South Africa in the Antarctic Circumnavigation Expedition: a multi-institutional and interdisciplinary scientific project

publisher versionThe polar regions are more critically affected by climate change than any other region on our planet.1,2 On the Antarctic continent and in its surrounding oceans, the effects of climate change are likely to be dramatic,3 and include largescale catastrophic ice melt, loss of habitat and biodiversity, and global sea level rise. The ‘Southern Ocean’ refers to the region where Atlantic, Indian and Pacific Ocean waters come together to encircle Antarctica. These waters connect the different ocean basins by linking the shallow and deep limbs of the global ocean current system (‘overturning circulation’) and play a critical role in storing and distributing heat and carbon dioxide (CO2 ). The Southern Ocean thus regulates not only the climate of the Antarctic, but of the entire earth system.1,4 By extension, the capacity of the global ocean to ameliorate earth’s changing climate is strongly controlled by the Southern Ocean. Marine phytoplankton (microscopic plants inhabiting the sunlit upper ocean) convert CO2 (an inorganic form of carbon) dissolved in surface waters into organic carbon through photosynthesis. This organic carbon fuels upper trophic levels such as fish, mammals and birds, and a portion sinks into the deep ocean where it remains stored for hundreds to thousands of years. This mechanism, which lowers the atmospheric concentration of CO2 , is termed the ‘biological pump’.5 The efficiency of the global ocean’s biological pump is currently limited by the Southern Ocean, where the macronutrients (nitrate and phosphate) required for photosynthesis are never fully consumed in surface waters. In theory, increased consumption of these nutrients could drive higher organic carbon removal to the deep ocean, enhancing the oceanic uptake of atmospheric CO2 . Indeed, more complete consumption of Southern Ocean nutrients is a leading hypothesis for the decrease in atmospheric CO2 that characterised the ice ages.6 Despite the global importance of the Southern Ocean, knowledge of the controls on and interactions among the physical, chemical and biological processes operating in Antarctic ecosystems is limited, largely because of a scarcity of in-situ observational data, compounded by the challenge of integrating siloed scientific fields. Given predictions that diverse aspects of Southern Ocean physics and carbon biogeochemistry are likely to change in the coming decades, a transdisciplinary approach to studying Antarctic systems is critical

Perinatal maternal life events and psychotic experiences in children at twelve years in a birth cohort study

Background: International studies indicate that the median prevalence of psychotic experiences in children is 7%. It has been proposed that environmental stress during pregnancy may affect the neurodevelopment of the foetus and lead to a vulnerability in the child to later stressors and psychopathology.Aim: In this study we explore the relationship between environmental stress during pregnancy and psychotic experiences in children in the general population at 12 years.Methods: We analysed a birth cohort of 5038 children from the Avon Longitudinal Study of Parents and Children. Environmental stress was measured as life event exposure. Data on life events were collected on women during their pregnancy, whilst psychotic experiences in the offspring were assessed at age 12.Results: There was a weak association between maternal exposure to life events and psychotic experiences at twelve years (crude OR 1.10 95% CI 1.02–1.18) per quartile of life event score. This association was not reduced after adjustment for socio-economic status, family history of schizophrenia, maternal education or birth weight but after adjustment for maternal anxiety and depression and smoking in early pregnancy there was no longer any evidence for an association (OR 1.01 95% CI 0.93–1.10).Conclusion: This study provides some evidence to suggest that stressful life events may affect child psychotic experiences through effects on maternal psychopathology, and possibly physiology, during pregnancy

Understanding social and clinical associations with unemployment for people with schizophrenia and bipolar disorders: large-scale health records study

Purpose People with severe mental illness (SMI) experience high levels of unemployment. We aimed to better understand the associations between clinical, social, and demographic inequality indicators and unemployment. Methods Data were extracted from de-identified health records of people with SMI in contact with secondary mental health services in south London, UK. A Natural Language Processing text-mining application was applied to extract information on unemployment in the health records. Multivariable logistic regression was used to assess associations with unemployment, in people with SMI. Results Records from 19,768 service users were used for analysis, 84.9% (n = 16,778) had experienced unemployment. In fully adjusted models, Black Caribbean and Black African service users were more likely to experience unemployment compared with White British service users (Black Caribbean: aOR 1.62, 95% CI 1.45–1.80; Black African: 1.32, 1.15–1.51). Although men were more likely to have experienced unemployment relative to women in unadjusted models (OR 1.36, 95% CI 1.26–1.47), differences were no longer apparent in the fully adjusted models (aOR 1.05, 95% CI 0.97–1.15). The presence of a non-affective (compared to affective) diagnosis (1.24, 1.13–1.35), comorbid substance use (2.02, 1.76–2.33), previous inpatient admissions (4.18, 3.71–4.70), longer inpatient stays (78 + days: 7.78, 6.34–9.54), and compulsory admissions (3.45, 3.04–3.92) were associated with unemployment, in fully adjusted models. Conclusion People with SMI experience high levels of unemployment, and we found that unemployment was associated with several clinical and social factors. Interventions to address low employment may need to also address these broader inequalities

