Effective communication in eliciting and responding to suicidal thoughts: a systematic review protocol

Background In the UK, over 6500 people die by suicide each year. In England alone, this is one person every 2 h. Professionals assess risk of suicide in face-to-face contacts with people potentially at risk. The National Confidential Inquiry into Suicide found that most people who took their life were classified as ‘low risk’ in their final contact with mental health services. Training for front-line staff in reducing suicide is a NHS priority. While there is considerable evidence on what to assess when exploring suicidal ideation, there is little evidence on how to ask sensitive questions to effectively identify suicide risk and how to respond in the treatment encounter to reduce patient distress and suicidal ideation. This is critical for identifying risk and putting appropriate care in place. Methods An electronic search will be conducted using MEDLINE, CINAHL, Cochrane Library, EMBASE and PsycINFO databases. Controlled studies of effectiveness will be identified using a predefined search strategy. The focus will be on suicidal thoughts/feelings rather than self-harm without intent to die. Two authors will independently screen articles using predefined inclusion and exclusion criteria and relevant data will be extracted using the Cochrane Collaboration data extraction form for randomised controlled trials (RCTs). Discrepancies between the two authors will be resolved by consensus or by consulting a third author at all levels of screening. We will assess the quality of evidence as well as risk of bias. A meta-analysis will be conducted if participants, interventions and comparisons are sufficiently similar, and we will perform the meta-analysis using Stata data analysis and statistical software. Discussion The results of this systematic review will be used to guide training and practice for health care professionals

Endophytes for Improving Ryegrass Performance: Current Status and Future Possibilities

The endophyte N. lolii was introduced naturally into New Zealand and Australia when perennial ryegrass seed was brought into these countries. Although the presence of the endophyte was recognised early in the 19th Century, its effects were only discovered in the early 1980s when it was found that these Wild-type strains of endophyte caused ryegrass staggers, a neuromuscular condition of grazing animals (Fletcher and Harvey 1981), and that they also protected their hosts from the effects of Argentine stem weevil (Listronotus bonariensis) a serious pest of ryegrass in New Zealand (Prestidge et al. 1982). These endophytes form systemic infections in the above-ground parts of their host plants, have no external stage and are maternally transmit-ted in seed. They produce alkaloids which have effects on herbivores, including sheep, cattle and invertebrates. Although all the alkaloids known to be produced by the endophytes have bioactivity against insects, not all are toxic to livestock. Research in New Zealand has focused on exploiting these endophytes for their natural biological control properties while minimising any effects on livestock

Aspects of the root ecology of Neotyphodium endophytes in Lolium perenne

Three different strains of the biotrophic endosymbiont, Neotyphodium, in perennial ryegrass were compared with endophyte-free ryegrass (Nil) for their effects on root herbivory, soil biota, root growth, root morphology and alkaloid and nutrient content in pot trials. Ryegrass infected with the endophyte strain, AR37, which produces janthitrem alkaloids, was toxic to a root aphid, Aploneura lentisci. Relative to Nil plants, ryegrass with Wild-type endophyte (producing the alkaloids peramine, ergovaline and lolitrem B) showed occasional resistance to A. lentisci whereas ryegrass with AR1 (producing peramine only) was highly susceptible. A high variability in root aphid populations among individual AR1 plants was related to plant genotype or a plant genotype/endophyte interaction. Differential effects of endophyte on A. lentisci were maintained under nutrient stress. Neither AR37 nor AR22 (a strain similar to AR1) in ryegrass affected feeding or survival of root-feeding larvae of the scarab Costelytra zealandica. Endophyte infection had no discernible adverse effects on populations of Collembola, oribatid mites or dorylaimid nematodes. Higher root aphid populations were associated with higher populations of Collembola and lower populations of nematodes. Rate of mycorrhizal colonisation of ryegrass infected with AR37 and Wild-type was slower than in AR1 and Nil but then proceeded rapidly to the extent that they became more heavily infected than AR1. After 2 years, infection of roots of AR1-infected plants was less than on AR37, Wild-type and Nil plants. Alkaloid content of roots was very low relative to that of leaf sheaths. Two janthitrem fractions were consistently found in roots of AR37 plants and may be the cause of toxicity to root aphid. Ergovaline and lolitrem B were only found in roots under certain conditions and adverse effects of Wild-type infection on A. lentisci could not be attributed conclusively to the presence of either alkaloid. Manipulation of herbivory by insecticide showed that root and foliar growth of AR1 and Nil plants were reduced by A. lentisci and also by an unidentified pseudococcid species infesting tillers. Root/shoot ratios were occasionally reduced in the presence of both species and in the presence of A. lentisci alone suggesting plant allocation to foliar growth in response to damage by these insects. Not all effects of endophyte infection were mediated by herbivory. AR1-infected ryegrass had a higher specific root length than Nil plants with AR37 and Wild-type intermediate between these. Insecticide treatment increased specific root length in all plants but relative differences between endophyte treatments remained the same. AR37 differed from other endophyte treatments in having a lower investment in root growth and increasing root nitrogen concentrations during summer followed by a relatively larger investment in root growth in autumn and early winter. Protection from herbivory meant that actual root biomass of AR37 plants was not less than in other treatments. Endophyte-infected plants had higher concentrations of potassium and phosphorus than Nil plants in roots but not in leaf blades. Nitrogen concentrations in roots were inversely related to root biomass resulting in AR1-infected plants having the highest concentrations of nitrogen due to the adverse effects of A. lentisci on root growth. The higher nutrient content of AR1-infected ryegrass compared with Nil may increase its susceptibility to A. lentisci. It is concluded that Neotyphodium infection has multiple but highly strain-specific effects on root ecology of perennial rye grass

