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Living in an area with few people from the same ethnic background has been associated with increased incidence of psychosis (the ethnic density effect).
Compare associations between neighbourhood ethnic density and incidence of non-affective psychosis for first and second generation migrants.
Population based cohort (2.2 million) of all those born 1st January 1965 or later and living in Denmark on their 15th birthday. We looked at a total of 106,000 migrants, including 62% first generation migrants. Ethnic density was determined at age 15 and we adjusted for age, gender, calendar period, parental psychiatric history and parental income at age 15.
For the first generation, we found no evidence that rates of non-affective psychosis were related to neighbourhood ethnic density for migrants from Africa (comparing lowest and highest quintiles): IRR 1.02 (95% CI 0.6–1.73), and the Middle East: IRR 0.96 (CI 0.68–1.35) and only weak evidence for migrants from Europe (excluding Scandinavia): IRR 1.35 (CI 0.98–1.84). Conversely, for the second generation rates of non-affective psychosis were increased for migrants from Africa in lower ethnic density neighbourhoods (comparing lowest and highest quintiles): IRR 3.97 (95% CI 1.81–8.69), Europe (excluding Scandinavia): IRR 1.82 (CI 1.28–2.59) and the Middle East: IRR 2.42 (CI 1.18–4.99).
There is strong evidence for an area ethnic density effect on psychosis incidence for second generation migrants, but not for first generation migrants. This could reflect a greater resilience among the latter group to the adverse effects of minority status.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Depression and pain are leading causes of global disability. However, there is a paucity of multinational population data assessing the association between depression and pain, particularly among low- and middle-income countries (LMICs) where both are common. Therefore, we investigated this association across 47 LMICs.
Community-based data on 273 952 individuals from 47 LMICs were analysed. Multivariable logistic and linear regression analyses were performed to assess the association between the International Classification of Diseases, 10th Revision depression/depression subtypes (over the past 12 months) and pain in the previous 30 days based on self-reported data. Country-wide meta-analysis adjusting for age and sex was also conducted.
The prevalence of severe pain was 8.0, 28.2, 20.2, and 34.0% for no depression, subsyndromal depression, brief depressive episode, and depressive episode, respectively. Logistic regression adjusted for socio-demographic variables, anxiety and chronic medical conditions (arthritis, diabetes, angina, asthma) demonstrated that compared with no depression, subsyndromal depression, brief depressive episode, and depressive episode were associated with a 2.16 [95% confidence interval (CI) 1.83–2.55], 1.45 (95% CI 1.22–1.73), and 2.11 (95% CI 1.87–2.39) increase in odds of severe pain, respectively. Similar results were obtained when a continuous pain scale was used as the outcome. Depression was significantly associated with severe pain in 44/47 countries with a pooled odds ratio of 3.93 (95% CI 3.54–4.37).
Depression and severe pain are highly comorbid across LMICs, independent of anxiety and chronic medical conditions. Whether depression treatment or pain management in patients with comorbid pain and depression leads to better clinical outcome is an area for future research.
Knowledge of ENT is important for many doctors, but undergraduate time is limited. This study aimed to identify what is thought about ENT knowledge amongst non-ENT doctors, and the key topics that the curriculum should focus on.
Doctors were interviewed about their views of ENT knowledge amongst non-ENT doctors, and asked to identify key topics. These topics were then used to devise a questionnaire, which was distributed to multiple stakeholders in order to identify the key topics.
ENT knowledge was generally thought to be poor amongst doctors, and it was recommended that undergraduate ENT topics be kept simple. The highest rated topics were: clinical examination; when to refer; acute otitis media; common emergencies; tonsillitis and quinsy; management of ENT problems by non-ENT doctors; stridor and stertor; otitis externa; and otitis media with effusion.
This study identified a number of key ENT topics, and will help to inform future development of ENT curricula.
It has been observed that mental disorders, such as psychosis, are more common for people in some ethnic groups in areas where their ethnic group is less common. We set out to test whether this ethnic density effect reflects minority status in general, by looking at three situations where individual characteristics differ from what is usual in a locality.
