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Prospective associations between diabetes and depressive symptoms across European regions: a secondary analysis of ELSA, TILDA, and SHARE datasets
Get PDFThis article investigates predictive associations between diabetes and depressive symptoms across Ireland, the United Kingdom, and four European regions. The data were obtained by merging datasets from three large prospective cohort studies—the English Longitudinal Study on Ageing, The Irish Longitudinal study on Ageing, and the Survey on Health, Ageing and Retirement in Europe. We first applied a survival analysis design to two samples of 43 061 and 35 993 participants, investigating elevated depressive symptoms as a risk factor for diabetes, and diabetes as a risk factor for elevated depressive symptoms, respectively. We next applied a multilevel modeling approach to examine depressive symptoms before, during, and after diabetes onset across 101 799 participants. We found a bidirectional association between diabetes and depressive symptoms; however, the strength of these associations did not significantly differ between the regions (P > .01). The results also showed that individuals with newly diagnosed diabetes consistently reported higher depressive symptoms than those without diabetes, even before diagnosis. However, we observed no country-specific differences in the gradual changes in depressive symptoms regardless of participants’ diabetes status. Diabetes at baseline was associated with higher risk of developing depression; and vice versa. These associations were not moderated by geographical location. Therefore, the risks of diabetes and depressive symptoms comorbidity seem to be equal across all observed geographic regions
Spatiotemporal disparity of breast cancer incidence in Iranian female populations at the district level from 2000 to 2021: Bayesian disease mapping
Get PDFIntroduction
While trends in breast cancer incidence in Iran are generally monitored at the national level, little is known about subnational variations in these trends. This study aimed to assess the levels and trends (2000–2021) of the relative risk (RR) of breast cancer incidence at the district level in Iran and its relation to key socioeconomic dimensions to understand the full extent of geographical and social inequalities in the country associated with breast cancer morbidity.
Methods
District-level incidence data by age and sex from the National Cancer Registry System of the Iranian Ministry of Health were used. Related covariates were extracted from the Census and Household Expenditure and Income Survey (HEIS) datasets. The RR of breast cancer incidence was estimated in women above the age of 30 for all 316 districts in Iran from 2000 to 2010 using a Bayesian spatiotemporal model. Finally, predictions were estimated for the period 2011–2021.
Results
The national RR of breast cancer incidence in Iran increased from 0.21 (95% credible interval (CrI): 0.19, 0.22) in 2000 to 0.66 (0.63, 0.68) in 2010 and 1.23 (1.18, 1.28) in 2021. The RR of breast cancer incidence was highest in Yazd (1.96 [1.63, 2.33]), Shiraz (1.90 [1.72, 2.09]) and Shemiranat (1.90 [1.12, 2.91]) in 2010 and in Tehran (3.99 [3.86, 4.33]), Bushehr (3.89 [3.07, 4.77]) and Abadan (3.67 [2.99, 4.39]) in 2021. In contrast, Savojbolagh, Saravan and Nikshahr had the lowest RRs in both 2010 (0.11 [0.05, 0.20], 0.17 [0.08, 0.30] and 0.20 [0.09, 0.36], respectively) and 2021 (0.19 [0.10, 0.33], 0.34 [0.18, 0.54] and 0.35 [0.17, 0.62], respectively). The RR of breast cancer incidence was 60% greater across districts in the highest YOS quintile (average years of schooling: 3.9) than in those in the lowest YOS quintile (average years of schooling: 2.2; relative index of inequality: 1.6).
Conclusions
The results show that the RR of breast cancer incidence has increased over time (2000–2021) at the national and subnational levels in Iran. Breast cancer is one of the few diseases with a positive education gradient, with a greater RR of breast cancer incidence among higher-educated women than among lower-educated women. However, this is likely due to better awareness of diagnostic approaches and access to those approaches rather than reflecting patterns in the true incidence of breast cancer. While social inequalities are a major barrier to reducing the prevalence and incidence of breast cancer, it is important to track the progress made at the district level based on the characteristics of specific policies aimed at reducing health inequalities. A scaling-up in the quality of healthcare services, national and subnational policies addressing prevention and treatment, and more specialised training programmes for women’s health are needed
Using recontextualisation theory to understand learning across multiple sites in simulation‐based nurse education
Get PDFAim: The aim of this discussion paper is to explore whether recontextualisation theory deepens our understanding of learning across multiple sites when introducing simulation‐based education (SBE) into nurse education. Background: The requirement for students to learn in clinical placements remains an aspiration as well as a regulatory requirement internationally. Yet, the increasing complexity of healthcare and the numbers of vacancies in the healthcare workforce globally have led to poor learning environments. In the context of faster internet speeds, rapid development in virtual technologies, affordability of hardware, and the move to online educational provision after the COVID‐19 pandemic, SBE has emerged as a key teaching method in health professional preparation programmes globally. Design: Critical discussion paper. Methods: This discussion paper is based on current literature on SBE and recontextualisation theory. Findings: Evaluations of SBE often show positive outcomes for learning in nurse education. Weaknesses and gaps in the evidence on SBE, such as the scarcity of control groups or longitudinal studies, have been identified. Using recontextualization theory, we argue that SBE may also increase the theory‐practice split for students across multiple sites of learning. Conclusions: The introduction of SBE offers supplementary positive learning opportunities to those in clinical practice while at the same time creating multiple sites of learning which are not always aligned. More needs to be done to teach from a curriculum which relies on students being motivated and able to learn across multiple sites of learning. Implications for the Profession and Patient Care: To support student nurses in UG professional preparation programmes which rely on SBE as well as clinical practice and universities, shared values between nurse educators and clinical nurses need to be enacted collaboratively. This could be achieved by reframing how students and nurses learn and rework knowledge across sites of learning
