Effective strategies to strengthen the mental health and wellbeing of Aboriginal and Torres Strait Islander people

Introduction: The purpose of this paper is to draw on Aboriginal and Torres Strait Islander (Indigenous) perspectives, theoretical understandings, and available evidence to answer questions about what is required to effectively address Indigenous people’s mental health and social and emotional wellbeing. Social and emotional wellbeing is a multifaceted concept. Although the term is often used to describe issues of ‘mental health’ and ‘mental illness’, it has a broader scope in that Indigenous culture takes a holistic view of health. It recognises the importance of connection to land, culture, spirituality, ancestry, family and community, how these connections have been shaped across generations, and the processes by which they affect individual wellbeing. It is a whole-of-life view, and it includes the interdependent relationships between families, communities, land, sea and spirit and the cyclical concept of life–death–life. Importantly, these concepts and understandings of maintaining and restoring health and social and emotional wellbeing differ markedly to those in many non-Indigenous-specific (or mainstream) programs that tend to emphasise an individual’s behavioural and emotional strengths and ability to adapt and cope with the challenges of life. This paper explores the central question of ‘what are culturally appropriate mental health and social and emotional wellbeing programs and services for Indigenous people, and how are these best delivered?’. It identifies Indigenous perspectives of what is required for service provision and program delivery that align with Indigenous beliefs, values, needs and priorities. It explores the evidence and consensus around the principles of best practice in Indigenous mental health programs and services. It discusses these principles of best practice with examples of programs and research that show how these values and perspectives can be achieved in program design and delivery. This paper seeks to provide an evidence-based, theoretically coherent discussion of the factors that influence the effective development, implementation and outcomes of initiatives to address Indigenous mental health and wellbeing issues. It seeks to assess whether the current investment in Indigenous people’s mental health is aligned with available evidence on what works. To this end, the paper reviews Australian literature and government health, mental health and social and emotional wellbeing policies and programs. The scope of programs and their criteria for inclusion in this paper are informed by the Key Result Area 4, Social and Emotional Wellbeing objectives, within the National Strategic Framework for Aboriginal and Torres Strait Islander Health 2003–13: Australian Government Implementation Plan 2007–2013. This paper acknowledges the holistic nature of health, mental health and wellbeing, and the effects of Australia’s colonial history and legacy on the contemporary state of Indigenous social and emotional wellbeing. It recognises that there is a complex relationship between social and emotional wellbeing, harmful substance misuse, suicide, and a range of social and economic factors. Although this paper encompasses the broad priorities identified within the key Indigenous mental health policies and frameworks, it does not provide a detailed discussion of programs and resources that, although relevant here, are covered in a number of existing Closing the Gap Clearinghouse resource sheets and issues papers (see Appendix 1). These interweavings and overlaps are not surprising given the complexity and interconnectedness of the issues and determinants that are being addressed to strengthen Indigenous mental health and wellbeing

Multiconfiguration Loads Analysis for Missions with an Uncertain Rideshare Manifest

Rideshare or “multi-manifest” missions – where several smaller “rideshare” spacecraft are launched together, usually with a larger “forward” spacecraft – are becoming increasingly common. In many cases, the properties or configuration of the rideshare spacecraft are not well-defined during initial launch manifesting and may not be finalized until a few months before launch. In this paper, a multiconfiguration loads analysis (MLA) process is presented that can enable flexibility in the mission manifesting process by allowing for uncertainty in the final rideshare configuration, including late manifest changes or swaps, without requiring additional loads analyses to those specified in the Load Cycle Process. By applying the MLA process, a set of adequately conservative loads can be generated for the forward spacecraft, launch vehicle, and potential rideshare spacecraft that account for uncertainty in the rideshare manifest and minimize the potential for issues late in the process. The MLA process will also define a mission-specific dynamic properties envelope that would allow rideshare spacecraft that “fit” within the envelope to be swapped. If all parts of the system are verified to match the models used in analysis and designed to survive the bounding loads, the launch manifest can be changed after analyses are completed, much closer to launch, without incurring increased risk

Surgeon Personal Factors Associated with Care Strategies in Musculoskeletal Telehealth

