely, we also found a negative effect of proportion of favourable habitat on bird abundance. There was no evidence that these relationships varied between conservation status or many of the traits considered, although there was some evidence that favourable condition was beneficial for habitat specialists, cold-adapted species, and varied by habitat. Our findings suggest that improving the condition of protected areas currently in unfavourable condition, will contribute to nature recovery as measured by species' abundance trends in some circumstances. This also suggests that achieving the “30 by 30” target without ensuring those protected areas are of sufficient quality, may not be sufficient to restore biodiversity

How Do Aspirations Matter?

This paper explores the complex roles of aspirations in relation to human development, drawing upon the capability approach. The paper examines the notion of feasibility of aspirations and the impact feasibility judgements have on aspiration formation and aspiration realisation, in terms of both capabilities and functionings. In particular this paper extends existing theory by building on Hart’s (2004, 2012) dynamic multi-dimensional model of aspiration and Hart’s (2012) aspiration set. The theorization builds on empirical work, undertaken in the UK, seeking to understand pupil’s aspirations on leaving school and college at age 17-19 as well as reviewing wider empirical and theoretical literature in this field. The discussion contributes to capability theory by extending understanding regarding first, the way that aspirations are connected to capabilities and functionings, secondly, the processes by which aspirations are converted into capabilities and thirdly, how certain capabilities become functionings. The paper reflects on the criteria that inform choices about the cultivation and selection of different aspirations on individual and collective bases. )n concluding the paper the question of ‘how do aspirations matter?’ is addressed. Ultimately an argument is made for the need to ‘reclaim’ a rich multi-dimensional concept of aspiration in order to pursue human development and flourishing for all

Coins and Cosmologies in Iron Age Western Britain

This is an Accepted Manuscript of an article published by Taylor & Francis in Cambridge Archaeological Journal on 27-6-18, available online: https://doi.org/10.1017/S0959774318000331Using an approach derived from material culture studies and semiotics, this speculative paper addresses possible relationships between humans and horses in the British Iron Age. Through a study of dominance of horse imagery found on Iron Age British coinage, specifically the Western coins traditionally attributed to the ‘Dobunni’, the author explores what these coins may be able to inform us regarding the possible relationships between humans and horses and their personhood therein. Drawing on wider evidence including faunal remains and other horse-related metalwork, it is argued that these coins could be interpreted as a manifestation of the complex perspectives surrounding a symbiotic relationship between humans and horses