OPENMINDS: CREATING A MENTAL HEALTH WORKSHOP FOR TEENAGERS TO TACKLE STIGMA AND RAISE AWARENESS

As a group of four clinical medical students from Cambridge University, we undertook a Student Selected Module (SSC- "OpenMinds") whereby we designed and delivered a workshop about mental health to year 9 pupils. The aim of our SSC was to produce an interactive, informative lesson which addressed the complex issues of stigma and discrimination against those suffering from a mental illness as well as teaching the pupils how to recognise mental health problems and provide them with guidance on how to seek help. We split a fifty minute session into the following sections: tackling stigma; how common mental illness is; celebrity examples; real life examples; role play; and small group work. To engage the pupils we used a combination of teaching modalities targeting all learning. We delivered the workshop to four separate classes and received feedback from the pupils after each. We used this feedback to adapt and improve our presentation and assess the efficacy. Feedback was overwhelmingly positive with the striking results of 101/109 pupils saying that they would recommend the workshop to a friend and 68/109 pupils saying they enjoyed all aspects. Our SSC built upon work by a contingent of trainee Psychiatrists who undertook a similar project of mental health education for teenagers, called "Heads above the rest", in Northern Ireland with great success. By continuing their work we were able to demonstrate that medical students can successfully complete the same project under the guidance of a Psychiatrist, thus increasing the sustainability of the project by reducing the time burden on the Psychiatrists. Participating in the project was also valuable to our own personal development of teaching skills

Implementation of midwifery continuity of care models for Indigenous women in Australia: Perspectives and reflections for the United Kingdom

© 2018 Maternity models that provide midwifery continuity of care have been established to increase access to appropriate services for Indigenous Australian women. Understanding the development and implementation of continuity models for Indigenous women in Australia provides useful insights for the development and implementation of similar models in other contexts such as those for vulnerable and socially disadvantaged women living in the United Kingdom. To ensure better health outcomes for mothers and babies, it is crucial to promote culturally competent and safe public health models in which midwives work collaboratively with the multidisciplinary team

Cost-benefit analysis of ecological networks assessed through spatial analysis of ecosystem services

1.The development of ecological networks could enhance the ability of species to disperse across fragmented landscapes and could mitigate against the negative impacts of climate change. The development of such networks will require widespread ecological restoration at the landscape scale, which is likely to be costly. However, little information is available regarding the cost-effectiveness of restoration approaches. 2.We address this knowledge gap by examining the potential impact of landscape-scale habitat restoration on the value of multiple ecosystem services across the catchment of the River Frome in Dorset, England. This was achieved by mapping the market value of four ecosystem services (carbon storage, crops, livestock and timber) under three different restoration scenarios, estimating restoration costs, and calculating net benefits. 3.The non-market value of additional services (cultural, aesthetic and recreational value) was elicited from local stakeholders using an online survey tool. Flood risk was assessed using a scoring approach. Spatial Multi-Criteria Analysis (MCA) was conducted, incorporating both market and non-market values, to evaluate the relative benefits of restoration scenarios. These were compared with impacts of restoration on biodiversity value. 4.Multi-Criteria Analysis results consistently ranked restoration scenarios above a non-restoration comparator, reflecting the increased provision of multiple ecosystem services. Restoration scenarios also provided benefits to biodiversity, in terms of increased species richness and habitat connectivity. However, restoration costs consistently exceeded the market value of ecosystem services. 5.Synthesis and applications. Establishment of ecological networks through ecological restoration is unlikely to deliver net economic benefits in landscapes dominated by agricultural land use. This reflects the high costs of ecological restoration in such landscapes. The cost-effectiveness of ecological networks will depend on how the benefits provided to people are valued, and on how the value of non-market benefits are weighted against the costs of reduced agricultural and timber production. Future plans for ecological restoration should incorporate local stakeholder values, to ensure that benefits to people are maximised. © 2012 The Authors. Journal of Applied Ecology © 2012 British Ecological Society

Association between SARS-CoV-2 exposure and antibody status among healthcare workers in two London hospitals: a cross-sectional study.

Background: Patient-facing (frontline) health-care workers (HCWs) are at high risk of repeated exposure to SARS-CoV-2. Aim: We sought to determine the association between levels of frontline exposure and likelihood of SARS-CoV-2 seropositivity amongst HCW. Methods: A cross-sectional study was undertaken using purposefully collected data from HCWs at two hospitals in London, United Kingdom (UK) over eight weeks in May-June 2020. Information on sociodemographic, clinical and occupational characteristics was collected using an anonymised questionnaire. Serology was performed using split SARS-CoV-2 IgM/IgG lateral flow immunoassays. Exposure risk was categorised into five pre-defined ordered grades. Multivariable logistic regression was used to examine the association between being frontline and SARS-CoV-2 seropositivity after controlling for other risks of infection. Findings: 615 HCWs participated in the study. 250/615 (40.7%) were SARS-CoV-2 IgM and/or IgG positive. After controlling for other exposures, there was non-significant evidence of a modest association between being a frontline HCW (any level) and SARS-CoV-2 seropositivity compared to non-frontline status (OR 1.39, 95% CI 0.84-2.30, P=0.200). There was 15% increase in the odds of SARS-CoV-2 seropositivity for each step along the frontline exposure gradient (OR 1.15, 95% CI 1.00-1.32, P=0.043). Conclusion: We found a high SARS-CoV-2 IgM/IgG seropositivity with modest evidence for a dose-response association between increasing levels of frontline exposure risk and seropositivity. Even in well-resourced hospital settings, appropriate use of personal protective equipment, in addition to other transmission-based precautions for inpatient care of SARS-CoV-2 patients could reduce the risk of hospital-acquired SARS-CoV-2 infection among frontline HCW

