Obsessive–compulsive disorder in young people

Obsessive–compulsive disorder (OCD) is one of the most debilitating psychiatric conditions in young people. In DSM-5 it is no longer characterised as an anxiety disorder, but instead is part of a group of ‘obsessive–compulsive and related disorders’. In the past 10 years, cognitive–behavioural therapy (CBT) has become well established as the first-choice treatment. This article explains some of the elements of CBT and describes new directions in research which might improve interventions.

On the evolutionary origins of obesity: a new hypothesis

Obesity is an escalating threat of pandemic proportions, currently affecting billions of people worldwide and exerting a devastating socioeconomic influence in industrialized countries. Despite intensive efforts to curtail obesity, results have proved disappointing. Although it is well recognized that obesity is a result of gene-environment interactions and that predisposition to obesity lies predominantly in our evolutionary past, there is much debate as to the precise nature of how our evolutionary past contributed to obesity. The “thrifty genotype” hypothesis suggests that obesity in industrialized countries is a throwback to our ancestors having undergone positive selection for genes that favored energy storage as a consequence of the cyclical episodes of famine and surplus after the advent of farming 10 000 years ago. Conversely, the “drifty genotype” hypothesis contends that the prevalence of thrifty genes is not a result of positive selection for energy-storage genes but attributable to genetic drift resulting from the removal of predative selection pressures. Both theories, however, assume that selection pressures the ancestors of modern humans living in western societies faced were the same. Moreover, neither theory adequately explains the impact of globalization and changing population demographics on the genetic basis for obesity in developed countries, despite clear evidence for ethnic variation in obesity susceptibility and related metabolic disorders. In this article, we propose that the modern obesity pandemic in industrialized countries is a result of the differential exposure of the ancestors of modern humans to environmental factors that began when modern humans left Africa around 70 000 years ago and migrated through the globe, reaching the Americas around 20 000 years ago. This article serves to elucidate how an understanding of ethnic differences in genetic susceptibility to obesity and the metabolic syndrome, in the context of historic human population redistribution, could be used in the treatment of obesity in industrialized countries

Interactive sensory objects for and by people with learning disabilities

This project engages people with learning disabilities to participate as co-researchers and explore museum interpretation through multisensory workshops using microcontrollers and sensors to enable alternative interactive visitor experiences in museums and heritage sites. This article describes how the project brings together artists, engineers, and experts in multimedia advocacy, as well as people with learning disabilities in the co-design of interactive multisensory objects that replicate or respond to objects of cultural significance in our national collections. Through a series of staged multi-sensory art and electronics workshops, people with learning disabilities explore how the different senses could be utilised to augment existing artefacts or create entirely new ones. The co-researchers employ multimedia advocacy tools to reflect on and to communicate their experiences and findings.

Interactive sensory objects for and by people with learning disabilities

This project engages people with learning disabilities to participate as co-researchers and explore museum interpretation through multisensory workshops using microcontrollers and sensors to enable alternative interactive visitor experiences in museums and heritage sites. This article describes how the project brings together artists, engineers, and experts in multimedia advocacy, as well as people with learning disabilities in the co-design of interactive multisensory objects that replicate or respond to objects of cultural significance in our national collections. Through a series of staged multi-sensory art and electronics workshops, people with learning disabilities explore how the different senses could be utilised to augment existing artefacts or create entirely new ones. The co-researchers employ multimedia advocacy tools to reflect on and to communicate their experiences and findings.

Operations research/management science tools for integrating people with disabilities into employment. A study on Valencia`s Sheltered Work Centres for Disabled

People with disabilities have a right to a full life in every sense and one of those fundamental rights is the possibility to work. In this paper, the importance of social employment integration of disabled people is highlighted as one of the stakeholders to be satisfied by companies in the new framework that corporate social responsibility is constructing. The objective of the paper is to revise the benefits of some well-known operations research/management science tools that, if applied correctly, have a double positive impact on work accessibility and improved productivity. The responses collected from managers of Valencia`s ShelteredWork Centres for Disabled by means of a structured questionnaire are used to analyse the level of implementation of these tools and their impact depending on the type of centre, the kind of disability and other structural variables.

Discovery of New Inhibitors of Schistosoma mansoni PNP by Pharmacophore-Based Virtual Screening

Schistosomiasis is considered the second most important tropical parasitic disease, with severe socioeconomic consequences for millions of people worldwide. Schistosoma monsoni, one of the causative agents of human schistosomiasis, is unable to synthesize purine nucleotides de novo, which makes the enzymes of the purine salvage pathway important targets for antischistosomal drug development. In the present work, we describe the development of a pharmacophore model for ligands of S. mansoni purine nucleoside phosphorylase (SmPNP) as well as a pharmacophore-based virtual screening approach, which resulted in the identification of three thioxothiazolidinones (1-3) with substantial in vitro inhibitory activity against SmPNP. Synthesis, biochemical evaluation, and structure activity relationship investigations led to the successful development of a small set of thioxothiazolidinone derivatives harboring a novel chemical scaffold as new competitive inhibitors of SmPNP at the low-micromolar range. Seven compounds were identified with IC(50) values below 100 mu M. The most potent inhibitors 7, 10, and 17 with 1050 of 2, 18, and 38 mu M, respectively, could represent new potential lead compounds for further development of the therapy of schistosomiasis.

