Impaired awareness of hypoglycaemia (IAH) is a major risk for severe hypoglycaemia in insulin treatment of type 1 diabetes (T1D). To explore the hypothesis that unhelpful health beliefs create ...barriers to regaining awareness, we conducted a multi-centre, randomised, parallel, two-arm trial (ClinicalTrials.gov NCT02940873) in adults with T1D and treatment-resistant IAH and severe hypoglycaemia, with blinded analysis of 12-month recall of severe hypoglycaemia at 12 and/or 24 months the primary outcome. Secondary outcomes included cognitive and emotional measures. Adults with T1D, IAH and severe hypoglycaemia despite structured education in insulin adjustment, +/- diabetes technologies, were randomised to the "Hypoglycaemia Awareness Restoration Programme despite optimised self-care" (HARPdoc, n = 49), a psychoeducation programme uniquely focussing on changing cognitive barriers to avoiding hypoglycaemia, or the evidence-based "Blood Glucose Awareness Training" (BGAT, n = 50), both delivered over six weeks. Median IQR severe hypoglycaemia at baseline was 52-12 per patient/year, 10-5 at 12 months and 00-2 at 24 months, with no superiority for HARPdoc (HARPdoc vs BGAT incident rate ratios 95% CI 1.250.51, 3.09, p = 0.62 and 1.260.48, 3.35, p = 0.64 respectively), nor for changes in hypoglycaemia awareness scores or fear. Compared to BGAT, HARPdoc significantly reduced endorsement of unhelpful cognitions (Estimated Mean Difference for Attitudes to Awareness scores at 24 months, -2.07 -3.37,-0.560, p = 0.01) and reduced scores for diabetes distress (-6.70-12.50,-0.89, p = 0.02); depression (-1.86-3.30, -0.43, p = 0.01) and anxiety (-1.89-3.32, -0.47, p = 0.01). Despite positive impact on cognitive barriers around hypoglycaemia avoidance and on diabetes-related and general emotional distress scores, HARPdoc was not more effective than BGAT at reducing severe hypoglycaemia.
Loneliness is a major public health concern with links to social and environmental factors. Previous studies have typically investigated loneliness as a stable emotional state using retrospective ...cross-sectional designs. Yet people experience different levels of loneliness throughout the day depending on their surrounding environment. In the present study, we investigated the associations between loneliness and social and environmental factors (i.e. overcrowding, population density, social inclusivity and contact with nature) in real-time. Ecological momentary assessment data was collected from participants using the Urban Mind smartphone application. Data from 756 participants who completed 16,602 assessments between April 2018 and March 2020 were used in order to investigate associations between momentary feeling of loneliness, the social environment (i.e. overcrowding, social inclusivity, population density) and the built environment (i.e. contact with nature) using multilevel modelling. Increased overcrowding and population density were associated with higher levels of loneliness; in contrast, social inclusivity and contact with nature were associated with lower levels of loneliness. These associations remained significant after adjusting for age, gender, ethnicity, education and occupation. The positive association between social inclusivity and lower levels of loneliness was more pronounced when participants were in contact with nature, indicating an interaction between the social and built environment on loneliness. The feeling of loneliness changes in relation to both social and environmental factors. Our findings have potential implications for public health strategies and interventions aimed at reducing the burden of loneliness on society. Specific measures, which would increase social inclusion and contact with nature while reducing overcrowding, should be implemented, especially in densely populated cities.
Purpose
The World Health Organisation (WHO) recently ranked air pollution as the major environmental cause of premature death. However, the significant potential health and societal costs of poor ...mental health in relation to air quality are not represented in the WHO report due to limited evidence. We aimed to test the hypothesis that long-term exposure to air pollution is associated with poor mental health.
Methods
A prospective longitudinal population-based mental health survey was conducted of 1698 adults living in 1075 households in South East London, from 2008 to 2013. High-resolution quarterly average air pollution concentrations of nitrogen dioxide (NO
2
) and oxides (NO
x
), ozone (O
3
), particulate matter with an aerodynamic diameter < 10 μm (PM
10
) and < 2.5 μm (PM
2.5
) were linked to the home addresses of the study participants. Associations with mental health were analysed with the use of multilevel generalised linear models, after adjusting for large number of confounders, including the individuals’ socioeconomic position and exposure to road-traffic noise.