Systematic review of fit note use for workers in the UK

ObjectivesThe fit note, introduced in England, Wales and Scotland in 2010, was designed to change radically the sickness certification process from advising individuals on their inability to work to advising them on what they could do if work could be adapted. Our review aimed to evaluate the following: (1) Is the ‘maybe fit’ for work option being selected for patients? (2) Are work solutions being recommended? (3) Has the fit note increased return to work? (4) Has the fit note reduced the length of sickness absence? We considered the way in which outcomes vary according to patient demographics including type of health problem.MethodsStudies were identified by a systematic search. We included all studies of any design conducted in the UK with working age adults, aged 16 or over, from 1 April 2010 to 1 Nov 2017. Risk of bias was assessed using a modified Newcastle-Ottawa Scale.ResultsThirteen papers representing seven studies met inclusion criteria. In the largest study, ‘maybe fit’ for work was recommended in 6.5% of fit notes delivered by general practitioners (GP; n=361 801) between April 2016 and March 2017. ‘Maybe fit’ recommendations were made in 8.5%–10% of fit notes received by primary care patients in employment, and in 10%–32% of patients seen by GPs trained in the Diploma in Occupational Medicine. ‘Maybe fit’ was recommended more for women, those with higher socioeconomic status, and for physical, as opposed to psychiatric disorders. The majority of fit notes with the ‘maybe fit’ option selected included work solutions. There was inconclusive evidence to suggest that the introduction of the fit note has reduced sickness absence among patients in employment.ConclusionsFit notes represent a major shift in public policy. Our review suggests that they have been incompletely researched and not implemented as intended.</jats:sec

Suicidal thoughts and behaviour among healthcare workers in England during the COVID-19 pandemic: A longitudinal study

BACKGROUND: During the COVID-19 pandemic, concern has been raised about suicide risk among healthcare workers (HCWs). We investigated the incidence risk and prevalence of suicidal thoughts and behaviour (STB), and their relationship with occupational risk factors, among National Health Service HCWs in England between April 2020 and August 2021. METHODS: In this longitudinal study, we analysed online survey data completed by 22,501 HCWs from 17 NHS Trusts at baseline (Time 1) and six months (Time 2). The primary outcome measures were suicidal ideation, suicide attempts, and non-suicidal self-injury. We used logistic regression to investigate the relationship between these outcomes and demographic characteristics and occupational factors. Results were stratified by occupational role (clinical/non-clinical). RESULTS: Time 1 and Time 2 surveys were completed by 12,514 and 7,160 HCWs, respectively. At baseline, 10.8% (95% CI = 10.1%, 11.6%) of participants reported having experienced suicidal thoughts in the previous two months, whilst 2.1% (95% CI = 1.8%, 2.5%) of participants reported having attempted suicide over the same period. Among HCWs who had not experienced suicidal thoughts at baseline (and who completed the Time 2 survey), 11.3% (95%CI = 10.4%, 12.3%) reported such thoughts six months later. Six months after baseline, 3.9% (95% CI = 3.4%, 4.4%) of HCWs reported attempting suicide for the first time. Exposure to potentially morally injurious events, lack of confidence about raising safety concerns and these concerns being addressed, feeling unsupported by managers, and providing a reduced standard of care were all associated with increased suicidal ideation among HCWs during the COVID-19 pandemic. At six months, among clinicians, a lack of confidence about safety concerns being addressed, independently predicted suicidal ideation. CONCLUSION: Suicidal thoughts and behaviour among healthcare workers could be reduced by improving managerial support and enhancing the ability of staff to raise safety concerns

Cohort profile: Working age adults accessing secondary mental healthcare services in South London (UK) and benefits – A data linkage of electronic mental healthcare records and benefits data

Objectives To present an overview of a cohort of working age adults accessing secondary mental healthcare services and benefits related to unemployment, sickness, disability, or income support and describe the different benefit types received across diagnostic and sociodemographic groups. Methods Using a novel data linkage containing electronic secondary mental health care records from the South London and Maudsley (SLaM) NHS Foundation Trust and benefits data from the Department for Work and Pensions (DWP), we present descriptive statistics on a cohort of working age adults. The data window covers the period January 2007-June 2020. Results We identified n=150,348 patients of working age (18-65 years), who had attended SLaM secondary mental health care services, 78.3% of which had received a benefit relating to unemployment, sickness, disability, or income support. Of this group, 68% had a recorded primary psychiatric diagnosis. We found that a much higher percentage of those with a primary psychiatric diagnosis received more than one benefit (69.4%) compared to those who had not received a primary psychiatric diagnosis (30.6%). Conclusions We showed types of benefits received among working age adults accessing secondary mental health care services. This cohort will be further examined to explore trajectories of mental health care and benefit receipt and provide evidence that will help to inform both DWP policies and mental health care delivery

