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Mental health prevention and promotion in general practice settings: A feasibility study
Get PDFBackground
Mental health problems are typically addressed and intervened through a reactive approach rather than a proactive or preventative one. The aim of this feasibility RCT was to explore the possibility of recruiting to, and delivering a brief psychological intervention, focusing upon mental health prevention and promotion, in General Practice (GP).
Methods
This was a two-arm feasibility study where participants were randomised to either: treatment-as-usual (TAU) from their General Practitioner; or to a brief psychological intervention. Sixty-four participants, aged 16 and over, from 10 GP surgeries, with mild to moderate mental health difficulties, as measured by the PHQ9 and GAD7, were recruited. Intervention engagement data were summarised utilising descriptive statistics. Descriptive statistics were used to summarise clinical outcome measures at baseline and follow-up and to informally compare the two groups. Cost-effectiveness was investigated using descriptive statistics to analyse the resource use of participants and Health-Related Quality of Life (HRQoL). Qualitative data were analysed through thematic analysis and interpret in relation to Normalisation Process Theory, to understand implementation processes and the intervention's mechanism of change (facilitators and barriers).
Results
The recruitment target was met within the set timeframe. 230 patients were screened for eligibility, 72 of which were eligible and 64 were randomised. 80 % were female and 91.5 % identified as being white British. 19 dropped out, 9 of which were in the intervention arm and 10 from the TAU arm. The most frequent reason was reported as, no longer requiring support or being uncontactable. Clinical outcome measures were completed and demonstrated sensitivity to change. No participant safety factors were reported which would limit a larger trial and health economic data was collated. All of the progression criteria were classified as ‘amber’ meaning that progression to a definitive randomised controlled trial is warranted but modifications to improve recruitment, intervention engagement and participant retention is needed. Qualitative feedback was generally positive, with participants noticing therapeutic benefit, commenting on the ease of access and General Practitioners found the offer fitted well within GP.
Discussion
As a feasibility trial, the results demonstrate that individuals in GP can be recruited to a trial focusing upon the delivery of a brief psychological intervention and the required clinical assessments to assess effectiveness can be obtained. Qualitative feedback was positive from participants and GP staff and early indications seemed to demonstrate an improvement in wellbeing and a reduction in anxiety and depression. However, modifications for a larger trial are recommended to enhance recruitment and retention
Providing specialist mental health care to youth justice service-involved young people
No full textIn England and Wales, amongst youth justice service involved young people, there is a high prevalence of mental health conditions. Yet, these young people are recognised as underserved by generic services and care pathways, necessitating local innovation. This commentary provides an overview of a mental health project serving this group based in specialist team in the child and adolescent mental health service of a single National Health Service trust. The article covers: (1) the project work and practice framework, informed by principles of trauma-informed care and involving close work with local youth justice service provision; and (2) ongoing efforts in practice research and the evaluation of care delivery, as supported by partnerships with academic colleagues
Making Sense of Power and Politics in Everyday Practice Through the 3Ps
No full textIntroduction: A Desire to Help Others
Since the death of George Floyd on May 25th, 2020 increased the visibility and expansion of the Black Lives Matter movement, there has been greater discussion about how to be a ‘good ally’ and support disadvantaged groups and social movements in order to eradicate discrimination and oppression in the world around us (Eddo-Lodge 2020; Reid 2021). As social work educators working with students, graduates and experienced practitioners, we have noticed that many students apply to social work degrees with the desire to be part of wider positive social change and act as a ‘good ally’ to disadvantaged groups within society. This determination is echoed within the social work profession more widely, as most social workers are drawn to this profession out of a desire to ‘help’ people (Ruch et al 2010; Trevithick 2011) and feel that this is a vocation instead of just a job. Part of this vocational pull is about taking a stand and challenging social inequality whilst supporting disadvantaged groups to gain greater power.
Social justice has been at the heart of social work practice for the past few decades (Cunningham & Cunningham 2014) and forms one of the core aims contained in the Global Social Work Statement of Ethical Principles held by the International Federation of Social Workers (IFSW 2018). The statement sets out clearly that in the promotion of social justice, all social workers should challenge ‘discrimination and institutional oppression’, ‘respect diversity’, ‘build solidarity’, make sure people have equal access to the resources they need, and importantly challenge ‘unjust polices and practices’ (IFSW 2018). In the UK, the British Association of Social Workers Code of Ethics also highlights the importance of social justice and human rights. Section 2.2 of the code states that ‘Social workers have a responsibility to promote social justice, in relation to society generally, and in relation to the people with whom they work.’ (BASW 2021). As Krumer-Nevo (2016) states, ‘the ethics of solidarity translates into practice when social workers take a stance and behave as partners of their service users in their struggle’ (p1802).
