The Experience of Unemployment in Ireland: A Thematic Analysis

This paper reports on the results of 13 semi-structured focus groups carried out with unemployed respondents across Ireland in 2010. The purpose of the research is to examine the subjective experience of unemployment across a wide range of dimensions. 15 overarching themes emerged from a detailed thematic analysis of the texts of the interviews. The themes highlight a wide range of aversive psychological states associated with unemployment. The themes examine: perceptions of the economic boom; reactions to the recession; attitudes toward media coverage; gender differences in experiences of unemployment; financial worries relating to unemployment; perceptions of the position of young people; uncertainty about the future; lack of structure and routine associated with unemployment; health issues associated with unemployment; identity challenges; the social context of unemployment; issues surrounding reentering employment; attitudes toward social protection payments; social comparison effect and perceptions of training services. This paper concludes with a brief discussion of the psychological impact of unemployment.

Effectiveness of financial incentives to improve adherence to maintenance treatment with antipsychotics: cluster randomised controlled trial

Objective: To test whether offering financial incentives to patients with psychotic disorders is effective in improving adherence to maintenance treatment with antipsychotics. Design: Cluster randomised controlled trial. Setting: Community mental health teams in secondary psychiatric care in the United Kingdom. Participants: Patients with a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder, who were prescribed long acting antipsychotic (depot) injections but had received 75% or less of the prescribed injections. We randomly allocated 73 teams with a total of 141 patients. Primary outcome data were available for 35 intervention teams with 75 patients (96% of randomised) and for 31 control teams with 56 patients (89% of randomised). Interventions: Participants in the intervention group were offered £15 (€17; $22) for each depot injection over a 12 month period. Participants in the control condition received treatment as usual. Main outcome measure: The primary outcome was the percentage of prescribed depot injections given during the 12 month intervention period. Results 73 teams with 141 consenting patients were randomised, and outcomes were assessed for 131 patients (93%).⇓ Average baseline adherence was 69% in the intervention group and 67% in the control group. During the 12 month trial period adherence was 85% in the intervention group and 71% in the control group. The adjusted effect estimate was 11.5% (95% confidence interval 3.9% to 19.0%, P=0.003). A secondary outcome was an adherence of ≥95%, which was achieved in 28% of the intervention group and 5% of the control group (adjusted odds ratio 8.21, 95% confidence interval 2.00 to 33.67, P=0.003). Although differences in clinician rated clinical improvement between the groups failed to reach statistical significance, patients in the intervention group had more favourable subjective quality of life ratings (β=0.71, 95% confidence interval 0.26 to 1.15, P=0.002). The number of admissions to hospital and adverse events were low in both groups and did not show substantial differences. Conclusion: Offering modest financial incentives to patients with psychotic disorders is an effective method for improving adherence to maintenance treatment with antipsychotics

Agreement between activPAL and ActiGraph for assessing children's sedentary time

BackgroundAccelerometers have been used to determine the amount of time that children spend sedentary. However, as time spent sitting may be detrimental to health, research is needed to examine whether accelerometer sedentary cut-points reflect the amount of time children spend sitting. The aim of this study was to: a) examine agreement between ActiGraph (AG) cut-points for sedentary time and objectively-assessed periods of free-living sitting and sitting plus standing time using the activPAL (aP); and b) identify cut-points to determine time spent sitting and sitting plus standing.MethodsForty-eight children (54% boys) aged 8&ndash;12 years wore a waist-mounted AG and thigh-mounted aP for two consecutive school days (9&ndash;3:30 pm). AG data were analyzed using 17 cut-points between 50&ndash;850 counts&middot;min&minus;1 in 50 counts&middot;min&minus;1 increments to determine sedentary time during class-time, break time and school hours. Sitting and sitting plus standing time were obtained from the aP for these periods. Limits of agreement were computed to evaluate bias between AG50 to AG850 sedentary time and sitting and sitting plus standing time. Receiver Operator Characteristic (ROC) analyses identified AG cutpoints that maximized sensitivity and specificity for sitting and sitting plus standing time.ResultsThe smallest mean bias between aP sitting time and AG sedentary time was AG150 for class time (3.8 minutes), AG50 for break time (&minus;0.8 minutes), and AG100 for school hours (&minus;5.2 minutes). For sitting plus standing time, the smallest bias was observed for AG850. ROC analyses revealed an optimal cut-point of 96 counts&middot;min&minus;1 (AUC = 0.75) for sitting time, which had acceptable sensitivity (71.7%) and specificity (67.8%). No optimal cut-point was obtained for sitting plus standing (AUC = 0.51).ConclusionsEstimates of free-living sitting time in children during school hours can be obtained using an AG cut-point of 100 counts&middot;min&minus;1. Higher sedentary cut-points may capture both sitting and standing time.<br /

