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For more than a decade, Improving Access to Psychological Therapies (IAPT) has been training a new workforce of psychological therapists. Despite evidence of stress and burnout both in trainee mental health professionals, and qualified IAPT clinicians, little is known about these topics in IAPT trainees. Consequently, this systematic review sought to establish the current state of the literature regarding stress and burnout in IAPT trainees. Electronic databases were searched to identify all published and available unpublished work relating to the topic. On the basis of pre-established eligibility criteria, eight studies (including six unpublished doctoral theses) were identified and assessed for quality. This review identifies that research into the experience of IAPT trainees is under-developed. Existing evidence tentatively suggests that IAPT trainees may experience levels of stress and burnout that are higher than their qualified peers and among the higher end of healthcare professionals more generally. The experience of fulfilling dual roles as mental health professionals and university students concurrently appears to be a significant source of stress for IAPT trainees. More research regarding the levels and sources of stress and burnout in IAPT trainees is urgently needed to confirm and extend these findings. Recommendations for future research in the area are given.
Key learning aims
(1) To establish the current state of the literature regarding stress and burnout in IAPT trainees.
(2) To raise practitioner, service and education-provider awareness regarding the levels and perceived sources of stress and burnout in IAPT trainees.
(3) To make recommendations regarding future research on the topic.
Head impact exposure (HIE) in youth football is a public health concern. The objective of this study was to determine if one season of HIE in youth football was related to cognitive changes.
Over 200 participants (ages 9–13) wore instrumented helmets for practices and games to measure the amount of HIE sustained over one season. Pre- and post-season neuropsychological tests were completed. Test score changes were calculated adjusting for practice effects and regression to the mean and used as the dependent variables. Regression models were calculated with HIE variables predicting neuropsychological test score changes.
For the full sample, a small effect was found with season average rotational values predicting changes in list-learning such that HIE was related to negative score change: standardized beta (β) = -.147, t(205) = -2.12, and p = .035. When analyzed by age clusters (9–10, 11–13) and adding participant weight to models, the R2 values increased. Splitting groups by weight (median split), found heavier members of the 9–10 cohort with significantly greater change than lighter members. Additionaly, significantly more participants had clinically meaningful negative changes: X2 = 10.343, p = .001.
These findings suggest that in the 9–10 age cluster, the average seasonal level of HIE had inverse, negative relationships with cognitive change over one season that was not found in the older group. The mediation effects of age and weight have not been explored previously and appear to contribute to the effects of HIE on cognition in youth football players.
Morning coffee is a common remedy following disrupted sleep, yet each factor can independently impair glucose tolerance and insulin sensitivity in healthy adults. Remarkably, the combined effects of sleep fragmentation and coffee on glucose control upon waking per se have never been investigated. In a randomised crossover design, twenty-nine adults (mean age: 21 (sd 1) years, BMI: 24·4 (sd 3·3) kg/m2) underwent three oral glucose tolerance tests (OGTT). One following a habitual night of sleep (Control; in bed, lights-off trying to sleep approximately 23.00–07.00 hours), the others following a night of sleep fragmentation (as Control but waking hourly for 5 min), with and without morning coffee approximately 1 h after waking (approximately 300 mg caffeine as black coffee 30 min prior to OGTT). Individualised peak plasma glucose and insulin concentrations were unaffected by sleep quality but were higher following coffee consumption (mean (normalised CI) for Control, Fragmented and Fragmented + Coffee, respectively; glucose: 8·20 (normalised CI 7·93, 8·47) mmol/l v. 8·23 (normalised CI 7·96, 8·50) mmol/l v. 8·96 (normalised CI 8·70, 9·22) mmol/l; insulin: 265 (normalised CI 247, 283) pmol/l; and 235 (normalised CI 218, 253) pmol/l; and 310 (normalised CI 284, 337) pmol/l). Likewise, incremental AUC for plasma glucose was higher in the Fragmented + Coffee trial compared with Fragmented. Whilst sleep fragmentation did not alter glycaemic or insulinaemic responses to morning glucose ingestion, if a strong caffeinated coffee is consumed, then a reduction in glucose tolerance can be expected.
