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London, United Kingdom

Academic Unit

London, United Kingdom
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Larsen J.,Drinkaware | Tew J.,University of Birmingham | Hamilton S.,McPin Foundation | Manthorpe J.,King's College London | And 3 more authors.
Journal of Mental Health | Year: 2015

Background: In England, personal budgets are offered to eligible people with severe mental health problems to enable them to purchase what is helpful for their quality of life or recovery. However, in-depth insight into peoples own perceptions of the outcomes is lacking.Aims: To investigate peoples own reporting of outcomes from using personal budgets in relation to social care needs arising from severe mental health problems.Method: A convenience sample of 47 individuals receiving personal budgets was recruited from three English local authorities. In-depth semi-structured interviews were subject to thematic framework analysis.Results: Most participants identified positive outcomes across domains interconnected through individual life circumstances, with mental health and wellbeing, social participation and relationships, and confidence and skills most commonly reported. Some needed more support than others to identify goals and make use of the personal budget to take a more active part in the society.Conclusions: Personal budgets can enable people to achieve outcomes that are relevant to them in the context of their lives, particularly through enhancing their wellbeing and social participation. Consideration should be given to distinguishing those individuals potentially requiring more support for engagement from those who can engage more independently to identify and pursue their goals. © 2015 Taylor & Francis, LLC. © 2015 Taylor & Francis, LLC.


Rosales J.,Clinica Meds | Garcia N.,Academic Unit | Rafols C.,Clinica Meds | Perez M.,Clinica Meds | Verdugo M.A.,Clinica Meds
Journal of Ultrasound in Medicine | Year: 2015

The objective of this study was to describe a perisciatic ultrasound-guided infiltration technique for treatment of deep gluteal syndrome and to report its preliminary clinical results. A mixture of saline (20 mL), a local anesthetic (4 mL), and a corticosteroid solution (1 mL) was infiltrated in the perisciatic region between the gluteus maximus and pelvitrochanteric muscles. Relative pain relief was achieved in 73.7% of the patients, with average preprocedural and postprocedural visual analog scale scores of 8.3 and 2.8, respectively. Fifty percent of patients reported recurrence of discomfort, and the average duration of the therapeutic effect in these patients was 5.3 weeks. © 2015 by the American Institute of Ultrasound in Medicine.


Purwar B.,Newcastle University | Ismail K.M.,University of Birmingham | Ismail K.M.,Academic Unit | Turner N.,Staffordshire University | And 6 more authors.
International Urogynecology Journal and Pelvic Floor Dysfunction | Year: 2015

Introduction and hypothesis: Spinal anaesthesia (SA) and general anaesthesia (GA) are widely used techniques for vaginal surgery for pelvic floor disorders with inconclusive evidence of the superiority of either. We conducted a randomised controlled trial (RCT) to assess the feasibility of a full scale RCT aiming to examine the effect of anaesthetic mode for vaginal surgery on operative, patient reported and length of hospital stay (LOHS) outcomes. Methods: Patients undergoing vaginal surgery, recruited through a urogynaecology service in a University teaching hospital, were randomised to receive either GA or SA. Patients were followed up for 12 weeks postoperatively. Pain was measured on a visual analogue scale; nausea was assessed with a four-point verbal rating scale. Patient’s subjective perception of treatment outcome, quality of life (QoL) and functional outcomes were assessed using the International Consultation on Incontinence Modular Questionnaire (ICIQ) on vaginal symptoms and the SF-36 questionnaire. Results: Sixty women were randomised, 29 to GA and 31 to SA. The groups were similar in terms of age and type of vaginal surgery performed. No statistically significant differences were noted between the groups with regard to pain, nausea, quality of life (QoL), functional outcomes as well as length of stay in the postoperative recovery room, use of analgesia postoperatively and LOHS. Conclusion: This study has demonstrated that a full RCT is feasible and should focus on the length of hospital stay in a subgroup of patients undergoing vaginal surgery where SA may help to facilitate enhanced recovery or day surgery. © 2015, The International Urogynecological Association.


Pavlickova H.,Academic Unit | Pavlickova H.,Queen Mary, University of London | Turnbull O.,Academic Unit | Bentall R.P.,University of Liverpool
British Journal of Clinical Psychology | Year: 2014

