An Assessment of Psychological Need in Emergency Medical Staff in the Northern Health and Social Care Trust Area

Setting: Psychological stress is increasingly recognised within emergency medicine, given the environmental and clinical stressors associated with the specialism. The current study assessed whether psychological distress is experienced by emergency medical staff and if so, what is the expressed need within this population? Participants: Participants included ambulance personnel, nursing staff, doctors and ancillary support staff within two Accident and Emergency (A&E) departments and twelve ambulance bases within one Trust locality in NI (N = 107). Primary and secondary outcome measures: The General Health Questionnaire (GHQ-12, Goldberg, 1972, 1978), Secondary Traumatic Stress Scale (STSS, Bride, 2004) and an assessment of need questionnaire were completed and explored using mixed method analysis. Results: Results showed elevated levels of psychological distress within each profession except ambulance service clinical support officers (CSOs). Elevated levels of secondary trauma symptomatology were also found; the highest were within some nursing grades and junior doctors. Decreased enjoyment in job over time was significantly associated with higher scores. Analysis of qualitative data identified sources of stress to include low morale. A total of 65% of participants thought that work related stressors had negatively affected their mental health. Participants explored what they felt could decrease psychological distress including improved resources and psychoeducation. Conclusion: There were elevated levels of distress and secondary traumatic stress within this population as well as an expressed level of need, on both systemic and support levels.

Prevalence and risk of Down syndrome in monozygotic and dizygotic multiple pregnancies in Europe: implications for prenatal screening

OBJECTIVE: To determine risk of Down syndrome (DS) in multiple relative to singleton pregnancies, and compare prenatal diagnosis rates and pregnancy outcome.

DESIGN: Population-based prevalence study based on EUROCAT congenital anomaly registries.

SETTING: Eight European countries.

POPULATION: 14.8 million births 1990-2009; 2.89% multiple births.

METHODS: DS cases included livebirths, fetal deaths from 20 weeks, and terminations of pregnancy for fetal anomaly (TOPFA). Zygosity is inferred from like/unlike sex for birth denominators, and from concordance for DS cases.

MAIN OUTCOME MEASURES: Relative risk (RR) of DS per fetus/baby from multiple versus singleton pregnancies and per pregnancy in monozygotic/dizygotic versus singleton pregnancies. Proportion of prenatally diagnosed and pregnancy outcome.

STATISTICAL ANALYSIS: Poisson and logistic regression stratified for maternal age, country and time.

RESULTS: Overall, the adjusted (adj) RR of DS for fetus/babies from multiple versus singleton pregnancies was 0.58 (95% CI 0.53-0.62), similar for all maternal ages except for mothers over 44, for whom it was considerably lower. In 8.7% of twin pairs affected by DS, both co-twins were diagnosed with the condition. The adjRR of DS for monozygotic versus singleton pregnancies was 0.34 (95% CI 0.25-0.44) and for dizygotic versus singleton pregnancies 1.34 (95% CI 1.23-1.46). DS fetuses from multiple births were less likely to be prenatally diagnosed than singletons (adjOR 0.62 [95% CI 0.50-0.78]) and following diagnosis less likely to be TOPFA (adjOR 0.40 [95% CI 0.27-0.59]).

CONCLUSIONS: The risk of DS per fetus/baby is lower in multiple than singleton pregnancies. These estimates can be used for genetic counselling and prenatal screening.

'Dancing the Downward Slide: Spaces of Affective Adjacency in Rian and Bird with Boy'

This chapter examines how the choreography of affect in two dance theatre works creates a space of affective adjacency—a space in which the building of an alternative structure of feeling and an alternative economy of the body can be experienced. Focusing on the choreographic use of repetition in Junk Ensemble’s Bird With Boy (2011) and Fabulous Beast Dance Theatre’s Rian (2011), it shows how the work required to build an alternative affective space can become visible. Although affect is most often viewed as a preconscious, ephemeral phenomenon (a passage of intensities), that can have little or no lasting impact on socio-political action, theorists such as Megan Watkins have argued for a consideration of the ‘cumulative aspects of affect’. Highlighting Spinoza’s distinction between affectus (the capacity for a body to affect and be affected), and affectio (the impact the affecting body leaves on the affected), Watkins points out that affectio can ‘leave a residue’ allowing for the ‘capacity of affect to be retained, to accumulate, to form dispositions and thus shape subjectivities’. The choreography of repetition in Bird With Boy and Rian presents sites for an examination of this accumulation of affect and its capacity not only to form and shape dispositions, but also, as Lauren Berlant suggests, ‘to move along and make worlds, situations, and environments’.

Resolving conflict in bipolar societies: The fate of political settlements in Fiji and Northern Ireland

Ethnically divided societies that might be described as ‘balanced bicommunal’ (where there are two communities, each of which comes close to representing half of the population) pose a particular challenge to conventional principles of collective decision-making, and commonly threaten political stability. This article analyses the experience of two such societies – Northern Ireland and Fiji – with a view to exploring whether there are common processes in the route by which political stability has been pursued. We assess the manner in which a distinctive relationship with Great Britain and its political culture has interacted with local conditions to produce a highly competitive, bipolar party system. This leads to consideration of the devices that have been adopted in an effort to bridge the gap between the communities: the Fiji constitution as amended in 1997, and Northern Ireland’s Good Friday Agreement of 1998. We focus, in particular, on the use of unusual (preferential voting) formulas for the election of parliamentarians and of an inclusive principle in the selection of ministers, and consider the contribution of these institutional devices to the attainment of political stability. We find that, in both cases, the intervention of forces from outside the political system had a decisive impact, though in very different ways. In addition to being underpinned by solid institutional design, for political settlements to work effectively, some minimal level of trust between rival elites is required.