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Homicide rates have fallen markedly in the UK over the past decade. There has been little research on whether homicides by people with mental disorder have contributed to this downward trend. Furthermore, there is limited information on trends in court outcomes for people with mental disorder who commit homicide.
To examine trends in general population homicide and homicide by people with mental disorder, and to explore court outcome.
We conducted a national, consecutive case series of homicide in England and Wales (1997–2015). Data were received from the Home Office Statistics Unit of Home Office Science. Clinical information was obtained from psychiatric reports and mental health services.
There has been a fall in the homicide rate in England and Wales since 2008. Despite this, the relative contribution of mental disorder as a proportion of all homicide has increased. Our findings also showed the inappropriate management of people with serious mental illness convicted of homicide. Of those who committed homicide and were diagnosed with schizophrenia, a third were imprisoned, and there was a marked fall in hospital order referrals. We found this to be linked to substance misuse comorbidity.
The proportional increase in homicide by people with schizophrenia suggests more complex factors may be driving rates, such as substance misuse. Addressing substance misuse comorbidity and maintaining engagement with services may help prevent patient homicide. Despite their complex needs, people with serious mental illness continue to be imprisoned. Improvements in assessment and the timely transfer of prisoners to health services are required.
The present study aimed to examine the temporal prevalence of overweight and obesity in Irish children through different methodologies and evaluate the change in rates between 1990 and 2019.
Anthropometric data from three Irish national food consumption surveys were used to examine the change in the prevalence of BMI and waist circumference-derived overweight and obesity levels.
Three cross-sectional food consumption surveys from the Republic of Ireland: the Irish National Nutrition Survey (1990), the National Children’s Food Survey (2005) and The Second National Children’s Food Survey (2019).
A demographically representative sample of Irish children aged 5–12 years: 1990 (n 148), 2005 (n 594) and 2019 (n 596).
Twelve percentage of children had overweight/obesity in 1990, which was significantly higher in 2005 at 25 % and significantly lower in 2019 at 16 % (P = 0·003). In 2019, more girls had overweight/obesity in comparison with boys (19 v. 14 %), whilst children from the lowest social class group had the highest levels of overweight/obesity (P = 0·019). Overall, the proportion of children with abdominal overweight/obesity was significantly lower in 2019 in comparison with 2005 (P ≤ 0·001).
Evidence from the most recent national survey suggests that overweight and obesity levels are plateauing and in some cases reducing in children in Ireland. Despite this, rates remain high, with the highest prevalence in 2019 observed in girls and in those from the lowest social class group. Thus, overweight/obesity prevention and intervention policies are necessary and should be continued.
Unit cohesion may protect service member mental health by mitigating effects of combat exposure; however, questions remain about the origins of potential stress-buffering effects. We examined buffering effects associated with two forms of unit cohesion (peer-oriented horizontal cohesion and subordinate-leader vertical cohesion) defined as either individual-level or aggregated unit-level variables.
Longitudinal survey data from US Army soldiers who deployed to Afghanistan in 2012 were analyzed using mixed-effects regression. Models evaluated individual- and unit-level interaction effects of combat exposure and cohesion during deployment on symptoms of post-traumatic stress disorder (PTSD), depression, and suicidal ideation reported at 3 months post-deployment (model n's = 6684 to 6826). Given the small effective sample size (k = 89), the significance of unit-level interactions was evaluated at a 90% confidence level.
At the individual-level, buffering effects of horizontal cohesion were found for PTSD symptoms [B = −0.11, 95% CI (−0.18 to −0.04), p < 0.01] and depressive symptoms [B = −0.06, 95% CI (−0.10 to −0.01), p < 0.05]; while a buffering effect of vertical cohesion was observed for PTSD symptoms only [B = −0.03, 95% CI (−0.06 to −0.0001), p < 0.05]. At the unit-level, buffering effects of horizontal (but not vertical) cohesion were observed for PTSD symptoms [B = −0.91, 90% CI (−1.70 to −0.11), p = 0.06], depressive symptoms [B = −0.83, 90% CI (−1.24 to −0.41), p < 0.01], and suicidal ideation [B = −0.32, 90% CI (−0.62 to −0.01), p = 0.08].