New Meanings to Old Rituals : The Emergence of Mourning Rituals in Shiʿite Islam

This paper will discuss the emergence of Shiʿite mourning rituals around the grave of Husayn b. ʿAli. After the killing of Husayn at Karbala’ in 61/680, a number of men in Kufa feel deep regret for their neglect to come to the help of the grand­son of the Prophet. They gather and discuss how they can best make penitence for this crime. Eventually, they decide to take to arms and go against the Umayyad army – to kill those that killed Husayn, or be killed them­selves in the attempt to find revenge for him. Thus, they are called the Penitents (Ar. Tawwābūn). On their way to the battlefield they stop at Husayn’s tomb at Karbala’, dedicat­ing themselves to remorseful prayer, crying and wailing over the fate of Husayn and their own sin. When the Penitents perform certain ritual acts, such as weeping and wailing over the death of Husayn, visiting his grave, asking for God’s mercy upon him on the Day of Judgment, demand blood revenge for him etc., they enter into already existing rituals in the pre-Islamic Arab and early Muslim context. That is, they enter into rituals that were traditionally performed at the death of a person. What is new is that the rituals that the Penitents perform have partially received a new content. As described, the rituals are performed out of loyalty towards Husayn and the family of the Prophet. The lack of loyalty in connection with the death of Husayn is conceived of as a sin that has to be atoned. Blood revenge thus be­comes not only a pure action of revenge to restore honor, but equally an expression for true religious conversion and penitence. Humphrey and Laidlaw argue that ritual actions in themselves are not bearers of meaning, but that they are filled with mean­ing by the performer. Accord­ing to them, ritual actions are apprehensible, i.e. they can be, and should be filled with meaning, and the people who perform them try to do so within the context where the ritual is performed. The story of the Penitents is a clear example of mourning rituals as actions that survive from earlier times, but that are now filled with new meaning when they are performed in a new and developing move­ment with a different ideology. In later Shiʿism, these rituals are elaborated and become a main tenet of this form of Islam.

Tha contribution of home-based technology to older people's quality of life in extra care housing

Background: British government policy for older people focuses on a vision of active ageing and independent living. In the face of diminishing personal capacities, the use of appropriate home-based technology (HBT) devices could potentially meet a wide range of needs and consequently improve many aspects of older people's quality of life such as physical health, psychosocial well-being, social relationships, and their physical or living environment. This study aimed to examine the use of HBT devices and the correlation between use of such devices and quality of life among older people living in extra-care housing (ECH).  Methods: A structured questionnaire was administered for this study. Using purposive sampling 160 older people living in extra-care housing schemes were selected from 23 schemes in England. A face-to-face interview was conducted in each participant's living unit. In order to measure quality of life, the SEIQoL-Adapted and CASP-19 were used.  Results: Although most basic appliances and emergency call systems were used in the living units, communally provided facilities such as personal computers, washing machines, and assisted bathing equipment in the schemes were not well utilised. Multiple regression analysis adjusted for confounders including age, sex, marital status, living arrangement and mobility use indicated a coefficient of 1.17 with 95% CI (0.05, 2.29) and p = 0.04 [SEIQoL-Adapted] and 2.83 with 95% CI (1.17, 4.50) and p = 0.001 [CASP-19].  Conclusions: The findings of the present study will be value to those who are developing new form of specialised housing for older people with functional limitations and, in particular, guiding investments in technological aids. The results of the present study also indicate that the home is an essential site for developing residential technologies.

Improving continence services for older people from the service-providers’ perspective : a qualitative interview study

Objective: To examine in depth the views and experiences of continence service leads in England on key service and continence management characteristics in order to identify and to improve our understanding of barriers to a good-quality service and potential facilitators to develop and to improve services for older people with urinary incontinence (UI). Design: Qualitative semistructured interviews using a purposive sample recruited across 16 continence services. Setting: 3 acute and 13 primary care National Health Service Trusts in England. Participants: 16 continence service leads in England actively treating and managing older people with UI. Results: In terms of barriers to a good-quality service, participants highlighted a failure on the part of commissioners, managers and other health professionals in recognising the problem of UI and in acknowledging the importance of continence for older people and prevalent negative attitudes towards continence and older people. Patient assessment and continence promotion regardless of age, rather than pad provision, were identified as important steps for a good-quality service for older people with UI. More rapid and appropriate patient referral pathways, investment in service capacity, for example, more trained staff and strengthened interservice collaborations and a higher profile within medical and nurse training were specified as being important facilitators for delivering an equitable and highquality continence service. There is a need, however, to consider the accounts given by our participants as perhaps serving the interests of their professional group within the context of interprofessional work. Conclusions: Our data point to important barriers and facilitators of a good-quality service for older people with UI, from the perspective of continence service leads. Further research should address the views of other stakeholders, and explore options for the empirical evaluation of the effectiveness of identified service facilitators.

