How to serve our ethnic minority communities better

On Jan 9, 2017, Theresa May, the British Prime Minister, gave a speech about “the burning injustice of mental illness”, mentioning “injustices in the way black people with mental ill health in particular are treated”, and promising that politicians would “take action to put things right.” In response to three decades of UK research on ethnic differences in mental health, such emotionally charged rhetoric has been commonplace, but has rarely produced meaningful change. Mental health care in ethnic minorities is complex, and needs dispassionate and objective scrutiny of evidence and its limitations, with careful disentanglement of the interactions between ethnicity, culture, community histories, legacies of racism, and the labyrinthine service structures that people with mental illness and their families must navigate to get appropriate help. In The Lancet Psychiatry, Phoebe Barnett and colleagues present findings from a systematic review and meta-analysis of ethnicity and legal detention of people with mental illness, an impressive attempt at providing just such scrutiny. Although the findings are not strikingly different from what is known, this comprehensive paper is a timely reminder of how far we are from fully understanding the problem—let alone solving it—and why the stated political intention to put things right might be easy to promise but hard to deliver

Black and minority ethnic people are more likely to be detained under the Mental Health Act 1983 : no clear evidence why

Question: Compared with White people, how frequently are people from Black and Minority Ethnic groups detained under the Mental Health Act 1983? Outcomes: Rates of compulsory detention under the Mental Health Act. METHODS Design: Systematic review with meta-analysis. Data sources: MEDLINE, EMBASE, CINAHL, PsycINFO, ASSIA, SIGLE, HMIC, Web of Science, Cochrane database and the National Research Register; 1984 to April 2005. CD-ROM for the British National Bibliography was also searched for relevant literature. Study selection and analysis: English language studies relating to compulsory detention under the Mental Health Act 1983 and including terms related to mental illness or forensic psychiatry, and with inclusion of 2 ethnic groups (any non-White). Odds of compulsory detention of people from Black and Minority Ethnic (BME) groups compared with White groups were combined using a fixed effects meta-analysis. Meta-regression was then used to explore reasons for heterogeneity between studies. It was based on subgroup analyses according to episode (first, second, etc), patient type (for example, civil or forensic), study quality, and year of publication. The authors then narratively discuss the possible theories for the difference in detention rates

Transition of care from child to adult mental health services : the great divide

Purpose of review: Adolescents with mental health problems often require transition of care from child and adolescent to adult mental health services. This review is a synthesis of current research and policy literature on transition to describe the barriers at the interface between child and adolescent mental health services and adult mental health services and outcomes of poor transition. Recent findings: Adolescence is a risk period for emergence of serious mental disorders. Child and adolescent mental health services and adult mental health services use rigid age cut-offs to delineate service boundaries, creating discontinuities in provision of care. Adolescent mental health services are patchy across the world. Several recent studies have confirmed that problems occur during transition in diverse settings across several countries. In physical health, there are emerging models of practice to improve the process and outcomes of transition, but there is very little comparable literature in mental healthcare. Summary: Poor transition leads to disruption in continuity of care, disengagement from services and is likely to lead to poorer clinical outcomes. Some young people, such as those with neurodevelopmental disorders and complex needs, are at a greater risk of falling through the care gap during transition. Services need robust and high-quality evidence on the process and outcomes of transition so that effective intervention strategies can be developed

Race and mental health : there is more to race than racism

Some minority ethnic groups in England and Wales have higher rates of admission for mental illness and more adverse pathways to care. Are the resulting accusations of institutional racism within psychiatry justified

A Cooperative Security Order for Asia-Pacific: Indian Perspectives on New Challenges and Opportunities

The Mongolian Journal of International Affairs; Number 11, 2004, Page 12-21 DOI: http://dx.doi.org/10.5564/mjia.v0i11.10