Background Bipolar disorder is a highly heritable illness, with a positive family history robustly predictive of its onset. It follows that studying biological children of parents with bipolar disorder may provide information about developmental pathways to the disorder. Moreover, such studies may serve as a useful test of theories that attribute a causal role in the development of mood disorders to psychological processes.Method Psychological style (including self-esteem, coping style with depression, domain-specific risk-taking, sensation-seeking, sensitivity to reward and punishment, and hypomanic personality and cognition) was assessed in 30 offspring of bipolar parents and 30 children of well parents. Parents of both child groups completed identical assessments.Results Although expected differences between parents with bipolar disorder and well parents were detected (such as low self-esteem, increased rumination, high sensitivity to reward and punishment), offspring of bipolar parents were, as a group, not significantly different from well offspring, apart from a modest trend towards lower adaptive coping. When divided into affected and non-affected subgroups, both groups of index children showed lower novelty-seeking. Only affected index children showed lower self-esteem, increased rumination, sensitivity to punishment, and hypomanic cognitions. Notably, these processes were associated with symptoms of depression.Conclusion Psychological abnormalities in index offspring were associated with having met diagnostic criteria for psychiatric illnesses and the presence of mood symptoms, rather than preceding them. Implications of the present findings for our understanding of the development of bipolar disorder, as well as for informing early interventions, are discussed. © 2014 The British Psychological Society.


Heer K.,University of Birmingham | Rose J.,University of Birmingham | Rose J.,Academic Unit | Larkin M.,University of Birmingham | Singhal N.,The National Center for Autism
International Journal of Human Rights in Healthcare | Year: 2015

Purpose – India has one of the more progressive disability frameworks in the developing world which tends to adopt western philosophies and principles (e.g. parent participation and advocacy) which to some degree mirrors the type of service delivery in the UK. The purpose of this paper is to adopt a cross-cultural perspective to explore caregiving amongst parents caring for a child with intellectual/developmental disabilities in India. Design/methodology/approach – Three focus groups were used to interview parents at Action for Autism (AFA) located in Delhi, India. The focus groups explored how disability is encountered within an Indian context. Findings – Two main themes were identified in the parents narratives which were “making the decision to get help” and “seeing disabilities in from a new perspective”. Family members played an important role in the decision to get help and acted as a platform for mothers to explore their own concerns. Seeing disability from a new perspective was a four stage process which included initially accepting the diagnosis and their child; regaining control through parenting skills training; witnessing positive changes in their children and themselves and reaping personal benefits as a result of their involvement with AFA. Research limitations/implications – The research is very small scale and focused on parents in a specific organisation, as a consequence the results cannot be generalised. Originality/value – The discourses of these individuals do provide a useful insight into the provision of services to children in India and provide a starting point for cross-cultural understanding of parenting children with disabilities. © 2015, © Emerald Group Publishing Limited.


Ceccherini-Nelli A.,Academic Unit | Priebe S.,Queen Mary, University of London
Social Psychiatry and Psychiatric Epidemiology | Year: 2011

Objective Suicides account for more than 30,000 deaths per year in the US alone. Suicide rates change over time, and the factors influencing them remain poorly understood. Economic factors, in particular unemployment, have been suggested as a major influence. However, the evidence for this has been inconsistent, which may be partly explained by shortcomings of the statistical methods used. Methods Time series analytical techniques (unit root and co-integration tests) were applied to test the associations over time between economic factors, i.e. unemployment, real gross domestic product per capita (RGDP) and the consumer price index (CPI) and death rates by suicide as collected by national agencies in the UK (1901-2006), US (1900-1997), France (1970-2004) and Italy (1970-2001). Traditional correlation analyses were used when appropriate. Results Co-integration and correlation tests showed a long-run association between economic factors and suicide rates. Increase/decrease of unemployment predicted an increase/decrease of suicide rates over long historical periods and in different nations. RGDP and the CPI were also linked with suicide rates, but this was not consistently so and the direction of the association varied. Conclusions Unemployment is a major factor influencing suicide rates over long periods of time and in different national contexts. It needs to be considered as a confounding factor in evaluations of suicide prevention strategies. © Springer-Verlag 2010.


Hodgetts V.A.,Sandwell and West Birmingham Hospitals NHS Trust | Morris R.K.,University of Birmingham | Morris R.K.,Academic Unit | Francis A.,Perinatal Institute | And 2 more authors.
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2015

