Making ends meet - relating a self-reported indicator of financial hardship to health status.

BACKGROUND: Area-based index of multiple deprivation (IMD) indicators of financial hardship lack individual specificity and sensitivity. This study compared self-reports of hardship with area measures in relation to health status. METHODS: Interviews in one London Borough, reported financial hardship and health status. Associations of health status with most and least deprived quintiles of the IMD 2015 were compared with self-reported hardship; always or sometimes 'having difficulty making ends meet at the end of the month' in relation to never. RESULTS: 1024 interviews reported hardship status in 1001 (98%). 392 people (39%) reported they 'always' or 'sometimes' had hardship. In multivariate analysis, self-reported hardship was more strongly associated with smoking; odds ratio = 5.4 (95% CI: 2.8-10.4) compared with IMD, odds ratio = 1.9 (95% CI: 1.2-3.2). Health impairment was also more likely with self-reported hardship, odds ratio = 11.1 (95% CI: 4.9-25.4) compared with IMD; odds ratio = 2.7 (95% CI: 1.4-5.3). Depression was similarly related; odds ratio = 2.4 (95% CI: 1.0-5.6) and 2.7 (95% CI: 1.2-6.6), respectively. CONCLUSIONS: Self-reported hardship was more strongly related to health status than area-based indicators. Validity and implementation in routine health care settings remains to be established.

Methodological challenges in evaluating the value of registers.

OBJECTIVES: Procedures and new medical devices are typically introduced into healthcare systems with limited evidence, when they might be ineffective or unsafe. Systematic data collection ("registers") can provide valuable "real world" evidence, but difficulties in funding registers are a major obstacle. A good economic case for the value of registers would therefore be useful. METHODS: (i) Literature search on specific purposes of registers. (ii) Surveys (a) of senior clinicians involved with registers, seeking examples of beneficial outcomes, and (b) of administrators, regarding costs of running registers. (iii) A scoping exercise for possible methods to value (financially) the outputs of registers. RESULTS: Four main categories of beneficial outcomes from registers were identified. These were-safety and quality assurance; training and quality improvement; complementing trial evidence and reducing uncertainty; and supporting trial research. Explicit examples of all these are presented, together with information about the costs of registers. Combining these with the scoping exercise we present suggestions for a methodology of assessing the value of registers across each of the categories. CONCLUSIONS: This study is unique in addressing methods for determining the financial value of registers, based on the amount they cost versus the financial benefits which may result from the evidence generated. Developing the suggested methods could support the case for funding new registers, by showing that their use can benefit healthcare systems through more efficient use of resources, so justifying their costs.

Improving Olympic health services: what are the common health care planning issues?

INTRODUCTION: Due to their scale, the Olympic and Paralympic Games have the potential to place significant strain on local health services. The Sydney 2000, Athens 2004, Beijing 2008, Vancouver 2010, and London 2012 Olympic host cities shared their experiences by publishing reports describing health care arrangements. HYPOTHESIS: Olympic planning reports were compared to highlight best practices, to understand whether and which lessons are transferable, and to identify recurring health care planning issues for future hosts. METHODS: A structured, critical, qualitative analysis of all available Olympic health care reports was conducted. Recommendations and issues with implications for future Olympic host cities were extracted from each report. RESULTS: The six identified themes were: (1) the importance of early planning and relationship building: clarifying roles early to agree on responsibility and expectations, and engaging external and internal groups in the planning process from the start; (2) the development of appropriate medical provision: most health care needs are addressed inside Olympic venues rather than by hospitals which do not experience significant increases in attendance during the Games; (3) preparing for risks: gastrointestinal and food-borne illnesses are the most common communicable diseases experienced during the Games, but the incidence is still very low; (4) addressing the security risk: security arrangements are one of the most resource-demanding tasks; (5) managing administration and logistical issues: arranging staff permission to work at Games venues ("accreditation") is the most complex administrative task that is likely to encounter delays and errors; and (6) planning and assessing health legacy programs: no previous Games were able to demonstrate that their health legacy initiatives were effective. Although each report identified similar health care planning issues, subsequent Olympic host cities did not appear to have drawn on the transferable experiences of previous host cities. CONCLUSION: Repeated recommendations and lessons from host cities show that similar health care planning issues occur despite different health systems. To improve health care planning and delivery, host cities should pay heed to the specific planning issues that have been highlighted. It is also advisable to establish good communication with organizers from previous Games to learn first-hand about planning from previous hosts.

