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Many male prisoners have significant mental health problems, including anxiety and depression. High proportions struggle with homelessness and substance misuse.
This study aims to evaluate whether the Engager intervention improves mental health outcomes following release.
The design is a parallel randomised superiority trial that was conducted in the North West and South West of England (ISRCTN11707331). Men serving a prison sentence of 2 years or less were individually allocated 1:1 to either the intervention (Engager plus usual care) or usual care alone. Engager included psychological and practical support in prison, on release and for 3–5 months in the community. The primary outcome was the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), 6 months after release. Primary analysis compared groups based on intention-to-treat (ITT).
In total, 280 men were randomised out of the 396 who were potentially eligible and agreed to participate; 105 did not meet the mental health inclusion criteria. There was no mean difference in the ITT complete case analysis between groups (92 in each arm) for change in the CORE-OM score (1.1, 95% CI –1.1 to 3.2, P = 0.325) or secondary analyses. There were no consistent clinically significant between-group differences for secondary outcomes. Full delivery was not achieved, with 77% (108/140) receiving community-based contact.
Engager is the first trial of a collaborative care intervention adapted for prison leavers. The intervention was not shown to be effective using standard outcome measures. Further testing of different support strategies for prison with mental health problems is needed.
People with serious mental illness (SMI) experience higher mortality partially attributable to higher long-term condition (LTC) prevalence. However, little is known about multiple LTCs (MLTCs) clustering in this population.
People from South London with SMI and two or more existing LTCs aged 18+ at diagnosis were included using linked primary and mental healthcare records, 2012–2020. Latent class analysis (LCA) determined MLTC classes and multinominal logistic regression examined associations between demographic/clinical characteristics and latent class membership.
The sample included 1924 patients (mean (s.d.) age 48.2 (17.3) years). Five latent classes were identified: ‘substance related’ (24.9%), ‘atopic’ (24.2%), ‘pure affective’ (30.4%), ‘cardiovascular’ (14.1%), and ‘complex multimorbidity’ (6.4%). Patients had on average 7–9 LTCs in each cluster. Males were at increased odds of MLTCs in all four clusters, compared to the ‘pure affective’. Compared to the largest cluster (‘pure affective’), the ‘substance related’ and the ‘atopic’ clusters were younger [odds ratios (OR) per year increase 0.99 (95% CI 0.98–1.00) and 0.96 (0.95–0.97) respectively], and the ‘cardiovascular’ and ‘complex multimorbidity’ clusters were older (ORs 1.09 (1.07–1.10) and 1.16 (1.14–1.18) respectively). The ‘substance related’ cluster was more likely to be White, the ‘cardiovascular’ cluster more likely to be Black (compared to White; OR 1.75, 95% CI 1.10–2.79), and both more likely to have schizophrenia, compared to other clusters.
The current study identified five latent class MLTC clusters among patients with SMI. An integrated care model for treating MLTCs in this population is recommended to improve multimorbidity care.
Recognizing the need for organizational change in a transition setting, we specify a research model entailing the effects of two important workplace variables on the relationship between dispositional resistance to change and organizational commitment. Organizational commitment is important because of its relationship with a host of considerations relevant to successful organizational change and development. We test the model with samples from four Ukrainian firms undergoing comparable substantive change, including in their human resource systems. The results indicate that the negative relationship between resistance to change and organization commitment is moderated by trust in management. Specifically, it is the lack of trust that exacerbates the negative influence of resistance to change on commitment. Also, high procedural justice strengthens the negative relationship, thereby reducing organizational commitment, an interesting divergence from the Western literature. These indigenous findings in a markedly different context from the West hold potential for theory that is richer and more comprehensive in its explanatory reach. The findings also provide useful insights for managers in Ukraine in their efforts to change organizational practices.
