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Evidence on the impact of the pandemic on healthcare presentations for self-harm has accumulated rapidly. However, existing reviews do not include studies published beyond 2020.
Aims
To systematically review evidence on presentations to health services following self-harm during the COVID-19 pandemic.
Method
A comprehensive search of databases (WHO COVID-19 database; Medline; medRxiv; Scopus; PsyRxiv; SocArXiv; bioRxiv; COVID-19 Open Research Dataset, PubMed) was conducted. Studies published from 1 January 2020 to 7 September 2021 were included. Study quality was assessed with a critical appraisal tool.
Results
Fifty-one studies were included: 57% (29/51) were rated as ‘low’ quality, 31% (16/51) as ‘moderate’ and 12% (6/51) as ‘high-moderate’. Most evidence (84%, 43/51) was from high-income countries. A total of 47% (24/51) of studies reported reductions in presentation frequency, including all six rated as high-moderate quality, which reported reductions of 17–56%. Settings treating higher lethality self-harm were overrepresented among studies reporting increased demand. Two of the three higher-quality studies including study observation months from 2021 reported reductions in self-harm presentations. Evidence from 2021 suggests increased numbers of presentations among adolescents, particularly girls.
Conclusions
Sustained reductions in numbers of self-harm presentations were seen into the first half of 2021, although this evidence is based on a relatively small number of higher-quality studies. Evidence from low- and middle-income countries is lacking. Increased numbers of presentations among adolescents, particularly girls, into 2021 is concerning. Findings may reflect changes in thresholds for help-seeking, use of alternative sources of support and variable effects of the pandemic across groups.
Child protection systems monitoring is key to ensuring children’s wellbeing. In England, monitoring is rooted in onsite inspection, culminating in judgements ranging from ‘outstanding’ to ‘inadequate’. But inspection may carry unintended consequences where child protection systems are weak. One potential consequence is increased child welfare intervention rates. In this longitudinal ecological study of local authorities in England, we used Poisson mixed-effects regression models to assess whether child welfare intervention rates are higher in an inspection year, whether this is driven by inspection judgement, and whether more deprived areas experience different rates for a given inspection judgement. We investigated the impact of inspection on care entry, Child Protection Plan-initiation, and child-in-need status. We found that inspection was associated with a rise in rates across the spectrum of interventions. Worse judgements yielded higher rates. Inspection may also exacerbate existing inequalities. Unlike less deprived areas, more deprived areas judged inadequate did not experience an increase in the less intrusive ‘child-in-need’ interventions. Our findings suggest that a narrow focus on social work practice is unlikely to address weaknesses in the child protection system. Child protection systems monitoring should be guided by a holistic model of systems improvement, encompassing the socioeconomic determinants of quality.
To investigate the current epidemiology of melioidosis in Yangon, Myanmar, between June 2017 and May 2019 we conducted enhanced surveillance for melioidosis in four tertiary hospitals in Yangon, where the disease was first discovered in 1911. Oxidase-positive Gram-negative rods were obtained from the microbiology laboratories and further analysed at the Department of Medical Research. Analysis included culture on Ashdown agar, the three disc sensitivity test (gentamicin, colistin and co-amoxiclav), latex agglutination, API 20 NE, antibiotic susceptibility testing, and a subset underwent molecular confirmation with a Burkholderia pseudomallei specific assay. Twenty one of 364 isolates (5.7%) were confirmed as B. pseudomallei and were mostly susceptible to the antibiotics used in standard therapy for melioidosis. Ten patients were from Yangon Region, nine were from Ayeyarwaddy region, and one each was from Kayin and Rakhine States. A history of soil contact was given by seven patients, five had diabetes mellitus and one had renal insufficiency. The patients presented with septicaemia (12 cases), pneumonia (three cases), urinary tract infection (two cases) and wound infection (four cases). Eighteen patients survived to hospital discharge. This study highlights the likelihood that melioidosis may be far more common, but underdiagnosed, in more rural parts of Myanmar as in other countries in SE Asia.
Heidegger regards movement not as a transition between states, but as a basic mode of being, and as such it plays an important role in his ontology (GA18:304; GA65:194). In this respect, Heidegger is following Aristotle’s lead – the significance of movement for Heidegger can be traced back to Aristotle’s observation that all natural entities (phusei onta) are characterized by movement in one way or another (GA19:103).
