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The COVID-19 pandemic has disrupted lives and livelihoods, and people already experiencing mental ill health may have been especially vulnerable.
Quantify mental health inequalities in disruptions to healthcare, economic activity and housing.
We examined data from 59 482 participants in 12 UK longitudinal studies with data collected before and during the COVID-19 pandemic. Within each study, we estimated the association between psychological distress assessed pre-pandemic and disruptions since the start of the pandemic to healthcare (medication access, procedures or appointments), economic activity (employment, income or working hours) and housing (change of address or household composition). Estimates were pooled across studies.
Across the analysed data-sets, 28% to 77% of participants experienced at least one disruption, with 2.3–33.2% experiencing disruptions in two or more domains. We found 1 s.d. higher pre-pandemic psychological distress was associated with (a) increased odds of any healthcare disruptions (odds ratio (OR) 1.30, 95% CI 1.20–1.40), with fully adjusted odds ratios ranging from 1.24 (95% CI 1.09–1.41) for disruption to procedures to 1.33 (95% CI 1.20–1.49) for disruptions to prescriptions or medication access; (b) loss of employment (odds ratio 1.13, 95% CI 1.06–1.21) and income (OR 1.12, 95% CI 1.06 –1.19), and reductions in working hours/furlough (odds ratio 1.05, 95% CI 1.00–1.09) and (c) increased likelihood of experiencing a disruption in at least two domains (OR 1.25, 95% CI 1.18–1.32) or in one domain (OR 1.11, 95% CI 1.07–1.16), relative to no disruption. There were no associations with housing disruptions (OR 1.00, 95% CI 0.97–1.03).
People experiencing psychological distress pre-pandemic were more likely to experience healthcare and economic disruptions, and clusters of disruptions across multiple domains during the pandemic. Failing to address these disruptions risks further widening mental health inequalities.
Reported associations between depression and myocardial infarction in some studies might be explained by use of psychotropic drugs, residual confounding, and/or reverse causation (whereby heart disease precedes depression). We investigated these hypotheses in a large prospective study of UK women with no previous vascular disease.
At baseline in median year 2001 (IQR 2001–2003), Million Women Study participants reported whether or not they were currently being treated for depression or anxiety, their self-rated health, and medication use during the previous 4 weeks. Follow-up was through linkage to national hospital admission and mortality databases. Cox regression yielded adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for the first myocardial infarction event in those reporting treatment for depression or anxiety (subdivided by whether or not the treatment was with psychotropic drugs) v. not, and stratified by self-reported health and length of follow-up.
During mean follow-up of 13.9 years of 690 335 women (mean age 59.8 years) with no prior heart disease, stroke, transient ischaemic attack, or cancer, 12 819 had a first hospital admission or death from myocardial infarction. The aHRs for those reporting treatment for depression or anxiety with, and without, regular use of psychotropic drugs were 0.96 (95% CI 0.89–1.03) and 0.99 (0.89–1.11), respectively. No associations were found separately in women who reported being in good/excellent or poor/fair health or by length of follow-up.
The null findings in this large prospective study are consistent with depression not being an independent risk factor for myocardial infarction.
To describe a pilot project infection prevention and control (IPC) assessment conducted in skilled nursing facilities (SNFs) in New York State (NYS) during a pivotal 2-week period when the region became the nation’s epicenter for coronavirus disease 2019 (COVID-19).
A telephone and video assessment of IPC measures in SNFs at high risk or experiencing COVID-19 activity.
SNFs in 14 New York counties, including New York City.
A 3-component remote IPC assessment: (1) screening tool; (2) telephone IPC checklist; and (3) COVID-19 video IPC assessment (ie, “COVIDeo”).
In total, 92 SNFs completed the IPC screening tool and checklist: 52 (57%) were conducted as part COVID-19 investigations, and 40 (43%) were proactive prevention-based assessments. Among the 40 proactive assessments, 14 (35%) identified suspected or confirmed COVID-19 cases. COVIDeo was performed in 26 (28%) of 92 assessments and provided observations that other tools would have missed: personal protective equipment (PPE) that was not easily accessible, redundant, or improperly donned, doffed, or stored and specific challenges implementing IPC in specialty populations. The IPC assessments took ∼1 hour each and reached an estimated 4 times as many SNFs as on-site visits in a similar time frame.
