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Therapy and diversity – an (un)therapeutic relationship?
Get PDFThere is fundamental confusion and notable omissions within counselling and
psychotherapy’s adoption of diversity principles. This prevents the profession
from achieving its aims of more respectful and efficacious clinical practice with
certain populations. The article argues that uncritical over-reliance on ideas from
outside the profession has resulted in a failure to appraise which groups might
require specific attention. Unacknowledged confusion between celebratory and
critical approaches to diversity is also identified as a source of practical muddle.
Putatively radical assertions about understanding minority group experience are
shown to actually exclude valuable ways of understanding social disadvantage,
which might better enhance our understanding and efficacy. The article concludes by suggesting that the multiple difficulties within the profession’s
embrace of diversity can be understood in terms of a refusal to reconsider the
theoretical, economic and organisational foundations of our therapeutic work to
which questions of diversity pose a serious challenge. A case is made for a more
open discussion of the relevant issues accompanied by a call for revised professional organization to support knowledge production
BMI is dead; long live waist-circumference indices: But which index should we choose to predict cardio-metabolic risk?
Get PDFBackground and Aims: There is growing evidence that Body Mass Index (BMI) is unfit for purpose. Waist circumference (WC) indices appear to be the preferred alternative, although it is not clear which WC index is optimal at predicting cardio-metabolic risk (CMR) and associated health outcomes.
Methods and Results: We obtained a stratified random probability sample of 53,390 participants from the Health Survey for England (HSE), 2008-2018. The four available CMR factors were; high-density lipoproteins (HDL) cholesterol, glycated haemoglobin (HbA1c), systolic (SBP) and diastolic blood pressure (DBP). Strength of association between the four cardio-metabolic risk factors and competing anthropometric indicators of weight status [BMI, Waist-to-height ratio (WHTR), unadjusted WC, and a new WC index independent of height, WHT∙5R=WC/height0.5] was assessed separately, using simple correlations and ANCOVAs, and together (combined) using MANCOVA, controlling for age, sex and ethnicity. Centile curves for the new index WHT∙5R=WC/height0.5were also provided.
Conclusions: Waist-circumference indices were superior to BMI when explaining/predicting our CMR factors, before and after controlling for age, sex and ethnicity. No single WC index was consistently superior. Results suggest that WHTR is the strongest predictor of HbA1c, confirming that shorter individuals are at great risk of diabetes. The most appropriate WC index associated with blood pressure was WHT∙5R for DBP, or unadjusted WC for SBP. Given HDL cholesterol is independent of height, the best predictor of HDL was WHT.5R. Clearly, “no one size fits all!”. MANCOVA identified WHT∙5R to be the best single WC index associated with a composite of all four CMR factors
Setting up a Recovery College: Exploring the Experiences of Mental Health Service-Users, Staff, Carers and Volunteers
Get PDFFollowing the first recovery college being established in 2009, there has been considerable growth in
the number of colleges internationally as they have become established features of service
transformations. This is the first study that has holistically explored setting up a recovery college
from the combined perspectives of service-users, staff, carers and volunteers involved in the
development process. An interpretative phenomenological analysis was undertaken following 25
semi-structured interviews. Results included three key themes of ‘Challenges in the early stages of
development’; ‘Having a shared understanding of recovery’; and the ‘Conceptualisation of Recovery
Colleges’. This study demonstrated that, as well as future groups seeking to set up a recovery college
having clear conceptualisations of personal recovery and the underpinning approach of their
recovery college, they should actively manage the level of integration between the college and its
host organisation, with open conversations about the power imbalances and roles of service-users,
staff, carers and volunteers involved. Those planning to develop a college should also be mindful
that although there will be the early challenges as outlined in this study, there are broader benefits
for both individuals and the wider organisation via the process of planning and discussions of how to
implement co-produced, recovery-oriented practice such as a recovery college
Women in the world of adult education 1920–1945
Get PDFThis article uncovers the important participation by women in adult education between 1920 and 1945 in Yorkshire. It contributes to the current historiography by using statistical evidence, not previously used, to quantify and analyse the numbers of women and men students participating in adult education. Regional statistics collected by the Workers’ Educational Association (WEA) in Yorkshire and the University of Leeds, show that the number of women students matched and sometimes outnumbered male students attending adult education classes before and during the Second World War. The evidence reinforces the hypothesis that when male students were not present (as in war time) to attend adult education, women students readily filled those student places. This hypothesis indicates that a paradox existed in the world of adult education whereby in theory equal opportunities existed for men and women to access adult education, but structural barriers remained in place that limited the ability of women to attend classes. The article argues that structural barriers were a distinctive element in making adult education realistically accessible to women following their enfranchisement in 1918 and 1928 as equal citizens. It encourages a rethinking of the relationship between gender, educational opportunities and citizenship in the early twentieth century
Agreement and relationship between measures of absolute and relative intensity during walking: a systematic review with meta-regression
Get PDFIntroduction
A metabolic equivalent (MET) is one of the most common methods used to objectively quantify physical activity intensity. Although the MET provides an ‘objective’ measure, it does not account for inter-individual differences in cardiorespiratory fitness. In contrast, ‘relative’ measures of physical activity intensity, such as heart rate reserve (HRR), do account for cardiorespiratory fitness. The purpose of this systematic review with meta-regression was to compare measures of absolute and relative physical activity intensity collected during walking.
