Life events, difficulties and dilemmas in the onset of chronic fatigue syndrome: a case-control study

Background. The role of stress in the onset of chronic fatigue syndrome is unclear. Our objectives in this study were first, to determine the relation between the onset of chronic fatigue syndrome and stressful life events and difficulties. Secondly, we examined the role of a particular type of problem, dilemmas, in the onset of chronic fatigue syndrome. Method. We used a case–control design with 64 consecutive referrals from an Infectious Diseases/Liaison Psychiatry Fatigue clinic and 64 age- and sex-matched controls from a general practice population control group in Leeds. We had two main outcome measures; the odds ratios of the risk of developing chronic fatigue syndrome after experiencing a severe life event, severe difficulties or both in the year and 3 months preceding onset; and the proportion of subjects in each group who experienced a dilemma prior to onset. Results. Patients with chronic fatigue syndrome were more likely to experience severe events and difficulties in the 3 months (OR=9, 95% CI 3·2 to 25·1) and year (OR=4·3, 95% CI 1·8 to 10·2) prior to onset of their illness than population controls. In the 3 months prior to onset 19 of the 64 patients (30%) experienced a dilemma compared to none of the controls. Conclusions. Chronic fatigue syndrome is associated with stressful events and difficulties prior to onset. Those events and difficulties characterized as being dilemmas seem to be particularly important

Routine administration of Health Related Quality of Life (HRQoL) and needs assessment instruments to improve psychological outcome: a systematic review

Background. Routine administration of Health Related Quality of Life (HRQoL) and needs assessment instruments has been advocated as part of clinical care to aid the recognition of psychosocial problems, to inform clinical decision making, to monitor therapeutic response and to facilitate patient-doctor communication. However, their adoption is not without cost and the benefit of their use is unclear. Method. A systematic review was conducted. We sought experimental studies that examined the addition of routinely administered measures of HRQoL to care in both psychiatric and non-psychiatric settings. We searched the following databases: MEDLINE, EMBASE, CINAHL, PsycLIT and Cochrane Controlled Trials Register (to 2000). Data were extracted independently and a narrative synthesis of results was presented. Results. Nine randomized and quasi-randomized studies conducted in non-psychiatric settings were found. All the instruments used included an assessment of mental well-being, with specific questions relating to depression and anxiety. The routine feedback of these instruments had little impact on the recognition of mental disorders or on longer term psychosocial functioning. While clinicians welcomed the information these instruments imparted, their results were rarely incorporated into routine clinical decision making. No studies were found that examined the value of routine assessment and feedback of HRQoL or patient needs in specialist psychiatric care settings. Conclusions. Routine HRQoL measurement is a costly exercise and there is no robust evidence to suggest that it is of benefit in improving psychosocial outcomes of patients managed in non-psychiatric settings. Major policy initiatives to increase the routine collection and use of outcome measures in psychiatric settings are unevaluated

INCREASING YOUR IMPACT VIA LEADERSHIP DEVELOPMENT

Labor and Human Capital,

Exploring knowledge exchange: a useful framework for practice and policy

Knowledge translation is underpinned by a dynamic and social knowledge exchange process but there are few descriptions of how this unfolds in practice settings. This has hampered attempts to produce realistic and useful models to help policymakers and researchers understand how knowledge exchange works. This paper reports the results of research which investigated the nature of knowledge exchange. We aimed to understand whether dynamic and fluid definitions of knowledge exchange are valid and to produce a realistic, descriptive framework of knowledge exchange. Our research was informed by a realist approach. We embedded a knowledge broker within three service delivery teams across a large mental health organisation, each of whom was grappling with specific challenges. The knowledge broker participated in the team's problem-solving process and collected observational fieldnotes. We also interviewed the team members. Observational and interview data were analysed quantitatively and qualitatively in order to determine and describe the nature of the knowledge exchange process in more detail. This enabled us to refine our conceptual framework of knowledge exchange. We found that knowledge exchange can be understood as a dynamic and fluid process which incorporates distinct forms of knowledge from multiple sources. Quantitative analysis illustrated that five broadly-defined components of knowledge exchange (problem, context, knowledge, activities, use) can all be in play at any one time and do not occur in a set order. Qualitative analysis revealed a number of distinct themes which better described the nature of knowledge exchange. By shedding light on the nature of knowledge exchange, our findings problematise some of the linear, technicist approaches to knowledge translation. The revised model of knowledge exchange which we propose here could therefore help to reorient thinking about knowledge exchange and act as a starting point for further exploration and evaluation of the knowledge exchange process

