Predictors of admission and readmission to hospital for major depression: A community cohort study of 52,990 individuals.

Background Our current knowledge about predictors of admission and re-admission to hospital as a result of major depressive disorder (MDD) is limited. Here we present a descriptive analysis of factors which are associated with MDD hospitalisations within a large population cohort. Methods We linked participants of the Scottish Health Survey (SHS) to historical and prospective hospital admission data. We combined information from the SHS baseline interview and historical hospitalisations to define a range of exposure variables. The main outcomes of interest were: (1) first time admission for MDD occurring after the SHS interview; and (2) readmission for MDD. We used Cox regression to determine the association between each predictor and each outcome, after adjusting for age, gender and deprivation quintile. Results 52,990 adult SHS participants were included. During a median follow-up of 4.5 years per participant, we observed 530 first-time admissions for MDD. A relatively wide range of factors – encompassing social, individual health status, and lifestyle-related exposures – were associated with this outcome (p&#60;0.05). Among the 530 participants exhibiting a de novo admission for MDD during follow-up, 118 were later re-admitted. Only older age (over 70) and a prior non-depression related psychiatric admission were associated with readmission for MDD. Limtations MDD was defined using records of International Classification of Disease hospital discharge codes rather than formal diagnostic assessments. Conclusion These findings have implications for mental health service organisation and delivery and should stimulate future research on predictive factors for admission and readmission in MDD.</p

Strategies for the treatment of Hepatitis C in an era of interferon-free therapies: what public health outcomes do we value most?

Objective: The expense of new therapies for HCV infection may force health systems to prioritise the treatment of certain patient groups over others. Our objective was to forecast the population impact of possible prioritisation strategies for the resource-rich setting of Scotland. Design: We created a dynamic Markov simulation model to reflect the HCV-infected population in Scotland. We determined trends in key outcomes (e.g. incident cases of chronic infection and severe liver morbidity (SLM)) until the year 2030, according to treatment strategies involving prioritising, either: (A) persons with moderate/advanced fibrosis or (B) persons who inject drugs (PWID). Results: Continuing to treat the same number of patients with the same characteristics will give rise to a fall in incident infection (from 600 cases in 2015 to 440 in 2030) and a fall in SLM (from 195 cases in 2015 to 145 in 2030). Doubling treatment-uptake and prioritising PWID will reduce incident infection to negligible levels (&#60;50 cases per year) by 2025, while SLM will stabilise (at 70–75 cases per year) in 2028. Alternatively, doubling the number of patients treated, but, instead, prioritising persons with moderate/advanced fibrosis will reduce incident infection less favourably (only to 280 cases in 2030), but SLM will stabilise by 2023 (i.e. earlier than any competing strategy). Conclusions: Prioritising treatment uptake among PWID will substantially impact incident transmission, however, this approach foregoes the optimal impact on SLM. Conversely, targeting those with moderate/advanced fibrosis has the greatest impact on SLM but is suboptimal in terms of averting incident infection

Social representation of the profession of psychology and the application of artificial intelligence: European Union regulatory authority and the application of psychology as a paradigm for the future

The digitisation of work affects thinking with respect to who will work, what work will entail and how governments will control change. The development of artificial intelligence (AI) is recognized as a threat and as a facilitator of change. The European Union leads in the development of regulatory power in the area. We examine these regulations and how they may affect the application of AI to work, especially with respect to psychology. Psychology is a profession universally conceived in the recent past to be immune from the predations of automation due to the level of cognitive and emotional skills believed to underly competence. The image or social representation of the discipline/profession plays a role in how the discipline is perceived and understood and how it is placed within the predicted matrix of jobs under threat. We demonstrate that psychology may not be immune in the context of a contemporary social representation. Regulatory practices in training and employment put psychology under threat as a “safe” profession. Europe has regulated and commodified the practice and training of psychology and hence has magnified the threat of replacement of those practices by AI. Governments and the professions need to be mindful of these consequences

