Aboriginal and Torres Strait Islander health and wellbeing: implications for a CBT framework

Research Aims/Questions: It has been acknowledged that the mental health of Australian Aboriginal and Torres Strait Islander people has been 'bedeviled' by the inappropriate application of non-Indigenous models of mental health. Given the poor health outcomes of Indigenous people, another approach to mental health practice is required. In order to enhance Indigenous health and wellbeing it is necessary for non-Indigenous practitioners to find a culturally safe way in which to enter the negotiated space of cross-cultural mental health. This will be facilitated through understanding both the points of similarity and divergence in perspectives of mental health across cultures. The current study aimed to explore urban Aboriginal and Torres Strait Islander’s understandings of mental health using a positive psychology framework. Methodology: A qualitative research project was conducted with a sample of 19 Australian Aboriginal and Torres Strait Islanders people. Data was collected via individual semi-structured interviews and focus groups. Thematic analysis was conducted to identify themes within the data. Conclusion: Four themes emerged as reflecting health and wellbeing – coping skills, knowledge, social support, and connectedness. The theme of connectedness to country, family and kinship, cultural knowledge and social networks emerged as reflecting a unique contribution to Indigenous health and wellbeing. However, the themes of coping skills, knowledge and social support shared cross-cultural meaning. In particular, coping skills identified in the behavioural, emotional and cognitive domains shared many cross-culturally applicable avenues for intervention. Therapeutic interventions in these domains are already well established within cognitive behaviour therapies. It is the cross-cultural understandings within these themes that offer clinicians a culturally safe avenue for supporting Australian Aboriginal and Torres Strait Islander health and wellbeing

"This town can't be that harmful": risk perception of lead exposure

Introduction: Much of the focus of lead risk health campaigns has been on vulnerable populations such as children and pregnant women, thus not communicating the risk of exposure for other adults. This becomes a particular issue for adults who are long-term residents of communities near lead mines as they can be at an increased risk of exposure to lead within their environment. As such, this study investigated the perceived risk of exposure to lead in residents of a lead mining community. Methods: Semi-structured interviews were held with 20 (3 male, 17 female) residents from a community in close proximity to a lead mine and were recruited through the community media and local organizations. Common themes were identified through an interpretative phenomenological analytical framework providing an in depth examination of the lived experiences of participants. Results: Majority of the participants did not perceive a health risk from exposure to lead. Those who reported a specific concern surrounding their exposure to lead had lived within the community for less than five years. However, it was commonly noted that the behaviors to control residents' exposure to lead were easily performed and low cost. Conclusions: These results suggest that residents of a community chronically exposed to lead seem to become complacent about their risk for poor health outcomes the longer they live within the community. These findings have implications for the communication of the risk of exposure to lead for adults who are chronically exposed to lead

'Round-table' ethical debate: is a suicide note an authoritative 'living will'?

Living wills are often considered by physicians who are faced with a dying patient. Although popular with the general public, they remain problems of authenticity and authority. It is difficult for the examining physician to know whether the patient understood the terms of the advance directive when they signed it, and whether they still consider it authoritative at the time that it is produced. Also, there is little consensus on what spectrum of instruments constitutes a binding advance directive in real life. Does a 'suicide note' constitute an authentic and authoritative 'living will'? Our panel of authorities considers this problem in a round-table discussion

Parents’ perspectives of factors affecting parent–adolescent communication about type 1 diabetes and negotiation of self-management responsibilities

Adolescence is an important time in which young people take on type 1 diabetes (T1D) self-management responsibility. Parents are key facilitators of this process. Little is known about parents’ experiences of communicating with their children about T1D during adolescence. Semi-structured interviews were conducted with 32 parents (24 mothers and 8 fathers) of adolescents (11–17 years) living with T1D to explore how parents communicate about T1D and self-management with their adolescent children. Parents were recruited through two national child and adolescent diabetes and endocrine clinics and online advertisement through a national diabetes advocacy organisation. Interviews were transcribed verbatim and thematically analysed. Six themes were identified: parent factors, quality of the parent–adolescent relationship, communication strategies, adolescent factors, communication triggers and family/system factors. Understanding factors that impact communication about self-management between parents and adolescents will enable healthcare professionals to provide support and targeted interventions as parent and adolescent roles change over time

Chameleon masculinity: developing the British ‘population-centred’ soldier

In this article I develop what I term chameleon masculinity as a specific form of gendered adaptation of military agency opened up by the post-9/11 shift towards ‘population-centred’ counterinsurgency and stabilisation. A gendered analysis of this carefully cultivated form of military agency is central to revealing some of the concealed embodied dynamics that challenge the hegemony of the traditional combat soldier, and in practice enables this form of war. Drawing on 18 months of anthropological fieldwork, for the most part alongside the UK’s Military Stabilisation Support Group, this research incorporates my auto-ethnography as an officer in the Royal Naval Reserves. Rather than focusing at the level of policy, strategy, and doctrine, I examine how the specialized and masculinized agency of ‘the chameleon’ translates tactically into the body of the British military stabilisation operative, showing how this is developed though intensive pre-deployment training in the UK, and embodied and practised through operational deployment in Afghanistan. This reveals the specific agency of chameleon masculinity and how its potential for inherent violence becomes deceptively ‘hidden in plain sight’