Using data from the South East London Community Health study (n = 1698) we investigated associations between minority status (defined by: ethnicity, household status and occupational social class) and risk of psychotic experiences, common mental disorders and parasuicide. We used a multilevel logistic model to examine cross-level interactions between minority status at individual and neighbourhood levels.
Being Black in an area where this was less common (10%) was associated with higher odds of psychotic experiences [odds ratio (OR) 1.34 95% confidence interval (CI) 1.07–1.67], and attempted suicide (OR 1.84 95% CI 1.19–2.85). Living alone where this was less usual (10% less) was associated with increased odds of psychotic experiences (OR 2.18 95% CI 0.91–5.26), while being in a disadvantaged social class where this was less usual (10% less) was associated with increased odds of attempted suicide (OR 1.33 95% CI 1.03–1.71). We found no evidence for an association with common mental disorders.
The relationship between minority status and mental distress was most apparent when defined in terms of broad ethnic group but was also observed for individual household status and occupational social class.
Studies have linked ethnic differences in depression rates with neighbourhood ethnic density although results have not been conclusive. We looked at this using a novel approach analysing whole population data covering just over one million GP patients in four London boroughs.
Using a dataset of GP records for all patients registered in Lambeth, Hackney, Tower Hamlets and Newham in 2013 we investigated new diagnoses of depression and antidepressant use for: Indian, Pakistani, Bangladeshi, black Caribbean and black African patients. Neighbourhood effects were assessed independently of GP practice using a cross-classified multilevel model.
Black and minority ethnic groups are up to four times less likely to be newly diagnosed with depression or prescribed antidepressants compared to white British patients. We found an inverse relationship between neighbourhood ethnic density and new depression diagnosis for some groups, where an increase of 10% own-ethnic density was associated with a statistically significant (p < 0.05) reduced odds of depression for Pakistani [odds ratio (OR) 0.81, 95% confidence interval (CI) 0.70–0.93], Indian (OR 0.88, CI 0.81–0.95), African (OR 0.88, CI 0.78–0.99) and Bangladeshi (OR 0.94, CI 0.90–0.99) patients. Black Caribbean patients, however, showed the opposite effect (OR 1.26, CI 1.09–1.46). The results for antidepressant use were very similar although the corresponding effect for black Caribbeans was no longer statistically significant (p = 0.07).
New depression diagnosis and antidepressant use was shown to be less likely in areas of higher own-ethnic density for some, but not all, ethnic groups.
Evidence suggests that there is a greater prevalence of pain, particularly chronic pain, in the older than in the younger population. This review looks at how dementia affects older people's ability to report pain, and indicates that pain is poorly assessed and managed in people living with dementia, in particular in care and acute settings. The review also reports findings from two recent studies looking at ways of improving the assessment and management of pain in acute settings. Multi-dimensional, patient-centred approaches to assessing and managing pain in those living with dementia are required, and future research should focus on innovative and practical approaches that can be applied in care home and acute settings.
Despite international concern about unregulated predictive genetic testing, there are surprisingly few data on both the determinants of community interest in such testing and its psychosocial impact.
A large population-based public survey with community-dwelling adults (n=1046) ascertained through random digit dialling. Attitudes were assessed by structured interviews.
The study found strong interest in predictive genetic testing for a reported susceptibility to depression. Once the benefits and disadvantages of such testing had been considered, there was significantly greater interest in seeking such a test through a doctor (63%) compared to direct-to-consumer (DTC; 40%) (p<0.001). Personal history of mental illness [odds ratio (OR) 2.58, p<0.001], self-estimation of being at higher than average risk for depression (OR 1.92, p<0.001), belief that a genetic component would increase rather than decrease stigma (OR 1.62, p<0.001), and endorsement of benefits of genetic testing (OR 3.47, p<0.001) significantly predicted interest in having such a test.
Despite finding attitudes that genetic links to mental illness would increase rather than decrease stigma, we found strong community acceptance of depression risk genotyping, even though a predisposition to depression may only manifest upon exposure to stressful life events. Our results suggest that there will be a strong demand for predictive genetic testing.