The Rapid ASKAP Continuum Survey (RACS) is the first large-area survey to be conducted with the full 36-antenna Australian Square Kilometre Array Pathfinder (ASKAP) telescope. RACS will provide a shallow model of the ASKAP sky that will aid the calibration of future deep ASKAP surveys. RACS will cover the whole sky visible from the ASKAP site in Western Australia and will cover the full ASKAP band of 700–1800 MHz. The RACS images are generally deeper than the existing NRAO VLA Sky Survey and Sydney University Molonglo Sky Survey radio surveys and have better spatial resolution. All RACS survey products will be public, including radio images (with
15 arcsec resolution) and catalogues of about three million source components with spectral index and polarisation information. In this paper, we present a description of the RACS survey and the first data release of 903 images covering the sky south of declination
made over a 288-MHz band centred at 887.5 MHz.
Cancer patients experience many diet and nutrition-related problems, which are often under-recognised and under-treated. Research suggests few healthcare professionals discuss dietary information with cancer patients. Consequently, patients may seek information from other sources. It is unknown what these information sources are or what types of advice patients obtain and follow. The aim of this study was to determine the source and type of diet information cancer patients obtain before their first dietetic assessment and the degree to which this is followed. This was a prospective, multi-center, cross-sectional observational study. Ethical approval was obtained for each centre. Consecutive cancer inpatients and outpatients were recruited for six months at seven tertiary centers. Patients were screened for eligibility. Inclusion criteria included solid tumour, over 18 years of age, new dietetic referral and ability to sign consent. Data collection was carried out by a dietitian during initial routine dietetic assessment. Participants were asked four questions about dietary advice since cancer diagnosis. To date, 74 participants (50% female) with a median age 60 (range 23–80) have been recruited. Forty percent reported weight loss of ≥ 5%. The median time from diagnosis to initial dietetic assessment was 3 months (range 0–242). Patients who obtained advice did so from several sources (median 2 sources per patient, range 0–6) prior to dietetic referral. In rank order these were; 1) family or friend (n = 31), 2) health professional (n = 24), 3) online forums or websites (n = 16) and 4) media (n = 14). Twenty-one (28%) had received no dietary advice. The most frequent advice obtained related to avoidance of certain foods; particularly dairy, meat and sugar. Fruit, vegetables, protein, juices and wholegrain were advised. Fifty-one percent followed the advice fully and 4% partially. Seven expressed disappointment at not having a dietetics referral earlier and identified the need for the hospital “to introduce good information early”. In conclusion, the majority of dietary and nutritional advice prior to dietetic referral came from friends, family, media and online forums and websites. Most advice related to the avoidance and/or promotion of particular foods. Cancer patients want dietary advice from dietitians at diagnosis to prevent unnecessary avoidance of certain foods and to reduce the risk of unintentional weight loss.
Contributors including Brian Eno, Demos Helsinki, California's Y Combinator Research and prominent academics explore the impact Universal Basic Income could have on work, welfare and inequality in the twenty-first century.
A few years ago, the idea of a universal basic income was widely dismissed as eccentric, as little more than a utopian pipedream. Since then, there has been a significant upsurge in interest, taking the idea from the fringes and up the political agenda in a number of countries.
A universal basic income (UBI) would see a tax-free, unconditional and non-contributory weekly income paid to every individual as of right, irrespective of how much they earned or their work status. Aimed at guaranteeing a no-strings-attached minimum, secure income for all, whatever their circumstances, a UBI would aim to replace at least part of existing national social security systems and would involve a profound revolution in the way income support is organised in most countries.
In the case of the UK, it would constitute a significant extension of the universal model of welfare and, by lowering dependency on means-tested benefits, would relieve the problems of low take-up, the poverty trap and stigma associated with the current system. It would be cheaper to administer, and would save large sums currently spent on processing claims, policing benefit claimants and assessing eligibility.
The idea of a UBI has a long pedigree. The earliest known debate on its essential principles came in 483bc with the discovery of a rich seam of silver in ancient Athenia. The find triggered an intense public discussion about how the potential revenue stream should be spent. One proposal was that it should be distributed among all 30,000 citizens in a regular and equal citizen’s dividend, a move that would have transformed the nature of Athenian society. In the event, the Athenian Assembly voted against the path-breaking idea and, instead, the windfall was used to expand the Athenian navy.