Remote IPC assessments by telephone and video were timely and feasible methods of assessing the extent to which IPC interventions had been implemented in a vulnerable setting and to disseminate real-time recommendations. Remote assessments are now being implemented across New York State and in various healthcare facility types. Similar methods have been adapted nationally by the Centers for Disease Control and Prevention.
There has been a lively debate about the economic and cultural-based drivers of support for populism. This article argues that economic concerns matter, but that they are realized through the relative gains and losses of social groups. Using new survey items in a large representative survey administered in Britain, it shows that citizens' economic assessments of the ethnic minority out-group – in relation to the group's situation 12 months ago and to assessments of the economic conditions of the white British in-group – are a predictor of support for Brexit. The results, which are robust to prior referendum vote, immigration attitudes and cultural sentiment, extend across income groups and national identity strength. Extending the analysis to a comparison of geographic in- and out-groups between local communities and London lends additional support to the argument. The implications of relative group-based economics are important for understanding Brexit and the economic sources of support for populism more broadly.
We describe an ultra-wide-bandwidth, low-frequency receiver recently installed on the Parkes radio telescope. The receiver system provides continuous frequency coverage from 704 to 4032 MHz. For much of the band (
), the system temperature is approximately 22 K and the receiver system remains in a linear regime even in the presence of strong mobile phone transmissions. We discuss the scientific and technical aspects of the new receiver, including its astronomical objectives, as well as the feed, receiver, digitiser, and signal processor design. We describe the pipeline routines that form the archive-ready data products and how those data files can be accessed from the archives. The system performance is quantified, including the system noise and linearity, beam shape, antenna efficiency, polarisation calibration, and timing stability.
The majority of self-management interventions are designed with a narrow focus on patient skills and fail to consider their potential as “catalysts” for improving care delivery. A project was undertaken to develop a patient self-management resource to support evidence-based, person-centered care for cancer pain and overcome barriers at the levels of the patient, provider, and health system.
The project used a mixed-method design with concurrent triangulation, including the following: a national online survey of current practice; two systematic reviews of cancer pain needs and education; a desktop review of online patient pain diaries and other related resources; consultation with stakeholders; and interviews with patients regarding acceptability and usefulness of a draft resource.
Findings suggested that an optimal self-management resource should encourage pain reporting, build patients’ sense of control, and support communication with providers and coordination between services. Each of these characteristics was identified as important in overcoming established barriers to cancer pain care. A pain self-management resource was developed to include: (1) a template for setting specific, measureable, achievable, relevant and time-bound goals of care, as well as identifying potential obstacles and ways to overcome these; and (2) a pain management plan detailing exacerbating and alleviating factors, current strategies for management, and contacts for support.
Significance of results
Self-management resources have the potential for addressing barriers not only at the patient level, but also at provider and health system levels. A cluster randomized controlled trial is under way to test effectiveness of the resource designed in this project in combination with pain screening, audit and feedback, and provider education. More research of this kind is needed to understand how interventions at different levels can be optimally combined to overcome barriers and improve care.
