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Suicidal behaviors are prevalent among college students; however, students remain reluctant to seek support. We developed a predictive algorithm to identify students at risk of suicidal behavior and used telehealth to reduce subsequent risk.
Data come from several waves of a prospective cohort study (2016–2022) of college students (n = 5454). All first-year students were invited to participate as volunteers. (Response rates range: 16.00–19.93%). A stepped-care approach was implemented: (i) all students received a comprehensive list of services; (ii) those reporting past 12-month suicidal ideation were directed to a safety planning application; (iii) those identified as high risk of suicidal behavior by the algorithm or reporting 12-month suicide attempt were contacted via telephone within 24-h of survey completion. Intervention focused on support/safety-planning, and referral to services for this high-risk group.
5454 students ranging in age from 17–36 (s.d. = 5.346) participated; 65% female. The algorithm identified 77% of students reporting subsequent suicidal behavior in the top 15% of predicted probabilities (Sensitivity = 26.26 [95% CI 17.93–36.07]; Specificity = 97.46 [95% CI 96.21–98.38], PPV = 53.06 [95% CI 40.16–65.56]; AUC range: 0.895 [95% CIs 0.872–0.917] to 0.966 [95% CIs 0.939–0.994]). High-risk students in the Intervention Cohort showed a 41.7% reduction in probability of suicidal behavior at 12-month follow-up compared to high-risk students in the Control Cohort.
Predictive risk algorithms embedded into universal screening, coupled with telehealth intervention, offer significant potential as a suicide prevention approach for students.
Infection prevention program leaders report frequent use of criteria to distinguish recently recovered coronavirus disease 2019 (COVID-19) cases from actively infectious cases when incidentally positive asymptomatic patients were identified on routine severe acute respiratory coronavirus virus 2 (SARS-CoV-2) polymerase chain reaction (PCR) testing. Guidance on appropriate interpretation of high-sensitivity molecular tests can prevent harm from unnecessary precautions that delay admission and impede medical care.
To examine differences in noticing and use of nutrition information comparing jurisdictions with and without mandatory menu labelling policies and examine differences among sociodemographic groups.
Cross-sectional data from the International Food Policy Study (IFPS) online survey.
IFPS participants from Australia, Canada, Mexico, United Kingdom and USA in 2019.
Adults aged 18–99; n 19 393.
Participants in jurisdictions with mandatory policies were significantly more likely to notice and use nutrition information, order something different, eat less of their order and change restaurants compared to jurisdictions without policies. For noticed nutrition information, the differences between policy groups were greatest comparing older to younger age groups and comparing high education (difference of 10·7 %, 95 % CI 8·9, 12·6) to low education (difference of 4·1 %, 95 % CI 1·8, 6·3). For used nutrition information, differences were greatest comparing high education (difference of 4·9 %, 95 % CI 3·5, 6·4) to low education (difference of 1·8 %, 95 % CI 0·2, 3·5). Mandatory labelling was associated with an increase in ordering something different among the majority ethnicity group and a decrease among the minority ethnicity group. For changed restaurant visited, differences were greater for medium and high education compared to low education, and differences were greater for higher compared to lower income adequacy.
Participants living in jurisdictions with mandatory nutrition information in restaurants were more likely to report noticing and using nutrition information, as well as greater efforts to modify their consumption. However, the magnitudes of these differences were relatively small.
This keywords entry proposes that critical infrastructure studies allows us to better understand the cultural lives of nineteenth-century theatrical repertoires and asks: How would conceptualizing theatrical repertoire as an imaginative infrastructure help us understand its cultural legacies in our own day? Nineteenth-century theatrical repertoires functioned in analogous ways to material-technical infrastructure: on one hand, providing routine and taken-for-granted conditions of performance; on the other, encoding asymmetric patterns of belonging and inclusion, proximity and distance, that we see reinforced by infrastructure. Repertoire is thus recast as a means of actively communicating and managing meaning on an enormous scale.
Calls for the integration of spirituality into psychiatric practice have raised concerns about boundary violations. We sought to develop a method to capture psychiatrists’ attitudes to professional boundaries and spirituality, explore consensus and understand what factors are considered. Case vignettes were developed, tested and refined. Three vignettes were presented to 80 mental health professionals (53% said they were psychiatrists; 39% did not identify their professional status). Participants recorded their reactions to the vignettes. Four researchers categorised these as identifying boundary violations or not and analysed the factors considered.
