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This study investigates suicide risk in late childhood and early adolescence in relation to a family-centered intervention, the Family Check-Up, for problem behavior delivered in early childhood. At age 2, 731 low-income families receiving nutritional services from Women, Infants, and Children programs were randomized to the Family Check-Up intervention or to a control group. Trend-level main effects were observed on endorsement of suicide risk by parents or teachers from ages 7.5 to 14, with higher rates of suicide risk endorsement in youth in the control versus intervention condition. A significant indirect effect of intervention was also observed, with treatment-related improvements in inhibitory control across childhood predicting reductions in suicide-related risk both at age 10.5, assessed via diagnostic interviews with parents and youth, and at age 14, assessed via parent and teacher reports. Results add to the emerging body of work demonstrating long-term reductions in suicide risk related to family-focused preventive interventions, and highlight improvements in youth self-regulatory skills as an important mechanism of such reductions in risk.
Strangely enough, no one has noticed in the life of Niccolò Machiavelli a pattern of engagement with Franciscans. Machiavelli's writings mark a significant shift in the development of Western ideas concerning happiness. It helps us better to understand this shift if we realize that an important part of what Machiavelli proposed was developed in opposition to teachings that were emphasized two centuries earlier by St. Francis of Assisi and that remained influential in Machiavelli's own day.
We can perhaps best illustrate the manner in which Machiavelli responded to the poverello from Assisi by looking at a dramatic passage in the Little Flowers of Saint Francis, a popular collection of stories concerning Francis that was composed in the late fourteenth century and circulated widely in Machiavelli's time – as it still does today. The author of the Little Flowers writes,
One day in winter, as St Francis was going with Brother Leo from Perugia to St Mary of the Angels, and was suffering greatly from the cold, he called to Brother Leo, who was walking on before him, and said to him: ‘Brother Leo, if it were to please God that the Friars Minor should give, in all lands, a great example of holiness and edification, write down, and note carefully, that this would not be perfect joy (letizia)’.
A little further on, St Francis called to him a second time: ‘O Brother Leo, if the Friars Minor were to make the lame to walk, if they should make straight the crooked, chase away demons, give sight to the blind, hearing to the deaf, speech to the dumb, and, what is even a far greater work, if they should raise the dead after four days, write that this would not be perfect joy’.
Shortly after, he cried out again: ‘O Brother Leo, if the Friars Minor knew all languages; if they were versed in all science; if they could explain all Scripture; if they had the gift of prophecy, and could reveal, not only all future things, but likewise the secrets of all consciences and all souls, write that this would not be perfect joy’.
Recent infection testing algorithms (RITA) for HIV combine serological assays with epidemiological data to determine likely recent infections, indicators of ongoing transmission. In 2016, we integrated RITA into national HIV surveillance in Ireland to better inform HIV prevention interventions. We determined the avidity index (AI) of new HIV diagnoses and linked the results with data captured in the national infectious disease reporting system. RITA classified a diagnosis as recent based on an AI < 1.5, unless epidemiological criteria (CD4 count <200 cells/mm3; viral load <400 copies/ml; the presence of AIDS-defining illness; prior antiretroviral therapy use) indicated a potential false-recent result. Of 508 diagnoses in 2016, we linked 448 (88.1%) to an avidity test result. RITA classified 12.5% of diagnoses as recent, with the highest proportion (26.3%) amongst people who inject drugs. On multivariable logistic regression recent infection was more likely with a concurrent sexually transmitted infection (aOR 2.59; 95% CI 1.04–6.45). Data were incomplete for at least one RITA criterion in 48% of cases. The study demonstrated the feasibility of integrating RITA into routine surveillance and showed some ongoing HIV transmission. To improve the interpretation of RITA, further efforts are required to improve completeness of the required epidemiological data.
