A narrative exploration of the lived experience of being born, raised in, and leaving a cultic group: the case of the Exclusive Brethren

There is considerable evidence that experiences in cultic groups can be harmful. Most studies have been on First Generation former members. Second Generation former cultic group members (SGA) are an under-researched population. Multi-Generational former members (MGA), i.e. those born into families whose membership of the cultic group goes back more than two generations appear never to have been researched. This thesis underpinned by social constructionism, explores the experiences of being born and raised in The Exclusive Brethren, an exemplar of a cultic group, and subsequently leaving. As a counselling psychologist and a former member of the Brethren, this thesis is of professional and personal interest. Unstructured interviews were conducted with three male and three female participants in their mid 30s to mid 70s, who left at various times over the last 50 years. Two participants are ‘true SGA’ –their parents were the first generation to join the Brethren. The other four are MGA coming from families with a long generational history in the Brethren. A qualitative narrative inquiry methodology was used, informed by critical and dialogical narrative analysis. Each story’s interview was represented in collaboration with the storytellers using their words as far as possible. At the heart of every story lay their experience in the Brethren; the doctrines and practices forming the bedrock. The stories told how storytellers came to leave and how, in leaving, they renegotiated their identities. A cross-story view led to a continuum model of families’ degree of enmeshment with the Brethren system. The representations were viewed through the lenses of disorganised attachment and identity theory. The implications for therapy were discussed stressing the importance of therapists’ knowledge of cultic groups. Approaches need to facilitate the telling of stories focussing on attachment, identity, trauma, bereavement as well as life and relationships skills

Creating a difference – a role for the arts in addressing child wellbeing in conflict-affected areas

Background Details findings from a project on the potential for arts activities and art therapy to support the mental health and wellbeing of children living in Kashmir. Methods The intervention engaged 30 school children over the course of one year who produced various forms of artwork and performances. In this paper, we report on project impacts, drawing on some of our qualitative measures including observations and interviews. Results Our research details impacts and improvements in areas of emotional expression, belonging, and agency. We also found an important role for schools to create safe, secure, and caring spaces to allow students to express themselves and work through traumatic feelings in a non-judgemental way. Conclusions School-based arts interventions can play an important role in the mental health and wellbeing of children. Critical here, however, are dedicated space, time, and resources to provide a supportive environment and to sustain activity in long-term

Development of a hospital electronic record frailty index (HerFI): an enhanced care alert score to identify older patients likely to require enhanced care on discharge from hospital

This thesis explores the different methods that are currently used to define frailty and the development of a new frailty index using routinely collected hospital data. The increasing ageing population means that older people account for the majority of the UK healthcare usage and spend therefore if the need for intervention can be quantified, adverse outcomes could be prevented. Data were extracted from the local systems at the Queen Elizabeth Hospital Birmingham for patients over 65 who were admitted as an emergency. A combination of 31 routinely collected test results were extracted and used to calculate a frailty score called FI-QEHB, by taking the sum of deficits divided by the total number of measurements for each patient. Machine Learning techniques were then used to firstly perform multiple imputation on missing data and then Classification and Regression Tree Analysis to determine the most important variables that predict mortality. This technique reduced the number of variables required to calculate a frailty score down to 6 from 31, and the area under the receiving operating characteristic (ROC) curve was used to assess the performance when the frailty score was added into a multivariable logistic regression model to predict emergency readmissions, mortality and whether a patient was discharged to a care home

Estimating the effects of preventive and weight-management interventions on the prevalence of childhood obesity in England: a modelling study

BACKGROUND: The effects of the systematic delivery of treatments for obesity are unknown. We aimed to estimate the potential effects on the prevalence of childhood obesity of systematically offering preventive and treatment interventions to eligible children in England, based on weight or health status. METHODS: For this modelling study, we developed a cross-sectional simulation model of the child and young adult population in England using data from multiple years of the Health Survey of England conducted between Jan 1, 2010, and Dec 31, 2019. Individuals were assessed for eligibility via age, BMI, and medical complications. Weight status was defined based on clinical criteria used by the UK National Institute of Health and Care Excellence. Published systematic reviews were used to estimate effect sizes for treatments, uptake, and completion for each weight-management tier. We used all available evidence, including evidence from studies that showed an unfavourable effect. We estimated the effects of two systematic approaches: a staged approach, in which children and young people were simultaneously given the most intensive treatment for which they were eligible, and a stepped approach, in which each management tier was applied sequentially, with additive effects. The primary outcomes were estimated prevalence of clinical obesity, defined as a BMI ≥98th centile on the UK90 growth chart, and difference in comparison with the estimated baseline prevalence. FINDINGS: 18 080 children and young people were included in the analytical sample. Baseline prevalence of clinical obesity was estimated to be 11·2% (95% CI 10·5 to 11·8) for children and young people aged 2-18 years. In modelling, we estimated absolute decreases in the prevalence of obesity of 0·9% (95% CI 0·1 to 1·8) for universal, preventive interventions; 0·2% (0·1 to 0·4) for interventions within a primary-care setting; 1·0% (0·1 to 2·1) for community and lifestyle interventions; 0·2% (0·0 to 0·4) for pharmaceutical interventions; and 0·4% (0·1 to 0·7) for surgical interventions. Staged care was estimated to result in an absolute decrease in the prevalence of obesity of 1·3% (-0·3 to 2·4) and stepped care was estimated to lead to an absolute decrease of 2·4% (0·1 to 4·8). INTERPRETATION: Although individual effect sizes for prevention and treatment interventions were small, when delivered at scale across England, these interventions have the potential to meaningfully contribute to reducing the prevalence of childhood obesity. FUNDING: UK National Institute for Health and Care Research