Diabetes Mellitus and Mortality after Acute Coronary Syndrome as a First or Recurrent Cardiovascular Event

Diabetes Mellitus (DM) is associated with adverse cardiovascular prognosis. However, the risk associated with DM may vary between individuals according to their overall cardiovascular risk burden. Therefore, we aimed to determine whether DM is associated with poor outcome in patients presenting with Acute Coronary Syndrome (ACS) according to the index episode being a first or recurrent cardiovascular event.We conducted a retrospective analysis of a prospective cohort study involving 2499 consecutively admitted patients with confirmed ACS in 11 UK hospitals during 2003. Usual care was provided for all participants. Demographic factors, co-morbidity and treatment (during admission and at discharge) factors were recorded. The primary outcome was all cause mortality (median 2 year follow up), compared for cohorts with and without DM according to their prior cardiovascular disease (CVD) disease status. Adjusted analyses were performed with Cox proportional hazards regression analysis. Within the entire cohort, DM was associated with an unadjusted 45% increase in mortality. However, in patients free of a history of CVD, mortality of those with and without DM was similar (18.8% and 19.7% respectively; p = 0.74). In the group with CVD, mortality of patients with DM was significantly higher than those without DM (46.7% and 33.2% respectively; p<0.001). The age and sex adjusted interaction between DM and CVD in predicting mortality was highly significant (p = 0.002) and persisted after accounting for comorbidities and treatment factors (p = 0.006). Of patients free of CVD, DM was associated with smaller elevation of Troponin I (p<0.001). However in patients with pre-existing CVD Troponin I was similar (p = 0.992).DM is only associated with worse outcome after ACS in patients with a pre-existing history of CVD. Differences in the severity of myocyte necrosis may account for this. Further investigation is required, though our findings suggest that aggressive primary prevention of CVD in patients with DM may have beneficially modified their first presentation with (and mortality after) ACS

Sufism and Liberation across the Indo-Afghan Border: 1880-1928

How do we understand links between sufism and pro-egalitarian revolutionary activism in the early twentieth century; and how did upland compositions of self and community help constitute revolutionary activism in South Asia more broadly? Using Pashto poetry as my archive I integrate a history of radical egalitarian thought and political practice to a holistic study of self-making; of imperial spatiality; and of shifting gradients of power in the regions between Kabul and Punjab. Amid a chaotic rise of new practices of imperial and monarchic hegemony around the turn of the twentieth century, I argue, older sedimentations of ‘devotee selfhood’ in the high valleys of eastern Afghanistan gave rise, in social spaces preserved by self-reflexive poetic practice and circulation, to conscious desires for avoidance of all forms of hierarchy or sovereignty, in favour of a horizontal politics of reciprocity. Such inchoate drives for freedom later played a role in constituting anti-statist revolutionary subjectivities across great geographical and social distance. From upland sufi roots they rippled outward to intersect with the work of transnational socialist and anti-imperialist militants in Indian nationalist circles too; and even influenced scholars at the heart of the nascent Afghan nation-state

Deep Sequencing of Pyrethroid-Resistant Bed Bugs Reveals Multiple Mechanisms of Resistance within a Single Population

A frightening resurgence of bed bug infestations has occurred over the last 10 years in the U.S. and current chemical methods have been inadequate for controlling this pest due to widespread insecticide resistance. Little is known about the mechanisms of resistance present in U.S. bed bug populations, making it extremely difficult to develop intelligent strategies for their control. We have identified bed bugs collected in Richmond, VA which exhibit both kdr-type (L925I) and metabolic resistance to pyrethroid insecticides. Using LD50 bioassays, we determined that resistance ratios for Richmond strain bed bugs were ∼5200-fold to the insecticide deltamethrin. To identify metabolic genes potentially involved in the detoxification of pyrethroids, we performed deep-sequencing of the adult bed bug transcriptome, obtaining more than 2.5 million reads on the 454 titanium platform. Following assembly, analysis of newly identified gene transcripts in both Harlan (susceptible) and Richmond (resistant) bed bugs revealed several candidate cytochrome P450 and carboxylesterase genes which were significantly over-expressed in the resistant strain, consistent with the idea of increased metabolic resistance. These data will accelerate efforts to understand the biochemical basis for insecticide resistance in bed bugs, and provide molecular markers to assist in the surveillance of metabolic resistance