Investigating mental health risk assessment in primary care and the potential role of a structured decision support tool, GRiST

Aim: To explore current risk assessment processes in general practice and Improving Access to Psychological Therapies (IAPT) services, and to consider whether the Galatean Risk and Safety Tool (GRiST) can help support improved patient care. Background: Much has been written about risk assessment practice in secondary mental health care, but little is known about how it is undertaken at the beginning of patients' care pathways, within general practice and IAPT services. Methods: Interviews with eight general practice and eight IAPT clinicians from two primary care trusts in the West Midlands, UK, and eight service users from the same region. Interviews explored current practice and participants' views and experiences of mental health risk assessment. Two focus groups were also carried out, one with general practice and one with IAPT clinicians, to review interview findings and to elicit views about GRiST from a demonstration of its functionality. Data were analysed using thematic analysis. Findings Variable approaches to mental health risk assessment were observed. Clinicians were anxious that important risk information was being missed, and risk communication was undermined. Patients felt uninvolved in the process, and both clinicians and patients expressed anxiety about risk assessment skills. Clinicians were positive about the potential for GRiST to provide solutions to these problems. Conclusions: A more structured and systematic approach to risk assessment in general practice and IAPT services is needed, to ensure important risk information is captured and communicated across the care pathway. GRiST has the functionality to support this aspect of practice.

Software and Services − Research and Education in Bulgaria

Доклад по покана, поместен в сборника на Националната конференция "Образованието в информационното общество", Пловдив, май, 2010 г.

Exploring care relations in later life: disentangling notions of care and choice

The experience of later life varies widely and is often framed in terms of the active lifestyles of the Third Age and the frailty and abjection of the Fourth Age. This thesis sought to understand how the concepts of care and choice are enacted, experienced and interrelated in the context of both informal and formal care in later life and how older people themselves, their families and significant others understand and experience these concepts. The discourse of personalisation that dominates care services has led to an emphasis on individual choice, control and independence so that those in need of care are faced with what has been described as the ‘logic of choice’, a focus on individual responsibility rather than care. Adopting a Feminist Foucauldian theoretical approach and drawing on Tronto’s (1993) ethic of care, this thesis explores the experiences of older people and their informal carers through dialogical narrative analysis. The stories begin with the recognition by individuals that there is a need for care and how this need is met through negotiations with families and significant others. As needs increase the physical and logistical limits of informal care by individuals are reached, often leading to a need to ‘choose’ formal care. Rather than impacting solely on the care recipient, formal care is shown as being an experience that is shared with informal carers. Indeed, the participants depict how informal care continues alongside formal care and how the boundaries between them become blurred. I argue that a binary division between actively making choices and being a passive recipient are not appropriate to understandings of care. By disentangling the notions of care and choice this thesis explores the extent to which these concepts are relevant to the experience of older people in specific care situations.

Kérdőjelek a közgazdaságtanban és oktatásában = Challenges in economic research and education

Ez az esszé a teljesség igénye nélkül kísérli meg áttekinteni azt, hogy mire vezetett a közgazdaságtan világméretekben megindult és a 2008-2009. évi válság lezáratlansága miatt vélhetően évtizedes szinten zajló önvizsgálata. A tudományszak egészét egyszerre jellemzi egyfajta tartalmi kiüresedés és a társtudományokkal való erőteljesebb kapcsolatkeresés, a módszertanok és az iskolák egymás mellett élése - ami egyáltalán nem békés -, valamint a gyakorlat által felvetett kérdések elméleti általánosításának igénye. A magyar közgazdaságtan hagyományos követő szerepe megmaradt, viszont a képzésben szerzett negyedszázados tapasztalatok és az új globális kihívások lényegi átalakításokat indokolnának a mai, túlságosan egységesített képzésben. _____ This essay joins the soul-searching that has developed globally among economists since the financial crisis of 2008-2009, whose still open-ended outcomes make it likely that such self-critical reassessments will continue in the years to come. Economics is marked by the parallel existence of substantive hollowing and in-creased reliance on interfaces with neighbouring disciplines. So the plurality and none-too-peaceful coexistence of schools and methodologies is likely to persist. Similarly abundant are the attempts to theorize and generalize new phenomena in policy and business practices. Hungarian economics continues to be a follower - a trend-taker rather than trend-setter - as it was in the inter-war period. Experience has been accumulating for over 25 years in introducing Western-style higher education in economics. The increase of student numbers and steep decrease in public funding thereof call for major restructuring in curricula, institutions and teaching methods and styles alike.