Prevalence of post-traumatic stress disorder and common mental disorders in health-care workers in England during the COVID-19 pandemic: a two-phase cross-sectional study

BACKGROUND: Previous studies on the impact of the COVID-19 pandemic on the mental health of health-care workers have relied on self-reported screening measures to estimate the point prevalence of common mental disorders. Screening measures, which are designed to be sensitive, have low positive predictive value and often overestimate prevalence. We aimed to estimate prevalence of common mental disorders and post-traumatic stress disorder (PTSD) among health-care workers in England using diagnostic interviews. METHODS: We did a two-phase, cross-sectional study comprising diagnostic interviews within a larger multisite longitudinal cohort of health-care workers (National Health Service [NHS] CHECK; n=23 462) during the COVID-19 pandemic. In the first phase, health-care workers across 18 NHS England Trusts were recruited. Baseline assessments were done using online surveys between April 24, 2020, and Jan 15, 2021. In the second phase, we selected a proportion of participants who had responded to the surveys and conducted diagnostic interviews to establish the prevalence of mental disorders. The recruitment period for the diagnostic interviews was between March 1, 2021 and Aug 27, 2021. Participants were screened with the 12-item General Health Questionnaire (GHQ-12) and assessed with the Clinical Interview Schedule-Revised (CIS-R) for common mental disorders or were screened with the 6-item Post-Traumatic Stress Disorder Checklist (PCL-6) and assessed with the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) for PTSD. FINDINGS: The screening sample contained 23 462 participants: 2079 participants were excluded due to missing values on the GHQ-12 and 11 147 participants due to missing values on the PCL-6. 243 individuals participated in diagnostic interviews for common mental disorders (CIS-R; mean age 42 years [range 21-70]; 185 [76%] women and 58 [24%] men) and 94 individuals participated in diagnostic interviews for PTSD (CAPS-5; mean age 44 years [23-62]; 79 [84%] women and 15 [16%] men). 202 (83%) of 243 individuals in the common mental disorders sample and 83 (88%) of 94 individuals in the PTSD sample were White. GHQ-12 screening caseness for common mental disorders was 52·8% (95% CI 51·7-53·8). Using CIS-R diagnostic interviews, the estimated population prevalence of generalised anxiety disorder was 14·3% (10·4-19·2), population prevalence of depression was 13·7% (10·1-18·3), and combined population prevalence of generalised anxiety disorder and depression was 21·5% (16·9-26·8). PCL-6 screening caseness for PTSD was 25·4% (24·3-26·5). Using CAPS-5 diagnostic interviews, the estimated population prevalence of PTSD was 7·9% (4·0-15·1). INTERPRETATION: The prevalence estimates of common mental disorders and PTSD in health-care workers were considerably lower when assessed using diagnostic interviews compared with screening tools. 21·5% of health-care workers met the threshold for diagnosable mental disorders, and thus might benefit from clinical intervention. FUNDING: UK Medical Research Council; UCL/Wellcome; Rosetrees Trust; NHS England and Improvement; Economic and Social Research Council; National Institute for Health and Care Research (NIHR) Biomedical Research Centre at the Maudsley and King's College London (KCL); NIHR Protection Research Unit in Emergency Preparedness and Response at KCL

SEAmester – South Africa’s first class afloat

publisher versionFrom Introduction: Marine science is a highly competitive environment. The need to improve the cohort of South African postgraduates, who would be recognised both nationally and internationally for their scientific excellence, is crucial. It is possible to attract students early on in their careers to this discipline via cutting-edge science, technology and unique field experiences. Through the engagement of students with real-life experiences such as SEAmester, universities supporting marine science postgraduate degree programmes can attract a sustainable throughput of numerically proficient students. By achieving a more quantitative and experienced input into our postgraduate degree programmes, we will, as a scientific community, greatly improve our long-term capabilities to accurately measure, model and predict the impacts of current climate change scenarios. The short-term goal is to attract and establish a cohort of proficient marine and atmospheric science graduates who will contribute to filling the capacity needs of South African marine science as a whole. The SEAmester programme, by involving researchers from across all the relevant disciplines and tertiary institutions, provides an opportunity to build a network of collaborative teaching within the marine field. In doing so, these researchers will foster and strengthen new and current collaborations between historically white and black universities (Figure 1). The long-term objective of SEAmester is to build critical mass within the marine sciences to ensure sustained growth of human capacity in marine science in South Africa – aligning closely with the current DST Research and Development strategies and the Operation Phakisa Oceans Economy initiative