In 90% of cases, at least three of the four researchers agreed on classification (boundary violation; possible boundary violation; no boundary violation). Participants’ opinion about boundary violations was heterogeneous. There was consensus that psychiatrists should not proselytise in clinical settings. Reasoning emphasised pragmatic concerns. Few participants mentioned their religious beliefs. Equivocation was common.
Mental health professionals seem unsure about professional boundaries concerning religion and spirituality in psychiatric practice.
The mere presence of predators or parasites can negatively impact the fitness of prey or hosts. Exposure to predators during an organism's development can have deleterious effects on juvenile survival and the subsequent adult stage. Currently, it is unknown if parasites have analogous impacts on host larval stages and whether these effects carry over into other subsequent life stages. However, parasites may be exerting widespread yet underestimated non-consumptive effects (NCEs). We tested if Drosophila nigrospiracula larvae avoid pupating near mite cues (caged Macrocheles subbadius) in arena experiments, and measured the rate of pupation in arenas with mites and arenas without mites. Larvae disproportionately pupated on the side of arenas that lacked mite cues. Furthermore, fewer larvae successfully pupated in arenas containing mites cues compared to arenas without mite cues. We found that ectoparasitic mites exert NCEs on Drosophila larvae, even though the larval stage is not susceptible to infection. We discuss these results in the context of parasite impacts on host population growth in an infectious world.
Mild cognitive impairment (MCI) may represent an intermediate, prodromal phase of dementia. Although persons with MCI (PwMCI) are able to function independently, they often experience reduced ability to carry out their usual activities. This can result in social, emotional and functional challenges.
To explore the understanding and psychosocial impact of receiving a diagnosis of MCI on patients and carers.
A cross-sectional cohort study was conducted at St James's Hospital Memory Clinic involving patients who attended the clinic for assessment from 1 January 2020 to 30 April 2021 and received a diagnosis of MCI. We completed questionnaires with patients and a nominated family member or friend of each patient (FwMCI).
Forty-seven PwMCI participated in the study, and 36 nominated family members and/or friends completed the FwMCI questionnaire. In our cohort of PwMCI, most of the participants were not aware of their diagnosis; only 21% used the term MCI, and only 25% attributed their problems to a pathological cause. The majority of participants had no recollection of any discussion around the likelihood of progression. One-third of participants expressed relief that they did not have dementia. Most PwMCI reported positive psychological well-being and did not endorse symptoms of depression or anxiety. There was slight discordance of illness perception among the PwMCI–FwMCI dyads. Forty-seven per cent of FwMCI reported at least a mild degree of carer burden on the Zarit Burden Scale.
Patients’ awareness of being diagnosed with MCI is relatively limited. Public education campaigns raising awareness about MCI can help influence the ‘illness representation’ for MCI and enable people to seek timely advice and support.
People with schizophrenia die almost 20 years earlier than the general population, most commonly from avertable cardiometabolic disease. Existing pharmacological weight-loss agents including metformin have limited efficacy. Recently available glucagon-like peptide (GLP-1) receptor agonists such as semaglutide have shown promise for weight loss but have yet to be trialled in this population.
To examine the efficacy of semaglutide to ameliorate antipsychotic-induced obesity in people with schizophrenia who have been treated with clozapine for more than 18 weeks.
This is a 36-week, double-blinded, randomised placebo-controlled trial. We will recruit 80 clozapine-treated patients with schizophrenia or schizoaffective disorder, aged 18–64 years, with a baseline body mass index ≥26 kg/m2, who will be randomised to subcutaneous semaglutide of 2.0 mg once a week or placebo for 36 weeks. The primary endpoint will be percentage change in body weight from baseline.
This trial will assess the efficacy and side-effects of the GLP-1 receptor agonist semaglutide on body weight and provide evidence on the possible clinical utility of semaglutide in patients with inadequate response to metformin. The study is registered with the Australian New Zealand Clinical Trials Registry (www.anzctr.org.au) with clinical trial registration number ACTRN12621001539820.
This research could benefit individuals with schizophrenia who experience significant health issues, leading to premature mortality, owing to antipsychotic-induced weight gain. Study findings will be disseminated through peer-reviewed publications and conference presentations.
