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Impact of integrating mental health services within existing tuberculosis treatment facilities
Get PDFFrom SAGE Publishing via Jisc Publications RouterHistory: received 2020-11-19, accepted 2021-04-01, epub 2021-04-27Publication status: PublishedIntroduction:: Depression and anxiety among tuberculosis (TB) patients can adversely affect TB treatment adherence and completion. Aim:: We studied whether integrating mental health services into existing TB treatment programs would reduce symptoms of depression and anxiety and improve treatment completion among patients with drug-susceptible TB. Methods:: Integrated practice units (IPUs) for TB and mental health were established within six existing TB treatment facilities in Karachi, Pakistan. Patients were screened for depression and anxiety and, if symptomatic, offered a mental health intervention consisting of at least four counseling sessions. We measured changes in reported levels of depression and anxiety symptoms from baseline following completion of counseling sessions, and rates of TB treatment completion. Results:: Between February 2017 and June 2018, 3500 TB patients were screened for depression and anxiety. 1057 (30.2%) symptomatic patients received a baseline adherence session. 1012 enrolled for a mental health intervention received at least 1 counseling session. 522 (51.5%) reported no symptoms after four to six sessions. Symptomatic patients who completed at least four counseling sessions had higher rates of TB treatment completion than those who did not (92.9% vs 75.1%; p < 0.0001). Conclusion:: Mental health interventions integrated within TB programs can help reduce symptoms of depression and anxiety and improve TB treatment completion
Decision making in the management of adults with malignant colorectal polyps: An exploration of the experiences of patients and clinicians
Get PDFThis is the peer reviewed version of the following article: Westwood, C., Lee, T., McSherry, R., Bettany-Saltikov, J., & Catlow, J. (2021). Decision making in the management of adults with malignant colorectal polyps: An exploration of the experiences of patients and clinicians Colorectal Disease, 23(8), 2052-2061. https://doi.org/10.1111/codi.15743, which has been published in final form at https://doi.org/10.1111/codi.15743. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.Aim: A diagnosis of colorectal polyp cancer presents a treatment dilemma. The decision between segmental resection versus endoscopic surveillance is difficult due to lack of good quality clinical evidence for either option. The aim of this study was to understand the decision-making experiences of both clinicians and patients when faced with such a diagnosis.
Methods: Qualitative, semi-structured interviews were undertaken with ten clinicians involved in the care of patients diagnosed with polyp cancer and five patients who had experience of a diagnosis of polyp cancer. All clinicians and patients were from four hospital Trusts across the North of England. Interviews were audio recorded, transcribed verbatim and analysed using the principles of Interpretative Phenomenological Analysis.
Results: Analysis of the interview transcripts evidenced the difficulties faced by both groups when faced with treatment decisions following a diagnosis of colorectal polyp cancer. Some of these difficulties were specific to either the clinician or patient group. Themes which were common to both groups included: complexity of risk information; external influences, unexpected diagnosis; and time. In addition, hospital system factors were disclosed which also influenced clinician and patient experiences.
Conclusion: This research study has evidenced several factors such as uncertainty, complexity of risk information and influences on decisions which are preventing patients being fully involved in treatment decisions following a diagnosis of colorectal polyp cancer. Recommendations for improvements in practice, including a framework to assist treatment decision making in the future have been highlighted.
What does this paper add to the literature?
This qualitative study is, to the authors knowledge, the first exploring clinician and patient experiences of treatment decision making following a colorectal polyp cancer diagnosis. Key factors influencing how treatment decisions are made have been identified. As a result, a framework is proposed highlighting critical factors for consideration to deliver patient centred care
Visual Sensory Experiences From the Viewpoint of Autistic Adults
Get PDFFrom Frontiers via Jisc Publications RouterHistory: received 2020-11-24, collection 2021, accepted 2021-05-10, epub 2021-06-08Publication status: PublishedAlthough previous research has investigated altered sensory reactivity in autistic individuals, there has been no specific focus on visual sensory experiences, particularly in adults. Using qualitative methods, this study aimed to characterize autistic visual sensory symptoms, contextualize their impact and document any associated coping strategies. A total of 18 autistic adults took part in four focus groups which involved questions around visual experiences, the impact of these on daily life, and strategies for their reduction. Transcripts of each session were thematically analyzed allocating six key themes. Participants described a range of visual hypersensitivities, including to light, motion, patterns and particular colors, which contributed to distraction and were frequently part of a wider multisensory issue. Such experiences had significant negative impacts on personal wellbeing and daily life with participants describing fatigue, stress and hindrances on day-to-day activities (e.g., travel and social activities). However, the degree of understanding that participants had about their visual experiences influenced their emotional response, with greater understanding reducing concern. Participants employed a variety of coping strategies to overcome visual sensory experiences but with varied success. Discussions also highlighted that there may be a poor public understanding of sensory issues in autism affecting how well autistic individuals are able manage their sensory symptoms. In summary, autistic adults expressed significant concern about their visual experiences and there is a need to improve understanding of visual experiences on a personal and public level as well as for developing potential support
The lexicon of antimicrobial peptides: a complete set of arginine and tryptophan sequences.