Young People's Attitudes, Perceptions and Experiences of Social Distancing and Self-Isolation During the Second Wave of the COVID-19 Pandemic.

Objectives: Social distancing and self-isolation were key parts of the UK's strategy for reducing the spread of COVID-19. This study explored young people's attitudes, perceptions and experiences of social distancing and social isolation during the COVID-19 pandemic. Methods: Qualitative individual, family and paired-friendship interviews were conducted. All 26 participants lived or worked in East London and were aged between 20 and 39 years. Results: Qualitative analysis revealed three main themes: 1) trust and breaking of the social distancing and self-isolation rules-trust in their friends to be careful and say if they are unwell; 2) own rule making-making their own household rules which made them less guilty about breaking national rules as they were adhering to rules (albeit their own); and 3) lack of clarity around self isolation and the need for practical support-confusion around length of time needed to self isolate and what self-isolation really meant. Conclusion: Developing more effective and targeted communications and practical support mechanisms to encourage better adherence to social distancing and self-isolation rules among young people will be essential to prevent the spread of COVID-19.

Service user attachments to psychiatric key workers and teams.

PURPOSE: The first aim of the study was to evaluate whether self-reported attachment styles of individuals with psychosis are consistent with their self-reported attachment in therapeutic relationships with both key workers and mental health teams. The second aim was to evaluate the level of concordance in attachment ratings given by different raters (self-report, key worker informant-report and team informant-report). METHODS: Three self-report versions of the Psychosis Attachment Measure (PAM; attachment in general relationships, attachment towards key worker and attachment in relation to the mental health team) were administered to 24 individuals with a diagnosis of psychosis in psychiatric rehabilitation settings. Key worker and 'team' informant versions of the PAM were also completed. RESULTS: There were strong, significant correlations among the three self-reported attachment measures. There was less consistent evidence of correlations between key worker ratings of attachment and self-report attachment ratings. The majority of the correlations between team ratings of attachment and self-report attachment were small and non-significant. CONCLUSIONS: Strong correlations among the self-reported PAM scales suggest that self-reported attachment in specific therapeutic relationships is consistent with self-reported attachment in general relationships. The self-ratings were not consistently correlated with informant-ratings and team informant ratings were particularly poorly correlated with self-ratings. This suggests that it is vital that teams consult service users themselves when making decisions about their care.

Social connectedness and engagement in preventive health services: an analysis of data from a prospective cohort study.

BACKGROUND: Evidence of the possible health benefits of social connectedness is increasing. We aimed to examine poor social connectedness as a possible barrier to participation in preventive health services among older people (aged 53-69 years). METHODS: We analysed data from a prospective cohort study of 5362 socially stratified births from the Medical Research Council National Survey of Health and Development enrolled in England, Scotland, and Wales in March 1946. At ages 68-69 years, participants reported participation in blood pressure and cholesterol measurement, eyesight and dental check-ups, influenza immunisation, and bowel and breast cancer screening. Our primary outcome measure summed participation across all these tests and services at ages 68-69 years. We tested associations between structural and functional social connectedness from ages 53 years to 69 years and total count of participation in these preventive services in Poisson models controlling for sex, education, occupational class, employment, chronic illnesses, and general practitioner consultations for health problems. FINDINGS: 940 (44%) of 2132 participants attended all preventive services within the recommended timeframes. At ages 68-69 years, being unmarried or not cohabiting (incident rate ratio [IRR] 1·33, 95% CI 1·20-1·47) and small personal social networks (IRR 1·51, 1·32-1·71) were independently associated with non-participation in more services, with associations consistent across most services. High social relationship quality at ages 68-69 years (IRR 0·91, 95% CI 0·87-0·95) and increasing social relationship quality from ages 53 years to 69 years (IRR 0·93, 0·89-0·97) were associated with low risk of non-participation. INTERPRETATION: Individuals with poor social connectedness appear to be at greater risk of not engaging in the full range of preventive services than individuals with good social connectedness. Improvement of access to social contacts and networks in older ages is already recommended for the maintenance of good mental health. This study suggests that social connectedness could also improve participation in a wide range of preventive health services, and hence could improve use of the health-care system and population health. FUNDING: UK Medical Research Council.

Arterial Responses to Acute Low-Level Ergot Exposure in Hereford Cows.

