Which doctors and with what problems contact a specialist service for doctors? A cross sectional investigation

Background: In the United Kingdom, specialist treatment and intervention services for doctors are underdeveloped. The MedNet programme, created in 1997 and funded by the London Deanery, aims to fill this gap by providing a self-referral, face-to-face, psychotherapeutic assessment service for doctors in London and South-East England. MedNet was designed to be a low-threshold service, targeting doctors without formal psychiatric problems. The aim of this study was to delineate the characteristics of doctors utilising the service, to describe their psychological morbidity, and to determine if early intervention is achieved. Methods: A cross-sectional study including all consecutive self-referred doctors (n = 121, 50% male) presenting in 2002–2004 was conducted. Measures included standardised and bespoke questionnaires both self-report and clinician completed. The multi-dimensional evaluation included: demographics, CORE (CORE-OM, CORE-Workplace and CORE-A) an instrument designed to evaluate the psychological difficulties of patients referred to outpatient services, Brief Symptom Inventory to quantify caseness and formal psychiatric illness, and Maslach Burnout Inventory. Results: The most prevalent presenting problems included depression, anxiety, interpersonal, self-esteem and work-related issues. However, only 9% of the cohort were identified as severely distressed psychiatrically using this measure. In approximately 50% of the sample, problems first presented in the preceding year. About 25% were on sick leave at the time of consultation, while 50% took little or no leave in the prior 12 months. A total of 42% were considered to be at some risk of suicide, with more than 25% considered to have a moderate to severe risk. There were no significant gender differences in type of morbidity, severity or days off sick. Conclusion: Doctors displayed high levels of distress as reflected in the significant proportion of those who were at some risk of suicide; however, low rates of severe psychiatric illness were detected. These findings suggest that MedNet clients represent both ends of the spectrum of severity, enabling early clinical engagement for a significant proportion of cases that is of importance both in terms of personal health and protecting patient care, and providing a timely intervention for those who are at risk, a group for whom rapid intervention services are in need and an area that requires further investigation in the UK

The impact generated by public and charity-funded research in the UK: A systematic literature review

Objective: To identify, synthesize and critically assess the empirical evidence of the impact generated by public and charity funded health research in the United Kingdom. Methods: We conducted a systematic literature review of the empirical evidence published in English in peer-reviewed journals between 2006 and 2017. Studies meeting the inclusion criteria were selected and their findings were analysed using the Payback Framework into five main categories: knowledge, benefits to future research and research use, benefits from informing policy and product development, health and health sector benefits and broader economic benefits. We assessed the studies for risk of selection, reporting and funding bias. Results: Thirteen studies met the inclusion criteria. The majority of the studies (10 out of 13) assessed impact at multiple domains including the main 5 key themes of the Payback Framework. All of them showed a positive impact of funded research on outcomes. Of those studies, one presented low risk of bias (8%), 6 studies were classified as presenting moderate risk of bias (46%) and 6 studies presented high risk of bias (46%). Conclusions: Empirical evidence on the impact of public and charity funded research is still limited and subject to funding and selection bias. More work is needed to establish the causal effects of funded research on academic outcomes, policy, practice and the broader economy

Young Muslim women's experiences of Islam and physical education in Greece and Britain: a comparative study

Previous research suggests that Muslim women can experience particular problems when taking physical education (PE) lessons, for example with dress codes, mixed-teaching and exercise during Ramadan; and they can face restrictions in extra-curricular activities for cultural and religious reasons. The area is under-researched and there is little evidence of comparative studies that explore similarities and differences in cross-national experiences, which is the aim of this paper. Two studies conducted in Greece and Britain that explored the views of Muslim women on school experiences of physical education are compared. Both studies focused on diaspora communities, Greek Turkish girls and British Asian women, living in predominantly non-Muslim countries. Growing concerns about global divisions between 'Muslims and the West' make this a particularly pertinent study. Qualitative data were collected by interviews with 24 Greek Muslim women, and 20 British Muslim women. \ud <P> \ud Physical education has national curriculum status and a similar rationale in both countries but with different cultures of formality and tradition, which impacted on pupils' experiences. Data suggested that Greek and British groups held positive views towards physical education but were restricted on their participation in extra-curricular activities. For the British women religious identity and consciousness of Islamic requirements were more evident than for the Greek women. Differences in stages of acculturation, historical and socio-cultural contexts contributed to less problematic encounters with physical education for Greek Muslims who appeared more closely assimilated into the dominant culture

The end of the beginning? Taking forward local democratic renewal in the post-referendum North East.