Our ALMA observations of HCO+ and HCN show such redshifted absorption toward an isolated core, BHR 71. Both lines show a similar redshifted absorption profile. We also found emissions of complex organic molecules (COMs) around 345 GHz from a compact region centered on the continuum source, which is barely resolved with a beam of 0″27, corresponding to ∼50 AU.
The current study examined within- and cross-language connectivity in four priming conditions: repetition, translation, within-language semantic and cross-language semantic priming. Unbalanced Hebrew–English bilinguals (N = 89) completed a lexical decision task in one of the four conditions in both languages. Priming effects were significantly larger from L1 to L2 for translation priming and marginally so for cross-language semantic priming. Priming effects were comparable for L1 and L2 in repetition and within-language semantic priming. These results support the notion that L1 words are more effective primes but also that L2 targets benefit more from priming. This pattern of results suggests that the lower frequency of use of L2 lexical items in unbalanced bilinguals contributes to asymmetrical cross-language priming via lower resting-level activation of targets and not only via less efficient lexical activation of primes, as highlighted by the BIA+ model.
Small food store interventions show promise to increase healthy food access in under-resourced areas. However, none have tested the impact of price discounts on healthy food supply and demand. We tested the impact of store-directed price discounts and communications strategies, separately and combined, on the stocking, sales and prices of healthier foods and on storeowner psychosocial factors.
Factorial design randomized controlled trial.
Twenty-four corner stores in low-income neighbourhoods of Baltimore City, MD, USA.
Stores were randomized to pricing intervention, communications intervention, combined pricing and communications intervention, or control. Stores that received the pricing intervention were given a 10–30 % price discount by wholesalers on selected healthier food items during the 6-month trial. Communications stores received visual and interactive materials to promote healthy items, including signage, taste tests and refrigerators.
All interventions showed significantly increased stock of promoted foods v. control. There was a significant treatment effect for daily unit sales of healthy snacks (β=6·4, 95 % CI 0·9, 11·9) and prices of healthy staple foods (β=–0·49, 95 % CI –0·90, –0·03) for the combined group v. control, but not for other intervention groups. There were no significant intervention effects on storeowner psychosocial factors.
All interventions led to increased stock of healthier foods. The combined intervention was effective in increasing sales of healthier snacks, even though discounts on snacks were not passed to the consumer. Experimental research in small stores is needed to understand the mechanisms by which store-directed price promotions can increase healthy food supply and demand.
Theorists of emotion typically recognize a number of features common to them: emotions are intentional, being directed towards objects in one's environment (including oneself); emotions involve the evaluation or appraisal of those objects as possessing various positive or negative values; emotions feel a certain way, in that there is something it is like to undergo an emotional experience; and finally emotions are expressed, involving a readiness or disposition to move one's body in a number of ways. Emotional expression in its variety – the topic of this volume of essays – is a phenomenon with which we are intimately familiar. It is something that we experience, both in ourselves and others, on a daily basis. As Edith Stein wrote, somewhat poetically,
I blush for shame, I irately clench my fist, I angrily furrow my brow, I groan with pain, am jubilant with joy […] as I live through the feeling, I feel it terminate in an expression or release expression out of itself.
(Stein 1970: 51)
But is a phenomenological description such as this supported by the scientific study and philosophical analysis of emotional expression? What is it for something to be an emotional expression and how do such expressions relate to other aspects of human psychology and behaviour? A common thought is that emotional expressions serve to communicate the emotional state of the expresser; indeed, the facial expression of emotion is often taken as the paradigm case in which the psychological states of others are made manifest to us (see, e.g., McNeill 2012; Smith 2013). Is this common-sense picture correct? In what sense can emotional expressions be thought of as communicative and what is it that they communicate? Further, emotional expressions are naturally thought to be subject to certain norms: a particular facial expression is required for an apology to be considered sincere, another when receiving a gift and so on. What, we may ask, is the role of such norms in guiding our emotional behaviour and how do they interact with the ‘release’ of emotional expression that Stein speaks of? These questions are amongst those pursued in the chapters of this volume and may be thought to fall under three broad headings: the nature of emotional expression, the communicative role of emotional expression and the normative significance of emotional expression.