Policies and interventions that enhance horizontal cohesion may protect combat-exposed units against post-deployment mental health problems. Efforts to support individual soldiers who report low levels of horizontal or vertical cohesion may also yield mental health benefits.
This chapter provides an interpretative framework for understanding the remarkable regeneration in Catholic thought in the first half of the twentieth century that inspired a renaissance in theology and liturgy, patristics and biblical studies, and contributed decisively to the pivotal reforms of Vatican II. The chapter is in three parts and considers, first, the emergence and development of a threefold stream of renewal at the center of ressourcement; second, the distinctive contribution of the leading Jesuit and Dominican pioneers of ressourcement to theological renewal, the churches, and society; and third, the transformation of Nouvelle Théologie into a universal program of reform.
This study explores the interplay of maternal depressive symptoms and use of antidepressant medication during gestation on the intranatal development of the infant limbic-hypothalamic-pituitary axis (LHPA). Infant neurologic markers at two weeks of age are also examined. Patterns of infant sleep within these groups are also explored.
In the study, pregnant women were screened for depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS), and their symptom severity was assessed longitudinally with the Beck Depression Inventory. Women were divided into 6 risk groups: low/stable, intermediate, and high/increasing depression based upon longitudinal symptom severity and medication use. The infant neuroendocrine system was examined using cord blood ACTH and cortisol. These infants were examined at 2 weeks of age using Neonatal Intensive Care Unit Neurobehavioral Scale (NNNS).
Infants born to women of the high/increasing depression group had significant elevations in cord blood ACTH at birth. On NNNS examination at two weeks, these infants were more hypotonic and less attentive. They habituated to stimuli more quickly and had fewer visual signs and higher skin reactivity. Infants born to women using antidepressants had further elevations in cord blood ACTH, and were found to be more tremulous and excitable during NNNS examination. Infants born to women with higher depression severity demonstrating aberrations in their early sleep patterns and sleep entrainment.
Maternal depression risk and antidepressant use may construe a different developmental pathway for development of the infant neuroendocrine axis which may impact early neonatal neurologic development.
The influence of pharmaceutical industry (PI) on clinical practice and research in psychiatry has been considered a serious problem. Strict rules and guidelines were developed to regulate the interactions between doctors and PI. However, there is an ongoing debate whether these were thoroughly implemented in practice and internalized by physicians. The objective of our study was to assess the attitudes and behaviors of trainees in psychiatry and child & adolescent psychiatry toward PI across Europe. Methodologically, a validated questionnaire with additional items was administered to1444 trainees in 20 European countries. The minimum response rate was set at 60%. We found a high variation across countries in number of interactions between trainees and PI representatives; Portugal and Turkey had the highest number of interactions. The majority (59.76%) agreed that interactions with PI representatives have an impact on physicians’ prescribing behavior; whereas only 29.26% and 19.79% agreed interactions with PI representatives and gifts from PI have impact on their own prescribing behavior, respectively. Most of the gifts were considered appropriate by the majority, except tickets to vacation spot and social dinner at a restaurant. Of the sample, 70.76% think they have not been given sufficient training regarding how to interact with PI representatives. Only less than 20% indicated they have guidelines at institutional or national level. In conclusion, there is substantial interaction between trainees and PI across countries. The majority feel inadequately trained regarding professional interaction with PI, and believes they are immune to the influence of PI.
Interactions between the pharmaceutical industry (PI) and psychiatrists have been under scrutiny recently, though there is little empirical evidence on the nature of the relationship and its intensity at psychiatry trainee level. We therefore studied the level of PI interactions and the underlying beliefs and attitudes in a large sample of European psychiatric trainees.
One thousand four hundred and forty-four psychiatric trainees in 20 European countries were assessed cross-sectionally, with a 62-item questionnaire.
The total number of PI interactions in the preceding two months varied between countries, with least interactions in The Netherlands (M (Mean) = 0.92, SD = 1.44, range = 0–12) and most in Portugal (M = 19.06, SD = 17.44, range = 0–100). Trainees were more likely to believe that PI interactions have no impact on their own prescribing behaviour than that of other physicians (M = 3.30, SD = 1.26 vs. M = 2.39, SD = 1.06 on a 5-point Likert scale: 1 “completely disagree” to 5 “completely agree”). Assigning an educational role to the pharmaceutical industry was associated with more interactions and higher gift value (IRR (incidence rate ratio) = 1.21, 95%CI = 1.12–1.30 and OR = 1.18, 95%CI = 1.02–1.37).