Project 20: Midwives’ insight into continuity of care models for women with social risk factors: what works, for whom, in what circumstances, and how

Introduction Continuity of care models are known to improve clinical outcomes for women and their babies, but it is not understood how. A realist synthesis of how women with social risk factors experience UK maternity care reported mechanisms thought to improve clinical outcomes and experiences. As part of a broader programme of work to test those theories and fill gaps in the literature base we conducted focus groups with midwives working within continuity of care models of care for women with social factors that put them at a higher chance of having poor birth outcomes. These risk factors can include poverty and social isolation, asylum or refugee status, domestic abuse, mental illness, learning difficulties, and substance abuse problems. Objective To explore the insights of midwives working in continuity models of care for women with social risk factors in order to understand the resources they provide, and how the model of care can improve women’s outcomes. Design Realist methodology was used to gain a deeper understanding of how women react to specific resources that the models of care offer and how these resources are thought to lead to particular outcomes for women. Twelve midwives participated, six from a continuity of care model implemented in a community setting serving an area of deprivation in London, and six from a continuity of care model for women with social risk factors, based within a large teaching hospital in London. Findings Three main themes were identified: ‘Perceptions of the model of care, ‘Tailoring the service to meet women’s needs’, ‘Going above and beyond’. Each theme is broken down into three subthemes to reveal specific resources or mechanisms which midwives felt might have an impact on women’s outcomes, and how women with different social risk factors respond to these mechanisms. Conclusions/implications for practice Overall the midwives in both models of care felt the service was beneficial to women and had a positive impact on their outcomes. It was thought the trusting relationships they had built with women enabled midwives to guide women through a fragmented, unfamiliar system and respond to their individual physical, emotional, and social needs, whilst ensuring follow-up of appointments and test results. Midwives felt that for these women the impact of a trusting relationship affected how much information women disclosed, allowing for enhanced, needs led, holistic care. Interesting mechanisms were identified when discussing women who had social care involvement with midwives revealing techniques they used to advocate for women and help them to regain trust in the system and demonstrate their parenting abilities. Differences in how each team provided care and its impact on women’s outcomes were considered with the midwives in the community-based model reporting how their location enabled them to help women integrate into their local community and make use of specialist services. The study demonstrates the complexity of these models of care, with midwives using innovative and compassionate ways of working to meet the multifaceted needs of this population

Changes in the Concentration of Leaf Nitrogen over the Season Affect the Diagnosis of Deficiency or Sufficiency in Strawberries in the Subtropics

Optimum leaf nitrogen (N) concentrations have been identified for strawberry (Fragaria ×ananassa Duch.) in temperate and Mediterranean areas, but whether these values are appropriate for the subtropics is unclear. Two experiments were conducted for 2 years to determine if the seasonal changes in the concentration of leaf N affect the diagnosis of deficiency or sufficiency of strawberry plants in Queensland, Australia. In 2014, ‘Festival’, ‘Fortuna’, and ‘Winter Dawn’ were planted in early April and grown with and without N for the entire season. Then, ‘Festival’ was planted the following year in mid- or late April and, again, was grown with and without N. Yield was slightly lower with N in 2014, but higher with it the following year, particularly in the early planting. The concentration of total N in young, fully expanded leaves decreased from 3.0% to 2.0% as leaf, crown, and root dry weight increased, while the concentration of nitrate-N (NO3-N) decreased from 1200–3200 to 50–500 mg/kg. These changes in leaf N were large enough to affect the diagnosis of N deficiency or sufficiency. The concentration of leaf N was less variable than the concentration of leaf NO3-N and, therefore, better for estimating the nutrient status of strawberry plants in the subtropics

Project20: Maternity care mechanisms that improve (or exacerbate) health inequalities. A realist evaluation

Background Women with low socioeconomic status and social risk factors are at a disproportionate risk of poor birth outcomes and experiences of maternity care. Specialist models of maternity care that offer continuity are known to improve outcomes but underlying mechanisms are not well understood. Aim To evaluate two UK specialist models of care that provide continuity to women with social risk factors and identify specific mechanisms that reduce, or exacerbate, health inequalities. Methods Realist informed interviews were undertaken throughout pregnancy and the postnatal period with 20 women with social risk factors who experienced a specialist model of care. Findings Experiences of stigma, discrimination and paternalistic care were reported when women were not in the presence of a known midwife during care episodes. Practical and emotional support, and evidence-based information offered by a known midwife improved disclosure of social risk factors, eased perceptions of surveillance and enabled active participation. Continuity of care offered reduced women’s anxiety, enabled the development of a supportive network and improved women’s ability to seek timely help. Women described how specialist model midwives knew their medical and social history and how this improved safety. Care set in the community by a team of six known midwives appeared to enhance these benefits. Conclusion The identification of specific maternity care mechanisms supports current policy initiatives to scale up continuity models and will be useful in future evaluation of services for marginalised groups. However, the specialist models of care cannot overcome all inequalities without improvements in the maternity system as a whole