This chapter develops a comparison of two projects based in the West End of Newcastle, both of which involved university–third sector collaborations focused on place-based action. Both of the projects began in 2015 and before the general election of that year, in a policy environment that combined severe cuts (from a relatively high base in terms of urban policy) with a multifaceted emphasis on public service innovation. One was the Fenham Pocket Park and the other was the Reclaim the Lanes project. The authors are David Webb, Armelle Tardiveau and Daniel Mallo (university researchers), and Caroline Emmerson (former Youth and Community Manager at the CHAT [Churches Acting Together] Trust), Marion Talbot (Newcastle City Councillor) and Mark Pardoe (Friends of Fenham Pocket Park Secretary). The projects took place at a time when the government was reforming public services amid a rhetoric of ‘localism’, which was perceived by many commentators as a way of focusing public attention on alleged top-down control under the earlier New Labour government and away from the real causes of austerity (Kisby, 2010; Levitas, 2012), while driving a broadly conceived privatisation agenda (Myers, 2017; Findlay-King et al, 2018). Nevertheless, in this chapter, we offer some empirical reflections on our efforts to take localism at its word and, by working within the envelope of this policy agenda, to extend democracy to communities and to everyday life.
Our core argument here relates to the tensions that arise from the simultaneous pursuit of localism and austerity. These tensions are also contextualised by the marketisation of the third sector and by the concentration of decision-making power within council structures. These conditions, we will argue, have important implications for the form of democratic innovation we were able to achieve, as well as, ultimately, the outcomes arising from the projects. In combination, their effect was to undermine and contain efforts at democratic innovation that might otherwise have come closer to the populist policy rhetoric of achieving ‘a radical shift of power from the centralised state to local communities’ (HM Government, 2010: 2). Through the two projects, we explore the limits that austerity places on social innovation and the implications these may have for the civic university agenda in a future that is likely to be defined by a postpandemic economic agenda.
The first demonstration of laser action in ruby was made in 1960 by T. H. Maiman of Hughes Research Laboratories, USA. Many laboratories worldwide began the search for lasers using different materials, operating at different wavelengths. In the UK, academia, industry and the central laboratories took up the challenge from the earliest days to develop these systems for a broad range of applications. This historical review looks at the contribution the UK has made to the advancement of the technology, the development of systems and components and their exploitation over the last 60 years.
To investigate the spatial distribution of self-harm incidence rates, their socioeconomic correlates and sex/age differences using data on self-harm presentations to emergency departments from The Manchester Self-Harm Project (2003–2013).
Methods
Smoothed standardised incidence ratios for index self-harm episodes (n = 14 771) and their associations with area-level socioeconomic factors across 258 small areas (median population size = 1470) in the City of Manchester municipality were estimated using Bayesian hierarchical models.
Results
Higher numbers and rates of self-harm were found in the north, east and far southern zones of the city, in contrast to below average rates in the city centre and the inner city zone to the south of the centre. Males and females aged 10–24, 25–44 and 45–64 years showed similar geographical patterning of self-harm. In contrast, there was no clear pattern in the group aged 65 years and older. Fully adjusted analyses showed a positive association of self-harm rates with the percentage of the unemployed population, households privately renting, population with limiting long-term illness and lone-parent households, and a negative association with the percentage of ethnicity other than White British and travel distance to the nearest hospital emergency department. The area-level characteristics investigated explained a large proportion (four-fifths) of the variability in area self-harm rates. Most associations were restricted to those aged under 65 years and some associations (e.g. with unemployment) were present only in the youngest age group.
Conclusions
The findings have implications for allocating prevention and intervention resources targeted at high-risk groups in high incidence areas. Targets for area-based interventions might include tackling the causes and consequences of joblessness, better treatment of long-term illness and consideration of the accessibility of health services.
Written by Lucretius in the first century BCE, De Rerum Natura is an elaboration of Epicurean atomism that ranges over the origin of the universe, the formation of worlds, weather systems, the emergence of life and of social order, morality, and much else besides. It can be picked over for interesting anticipations of modern atomism and of evolutionary theory. Yet, as a materialist account of the emergence of order, it depends on an account of causality and law which has some surprises, and it is on these that I want to focus here. The familiar image of atoms moving and combining may lead one to expect that order in the universe depends ultimately on fixed laws governing the movement of atoms. Although there are some grounds for such a reading, they are not compelling, and Lucretius is otherwise quite clear that order consists of regularities that arise locally, varying from time to time and from place to place. That this theory of local regularities has been eclipsed by the assumption that laws are fixed says more about our own views than those of Lucretius. From the standpoint of contemporary approaches to causality, Lucretius’ account can be described as a regularity theory, where the regularities in question are a feature of the world (and not just of our perception of it). But it is distinctive in that cause and effect do not always and everywhere proceed according to the same invariable laws. Instead, causality precedes laws, which, as regularities, emerge locally and evolve along with the phenomena they determine. The causal structure of the universe is therefore real, but radically contingent. This idea sets Lucretius’ account apart from almost all existing theories of causality and law. Notable exceptions can be found in the work of Charles Sanders Peirce, to some extent in that of Émile Boutroux, and in certain quarters of contemporary cosmology. For example, Peirce writes that “there is room for serious doubt whether the fundamental laws of mechanics hold good for single atoms,” and advises that science turn its attention to “a natural history of laws of nature.” On his part, Boutroux declares that “it is chance, or destiny, or an ensemble of capricious wills, that presides in the universe.”
