Sex Trafficking: Explanations and Suggested Solutions

This thesis employs framing theory (Goffman 1974) to analyze interviews with sex workers and three groups of service providers experienced with sex trafficking: (1) law enforcement officials, (2) social service agents, and (3) health care providers. The data set, \u27International and Domestic Trends in Sex Trafficking of Women in the United States, 1999-2000,\u27 was collected in 2000 by Dr. Donna Hughes and Dr. Janice Raymond and entails verbatim interviews on various topics regarding sex trafficking including explanations for occurrence and solutions for combating sex trafficking in the United States. Framing theory was used to analyze the diagnostic and prognostic frames for variation between and within groups and measure the consistency of solutions and explanations. I find that the dominant diagnostic frame was a financial frame, whereas the dominant prognostic frame was a need for law change. Groups vary somewhat in their articulation of frames. Moreover, the prognostic frames do not coordinate with diagnostic frames. In other words, suggested solutions do not match perceived explanations. This thesis adds to the current literature on sex trafficking as it introduces a new perspective for explaining the occurrence of domestic and international sex trafficking, while offering solutions for combating the practice in the United States

Depression in primary care patients with coronary heart disease: baseline findings from the UPBEAT UK study

BACKGROUND: An association between depression and coronary heart disease is now accepted but there has been little primary care research on this topic. The UPBEAT-UK studies are centred on a cohort of primary patients with coronary heart disease assessed every six months for up to four years. The aim of this research was to determine the prevalence and associations of depression in this cohort at baseline. METHOD: Participants with coronary heart disease were recruited from general practice registers and assessed for cardiac symptoms, depression, quality of life and social problems. RESULTS: 803 people participated. 42% had a documented history of myocardial infarction, 54% a diagnosis of ischaemic heart disease or angina. 44% still experienced chest pain. 7% had an ICD-10 defined depressive disorder. Factors independently associated with this diagnosis were problems living alone (OR 5.49, 95% CI 2.11-13.30), problems carrying out usual activities (OR 3.71, 95% CI 1.93-7.14), experiencing chest pain (OR 3.27, 95% CI 1.58-6.76), other pains or discomfort (OR 3.39, 95% CI 1.42-8.10), younger age (OR 0.95 per year 95% CI 0.92-0.98). CONCLUSION: Problems living alone, chest pain and disability are important predictors of depression in this population

The chronic disease management model for depression in primary care

Objective: This paper reviews the development of chronic disease management approaches, and explores the suitability and effectiveness of these ways of organizing care for depression. Method: The relevant literature including systematic reviews, service evaluations, and clinical guidelines have been appraised to provide a review of the development of health care management approaches for long term conditions and their application to depression. Results: The chronic care model originally developed in the USA has been successfully adopted in other countries, and has been applied to the management of depression in primary care. This multicomponent approach involves enhanced collaboration between primary and secondary care clinicians often by means of case managers, support for improved patient self-management, and systematic follow-up. These approaches to health care organization significantly enhance the quality of care for depression: reviews consistently show improvements in depression severity, treatment adherence, and patient satisfaction. Conclusions: There appears value in the continued use of chronic disease management approaches for depression in primary care. For depression alone and depression combined with medical conditions there is consistent evidence for beneficial effects on depression outcomes. However there remain challenges in tailoring these approaches to influence physical outcomes in patients with medical comorbidity

Genetic correlations among psychiatric and immune-related phenotypes based on genome-wide association data [preprint]