Ergot alkaloids are toxic secondary metabolites produced by the fungus Claviceps purpurea that contaminate cereal grains. Current Canadian standards allow 2 to 3 parts per million of ergot alkaloids in animal feed. The purpose of this study was to determine whether hemodynamic parameters were altered when beef cows were fed permissible levels of ergot alkaloids (i.e., <3 ppm) on a short-term basis. A dose-response relationship between ergot alkaloid concentration and hemodynamic changes in caudal (coccygeal), median sacral, and internal iliac arteries was hypothesized. Beef cows were randomly allocated to: Control (<15 µg total ergot alkaloids/kg dry matter), Low (132 µg/kg), Medium (529 µg/kg), and High (2115 µg/kg) groups (n = 4 per group). Animals were fed 8.8 kg of dry matter daily for 4 days (pre-treatment), 7 days (treatment), and 4 days (post-treatment). The caudal, median sacral, and internal iliac arteries were examined daily using ultrasonography in B-mode and Doppler (color and spectral) mode and hemodynamics endpoints were analyzed by repeated measures mixed model analyses. Caudal artery diameter decreased in the Medium (p = 0.004) and High (p < 0.001) groups compared to pre-treatment values and the pulsatility index increased (p ≤ 0.033) in all ergot treatments during the post-exposure period compared to the Control group. Blood volume per pulse (mL) and blood flow (mL/min) through the caudal artery during the treatment period were reduced in the Medium (-1.0 mL reduction; p ≤ 0.004) and High (-1.1 mL p ≤ 0.006) groups compared to pre-treatment values. The median sacral artery diameter decreased in the Medium (p = 0.006) and High (p = 0.017) treatments compared to the Control group. No differences were detected in any hemodynamic endpoints for the internal iliac artery except changes in pulse rate (p = 0.011). There was no treatment (p > 0.554) or Treatment*Time interaction (p > 0.471) for plasma prolactin concentration or body temperature. In conclusion, alterations in caudal artery hemodynamics were detected when cows were fed 529 and 2115 µg ergot alkaloids per kg dry matter per day for 1 week. The caudal artery was more sensitive to ergot alkaloids than the median sacral and internal iliac arteries. Our results partially support the hypothesis of a dose-response effect of ergot alkaloids in feed on hemodynamics.

'Poor me' versus 'bad me' paranoia and the instability of persecutory ideation.

OBJECTIVES: To investigate whether there are two stable types of paranoia, 'poor me' and 'bad me', as described by Trower and Chadwick (1995), and whether beliefs about the deservedness of persecution are associated with psychological measures. METHODS: In-patients experiencing persecutory delusions were assigned either to 'poor me' (PM) or 'bad me'(BM) groups, according to their rating of a perceived deservedness scale, which was repeated on subsequent assessments. Participants were assessed for depression (BDI); construction of the self (Self-to-Others Scale); autonomy and sociotropy (PSI); perceived parental behaviour (PBI); attributional style (ASQ) and, meaningful daily events (DEI, devised for the study). A healthy control group was also assessed. RESULTS: Many patients' perceived deservedness of persecution varied across time, so that some patients were PM at one point in time but BM at another. BM paranoia was associated with high levels of depression. PM and BM patients groups both scored higher than the controls on the subscales of Self-to-Others Scale and on the PSI. PM patients exhibited a marked self-serving bias on the ASQ, and reported less parental care on the PSI, compared to the BM patients. Both groups reported less PBI mother care than the controls. BM patients reported more failure events than PM patients or controls. PM patients reported more loss of control events than the than BM patients and controls. CONCLUSIONS: PM and BM paranoia may represent separate phases of an unstable phenomenon. The findings are consistent with an attributional account of paranoid thinking.

An analogue study of attributional complexity, theory of mind deficits and paranoia.

Recent research suggests that the tendency of paranoid individuals to attribute negative events to external personal factors and positive events to internal factors may be associated with difficulties in understanding the mental states of others, referred to as theory of mind (ToM). The present study aimed to investigate the relationship of these factors with attributional complexity and motivation. In an analogue sample, a relative ToM impairment was associated with an increased tendency to attribute negative events to external personal factors but not with differences in attributional complexity. This indicates that paranoid tendencies and mentalizing deficits are not associated with attributional simplicity, but may be related to schematic patterns of cognition.

Nurse training. Teenage hang-ups.