Psychotic experiences (PEs), including hallucination- and delusion-like experiences, are robustly associated with self-injurious thoughts and behaviours (SITB) in the general population. However, it remains unclear as to why there is an association. The purpose of this systematic review was to elucidate the role of other factors that influence the association between PEs and SITB and, in doing so, highlight potential mechanisms underlying the relationship. A search of electronic international databases was undertaken, including PubMed, PsycINFO and EMBASE, and eligible studies were grouped according to seven confounder categories: sociodemographics, mental disorders, alcohol and substance use, environmental, psychological, intervention and family history/genetic factors. The systematic search strategy identified 41 publications reporting on 1 39 427 participants from 16 different countries. In the majority of studies, where adjustment for other variables occurred, the association between PEs and SITB persisted, suggesting PEs have an independent role. Common mental disorders, psychological distress and negative environmental exposures explained a substantial amount of the variance and therefore need to be considered as potential underlying mechanisms. There was high variability in the variables adjusted for in these studies, and so the question still remains as to whether the association between PEs and self-harm/suicidality can be attributed (fully or in part) to confounding and mediating factors or directly causal mechanisms. Regardless of causality, the now extensive literature reporting an association between these two clinical phenomena supports the broad usefulness of PEs as an indicator of risk for SITB.
The UK has one of the largest systems of immigration detention in Europe.. Those detained include asylum-seekers and foreign national prisoners, groups with a higher prevalence of mental health vulnerabilities compared with the general population. In light of little published research on the mental health status of detainees in immigration removal centres (IRCs), the primary aim of this study was to explore whether it was feasible to conduct psychiatric research in such a setting. A secondary aim was to compare the mental health of those seeking asylum with the rest of the detainees.
Cross-sectional study with simple random sampling followed by opportunistic sampling. Exclusion criteria included inadequate knowledge of English and European Union nationality. Six validated tools were used to screen for mental health disorders including developmental disorders like Personality Disorder, Attention Deficit Hyperactivity Disorder (ADHD), Autistic Spectrum Disorder (ASD) and Intellectual Disability, as well as for needs assessment. These were the MINI v6, SAPAS, AQ-10, ASRS, LDSQ and CANFOR. Demographic data were obtained using a participant demographic sheet. Researchers were trained in the use of the screening battery and inter-rater reliability assessed by joint ratings.
A total of 101 subjects were interviewed. Overall response rate was 39%. The most prevalent screened mental disorder was depression (52.5%), followed by personality disorder (34.7%) and post-traumatic stress disorder (20.8%). 21.8% were at moderate to high suicidal risk. 14.9 and 13.9% screened positive for ASD and ADHD, respectively. The greatest unmet needs were in the areas of intimate relationships (76.2%), psychological distress (72.3%) and sexual expression (71.3%). Overall presence of mental disorder was comparable with levels found in prisons. The numbers in each group were too small to carry out any further analysis.
It is feasible to undertake a psychiatric morbidity survey in an IRC. Limitations of the study include potential selection bias, use of screening tools, use of single-site study, high refusal rates, the lack of interpreters and lack of women and children in study sample. Future studies should involve the in-reach team to recruit participants and should be run by a steering group consisting of clinicians from the IRC as well as academics.
Excavations at La Sagesse Convent, Romsey, uncovered a Final Upper Palaeolithic flint assemblage representing an open-air, short-term camp. The site is in the Test Valley on a low gravel terrace at the edge of the river system. Two scatters were found. Although not in situ, little lateral movement is indicated for at least one of these scatters from which several core reduction sequences could be determined through a programme of refitting. The other scatter appears to have suffered more post-depositional disturbance. One scatter appears to have functioned as a knapping station, while the other may have been an area of tool production. Chronological, technological, and cultural affinities are discussed and it is concluded that the flint assemblage belongs with the Final Upper Palaeolithic Hengistbury-type industries, probably dating to the second part of the Windermere interstadial (c. 12,500–11,000 cal BC; 12,000–11,000 BP).