Methods
A systematic search of four databases (SPORTDiscus, Medline, Academic Search Premier and CINAHL) was completed. Keyword searches were: (i) step* OR walk* OR strid* OR "physical activity"; (ii) absolute OR “absolute intensity” OR mets OR metabolic equivalent OR actigraph* OR acceleromet*; (iii) relative OR “relative intensity” OR "heart rate" OR "heart rate reserve" OR “VO2 reserve” OR VO2* OR “VO2 uptake” OR HRmax* OR metmax. Categories (i) to (iii) were combined using ‘AND;’ with studies related to running excluded. A Bayesian regression was conducted to quantify the relationship between METs and %HRR, with Bayesian logistic regression conducted to examine the classification agreement between methods. A modified Downs and Black scale incorporating 13 questions relative to cross-sectional study design was used to assess quality and risk of bias in all included studies.
Results
A total of 15 papers were included in the systematic review. A comparison of means between absolute (METs) and relative (%HRR, %HRmax, %VO2R, %VO2max, HRindex) values in 8 studies identified agreement in how intensity was classified (light, moderate or vigorous) in 60% of the trials. We received raw data from three authors, incorporating 3 studies and 290 participants. A Bayesian random intercept logistic regression was conducted to examine the agreement between relative and absolute intensity, showing agreement in 43% of all trials. Two studies had identical relative variables (%HRR) totalling 240 participants included in the Bayesian random intercept regression. The best performing model was a log-log regression, which showed that for every 1% increase in METs, %HRR increased by 1.12% (95% CI: 1.10 – 1.14). Specifically, the model predicts at the lower bound of absolute moderate intensity (3 METs), %HRR was estimated to be 33% (95%CI: 18 – 57) and at vigorous intensity (6 METs) %HRR was estimated to be 71% (38 – 100).
