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Irish Travellers are an indigenous ethnic minority (IEM) with poor health outcomes. Whilst they constitute less than 1% of the Irish population, they account for 10% of national young adult male suicide statistics.
A rapid review of scientific publications related to mental health and suicide in Irish Travellers was undertaken following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Searches of PubMed, PsycINFO and Google Scholar were performed. Eligibility criteria included: (i) Irish Travellers/Gypsy Travellers; (ii) information on mental health/suicide/self-harm; (iii) psychosocial anthropological perspectives of mental health; (iv) publications in english. Data on studies including design, methods, participants and key findings were extracted using a spreadsheet template.
From 5160 scientific references over the past 20 years, 19 papers made reference to Traveller mental health, and only 5 papers made specific data-based reference to suicide in Travellers. It was only when we qualified Travellers as being ‘Irish Travellers’ in our scientific review did we detect meaningful references to their existence as an IEM, and their health and well-being. Due to sample sizes and heterogeneity in design, results were synthesised narratively.
This paper draws together strands from the disciplines of psycho/socio/anthropological perspectives to gain deeper insights into mental health and suicide in Irish Travellers. In a knowledge vacuum, it behoves the scientific community to explain the value of scientific research and rigour to both policymakers as well as Travellers, shifting the existing discourse towards new knowledge and understanding around mental health and suicide in Travellers.
Irish Travellers are an indigenous ethnic minority population in Ireland, with poor life expectancy. This study aims to identify factors associated with reported discrimination and how this affects their experiences of accessing and quality of health services, including mental health.
The All Ireland Traveller Health Study was a cross-sectional census study in 2010. All Traveller families completed a survey questionnaire (n = 6540), and at random an adult selected from the family completed either a health status (health status study = 1547) or health services utilisation survey (HSU = 1576). Experience of discrimination (EOD) from the census was analysed in relation to HSU data on services used in the previous 12 months and reported experiences of access and quality of that health service. Census variables were analysed in relation to EOD and perceived discrimination (PD).
In the final models, EOD and PD were significantly associated with socio-demographic, socio-cultural and living conditions. The multivariate odds of reporting EOD ranged from OR 1.84 to 2.13 and were significant for those reporting worse opportunities in accessing health services, mental health (p = 0.001), hospitals (p < 0.001) and public health nurses (p < 0.001). The multivariate odds of reporting EOD ranged from OR 1.95 to 2.71 and remained significant for those who reported they had poorer experiences than others when using health services, quality of experience (OR 2.18, p =< 0.001), trust in providers (OR 1.95, p =< 0.001) and appropriate information (OR 2.71, p =< 0.001).
Travellers experience high levels of discrimination which negatively affects their engagement with health services. Culturally competent services need to be developed.
To utilise a community-based participatory approach in the design and implementation of an intervention targeting diet-related health problems on Navajo Nation.
A dual strategy approach of community needs/assets assessment and engagement of cross-sectorial partners in programme design with systematic cyclical feedback for programme modifications.
Navajo Nation, USA.
Navajo families with individuals meeting criteria for programme enrolment. Participant enrolment increased with iterative cycles.
The Navajo Fruit and Vegetable Prescription (FVRx) Programme.
A broad, community-driven and culturally relevant programme design has resulted in a programme able to maintain core programmatic principles, while also allowing for flexible adaptation to changing needs.
To obtainconsensus from non-consultant hospital doctors and consultants indeveloping a eLearning module for teaching non-consultant hospital doctorsabout delirium
1) A questionnaire to assess knowledge regarding deliriumwas administered to Medical NCHDs and toPsychiatry NCHDs. A 50 minute teaching session was provided to the PsychiatryNCHDs, which included an existing e-learning module for undergraduateson delirium developed in University College Dublin(UCD). Followingthis feedback was obtained regarding the module and what changes would berequired for it to meet the training needs of non consultant hospital doctors.