To work in solidarity and as partners requires awareness and understanding of power dynamics and how they operate in relation to discrimination and oppression on structural, systemic and personal levels as well as the intersectionality of discrimination. Social work education and training plays an important role in assisting students and practitioners to understand the implications of these dynamics as well as how the ethical principles, the professional codes and standards for social work and human rights can become alive and central within their practice instead of remaining abstract concepts or tick box exercises that reinforce discriminatory practice and oppression (Charfe & Gardner 2020).
As we explore in this chapter, the Danish social pedagogical concept of the 3 Ps (Jappe 2010) – the Professional, Personal and Private Self – can help practitioners make sense of power and politics within a practice context that requires them to navigate systems which frequently challenge their values base. The 3 Ps invites critical reflection on questions such as: How might their personal attitudes towards power and politics benefit social workers in their professional capacity and enable them to work in an authentically anti-oppressive way? Do they hold views which do not enhance their ability to meaningfully support the people they work alongside and which should therefore be kept private? By offering an accessible yet nuanced framework, social work students and practitioners can explore answers to these and related questions together with others and recognize that these answers very much depend on contextual factors, meaning that they require professionals’ situated judgment
Evolving the Control-Chaos Continuum: Part 1 – Translating Knowledge to Enhance On-Pitch Rehabilitation
Get PDFBACKGROUND: On-pitch rehabilitation is a crucial part of returning to sport after injury in elite soccer. The control-chaos continuum (CCC) initially offered a framework for practitioners to plan on-pitch rehabilitation, focusing on physical preparation and sport-specificity. However, our experiences with the CCC, combined with recent research in injury neurophysiology, point to a need for an updated model that integrates practice design and physical-cognitive interactions.
CLINICAL QUESTION: What are the insights from injury neurophysiology, soccer performance, and coaching science, needed to update the CCC and improve the planning, delivery, and progression of on-pitch rehabilitation in elite soccer?
KEY RESULTS: Drawing on extensive experience in elite sport, we explain how recent research on neurophysiological recovery from injury, game models, and practice design has been applied to update the CCC and evolve the existing framework.
CLINICAL APPLICATION: The evolution of the CCC expands on the original model to enhance planning, delivery, and progression of on-pitch rehabilitation. The updated framework incorporates elements of visual cognition, attentional challenges, decision-making, and progressive representation of the game model to enhance sport-specific preparation for returning to sport
THE RELATIONSHIP BETWEEN JOB ROTATION AND WORK ENGAGEMENT: THE MEDIATING ROLE OF JOB SATISFACTION
Get PDFJob rotation has become an effective tool in providing employees with more skills, knowledge and experience in a number of jobs within companies, in addition to its role in improving employee performance. This study investigated the relationship between job rotation and job satisfaction, and work engagement. Furthermore, the study explored the relationship between job satisfaction and work engagement. Finally, the study examined the mediating role of job satisfaction in the link between job rotation and work engagement. This study was conducted on three oil and gas companies out of six companies operating in Qatar.
A quantitative approach questionnaire was deployed to collect information from nearly 300 senior staff in oil and gas companies in Qatar. The data was analysed using Structure Equation Modelling (SEM). So, the current study’s population comprises employees who graduated from university and work as supervisors in Qatari oil and gas companies. Such staff are designated as “senior staff” by the researcher in the current study.
The study's findings indicated that job rotation has a significant and positive link with both job satisfaction and work engagement. Furthermore, job satisfaction has a significant and positive link with work engagement. Finally, the findings revealed that job satisfaction acts as a full mediator in the link between job rotation and work engagement.