Preformed metal crowns for decayed primary molar teeth

BackgroundPreformed metal crowns (PMCs) are recommended by the British Society of Paediatric Dentistry (BSPD) for restoring badly broken down primary molar teeth. However, few dental practitioners adopt this technique in clinical practice, citing cost and clinical difficulty as reasons for this. Whilst there is a subjective impression by clinical academics that PMCs provide a more durable restoration than filling materials, there appears to be little evidence within the literature to support this.ObjectivesThe primary aim of this systematic review was to compare clinical outcomes for primary molar teeth restored using PMCs compared to those restored with filling materials.Search methodsThe literature was searched using: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2005, Issue 3); MEDLINE (1966 to August 2005); EMBASE (1980 to August 2005); System for Information on Grey Literature in Europe (SIGLE) (1976 to August 2005). Relevant publications' reference lists were reviewed for relevant articles. The most recent search was carried out on 24 August 2005.Selection criteriaRandomised controlled trials (RCTs) that assessed the effectiveness of PMCs compared with filling materials or where there had been no treatment in children with untreated tooth decay in one or more primary molar teeth.Data collection and analysisTwo review authors independently assessed the title and abstracts for each article from the search results to decide whether it was likely to be relevant. Full papers were obtained for relevant articles and all three review authors studied these.Main resultsForty‐seven records were retrieved by the search strategies of which some were duplicates. Of these, 14 studies were scrutinised. No studies met the inclusion criteria and six studies were excluded from the review as they were either retrospective in design or reported as prospective outcomes but not randomised. No data were available for extraction and analysis and therefore, no conclusion could be made as to whether PMCs were more successful than filling materials for restoring primary molar teeth.Authors' conclusionsNo RCTs were available for appraisal. Whilst this technique is recommended by the BSPD for use in clinical practice, the evidence to support this is not strong, consisting mainly of case reports and uncontrolled studies. It is important that the absence of evidence for PMCs is not misinterpreted as evidence for their lack of efficacy.There is a strong need for prospective RCTs comparing PMCs and fillings for managing decayed primary molar teeth. The lower levels of evidence that have been produced, however, have strength in that the clinical outcomes are consistently in favour of PMCs, despite many of the studies placing PMCs on the most damaged of the pair of teeth being analysed

A brief report on the assessment of the impacts from aircraft and other factors on visitor use and amenity at Whitehaven Beach, Whitsunday Island

A brief report on the assessment of the impacts from aircraft anf other factors on visitor use and amenity at Whitehaven Beach, Whitsunday Island

Precursors and Possible Effects of Psychological Stress

The term stress can be used to refer to a generalised somatic response, involving hormonal activity, which renders an individual ready to react to a wide range of events. With continued stress there can result a wide range of pathological developments, including physical and psychological symptoms. This paper will review the social and psychological factors which appear to increase the stress response and will also examine some of the physical consequences of exposure to stress-inducing agents. Emphasis will be given to the possibilities that stress may result from common experiences of living in modern complex society. Individual differences need to be considered as moderators of stress, and also the means whereby people may be taught to cope with stress

Secondary Rayleigh-Taylor type Instabilities in the Reconnection Exhaust Jet as a Mechanism for Supra-Arcade Downflows

Supra-arcade downflows (hereafter referred to as SADs) are low-emission, elongated, finger-like features usually observed in active-region coronae above post-eruption flare arcades. Observations exhibit downward moving SADs intertwined with bright upward moving spikes. Whereas SADs are dark voids, spikes are brighter, denser structures. Although SADs have been observed for decades, the mechanism of formation of SADs remains an open issue. In our three-dimensional resistive magnetohydrodynamic simulations, we demonstrate that secondary Rayleigh-Taylor type instabilities develop in the downstream region of a reconnecting current sheet. The instability results in the formation of low-density coherent structures that resemble SADs, and high-density structures that appear to be spike-like. Comparison between the simulation results and observations suggests that secondary Rayleigh-Taylor type instabilities in the exhaust of reconnecting current sheets provide a plausible mechanism for observed SADs and spikes