Elevated incidence of psychotic illness has been consistently shown among migrant populations. Ethnic density, the proportion of an ethnic group in a defined area, is cited as one factor with a reduced risk of psychosis where ethnicity is shared. However, UK studies have shown mixed results. We set out to re-examine the ethnic density effect at a greater level of geographic detail than previous studies.
Using a large sample of patient records from general practitioners in South East London, we were able to assess neighbourhood factors at the detailed lower super output area level. This comprises, on average, 1500 people compared with around 6000 per ward, the measure used in previous studies. We compared black (Afro-Caribbean) and white psychosis incidence by neighbourhood ethnic density over a 10-year period.
We found a clear negative association between ethnic density and psychosis incidence. In neighbourhoods where black people comprised more than 25% of the population, there was no longer a statistically significant ethnic difference in psychosis rates. However, where black people were less well represented, their relative risk increased nearly threefold [odds ratio (OR) 2.88, 95% confidence interval (CI) 1.89–4.39]. Furthermore, incidence rates for black people in the lowest density quintiles were over five times greater than in the most dense quintile (OR 5.24, 95% CI 1.95–14.07). However, at ward level this association was much weaker and no longer statistically significant.
Ethnic density is inversely related to psychosis incidence at a detailed local neighbourhood level.
A new high precision U–Pb zircon age of 710.8 ± 1.5 Ma for granophyric granitic rock from the Stanner Hanter Complex of the Welsh Borderland lies just within error of an older Rb–Sr isochron age. ϵNd values of −0.3 and −1.2 combined with TDM of 1394 Ma and 1468 Ma indicate that the magma incorporated an older crustal source component. The Nd data highlight differences with western Avalonia, the widely considered Late Neoproterozoic north American counterpart to southern Britain, and point toward a closer similarity with other Peri-Gondwanan terranes that incorporate older, cratonic source material.
A limited, randomized, blind, placebo-controlled trial of Q fever and influenza vaccines has been conducted in three Queensland abattoirs on a sequential analysis design. Ninety-eight subjects were given Q fever vaccine and 102 influenza vaccine. Q fever cases were observed in unvaccinated workers in all three abattoirs during the period of observation.
A total of seven Q fever cases in one group, one more than the number required to achieve statistical significance between the two vaccine groups, was reached after 15 months with the cases coming from two of the abattoirs. These Q fever cases were in the group which had been given influenza vaccine and none in that given Q fever vaccine.
Symptomless seroconversion rates of 24% were found in the remaining influenza virus vaccinees, and those without immunity were given Q fever vaccine.
Previous work has suggested that dimensional data obtained from digital image analysis (DIA) has potential to predict the slaughter liveweights of finished beef cattle (Hyslop et al, 2008). Both farmers and cattle buyers may benefit from being able to select animals to meet slaughter specifications more accurately on-farm. The objective of the current study was to assess the feasibility of an on-farm DIA system to predict a number of characteristics in beef steers at slaughter.
Synchrotron based μ-XRF, μ-XAS and μ-XRD have made a major impact in the field of environmental science in the last ten years. One of the first seven ‘day one’ beamlines on the Diamond Light Source is a microfocus spectroscopy beamline, beamline I18. Here the current status of the beamline and the opportunities it presents in the field of environmental science are described, with results from two of the first experiments also included. The first is based on the use of bonemeal to remediate soil. We used Zn K-edge and Pb L3-edge spectroscopy to characterize the speciation of these two elements on a soil after bonemeal treatment. The results are compared with bulk measurements taken on the whole soil and standard materials. The second experiment described here is a study of the speciation and association of Ni in a laterite from Moa Bay, Cuba. Here the differences in the Ni speciation associated with Mn oxides are examined and compared with Fe oxides phases.
Previous work has shown that dimensional information derived from visual images can be used to accurately estimate pig growth, in terms of size and shape (Doeschl et al, 2004). The use of visual images to derive accurate estimates of weight could be very useful information in the commercial environment within and across the livestock industries. The objective of the current study was to examine a small number of digital images of finished beef cattle to ascertain if digital image analysis (DIA) has potential to predict the liveweight (LW) of the animals at slaughter.