A survey of acute trusts' nurse cadet schemes in England showed a wide variety in entry requirements and qualifications offered. Most schemes offered successful students a place on a nurse training scheme. Legal issues surrounding 16-year-olds working in hospitals need to be clarified. Standardisation of entry requirements and course qualifications is required. At present, a student could complete a cadet course in one part of the country and not be eligible for nurse training elsewhere.

Healthcare planning for the Olympics in London: a qualitative evaluation.

BACKGROUND: Mass gatherings, such as the Olympic and Paralympic Games, represent an enormous logistical challenge for the host city. Health service planners must deliver routine and emergency services and, in recent Games, health legacy initiatives, for the local and visiting population. However there is little evidence to support their planning decisions. We therefore evaluated the strategic health planning programme for the London 2012 Olympic and Paralympic Games to identify generalisable information for future Games. METHODS: We thematically analysed data from stakeholder interviews and documents. The data were prospectively collected in three phases, before, during and after the Games. FINDINGS: We identified five key themes: (1) Systemic Improvement for example in communications, (2) Effective relationships led to efficiencies and permanent gains, such as new relationships with the private sector (3) Difficult relationships led to inefficiencies, for instance, duplication in testing and exercising emergency scenarios, (4) Tendency to over-estimate demand for care, particularly emergency medicine, and (5) Difficulties establishing a health legacy due to its deprioritisation and lack of vision by the programme team. INTERPRETATION: Enduring improvements which are sustained after the Games are possible, such as the establishment of new and productive partnerships. Relationships must be established early on to avoid duplication, delay and unnecessary expense. There should be greater critical evaluation of the likely demand for health services to reduce the wasting of resources. Finally, if a health legacy is planned, then clear definitions and commitment to its measurement is essential.

Psychological processes and paranoia: implications for forensic behavioural science.

Paranoid delusions have recently become the focus of empirical research. In this article, we review studies of the psychological mechanisms that might be involved in paranoid thinking and discuss their implications for forensic behaviour science. Paranoia has not been consistently associated with any specific neuropsychological abnormality. However, evidence supports three broad types of mechanism that might be involved in delusional thinking in general and paranoia in particular: anomalous perceptual experiences, abnormal reasoning, and motivational factors. There is some evidence that paranoia may be associated with hearing loss, and good evidence that paranoid patients attend excessively to threatening information. Although general reasoning ability seems to be unaffected, there is strong evidence that a jumping- to-conclusions style of reasoning about data is implicated in delusions in general, but less consistent evidence specifically linking paranoia to impaired theory of mind. Finally, there appears to be a strong association between paranoia and negative self-esteem, and some evidence that attempts to protect self-esteem by attributing negative events to external causes are implicated. Some of these processes have recently been implicated in violent behaviour, and they therefore have the potential to explain the apparent association between paranoid delusions and offending.

Attentional and memory bias in persecutory delusions and depression.

BACKGROUND: Previous research has indicated that persecutory delusions and depression may share similar cognitive biases at implicit levels of processing, but differentiate at explicit levels, supporting the theory that paranoia may have a protective function against underlying negative schemata. The study aimed to investigate attentional bias and both implicit and explicit memory biases for personally salient and standardised emotional stimuli in persecutory delusions and depression. SAMPLING: 36 participants, with 12 in each group, were interviewed in order to generate personally salient stimuli to be employed within the cognitive tests. Standardised emotional stimuli were additionally employed as a control. Participants completed two probe detection tasks, one including personally salient stimuli and one including standard emotional stimuli. Memory for the stimuli presented in this task was assessed by a free recall task (explicit memory) followed by a word completion task (implicit memory). RESULTS: On an implicit memory task, both the deluded and depressed groups displayed comparable retrieval of positive and negative words. However, on the explicit memory task, the depressed group demonstrated a bias for negative stimuli, whereas the deluded group demonstrated a bias for positive stimuli. The groups did not demonstrate an attentional bias for personally salient information. However, an attentional bias for standardised emotional stimuli was found in the depressed group, although this was not specific to either negative or positive stimuli. CONCLUSION: The results indicate that depression and persecutory delusions may share similar patterns of processing at an implicit level but differentiate at the explicit level, which may be indicative of cognitive avoidance of threatening stimuli in psychosis. However, this does not seem to be a feature of automatic attentional processes in people with persecutory delusions. Implications for further research are discussed.