Improving immunization uptake rates among Gypsies, Roma and Travellers: a qualitative study of the views of service providers

BACKGROUND: Gypsies, Roma and Travellers are at risk of low uptake of routine immunizations. Interventions to improve uptake in these communities are seldom evaluated. As part of a qualitative study exploring barriers and facilitators to immunization uptake in Travellers, we report service provider (SP) perspectives. METHODS: We interviewed immunization SPs working with six Traveller communities across four UK cities. Participants included frontline staff and those with strategic or commissioning roles. Semi-structured interviews explored perceived attitudes of Travellers to vaccinations, local service delivery, and opportunities and challenges to improving uptake. Audio-recordings were transcribed, analyzed thematically and mapped to a socio-ecological model of health. RESULTS: 39 SPs participated. Four overarching themes were identified: building trusting relationships between SPs and Travellers; facilitating attendance at appointments; improving record keeping and monitoring and responding to local and national policy change. Travellers were perceived as largely supportive of immunizations, though system and organizational processes were recognized barriers to accessing services. CONCLUSIONS: Findings were broadly consistent across Traveller groups and settings. The barriers identified could often be addressed within existing infrastructure, though require system or policy change. Development of a culturally competent system appears important to enable equity in access to immunizations for Travellers

Developing an evaluation strategy in Kashmir: assessing the impact of an arts intervention with school children in an area of conflict

About 1 in 6 children live in areas of conflict globally (Save the children, 2022), with significant impact on mental health, behaviour, and life outcomes (Buser et al., 2023). Research on ways to help prevent and reduce suffering is paramount, yet assessing the impact of interventions on children in the context of conflict is challenging, beset with ethical, cultural and psychometric difficulties (Newman et al., 2006). This practice report shares and reflects on the research strategy developed to evaluate the impact of an arts intervention in the Kashmir Valley, funded by an AHRC Urgency bid to help children in crisis. The study took part in a highly militarised area, where children were regularly exposed to violence, protests and resistance, and education and family life were heavily impacted by military lockdowns. When the study began (June 2020) conditions were further intensified by rising cases of coronavirus. The arts-based intervention occurred at one school and ran throughout their academic year (from August 2020). Thirty children (aged 12-15) were referred by the school to participate in a programme that was integrated into the curriculum and included a range of art activities: painting, writing, puppetry, music and performance, designed to enable expression and improve wellbeing, led by an artist and art therapist (Buser et al., 2023)

Electrocardiographic safety evaluation of dihydroartemisinin piperaquine in the treatment of uncomplicated falciparum malaria.

Dihydroartemisinin-piperaquine (DP) could become a leading fixed combination malaria treatment worldwide. Although there is accumulating evidence of efficacy and safety from clinical trials, data on cardiotoxicity are limited. In two randomized controlled trials in Thailand, 56 patients had ECGs performed before treatment, 4 hours after the first dose, and 4 hours after the last dose. The mean (95% CI) changes in QTc interval (Bazett's correction) were 2 (-6 to 9) ms and 14 (7 to 21) ms, respectively. These small changes on the third day of treatment are similar to those observed elsewhere in the convalescent phase following antimalarial treatment with drugs known to have no cardiac effects and are therefore likely to result from recovery from acute malaria and not the treatment given. At therapeutic doses, DP does not have clinically significant effects on the electrocardiogram

In/secure childhoods: Children and conflict in Kashmir

This paper focuses on art productions by children participating in an art-based wellbeing intervention project in Kashmir. Drawing on feminist security studies, we conducted narrative analysis to explore how children represent in/security. The locations of in/security were the environment, the body, and the socio-political realm. Children articulated nuanced and complex representations of the natural and social world, influenced by local and global forces, and created their own meanings and practices of in/security