Results
We found robust evidence for interquartile range increases in PM
2.5
, NO
x
and NO
2
to be associated with 18–39% increased odds of common mental disorders, 19–30% increased odds of poor physical symptoms and 33% of psychotic experiences only for PM
10
. These longitudinal associations were more pronounced in the subset of non-movers for NO
2
and NO
x
.
Conclusions
The findings suggest that traffic-related air pollution is adversely affecting mental health. Whilst causation cannot be proved, this work suggests substantial morbidity from mental disorders could be avoided with improved air quality.
The worldwide pooled prevalence of psychiatric disorders in children is 13.4%. Studying the prevalence of childhood psychiatric disorders across radically different economic systems and social ...structures could indicate universal factors leading to their development. The prevalence of childhood psychiatric disorders in a mixed-subsistence foraging society has not been studied. The Strengths and Difficulties Questionnaire and the Development and Well-Being Assessment were used to compare the prevalence of behavioural symptoms and psychiatric disorders in Hadza children aged 5-16 years (n = 113) to a nationally representative sample from England (n = 18,029) using a cross-sectional study design. Emotional problems, conduct problems and hyperactivity were lower in the Hadza children. Prosocial behaviour and peer problems were higher in Hadza children. 3.6% of Hadza children met the criteria for a psychiatric disorder compared to 11.8% of English children. All psychiatric disorders in Hadza children were co-morbid with autism spectrum disorder. No child from the Hadza group met the criteria for an emotional, behaviour or eating disorder. Further work should study the factors which lead to the different prevalence of psychiatric disorders in Hadza children.
Designing implementation research can be a complex and daunting task, especially for applied health researchers who have not received specialist training in implementation science. We developed the ...Implementation Science Research Development (ImpRes) tool and supplementary guide to address this challenge and provide researchers with a systematic approach to designing implementation research.
A multi-method and multi-stage approach was employed. An international, multidisciplinary expert panel engaged in an iterative brainstorming and consensus-building process to generate core domains of the ImpRes tool, representing core implementation science principles and concepts that researchers should consider when designing implementation research. Simultaneously, an iterative process of reviewing the literature and expert input informed the development and content of the tool. Once consensus had been reached, specialist expert input was sought on involving and engaging patients/service users; and economic evaluation. ImpRes was then applied to 15 implementation and improvement science projects across the National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London, a research organisation in London, UK. Researchers who applied the ImpRes tool completed an 11-item questionnaire evaluating its structure, content and usefulness.
Consensus was reached on ten implementation science domains to be considered when designing implementation research. These include implementation theories, frameworks and models, determinants of implementation, implementation strategies, implementation outcomes and unintended consequences. Researchers who used the ImpRes tool found it useful for identifying project areas where implementation science is lacking (median 5/5, IQR 4-5) and for improving the quality of implementation research (median 4/5, IQR 4-5) and agreed that it contained the key components that should be considered when designing implementation research (median 4/5, IQR 4-4). Qualitative feedback from researchers who applied the ImpRes tool indicated that a supplementary guide was needed to facilitate use of the tool.
We have developed a feasible and acceptable tool, and supplementary guide, to facilitate consideration and incorporation of core principles and concepts of implementation science in applied health implementation research. Future research is needed to establish whether application of the tool and guide has an effect on the quality of implementation research.
The mental health benefits of everyday encounters with birdlife for mental health are poorly understood. Previous studies have typically relied on retrospective questionnaires or artificial set-ups ...with little ecological validity. In the present study, we used the Urban Mind smartphone application to examine the impact of seeing or hearing birds on self-reported mental wellbeing in real-life contexts. A sample of 1292 participants completed a total of 26,856 ecological momentary assessments between April 2018 and October 2021. Everyday encounters with birdlife were associated with time-lasting improvements in mental wellbeing. These improvements were evident not only in healthy people but also in those with a diagnosis of depression, the most common mental illness across the world. These findings have potential implications for both environmental and wildlife protection and mental healthcare policies. Specific measures, aimed at preserving and increasing everyday encounters with birdlife in urban areas, should be implemented.
Using smartphone-based ecological momentary assessment, this study investigated an association between natural diversity on mental wellbeing. A sample of 1,998 participants completed 41,448 ...assessments between April 2018 and September 2023. Environments which included a larger range of natural features, such as trees, plants and birdlife (high natural diversity) were associated with greater mental wellbeing than environments including a smaller range of natural features (low natural diversity). There was evidence of a mediating effect of natural diversity on the association between natural environments and mental wellbeing. These results highlight the importance of policies and practices that support richness of biodiversity for public mental health.