Feminine Concepts of Leadership and Power: A New Framework for Development Ethics and Education Development

The last twenty years have been a period of growth in education development, development ethics, and female leadership studies. Literature indicates meaningful connections between these disciplines and points towards reassessment of obstacles to systemic change. A new term enpowerment is coined to define a proposed framework for ethical development practice.

Under the ABC Umbrella: Orphanages, Rights, and Education in Mexico

The National System for the Integral Development of the Family (DIF) in Mexico assists children in orphanages. This paper provides an overview of its current practices, and advocates a holistic educational/social model for “alternative orphanages,” integrating Maslow’s Hierarchy of Needs and the rights-based approach. The model complements DIF’s social efforts.

The Role of Forgiveness in Adult Learning and Education

Adverse experiences can initiate angry and negative emotions and if not addressed and resolved have the ability to impede learning. Forgiveness counseling gives learners and educators a way to extinguish the power of these hindering emotions and thereby enhance learning.

Sexiles in the Classroom: Understanding Intersectionalities of Sexuality, Immigration, and Education

This paper presents an overview of literature on adult educators who are both queer and immigrant. Although very little scholarly writing exists, several scholars describe the experiences of queer immigrants as being anchored to systemic heteronormativity. Additionally, the experiences of immigrant adult educators suggest difficult encounters with racism and sexism.

Inadequacy of Micronutrients, Fat, and Fiber Consumption in the Diets of Haitian-, African- and Cuban-Americans with and without Type 2 Diabetes

Micronutrient insufficiency, low dietary fiber, and high saturated fat intake have been associated with chronic diseases. Micronutrient insufficiencies may exacerbate poor health outcomes for persons with type 2 diabetes and minority status. We examined dietary intakes using the Recommended Dietary Allowances (RDAs) of micronutrients, and Adequate Intakes (AIs) of fiber, and Dietary Guidelines for Americans (DGA) for saturated fat in Haitian-, African-, and Cuban- Americans (n = 868), approximately half of each group with type 2 diabetes. Insufficient intakes of vitamins D and E and calcium were found in over 40 % of the participants. Over 50 % of African- and Cuban- Americans consumed over 10 % of calories from saturated fat. Haitian-Americans were more likely to have insufficiencies in iron, B-vitamins, and vitamins D and E, and less likely to have inadequate intake of saturated fat as compared to Cuban-Americans. Vitamin D insufficiency was more likely for Haitian-Americans as compared to African- Americans. Diabetes status alone did not predict micronutrient insufficiencies; however, Haitian-Americans with no diabetes were more likely to be insufficient in calcium. Adjusting for age, gender, energy, smoking, physical activity, access to health care, and education negated the majority of micronutrient insufficiency differences by ethnicity. These findings suggest that policies are needed to ensure that low-cost, quality produce can be accessed regardless of neighborhood and socioeconomic status.

Association of increasing age with receipt of specialist care and long-term mortality in patients with non-ST elevation myocardial infarction

© The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Pro day care and welfare demonstrator confronts a KKK member in front of convention center

General note: Title and date provided by Bettye Lane.

Class in infant care and breastfeeding

Inscriptions: Verso: [stamped] Photograph by Freda Leinwand. [463 West Street, Studio 229G, New York, NY 10014].

Class in infant care and breastfeeding

General note: Title provided by Freda Leinwand.

Class in infant care and breastfeeding

Inscriptions: Verso: [stamped] Photograph by Freda Leinwand. [463 West Street, Studio 229G, New York, NY 10014].