Rethinking global health research: towards integrative expertise

The Bamako Call for Action on Research for Health stresses the importance of inter-disciplinary, inter-ministerial and inter-sectoral working. This challenges much of our current research and postgraduate research training in health, which mostly seeks to produce narrowly focused content specialists. We now need to compliment this type of research and research training, by offering alternative pathways that seek to create expertise, not only in specific narrow content areas, but also in the process and context of research, as well as in the interaction of these different facets of knowledge. Such an approach, developing 'integrative expertise', could greatly facilitate better research utilisation, helping policy makers and practitioners work through more evidence-based practice and across traditional research boundaries

Affective Distress and Amputation-Related Pain Among Older Men with Long-Term, Traumatic Limb Amputations

Psychological distress and postamputation pain were investigated in a sample of 582 males with long-term limb amputations (mean time since amputation 639.3 months, standard deviation 166.1; range 240â784 months). Prevalence of significant depressive symptoms (Hospital Anxiety and Depression Scale [HADS]-D score ⥠8) was 32.0%, and 34.0% of respondents met the screening criterion for clinical anxiety (HADS-A score ⥠8). Nearly one quarter (24.6%) of respondents reported significant post-traumatic psychological stress symptoms (Impact of Event Scale scores ⥠35). In total, 87.8% experienced either phantom or residual limb pain. Affective distress scores differed according to the respondents' type of pain experience. Respondents who experienced residual limb pain reported significantly higher affective distress scores than those with no phantom or residual limb pain. Many older individuals with long-term traumatic limb amputations could benefit from interventions to ameliorate affective distress and appropriate residual limb pain treatment

Coping strategies as predictors of psychosocial adaptation in a sample of elderly veterans with acquired lower limb amputations

This study examines the contribution of demographic/amputation-related variables and coping strategies to the prediction of psychosocial adaptation in veterans with acquired lower limb amputations. Multiple indicators of the psychosocial adjustment of 796 individuals in the UK aged between 26â92 years with lower limb amputations were assessed. Hierarchical linear regressions were performed to investigate relationships between demographic/amputationrelated variables (i.e. age, time since amputation, amputation level and amputation aetiology), the dimensions of coping (namely problem solving, seeking social support and avoidance) and self-reported adaptation to amputation, as well as symptoms of intrusion, anxiety and depression. Results indicated that coping styles were important predictors of psychosocial adaptation. Avoidance was strongly associated with psychological distress and poor adjustment. In contrast, problem solving was negatively associated with depressive and anxious symptomatology whereas seeking social support was negatively associated with symptoms of depression and positively associated with social adaptation. These findings suggest the potential for interventions designed to promote particular coping strategies to improve psychosocial outcomes

The Role of Awakening Cortisol and Psychological Distress in Diurnal Variations in Affect: A Day Reconstruction Study

People often feel unhappy in the morning but better later in the day, and this pattern may be amplified in the distressed. Past work suggests that one function of cortisol is to energize people in the mornings. In a study of 174 students we tested to see if daily affect patterns, psychological distress, and awakening cortisol levels were interlinked. Affect levels were assessed using the Day Reconstruction Method (Kahneman, Krueger, Schkade, Schwarz, & Stone, 2004) and psychological distress was measured using the Depression Anxiety Stress Scales (Antony, Bieling, Cox, Enns, & Swinson, 1998). On average positive affect increased markedly in a linear pattern across the day whilst negative affect decreased linearly. For the highly distressed this pattern was stronger for positive affect. Lower than average morning cortisol, as assessed by two saliva samples at waking and two samples 30 minutes after waking, predicted a clear increasing pattern of positive affect throughout the day. When we examined the interlinkages between affect patterns, distress, and cortisol our results showed that a pronounced linear increase in positive affect from morning through to evening occurred chiefly among distressed people with below average cortisol levels upon awakening. Psychological distress, whilst not strongly associated with morning cortisol levels, does appear to interact with cortisol levels to profoundly influence affect.Cortisol, Psychological Distress, Positive Affect, Diurnal Variation, Day Reconstruction Method

Naturalistic monitoring of the affect-heart rate relationship: A Day Reconstruction Study

Objective: Prospective studies have linked both negative affective states and trait neuroticism with hypertension, cardiovascular disease, and mortality. However, identifying how fluctuations in cardiovascular activity in day-to-day settings are related to changes in affect and stable personality characteristics has remained a methodological and logistical challenge. Design - In the present study, we tested the association between affect, affect variability, personality and heart rate (HR) in daily life. Measures: We utilized an online day reconstruction survey to produce a continuous account of affect, interaction, and activity patterns during waking hours. Ambulatory HR was assessed during the same period. Consumption, activity, and baseline physiological characteristics were assessed in order to isolate the relationships between affect, personality and heart rate. Results: Negative affect and variability in positive affect predicted an elevated ambulatory HR and tiredness a lower HR. Emotional stability was inversely related to HR, whereas agreeableness predicted a higher HR. Baseline resting HR was unrelated to either affect or personality. Conclusion: The results suggest that both state and trait factors implicated in negative affectivity may be risk factors for increased cardiovascular reactivity in everyday life. Combining day reconstruction with psychophysiological and environmental monitoring is discussed as a minimally invasive method with promising interdisciplinary relevance.heart rate, negative affect, affect variability, Big Five, Day Reconstruction Method