There are frequent interactions between European psychiatric trainees and the PI, with significant variation between countries. We identified several factors affecting this interaction, including attribution of an educational role to the PI. Creating alternative educational opportunities and specific training dedicated to PI interactions may therefore help to reduce the impact of the PI on psychiatric training.
It is estimated that 1 in 10 people have a personality disorder. People with emotionally unstable personality disorder are at high risk of suicide. Despite being frequent users of mental health services, there is often no clear pathway for patients to access effective treatments.
To describe the characteristics of patients with personality disorder who died by suicide, examine clinical care pathways and explore whether the care adhered to National Institute for Health and Care Excellence guidance.
National consecutive case series (1 January 2013 to 31 December 2013). The study examined the health records and serious incident reports of patients with personality disorder who died by suicide in the UK.
The majority had a diagnosis of borderline/emotionally unstable or antisocial personality disorder. A high proportion of patients had a history of self-harm (n = 146, 95%) and alcohol (n = 101, 66%) or drug misuse (n = 79, 52%). We found an extensive pattern of service contact in the year before death, with no clear pathway for patients. Care was inconsistent and there were gaps in service provision. In 99 (70%) of the 141 patients with data, the last episode of care followed a crisis. Access to specialised psychological therapies was limited; short-term in-patient admissions was adhered to; however, guidance on short-term prescribing for comorbid conditions was not followed for two-thirds of patients.
Continuity and stability of care is required to prevent, rather than respond to individuals in crisis. A comprehensive audit of services for people with personality disorder across the UK is recommended to assess the quality of care provided.
Dietary patterns describe the combination of foods and beverages in a diet and the frequency of habitual consumption. Better understanding of childhood dietary patterns and antenatal influences could inform intervention strategies to prevent childhood obesity. We derived empirical dietary patterns in 1142 children (average age 6·0 (sd 0·2) years) in New Zealand, whose mothers had participated in the Screening for Pregnancy Endpoints (SCOPE) cohort study and explored associations with measures of body composition. Participants (Children of SCOPE) had their diet assessed by FFQ, and dietary patterns were extracted using factor analysis. Three distinct dietary patterns were identified: ‘Healthy’, ‘Traditional’ and ‘Junk’. Associations between dietary patterns and measures of childhood body composition (waist, hip, arm circumferences, BMI, bioelectrical impedance analysis-derived body fat % and sum of skinfold thicknesses (SST)) were assessed by linear regression, with adjustment for maternal influences. Children who had higher ‘Junk’ dietary pattern scores had 0·24 (sd 0·08; 95 % CI 0·04, 0·13) cm greater arm and 0·44 (sd 0·05; 95 % CI 0·01, 0·10) cm greater hip circumferences and 1·13 (sd 0·07; 95 % CI 0·03, 0·12) cm greater SST and were more likely to be obese (OR 1·74; 95 % CI 1·07, 2·82); those with higher ‘Healthy’ pattern scores were less likely to be obese (OR 0·62; 95 % CI 0·39, 1·00). In a large mother–child cohort, a dietary pattern characterised by high-sugar and -fat foods was associated with greater adiposity and obesity risk in children aged 6 years, while a ‘Healthy’ dietary pattern offered some protection against obesity. Targeting unhealthy dietary patterns could inform public health strategies to reduce the prevalence of childhood obesity.
How do citizens within countries hosting U.S. military personnel view that presence? Using new cross-national survey data from 14 countries, we examine how different forms of exposure to a U.S. military presence in a country affect attitudes toward the U.S. military, government, and people. We find that contact with U.S. military personnel or the receipt of economic benefits from the U.S. presence correlates with stronger support for the U.S. presence, people, and government. This study has profound implications for the role that U.S. installations play in affecting the social fabric of host nations and policy implications for the conduct of U.S. military activities outside the United States.