Get PDFFrom Europe PMC via Jisc Publications RouterHistory: ppub 2021-05-01, epub 2021-05-21Publication status: PublishedFunder: Biotechnology and Biological Sciences Research Council; Grant(s): BB/M011208/1Our understanding of the activity of cationic antimicrobial peptides (AMPs) has focused on well-characterized natural sequences, or limited sets of synthetic peptides designed de novo. We have undertaken a comprehensive investigation of the underlying primary structural features that give rise to the development of activity in AMPs. We consider a complete set of all possible peptides, up to 7 residues long, composed of positively charged arginine (R) and / or hydrophobic tryptophan (W), two features most commonly associated with activity. We found the shortest active peptides were 4 or 5 residues in length, and the overall landscapes of activity against gram-positive and gram-negative bacteria and a yeast were positively correlated. For all three organisms we found a single activity peak corresponding to sequences with around 40% R; the presence of adjacent W duplets and triplets also conferred greater activity. The mechanistic basis of these activities comprises a combination of lipid binding, particularly to negatively charged membranes, and additionally peptide aggregation, a mode of action previously uninvestigated for such peptides. The maximum specific antimicrobial activity appeared to occur in peptides of around 10 residues, suggesting 'diminishing returns' for developing larger peptides, when activity is considered per residue of peptide
The wedding of two trees: connections, equivalences, and subjunctivity in a Tamil ritual
Get PDFFrom Wiley via Jisc Publications RouterHistory: pub-electronic 2021-06-25Article version: VoRPublication status: PublishedAbstract: A wedding between two trees in a Tamil village reveals that a tree can be more than, while still remaining, a tree. It needs to be a tree because trees do certain things. It can be made more than a tree, however, through a logic of homological connections which temporarily create equivalences between trees and divinities. The wedding (kalyanam), a ubiquitous Tamil ritual form which pertains not only to marriage, creatively and subjunctively opens up new possibilities to change ‘it could be’ and ‘it should be’ to ‘let it be so’. The wedding of two trees seeks to materialize ideal situations and outcomes by mobilizing the aliveness of trees, a quality they share with humans and animals, without positing personhood, identity, or confusing categories. In making this argument, I question choices of comparators in anthropological analyses which posit a holistic ‘non‐West’ against a dualistic ‘West’ and contrast a taken‐for‐granted ‘us’ with ‘our’ really rather different ‘others’
The expanding world of tissue‐resident macrophages
Get PDFFrom Wiley via Jisc Publications RouterHistory: received 2021-03-02, rev-recd 2021-03-02, accepted 2021-06-08, pub-electronic 2021-06-27Article version: VoRPublication status: PublishedFunder: the Medical Research Council UK; Grant(s): MR/K01207X/2, MR/L008076/1Funder: the Wellcome Trust; Grant(s): 106898/A/15/ZAbstract: The term ‘macrophage’ encompasses tissue cells that typically share dependence on the same transcriptional regulatory pathways (e.g. the transcription factor PU.1) and growth factors (e.g. CSF1/IL‐34). They share a core set of functions that largely arise from a uniquely high phagocytic capacity manifest in their ability to clear dying cells, pathogens and scavenge damaged, toxic or modified host molecules. However, macrophages demonstrate a remarkable degree of tissue‐specific functionality and have diverse origins that vary by tissue site and inflammation status. With our understanding of this diversity has come an appreciation of the longevity and replicative capacity of tissue‐resident macrophages and thus the realisation that macrophages may persist through tissue perturbations and inflammatory events with important consequences for cell function. Here, we discuss our current understanding of the parameters that regulate macrophage survival and function, focusing on the relative importance of the tissue environment versus cell‐intrinsic factors, such as origin, how long a cell has been resident within a tissue and prior history of activation. Thus, we reconsider the view of macrophages as wholly plastic cells and raise many unanswered questions about the relative importance of cell life‐history versus environment in macrophage programming and function
Critical analysis of the Armed Forces Covenant Fund Trust Aged Veterans Fund