Individuals with psychiatric disorders have elevated rates of autoimmune comorbidity and altered immune signaling. It is unclear whether these altered immunological states have a shared genetic basis with those psychiatric disorders. The present study sought to use existing summary-level data from previous genome-wide association studies (GWASs) to determine if commonly varying single nucleotide polymorphisms (SNPs) are shared between psychiatric and immune-related phenotypes. We estimated heritability and examined pair-wise genetic correlations using the linkage disequilibrium score regression (LDSC) and heritability estimation from summary statistics (HESS) methods. Using LDSC, we observed significant genetic correlations between immune-related disorders and several psychiatric disorders, including anorexia nervosa, attention deficit-hyperactivity disorder, bipolar disorder, major depression, obsessive compulsive disorder, schizophrenia, smoking behavior, and Tourette syndrome. Loci significantly mediating genetic correlations were identified for schizophrenia when analytically paired with Crohns disease, primary biliary cirrhosis, systemic lupus erythematosus, and ulcerative colitis. We report significantly correlated loci and highlight those containing genome-wide associations and candidate genes for respective disorders. We also used the LDSC method to characterize genetic correlations amongst the immune-related phenotypes. We discuss our findings in the context of relevant genetic and epidemiological literature, as well as the limitations and caveats of the study

School nurses' involvement, attitudes and training needs for mental health work: a UK-wide cross-sectional study

Aim.  The aim of this study was to identify school nurses’ views concerning the mental health aspects of their role, training requirements and attitudes towards depression in young people. Background.  Mental health problems in children and young people have high prevalence worldwide; in the United Kingdom they affect nearly 12% of secondary school pupils. School nurses have a wide-ranging role, and identifying and managing mental health problems is an important part of their work Methods.  A cross-sectional study was conducted using a postal questionnaire sent to a random sample of 700 school nurses throughout the United Kingdom in 2008. Questions concerned involvement in mental health work and training needs for this work. Attitudes were measured using the Depression Attitude Questionnaire Results.  Questionnaires were returned by 258 (37%) nurses. Nearly half of respondents (46%) had not received any postregistration training in mental health, yet 93% agreed that this was an integral part of their job. Most (55%) noted that involvement with young people’s psychological problems occupied more than a quarter of their work time. Staff attitudes were broadly similar to those of other primary care professionals, and indicated a rejection of stigmatizing views of depression and strong acknowledgement of the role of the school nurse in providing support. Conclusion.  Working with young people who self-harm, and recognizing and being better equipped to assist in managing depression and anxiety are key topics for staff development programmes

Bond graph modeling of nuclear reactor dynamics. [PWR]

A tenth-order linear model of a pressurized water reactor (PWR) is developed using bond graph techniques. The model describes the nuclear heat generation process and the transfer of this heat to the reactor coolant. Comparisons between the calculated model response and test data from a small-scale PWR show the model to be an adequate representation of the actual plant dynamics. Possible application of the model in an advanced plant diagnostic system is discussed

Depression and anxiety symptom trajectories in coronary heart disease: Associations with measures of disability and impact on 3-year health care costs

Background: As mortality from coronary heart disease (CHD) falls, years lived with disability increase. Depression and anxiety are known indicators of poor outcomes in CHD, but most research has measured distress symptoms at one time point, often following acute events. Here we consider the long-term trajectories of these symptoms in established CHD, and examine their association to distinct measures of disability and impact on costs. Methods and results: 803 patients with diagnosis of CHD were recruited from primary care, and completed detailed assessments every 6 months for 3 years. Latent class growth analysis (LCGA) was used to identify 5 distinct symptom trajectories based on the Hospital Anxiety and Depression Questionnaire (HADS): ‘stable low’, ‘chronic high’, ‘improving’, ‘worsening’, and ‘fluctuating’. The ‘chronic high’ group had highest association with reporting of chest pain (RRR 5.8, CI 2.9 to 11.7), smoking (2.9, 1.1 to 6.3), and poorer physical (0.88, 0.83–0.93) and mental (0.78, 0.73–0.84) quality of life. The ‘chronic high’ and ‘worsening’ trajectories had significantly higher health-care costs over the ‘stable low’ trajectory (107.2% and 95.5% increase, respectively). In addition, our trajectories were the only significant variable associated with increased health-care costs across the 3 years. Conclusions: Symptoms of depression and anxiety are highly prevalent in stable CHD patients, and their long-term trajectories are the single biggest driver of health care costs. Managing morbidity in these patients, in which depression and anxiety play a key role in, should become the primary focus of policy makers and future clinical trials