Objectives To assess the effect of timing of folic acid (FA) supplementation during pregnancy on the risk of the neonate being small for gestational age (SGA). Design A population database study and a systematic review with meta-analysis including the results of this population study. Setting and data sources A UK regional database was used for the population study and an electronic literature search (from inception until August 2013) for the systematic review. Participants and included studies Singleton live births with no known congenital anomalies; 111 736 in population study and 188 796 in systematic review. Outcome measures, data extraction and analysis The main outcome was SGA based on customised birthweight centile. Associations are presented as odds ratios (OR) and adjusted odds ratios (aOR), adjusted for maternal and pregnancy-related characteristics. Results Of 108 525 pregnancies with information about FA supplementation, 92 133 (84.9%) had taken FA during pregnancy. Time of commencement of supplementation was recorded in 39 416 pregnancies, of which FA was commenced before conception in 10 036, (25.5%) cases. Preconception commencement of FA supplementation was associated with reduced risk of SGA <10th centile (aOR 0.80, 95% CI 0.71-0.90, P < 0.01) and SGA <5th centile (aOR 0.78, 95% CI 0.66-0.91, P < 0.01). This result was reproduced when the data were pooled with other studies in the systematic review, showing a significant reduction in SGA (<5th centile) births with preconception commencement of FA (aOR 0.75, 95% CI 0.61-0.92, P < 0.006). In contrast, postconception folate had no significant effect on SGA rates. Conclusion Supplementation with FA significantly reduces the risk of SGA at birth but only if commenced preconceptually independent of other risk factors. Systematic review registration This systematic review was prospectively registered with PROSPERO number CRD42013004895. © 2014 Royal College of Obstetricians and Gynaecologists.


Tungaraza T.E.,Steps to Health | Gupta S.,Wrexham Maelor Hospital | Jones J.,Wrexham Maelor Hospital | Poole R.,Glyndwr University | Slegg G.,Academic Unit
Psychiatrist | Year: 2010

Aims and method: To determine the pattern of psychotropic prescribing in a group of people with psychosis who were living in the community under community mental health team (CMHT) care. Case-note entries over the previous 12 months were examined. Results: Only a third of individuals were on one psychotropic medication. Atypical antipsychotics were prescribed to 80.6%. Polypharmacy was common. A third of people were taking three or more psychotropic drugs and 13.7% were on high-dose regimes, mostly involving two atypical antipsychotics. Clinical implications: The use of atypicals has not eliminated polypharmacy or highdose antipsychotic regimes. Clinicians need to be aware of this long-standing problem.


Cox G.,Academic Unit | Einhorn T.A.,Leeds General Infirmary | Einhorn T.A.,Boston University | Tzioupis C.,Academic Unit | Giannoudis P.V.,Academic Unit
Journal of Bone and Joint Surgery - Series B | Year: 2010

Biochemical markers of bone-turnover have long been used to complement the radiological assessment of patients with metabolic bone disease. Their implementation in daily clinical practice has been helpful in the understanding of the pathogenesis of osteoporosis, the selection of the optimal dose and the understanding of the progression of the onset and resolution of treatment. Since they are derived from both cortical and trabecular bone, they reflect the metabolic activity of the entire skeleton rather than that of individual cells or the process of mineralisation. Quantitative changes in skeletal-turnover can be assessed easily and non-invasively by the measurement of bone-turnover markers. They are commonly subdivided into three categories; 1) bone-resorption markers, 2) osteoclast regulatory proteins and 3) bone-formation markers. Because of the rapidly accumulating new knowledge of bone matrix biochemistry, attempts have been made to use them in the interpretation and characterisation of various stages of the healing of fractures. Early knowledge of the individual progress of a fracture could help to avoid delayed or nonunion by enabling modification of the host's biological response. The levels of bone-turnover markers vary throughout the course of fracture repair with their rates of change being dependent on the size of the fracture and the time that it will take to heal. However, their short-term biological variability, the relatively low bone specificity exerted, given that the production and destruction of collagen is not limited to bone, as well as the influence of the host's metabolism on their concentration, produce considerable intra- and inter-individual variability in their interpretation. Despite this, the possible role of bone-turnover markers in the assessment of progression to union, the risks of delayed or nonunion and the impact of innovations to accelerate fracture healing must not be ignored. ©2010 British Editorial Society of Bone and Joint Surgery.


PubMed | Academic Unit
Type: Journal Article | Journal: Social psychiatry and psychiatric epidemiology | Year: 2011

Suicides account for more than 30,000 deaths per year in the US alone. Suicide rates change over time, and the factors influencing them remain poorly understood. Economic factors, in particular unemployment, have been suggested as a major influence. However, the evidence for this has been inconsistent, which may be partly explained by shortcomings of the statistical methods used.Time series analytical techniques (unit root and co-integration tests) were applied to test the associations over time between economic factors, i.e. unemployment, real gross domestic product per capita (RGDP) and the consumer price index (CPI) and death rates by suicide as collected by national agencies in the UK (1901-2006), US (1900-1997), France (1970-2004) and Italy (1970-2001). Traditional correlation analyses were used when appropriate.Co-integration and correlation tests showed a long-run association between economic factors and suicide rates. Increase/decrease of unemployment predicted an increase/decrease of suicide rates over long historical periods and in different nations. RGDP and the CPI were also linked with suicide rates, but this was not consistently so and the direction of the association varied.Unemployment is a major factor influencing suicide rates over long periods of time and in different national contexts. It needs to be considered as a confounding factor in evaluations of suicide prevention strategies.

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