Previous research indicates that dialectical behaviour therapy for adolescents (DBT-A) is effective in treating emotionally dysregulated adolescents with self-harm and/or suicidal ideation. As part of the DBT-A programme, parents attend the weekly skills group with their child. However, few studies have evaluated parental outcomes in DBT-A. This multi-site study aims to explore the outcomes and experiences of parents who participated in a 16-week DBT-A programme in Ireland.
This study was conducted in community-based child and adolescent mental health services (CAMHS) in the national public health system in Ireland. Participants were parent/guardians of adolescents attending a DBT-A programme in their local CAMHS. Participants attended the group skills component of the DBT-A programme. This study utilised a mixed methods approach where both quantitative and qualitative data were collected from participants. Self-report measures of burden, grief and parental stress were completed at pre-intervention, post-intervention and 16-week follow-up. Qualitative written feedback was obtained at post-intervention. The data were analysed using multi-level linear mixed-effects models and content analysis.
One hundred participants (76% female) took part in this study. Significant decreases were reported for objective burden, subjective burden, grief and parental stress from pre- to post-intervention (p < 0.01). Participants reported that the skills component of DBT-A was useful in meeting their own needs and the needs of their child.
DBT-A shows promise for parents as well as their adolescent child. Future studies should evaluate changes to family relationships following completion of the programme and also include controlled comparison groups.
Massive IQ gains over time showed that obsolete norms had inflated estimates of the effects of intervention, adoption, and aging; and misdiagnosis of whether individuals had met IQ cutting lines that affected everything from the administration of the death penalty to who should benefit from special education. There were also important studies cited in the literature as if they could be taken at face value – the adoption study by Skodak and Skeels, for example. In America, obsolete norms had turned the death penalty into a lottery: you survive if you took a current test and got sixty-eight; you die if you took an obsolete test and got seventy-five. Research on the causes of IQ gains showed that environmental factors had a potency hitherto unappreciated, illuminated the history of cognitive progress in the twentieth century and its social significance, and recast the debate about group differences in IQ.
The role of meat in the diet has come under scrutiny recently due to an increased public emphasis on providing healthy diets from sustainable food systems and due to health concerns relating to the consumption of red and processed meat. The present review aimed to summarise dietary guidelines relating to meat, actual meat intakes and the contribution of meat to energy and nutrient intakes of children, teenagers and adults in Europe. The available literature has shown that food-based dietary guidelines for most countries recommend consuming lean meat in moderation and many recommend limiting red and processed meat consumption. Mean intakes of total meat in Europe range from 40 to 160 g/d in children and teenagers and from 75 to 233 g/d in adults. Meat contributes to important nutrients such as protein, PUFA, B vitamins, vitamin D and essential minerals such as Fe and Zn; however, processed meat contributes to significant proportions of saturated fat and Na across population groups. While few data are available on diaggregated intakes of red and processed meat, where data are available, mean intakes in adults are higher than the upper limits recommended by the UK Scientific Advisory Committee on Nutrition (70 g/d) and the World Cancer Research Fund (500 g/week). While there are no recommendations for red and processed meat consumption in children and teenagers, intakes currently range from 30 to 76 g/d. The present review provides a comprehensive overview of the role of meat in the European diet which may be of use to stakeholders including researchers, policy makers and the agri-food sector.
Hypoxemic patients often desaturate further with movement and transport. While inhaled epoprostenol does not improve mortality, improving oxygenation allows for transport of severely hypoxemic patients to tertiary care centers with a related improvement in mortality rates. Extracorporeal membrane oxygenation (ECMO) use is increasing in frequency for patients with refractory hypoxemia, and with increasing regionalization of care, safe transport of hypoxemic patients only becomes more important. In this series, four cases are presented of young patients with severe hypoxemic respiratory failure from Legionnaires’ disease transported on inhaled epoprostenol to ECMO centers for consideration of cannulation. With continued climate changes, Legionella and other pathogens are likely to be a continued threat. As such, optimizing oxygenation to allow for transport should continue to be a priority for critical care transport (CCT) services.