Written by Lucretius in the first century BCE, De Rerum Natura is an elaboration of Epicurean atomism that ranges over the origin of the universe, the formation of worlds, weather systems, the emergence of life and of social order, morality, and much else besides. It can be picked over for interesting anticipations of modern atomism and of evolutionary theory. Yet, as a materialist account of the emergence of order, it depends on an account of causality and law which has some surprises, and it is on these that I want to focus here. The familiar image of atoms moving and combining may lead one to expect that order in the universe depends ultimately on fixed laws governing the movement of atoms. Although there are some grounds for such a reading, they are not compelling, and Lucretius is otherwise quite clear that order consists of regularities that arise locally, varying from time to time and from place to place. That this theory of local regularities has been eclipsed by the assumption that laws are fixed says more about our own views than those of Lucretius. From the standpoint of contemporary approaches to causality, Lucretius’ account can be described as a regularity theory, where the regularities in question are a feature of the world (and not just of our perception of it). But it is distinctive in that cause and effect do not always and everywhere proceed according to the same invariable laws. Instead, causality precedes laws, which, as regularities, emerge locally and evolve along with the phenomena they determine. The causal structure of the universe is therefore real, but radically contingent. This idea sets Lucretius’ account apart from almost all existing theories of causality and law. Notable exceptions can be found in the work of Charles Sanders Peirce, to some extent in that of Émile Boutroux, and in certain quarters of contemporary cosmology. For example, Peirce writes that “there is room for serious doubt whether the fundamental laws of mechanics hold good for single atoms,” and advises that science turn its attention to “a natural history of laws of nature.” On his part, Boutroux declares that “it is chance, or destiny, or an ensemble of capricious wills, that presides in the universe.”
In 1964 (Solar Cycle 20; SC 20), Patrick McIntosh began creating hand-drawn synoptic maps of solar magnetic features, based on Hα images. These synoptic maps were unique in that they traced magnetic polarity inversion lines, and connected widely separated filaments, fibril patterns, and plage corridors to reveal the large-scale organization of the solar magnetic field. Coronal hole boundaries were later added to the maps, which were produced, more or less continuously, into 2009 (i.e., the start of SC 24). The result was a record of ~45 years (~570 Carrington rotations), or nearly four complete solar cycles of synoptic maps. We are currently scanning, digitizing and archiving these maps, with the final, searchable versions publicly available at NOAA's National Centers for Environmental Information. In this paper we present preliminary scientific studies using the archived maps from SC 23. We show the global evolution of closed magnetic structures (e.g., sunspots, plage, and filaments) in relation to open magnetic structures (e.g., coronal holes), and examine how both relate to the shifting patterns of large-scale positive and negative polarity regions.
Observational studies have suggested that 25-hydroxyvitamin D (25(OH)D) levels are associated with inflammatory markers. Most trials reporting significant associations between vitamin D intake and inflammatory markers used specific patient groups. Thus, we aimed to determine the effect of supplementary vitamin D using secondary data from a population-based, randomised, placebo-controlled, double-blind trial (Pilot D-Health trial 2010/0423). Participants were 60- to 84-year-old residents of one of the four eastern states of Australia. They were randomly selected from the electoral roll and were randomised to one of three trial arms: placebo (n 214), 750 μg (n 215) or 1500 μg (n 215) vitamin D3, each taken once per month for 12 months. Post-intervention blood samples for the analysis of C-reactive protein (CRP), IL-6, IL-10, leptin and adiponectin levels were available for 613 participants. Associations between intervention group and biomarker levels were evaluated using quantile regression. There were no statistically significant differences in distributions of CRP, leptin, adiponectin, leptin:adiponectin ratio or IL-10 levels between the placebo group and either supplemented group. The 75th percentile IL-6 level was 2·8 pg/ml higher (95 % CI 0·4, 5·8 pg/ml) in the 1500 μg group than in the placebo group (75th percentiles:11·0 v. 8·2 pg/ml), with a somewhat smaller, non-significant difference in 75th percentiles between the 750 μg and placebo groups. Despite large differences in serum 25(OH)D levels between the three groups after 12 months of supplementation, we found little evidence of an effect of vitamin D supplementation on cytokine or adipokine levels, with the possible exception of IL-6.
HS: Can you tell us about when you first came across the social model of disability? What impact did it have on you, as a psychiatric system survivor?