This article draws upon the author’s commissioned research on the nature of regional governance following the 2004 Referendum in the North East on elected regional assemblies. The article aimed to both capture these views and to assess how the ‘No vote in the referendum has impacted on subsequent developments in sub-national governance. The article provides both an empirical overview of recent developments and engages with the wider conceptual debates on democratic renewal. The arguments covered in this output are aimed at both academic and practitioner audiences, and have been also disseminated at regional and national conferences

Impact of FTO genotypes on BMI and weight in polycystic ovary syndrome : a systematic review and meta-analysis

Aims/hypothesis FTO gene single nucleotide polymorphisms (SNPs) have been shown to be associated with obesity-related traits and type 2 diabetes. Several small studies have suggested a greater than expected effect of the FTO rs9939609 SNP on weight in polycystic ovary syndrome (PCOS). We therefore aimed to examine the impact of FTO genotype on BMI and weight in PCOS. Methods A systematic search of medical databases (PubMed, EMBASE and Cochrane CENTRAL) was conducted up to the end of April 2011. Seven studies describing eight distinct PCOS cohorts were retrieved; seven were genotyped for SNP rs9939609 and one for SNP rs1421085. The per allele effect on BMI and body weight increase was calculated and subjected to meta-analysis. Results A total of 2,548 women with PCOS were included in the study; 762 were TT homozygotes, 1,253 had an AT/CT genotype, and 533 were AA/CC homozygotes. Each additional copy of the effect allele (A/C) increased the BMI by a mean of 0.19 z score units (95% CI 0.13, 0.24; p = 2.26 × 10−11) and body weight by a mean of 0.20 z score units (95% CI 0.14, 0.26; p = 1.02 × 10−10). This translated into an approximately 3.3 kg/m2 increase in BMI and an approximately 9.6 kg gain in body weight between TT and AA/CC homozygotes. The association between FTO genotypes and BMI was stronger in the cohorts with PCOS than in the general female populations from large genome-wide association studies. Deviation from an additive genetic model was observed in heavier populations. Conclusions/interpretation The effect of FTO SNPs on obesity-related traits in PCOS seems to be more than two times greater than the effect found in large population-based studies. This suggests an interaction between FTO and the metabolic context or polygenic background of PCOS

The POLIPO Security Framework

Systems of systems are dynamic coalitions of distributed, autonomous and heterogeneous systems that collaborate to achieve a common goal. While offering several advantages in terms of scalability and flexibility, the systems of systems paradigm has a significant impact on systems interoperability and on the security requirements of the collaborating systems. In this chapter we introduce POLIPO, a security framework that protects the information exchanged among the systems in a system of systems, while preserving systems’ autonomy and interoperability. Information is protected from unauthorized access and improper modification by combining context-aware access control with trust management. Autonomy and interoperability are enabled by the use of ontology-based services. More precisely, each authority may refer to different ontologies to define the semantics of the terms used in the security policy of the system it governs and to describe domain knowledge and context information. A semantic alignment technique is then employed to map concepts from different ontologies and align the systems’ vocabularies. We demonstrate the applicability of our solution with a prototype implementation of the framework for a scenario in the maritime safety and security domain

Structured activity and multiple group memberships as mechanisms of increased depression among young people not in employment, education or training

