Systematic review of interventions to improve the psychological well-being of general practitioners

BACKGROUND: The health of doctors who work in primary care is threatened by workforce and workload issues. There is a need to find and appraise ways in which to protect their mental health, including how to achieve the broader, positive outcome of well-being. Our primary outcome was to evaluate systematically the research evidence regarding the effectiveness of interventions designed to improve General Practitioner (GP) well-being across two continua; psychopathology (mental ill-health focus) and 'languishing to flourishing' (positive mental health focus). In addition we explored the extent to which developments in well-being research may be integrated within existing approaches to design an intervention that will promote mental health and prevent mental illness among these doctors.

METHODS: Medline, Embase, Cinahl, PsychINFO, Cochrane Register of Trials and Web of Science were searched from inception to January 2015 for studies where General Practitioners and synonyms were the primary participants. Eligible interventions included mental ill-health prevention strategies (e.g. promotion of early help-seeking) and mental health promotion programmes (e.g. targeting the development of protective factors at individual and organizational levels). A control group was the minimum design requirement for study inclusion and primary outcomes had to be assessed by validated measures of well-being or mental ill-health. Titles and abstracts were assessed independently by two reviewers with 99 % agreement and full papers were appraised critically using validated tools.

RESULTS: Only four studies (with a total of 997 GPs) from 5392 titles met inclusion criteria. The studies reported statistically significant improvement in self-reported mental ill-health. Two interventions used cognitive-behavioural techniques, one was mindfulness-based and one fed-back GHQ scores and self-help information.

CONCLUSION: There is an urgent need for high quality, controlled studies in GP well-being. Research on improving GP well-being is limited by focusing mainly on stressors and not giving systematic attention to the development of positive mental health.

Psychological distress in mothers of children admitted to a nutritional rehabilitation unit in Malawi - a comparison with other paediatric wards

In a previous study we found a very high prevalence of psychological distress in mothers of children admitted to a nutritional rehabilitation unit (NRU) in Malawi, Africa. The objective of this study was to compare the prevalence and severity of maternal distress within the NRU with that in other paediatric wards. Given the known association between poor maternal psychological well-being and child undernutrition in low- and middle-income countries, we hypothesised that distress would be higher among NRU mothers. Mothers of consecutive paediatric inpatients in a NRU, a high-dependency (and research) unit and an oncology ward were assessed for psychological distress using the Self-Reporting Questionnaire (SRQ). Two hundred sixty-eight mothers were interviewed (90.3% of eligible). The prevalence of SRQ score ≥8 was 35/150 {23.3% [95% confidence interval (CI) 16.8- 30.9%]} on the NRU, 13/84 [15.5% (95% CI 8.5-25.0%)] on the high-dependency unit and 7/34 [20.6% (95% CI 8.7-37.9%)] on the oncology ward (χ(2)  = 2.04, P = 0.36). In linear regression analysis, the correlates of higher SRQ score were child diarrhoea on admission, child diagnosed with tuberculosis, and maternal experience of abuse by partner; child height-for-age z-score fell only just outside significance (P = 0.05). In summary, we found no evidence of greater maternal distress among the mothers of severely malnourished children within the NRU compared with mothers of paediatric inpatients with other severe illnesses. However, in support of previous research findings, we found some evidence that poor maternal psychological well-being is associated with child stunting and diarrhoea.

Assessment of the impact speed and angle conditions for the EN1317 barrier tests

Roadside safety barriers designs are tested with passenger cars in Europe using standard EN1317 in which the impact angle for normal, high and very high containment level tests is 20°. In comparison to EN1317, the US standard MASH has higher impact angles for cars and pickups (25°) and different vehicle masses. Studies in Europe (RISER) and the US have shown values for the 90th percentile impact angle of 30°–34°. Thus, the limited evidence available suggests that the 20° angle applied in EN 1317 may be too low.
The first goal of this paper is to use the US NCHRP database (Project NCHRP 17–22) to assess the distribution of impact angle and collision speed in recent ROR accidents. Second, based on the findings of the statistical analysis and on analysis of impact angles and speeds in the literature, an LS-DYNA finite element analysis was carried out to evaluate the normal containment level of concrete barriers in non-standard collisions. The FE model was validated against a crash test of a portable concrete barrier carried out at the UK Transport Research Laboratory (TRL).
The accident data analysis for run-off road accidents indicates that a substantial proportion of accidents have an impact angle in excess of 20°. The baseline LS-DYNA model showed good comparison with experimental acceleration severity index (ASI) data and the parametric analysis indicates a very significant influence of impact angle on ASI. Accordingly, a review of European run-off road accidents and the configuration of EN 1317 should be performed.