OBJECTIVES/SPECIFIC AIMS: Using a novel biomechanical-based motor speech assessment alongside commonly used clinically-based motor speech assessments, the goal of this study was to describe longitudinal recovery in speech movements and functional speech in a cohort of 5 patients following facial transplantation. METHODS/STUDY POPULATION: Five participants who had received either full or partial face transplantation were included in this study. Each participant received a unique facial graft from their donor, which included varied amounts of soft tissue, facial musculature, nerve, and bone. Two participants were early in the recovery period and were assessed from zero to 24 months post-transplantation. Three participants were late in the recovery period and were assessed from 36 to 60 months post-transplantation. Each participant completed two data collection sessions and the average time between sessions was 20.4 months. At each session, orofacial movements were recorded using a 3D motion capture system. A 4-sensor head marker was used to subtract head movement (translation and rotation) from the facial markers. The analyses in this study were restricted to two markers: midline lower lip and a virtually calculated midline jaw marker. A marker at the top of the nose bridge was used as the origin point. The following kinematic variables were obtained from each lip-jaw movement time-series: peak movement speed (mm/s), and displacement (mm). Each patient was instructed to perform 10 repetitions of the phrase “buy bobby a puppy” at his or her typical speaking rate and volume. Sentence-level intelligibility was obtained using the Sentence Intelligibility Test (SIT) and word-level intelligibility was obtained using the Word Intelligibility Test, using standard procedures. Intelligibility, measured in percentage of words correctly transcribed, and speaking rate, measured in words per minute (wpm), was derived from the SIT sentences for each patient. Intelligibility, measured in percentage of words correctly chosen via multiple choice was derived from the Word Intelligibility Test. RESULTS/ANTICIPATED RESULTS: Effect sizes (Cohen’s d) across the 10 trials of “buy bobby a puppy” were computed to assess the effects of recovery time on range of motion and speed of the lower lip alone, the jaw alone, and the lower lip and jaw together for both range of motion and for speed. The largest effect sizes were observed for increased range of motion and increased speed of the articulators for participants within 24 months of surgery. Smaller effect sizes were observed for these parameters for the participants in the later stages of recovery, with some participants showing declines in range of motion and speed of some but not all articulators. Descriptive statistics indicate that both speech and word intelligibility improvements are most notable in the first two years following transplantation and appear to plateau during the later stages of recovery. Only two out of five of our participants achieved “normal” speech intelligibility (i.e., >97%) at five years post-transplantation. DISCUSSION/SIGNIFICANCE OF IMPACT: Biomechanical assessment revealed that kinematic recovery of articulator range of motion and speed appears most significant in the first two years following surgery, but that improvement continues to some degree as far as five-years post-transplant. Clinically-based assessments suggest that gains in intelligibility appear to plateau by 3-years post-surgery.
High body mass index (BMI) has been associated with lower risks of suicidal behaviour and being underweight with increased risks. However, evidence is inconsistent and sparse, particularly for women. We aim to study this relationship in a large cohort of UK women.
In total 1.2 million women, mean age 56 (s.d. 5) years, without prior suicide attempts or other major illness, recruited in 1996–2001 were followed by record linkage to national hospital admission and death databases. Cox regression yielded relative risks (RRs) and 95% confidence intervals (CIs) for attempted suicide and suicide by BMI, adjusted for baseline lifestyle factors and self-reported treatment for depression or anxiety.
After 16 (s.d. 3) years of follow-up, 4930 women attempted suicide and 642 died by suicide. The small proportion (4%) with BMI <20 kg/m2 were at clearly greater risk of attempted suicide (RR = 1.38, 95% CI 1.23–1.56) and suicide (RR = 2.10, 1.59–2.78) than women of BMI 20–24.9 kg/m2; p < 0.0001 for both comparisons. Small body size at 10 and 20 years old was also associated with increased risks. Half the cohort had BMIs >25 kg/m2 and, while risks were somewhat lower than for BMI 20–24.9 kg/m2 (attempted suicide RR = 0.91, 0.86–0.96; p = 0.001; suicide RR = 0.79, 0.67–0.93; p = 0.006), the reductions in risk were not strongly related to level of BMI.
Being underweight is associated with a definite increase in the risk of suicidal behaviour, particularly death by suicide. Residual confounding cannot be excluded for the small and inconsistent decreased risk of suicidal behaviour associated with being overweight or obese.
This chapter provides evidence for the three concepts of competence, drawing on public opinion data spanning over more than sixty years in the U.S., U.K. and Canada, more than fifty years in Germany and twenty-five years in Australia. The authors examine how much volatility exists in issue competence evaluations across time and across countries, using different measures. They reveal how issue ownership change – defined as a substantial gain or loss in average ratings across an election cycle– is actually quite common. They show how public opinion about issue competence exhibits common variation over time, such that broad shifts are observed where a party's ratings move on all issues together; resulting in a mood in public opinion about competence, or in ‘generalised competence’. The chapter highlights how each of the concepts has unique characteristics, and also how each interplays with the all-important concept of party identification. Issue ownership rankings tend to cut through partisan biases; partisans are more likely than others to update their evaluations of party handling of issues; and generalised competence is distinct to macro-partisanship and tends to lead partisanship more than be driven by it.