The Taita Falcon Falco fasciinucha is known to occur and breed at only a few locations in eastern and southern Africa and is currently listed as globally “Vulnerable” and “Critically Endangered” in South Africa. An accurate estimation of its conservation status is however hampered by a lack of data and understanding of the species’ habitat requirements and competitive interactions with congeners. Our aim was to address some of these knowledge gaps. We conducted cliff-nesting raptor surveys across a substantial area of the Mpumalanga/Limpopo escarpment in north-eastern South Africa and modelled habitat suitability for nesting Taita Falcons in relation to the proximity of conspecifics and a community of five other sympatric cliff-nesting raptor species, and in relation to a suite of biotic and abiotic environmental variables. Results suggested the location of Taita Falcon nest sites was negatively associated with distance to the nearest pair of conspecifics and the nearest pair of Lanner Falcons Falco biarmicus, and positively associated with tracts of intact, unfragmented forest and woodland around the base of the cliffs. Our results indicated that Taita Falcon and Lanner Falcon appeared to be responding in opposite ways to a directional change in environmental conditions. This response appeared to be detrimental to Taita Falcon and beneficial to Lanner Falcon. Furthermore, the degradation and destruction of Afrotropical woodland and forest is a documented and ongoing reality, both locally and across much of the Taita Falcon’s global distribution. We argue that our findings are sufficient to justify uplisting Taita Falcon to globally “Endangered”.
The Kent and Medway Partnership Trust (KMPT) Rehabilitation service strategy 2020-2025 in line with NICE guidance for Complex Psychosis 2020, sets out to deliver a complete mental health rehabilitation pathway with local provision of high dependency rehabilitation units (HDRU), open rehabilitation units and community rehabilitation provision across the county. There is a lack of HDRU provision in Kent and Medway in its rehabilitation pathway. All HDRU provision is by external providers, often out of area, dislocating people from family support and local resources essential for their recovery and integration. Kent has a relatively high number of out of area (OAT) placements based on national benchmark data (GIRFT). The proposal to develop a HDRU locally led to a review of local population needs for HDRU. The review with the existing OAT data provided information on the number of HDRU beds required in Kent and Medway.
We identified 564 patients who had had 5 or more Mental Health Act assessments, in cluster 16 and 17, more than 3 admissions to psychiatric inpatient units and with CTO recalls. Two senior clinicians reviewed these patients against the HDRU eligibility criteria. Demographics, diagnosis and comorbidities were also recorded.
119/564 patients met the threshold for HDRU assessment. Using our conversation rate from referral to admission in our open rehab, it means about 20% (24) of this cohort would require treatment in a HDRU. Demographics, diagnosis and comorbidities were reviewed which gave important information about service provision requirements. This was compared with NICE guidance recommendations of 1 high dependency unit per 600,000 - 1,000,000. Therefore, based on this, we would be expected to have between 23 and 38 patients requiring HDRU treatment.
A high level of unmet need for HDRU exists in Kent and there is a need for further recognition of the relevance within the rehabilitation pathway. Lack of local provision of HDRUs means the use of longer, expensive and variable quality out of area or private placements. These can be not only detrimental for patients due to a loss of connection to an area and social network but a drain on resources. These results support the case for x2 12 bedded HDRUs. The lack of provision of HDRU impacts on the wider system and patient's timely access to appropriate treatment pathways.
There are increasing amounts of documented evidence that Black and Ethnic Minority (BME) NHS staff are more likely to face exclusion and discrimination. The MWRES- Medical Workforce Race Equality Standards Report details the disadvantages faced by BME doctors in the NHS. This piece of work shows a strategy to support doctors of African and Caribbean origin working in HPFT. Launched in 2021, the HPFT African and Caribbean Doctors Buddy Group (ACDBG) is a group for all doctors of any grade working in HPFT from African and Caribbean backgrounds. The group aims to bring together doctors of these backgrounds to build a group of clinicians who advocate for equity for African and Caribbean patients and medical professionals. Another key focus of the group is to support and motivate each other, focusing on individual health and well-being and sharing mutually beneficial experiences.
Doctors of the groups' ethnic backgrounds across all grades identified 34 (20.1%) African-Caribbean doctors out of the 169 BAME doctors in Hertfordshire Partnership University NHS Foundation Trust (HPFT). Of this, there are 30 doctors of African and 4 of Caribbean backgrounds, with 14 in Consultant, 7 in Staff Grade, Associate Specialist and Specialty (SAS) and 13 in Training posts.
