Challenges faced by mental health interpreters in East London: An interpretative phenomenological analysis

Background/Aims/Objectives - The role of an interpreter is instrumental for people not fluent in the new language of their host community or country where they are living. This subject is an important one and not enough is known, especially about the challenges faced by mental health interpreters. Methodology/Methods - The study examined how interpreters drew on direct translation, cultural meanings and non-verbal information while interpreting and how they convey these to both service users and providers. An Interpretative Phenomenological Analysis was adopted to analyse three semi-structured interviews with female mental health interpreters that lasted approximately 60 minutes each. All participants were self-identified as fluent in at least two languages and had attended a minimum of six months training on mental health interpreting. Results/Finding - The challenges of mental health interpreting were revealed in three overarching themes: (i) Sensitive nature of interpreting and challenges associated with ensuring accuracy. (ii) Multitasking to convey literal words, feelings and cultural meanings. (iii) Exposure to the risk of vicarious trauma and insufficient organisational support. Discussion/Conclusion - The study concluded that mental health interpreters should have more access to training and development, organisational support, professional recognition and adequate acknowledgement of their essential role in service provision to people not fluent with the new language of their present community or country

Careif Position Statement on Migration and Mental Health

People have moved from one place to another within the same country or across national borders for millennia. The reasons for such movements have varied, as does the duration for which people migrate. With globalisation and global connections across countries, migration has increased. The process of migration and its impact on the mental health of individuals has been and will remain heterogeneous. The responses of migrants to the process vary, depending upon a number of factors. Individuals may migrate individually, with their families or in groups. They may move to avoid political or religious persecution and seek political asylum in another country (forced migration) or migrate for personal, employment, economic or educational reasons (voluntary migration). Although these two categorisations are often a little more complex than this. Not all migrants will feel negatively affected by migration. People may migrate on a seasonal, recurrent, permanent or temporary basis. It may be within or across generations. Many migrants will never access mental health services, whilst others may use these in varying ways and with diverse requirements or presentations. The experiences and requirements of voluntary and involuntary migrants may differ. Mental health Services may need to ensure that they are accessible and appropriate to all members of society including those who have migrated. This paper makes some suggestions in relation to this

Realization of an Interacting Two-Valley AlAs Bilayer System

By using different widths for two AlAs quantum wells comprising a bilayer system, we force the X-point conduction-band electrons in the two layers to occupy valleys with different Fermi contours, electron effective masses, and g-factors. Since the occupied valleys are at different X-points of the Brillouin zone, the interlayer tunneling is negligibly small despite the close electron layer spacing. We demonstrate the realization of this system via magneto-transport measurements and the observation of a phase-coherent, bilayer $\nu$=1 quantum Hall state flanked by a reentrant insulating phase.Comment: 5 page

Contributions of Non-consumptive Wildlife Tourism to Conservation

Wildlife tourism has the potential to contribute to conservation through a variety of mechanisms. This chapter presents a preliminary assessment of the extent to which this potential is currently being realised, comparing tourism based on viewing of animals in captive settings (with a focus on federated zoos) with that in free-ranging situations (wildlife watching). The key mechanisms involved are: direct wildlife management and research; use of income derived from wildlife tourism to fund conservation; education of visitors to behave in a more conservation-friendly manner; political lobbying in support of conservation; and provision of a socio-economic incentive for conservation. All of these occur in at least some zoos and wildlife-watching situations, and collectively the contribution of non-consumptive wildlife tourism to conservation is significant, though impossible to quantify. The key strengths of the zoo sector in this regard are its inputs into captive breeding and its potential to educate large numbers of people. in contrast, wildlife watching provides significant socio-economic incentives for conservation of natural habitats. There seem to be significant opportunities for expanding the role of non-consumptive wildlife tourism in conservation

Ten women's decision-making experiences in threatened preterm labour: Qualitative findings from the EQUIPTT trial.