'Men give in to chips and beer too easily': How working-class men make sense of gender differences in health

This article, based on qualitative research with working-class men, explores men's perceptions and experiences regarding gender differences in health. It demonstrates how men put forward a range of behavioural/cultural, materialist/structural and psychosocial factors, which were believed to differently impact men's health compared to women. A common theme underpinning their explanations was the ways in which men and women were located within two distinct gender categories. These characterisations were used to explain why health-damaging beliefs and behaviours were more prevalent among men and also why men were better suited for certain kinds of jobs, albeit with potential costs to their health. Men also believed that women were protected from the damaging physical and emotional impact of manual employment because of their primary role within the home and because they were less emotionally robust, which required men to shield women from the stresses they experienced. However, men's emotional withdrawal can also be viewed as another example of how men use whatever resources are available to achieve and maintain dominance over women. Finally, the article demonstrates how a gender- and class-based approach can capture the impact of men's health-related practices alongside the broader cultural and structural influences on men's health

From causes to solutions - insights from lay knowledge about health inequalities

<p>Abstract</p> <p>Background</p> <p>This paper reports on a qualitative study of lay knowledge about health inequalities and solutions to address them. Social determinants of health are responsible for a large proportion of health inequalities (unequal levels of health status) and inequities (unfair access to health services and resources) within and between countries. Despite an expanding evidence base supporting action on social determinants, understanding of the impact of these determinants is not widespread and political will appears to be lacking. A small but growing body of research has explored how ordinary people theorise health inequalities and the implications for taking action. The findings are variable, however, in terms of an emphasis on structure versus individual agency and the relationship between being 'at risk' and acceptance of social/structural explanations.</p> <p>Methods</p> <p>This paper draws on findings from a qualitative study conducted in Adelaide, South Australia, to examine these questions. The study was an integral part of mixed-methods research on the links between urban location, social capital and health. It comprised 80 in-depth interviews with residents in four locations with contrasting socio-economic status. The respondents were asked about the cause of inequalities and actions that could be taken by governments to address them.</p> <p>Results</p> <p>Although generally willing to discuss health inequalities, many study participants tended to explain the latter in terms of individual behaviours and attitudes rather than social/structural conditions. Moreover, those who identified social/structural causes tended to emphasise individualized factors when describing typical pathways to health outcomes. This pattern appeared largely independent of participants' own experience of advantage or disadvantage, and was reinforced in discussion of strategies to address health inequalities.</p> <p>Conclusions</p> <p>Despite the explicit emphasis on social/structural issues expressed in the study focus and framing of the research questions, participants did not display a high level of knowledge about the nature and causes of place-based health inequalities. By extending the scope of lay theorizing to include a focus on solutions, this study offers additional insights for public health. Specifically it suggests that a popular constituency for action on the social determinants of health is unlikely to eventuate from the current popular understandings of possible policy levers.</p

Community empowerment and mental wellbeing: longitudinal findings from a survey of people actively involved in the big local place-based initiative in England