Get PDFBackground: Relatively little research is available regarding the specific needs of older military veterans and the services introduced to support them. In 2016, the Armed Forces Covenant Fund Trust launched the Aged Veterans Fund (AVF), to understand the impact that military service may have on ageing, and to support initiatives targeting their health and well-being. This fund was financed for 5 years and included 19 UK portfolio projects. Method: The paper presents a retrospective evaluation on the processes and impact of the AVF, with the intent of informing policy, educational services, service providers and stakeholders of the lessons learnt. The inclusion criteria was veterans and their families aged 65 years of age or over. In 2019, data were drawn from documentary evidence related to the programmes. Qualitative analysis were performed on 78 eligible sources and 10 themes were identified. Results: Programmes were rolled out via collaborative partnerships referrals, focusing on person-centred or skill-exchange approaches. Challenges were encountered, such as capacity and timelines issues. A limited amount of associated cost-savings was observed, even if examples of sustainability and high satisfaction were reported. Evidence was found of programmes boosting health and well-being outcomes, in raising awareness, and in positively impacting on clinical practice, such as re-admission rates. Conclusion: The AVF programmes were successful in their intent to provide support to older veterans and their families. The findings provide indicators of the next steps required for the support of ageing veterans. Further investigation of the cost-effectiveness of age-friendly veterans’ services is needed
Recovery capital in the context of homelessness, high levels of alcohol consumption, and adverse significant life events
Get PDFHomelessness and heavy alcohol consumption are increasing global public health concerns. Homelessness is associated with poorer health outcomes, shorter life expectancy, and are more likely to engage in health risk behaviours. High levels of alcohol consumption intersect with the cause and effect of homelessness making this an important consideration for research. This is explored through a theoretical lens of recovery capital, referring to the resources required to initiate and maintain recovery, and is applied to both heavy alcohol consumption and homelessness. Life history calendars were utilised alongside semi-structured interviews to explore the impact that adverse life events had on alcohol consumption and living situations with 12 participants in contact with homelessness services in North-West England. The findings consider how social, health, and structural-related adverse life events were both a cause and effect of homelessness and increasing consumption of alcohol, which were further exacerbated by a lack of recovery capital. The authors argue for further consideration relating to the intersection of homelessness and high levels of alcohol consumption in relation to recovery capital. The findings have implications for policy and practice by demonstrating the need for relevant services to help individuals develop and maintain resources that will sustain recovery capital
Home-based nursing care competencies: A scoping review
No full textThis article is not available on ChesterRepTo identify and consolidate the available evidence about nursing-related competencies for home-based care. Over recent years, the demand for home-based nursing care has increased because of the need to meet the increasing need for chronic disease care to be delivered in patients' homes. However, knowledge is lacking about the expected competencies for home-based care nurses. A scoping review was conducted in accordance with Arksey and O'Malley's six-step scoping review framework and the PRISMA-ScR guidelines. The review identified literature using five electronic databases (CINAHL, PubMed, Embase, Cochrane and Scopus) and a hand search for grey literature in relevant home-based care journals and online searches. Key search terms and inclusion and exclusion criteria were used as strategies to identify relevant articles. Sixty-four articles were eligible for inclusion. Mapping and narrative synthesis of 116 elements related to home-based nursing care competencies identified the following 10 competencies: (1) care assessments; (2) performance of nursing procedures; (3) management of health conditions; (4) critical thinking and problem-solving skills; (5) interpersonal relationships and communication; (6) interdisciplinary collaboration; (7) leadership and resource management; (8) professional development; (9) technological literacy; (10) quality and safety. This review provides insight into current knowledge about home-based nursing care competencies. These competencies could be used to evaluate nurses' competence level for home-based care or for development of appropriate professional education. The review also outlines the scope of nursing practice in home-based care, which provides support for some form of standardisation of home-based nursing care expectations across various stakeholders. [Abstract copyright: © 2021 John Wiley & Sons Ltd.
The Oxford Handbook of the Bible and American Popular Culture
No full textThis essay examines the Bible in American television, focusing in particular on the twenty-first century. It suggests that there are three broad categories which may helpfully illustrate and encompass the diverse ways in which the Bible appears and/or is utilized: (i) educating about the Bible (e.g., documentaries); (ii) dramatizing the Bible (renditions of biblical stories); and (iii) drawing on the Bible (the impact or use of the Bible in other television programs). Examining each of these in turn, this essay highlights the prevalence of the Bible within television and thus within American popular culture more generally, as well as considering some of the myriad ways in which it has been read, used, and interpreted. In particular, it endeavors to show how the medium can function as a tool for both reflecting and promoting levels of biblical literacy among its audience
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