Peerstøtte i en recoveryorienteret praksis: Om paradoksale handlerum og formålsuklarheder i et felt i udvikling

Recovery is an increasingly prioritized political agenda in the Danish psychiatric system. A main initiative concerns the implementation of peer support, which offers a unique supplement to the efforts of (other) professionals through the sharing of experiences from people with user background. Despite a strong and positive overall narrative regarding recovery, providing peer support in practice may, however, be experienced as challenging for the peer workers.In this article, we want to explore how the political objective of recovery-supporting initiatives (here peer support, specifically) plays out in practice, and how concrete everyday life conditions frame the spaces of opportunity that such efforts are realized in. To do so, the article is anchored in a critical psychological research tradition and draws on participant observations and interviews with peer workers to bring forward their perspectives.The article points out – and seeks to nuance – how political intentions bear the risk of instating paradoxical demands on peer workers, leaving the individual peer worker with the task and responsibility of navigating often complex action spaces, in an attempt to carry out an unclear assignment.Keywords:Peer support, recovery, politics of everyday life, psychiatry, practice paradoxesRecovery er i stigende grad en politisk prioriteret dagsorden i den danske psykiatri. I den forbindelse er et af initiativerne implementeringen af peerstøtte, som gennem fæl-les erfaring blandt mennesker med brugerbaggrund muliggør et unikt supplement til de fagprofessionelles indsats. I praksis kan det dog opleves udfordrende for de peer-arbejdere, som står med opgaven om at udbrede og levendegøre recovery gennem deres tilstedeværelse på tværs af de psykiatriske indsatser. Med artiklen ønsker vi at undersøge, hvordan peerstøtte konkret udfolder sig i praksis, fra et peerarbejderper-spektiv. Artiklen tager afsæt i en kritisk psykologisk forskningstradition og undersøger med afsæt i deltagerobservationer og interviews med peerarbejdere, hvordan den po-litiske målsætning om recoveryunderstøttende tiltag udspiller sig i praksis, og hvor-dan hverdagslivets konkrete betingelser rammesætter de mulighedsrum som indsat-serne (her peerstøtte) skal implementeres i. Artiklen peger på – og søger at nuancere – hvorledes politiske intentioner risikerer at medføre paradoksale fordringer til prak-tikere (her peerarbejderne), og hvordan det overlader den enkelte med opgaven og ansvaret for at navigere i ofte komplekse handlerum og med uklart opdrag. Nøgleord:Peerstøtte, recovery, hverdagslivets politik, psykiatri, praksisparadokse

Agents intervening against delirium in the intensive care unit trial-Protocol for a secondary Bayesian analysis

Background Delirium is highly prevalent in the intensive care unit (ICU) and is associated with high morbidity and mortality. The antipsychotic haloperidol is the most frequently used agent to treat delirium although this is not supported by solid evidence. The agents intervening against delirium in the intensive care unit (AID-ICU) trial investigates the effects of haloperidol versus placebo for the treatment of delirium in adult ICU patients. Methods This protocol describes the secondary, pre-planned Bayesian analyses of the primary and secondary outcomes up to day 90 of the AID-ICU trial. We will use Bayesian linear regression models for all count outcomes and Bayesian logistic regression models for all dichotomous outcomes. We will adjust for stratification variables (site and delirium subtype) and use weakly informative priors supplemented with sensitivity analyses using sceptical priors. We will present results as absolute differences (mean differences and risk differences) and relative differences (ratios of means and relative risks). Posteriors will be summarised using median values as point estimates and percentile-based 95% credibility intervals. Probabilities of any benefit/harm, clinically important benefit/harm and clinically unimportant differences will be presented for all outcomes. Discussion The results of this secondary, pre-planned Bayesian analysis will complement the primary frequentist analysis of the AID-ICU trial and facilitate a nuanced and probabilistic interpretation of the trial results.Peer reviewe

[Book Review] OMURA, Yutaka. 2008. The fundamental study regarding the history of prehistoric archaeology in Japan:The study of Sugao Yamanouchi and those around him Rokuichisyobo, pp.1-215.