Breakfast cereals are widely consumed in Ireland with over 80% of adults choosing ready-to-eat cereals or porridge. In terms of healthy eating, breakfast cereals are considered a nutritious choice and are not expected to contribute significantly to daily salt intakes. Since 2003, the Food Safety Authority of Ireland has coordinated a salt reduction programme to achieve voluntary reduction by the food industry in the salt content of processed foods available in Ireland. This study aims to examine whether salt levels of breakfast cereals are decreasing due to reformulation practices.
A random selection of breakfast cereals on the Irish market were sampled using the following categories: rice-based, bran-based, cornflake-type, biscuit-based, multigrain, muesli and no added salt/low salt varieties in 2003, 2007, 2011 and 2015 (muesli and no added salt/low salt varieties were not sampled again in 2015) (n687). Samples were analysed for sodium content using atomic emission spectrophotometry and converted to salt (g) per 100 g of the food product by multiplying by 2.54. Results were analysed using IBM SPSS (version 25). As data was not normally distributed, median values (minimum and maximum) were investigated across breakfast cereal categories at the different time-points. Differences between the time-points were assessed using Krusal-Wallis test and Mann-Whitney U tests.
In 2003, salt levels were found to be highest in cornflake-type cereals and lowest in no added salt/low salt cereals (2.02 g (0.20–2.31) and 0.01 g (0.0–0.03) per 100 g respectively). The salt content of rice-based, bran-based, cornflake-type, biscuit-based and multigrain varieties significantly decreased (up to 65% in cornflake-type cereals) until 2011. No further reduction was achieved for rice-based, bran-based and cornflake-type varieties in 2015 and a significant increase in salt was observed for biscuit-based (p = 0.001) and multigrain products (p = 0.007). Between 2003 and 2011, no reduction in salt levels was observed for muesli or no added salt/low salt products.
This study revealed there has been a significant reduction in the salt content of breakfast cereals since 2003 – an important finding considering breakfast cereals are recommended for healthy eating. However, this work also shows that continuous salt monitoring is necessary to ensure this reduction in breakfast cereals is maintained. Future FSAI reformulation work will examine a range of nutrients in food products as the food industry have committed to achieve a gradual reduction in fat, saturated fat and sugar, as well as salt, as part of the National Obesity Policy and Action Plan.
Meta-analyses of epidemiological data report that adults who carry a common polymorphism, the MTHFR 677C→T, in the gene encoding the folate-metabolising enzyme methylenetetrahydrofolate reductase (MTHFR) have a 40% increased risk of CVD and an 87% increased risk of hypertension. Riboflavin (vitamin B2), in its co-enzymatic form flavin adenine nucleotide (FAD), is required as a co-factor by MTHFR and previous trials in hypertensive patients have shown a blood pressure lowering response to riboflavin supplementation that is specific to individuals homozygous for this polymorphism (TT genotype). Low folate status is commonly reported in adults with the TT genotype however the effect of this genetic variant on riboflavin status has not previously been investigated. The aim of this study, therefore, was to investigate dietary intake and biomarker status of riboflavin by MTHFR genotype in Irish adults using data from the National Adult Nutrition Survey (2008–2010) (www.iuna.net).
It was found that 12% of the population had the TT genotype. As expected, there was no significant difference in riboflavin intake across the genotype (CC, CT or TT) groups. Similarly, no significant genotype differences in riboflavin status (EGRac) were observed (1.36 vs 1.37 vs 1.38 respectively). Overall, 61% of the total population had EGRac values > 1.3, indicative of low/deficient status with no significant difference observed between the genotype groups (60%,61% and 61%, respectively).
These data suggest that riboflavin status is not influenced by the C677T polymorphism in MTHFR in this cohort of nationally representative Irish adults. Further research is needed to see the impact of riboflavin status on blood pressure across the genotype groups in this nationally representative cohort of Irish adults.
In the UK 21% of pregnant women are categorised as obese(1). Women who enter pregnancy with a high body mass index (BMI) are at greater risk of gestational weight gain (GWG) above that recommended by the Institute of Medicine (IOM) and are less likely to return to their pre-pregnancy weight compared to women with a healthy BMI(2). Pregnancy can therefore alter a woman's weight gain trajectory across the life course, through retention of gestational weight gained. Given the increase in prevalence of obesity among women of reproductive age, the aim of this study was to identify antenatal and postnatal modifiable determinants associated with successful postpartum weight loss in women who participated in UPBEAT; a multi-centre randomised controlled trial comparing a lifestyle intervention of diet and physical activity to standard care during pregnancy.