Statistical Tests for Joint Analysis of Performance Measures

Recently there has been an increasing interest in the development of new methods using Pareto optimality to deal with multi-objective criteria (for example, accuracy and architectural complexity). Once one has learned a model based on their devised method, the problem is then how to compare it with the state of art. In machine learning, algorithms are typically evaluated by comparing their performance on different data sets by means of statistical tests. Unfortunately, the standard tests used for this purpose are not able to jointly consider performance measures. The aim of this paper is to resolve this issue by developing statistical procedures that are able to account for multiple competing measures at the same time. In particular, we develop two tests: a frequentist procedure based on the generalized likelihood-ratio test and a Bayesian procedure based on a multinomial-Dirichlet conjugate model. We further extend them by discovering conditional independences among measures to reduce the number of parameter of such models, as usually the number of studied cases is very reduced in such comparisons. Real data from a comparison among general purpose classifiers is used to show a practical application of our tests.

Psychological determinants of consumer acceptance of personalised nutrition in 9 European countries

OBJECTIVE: To develop a model of the psychological factors which predict people's intention to adopt personalised nutrition. Potential determinants of adoption included perceived risk and benefit, perceived self-efficacy, internal locus of control and health commitment.

METHODS: A questionnaire, developed from exploratory study data and the existing theoretical literature, and including validated psychological scales was administered to N=9381 participants from 9 European countries (Germany, Greece, Ireland, Poland, Portugal, Spain, the Netherlands, the UK, and Norway).

RESULTS: Structural equation modelling indicated that the greater participants' perceived benefits to be associated with personalised nutrition, the more positive their attitudes were towards personalised nutrition, and the greater their intention to adopt it. Higher levels of nutrition self-efficacy were related to more positive attitudes towards, and a greater expressed intention to adopt, personalised nutrition. Other constructs positively impacting attitudes towards personalised nutrition included more positive perceptions of the efficacy of regulatory control to protect consumers (e.g. in relation to personal data protection), higher self-reported internal health locus of control, and health commitment. Although higher perceived risk had a negative relationship with attitude and an inverse relationship with perceived benefit, its effects on attitude and intention to adopt personalised nutrition was less influential than perceived benefit. The model was stable across the different European countries, suggesting that psychological factors determining adoption of personalised nutrition have generic applicability across different European countries.

CONCLUSION: The results suggest that transparent provision of information about potential benefits, and protection of consumers' personal data is important for adoption, delivery of public health benefits, and commercialisation of personalised nutrition.

Construção de instrumentos de avaliação da dislexia

Com este trabalho, pretendemos descrever a construção da Bateria de Avaliação da Dislexia de Desenvolvimento (BADD), caracterizá-la metricamente, apresentar e discutir os resultados. Este instrumento de avaliação da dislexia foi aplicado a 555 crianças portuguesas, com idades compreendidas entre os 7 e os 12 anos de idade. Analisamos os processos cognitivos implicados na aprendizagem da leitura e escrita e aqueles que se encontram afectados em crianças com dislexia de desenvolvimento, nomeadamente a consciência fonológica, memória fonológica de trabalho, leitura e velocidade, escrita sob ditado, cálculo matemático, compreensão de frases, memória de curto e longo prazo e sequências. Foram assim comparadas as pontuações totais de acertos por teste entre crianças normoléxicas e crianças disléxicas, no sentido de verificar em que testes estes se diferenciam e, neste sentido, constituir um conjunto de testes que permitam uma avaliação da dislexia de desenvolvimento. Através da análise dos resultados ao nível da consistência interna do instrumento, verificamos que esta bateria de testes apresenta uma consistência elevada, aumentando após a exclusão do item Teste de Velocidade de Leitura, tempo, que será considerado como item isolado e utilizado à parte da bateria. Outro dos objectivos deste estudo foi o de reforçar a hipótese originalmente colocada de que a performance dos disléxicos nestes testes seria claramente inferior à do grupo controlo, permitindo desta forma diferenciar os dois grupos. Neste sentido, podemos concluir que a validação de uma bateria nestes moldes vem reforçar a importância de testes psicométricos como um dos elementos de uma avaliação psicológica, tornando-se fundamental para uma avaliação atempada e coerente com o quadro teórico da dislexia de desenvolvimento.