In practice, this study will assist Qatari oil and gas companies in increasing their performance by implementing effective job rotation programmes to boost job satisfaction and work engagement, which leads to improved employee performance. As a result, implementing effective job rotation programmes with the aim of increasing job satisfaction and work engagement will encourage oil and gas company managers to expand the use of job rotation in various jobs, to provide employees in all departments with a wide range of abilities and experiences, which will improve performance
The Galactic Bulge exploration IV.: RR~Lyrae stars as traces of the Galactic bar -- 3D and 5D analysis, extinction variation
Get PDFRR Lyrae stars toward the Galactic bulge are used to investigate whether this old stellar population traces the Galactic bar. Although the bar is known to dominate the mass in the inner Galaxy, there is no consensus on whether the RR Lyrae star population, which constitutes some of the most ancient stars in the bulge and thus traces the earliest epochs of star formation, contributes to the barred bulge. We create new reddening maps and derive new extinction laws from visual to near-infrared passbands using improved RR Lyrae period-absolute magnitude-metallicity relations, enabling distance estimates for individual bulge RR Lyrae variables. The extinction law is most uniform in RIKs and RJKs and the distances to individual RR Lyrae based on these colors are determined with an accuracy of 6 and 4%, respectively. Using only the near-infrared passbands for distance estimation, we infer the distance to the Galactic center equal to dcenJKs = 8217 ± 1(stat) ± 528(sys) pc after geometrical correction. We show that variations in the extinction law toward the Galactic bulge can mimic a barred spatial distribution in the bulge RR Lyrae star population in visual passbands. This arises from a gradient in extinction differences along Galactic longitudes and latitudes, which can create the perception of the Galactic bar, particularly when using visual passband-based distances. A barred angle in the RR Lyrae spatial distribution disappears when near-infrared passband-based distances are used, as well as when reddening law variations are incorporated in visual passband-based distances. The prominence of the bar, traced by RR Lyrae stars, depends on their metallicity, with metal-poor RR Lyrae stars ([Fe/H] −1.0 dex) RR Lyrae stars do show a barred bulge signature in spatial properties derived using near-infrared distances, with an angle of ι = 18 ± 5 deg, consistent with previous bar measurements from the literature. This also hints at a younger age for this RR Lyrae subgroup. The 5D kinematic analysis, primarily based on transverse velocities, indicates a rotational lag in RR Lyrae stars compared to red clump giants. Despite variations in the extinction law, our kinematic conclusions are robust across different distance estimation methods
Social support in the perinatal period: a feminist exploration of asylum seeker and refugee women’s experiences and suggestions for change
Get PDFAsylum seeking and refugee women in the UK face significant challenges to their perinatal wellbeing, with high levels of maternal mortality and morbidity experiencing multiple disadvantages and inequalities due to their immigration status, gender, migration experience and minoritised ethnic status. These women can lack social support and improving the level of social support available to women who experience multiple disadvantages can be a way of improving their perinatal experiences and wellbeing. There are, however, currently no studies which explore this in the context of asylum seeking and refugee women in the UK.
A feminist-informed study was undertaken aiming to explore asylum seeker and refugee women’s experiences of social support in the perinatal period and their suggestions for change. A critical interpretative synthesis was undertaken to explore existing literature on perinatal social support for asylum seeking and refugee women in a European context. From this, two empirical studies, underpinned by feminist social constructionist epistemology were undertaken to explore asylum seeking and refugee women’s experiences of perinatal social support in the UK and the ways they felt this support could be improved. Women with lived experience, and staff and volunteers who supported them, were interviewed using feminist semi-structured interviews (n=22), then for study 2, four focus groups, including a member checking group (n=11) were undertaken.
Findings from the studies identified key issues around needing social support to access statutory services and overcome challenges to meet basic needs. The role and nature of networks of support were discussed, getting support right to meet women’s needs, and who provides support and how. Midwives were considered central to provide support and knowledge and communication. These results fit with the ethics of care, placing women’s experiences within the socio-political context of the immigration system and current healthcare provision, focusing on ideas of the careless state, the voluntary sector and the creation of caring communities, systemic carelessness in maternity care, promiscuous care and gender and care.
The research marks a unique contribution to knowledge being the first study, using a feminist-informed approach, to explore UK based asylum seeking and refugee women’s experiences and perceptions of social support and their suggestions for change
Avelumab first-line (1L) maintenance therapy in advanced urothelial carcinoma: Final analysis from a real-world study in the UK.