710 women completed the 6-month postpartum follow-up visit, 464 (65%) of which provided complete data for the analysis. Using regression analysis, we examined the relationship between postpartum weight retention (PPWR; calculated by subtracting pre-pregnancy weight from six-month postpartum weight) and modifiable determinants including: reported glycaemic index and smoking status at baseline (15–18 weeks’ gestation), GWG within the IOM recommendations, self-reported postpartum physical activity (categorised as low, moderate or high) and mode of infant feeding (breastfed, formula or mixed). Women were excluded if they gave birth < 37 weeks gestation or they were pregnant at the 6-month visit. Results were adjusted for age, BMI, ethnicity, socio-economic status, parity and randomisation arm.
In this cohort of obese women 52% were at or below their pre-pregnancy weight by 6 months postpartum. Overall, there was a reduction in PPWR of -0.23 ± 6.7 kg [-23.5 to 23.0 kg]. In an adjusted multiple regression model, women who breastfed for ≥ 4months, had moderate or high levels of physical activity and appropriate GWG, were more likely to be at or below their pre-pregnancy weight by 6-months postpartum (all p < 0.02). In a mutually-adjusted multivariate model, for each additional factor women lost a further -1.5 kg (95%CI -2.3 to -0.68; p < 0.001) compared to their pre-pregnancy weight.
This study has shown that there is an incremental association with postpartum weight loss and the identified modifiable determinants. These findings support initiatives which target any or all these factors during the antenatal and postnatal periods to help support women with returning to their pre-pregnancy weight.
Over half of the Irish population is overweight or obese. The Obesity Policy and Action Plan 2016–2025 will set reformulation targets for fat, saturated fat and sugar in Ireland and review progress. In 2016, the Food Safety Authority of Ireland undertook a cross-sectional market scan of yoghurts to evaluate the energy, fat, saturated fat and sugar content based solely on declared nutrition labels. The aims of this 2018 study were to verify the accuracy of declared nutrition information on yoghurts and to confirm the suitability of declared nutrition labels for energy, fat, saturated fat and sugar reformulation monitoring.
Yoghurts identified in the 2016 market scan (n578) were weighted based on categorisation of manufacturer type (branded, own brand), product category (natural, flavoured and luxury) and declared nutrition content. Samples (n200) were randomly selected from these weighted groups and tested by a laboratory accredited for energy, fat, saturated fat, and sugar analysis. Data was analysed using IBM SPSS (version25). As data was not normally distributed, median values were investigated for declared and tested energy, fat, saturated fat and sugar content using Wilcoxon Signed-Rank Test and Spearman Rank-Order Correlation.
Of the tested yoghurts, 3% (n6), 5% (n9) and 19% (n31) were outside the recommended European Commission (EC) labelling tolerance for fat, saturated fat and sugar, respectively. Tested nutrient content was consistently lower than declared. There was a statistically significant difference in declared vs. tested energy (87kcal vs. 84kcal p = 0.03), fat (2.7 g vs. 2.5 g p < 0.001), and sugar (9.9 g vs. 8.7 g p < 0.001) content per 100 g yoghurt. Declared vs. tested sugar content per 100 g yoghurt was statistically significant across all yoghurt types, including natural (4.8 g vs. 3.4 g p < 0.001), flavoured (9.7 g vs. 8.6 g p < 0.001) and luxury (15 g vs. 13.6 g p = 0.002). There was a statistically significant difference between declared vs. tested fat (2.8 g vs. 2.5 g p < 0.001) and saturated fat (1.9 g vs.1.6 g p = 0.017) content of own brand yoghurts per 100 g. There was a positive correlation between energy content and portion size (r = .2,p < 0.01).
There was a high level of agreement between declared vs. tested fat and saturated fat content of yoghurts, but a lower level of agreement between declared vs. tested sugar content of yoghurts. This indicates that declared nutrition labels are suitable for reformulation monitoring of fat and saturated fat, but may not be suitable for sugar. This finding will be further investigated and tested in future work planned for nutrition label verification of other food categories.