Application of a novel tool for diagnosing bile acid diarrhoea

Bile acid diarrhoea (BAD) is a common disease that requires expensive imaging to diagnose. We have tested the efficacy of a new method to identify BAD, based on the detection of differences in volatile organic compounds (VOC) in urine headspace of BAD vs. ulcerative colitis and healthy controls. A total of 110 patients were recruited; 23 with BAD, 42 with ulcerative colitis (UC) and 45 controls. Patients with BAD also received standard imaging (Se75HCAT) for confirmation. Urine samples were collected and the headspace analysed using an AlphaMOS Fox 4000 electronic nose in combination with an Owlstone Lonestar Field Asymmetric Ion Mobility Spectrometer (FAIMS). A subset was also tested by gas chromatography, mass spectrometry (GCMS). Linear Discriminant Analysis (LDA) was used to explore both the electronic nose and FAIMS data. LDA showed statistical differences between the groups, with reclassification success rates (using an n-1 approach) at typically 83%. GCMS experiments confirmed these results and showed that patients with BAD had two chemical compounds, 2-propanol and acetamide, that were either not present or were in much reduced quantities in the ulcerative colitis and control samples. We believe that this work may lead to a new tool to diagnose BAD, which is cheaper, quicker and easier that current methods

Screening for markers of frailty and perceived risk of adverse outcomes using the Risk Instrument for Screening in the Community (RISC)

BACKGROUND: Functional decline and frailty are common in community dwelling older adults, increasing the risk of adverse outcomes. Given this, we investigated the prevalence of frailty-associated risk factors and their distribution according to the severity of perceived risk in a cohort of community dwelling older adults, using the Risk Instrument for Screening in the Community (RISC). METHODS: A cohort of 803 community dwelling older adults were scored for frailty by their public health nurse (PHN) using the Clinical Frailty Scale (CFS) and for risk of three adverse outcomes: i) institutionalisation, ii) hospitalisation and iii) death, within the next year, from one (lowest) to five (highest) using the RISC. Prior to scoring, PHNs stated whether they regarded patients as frail. RESULTS: The median age of patients was 80 years (interquartile range 10), of whom 64% were female and 47.4% were living alone. The median Abbreviated Mental Test Score (AMTS) was 10 (0) and Barthel Index was 18/20 (6). PHNs regarded 42% of patients as frail, while the CFS categorized 54% (scoring ≥5) as frail. Dividing patients into low-risk (score one or two), medium-risk (score three) and high-risk (score four or five) using the RISC showed that 4.3% were considered high risk of institutionalization, 14.5% for hospitalization, and 2.7% for death, within one year of the assessment. There were significant differences in median CFS (4/9 versus 6/9 versus 6/9, p < 0.001), Barthel Index (18/20 versus 11/20 versus 14/20, p < 0.001) and mean AMTS scores (9.51 versus 7.57 versus 7.00, p < 0.001) between those considered low, medium and high risk of institutionalisation respectively. Differences were also statistically significant for hospitalisation and death. Age, gender and living alone were inconsistently associated with perceived risk. Frailty most closely correlated with functional impairment, r = −0.80, p < 0.001. CONCLUSION: The majority of patients in this community sample were perceived to be low risk for adverse outcomes. Frailty, cognitive impairment and functional status were markers of perceived risk. Age, gender and social isolation were not and may not be useful indicators when triaging community dwellers. The RISC now requires validation against adverse outcomes

Variation in gas and volatile compound emissions from human urine as it ages, measured by an electronic nose

The medical profession is becoming ever more interested in the use of gas-phase biomarkers for disease identification and monitoring. This is due in part to its rapid analysis time and low test cost, which makes it attractive for many different clinical arenas. One technology that is showing promise for analyzing these gas-phase biomarkers is the electronic nose-an instrument designed to replicate the biological olfactory system. Of the possible biological media available to "sniff", urine is becoming ever more important as it is easy to collect and to store for batch testing. However, this raises the question of sample storage shelf-life, even at -80 °C. Here we investigated the effect of storage time (years) on stability and reproducibility of total gas/vapour emissions from urine samples. Urine samples from 87 patients with Type 2 Diabetes Mellitus were collected over a four-year period and stored at -80 °C. These samples were then analyzed using FAIMS (field-asymmetric ion mobility spectrometry-a type of electronic nose). It was discovered that gas emissions (concentration and diversity) reduced over time. However, there was less variation in the initial nine months of storage with greater uniformity and stability of concentrations together with tighter clustering of the total number of chemicals released. This suggests that nine months could be considered a general guide to a sample shelf-life

Citizens defining citizenship : a model grounded in lived experience and its implications for research, policy and practice

Citizenship is gaining currency in health and social care internationally as a way of making sense of the lived experiences of people with major life disruptions who face exclusion, marginalisation and discrimination, but the concept is often contested, poorly defined and understood. This paper charts the development of an empirical model of citizenship within Scotland, UK. A mixed method, community based participatory research approach using 10 focus groups (n = 77), concept mapping exercises (n = 45) and statement clarity and relevant ratings (n = 242) was used to develop a model of citizenship that is grounded in the lived experience of participants, which is absent from current conceptualisations of citizenship. Multidimensional scaling and hierarchical cluster analysis revealed five core domains emerging from our work: 'building relationships', 'autonomy and acceptance', 'access to services and supports', 'shared values and social roles' and 'civic rights and responsibilities' representing the personal meanings of citizenship for participants. We argue that the value of this model is that is draws upon the personal understandings and experiences of participants who emphasised the "banal ordinariness" of its core elements. We suggest that the model makes an original contribution by clearly illustrating the practical applicability of citizenship as a concept thus enhancing existing theories of citizenship. Our model highlights the interplay between the relational and structural aspects of citizenship and acknowledging the barriers that marginalised groups face in claiming their citizenship rights. It offers a call to action for policy makers and practitioners to set goals that contribute to the social inclusion of those who have experienced major life disruptions