大村 裕著『日本先史考古学史の基礎研究-山内清男の学問とその周辺の人々-』A5判 215頁,六一書房,2008年5月刊,本体価格2,500円+税本稿は大村裕氏『日本先史考古学史の基礎研究-山内清男の学問とその周辺の人々-』の書評である。著者はまず日本先史考古学の基盤を築いた山内清男を基軸として、その周囲に展開した研究者の活動を対象としつつ、わが国の先史考古学研究史の再検討を試みる。その中でとくに山内の先人として、その学問形成に直接的な影響を与えたと想定される研究者についてやや予察的な検討を行っている。これは、隣接する学問分野(人類学・歴史学・民俗学・社会学など)の方法論を採り入れたものであり、今後とも斯学に新たな視点を提供していくものと思われる。また、著者は研究史的な検証と併行して、山内の学問的体系とは如何なるものなのかということについても考究した。様々な資料を駆使して、山内が残した論文を詳細に読み解いていく手法は堅実で説得力がある。とくに従来、余りにも素朴に考えられてきた「繩紋」という用語について、原典の丹念な読解によって、その理解に一入の深化を与えたと言える。また文様帯系統論についても、その発想の根源にある生物学的な知見に注目し、難解と言われてきた理論の理解を援ける視点を提供した。さらに、これらを総合し、著者自身が直面する学問的課題に対処するための方法を実際の資料に即して展開したことは、山内の学問に真摯に学んだ研究者のものとして、後学にも資するところ大であると思われる

Spectrum of Perforin Gene Mutations in Familial Hemophagocytic Lymphohistiocytosis

Familial hemophagocytic lymphohistiocytosis (FHL) is an autosomal recessive disease of early childhood characterized by nonmalignant accumulation and multivisceral infiltration of activated T lymphocytes and histiocytes (macrophages). Cytotoxic T and natural killer (NK) cell activity is markedly reduced or absent in these patients, and mutations in a lytic granule constituent, perforin, were recently identified in a number of FHL individuals. Here, we report a comprehensive survey of 34 additional patients with FHL for mutations in the coding region of the perforin gene and the relative frequency of perforin mutations in FHL. Perforin mutations were identified in 7 of the 34 families investigated. Six children were homozygous for the mutations, and one patient was a compound heterozygote. Four novel mutations were detected: one nonsense, two missense, and one deletion of one amino acid. In four families, a previously reported mutation at codon 374, causing a premature stop codon, was identified, and, therefore, this is the most common perforin mutation identified so far in FHL patients. We found perforin mutations in 20% of all FHL patients investigated (7/34), with a somewhat higher prevalence, ∼30% (6/20), in children whose parents originated from Turkey. No other correlation between the type of mutation and the phenotype of the patients was evident from the present study. Our combined results from mutational analysis of 34 families and linkage analysis of a subset of consanguineous families indicate that perforin mutations account for 20%–40% of the FHL cases and the FHL 1 locus on chromosome 9 for ∼10%, whereas the major part of the FHL cases are caused by mutations in not-yet-identified genes

National trends in total cholesterol obscure heterogeneous changes in HDL and non-HDL cholesterol and total-to-HDL cholesterol ratio : a pooled analysis of 458 population-based studies in Asian and Western countries

Background: Although high-density lipoprotein (HDL) and non-HDL cholesterol have opposite associations with coronary heart disease, multi-country reports of lipid trends only use total cholesterol (TC). Our aim was to compare trends in total, HDL and nonHDL cholesterol and the total-to-HDL cholesterol ratio in Asian and Western countries. Methods: We pooled 458 population-based studies with 82.1 million participants in 23 Asian and Western countries. We estimated changes in mean total, HDL and non-HDL cholesterol and mean total-to-HDL cholesterol ratio by country, sex and age group. Results: Since similar to 1980, mean TC increased in Asian countries. In Japan and South Korea, the TC rise was due to rising HDL cholesterol, which increased by up to 0.17 mmol/L per decade in Japanese women; in China, it was due to rising non-HDL cholesterol. TC declined in Western countries, except in Polish men. The decline was largest in Finland and Norway, at similar to 0.4 mmol/L per decade. The decline in TC in most Western countries was the net effect of an increase in HDL cholesterol and a decline in non-HDL cholesterol, with the HDL cholesterol increase largest in New Zealand and Switzerland. Mean total-to-HDL cholesterol ratio declined in Japan, South Korea and most Western countries, by as much as similar to 0.7 per decade in Swiss men (equivalent to similar to 26% decline in coronary heart disease risk per decade). The ratio increased in China. Conclusions: HDL cholesterol has risen and the total-to-HDL cholesterol ratio has declined in many Western countries, Japan and South Korea, with only a weak correlation with changes in TC or non-HDL cholesterol.Peer reviewe

Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants

© The Author(s) 2018. Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probittransformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the highincome Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries(1,2). However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world(3) and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health(4,5). However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular riskchanged from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.Peer reviewe

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe