Secondary prevention of cardiovascular disease in different primary healthcare systems with and without pay-for-performance

Objective: To compare baseline cardiovascular risk management between people recruited from two different healthcare systems, to a research trial of an intervention to optimize secondary prevention. Design: Cross-sectional study. Setting: General practices, randomly selected: 16 in Northern Ireland (NI) (UK NHS, ‘strong’ infrastructure); 32 in Republic of Ireland (RoI) (mixed healthcare economy, less infrastructure). Patients: 903 (mean age 67.5 years; 69.9% male); randomly selected, known coronary heart disease. Main outcome measures: Blood pressure, cholesterol, medications; validated questionnaires for diet (DINE), exercise (Godin), quality of life (SF12); healthcare usage. Results: More RoI than NI participants had systolic BP>140 mmHg (37% v 28%, p=0.01) and cholesterol >5mmol/l (24% v 17%, p=0.02): RoI mean systolic BP was higher (139 v 132 mm Hg). More RoI participants reported a high fibre intake (35% v 23%), higher levels of physical activity (62% v 44%), and better physical and mental health (SF12); they had more GP (5.6 v 4.4) and fewer nurse visits (1.6 v 2.1) in the previous year. Fewer in RoI (55% v 70%) were prescribed B blockers. Both groups’ ACE inhibitor (41%; 48%) prescribing was similar; high proportions were prescribed statins (84%; 85%) and aspirin (83%; 77%). Conclusions Blood pressure and cholesterol are better controlled among patients in a primary healthcare system with a ‘strong’ infrastructure supporting computerization and rewarding measured performance but this is not associated with healthier lifestyle or better quality of life. Further exploration of differences in professionals’ and patients’ engagement in secondary prevention in different healthcare systems is needed.

Impact of persistent substance misuse on 1-year outcome in first-episode psychosis

Background: Substance misuse is a common comorbid problem in people presenting with first-episode psychosis and is associated with a poor short-term outcome.

Aims: The aim of this study is to examine differences in baseline characteristics and 1-year outcome between individuals with first-episode psychosis who have never misused substances, those who stop misusing substances after initial presentation and those who persistently misuse substances over the 1-year assessment period.

Method: Patients were recruited to the Northern Ireland First Episode Psychosis Study (n=272). Clinical assessments were performed at baseline and at 1 year (n=194) and data were collected from the case notes.

Results: Individuals with persistent substance misuse had more severe depression, more positive symptoms, poorer functional outcome and greater rates of relapse at 1 year than those who stopped and those who had never misused substances. There were no differences in outcome between people who had never misused substances and those who stopped misusing after presentation.

Conclusions: These results support assertive intervention targeted at comorbid substance misuse in individuals with first-episode psychosis.

Reconsidering Respect: Its Role in the British Prison Service

This article examines the meaning of respect in the interpersonal relationships within Her Majesty’s Prison Service. It is argued that respect-as-esteem and respect-asconsideration are often confused and unequally emphasised in modern society. This confusion is especially evident within the prison context where, due to the prison service’s ‘decency agenda’, the respectful treatment of inmates has become a topical issue. What does respect mean in prison? Why is it important? How can respectful relationships be established between staff and inmates? This article discusses these questions and proposes that there are different forms of respect possible between people. It is argued that there needs to be a recognition of the nuances of meaning when we use the word respect and that ‘respect-as-consideration’ may be the form of respect most consistently achievable, at the present time, within interpersonal relationships in English and Welsh prisons.

Comparisons, mental models, and the action effect in judgments of regret

People tend to attribute more regret to a character who has decided to take action and experienced a negative outcome than to one who has decided not to act and experienced a negative outcome. For some decisions, however, this finding is not observed in a between-participants design and thus appears to rely on comparisons between people's representations of action and their representations of inaction. In this article, we outline a mental models account that explains findings from studies that have used within- and between-participants designs, and we suggest that, for decisions with uncertain counterfactual outcomes, information about the consequences of a decision to act causes people to flesh out their representation of the counterfactual states of affairs for inaction. In three experiments, we confirm our predictions about participants' fleshing out of representations, demonstrating that an action effect occurs only when information about the consequences of action is available to participants as they rate the nonactor and when this information about action is informative with respect to judgments about inaction. It is important to note that the action effect always occurs when the decision scenario specifies certain counterfactual outcomes. These results suggest that people sometimes base their attributions of regret on comparisons among different sets of mental models.

Portfolio of Compositions investigating ensemble improvisation, distributed and real-time scoring, and multi-nodal input and output

This output is a collection of compositions which explore issues of ensemble improvisation, ensemble management and orchestration, real-time and distributed scoring, multi-nodal inputs and outputs, and animated and graphic notation. Compositions include: Activities I; tutti, duet, trio, solo, quartet; Lewitt Notations I; Webwork I; and Sometimes I feel the space between people (voices) in terms of tempos. These compositions are presented in computer animated scores which are synchronized through the network and subject to real-time modification and control. They can be performed by ensembles distributed over large physical spaces connected by the network. The scores for these compositions include software which displays the animations to the performers, software to structure and disseminate score events, and triggering software that allows the control of a performance to be distributed. Scores can also include live electronics which are coordinated with graphic events.

The Landscape of Differences: Contact and Segregation in the Everyday Encounters

The article examines everyday life in Northern Ireland’s segregated communities and focus on a neglected empirical dimension of ethnic and social segregation developed within the socio-spatial relations between people and their built environment. It shows how the everyday urban encounters are reproduced through negotiating differences and the ways in which living in divided communities lead to social inequality and imbalanced use of space. The article employed qualitative research methods with individuals and community groups from the Fountain estate, a small Protestant enclave in Derry/Londonderry. Their stories were replete with cases of injustice and insights into the daily struggles that have generally occurred within theories of contact and social segregation as a whole. In fact, people in the Fountain presented their own intertextual references on what was more significant for them as a matter of routine survival and belonging, which allowed them to be more constructive about themselves. While segregation has persisted for multiple decades; time is believed to be the factor most likely to change it, as it is hoped that the younger generation will provide lasting change to Northern Ireland and eventual peace between currently segregated communities.

Holocene landscape intervention and plant food production strategies in island and mainland Southeast Asia

In the areas adjacent to the drowned Pleistocene continent of Sunda – present-day Mainland and Island SE Asia – the Austronesian Hypothesis of a diaspora of rice cultivators from Taiwan ∼4200 years ago has often been linked with the start of farming. Mounting evidence suggests that these developments should not be conflated and that alternative explanations should be considered, including indigenous inception of complex patterns of plant food production and early exchange of plants, animals, technology and genes. We review evidence for widespread forest disturbance in the Early Holocene which may accompany the beginnings of complex food-production. Although often insubstantial, evidence for incipient and developing management of rainforest vegetation and of developing complex relationships with plants is present, and early enough to suggest that during the Early to mid-Holocene this vast region was marked by different approaches to plant food production. The trajectory of the increasingly complex relationships between people and their food organisms was strongly locally contingent and in many cases did not result in the development of agricultural systems that were recognisable as such at the time of early European encounters. Diverse resource management economies in the Sunda and neighbouring regions appear to have accompanied rather than replaced a reliance on hunting and gathering. This, together with evidence for Early Holocene interaction between these neighbours, gives cause for us to question some authors continued adherence to a singular narrative of the Austronesian Hypothesis and the ‘Neolithisation’ of this part of the world. It also leads us to suggest that the forests of this vast region are, to an extent, a cultural artefact.

Social Equality: On what it means to be equals

The first collected volume on social and relational equality.
Addresses a gap in the literature - while many philosophers have pointed to the importance of social equality, it requires much more theoretical development, which this volume aims to provide.
Offers a unique answer to the debate about whether or not equality is valuable.
Features a foreword by eminent political theorist David Miller
Includes new contributions by some of the most well-known contemporary moral and political philosophers, such as Samuel Scheffler and Jonathan Wolff.
Is equality valuable? This question dominates many discussions of social justice, which tend to center on whether certain forms of distributive equality are valuable, such as the equal distribution of primary social goods. But these discussions often neglect what is known as social or relational equality. Social equality suggests that equality is foremost about relationships and interactions between people, rather than being primarily about distribution.

A number of philosophers have written about the significance of social equality, and it has also played an important role in real-life egalitarian movements, such as feminism and civil rights movements. However, as it has been relatively neglected in comparison to the debates about distributive equality, it requires much more theoretical attention. This volume brings together a collection of ten original essays which present new analyses of social and relational equality in philosophy and political theory. The essays analyze the nature of social equality, as well as its relationship to justice and politics.

Readership: The book is primarily aimed at professionals in the field - philosophers (especially in moral, social and political philosophy) and political theorists. It is also aimed at the academic library market. Moreover, the book should be of interest to advanced undergraduate and postgraduate students attending courses on theories of equality and/or social justice.

Collective synchrony increases prosociality towards non-performers and out-group members

Previous research has found that behavioural synchrony between people leads to greater prosocial tendencies towards co-performers. In this study we investigated the scope of this prosocial effect: does it extend beyond the performance group to an extended in-group (extended parochial prosociality) or even to other people in general (generalized prosociality)? Participants performed a simple rhythmic movement either in time (synchrony condition) or out of time (asynchrony condition) with each other. Before and during the rhythmic movement, participants were exposed to a prime that made salient an extended in-group identity. After the task, half the participants had the opportunity to help an extended in-group member; the other half had the opportunity to help an out-group member. We found a main effect of our synchrony manipulation across both help targets suggesting that the prosocial effects of synchrony extend to non-performers. Furthermore, there was a significantly higher proportion of participants willing to help an out-group member after moving collectively in synchrony. This study shows that under certain intergroup contexts synchrony can lead to generalized prosociality with performers displaying greater prosociality even towards out-group members.

Lung clearance index in adults and children with cystic fibrosis

Background: Lung clearance index (LCI) has good clinimetric properties and an acceptable feasibility profile as a surrogate endpoint in Cystic Fibrosis (CF). Although most studies to date have been in children, increasing numbers of adults with CF also have normal spirometry. Further study of LCI as an endpoint in CF adults is required. Therefore, the purpose of this study was to determine the clinimetric properties of LCI over the complete age range of people with CF. Methods: Clinically stable adults and children with CF and age matched healthy controls were recruited. Results: LCI and spirometry data for 110 CF subjects and 61 controls were collected at a stable visit. CF Questionnaire-Revised (CFQ-R) was completed by 80/110 CF subjects. Fifty-six CF subjects completed a second stable visit. The LCI CV% was 4.1% in adults and 6.3% in children with CF. The coefficient of repeatability of LCI was 1.2 in adults and 1.3 in children. In both adults and children, LCI (AUCROC=0.93 and 0.84) had greater combined sensitivity and specificity to discriminate between people with CF and controls compared to FEV1 (AUCROC=0.88 and 0.60) and FEF25-75 (AUCROC=0.87 and 0.68). LCI correlated significantly with the CFQ-R treatment burden in adults (r=-0.37; p<0.01) and children (r=-0.50; p<0.01). Washout tests were successful in 90% of CF subjects and were perceived as comfortable and easy to perform in both adults and children. Conclusions: These data support the use of LCI as a surrogate outcome measure in CF clinical trials in adults as well as children.

Statin prescription initiation and lifestyle behaviour: a primary care cohort study

BACKGROUND: Statin prescribing and healthy lifestyles contribute to declining cardiovascular disease mortality. Recent guidelines emphasise the importance of giving lifestyle advice in association with prescribing statins but adherence to healthy lifestyle recommendations is sub-optimal. However, little is known about any change in patients' lifestyle behaviours when starting statins or of their recall of receiving advice. This study aimed to examine patients' diet and physical activity (PA) behaviours and their recall of lifestyle advice following initiation of statin prescribing in primary care.

METHOD: In 12 general practices, patients with a recent initial prescription of statin therapy, were invited to participate. Those who agreed received a food diary by post, to record food consumed over 4 consecutive days and return to the researcher. We also telephoned participants to administer brief validated questionnaires to assess typical daily diet (DINE) and PA level (Godin). Using the same methods, food diaries and questionnaires were repeated 3 months later. At both times participants were asked if they had changed their behaviour or received advice about their diet or PA.

RESULTS: Of 384 invited, 122 (32 %) participated; 109 (89.3 %) completed paired datasets; 50 (45.9 %) were male; their mean age was 64 years. 53.2 % (58/109) recalled receiving lifestyle advice. Of those who did, 69.0 % (40/58) reported having changed their diet or PA, compared to 31.4 % (16/51) of those who did not recall receiving advice. Initial mean daily saturated fat intake (12.9 % (SD3.5) of total energy) was higher than recommended; mean fibre intake (13.8 g/day (SD5.5)), fruit/vegetable consumption (2.7 portions/day (SD1.3)) and PA levels (Godin score 7.1 (SD13.9)) were low. Overall, although some individuals showed evidence of behaviour change, there were no significant changes in the proportions who reported high or medium fat intake (42.2 % v 49.5 %), low fibre (51.4 % v 55.0 %), or insufficient PA (80.7 % v 83.5 %) at 3-month follow-up.