The identified doctors received an invitation to attend the group meeting. Attendance was optional; membership was free with no long-term commitment. The group has an active social media presence to communicate and attract interested colleagues.
The group has met at least three times a year to provide opportunities for meaningful engagement and networking. These have included formal meetings as well as informal dinner events. Feedback from attendees has been very positive, with members mainly commenting on having found support from fellow members in navigating new experiences or learning from how others have sorted culturally unique challenges encountered in their working lives. Our international doctors have expressed joy in finding a resource to obtain guidance in settling into work and support with career development.
Feedback received from members of the group indicate that the doctors have found the group extremely useful. It gives an opportunity for expressive communication to promptly address concerns of any form or nature, on a personal or collective level, thereby improving positive well-being and career progression. Their positive experiences in pastoral care improved inclusion, productivity, retention and ultimately quality of care provided to service users.
As of 2018, there were over 11 million people imprisoned globally. Suicide and self-harm rates have been found to be markedly elevated among imprisoned individuals, however there is much less literature reporting on risk factors for suicide and self-harm following prison release. The immediate post-release period has been found to be a particularly high-risk period for suicide and self-harm. Since many more people are released into the community every year than people kept imprisoned, released prisoners' health is a matter of public health concern. With the societal impact of this topic in mind, this systematic review aims to collate the risk factors for suicide and self-harm upon release from prison.
PubMed, PsycINFO, MEDLINE, and Cochrane were systematically searched using keywords relating to prison release, self-harm and suicide for articles published since 1/1/12. Studies were included if they reported data on risk factors for self-harm or suicide and followed prespecified inclusion criteria. Articles were screened by the author and uncertainty was settled by two independent reviewers. Included studies were evaluated using standardised quality assessment tools. Quantitative data were narratively synthesised due to a high level of heterogeneity in between studies.
248 articles were identified in total. 10 articles were included, reporting data on self-harm and suicide risk factors from 5 countries. Studies ranged from moderate (n = 2) to high quality (n = 8). Risk factors were categorised into the following: demographic characteristics, psychiatric history, conviction type, and imprisonment history. Risk factors which did not fit into any of these categories were categorised into an ”other” group. It was found that there were many non-modifiable factors such as violent convictions, female sex, Indigenous (Torres Strait Islander or Aboriginal) ethnicity, and single relationship status which increase self-harm or suicide risk upon release.
To our knowledge, this is the first systematic review to collate the risk factors for suicide and self-harm following prison release. The results show a complex variety of risk factors. The high mortality rate in this group necessitates the need for strategies to intervene before community re-entry. Study into risk factors post-release may guide identification of at-risk groups to target with proactive, coordinated care pre- and post-release. It is likely this will require a multifactorial approach including health, social and community programmes.
Lithium is a well-recognised treatment in Affective Disorders. Careful monitoring is required due to its narrow therapeutic index. Adherence to monitoring standards has been generally poor with high levels of incidents reported to the National Patient Safety Agency leading to financial settlements and inclusion in patient safety alert potentially selected on inspection by the Care Quality Commission. This audit aimed at mapping the provision of lithium monitoring for patients stable on Lithium in Vale Royal to facilitate implementation of quality improvements in ongoing transformation of community services. There are twelve general practices in Primary Care (PC) for this area, one specialist mental health Trust Cheshire and Wirral Partnership NHS Trust (CWP) and one Hospital Trust MidCheshire Hospital Trust (MCHT).
1. Systems inventory
No lithium central register was identified.
All lithium requests were processed by North Midlands and Cheshire Pathology services (NMCPS).
In specialist care lithium was managed by one Consultant Psychiatrist.
In primary care nine practices provided information, all supported by a software overseen by administrative staff working collaboratively with doctors.
b. Data collection.
Anonymised Lithium results for adult patients stable between November 2021–2022 were collected from NMCPS.
Plasma levels and frequency were compared to generally accepted standards of 0.4-1 mmol/L every 6 months for stable patients.
Ninety patients were identified, eighty in PC and ten with CWP, median age 58, females (53%)/males (47%) gender ratio.
Frequency was mostly 3 monthly for 74% of patients in PC and 80% for CWP.