Combined Neuro-Fuzzy Vertical Handover Decision Criteria for LTE/LTE-A Networks

Verti??l h?nd?ver has gained signifi??nt imp?rt?n?e due t? the enh?n?ements in m?bility m?dels by the F?urth Gener?ti?n (4G) te?hn?l?gies. ? h?nd?ver de?isi?n s?heme in LTE netw?rks is either b?sed on single ?r multiple ?riteri?. The number ?f ?riteri? dire?tly depending ?n the t?t?l h?nd?ver time. Simil?rly, the time required f?r sele?ting ? t?rget netw?rk during h?nd?ver is ?ls? in?re?sed with the in?re?se in ? number ?f p?r?meters. Tr?diti?n?l h?nd?ver de?isi?n ?ppr???hes ?re m?inly b?sed ?n the single p?r?meter. But, with the intr?du?ti?n ?f heter?gene?us wireless netw?rks, the perf?rm?n?e ?f these single p?r?meter de?isi?n s?hemes is highly redu?ed. Theref?re, rese?r?hers intr?du?e multi-?riteri? h?nd?ver de?isi?n s?hemes. The ??mplexity ?nd pr??essing ?f multi-?riteri? during h?nd?ver is ? ??mplex j?b ?nd hen?e these s?hemes require high h?nd?ver time whi?h ultim?tely le?ds t? the high p??ket l?ss ?nd even bre?king ?f ??nne?ti?n. M?re?ver, these enh?n?ements ?re limited t? spe?ifi? s?en?ri?s ?nd hen?e d? n?t pr?vide supp?rt f?r generi? m?bility. T? ?ddress the ?h?llenges, ? generi? verti??l h?nd?ver m?n?gement s?heme f?r heter?gene?us wireless netw?rks is pr?p?sed. A Neur?-fuzzy b?sed verti??l h?nd?ver de?isi?n m?del has been offered in ?rder t? impr?ve Q?S in heter?gene?us wireless netw?rks. T? keep the ??nne?ti?n ?live during h?nd?ver ?n impr?ved h?nd?ver str?tegy has been offered

Ethnicity and the Mental Health Act 1983

Background Black and minority ethnic (BME) patients are disproportionately detained under the Mental Health Act 1983. There has been no systematic exploration of differences within and between ethnic groups, nor of the explanations put forward for this excess. Aims To systematically review detention and ethnicity, with meta-analyses of detention rates for BME groups, and to explore the explanations offered for ethnic differences in detention rates. Method Literature search and meta-analysis. Explanations offered were categorised, supporting literature was accessed and the strength of the evidence evaluated. Results In all, 49 studies met inclusion criteria; of these, 19 were included in the meta-analyses. Compared with White patients, Black patients were 3.83 times, BME patients 3.35 times and Asian patients 2.06 times more likely to be detained. The most common explanations related to misdiagnosis and discrimination against BME patients, higher incidence of psychosis and differences in illness expression. Many explanations, including that of racism within mental health services, were not supported by clear evidence. Conclusions Although BME status predicts psychiatric detention in the UK, most explanations offered for the excess detention of BME patients are largely unsupported

“I’m just a long history of people rejecting referrals” experiences of young people who fell through the gap between child and adult mental health services

The paediatric-adult split in mental health care necessitates young people to make a transition between services when they reach the upper end of child and adolescent mental health services (CAMHS). However, we know that this transition is often poor, and not all young people who require ongoing support are able to continue care in adult mental health services (AMHS). These young people are said to have fallen through the gap between services. This research aimed to explore the reasons why young people fall through the gap between CAMHS and AMHS, and what effect his has had on them and their families. Narrative interviews were conducted with 15 young people and 15 parents, representing 19 unique transition stories. Themes were identified collaboatively using thematic analysis. Reasons for falling through the gap were grouped into systemic problems and problems with the quality of care received. Effects of alling through the gap were grouped into separate themes for young people (feeling abandoned; struggling to manage without continued care; problems with medication) and parents (emotional impact of care ending; parents taking an active role in the young person’s care). To our knowledge, this is the firt qualitative study that has focused only on the experiences of young people who have fallen through the gap between services. This research adds novel findings o existing literature regarding barriers to transition and the effectsof discontinuity of care

Les échanges commerciaux sino-indiens : des bases solides, un avenir prometteur

L’essor des échanges commerciaux entre la Chine et l’Inde est le principal facteur à l’origine du rapprochement sino-indien. Il a permis l’accroissement de la confiance entre les deux pays et l’amélioration de leur perception mutuelle. Le commerce frontalier, en particulier, a entraîné d’importants changements dans leurs régions frontalières. Cela a contribué à la détente et à la paix, et a facilité les négociations de leurs différends frontaliers