Aims Young people Not in Employment, Education and Training (NEET) are at increased risk of depression, yet mechanisms of this association are poorly understood. We hypothesised that being NEET has both behavioural and social identity consequences and that reductions in structured activity and multiple group memberships underlie increased depression in this group. Our purpose was to assess first whether depression was greater for NEET compared to non‐NEET young people from the same geographical locality, and secondly, whether a loss of structured activity leading to a reduction in multiple group memberships explains the NEET‐depression association. Methods The present study was a cross‐sectional between‐groups design using convenience sampling. Measures of depression, structured activity and multiple group memberships were obtained from 45 NEET young people and 190 university students (non‐NEET). Results The NEET group reported significantly more depression symptoms compared to the non‐NEET student control group. A path model specifying NEET status as a predictor of depression, with this association mediated by a reduction in structured activity and fewer multiple group memberships (standardised indirect = 0.03, unstandardised indirect = 0.62, P = 0.052, 95% bias corrected confidence intervals [0.21,1.44]), provided excellent fit to our data: χ2(3) = 0.26, P = 0.968, comparative fit index (CFI) = 1.00, root mean square error of approximation (RMSEA)<0.01, standardized root mean square residual (SRMR) = 0.01). Conclusions Our findings suggest that depression is elevated amongst NEET young people compared to non‐NEET students from the same locality. The association between NEET status and depression was partially mediated by reduced structured activity and its association with reduced multiple group memberships. Although using cross‐sectional data, our findings suggest social interventions may be a key resource in ameliorating depression amongst NEET young people; through preserving engagement in structured activity and the wellbeing benefits derived from arising multiple group memberships. Methods: The present study was a cross-sectional between-groups design using convenience sampling. Measures of depression, structured activity and multiple group memberships were obtained from 45 ‘NEET’ young people and 190 university students (Non-‘NEET’). Results: The NEET group reported significantly more depression symptoms compared to the Non-NEET student control group. A path model specifying NEET status as a predictor of depression, with this association mediated by a reduction in structured activity and fewer multiple group memberships (standardised indirect = 0.03, unstandardised indirect= 0.62, p= .052, 95% Bias Corrected CIs [0.21; 1.44]), provided excellent fit to our data χ2(3)= 0.26, p= .968, CFI= 1.00, RMSEA< .01, SRMR= .01, AIC= 2,792.75, BIC= 2,818.20). Conclusions: Our findings suggest depression is elevated amongst NEET young people compared to Non-NEET students from the same locality. The association between NEET status and depression was partially mediated by reduced structured activity and its association with reduced multiple group memberships. Although cross-sectional, our findings suggest social interventions may be a key resource in ameliorating depression amongst NEET young people; through preserving engagement in structured activity and the wellbeing benefits derived from arising multiple group memberships

The impact of mental health recovery narratives on recipients experiencing mental health problems: Qualitative analysis and change model.

BACKGROUND: Mental health recovery narratives are stories of recovery from mental health problems. Narratives may impact in helpful and harmful ways on those who receive them. The objective of this paper is to develop a change model identifying the range of possible impacts and how they occur. METHOD: Semi-structured interviews were conducted with adults with experience of mental health problems and recovery (n = 77). Participants were asked to share a mental health recovery narrative and to describe the impact of other people's recovery narratives on their own recovery. A change model was generated through iterative thematic analysis of transcripts. RESULTS: Change is initiated when a recipient develops a connection to a narrator or to the events descripted in their narrative. Change is mediated by the recipient recognising experiences shared with the narrator, noticing the achievements or difficulties of the narrator, learning how recovery happens, or experiencing emotional release. Helpful outcomes of receiving recovery narratives are connectedness, validation, hope, empowerment, appreciation, reference shift and stigma reduction. Harmful outcomes are a sense of inadequacy, disconnection, pessimism and burden. Impact is positively moderated by the perceived authenticity of the narrative, and can be reduced if the recipient is experiencing a crisis. CONCLUSIONS: Interventions that incorporate the use of recovery narratives, such as peer support, anti-stigma campaigns and bibliotherapy, can use the change model to maximise benefit and minimise harms from narratives. Interventions should incorporate a diverse range of narratives available through different mediums to enable a range of recipients to connect with and benefit from this material. Service providers using recovery narratives should preserve authenticity so as to maximise impact, for example by avoiding excessive editing

International journalism and the emergence of transnational publics: between cosmopolitan norms, the affirmation of identity and market forces

Much has been written about transnational public spheres, though our understanding of their shape and nature remains limited. Drawing on three alternative conceptions of newswork as public communication, this article explores the role of international journalists in shaping transnational publics. Based on a series of original interviews, it asks how journalists are oriented in their newswork (e.g. are they cosmopolitan or parochial in their orientation) and how they ‘imagine’ the public. It finds that interviewees imagine a polycentric transnational public and variously frame their work as giving voice to those affected by an issue (imagining the public as a cosmopolitan community of fate), performing and reaffirming a particular kind of identity and belonging (imagining the public as a nation) or pursuing audiences wherever they may be (imagining the public as the de facto audience)