In 1516, the social philosopher, Thomas More, floated the idea of a regular basic income as of right in his fictional fantasy Utopia. In 1797 the British-born champion of democracy, Thomas Paine, called for every person to be paid, at the age of 21, a sum of £15 and for those over 50, the sum of £10. ‘It is a right’, he emphasised, ‘and not a charity’. This sum, he argued, would come from a national fund financed from a charge on the ownership of land, thereby ensuring that part of the benefit of that ownership would be shared among all citizens.
‘Our pilot will be the largest experiment of a basic income in history, with 6,000 people in 40 communities receiving a basic income for more than a decade, and more than 16,000 people receiving some type of cash transfer.’
The US-based non-governmental organisation, GiveDirectly, is among the leaders of the cash transfer movement, and the first non-profit organisation devoted exclusively to enabling funders to send money directly to the extreme poor. From its roots in Kenya, GiveDirectly has grown across East Africa while driving public debate about the role cash transfers should play. Rigorous experimental evidence has played a key role in this growth: GiveDirectly was founded in light of the strong evidence that cash transfers were working, and has also conducted a number of randomised controlled trials which have further strengthened that evidence base. These evaluations have shown that such transfers lead to a host of positive impacts, from higher living standards to greater food security and even improved psychological well-being. In addition, old concerns – that the poor would abuse transfers on alcohol, for example, or stop working – have not been borne out in the data.
We are tremendously excited to be launching our basic income initiative, which represents both a major new chapter in our history and a continuation of the principles we have stood for from the beginning. For context, essentially every dollar we have delivered to date has been part of a short-term or ‘lump-sum’ transfer, an immediate transfer of capital which recipients are then free to use or invest as they please. We think this approach makes sense given the evidence that the poor often have access to investment opportunities with very high rates of return: rather than keep the money in our accounts, we prefer to move it out as quickly as possible. Basic income is if anything the exact opposite approach to designing transfers, since it commits to providing small payments in perpetuity.
But we believe that today’s global conversation about basic income represents a unique opportunity. Opinions are incredibly polarised, from sceptics who call basic income ‘a senseless act of preemptive self-sabotage’ to optimists calling it ‘to the 21st century what civil and political rights were to the 20th.
The last few years have seen what the Paris-based OECD has called a ‘remarkable’ jump in interest in a universal basic income. Pilots, of varying forms and ambition, some funded by national governments and others by crowd-funding charities (such as Eight and GiveDirectly) and wealthy industrialists (such as those at Y Combinator), are under way in a mix of developed and developing countries. While the full impact of these pilots will not be known for some years, they are having a galvanising effect on the UBI debate. The pilots – and more may follow – represent, in themselves, a remarkable global social experiment. As well as taking place, more or less simultaneously, in a diversity of nations and continents, they are well constructed, will offer significant evidence on the potential impact of different models of UBI and are being very closely observed.
What binds supporters of a basic income, and many of the contributions in this book, is its potential to plug some of the holes in existing systems of social security, and to offer greater social protection in an era of growing work insecurity and risk. But a UBI also does much more than this. Many contributors – from Insead’s Eduardo Rodriguez-Montemayor in Chapter 2 to The Leap Manifesto’s Avi Lewis and Katie McKenna in Chapter 12 – talk of how, by encouraging greater choice and strengthening labour’s bargaining power, a UBI would empower citizens and help meet growing public demands for a fairer society. In Chapter 23, Philippe Van Parijs argues that a UBI’s guaranteed income floor – below which no-one would fall – should be central to the renewal of social democracy.
Nevertheless, a UBI is not, as one contributor puts it, ‘a magical solution’. It will help deal with some of the fault lines of today’s economic and social systems, but not all. It is therefore important, as several contributors have cautioned, that the case for UBI is not overstated, and that it is clear that a UBI would need to be accompanied by other reforms targeted at issues like work insecurity, stagnant and falling wages, and the growing concentration of wealth ownership. There are also many different models of a UBI, while actual schemes would need to be tailored to different tax systems, social cultures and stages of development.