Understanding citizenship within a health and social care context in Scotland using community based participatory research methods

Community based participatory research (CBPR) principles were used to develop a conceptual framework of citizenship for people experiencing mental health problems and/or other life disrupting events in Scotland. This case study illustrates the use of a participatory methodology replicating an approach adopted as part of an international collaboration in understanding citizenship across diverse social and cultural contexts. Reflecting on the approach taken, we argue that it encourages the development of a model of citizenship that is entirely grounded in the perspectives and lived experiences of the participants. We consider the importance of ‘meaningfully’ engaging peer researchers throughout the research process, exploring the methodological issues, challenges and opportunities when working in partnership. The importance of adopting a reflexive approach throughout the research approach is emphasised. We consider how the need for adequate resources, preparatory work, training and research management is key to the success of a CBPR approach with peer researchers. Finally, we suggest making appropriate adaptations to any research methodology when working with diverse populations, particularly the ‘seldom heard’ groups within society, in order to inform health and social policy and practice

The Impact of Depression, Anxiety and Personality Disorders on the Outcome of Patients with Functional Limb Weakness – Individual Patient Data Meta-Analysis

Objective: Psychiatric comorbidities such as depression, anxiety, and personality disorders are common in patients with functional limb weakness/paresis (FND-par). The impact of these conditions on the prognosis of FND-par has not been systematically reviewed. The aim of this study was to identify a potential prognostic effect of comorbid depression, anxiety, and/or personality disorder on prognosis in patients with FND-par. Methods: A systematic review was performed to identify studies that reported measures of baseline depression, anxiety, and/or personality disorder, and physical disability. An individual patient data meta-analysis was subsequently performed. Results: Eight studies comprising 348 individuals were included (7 prospective cohorts; 1 case-control study). There was heterogeneity in sample size, follow-up duration, and treatment modality. Depression and anxiety were present in 51.4% and 53.0% of FND-par patients, respectively. In individuals whose FND-par improved, there was no significant difference between those with versus without depression (52.6% vs 47.4%, p = 0.69) or those with versus without anxiety (50.3% vs 49.7%, p = 0.38). Meta-analysis showed no clear impact of baseline depression or anxiety per se [pooled OR for depression 0.85 (95%CI 0.50–1.45; p = 0.40) and anxiety 0.84 (95%CI 0.51–1.38; p = 0.91)]; and of depression or anxiety severity [pooled OR for depression 1.23 (95%CI 0.63–2.39; p = 0.91) and anxiety 1.40 (95%CI 0.70–2.78; p = 0.58)] on FND-par outcome. Insufficient data were available to assess the impact of personality disorders. Conclusion: We found no evidence that depression or anxiety influenced outcome in FND-par. Large-scale, prospective studies in FND-par, and other FND subtypes, are needed to fully contextualize the impact of concurrent mental health concerns on outcomes.</p

What's citizenship got to do with mental health? Rationale for inclusion of citizenship as part of a mental health strategy

Purpose: People with lived experience of mental health problems (MHPs) are often marginalised and have difficulty achieving community inclusion. Citizenship, a relatively novel concept in mental health, provides a means of understanding what is necessary for marginalised individuals and groups to gain a sense of belonging within their communities. By exploring the “what, why, how and who” of citizenship, the purpose of this paper is to provide a rationale for the inclusion of citizenship as part of a person-centred and holistic mental health strategy. Design/methodology/approach: A community-based participatory research (CBPR) approach, with peer researchers, was adopted to develop a model of citizenship within a Scottish context. The aim of the model is to link the concept of citizenship with specific strategies that systems, agencies and individuals can use within mental health policy and practice to promote greater inclusion and participation. Concept mapping was used as part of a mixed-methods participatory methodology and data were then analysed using multivariate statistical methods of multidimensional scaling and hierarchical cluster analysis. Findings: It is argued that using a CBPR approach, utilising concept mapping, encourages the development of a model of citizenship that is entirely grounded in the perspectives and lived experiences of people with MHPs. The need for adequate resources, preparatory work, training, research management and reflexive practice are key to the success of a CBPR approach with peer researchers. Originality/value: Working with peer researchers and key stakeholder groups is central to a CBPR approach and the implementation of a model of citizenship within mental health policy and practice. Developing a model of citizenship derived specifically from the experiences of people with lived experience is likely to promote their inclusion. It provides a means of challenging the structural deficits and inequalities that cause distress and prevent people with lived experience of MHPs of recovering their citizenship