Background: Most surgeons used, or are currently using telehealth during the SARS-CoV-2 (COVID-19) pandemic. We studied surgeon personal factors associated with relative use of telehealth during the worldwide height of the pandemic. Questions/Purposes: (1) Are there any personal factors/characteristics associated with use and utilization of telehealth? (2) What are surgeon’s perspectives/ opinions with regard to use of telehealth for five common upper extremity conditions in terms of future prospects and viability? Methods: Hand and upper extremity surgeons in the Science of Variation Group (SOVG) were invited to participate in a web-based survey. The first part of the survey focused on surgeon characteristics and work preferences. The second part focused on care strategies during the pandemic and utilization of telehealth. The final part of the survey addressed the care of five common upper extremity conditions during the pandemic. Results: Ninety percent of surgeons used telehealth during the first few months of the pandemic, but only 20% of visits were virtual. A greater percentage of telehealth visits compared to office visits was independently associated with a policy of only seeing people with emergencies in person (RC: 0.64; CI 95%: 0.21 to 1.1; P&lt;0.01). Surgeons found it difficult to reproduce most parts of the physical examination on video, but relatively easy to make a diagnosis, with both ratings associated with less belief that the physical exam is essential. Comfort in offering surgery by video visit was associated with having young children, preference for remote meetings, and less belief that the physical exam is essential. Conclusion: Utilization of, and comfort with, telehealth is related to personal factors and preferences, acceptance of a more limited physical examination in particular. Utilization of early adopters and training to increase comfort with the probabilistic aspects of medicine could facilitate incorporation of telehealth into standard practice.</p

Are Patient Linguistic Tones Associated with Mental Health and Perceived Clinician Empathy?

Background:Musculoskeletal specialists have the expertise to distinguish between (1) symptoms that correspond well with observed pathophysiology and (2) disproportionate or incongruent symptoms that may suggest mental and social health opportunities. There is evidence that patient verbal and nonverbal communication can help with this discernment. This study carried this line of research one step further by addressing whether patient linguistic tones, as assessed with use of Linguistic Inquiry and Word Count (LIWC), are associated with symptoms of depression and health anxiety. We also sought associations between both patient and clinician linguistic tones and patient-perceived clinician empathy.Methods:A secondary analysis of transcripts of video and audio recordings of 109 adult patients seeking musculoskeletal specialty care was performed. Patients also completed questionnaires quantifying symptoms of depression (PROMIS [Patient-Reported Outcomes Measurement Information System] Depression computerized adaptive test), self-efficacy when in pain (Pain Self-Efficacy Questionnaire, 2-question version), symptoms of health anxiety (5-item Short Health Anxiety Inventory [SHAI-5]), and perceived clinician empathy (Jefferson Scale of Patient Perceptions of Physician Empathy [JSPPPE]). LIWC was used to detect the relative strength of various emotional tones, cognitive processes, and core drives and needs. Bivariate and multivariable regression analyses sought factors associated with symptoms of depression, symptoms of health anxiety, and patient perception of clinician empathy.Results:After accounting for demographic variables, there were no specific patient linguistic tones (e.g., sadness, positive emotions, negative emotions, anger, and the use of adjectives) associated with health anxiety and symptoms of depression, pain, self-efficacy, and patient-perceived clinician empathy. There were no clinician linguistic tones associated with perceived clinician empathy. There was no relationship between the sum of emotional words and symptoms of depression.Conclusions:Musculoskeletal specialists cannot depend on people experiencing symptoms of psychological distress to verbally express their feelings.Clinical Relevance:Specialists may be more likely to identify important symptoms of psychological distress if they anticipate lower emotional expressiveness and are attentive to specific words, concepts, and mannerisms known to be associated with distress.</p

The long-term impact of folic acid in pregnancy on offspring DNA methylation : follow-up of the Aberdeen folic acid supplementation trial (AFAST)

Funding This work was supported by the NIHR Bristol Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. R.C.R., G.C.S., N.K., T.G., G.D.S. and C.L.R. work in a unit that receives funds from the University of Bristol and the UK Medical Research Council (MC_UU_12013/1, MC_UU_12013/2 and MC_UU_12013/8). This work was also supported by CRUK (grant number C18281/A19169) and the ESRC (grant number ES/N000498/1). C.M.T. is supported by a Wellcome Trust Career Re-entry Fellowship (grant number 104077/Z/14/Z).Peer reviewedPublisher PD

Draper Station Analysis Tool

Draper Station Analysis Tool (DSAT) is a computer program, built on commercially available software, for simulating and analyzing complex dynamic systems. Heretofore used in designing and verifying guidance, navigation, and control systems of the International Space Station, DSAT has a modular architecture that lends itself to modification for application to spacecraft or terrestrial systems. DSAT consists of user-interface, data-structures, simulation-generation, analysis, plotting, documentation, and help components. DSAT automates the construction of simulations and the process of analysis. DSAT provides a graphical user interface (GUI), plus a Web-enabled interface, similar to the GUI, that enables a remotely located user to gain access to the full capabilities of DSAT via the Internet and Webbrowser software. Data structures are used to define the GUI, the Web-enabled interface, simulations, and analyses. Three data structures define the type of analysis to be performed: closed-loop simulation, frequency response, and/or stability margins. DSAT can be executed on almost any workstation, desktop, or laptop computer. DSAT provides better than an order of magnitude improvement in cost, schedule, and risk assessment for simulation based design and verification of complex dynamic systems