Conclusion
This study highlights the discrepancies between absolute and relative measures of physical activity intensity during walking, with large disagreement observed between methods and large variation in %HRR at a given MET. The large inter-individual differences associated with %HRR indicate the need for individualised physical activity guidelines and monitoring. As such, the measurement of relative intensity should be more highly prioritised as part of physical activity programmes and guidelines
“We are the forgotten grievers”: Bereaved family members’ experiences of support and mental ill-health following a road traffic collision
Get PDFRoad traffic collisions (RTCs) are a global public health concern; however, research on the impact
of bereavement on families remains limited. A critical realist approach was adopted to explore
experiences of families suffering bereavement following RTCs, using interviews with 14 participants in the United Kingdom (UK) who have lost a family member. Three key themes were identified: (1) worsening mental health following bereavement, (2) negative impact of an RTC-related
bereavement upon family members, (3) limited support following an RTC. Findings highlighted
the requirement for appropriate support for bereaved families, and outlined significant flaws
within the UK legal system, sentencing, and treatment of families
Parish politics and godly agitation in late Interregnum Scotland
Get PDFFollowing the English invasion of Scotland in July 1650, ministers and laymen in the Church of Scotland splintered between Protester and Resolutioner factions: The Protesters argued that the Church of Scotland required further moral reformation in order to appease a vengeful God and the Resolutioners were more content to accept the reintegration of former royalists into places of trust following the Civil Wars. This article explores the profound ways in which this split fundamentally altered relationships in the unusually well-documented parish of Crichton in Midlothian. Unlike other studies that have emphasized the ways in which the Protesters moved towards a position of separation from the rest of the Kirk, this article explores a group of Protesters who sought to actively reform the Kirk from within. Godly agitation in parish affairs was characterized by three traits: it was coordinated, remarkably litigious, and disseminated in manuscript libels and petitions rather than print. Ultimately, while this godly elite was adept at agitating for further reformation at the parish level, it did so without seceding from the structures of the national Church altogether
Comparing individual and population differences in VE/VCO2 slopes using centile growth curves and log-linear allometry
Get PDFIdentifying vulnerable groups and/or individuals’ cardiorespiratory fitness (CRF) is an important challenge for clinicians/researchers alike. To quantify CRF accurately, the assessment of several variables is now standard practice including maximal oxygen uptake (VO2) and ventilatory efficiency, the latter assessed using the minute ventilation/carbon dioxide production (VE/VCO2) slope. Recently, reference values (centiles) for VE/VCO2 slopes for men and women aged 20 to 80 have been published, using cardiopulmonary exercise testing (CPX) data (treadmill protocol) from the Fitness Registry and the Importance of Exercise National Database (FRIEND Registry).
In the current observational study, we provide centile curves for the FRIEND Registry VE/VCO2 slopes, fitted using the generalised additive model for location, scale and shape (GAMLSS), to provide individuals with a more precise estimate of where their VE/VCO2 slopes fall within the population. We also confirm that by adopting allometric models (incorporating a log-transformation), the resulting ANCOVAs provided more normal and homoscedastic residuals, with superior goodness-of-fit using the Akaike information criterion AIC=14671 (compared with traditional ANCOVA’s AIC=15008) that confirms allometric models are vastly superior to traditional ANCOVA models.
In conclusion, providing sex-by-age centile curves rather than referring to reference tables for ventilatory efficiency (VE/VCO2 slopes) will provide more accurate estimates of where an individual’s particular VE/VCO2 slope falls within the population. Also, by adopting allometric models researchers are more likely to identify real and valid inferences when analysing population/group differences in VE/VCO2 slopes
Men’s experiences of help-seeking for female-perpetrated intimate partner violence: A qualitative exploration
Get PDFThe subject of female-perpetuated intimate partner violence (IPV) against men has been one of controversy, with well-rehearsed arguments surrounding both the nature and existence of female-perpetrated abuse against men. The aims of this study were to explore men’s help-seeking experiences and/or their perceptions of utilising support services/support networks following IPV victimisation. Consequently, this study explored the help-seeking experiences of 26, largely British, men who self-identified as having experienced female-perpetrated IPV. As the focus was on subjective experiences, a qualitative design was employed. Participation was invited from men who had sought help for their IPV victimisation from a range of sources as well as those who had not sought help at all. Semi-structured interviews explored the men’s experiences of seeking help, and barriers to seeking help, following IPV. The data were analysed using reflexive thematic analysis. Some of the participants who took part in this study had received formal support for their experiences of IPV. (i.e., counselling, calling IPV helplines and support services, contact with social workers or the police) and informal support (e.g., speaking to work colleagues, family, and friends). Five participants had never spoken to anybody about their experiences prior to taking part in the interview. A range of barriers prevented the men from seeking help. First and foremost, the importance of maintaining a sense of masculinity consistently underpinned the participants’ narratives. The men’s fear of being judged negatively by others was often not unfounded. Negative help-seeking experiences included being treated with suspicion and contempt. Positive help-seeking experiences facilitated the men in recognising their relationship as abusive, which for some of the men was influential in their decision to leave or seek help. The lack of recognition and understanding of male IPV within society was of concern to most of the men. Some expressed a desire to use their own experiences in order to help other men in abusive relationships. These results have important implications for the development of appropriate support for male victims, including the need for practitioners to be non-judgmental whilst assisting men in recognising their relationship as abusive