Routinely administered questionnaires for depression and anxiety : systematic review

Objectives To examine the effect of routinely administered psychiatric questionnaires on the recognition, management, and outcome of psychiatric disorders in non-psychiatric settings. Data sources Embase, Medline, PsycLIT, Cinahl, Cochrane Controlled Trials Register,and hand searches of key journals. Methods A systematic review of randomised controlled trials of the administration and routine feedback of psychiatric screening and outcome questionnaires to clinicians in non-psychiatric settings. narrative overview of key design features and end points, together with a random effects quantitative synthesis of comparable studies. Main outcome measures Recognition of psychiatric disorders after feedback of questionnaire results; interventions for psychiatric disorders and outcome of psychiatric disorders. Results Nine randomised studies were identified that examined the use of common psychiatric instruments in primary care and general hospital settings. Studies compared the effect of the administration of these instruments followed by the feedback of the results to clinicians, with administration with no feedback. Meta-analytic pooling was possible for four of these studies (2457 participants), which measured the effect of feedback on the recognition of depressive disorders. Routine administration and feedback of scores for all patients (irrespective of score) did not increase the overall rate of recognition of mental disorders such as anxiety and depression (relative risk of detection of depression by clinician after feedback 0.95, 95% confidence interval 0.83 to 1.09). Two studies showed that routine administration followed by selective feedback for only high scores increased the rate of recognition of depression (relative risk of detection of depression after feedback 2.64, 1.62 to 4.31). This increased recognition, however, did not translate into an increased rate of intervention. Overall, studies of routine administration of psychiatric measures did not show an effect on patient outcome. Conclusions The routine measurement of outcome is a costly exercise. Little evidence shows that it is of benefit in improving psychosocial outcomes of those with psychiatric disorder managed in non-psychiatric settings

Enhanced bioremediation of 1,1,2,2-tetrachloroethane in wetland soils

This research investigated the capability of wetland soils to function as a medium for the degradation of 1,1,2,2-TeCA and its daughter products, and the influence of different hydrogen donors and nutrients on this process. The rate constants calculated for this study, show that removal of 1,1,2,2-TeCA is occurring in the microcosms receiving hydrogen donors as well as the biotic controls. The parent compound was undergoing complete degradation to ethene, which was confirmed by ethene analysis, as well as monitoring the intermediate compounds. The analysis for the degradation products of 1,1,2,2-tetrachloroethene is important in determining the overall potential for successful degradation of the parent compound. The major biotic daughter products of TeCA are the 1,2-dichloroethene isomers, vinyl chloride and ethene. The mass balance of the study had recoveries within 40% of the initial injection. From the data collected in this study, it can be shown that enhanced bioremediation can be a viable strategy for the improvement of the soil degradation phase of wetland remediation processes. The addition of hydrogen donors to the wetland soils showed the ability to support a complete degradation process in the deepsoil. By amending the system with a slow release hydrogen donor such as butyrate and introducing a known dechlorinating culture, early success could be achieved until over time a well established dechlorinator population is produced

Engaging Citizens with Televised Election Debates through Online Interactive Replays

In this paper we tackle the crisis of political trust and public engagement with politics by investigating new methods and tools to watch and take part in televised political debates. The paper presents relevant research at the intersection of citizenship, technologies and government/democracy, and describes the motivation, requirements and design of Democratic Replay, an online interactive video replay platform that offers a persistent, customisable digital space for: (a) members of the public to express their views as they watch online videos of political events; and (b) enabling for a richer collective understanding of what goes on in these complex media events