The Expression of Emotion collects cutting-edge essays on emotional expression written by leading philosophers, psychologists, and legal theorists. It highlights areas of interdisciplinary research interest, including facial expression, expressive action, and the role of both normativity and context in emotion perception. Whilst philosophical discussion of emotional expression has addressed the nature of expression and its relation to action theory, psychological work on the topic has focused on the specific mechanisms underpinning different facial expressions and their recognition. Further, work in both legal and political theory has had much to say about the normative role of emotional expressions, but would benefit from greater engagement with both psychological and philosophical research. In combining philosophical, psychological, and legal work on emotional expression, the present volume brings these distinct approaches into a productive conversation.
Social relationships can impact youths’ eating and physical activity behaviours; however, the best strategies for intervening in the social environment are unknown. The objectives of the present study were to provide in-depth information on the social roles that youths’ parents and friends play related to eating and physical activity behaviours and to explore the impact of other social relationships on youths’ eating and physical activity behaviours.
Convergent parallel mixed-methods design.
Low-income, African American, food desert neighbourhoods in Baltimore City, MD, USA.
Data were collected from 297 youths (53 % female, 91 % African American, mean age 12·3 (sd 1·5) years) using structured questionnaires and combined with in-depth interviews from thirty-eight youths (42 % female, 97 % African American, mean age 11·4 (sd 1·5) years) and ten parents (80 % female, 50 % single heads of house, 100 % African American).
Combined interpretation of the results found that parents and caregivers have multiple, dynamic roles influencing youths’ eating and physical activity behaviours, such as creating health-promoting rules, managing the home food environment and serving as a role model for physical activity. Other social relationships have specific, but limited roles. For example, friends served as partners for physical activity, aunts provided exposure to novel food experiences, and teachers and doctors provided information related to eating and physical activity.
Obesity prevention programmes should consider minority youths’ perceptions of social roles when designing interventions. Specifically, future research is needed to test the effectiveness of intervention strategies that enhance or expand the supportive roles played by social relationships.
To examine associations between food insecurity, excess body weight, psychosocial factors and food behaviours among low-income African-American families.
Cross-sectional survey of participants in the baseline evaluation of the B’More Healthy Communities for Kids (BHCK) obesity prevention trial. We collected data on socio-economic factors, food source destinations, acquiring food, preparation methods, psychosocial factors, beliefs and attitudes, participation in food assistance programmes, anthropometry and food security. We used principal component analysis to identify patterns of food source destinations and logistic regression to examine associations.
Fourteen low-income, predominantly African-American neighbourhoods in Baltimore City, MD, USA.
Two hundred and ninety-eight adult caregiver–child (10–14 years old) dyads.
Of households, 41·6 % had some level of food insecurity and 12·4 % experienced some level of hunger. Food-insecure participants with hunger were significantly more likely to be unemployed and to have lower incomes. We found high rates of excess body weight (overweight and obesity) among adults and children (82·8 % and 37·9 % among food insecure without hunger, 89·2 % and 45·9 % among food insecure with hunger, respectively), although there were no significant differences by food security status. Food source usage patterns, food acquisition, preparation, knowledge, self-efficacy and intentions did not differ by food security. Food security was associated with perceptions that healthy foods are affordable and convenient. Greater caregiver body satisfaction was associated with food insecurity and excess body weight.
In this setting, obesity and food insecurity are major problems. For many food-insecure families, perceptions of healthy foods may serve as additional barriers to their purchase and consumption.