Shared-decision making in designing new healthcare environments : ready to take off for improved quality

Background Successful implementation of new methods and models of healthcare to achieve better patient outcomes and safe, person-centered care is dependent on the physical environment of the healthcare architecture in which the healthcare is provided. Thus, decisions concerning healthcare architecture are critical because it affects people and work processes for many years and requires a long-term financial commitment from society. In this paper, we describe and suggest several strategies (critical factors) to promote shared-decision making when planning and designing new healthcare environments. Discussion This paper discusses challenges and hindrances observed in the literature and from the authors extensive experiences in the field of planning and designing healthcare environments. An overview is presented of the challenges and new approaches for a process that involves the mutual exchange of knowledge among various stakeholders. Additionally, design approaches that balance the influence of specific and local requirements with general knowledge and evidence that should be encouraged are discussed. Summary We suggest a shared-decision making and collaborative planning and design process between representatives from healthcare, construction sector and architecture based on evidence and end-users’ perspectives. If carefully and systematically applied, this approach will support and develop a framework for creating high quality healthcare environments.

Working out intimacy: young people and friendship in an age of reflexivity

Drawing upon a longitudinal, interview-based study of Australian secondary school students, this article explores young people's friendship experiences and attitudes to intimacy and the interpersonal. The discussion develops in relation to the work of Anthony Giddens on detraditionalisation and reflexivity, and Nikolas Rose on modernity and the self. First, I argue that feminism and psychotherapeutic ways of constituting and knowing the self are reconfiguring the cultural meanings of intimacy. Second, I suggest that this reworking of intimacy has differential and uneven effects and has particular consequences for the production of gendered subjectivities. Third, I raise some critical questions about the extent to which either Giddens's or Rose's account can properly capture the gendered and situated experiences of intimacy. I offer examples in which gender is being rearticulated in new yet familiar ways and note some persistent tensions in desires for connection and community versus autonomy and freedom. Carol Gilligan's work on gender differences in orientations to autonomy and connection is briefly revisited. Overall, it is argued that we need to take more account of how class, location and schooling differences influence dispositions to friendship and the interpersonal, and this is elaborated through a discussion of the 'relationship orientations' of two white Australian young men.

The Archaeology of No man's land: Indigenous camps at Corindi Beach, mid-north coast New South Wales

At Corindi Beach on the mid-north coast of New South Wales are five twentieth century campsites located on the fringes of the township, beside the town racecourse, an area called by local Aboriginal people 'No man's land'. These campsites are important symbols of the self-sufficient lifestyle followed by the Corindi Beach Indigenous community in the twentieth century and are a physical reminder of cross-cultural relationships between local people over the last hundred years. In a collaborative research project with Yarrawarra Aboriginal Corporation, these places are being documented through studying oral history, the cultural landscape and the material culture left behind at these places.

The Left in Australia: time for a new renewal?

For the purpose of the article the author takes as a starting point the approach taken by the Italian writer, Norberto Bobbio, who identifies the Left with egalitarianism and distinguishes left leaning positions which support equality, from right wing ones which support inequality. Thus, in its broadest form, the term `Left' refers to ideas and philosophies, people, groups and political and social movements whose normative base is embedded in a commitment to an egalitarian society. However, the term 'equality,' like the term 'Left,' is not always straightforward.

New community governance in small rural towns: the Australian experience

State and federal governments in Australia have developed a range of policy instruments for rural areas in Australia that are infused with a new sense of ‘community’, employing leading concepts like social capital, social enterprise, community development, partnerships and community building. This has encouraged local people and organisations to play a greater role in the provision of their local services and has led to the development of a variety of ‘community’ organisations aimed at stemming social and economic decline. In Victoria, local decision-making, before municipal amalgamations, gave small towns some sense of autonomy and some discretion over their affairs. However, following municipal amalgamations these small towns lost many of the resources—legal, financial, political, informational and organisational—associated with their former municipal status. This left a vacuum in these communities and the outcome was the emergence of local development groups. Some of these groups are new but many of them are organisations that have been reconstituted as groups with a broader community focus. The outcomes have varied from place to place but overall there has been a significant shift in governance processes at community level. This paper looks at the processes of ‘community governance’ and how it applies in a number of case studies in Victoria.