Ecotoxicological tests using Chironomus riparius

Os sistemas aquáticos naturais podem estar sujeitos frequentemente a entrada de tóxicos, quer seja através da lixiviação dos campos agrícolas ou da descarga por parte de unidades industriais. Avaliar o impacto potencial destes contaminantes nos sistemas aquáticos é muito importante, porque pode promover consequências sérias no balanço ecológico dos ecossistemas. Os efeitos de níveis sub-letais destes tóxicos nas populações aquáticas são detectados, em muitos casos, somente após diversas gerações, dependendo da espécie e do contaminante. O comportamento animal é considerado como sendo a primeira linha de defesa perante estímulos ambientais, e pode ser uma representação de alterações fisiológicas no organismo, sendo portanto um indicador excelente de alterações ambientais. O desenvolvimento dos sistemas de aviso prévio que integram parâmetros comportamentais pode ajudar a prever mais rapidamente possíveis alterações ao nível das populações naturais, do que a utilização de testes ecotoxicológicos padrão com a mesma finalidade. O conhecimento acerca de possíveis implicações devido a alterações comportamentais, em organismos bentónicos e em populações do campo sujeitas a tóxicos, é ainda escasso. Sabendo isto, neste estudo pretendeu-se investigar como o comportamento de Chironomus riparius – usando um biomonitor em tempo real – e outros parâmetros tais como crescimento, emergência de adultos, bioacumulação e biomarcadores, são afectados pela exposição a imidacloprid e ao mercúrio, que foram seleccionados como contaminantes. Os resultados demonstraram que a exposição às concentrações sub-letais de imidacloprid afecta o crescimento e o comportamento dos quironomídeos e que estes organismos podem recuperar de uma exposição curta ao insecticida. O comportamento que corresponde à ventilação de C. riparius revelou-se como um parâmetro mais sensível do que a locomoção e do que as respostas bioquímicas, quando as larvas foram sujeitas ao imidacloprid. Larvas de C. riparius expostas a concentrações sub-letais de mercúrio apresentaram uma tendência de diminuição de actividade comportamental, em testes com concentrações crescentes do tóxico; o crescimento das larvas foi também prejudicado, e as taxas de emergência de adultos e o tempo de desenvolvimento apresentaram retardamento. Estes organismos podem bioacumular rapidamente o mercúrio em condições de não alimentação e apresentam uma lenta depuração deste metal. Estes efeitos podem, em último caso, conduzir a prováveis repercussões ao nível da população e das comunidades. As reduções em actividades comportamentais, mesmo em concentrações baixas, podem diminuir a quantidade de tempo gasta na procura de alimento, produzindo efeitos aos níveis morfo-fisiológicos, e assim afectar severamente o desempenho dos quironomídeos no ambiente. O uso destes factores comportamentais como um parâmetro ecotoxicológico sub-letal relevante ao nível da toxicologia aumentará a versatilidade dos testes, permitindo uma resposta comportamental mensurável e quantitativa ao nível do organismo, utilizando uma avaliação não destrutiva, e assim certificando que esta aproximação pode ser usada em testes ecotoxicológicos futuros.

Habilidades sociais, bem-estar psicológico e rendimento escolar

O propósito do presente estudo foi o de examinar o impacto da implementação de um programa de desenvolvimento de habilidades sociais no bem-estar psicológico (BEP) e no rendimento escolar numa amostra de estudantes adolescentes portugueses. Para aferir o BEP, foi utilizada a versão portuguesa de 30 itens para adolescentes das escalas de Ryff; o rendimento escolar foi aferido com recurso às avaliações finais de cada período letivo. O programa utilizado baseou-se no desenvolvimento das habilidades sociais de comunicação, assertividade e resolução de problemas, durante o ano letivo numa frequência semanal de 45 minutos nas aulas de Formação Cívica, em estudantes do 7º e 8º anos de escolaridade. Os dados longitudinais foram analisados através da estatística não paramétrica, recorrendo aos testes Wilcoxon-Mann-Whitney correlação de Spearman do programa SPSS®, versão 20.0. Os resultados mostram impacto do programa de desenvolvimento de habilidades sociais nas dimensões do BEP – autoaceitação, relações positivas com os outros, domínio do meio, crescimento pessoal, objetivos na vida e no BEP global em um ou mais momentos do pós teste. Os resultados demonstram igualmente correlações positivas entre as dimensões do BEP – autonomia, autoaceitação, domínio do meio, objetivos na vida e do BEP global e o rendimento escolar, em três ou mais momentos observados.