2) In the first step of the DELPHIprocess, feedback from medical consultants was obtained in relation to thethemes and topics to be included in the delirium e-learning module.
•In the first iteration of the DELPHI process, both NCHDs and Consultants identified relevant learning outcomes for an eLearning module on delirium for postgraduate medical trainees.
The next iteration of the DELPHI process will refine the themespreviously identified in order to achieve consensus among the NCHD andconsultant groups surveyed. This will be the basis for the design of aneLearning module about delirium.
Restricting access to lethal means is an effective suicide prevention strategy. However, there is little discussion in the literature about the potential contribution of prescribing practices on discharge from inpatient psychiatric care (which has been established as a high-risk period for suicide) to suicide deaths by overdose of prescribed medication. This study aimed to assess the quantity, toxicity and potential lethality of psychotropic medication being prescribed on discharge from psychiatric care to those with and without indices of suicidality.
Patient demographic, clinical and prescription data were collected from 50 randomly selected charts following discharge from inpatient psychiatric care. Psychotropic medications (dose × duration) on discharge were converted to their equivalent doses of neuroleptics, antidepressants and anxiolytics to rate toxicity and potential lethality, using the Maudsley Prescribing Guidelines. Mood stabilizing medications were also documented.
39% of prescriptions analysed contained toxic and potentially fatal doses of either neuroleptic or antidepressant equivalent medication.
Patient discharge from inpatient psychiatric care presents a golden opportunity to moderate access to potentially fatal psychotropic medication. Iatrogenic provision of lethal means for suicide during a period of increased risk and in a group at increased suicide risk may impact suicide prevention efforts and requires further in-depth research. Current prescribing practices may be a missed opportunity to intervene in this regard.
Endophenotypes are laboratory-based measures hypothesized to lie in the causal chain between genes and clinical disorder, and to serve as a more powerful way to identify genes associated with the disorder. One promise of endophenotypes is that they may assist in elucidating the neurobehavioral mechanisms by which an associated genetic polymorphism affects disorder risk in complex traits. We evaluated this promise by testing the extent to which variants discovered to be associated with schizophrenia through large-scale meta-analysis show associations with psychophysiological endophenotypes.
We genome-wide genotyped and imputed 4905 individuals. Of these, 1837 were whole-genome-sequenced at 11× depth. In a community-based sample, we conducted targeted tests of variants within schizophrenia-associated loci, as well as genome-wide polygenic tests of association, with 17 psychophysiological endophenotypes including acoustic startle response and affective startle modulation, antisaccade, multiple frequencies of resting electroencephalogram (EEG), electrodermal activity and P300 event-related potential.
Using single variant tests and gene-based tests we found suggestive evidence for an association between contactin 4 (CNTN4) and antisaccade and P300. We were unable to find any other variant or gene within the 108 schizophrenia loci significantly associated with any of our 17 endophenotypes. Polygenic risk scores indexing genetic vulnerability to schizophrenia were not related to any of the psychophysiological endophenotypes after correction for multiple testing.
The results indicate significant difficulty in using psychophysiological endophenotypes to characterize the genetically influenced neurobehavioral mechanisms by which risk loci identified in genome-wide association studies affect disorder risk.
The emergence of invasive fungal wound infections (IFIs) in combat casualties led to development of a combat trauma-specific IFI case definition and classification. Prospective data were collected from 1133 US military personnel injured in Afghanistan (June 2009–August 2011). The IFI rates ranged from 0·2% to 11·7% among ward and intensive care unit admissions, respectively (6·8% overall). Seventy-seven IFI cases were classified as proven/probable (n = 54) and possible/unclassifiable (n = 23) and compared in a case-case analysis. There was no difference in clinical characteristics between the proven/probable and possible/unclassifiable cases. Possible IFI cases had shorter time to diagnosis (P = 0·02) and initiation of antifungal therapy (P = 0·05) and fewer operative visits (P = 0·002) compared to proven/probable cases, but clinical outcomes were similar between the groups. Although the trauma-related IFI classification scheme did not provide prognostic information, it is an effective tool for clinical and epidemiological surveillance and research.