Levels below 0.4 mmol/L were found in 22.5% of levels measured in PC and 27% for CWP, and over 1 mmol/L in 5% in PC and 0% CWP.
This audit revealed that lithium monitoring for stable patients was primarily managed in PC.
Lithium level was measured more frequently than recommended which could be due to automated cues. Levels were often maintained at the lower end of the range. Those findings could be medically related.
Both computer and clinician led systems allowed for meeting, if not exceeding, targets.
Electronic systems are likely cost savings over a specialist clinic but could generate potentially unnecessary automatic checks, still require data reviews and medical oversight. This could be addressed by system amendments and an audit programme.
The absence of formally recognised central register could be remediated by shared agreement and managed by NMCPS.
Systemic approach to lithium monitoring can be collaboratively extrapolated to other localities, medications, or targets .
To establish if there were any significant changes in the number of referrals for psychiatric assessment or prescribing rates of psychotropic medication in the South Edinburgh tier 3 CAMHS team during the first year of the COVID-19 pandemic compared to the previous year. To explore factors that might be responsible for these changes.
Referrals to the Psychiatric Assessment Clinic were analysed between the periods of 23rd March 2019 and 22nd March 2020 and 23rd March 2020 to 22nd March 2021. Using the unique numeric patient identifier, data from these referrals was gathered retrospectively by looking at clinical documentation on the healthcare information system used across NHS Lothian. Data were gathered for 243 patients.
Data were collected on psychiatric diagnosis and, if medication was prescribed, what class of medication this was. Information on potential confounding factors was also gathered including sex, age, co-morbid psychiatric diagnoses, history of self-harming behaviours and suicide attempts, family set-up, schooling and other support services involved. Information was stored anonymously.
Data were coded. Statistical analysis was undertaken using SPSS (statistical package for the social sciences).
Referrals for psychiatric assessment almost doubled from 83 pre-pandemic to 160 during the first year of the pandemic. Referral rates for most psychiatric disorders increased. The proportion of patients prescribed psychotropic medication increased significantly during the first year of the COVID-19 pandemic compared to the year preceding (P=0.031).
Analysis of possible confounding factors was completed. Anti-depressant prescribing rates for those from non-nuclear families increased significantly in the year during the pandemic (P=0.012). Other differences were observed but these were not statistically significant. The numbers of patients who self-harmed, attempted suicide or carried out both increased from 42 to 79.
Findings add to the existing body of literature highlighting an increase in referrals to mental health services and prescribing of psychotropic medications in the first year of the pandemic in comparison to those pre-pandemic. No clear conclusions could be drawn about factors responsible for change. Continuing to monitor referrals and confounding factors over time would be useful from a public health perspective. It would allow trends to be drawn so that planning can be carried out for future pandemics.
This essay adapts Dietrich Bonhoeffer's ‘orders of preservation’ to address the sharp rise in species extinctions due to human causes. I argue that Bonhoeffer's creative use of preservation orders to build an international alliance provides the scope required to meet the present biodiversity crisis while pre-empting Karl Barth's criticism of static regionalism and avoiding problematic elements in Carl Schmitt's concept of the ‘restraining force’. Drawing on Bonhoeffer's 1932 address, ‘On the Theological Foundation of the Work of the World Alliance’, I present three convictions to guide the task of preservation today, which include the formation of alliances between ecclesial and scientific communities in order to properly specify God's commandment.
Government regulation shapes many aspects of the design of a product. This paper addresses the effect of the complexity of a regulation on product architecture through the structure of the regulation itself. The structure of a regulation derives from dependencies among requirements and parameters in the regulation that are ipso facto design elements. Since design elements such as requirements and parameters have no formal definition in regulation, it is difficult to identify them accurately and consistently. We apply two approaches to defining and coding requirements and parameters in the context of washing machine regulation. The two coding approaches generate networks of design elements that are analyzed to measure the complexity of the regulation and by extension the product. We find significant differences in the complexity of the regulation when coded in different ways and note deficiencies and strengths of each approach. These findings will support future research to measure the impact of regulatory complexity on product architecture.
A survey was conducted among Canadian tertiary neonatal intensive care units. Of the 27 sites who responded, 9 did not have any form of antimicrobial stewardship, and 11 used vancomycin for empirical coverage in late-onset-sepsis evaluations. We detected significant variations in the diagnostic criteria for urinary tract infection and ventilator-associated pneumonia.