No full textBackground: In the JAVELIN Bladder 100 phase 3 trial, avelumab 1L maintenance therapy plus best supportive care (BSC) significantly improved overall survival (OS) and progression-free survival (PFS) vs BSC alone in patients with locally advanced or metastatic urothelial carcinoma (la/mUC) that had not progressed with 1L platinum-based chemotherapy (PBC). In the UK, initial access to avelumab was provided via the Early Access to Medicines Scheme (EAMS) from September 2020. This study reports 24-month real-world outcomes in patients treated with avelumab 1L maintenance via the EAMS in the UK. Methods: Patients aged ≥18 years who had been diagnosed with la/mUC, demonstrated at least stable disease following 1L PBC, and initiated avelumab since October 2020 were recruited consecutively from 10 UK hospitals. Primary outcomes included real-world OS, real-world PFS, and treatment patterns by 24 months. Recruitment was completed in June 2022, and all patients had completed 24 months of follow-up from avelumab initiation by June 2024. Results: Of 106 patients recruited, 78 (73.6%) were male. Median age at diagnosis of la/mUC was 72 years. Primary tumor site was bladder in 40 (78%), and the most common metastatic sites were lymph node in 64 (60.4%), lung in 31 (33%), and bone in 20 (21.3%). ECOG performance status was 0 in 35 (33.0%),1 in 36 (34%), 2-4 in 5 (4.7%), and not recorded in 30 (28.3%). 1L PBC was carboplatin/gemcitabine in 55 (51.9%) and cisplatin/gemcitabine in 49 (46.2%). Response to 1L PBC was partial or complete response in 63 (60.0%). From avelumab initiation, median OS was 16.8 months (95% CI, 11.6-23.4) and median PFS was 8.7 months (95% CI, 7.1-14.2). Median OS from the start of 1L PBC in this population without disease progression after 1L PBC was 21.8 months (95% CI, 17.0-28.9). In subgroup analyses of patients who had received 1L carboplatin/gemcitabine or cisplatin/gemcitabine, median OS from avelumab initiation was 14.4 months (95% CI, 10.1-not estimable [NE]) and 21.4 months (95% CI, 15.4-NE), and median OS from start of 1L PBC was 19.5 months (95% CI, 14.8-NE) and 26.7 months (95% CI, 20.5-NE), respectively. Conclusions: These results provide evidence of the clinical effectiveness of avelumab 1L maintenance therapy in patients who were progression free following 1L PBC in a UK real-world setting. Median OS was shorter than previously observed in the JAVELIN Bladder 100 trial, which may be due to the worse ECOG performance status and higher proportion of patients who had received 1L carboplatin-based chemotherapy in this real-world population
What aspects of staff, prisoner and systemic attributes have been found to reduce or increase the likelihood of sexual boundary violations in prisons?
Get PDFPurpose
Sexual boundary violations (SBV) can have significant implications in any environment, including that of a prison setting. Conducting research on a sensitive topic in prison services can be difficult to achieve, however, understanding why SBV occur can support the development of proactive policies and effective management strategies.
Design/methodology/approach
The aim of this rapid evidence assessment was to collate information relating to why SBV occur through a structured review.
Findings
A total of 12 studies were found to meet the inclusion criteria and were quality appraised. Narrative synthesis was used to review the data and identify common factors. Two overarching themes emerged from the data, which included factors that increase the likelihood of SBV to occur in prisons and personal motivators. Most studies included in the review were qualitative and all were based in the USA, which may limit the generalisability of the findings to other countries.
Research limitations/implications
Most of the studies included in the review were qualitative, and all were based in the USA, which may limit the generalisability of the findings to other countries.
Practical implications
Recommendations for practice are provided in terms of how SBV can be reduced and how people can be best supported.
Originality/value
This review helps build on the current understanding of SBV, which poses a risk to the safety and well-being of both staff and prisoners. Recommendations for practice are provided in terms of how SBV can be reduced and how people can be best supported
Food Safety Governance in Zimbabwe: Challenges, Regulatory Gaps, and Strategies for Global Compliance
No full textFood safety is a critical global public health issue, with foodborne illnesses identified as one of the leading causes of mortality worldwide. This study provides a comprehensive review of Zimbabwe’s food safety control legislative framework system, focusing on its legislative and regulatory framework and compliance with international standards. The research employed qualitative methods, including document analysis and key informant interviews.
The results show that Zimbabwe had a broad food safety framework comprising 15 Acts and 31 regulations overseen by multiple ministries. However, many of these Acts and regulations are outdated and need revision to meet emerging global food safety standards. Additionally, the food safety legislation framework is characterised by fragmentation and oversight by multiple agencies, leading to duplicated efforts, jurisdictional overlaps, and inefficiencies in enforcing standards. The study also highlights challenges faced by the three public food control laboratories where a lack of coordination and centralised data sharing impedes effective regulatory oversight. The findings reveal the urgent need for regulatory updates, improved inter-agency collaboration, and alignment with international standards to enhance food safety and protect public health. Recommendations include harmonising Zimbabwe’s food control system under a centralised framework to promote collaboration among agencies, eliminate redundancies, and create a cohesive approach to food safety management