Učinak dodataka biotina i cinka na zdravlje papaka i kvalitetu mlijeka mliječnih krava

The objective of this field study was to evaluate the effect of biotin and zinc sulphate (ZnSO4) supplementation on hoof health and milk quality in lactating dairy cows. Clinically lame (n = 31) and healthy (n = 28) cows were selected on the basis of locomotion scores (LS), and were randomly assigned to either the ‘treatment group’ [clinically lame treatment (CLT) = 17 and healthy treatment (HT) = 15; supplemented with 1 g of 2% biotin and 4 g of ZnSO4 daily for 4 mo] or the ‘control group’ [clinically lame control (CLC) = 14 and healthy control (HC) = 13]. Locomotion scores, body condition scores, and milk quality and yield were estimated before and after the end of the study. Also, hoof trimming was undertaken before and after the supplementation period, and claw lesions were observed for type and severity. Sole thickness (ST) was measured by ultrasonography in some of the back claws in treatment and control cows. Data were analyzed using likelihood ratio Chi-square and paired t tests. At the end of the study, there was a significant improvement in the LS (P<0.001); heel horn erosion score (P<0.05); overgrown sole score (P<0.001); and sole haemorrhage score (P<0.01) in the CLT cows. Some of these lesion scores deteriorated in the HC cows. Sole thickness increased in the CLT cows (P<0.05), whereas it decreased in the CLC cows (P<0.05). The milk somatic cell count (SCC) decreased (P<0.05), whereas milk yield (P<0.001) and fat content (P<0.05) increased in the CLT cows. A significant decline in the average SCC (P<0.05) in the HT was also observed. We concluded that concurrent supplementation with biotin and ZnSO4 seems to be beneficial for correction and prevention of claw lesions, as well as improvement of milk quantity and quality in clinically lame dairy cows.Cilj ovoga istraživanja bio je procijeniti učinak dodataka biotina i cinkova sulfata (ZnSO4) na zdravlje papaka i kvalitetu mlijeka u mliječnih krava. Klinička hrome (n = 31) i zdrave krave (n = 28) odabrane su na temelju ocjene pokretljivosti (LS) te su slučajnim odabirom podijeljene u pokusnu i kontrolnu skupinu. Pokusnu skupinu činile su klinički hrome (CLT, n = 17) i zdrave (HT, n = 15) krave kojima je u hranu dodan 1 g 2 %-tnog biotina i 4 g ZnSO4 dnevno tijekom 4 mjeseca, Kontrolnu skupinu činile su hrome krave (CLC, n = 14 i zdrave krave (HC, n = 13). Pokretljivost, tjelesna kondicija te kvaliteta i količina mlijeka procijenjeni su prije i nakon završetka istraživanja. Također, prije i poslije dodavanja dodataka hrani provedena je kirurška obrada papaka te je promatrana vrsta i težina oštećenja papaka. Debljina tabana (ST) stražnjih papaka nekih krava mjerena je ultrazvučno u pokusnoj i kontrolnoj skupini. Podaci su analizirani omjerom vjerodostojnosti hi-kvadrat testa i parnog t-testa. Na kraju istraživanja uočen je znakovit napredak LS-a (P < 0,001); vjerodostojnosti hi-kvadrat testa i parnog t-testa. Neke su se od tih ocjena oštećenja pogoršale u krava u HC skupini krava. Debljina tabana povećala se u krava u pokusnoj skupini (P < 0,05), dok je u krava u kontrolnoj skupini smanjena (P < 0,05). Broj somatskih stanica u mlijeku (SCC) smanjen je (P < 0,05), dok su prinos mlijeka (P < 0,001) i sadržaj masti (P < 0,05) povećani u krava u pokusnoj skupini. Također, utvrđeno je znakovito smanjenje prosječnog broja SCC-a (P < 0,05) u zdravih krava u pokusnoj skupini. Zaključeno je da bi istodobno dodavanje biotina i cinkova sulfata u hranu moglo biti korisno u korekciji i prevenciji oštećenja papaka kao što bi moglo pridonijeti količini i kvaliteti mlijeka kod klinički hromih mliječnih krava