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Pay-for-performance policies aim to improve population health by incentivising improvements in quality of care.
To assess the relationship between general practice performance on severe mental illness (SMI) and depression indicators under a national incentivisation scheme and suicide risk in England for the period 2006–2014.
Longitudinal spatial analysis for 32 844 small-area geographical units (lower super output areas, LSOAs), using population-structure adjusted numbers of suicide as the outcome variable. Negative binomial models were fitted to investigate the relationship between spatially estimated recorded quality of care and suicide risk at the LSOA level. Incidence rate ratios (IRRs) were adjusted for deprivation, social fragmentation, prevalence of depression and SMI as well as other 2011 Census variables.
No association was found between practice performance on the mental health indicators and suicide incidence in practice localities (IRR=1.000, 95% CI 0.998–1.002). IRRs indicated elevated suicide risks linked with area-level social fragmentation (1.030; 95% CI 1.027–1.034), deprivation (1.013, 95% CI 1.012–1.014) and rurality (1.059, 95% CI 1.027–1.092).
Primary care has an important role to play in suicide prevention, but we did not observe a link between practices' higher reported quality of care on incentivised mental health activities and lower suicide rates in the local population. It is likely that effective suicide prevention needs a more concerted, multiagency approach. Better training in suicide prevention for general practitioners is also essential. These findings pertain to the UK but have relevance to other countries considering similar programmes.
The elevated risk of suicide in prison and after release is a well-recognised and serious problem. Despite this, evidence concerning community-based offenders' suicide risk is sparse. We conducted a population-based nested case–control study of all people in a community justice pathway in England and Wales. Our data show 13% of general population suicides were in community justice pathways before death. Suicide risks were highest among individuals receiving police cautions, and those having recent, or impending prosecution for sexual offences. Findings have implications for the training and practice of clinicians identifying and assessing suicidality, and offering support to those at elevated risk.
This study evaluates the contribution of energy-dense, nutrient-poor ‘extra’ foods to the diets of 16–24-month-old children from western Sydney, Australia.
An analysis of cross-sectional data collected on participants in the Childhood Asthma Prevention Study (CAPS), a randomised trial investigating the primary prevention of asthma from birth to 5 years. We collected 3-day weighed food records, calculated nutrient intakes, classified recorded foods into major food groups, and further classified foods as either ‘core’ or ‘extras’ according to the Australian Guide to Healthy Eating.
Pregnant women, whose unborn child was at risk of developing asthma because of a family history, were recruited from all six hospitals in western Sydney, Australia. Data for this study were collected in clinic visits and at participants’ homes at the 18-month assessment.
Four hundred and twenty-nine children participating in the CAPS study; 80% of the total cohort.
The mean consumption of ‘extra’ foods was ∼150 g day− 1 and contributed 25–30% of the total energy, fat, carbohydrate and sodium to the diets of the study children. ‘Extra’ foods also contributed around 20% of fibre, 10% of protein and zinc, and about 5% of calcium. Children in the highest quintile of ‘extra’ foods intake had a slightly higher but not significantly different intake of energy from those in the lowest quintile. However, significant differences were evident for the percentage of energy provided by carbohydrate and sugars (higher) and protein and saturated fat (lower). The intake of most micronutrients was also significantly lower among children in the highest quintile of consumption. The intake of ‘extra’ foods was inversely associated with the intake of core foods.
The high percentage of energy contributed by ‘extra’ foods and their negative association with nutrient density emphasise the need for dietary guidance for parents of children aged 1–2 years. These preliminary data on commonly consumed ‘extra’ foods and portion sizes may inform age-specific dietary assessment methods.
Megalithic art has often been treated as a unitary phenomenon, related to the spread of farming across Western Europe. This approach does not do justice to the very different ways in which tomb decoration was employed by particular communities. This article focuses on the megalithic art of Orkney, much of it recorded for the first time during a recent field survey. This is normally interpreted as a local variant of the style of ‘art’ found in Neolithic Ireland, but on close examination it has much stronger links with the abstract motifs found in local settlements. Whereas the megalithic art of Ireland may have celebrated the passage of the dead to another world, in Orkney it was used to emphasize their continued involvement in the affairs of the living.
Interdiffusion of Si/Si0.85Ge0.15 heterojunctions subjected to annealing in inert and oxidizing ambients was investigated as a function of temperature (900 to 1200 °C) and time, allowing comparison between intrinsic diffusion and diffusion under interstitial injection. The Ge diffusivity was extracted using the process simulation program FLOOPS. A time-independent diffusivity was observed for all temperatures. The calculated Ge diffusivity in oxidizing ambient was comparable to that in inert ambient indicating that the interstitial concentration plays a minimal role in interdiffusion. A fractional interstitial component, f1, equal to 0.10 is estimated for annealing temperatures in the range 900 to 1100 °C, while f1 increases to approximately 0.17 at 1200 °C. This may indicate a change in diffusion mechanism at a temperature greater than 1100 °C
The West Suffolk Strategy to Combat Alcohol Misuse and the first edition of the Good Beer Guide to Belgium and Holland hit the streets on the same day. More importantly the press releases hit the newsdesks of the regional media by the same post. Fortunately, alcohol is entertainment and alcoholism is public affairs so none of the news editors twigged that the two publications had the same author.
Objective: To evaluate the clinical usefulness of carbohydrate deficient transferrin (CDT) as an indicator of alcohol dependence (DSM 111R). Method: Subjects included 18 patients with alcohol dependence and 36 controls (15 recovering alcohol dependents and 21 blood donors). Blood samples from the subjects were analysed for CDT, mean corpuscular volume (MCV) and γ Glutamyltransferase (γGT). These indicators were compared for their sensitivities and specificities to detect excessive alcohol use. Results: Amongst patients with alcohol dependence, CDT was detected in all (100%), γGT was raised in 8 (44%) and MCV was raised in 4 (22%). CDT was detected in five of the 36 controls. Conclusion: CDT was the most sensitive indicator of alcohol dependence. However, CDT showed a much higher false positive rate compared to previous studies. More research is required to elicit at what level of alcohol consumption CDT becomes positive. CDT could prove to be a clinically useful indicator of excessive alcohol use in future.
Freeman pointed out that in 1968 the Royal Commission on Medical Education suggested that “every psychiatrist should be familiar with the conduct of community psychiatry”. In 1987, we still seem to be no nearer achieving this recommendation despite the fact that 60,000 patients have since been discharged into the community, most mental hospitals are being reduced in size and 32% are due to be closed. Whilst doubts have been expressed about the wisdom of these changes, it is unlikely that the process will be reversed. Progress towards adequate training in community psychiatry has been both sluggish and sporadic.
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