CONCLUSION: Whilst approximately half of our cohort recalled receiving lifestyle advice associated with statin prescribing this did not translate into significant changes in diet or PA. Further research is needed to explore gaps between people's knowledge and behaviours and determine how best to provide advice that supports behaviour change.

Content validity of the Illness Perception Questionnaire-Revised for people with Type 2 Diabetes: A Think-Aloud study

Objectives: To access the cognitions of adults with type 2 diabetes whilst completing items on the Illness Perceptions Questionnaire – Revised (IPQ-R). To determine whether these cognitions are congruent with the meaning of items and subscales as interpreted by researchers and clinicians using the IPQ-R and to identify the nature and extent of problems that individuals experience when completing the IPQ-R.
Design: Participants (n=36) were recruited from a primary care diabetes clinic and a hospital diabetes clinic. They were asked to complete the IPQ-R using a ‘think-aloud’ methodology.
Main Outcome Measures: Transcripts were analysed to identify instances where participants expressed problems with item completion, or where there was inconsistency between verbal and written responses.
Results: The most problematic subscales were those of ‘personal control’ and ‘consequences’.
Conclusion: Generally, participants found the IPQ-R unproblematic. However, participants had problems with the concept of ‘cure’ and ‘symptoms’ in the context of type 2 diabetes, and with the negative phrasing used in some items. These findings have important implications for the interpretation of IPQ-R scores, particularly when the IPQ-R is used as the basis for individualised interventions among people with type 2 diabetes.

The relationship between the recognition of facial expressions and self-reported anger in people with intellectual disabilities

Background This study aims to examine the relationship between how individuals with intellectual disabilities report their own levels of anger, and the ability of those individuals to recognize emotions. It was hypothesized that increased expression of anger would be linked to lower ability to recognize facial emotional expressions and increased tendency to interpret facial expressions in a hostile or negative manner. It was also hypothesized increased levels of anger may lead to the altered perception of a particular emotion.

Method A cross-sectional survey design was used. Thirty participants completed a test of facial emotion recognition (FER), and a self-report anger inventory (Benson & Ivins 1992) as part of a structured interview.

Results Individuals with higher self-reported anger did not show significantly reduced performance in FER, or interpret facial expressions in a more hostile manner compared with individuals with less self-reported anger. However, they were less accurate in recognizing neutral facial emotions.

Conclusions It is tentatively suggested that individuals with high levels of anger may be likely to perceive emotional content in a neutral facial expression because of their high levels of emotional arousal.

Reducing the mapping between perception and action facilitates imitation

This study investigated two hypotheses regarding the mapping of perception to action during imitation. The first hypothesis predicted that as children’s cognitive capacities increase the tendency to map one goal and disregard others during imitation should decrease. This hypothesis was tested by comparing the performances of 168 4- to 7-year-olds in a gestural imitation task developed by Bekkering, Wohlschläger, and Gattis. The second hypothesis predicted that reducing the mapping between perception and action should reduce the demands on the cognitive resources of the child. This hypothesis was tested by creating a condition in which perception and action overlapped by sharing objects between experimenter and child. In three experimental conditions, an adult modelled four gestures, directed at either: 1) one of two sets of round stickers (proprietary objects); 2) the same location on the table, without any sticker (no objects); or 3) one set of round stickers, which were shared with the child (shared objects). The results confirmed both hypotheses. Four- and five-year-olds imitated less accurately when imitation involved mapping of both objects and movements (proprietary and shared objects) than when imitation involved mapping movements only (no objects). Seven-year-olds imitated accurately in all three conditions, demonstrating that increased cognitive capacity allowed them to map multiple goals from perception to action. Most importantly, reducing the mapping between perception and action in the shared objects condition facilitated imitation, specifically for the transitional group, 6-year-olds. We conclude that mapping between perception and action is not direct, but resembles mapping relations in analogical reasoning: cognitive processes mediate mapping from perception to action.