Rates of suicide attempts and deaths are highest on Mondays and these occur more frequently in the morning or early afternoon, suggesting weekly temporal and diurnal variation in suicidal behaviour. ...It is unknown whether there are similar time trends on social media, of posts relevant to suicide. We aimed to determine temporal and diurnal variation in posting patterns on the Reddit forum SuicideWatch, an online community for individuals who might be at risk of, or who know someone at risk of suicide.
We used time series analysis to compare date and time stamps of 90,518 SuicideWatch posts from 1st December 2008 to 31st August 2015 to (i) 6,616,431 posts on the most commonly subscribed general subreddit, AskReddit and (ii) 66,934 of these AskReddit posts, which were posted by the SuicideWatch authors.
Mondays showed the highest proportion of posts on SuicideWatch. Clear diurnal variation was observed, with a peak in the early morning (2:00-5:00 h), and a subsequent decrease to a trough in late morning/early afternoon (11:00-14:00 h). Conversely, the highest volume of posts in the control data was between 20:00-23:00 h.
Posts on SuicideWatch occurred most frequently on Mondays: the day most associated with suicide risk. The early morning peak in SuicideWatch posts precedes the time of day during which suicide attempts and deaths most commonly occur. Further research of these weekly and diurnal rhythms should help target populations with support and suicide prevention interventions when needed most.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Differences in health service use between ethnic groups have been well documented, but little research has been conducted on inequalities in access to mental health services among young people. This ...study examines inequalities in pathways into care by ethnicity and migration status in 12–29 years old accessing health services in south east London. This study analyses anonymized electronic patient record data for patients aged 12–29 referred to a south east London mental health trust between 2008 and 2016 for an anxiety or non-psychotic depressive disorder (
n
= 18,931). Multinomial regression was used to examine associations between ethnicity, migration status, and both referral source and destination, stratified by age group. Young people in the Black African ethnic group were more likely to be referred from secondary health or social/criminal justice services compared to those in the White British ethnic group; the effect was most pronounced for those aged 16–17 years. Young people in the Black African ethnic group were also significantly more likely to be referred to inpatient and emergency services compared to those in the White British ethnic group. Black individuals living in south east London, particularly those who identify as Black African, are referred to mental health services via more adverse pathways than White individuals. Our findings suggest that inequalities in referral destination may be perpetuated by inequalities generated at the point of access.
Aims/hypothesis
Problematic hypoglycaemia still complicates insulin therapy for some with type 1 diabetes. This study describes baseline emotional, cognitive and behavioural characteristics in ...participants in the HARPdoc trial, which evaluates a novel intervention for treatment-resistant problematic hypoglycaemia.
Methods
We documented a cross-sectional baseline description of 99 adults with type 1 diabetes and problematic hypoglycaemia despite structured education in flexible insulin therapy. The following measures were included: Hypoglycaemia Fear Survey II (HFS-II); Attitudes to Awareness of Hypoglycaemia questionnaire (A2A); Hospital Anxiety and Depression Index; and Problem Areas In Diabetes.
k
-mean cluster analysis was applied to HFS-II and A2A factors. Data were compared with a peer group without problematic hypoglycaemia, propensity-matched for age, sex and diabetes duration (
n
= 81).
Results
The HARPdoc cohort had long-duration diabetes (mean ± SD 35.8 ± 15.4 years), mean ± SD Gold score 5.3 ± 1.2 and a median (IQR) of 5.0 (2.0–12.0) severe hypoglycaemia episodes in the previous year. Most individuals had been offered technology and 49.5% screened positive for anxiety (35.0% for depression and 31.3% for high diabetes distress). The cohort segregated into two clusters: in one (
n
= 68), people endorsed A2A cognitive barriers to hypoglycaemia avoidance, with low fear on HFS-II factors; in the other (
n
= 29), A2A factor scores were low and HFS-II high. Anxiety and depression scores were significantly lower in the comparator group.
Conclusions/interpretation
The HARPdoc protocol successfully recruited people with treatment-resistant problematic hypoglycaemia. The participants had high anxiety and depression. Most of the cohort endorsed unhelpful health beliefs around hypoglycaemia, with low fear of hypoglycaemia, a combination that may contribute to persistence of problematic hypoglycaemia and may be a target for adjunctive psychological therapies.
Graphical abstract
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