In this chapter the concept of generalised competence is used to analyse and explain one of the most significant and yet largely unexplained questions about politics and electoral support. Why do parties so regularly lose public support over their period in office? A pattern of generalised competence is revealed consistent with the "costs of governing", or "costs of ruling". A theory of costs of governing is argued for based on time-varying attribution of blame. Voters' judge incumbent parties' performance in predictable ways - delineated by different time periods. Specifically, the theory argues that newly elected governments experience a largely blame-free honeymoon period, followed by a period of responsibility attribution (and blame) with a bias towards negative information, and the accumulation of blame up until a saturation point where voters have made their minds up on the incumbent and new information is of little use. Support for this theory is found based on analysis of support for incumbents in five countries (the U.S., U.K., Canada, Australia and Germany), in addition to evidence consistent with a "coalition of minorities" explanation, whereby voters punish incumbents for cumulative deviation from public preferences for policy.
For ownership, performance and generalised competence to add meaningfully to the understanding of electoral behaviour, their effects should be observed individually and in combination. This chapter demonstrates how each concept influences voting decisions and therefore how each shapes election outcomes. Analyses of individual level data, and of aggregate level data, shows effects for all three concepts in vote choices in the U.S. and in the U.K., controlling for key variables. Furthermore, the chapter assesses the question of when and why competence should be particularly important to elections, taking the valence argument of Donald Stokes that events and some elections should cause competence to matter more. This suggests that the concepts of competence are not always equally important in explaining electoral support over time, but that their influence depends upon the political context. The drivers of this importance appear to be shaped by major political, economic, policy and international events, and the role of elections in establishing when vote choices are – or are not – more closely associated with issue competence.
Competence is central to elections and it is therefore central to political elites. The concluding chapter reflects on the theoretical and empirical insights offered in the book through its three ways of thinking about public opinion about competence: as relatively stable issue strengths, or reputations on different policy issues (ownership), as short-term fluctuations in issue ratings (performance), and as the general way in which parties are rated to be competent, or incompetent (generalised competence). The chapter considers how the data demonstrated throughout the book might cause researchers to re-think what they think of as ‘issue ownership’ and what the implications of this might be. It outlines how the findings on ownership, performance and competence contribute to understanding across a range of fields, such as theories of party competition, understanding of elections, costs of ruling, and the responsiveness and accountability of political elites on policy performance. The chapter concludes that party policy reputations, political campaigns and the importance of competence are – to a large extent – the outcomes of events rather than under the control of political parties and governments. This challenges the notions that political power is used to frame and condition the basis of electoral choice; politicians have to respond to the politics of competence as much as they are the drivers of it.
This chapter addresses a major gap in current understanding of issue ownership. While the existing literature offers ideas about what may cause ownership change, and some examination of isolated cases, there has - until now - been no systematic test of why parties lose and gain issue ownership. The authors provide such a test in this chapter, providing cross-national over-time evidence in support of a theory of issue ownership change. The theory argues that ownership change should occur when something happens that is so clear a signal, and so symbolic, that widely held beliefs about political parties are thrown into question. Either a major performance shock or a major symbolic policy change should take place, and there should be party supply to compete on the issue. Conditions associated with 37 changes in issue ownership in the U.S., U.K., Australia and Germany are analysed, alongside cases of no-ownership-change, enabling the authors to show that in all cases of issue ownership change there are pre-conditions of public and/or political salience, the presence of a symbolic performance shock or change, and the presence of a symbolic policy shift by a party. The simultaneous presence of those conditions is not observed in cases of ownership stability - for seven issues over 58 separate election cycles – providing further evidence for the theory.
This chapter reviews the literature on issue ownership and competence, and offers a response. It navigates the theories and evidence from which the authors construct their argument for the three concepts of issue competence used in the book; ownership, performance and generalised competence. The chapter highlights confusion in understandings of issue ownership as a long-term reputation and a short-term lease; considers measurement problems in the analysis of issue ownership (especially relating to partisan endogeneity); and explains the different implications of long-term and short-term competence. It explains why issue ownership should be separated from performance, why the concept of valence has come to mean almost everything and nothing in the formal literature, and why the term ‘valence’ should be used with caution. The authors highlight a general notion of competence, how that builds on existing research and why and how it arises. The chapter outlines how the different concepts of public opinion can be measured for the purpose of analysis, at both an individual and aggregate level, and how they are defined and measured throughout the book.