BACKGROUND: Clinical triage of women in threatened preterm labour (TPTL) could be improved through utilising the QUiPP App, as symptoms alone are poor predictors of early delivery. As most women in TPTL ultimately deliver at term, they must weigh this likelihood with their own personal considerations, and responsibilities. The importance of personal considerations was highlighted by the 2015 Montgomery ruling, and the significance of shared decision-making. AIMS: Through qualitative interviews, the primary aim was to explore women's decision-making experiences in TPTL through onset of symptoms, triage, clinical assessment, and discharge. METHODS: Qualitative interviews were undertaken as part of the EQUIPTT study (REC: 17/LO/1802) using a semi-structured interview schedule. Descriptive labels of the coding scheme were applied to the raw transcript data. This coding scheme was then increasingly refined into key themes and allowed parallels to be made within and between cases. RESULTS: Ten ethnically diverse women who presented at six different London hospitals sites in TPTL were interviewed. Three final themes emerged from the data incorporating 10 sub-themes, 'Seeking help', 'Being "assessed" vs making clinical decisions together', and 'End result.' CONCLUSION: Women described their busy lives and the need to juggle their commitments. Participants drew comparisons between their TPTL symptoms and 'period pain,' contrasting to typical medical terminology. Shared decision-making and the clinician-patient relationship could be improved through clinicians utilizing terminology women understand and relate to. Women used language that highlighted the clinician-patient power balance. While not fully involved in shared decision-making, women were overall satisfied with their care

Clinicians' experiences of using and implementing a medical mobile phone app (QUiPP V2) designed to predict the risk of preterm birth and aid clinical decision making.

BACKGROUND: As the vast majority of women who present in threatened preterm labour (TPTL) will not deliver early, clinicians need to balance the risks of over-medicalising the majority of women, against the potential risk of preterm delivery for those discharged home. The QUiPP app is a free, validated app which can support clinical decision-making as it produces individualised risks of delivery within relevant timeframes. Recent evidence has highlighted that clinicians would welcome a decision-support tool that accurately predicts preterm birth. METHODS: Qualitative interviews were undertaken as part of the EQUIPTT study (The Evaluation of the QUiPP app for Triage and Transfer) (REC: 17/LO/1802) which aimed to evaluate the impact of the QUiPP app on management of TPTL. Individual semi-structured telephone interviews were used to explore clinicians' (obstetricians' and midwives') experiences of using the QUiPP app and how it was implemented at their hospital sites. Thematic analysis was chosen to explore the meaning of the data, through a framework approach. RESULTS: Nineteen participants from 10 hospital sites in England took part. Data analysis revealed three overarching themes which were: 'experience of using the app', 'how QUiPP risk changes practice' and 'successfully adopting QUiPP: context is everything'. With these final themes we appeared to have achieved our aim of exploring the clinicians' experiences of using and implementing the QUiPP app. CONCLUSION: This study explored different clinician's experiences of implementing the app. The organizational and cultural context at different sites appeared to have a large impact on how well the QUiPP app was implemented. Future work needs to be undertaken to understand how best to embed the intervention within different settings. This will inform scale up of QUiPP app use across the UK and ensure that clinicians have access to this free, easy-to-use tool which can positively aid clinical decision making when caring for women in TPTL. CLINICAL TRIAL REGISTRY AND REGISTRATION NUMBER: ISRCTN 17846337, registered 08th January 2018, https://doi.org/10.1186/ISRCTN17846337

Determinants of willingness to pay for hip and knee joint replacement surgery for osteoarthritis

Objectives. To determine whether patients with osteoarthritis (OA) would be willing to pay for joint replacement and whether patient characteristics or health outcomes, including pain, physical function and health-related quality of life, were related to willingness to pay (WTP). Methods. Patients who had undergone primary total hip replacement (THR) or total knee replacement (TKR) for OA completed a disease-specific questionnaire (Western Ontario and McMaster: WOMAC index), a generic measure of health status (Medical Outcome Study Short Form-36: SF-36) and an Evaluation Questionnaire to measure WTP and satisfaction with the replacement. Results. Responses were obtained from 109 (77%) THR patients and 129 (72%) TKR patients. Mean age of respondents was 67 yr for THR (47% female) and 73 yr for TKR (60% female). Overall, 85% of patients responded to the WTP question. Of the THR patients, 71% were willing to pay something, 11% were not willing to pay anything and 18% did not answer the question. For TKR patients these figures were 70, 16 and 14% respectively. However, of those who responded to the WTP question, only 25% of the THR patients and 18% of the TKR patients indicated they would be willing to pay the actual current average cost of the operation in Australia (≥ A$15 000). A lower postoperative pain score (as measured by the WOMAC index) was a significant predictor of WTP for both THR and TKR patients. Income also significantly predicted WTP in THR patients but not in TKR patients. The other significant predictors for TKR patients were older age, having private health insurance and willingness to recommend joint replacement to others. Conclusions. Willingness to pay was a measure that was understandable and acceptable to patients, most of whom were willing to pay something. There was a high correlation between WTP, good health outcomes and patient satisfaction, pain relief being the dominant determinant