Background: Community empowerment initiatives are receiving increased interest as ways of improving health and reducing health inequalities. Purpose: Longitudinally examine associations between collective control, social-cohesion and mental wellbeing amongst participants in the Big Local community empowerment initiative across 150 disadvantaged areas of England. Methods: As part of the independent Communities in Control study, we analysed nested cohort survey data on mental wellbeing (Short Warwick Edinburgh Mental Wellbeing Scale—SWEMWBS) and perceptions of collective control and social-cohesion. Data were obtained in 2016, 2018 and 2020 for 217 residents involved in the 150 Big Local areas in England. Adjusted linear mixed effect models were utilized to examine changes in SWEMWBS over the three waves. Subgroup analysis by gender and educational level was conducted. Results: There was a significant 1.46 (0.14, 2.77) unit increase in mental wellbeing score at wave 2 (2018) but not in wave 3 (2020) (0.06 [−1.41, 1.53]). Across all waves, collective control was associated with a significantly higher mental wellbeing score (3.36 [1.51, 5.21]) as was social cohesion (1.09 [0.19, 2.00]). Higher educated participants (1.99 [0.14, 3.84]) and men (2.41 [0.55, 4.28]) experienced significant increases in mental wellbeing in 2018, but lower educated participants and women did not. Conclusion: Collective control and social cohesion are associated with better mental wellbeing amongst residents engaged with the Big Local initiative. These health benefits were greater amongst men and participants from higher educational backgrounds. This suggests that additional care must be taken in future interventions to ensure that benefits are distributed equally

Exploring perceived barriers, drivers, impacts and the need for evaluation of public involvement in health and social care research: a modified Delphi study

Mixed method, three-phase, modified Delphi technique, conducted as part of a larger MRC multiphase project: http://www.piiaf.org.ukThis is a freely-available open access publication. Please cite the published version which is available via the DOI link in this recordAbstract Objective To explore areas of consensus and conflict in relation to perceived public involvement (PI) barriers and drivers, perceived impacts of PI and ways of evaluating PI approaches in health and social care research. Background Internationally and within the UK the recognition of potential benefits of PI in health and social care research is gathering momentum and PI is increasingly identified by organisations as a prerequisite for funding. However, there is relatively little examination of the impacts of PI and how those impacts might be measured. Design Mixed method, three-phase, modified Delphi technique, conducted as part of a larger MRC multiphase project. Sample Clinical and non-clinical academics, members of the public, research managers, commissioners and funders. Findings This study found high levels of consensus about the most important barriers and drivers to PI. There was acknowledgement that tokenism was common in relation to PI; and strong support for the view that demonstrating the impacts and value of PI was made more difficult by tokenistic practice. PI was seen as having intrinsic value; nonetheless, there was clear support for the importance of evaluating its impact. Research team cohesion and appropriate resources were considered essential to effective PI implementation. Panellists agreed that PI can be challenging, but can be facilitated by clear guidance, together with models of good practice and measurable standards. Conclusions This study is the first to present empirical evidence of the opinions voiced by key stakeholders on areas of consensus and conflict in relation to perceived PI barriers and drivers, perceived impacts of PI and the need to evaluate PI. As such it further contributes to debate around best practice in PI, the potential for tokenism and how best to evaluate the impacts of PI. These findings have been used in the development of the Public Involvement Impact Assessment Framework (PiiAF), an online resource which offers guidance to researchers and members of the public involved in the PI process.The study was supported by the Medical Research Council's Methodology Research Programme [G0902155/93948]

Methods for the thematic synthesis of qualitative research in systematic reviews

<p>Abstract</p> <p>Background</p> <p>There is a growing recognition of the value of synthesising qualitative research in the evidence base in order to facilitate effective and appropriate health care. In response to this, methods for undertaking these syntheses are currently being developed. Thematic analysis is a method that is often used to analyse data in primary qualitative research. This paper reports on the use of this type of analysis in systematic reviews to bring together and integrate the findings of multiple qualitative studies.</p> <p>Methods</p> <p>We describe thematic synthesis, outline several steps for its conduct and illustrate the process and outcome of this approach using a completed review of health promotion research. Thematic synthesis has three stages: the coding of text 'line-by-line'; the development of 'descriptive themes'; and the generation of 'analytical themes'. While the development of descriptive themes remains 'close' to the primary studies, the analytical themes represent a stage of interpretation whereby the reviewers 'go beyond' the primary studies and generate new interpretive constructs, explanations or hypotheses. The use of computer software can facilitate this method of synthesis; detailed guidance is given on how this can be achieved.</p> <p>Results</p> <p>We used thematic synthesis to combine the studies of children's views and identified key themes to explore in the intervention studies. Most interventions were based in school and often combined learning about health benefits with 'hands-on' experience. The studies of children's views suggested that fruit and vegetables should be treated in different ways, and that messages should not focus on health warnings. Interventions that were in line with these suggestions tended to be more effective. Thematic synthesis enabled us to stay 'close' to the results of the primary studies, synthesising them in a transparent way, and facilitating the explicit production of new concepts and hypotheses.</p> <p>Conclusion</p> <p>We compare thematic synthesis to other methods for the synthesis of qualitative research, discussing issues of context and rigour. Thematic synthesis is presented as a tried and tested method that preserves an explicit and transparent link between conclusions and the text of primary studies; as such it preserves principles that have traditionally been important to systematic reviewing.</p