The Positive Psychology of Maritime Health

The remote, isolated, confined, and safety-critical environment of seafaring exposes seafarers to a very specific assortment of stressors. Research suggests that seafarers as a professional group are amongst those at high risk for stress and associated mental health conditions. This article explores positive psychology as an approach to supporting wellbeing at sea. Positive psychology may support health, positive attitudes and productive work behaviour; however it cannot and should not be employed as a means of inoculating seafarers against the negative consequences of fundamentally unreasonable work practices. Rather, positive psychology can help seafarers thrive in an overall context that recognises and enacts the benefits of a positive and reasonable work environment. Recommendations are made for future research regarding online or computer-based positive psychology interventions and training, and research on maritime health at the systems level

The Positive Psychology of Maritime Health

The remote, isolated, confined, and safety-critical environment of seafaring exposes seafarers to a very specific assortment of stressors. Research suggests that seafarers as a professional group are amongst those at high risk for stress and associated mental health conditions. This article explores positive psychology as an approach to supporting wellbeing at sea. Positive psychology may support health, positive attitudes and productive work behaviour; however it cannot and should not be employed as a means of inoculating seafarers against the negative consequences of fundamentally unreasonable work practices. Rather, positive psychology can help seafarers thrive in an overall context that recognises and enacts the benefits of a positive and reasonable work environment. Recommendations are made for future research regarding online or computer-based positive psychology interventions and training, and research on maritime health at the systems level

Maritime health: a review with suggestions for research

International maritime health has largely developed within the sphere of occupational health services and international health problems. We reviewed publications in the journal International Maritime Health from 2000 to 2010 to establish the coverage of the journal and the scope of research in maritime health. We identified six thematic categories: healthcare access, delivery and integration; telehealth; non-communicable diseases and physical health problems; communicable diseases; psychological functioning and health; and safety-related issues. We describe the research within these themes and report on their publication prominence. We also analyse the research in terms of its geographical focus, the population groups addressed and the research methodologies used. We suggest a broadening of maritime research to include randomised controlled trials, longitudinal studies and more qualitative research; more research addressing the context for non-European seafarers; and research on seafarers spouses and family supports and obligations. We also recommend more research on psychosocial and cultural issues and on telehealth, as well as the development of a stronger systems perspective for promoting maritime health

Access to health care of persons with disabilities as an indicator of equity in health systems

Health systems are often evaluated using indicators such as maternal mortality, which reflect the health status of the population and the effectiveness of health services. Addressing the right to health of persons with disabilities is a significant challenge for health systems because health services for this subgroup are interdependent on other sectors in society, such as education, employment and transportation. By considering health care access of persons with disabilities, it is possible to evaluate the overall effectiveness of the health system in terms of equity, accessibility and right to health

Identifying Predictors of Stress and Job Satisfaction in a Sample of Merchant Seafarers Using Structural Equation Modeling

Background: Seafarers are amongst occupational groups with the highest risk for stress, a factor known to impact on mental health. Psychological issues such as depression, anxiety, suicide, and alcohol or drug dependence are recognized health problems within the maritime sector. The primary aim of this study was to identify which individual and occupational factors, known to impact on psychological functioning across the maritime industry and other sectors, best predict perceived stress and job satisfaction among a sample of merchant seafarers.Methods: Secondary data analysis was conducted using a work experiences and attitudes questionnaire administered by a large shipping company to seafarers within their organization. Structural equation modeling was conducted using a proposed theoretical model of perceived stress and job satisfaction in a sample of merchant seafarers.Results: While the structural equation model produced acceptable fit to the sample data according to numerous goodness-of-fit statistics, the comparative fit index and Tucker-Lewis index results indicated less than satisfactory model fit. The model explained 23.8% of variance in the criterion variable of perceived stress, and the strongest predictive effect was for dispositional resilience. The model explained 70.6% of variance in the criterion variable of job satisfaction, and the strongest predictive effect was for instrumental work support.Conclusion: When addressing the psychosocial well-being of merchant seafarers, findings of this study suggest that dispositional resilience may be a particularly important factor with regards to perceived stress, while instrumental work support appears to be a critical factor in relation to job satisfaction. Importantly, however, an overall work environment that is perceived by employees as supportive, equal and just is a cornerstone for the psychosocial well-being of seafarers