DW: Very briefly, it begins with what I now call my four years of madness in the late 1990s. It was not until after this time that I found out about and began to get involved in (mental health) consumer advocacy, activism and politics. I also started my PhD on suicide around this time. All this led to my first contact with the World Network of Users and Survivors of Psychiatry (WNUSP), and organisations like MindFreedom in the US, which opened my eyes to the global movement for radical change in how we think about and respond to madness (madness is my preferred alternative – not everyone's choice – to the harmful pseudoscience label of ‘mental illness’). We had nothing like these organisations in Australia. The ‘consumer’ organisations that we had here at that time were pretty locked into the medical model of madness and focused on service delivery, not human rights. Which remains the situation today, sadly. I know because I made the mistake of chairing one of these organisations for a while. WNUSP also introduced me to the work being done at that time on the UN Convention on the Rights of Persons with Disabilities (CRPD), which further opened my eyes to what was needed and what was possible. It's been a breathtaking, exhilarating and incredibly rewarding journey for me, but also a demanding, frustrating and infuriating journey at times, which has contributed to the illness and disability (aka burn-out) that has led to my premature and unofficial ‘retirement’ from activism. Perhaps the most inspirational part of this wild journey has been to meet and work with some extraordinary people with disabilities who have taught me so much about what it is to be human – and even more about what human rights really means. I’d like to especially honour Lesley Hall who was not only a great leader of the disability movement here in Australia (and globally) but also great fun to be with – her sudden passing away just a few months ago was a great shock and a great loss. Vale, Lesley.
Surveillance in public health is the means by which people who are responsible for preventing or controlling threats to health get the timely, ongoing, and reliable information they need about the occurrence, antecedents, time course, geographic spread, consequences, and nature of these threats among the populations they serve. “Policy surveillance” is the ongoing, systematic collection, analysis, and dissemination of information about laws and other policies of health importance.
By
Jonathan K. Webb, University of Technology Sydney, Australia,
Peter S. Harlow, Taronga Conservation Society Australia,
David A. Pike, James Cook University, Queensland, Australia
Australia has a spectacular and diverse reptile fauna approaching 1000 species, 93% of which are endemic to the continent. Despite this, there is a paucity of information on the biology of Australian reptiles compared with mammals and birds. The single greatest threat to Australian reptiles is the removal of native vegetation, most of which has occurred in the state of Queensland during the past few decades. Since European settlement in Australia, land clearing for stock grazing and other agricultural activities has reduced the extent of native vegetation, and resulted in extensive habitat fragmentation. Ultimately, habitat fragmentation leads to species loss and local extinctions. Other threats to Australian reptiles include livestock grazing, which occurs on 55% of the continent, coupled with changing fire regimes and predation by exotic predators, especially foxes and feral cats. Currently, we know little about the long-term impacts of pastoralism, fire and introduced predators on reptile communities. The conservation of Australian reptiles requires urgent changes in government policy to reduce rates of vegetation clearing. A critical challenge is the conservation of reptiles in the vast arid and semi-arid regions, where reptile diversity is remarkably high. This will require coordinated management of threatening processes across multiple land tenures, including pastoral leases, crown lands, Aboriginal lands and conservation reserves. In southern Australia, the conservation of reptiles in fragmented landscapes will require strategic tree planting to increase the sizes of habitat remnants and their connectivity, in addition to retaining important structural habitat features such as rock outcrops, old growth trees and fallen timber. In addition to in situ conservation practices, breeding programmes are being employed to prevent the extinction of imperilled species.
We investigated whether a higher number of fast-food outlets in an individual’s home neighbourhood is associated with increased prevalence of type 2 diabetes mellitus and related risk factors, including obesity.
Design
Cross-sectional study.
Setting
Three UK-based diabetes screening studies (one general population, two high-risk populations) conducted between 2004 and 2011. The primary outcome was screen-detected type 2 diabetes. Secondary outcomes were risk factors for type 2 diabetes.
Subjects
In total 10 461 participants (mean age 59 years; 53 % male; 21 % non-White ethnicity).
Results
There was a higher number of neighbourhood (500 m radius from home postcode) fast-food outlets among non-White ethnic groups (P<0·001) and in socially deprived areas (P<0·001). After adjustment (social deprivation, urban/rural, ethnicity, age, sex), more fast-food outlets was associated with significantly increased odds for diabetes (OR=1·02; 95 % CI 1·00, 1·04) and obesity (OR=1·02; 95 % CI 1·00, 1·03). This suggests that for every additional two outlets per neighbourhood, we would expect one additional diabetes case, assuming a causal relationship between the fast-food outlets and diabetes.
Conclusions
These results suggest that increased exposure to fast-food outlets is associated with increased risk of type 2 diabetes and obesity, which has implications for diabetes prevention at a public health level and for those granting planning permission to new fast-food outlets.