The Changing Picture of Docklands
No full textPoster from the Docklands Community Poster Project as part of an exhibition of posters from the past 50 years of protest
Mental health and suicide research with migrants in Australia: necessary knowledge, skills and engagement strategies
Get PDF(1) Research is fundamentally important in developing evidence-informed and effective policies and appropriate programs and services to reduce the burden of mental health problems, and prevent suicide, among migrants. However, this population continues to be underrepresented in mental health and suicide research, resulting in large evidence gaps that limit policy making, service design and delivery, as well as evaluation of outcomes. (2) Experts in mental health and suicide prevention research with migrants provided free-text responses to a survey that asked about the knowledge and skills required to effectively conduct mental health and suicide prevention research with migrants, and effective strategies for engaging migrant and refugee communities in such research. An adapted thematic analysis method was used to analyze the free-text responses to the six questions. (3) The study identified specific areas of knowledge and skills required for effective mental health and suicide research with migrants; the methodological and ethical challenges that may arise in such research; and strategies that are likely to be effective in engaging people with lived experience and migrant and refugee communities in such research. (4) The findings from this project can be used to inform researchers on how to ethically and effectively undertake mental health and suicide research with migrant and refugee populations
On uneven ground: embracing the challenges of inter-limb asymmetries and their assessment
Get PDFInter-limb asymmetry is often misunderstood in sports and healthcare, with natural differences seen as problems usually needing correction. Evidence linking inter-limb asymmetries to increased injury risk or reduced performance is weak, and asymmetries of 5-15% (or even higher) typically do not increase the likelihood of injury. Assessing inter-limb asymmetries is a complex matter. Practitioners should select tests aligned with sports demands and track changes over time, rather than relying on single time point data. Ongoing temporal assessments help distinguish meaningful trends from natural fluctuations. Measurement error should also be considered to ensure changes exceed the minimal detectable change and reflect genuine performance or shifts in injury risk. Intra-individual analysis is recommended over averages across groups, as they can obscure meaningful variations. Arbitrary thresholds for what may be considered “normal” asymmetries oversimplify a continuous variable, potentially leading to misleading conclusions. Focusing on ranges (e.g., confidence intervals) instead of point values (e.g., mean) provides a more nuanced view. In addition, interpreting raw limb data alongside asymmetry metrics is crucial, as similar asymmetry percentages may arise from different limb strength profiles. Tracking raw data ensures that interventions improve performance, even if asymmetries persist. We provide a framework to help guide practitioners’ decisions. Task specificity and context, temporal stability, measurement quality, and raw performance data are key pieces of the puzzle. Before implementing “asymmetry-correcting” programs, practitioners should answer key questions, for which we provide a user-friendly decision tree. Not all asymmetries are likely to yield meaningful benefits if corrected, and intervening in asymmetry should result from a carefully reasoned process that requires establishing relevance, ensuring measurement quality, gathering appropriate data, and considering practical implications
Memories of the futures of drama education: attempt structures, minor gestures and Forced Entertainment
No full textThis article suggests that Erin Manning’s notion of ‘the minor gesture’ can emerge from what Tim Etchells, artistic director of Forced Entertainment, describes as ‘attempt structures’, where performers engage with a set of performance rules in a range of ways. It does this through discussion of both the work of Forced Entertainment and Impact Theatre Cooperative. It further suggests that drama, theatre and performance pedagogy might draw on these ideas to develop a creative process which generates what Manning calls ‘memories of the future’
Death became her: victims, killers and gender bias in contemporary crime fiction
No full textIn this paper I will explore the relationship between gender and violence in contemporary crime and thriller fiction. Incorporating recent debates around ‘dead girl’ tropes, revenge dramas and theories of the gaze, I will explore the difficulties of writing in a genre that, until relatively recently, has been saturated with dead women. Focusing on a selection of pivotal novels, films and television shows from the past fifteen years including Gone Girl, My Sister the Serial Killer and Bad Sisters I will discuss the shifting fashions of female representation in crime fiction from faceless victims and unreliable narrators to ruthless cops and caustic murderers.
At the same time, I will consider my own position as a crime and thriller writer, interrogating the process of character creation and plot construction in relation to who might die, kill or survive on the page. If I invent a sharp female serial killer, how can realism be maintained when hardly any exist? If my ‘final girl’ triumphs how will readers feel when they put down the book and return to a world in which those girls rarely survive? In essence, this paper will explore how we might create and consume exciting thrillers when the genre we enjoy writing, reading and subverting is built on women’s suffering, exploitation and death. With violence against women and girls in the UK at ‘epidemic’ levels, can escapism and hope be found in radical crime fiction that reframes outmoded gender tropes and upends victim/killer archetypes
Priority promotion with Parysian flair
No full textWe develop an algorithm that combines the advantages of Priority Promotion, that is one of the leading approaches to solving large parity games in practice, with the quasi-polynomial time guarantees offered by Parys' algorithm. Hybridising these algorithms sounds both natural and difficult, as they both generalise the classic recursive algorithm in different ways that appear to be irreconcilable: while the promotion transcends the call structure, the guarantees change on each level. We show that an interface that respects both is not only effective, but also efficient