Dopaminergic function is thought to be altered in major depression and, in animal studies, is reduced in omega-3 polyunsaturated fatty acid (PUFA) deficiency states. Therefore we studied PUFAs and resting prolactin, a marker for dopaminergic tone, and cerebrospinal fluid homovanillic acid (HVA), the chief dopamine metabolite. In medication-free adults (n = 23) with DSM-IV major depressive disorder (MDD), we measured plasma phospholipid levels of omega-3 PUFAs docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), the omega-6 PUFA arachidonic acid (AA), and plasma prolactin levels before and after administration of dl-fenfluramine (FEN). In a subset of patients (n = 14), cerebrospinal fluid levels of HVA and the serotonin metabolite, 5-hydroxyindoleacetic acid (5-HIAA), were obtained through lumbar puncture. Baseline prolactin was negatively correlated with omega-3 PUFAs (logDHA, F1,21 = 20.380, p < 0.001; logEPA, F1,21 = 10.051, p = 0.005) and positively correlated with logAA:DHA (F1,21 = 15.263, p = 0.001), a measure of omega-6/omega-3 balance. LogDHA was negatively correlated with CSF HVA (Spearman's ρ = −0.675, p = 0.008) but not 5-HIAA (Spearman's ρ = −0.143, p = 0.626) after controlling for sex and HVA – 5-HIAA correlation. PUFAs did not predict the magnitude of the FEN-stimulated change in prolactin, considered to be a serotonin effect. The robust relationship of omega-3 PUFAs with dopaminergic but not serotonergic indices suggests that omega-6:omega-3 balance may impact depression pathophysiology through effects on the dopaminergic system.
We observed several swarms of repeating low-frequency (1–5 Hz) seismic events during a 3 week period in May–June 2010, near the summit of Mount Rainier, Washington, USA, that likely were a result of stick–slip motion at the base of alpine glaciers. The dominant set of repeating events (‘multiplets’) featured >4000 individual events and did not exhibit daytime variations in recurrence interval or amplitude. Volcanoes and glaciers around the world are known to produce seismic signals with great variability in both frequency content and size. The low-frequency character and periodic recurrence of the Mount Rainier multiplets mimic long-period seismicity often seen at volcanoes, particularly during periods of unrest. However, their near-surface location, lack of common spectral peaks across the recording network, rapid attenuation of amplitudes with distance, and temporal correlation with weather systems all indicate that ice-related source mechanisms are the most likely explanation. We interpret the low-frequency character of these multiplets to be the result of trapping of seismic energy under glacial ice as it propagates through the highly heterogeneous and attenuating volcanic material. The Mount Rainier multiplet sequences underscore the difficulties in differentiating low-frequency signals due to glacial processes from those caused by volcanic processes on glacier-clad volcanoes.
Youth and young adult suicide has increasingly appeared on international vital statistics as a rising trend of concern in age-specific mortality over the past 50 years. The reporting of suicide deaths in 5-year age bands, which has been the international convention to date, may mask a greater understanding of year-on-year factors that may accelerate or ameliorate the emergence of suicidal thoughts, acts and fatal consequences. The study objective was to identify any year-on-year period of increased risk for youth and young adult suicide in the UK and Ireland.
Collation and examination of international epidemiological datasets on suicide (aged 18–35) for the UK and Ireland 2000–2006 (N = 11 964). Outcome measures included the age distribution of suicide mortality in international datasets from the UK and Ireland, 2000–2006.
An accelerated pattern of risk up to the age of 20 for the UK and Ireland which levels off moderately thereafter was uncovered, thus identifying a heretofore unreported age-related epidemiological transition for suicide.
The current reporting of suicide in 5-year age bands may conceal age-related periods of risk for suicide. This may have implications for suicide prevention programmes for young adults under age 21.
We assess and compare: (a) the attitudes of final-year medical students in 2010 to their 1994 counterparts; (b) the attitudes of third-year medical students with those of their final-year colleagues; (c) the impact of two different teaching modules on students' attitudes. All students completing the year 3 psychiatry preclinical module and the final-year clinical clerkship were asked to anonymously complete three well-validated attitudinal questionnaires on the first and final day of their module in psychiatry.
These data indicate that Irish medical students have a positive attitude to psychiatry even prior to the start of their clinical training in psychiatry. This attitude is significantly more positive now than it was in 1994. A positive attitudinal change was brought about only by the final-year psychiatric clerkship. Students who have completed a degree prior to medicine are less likely to express an interest in a career in psychiatry.
If we are to address the recruitment difficulties in psychiatry we need to look at innovative and specific ways of translating these positive attitudes into careers in psychiatry.
Glyphosate is widely used for weed control in the grape growing industry in southern Australia. The intensive use of glyphosate in this industry has resulted in the evolution of glyphosate resistance in rigid ryegrass. Two populations of rigid ryegrass from vineyards, SLR80 and SLR88, had 6- to 11-fold resistance to glyphosate in dose-response studies. These resistance levels were higher than two previously well-characterized glyphosate-resistant populations of rigid ryegrass (SLR77 and NLR70), containing a modified target site or reduced translocation, respectively. Populations SLR80 and SLR88 accumulated less glyphosate, 12 and 17% of absorbed glyphosate, in the shoot in the resistant populations compared with 26% in the susceptible population. In addition, a mutation within the target enzyme 5-enolpyruvylshikimate-3-phosphate synthase (EPSPS) where Pro106 had been substituted by either serine or threonine was identified. These two populations are more highly resistant to glyphosate as a consequence of expressing two different resistance mechanisms concurrently.
There are many reasons why agricultural researchers carefully evaluate approaches to experimental data analysis. Agricultural experiments are typically highly complex, with many types of variables often collected at a wide range of temporal and spatial scales. Furthermore, research in the developing world is often conducted on-farm where simple and conventional experimental designs are often unsuitable. Recently, a variant of stochastic dominance called stochastic efficiency with respect to a function (SERF) has been developed and used to analyse long-term experimental data. Unlike traditional stochastic dominance approaches, SERF uses the concept of certainty equivalents (CEs) to rank a set of risk-efficient alternatives instead of finding a subset of dominated alternatives. This study evaluates the efficacy of the SERF methodology for analysing conventional and conservation tillage systems using 14 years (1990–2003) of economic budget data collected from 36 experimental plots at the Iowa State University Northeast Research Station near Nashua, IA, USA. Specifically, the SERF approach is used to examine which of two different tillage systems (chisel plough and no-till) on continuous corn (Zea mays) and corn/soyabean (Glycine max) rotation cropping systems are the most risk-efficient in terms of maximizing economic profitability (gross margin and net return) by crop across a range of risk aversion preferences. In addition to the SERF analysis, we also conduct an economic analysis of the tillage system alternatives using mean-standard deviation and coefficient of variation for ranking purposes. Decision criteria analysis of the economic measures alone provided somewhat contradictive and non-conclusive rankings, e.g. examination of the decision criteria results for gross margin and net return showed that different tillage system alternatives were the highest ranked depending on the criterion and the cropping system (e.g. individual or rotation). SERF analysis results for the tillage systems were also dependent on the cropping system (individual, rotation or whole-farm combined) and economic outcome of interest (gross margin or net return) but only marginally on the level of risk aversion. For the individual cropping systems (continuous corn, rotation corn and rotation soyabean), the no-till tillage and rotation soyabean system was the most preferred and the chisel plough tillage and continuous corn system the least preferred across the entire range of risk aversion for both gross margin and net return. The no-till tillage system was preferred to the chisel plough tillage system when ranking within the continuous corn and the corn-soyabean rotation cropping systems for both gross margin and net return. Finally, when analysing the tillage system alternatives on a whole-farm basis (i.e. combined continuous corn and corn-soybean rotation), the no-till tillage system was clearly preferred to the chisel plough tillage system for both gross margin and net return. This study indicates that the SERF method appears to be a useful and easily understood tool to assist farm managers, experimental researchers and, potentially, policy makers and advisers on problems involving agricultural risk.
We begin our investigation of the research laboratories by focusing on the overarching purpose for which they were created: to solve complex, interdisciplinary problems. Activities surrounding problem solving drive much of what transpires in these research labs. It has long been a central assumption of cognitive studies of science and technology that the cognitive resources scientists bring to bear in problem solving are not different in kind from those used in more ordinary instances, but rather lie along a continuum. Construing the problem-solving strategies that scientists have developed as sophisticated, highly reflective outgrowths of ordinary reasoning and representational practices allows researchers in this area to both draw from and inform the study of the nature of cognition.
The idea that problem solving plays a significant role in cognitive processes has been central to cognitive psychology since its emergence in the mid-20th century. Earlier, however, the notion that problem solving is an important part of the processes involved in learning, creativity, insight, and cognitive/conceptual change was represented in Dewey's analysis of the essential elements of effective pedagogy in How We Think:
The best, indeed the only preparation is arousal to a perception of something that needs explanation, something unexpected, puzzling, peculiar. When the feeling of a genuine perplexity lays hold of any mind (no matter how the feeling arises), that mind is alert and inquiring, because stimulated from within. The shock, the bite, of a question will force the mind to go wherever it is capable of going, better than will the most ingenious pedagogical devices unaccompanied by this mental ardor. […]
In this chapter we consider the role of emotion in research practices by examining a class of expressions we have coded and analyzed as implicating emotion, affect, or motivation in the interview data. As noted, this book with its current focus was not planned at the time we began to analyze interview data, and we did not approach coding with the explicit goal of identifying expressions of this kind within the interviews conducted. However, while we were seeking to describe and code cognitive practices as evidenced in the interviews, we found striking examples of interview text that did not fit traditional cognitive categories, but seemed rather to have an affective or emotional tone. Other passages seemed expressive of desires, goals, and aspirations. Although not clearly cognitive, passages of these kinds seemed intimately related to and interwoven with accounts of problem formulation and solving, leading us eventually to code “affect/motivation” as a higher-order category and for this book to include it in the domain of general sense-making that is characteristic of laboratory activity. As Thagard remarked recently, “Affect is a natural subject for a dynamical theory that emphasizes the flow of thought and the complex interactions of emotion and cognition” (2008, p. 51). We also found that affective, emotional, and motivational expressions related intimately to identity formations, as is discussed in some detail in the next chapter.
Importantly, we assigned codes for affective and motivational expressions in both laboratories (A and D) and across levels of expertise, from PI to novice.
In this chapter we describe the contexts of science practice that we studied and the approaches to the data collection and analysis that are the basis of this text. Along the way we note methodological issues and controversies as they relate to our analysis and apply more generally to the use of qualitative methods in psychology. Thus this chapter is comparable to the methods section of a traditional research study, but it contains departures in form in keeping with the theoretical aims of this text.
PARTICIPANTS, CONTEXT, AND HISTORY
Our framing assumption is that the cognitive practices of the laboratory are both situated in the laboratory and distributed across systems of interacting persons, artifacts, instruments, and traditions. The situated approach to cognition construes intelligent behavior as arising within particular settings such that its features are dependent on that setting, in contrast with a view of cognition as an abstract realm or self-regulating process. The assertion is that “problem solving is carried out in conjunction with the environment” (Brown, Collins, & Duguid, 1989, p. 36, emphasis added). By distributed, we mean that we regard brain and environment as co-constituting a single complex system, inasmuch as the forms of sense-making and problem solving that occur would not be possible in isolation from that environment, including the social environment.