Seismic retrofitting of RC buildings using CFRP and post-tensioned metal straps: shake table tests

This article examines the effectiveness of two innovative retrofitting solutions at enhancing the seismic behaviour of a substandard reinforced concrete building tested on a shake table as part of the Pan-European funded project BANDIT. To simulate typical substandard construction, the reinforcement of columns and beam-column joints of the full-scale structure had inadequate detailing. An initial series of shake table tests were carried out to assess the seismic behaviour of the bare building and the effectiveness of a first retrofitting intervention using Post-Tensioned Metal Straps. After these tests, columns and joints were repaired and subsequently retrofitted using a retrofitting solution consisting of Carbon Fibre Reinforced Polymers and Post-Tensioned Metal Straps applied on opposite frames of the building. The building was then subjected to unidirectional and three-dimensional incremental seismic excitations to assess the effectiveness of the two retrofitting solutions at improving the global and local building performance. The article provides details of the above shake table testing programme and retrofitting solutions, and discusses the test results in terms of the observed damage, global damage indexes, performance levels and local strains. It is shown that whilst the original bare building was significantly damaged at a peak ground acceleration (PGA) of 0.15g, the retrofitted building resisted severe threedimensional shake table tests up to PGA=0.60g without failure. Moreover, the retrofitting intervention enhanced the interstorey drift ratio capacity of the 1st and 2nd floors by 160% and 110%, respectively. Therefore, the proposed dual retrofitting system is proven to be very effective for improving the seismic performance of substandard buildings.

Full-Scale Shaking Table Tests on a Substandard RC Building Repaired and Strengthened with Post-Tensioned Metal Straps

The effectiveness of a novel Post-Tensioned Metal Strapping (PTMS) technique at enhancing the seismic behaviour of a substandard RC building was investigated through full-scale shake-table tests during the EU-funded project BANDIT. The building had inadequate reinforcement detailing in columns and joints to replicate old construction practices. After the bare building was initially damaged significantly, it was repaired and strengthened with PTMS to perform additional seismic tests. The PTMS technique improved considerably the seismic performance of the tested building. Whilst the bare building experienced critical damage at an earthquake of PGA=0.15g, the PTMS-strengthened building sustained a PGA=0.35g earthquake without compromising stability.

A Psychological Exploration of Long-Term LSD Users

All research involving the psychoactive compound lysergic acid diethylamide (LSD) was terminated globally following its prohibition more than 50 years ago, though illicit use remained fairly stable. A considerable resurgence of research interest in LSD has received considerable attention in various publications and professional fora. One of the main applications considered is LSD-assisted psychotherapy to address a number of difficulties like end-of-life anxiety, addiction/alcoholism, post-traumatic stress, and depression. However, due to the highly contradictory nature of early research findings and division in the literature, one is left uncertain as to whether psychology as a profession is currently equipped to critically evaluate these advances, let alone embrace them. The purpose of the present study was to contribute to current psychological knowledge on long-term LSD use. A group of long-term LSD users who claimed beneficial use were the focus here. A mixed methods design was employed. 110 users completed an online survey assessing for demographics, patterns of use, and specific personality traits through three psychometric measures, Big Five Inventory (BFI), General Self Efficacy scale (GSE) and Satisfaction With Life Scale (SWLS). Eight individual interviews were also conducted and analysed by Thematic Analysis (TA). Gaining different perspectives on reality and increasing self- awareness appeared to be essential elements of the belief system that these non-problematic long-term LSD users adopted in order to make sense of their LSD use. Qualitative findings also suggested the existence of a common set of life values, rules and the adoption of a hierarchical system between LSD users. Novices appeared to be tutored and guided by elders whose presence and input was valued and who were listened to and respected. A role for ‘wiser/elder’ users as those imparting valuable knowledge to novices was therefore also suggested. The underlying aim may possibly be an attempt to minimise risks and maximise potential benefits of LSD use. A prospective role for LSD as a deterrent of substance misuse, a ‘gateway drug to no drugs’ was also hinted and remains in need of iv further investigation. Claims regarding beneficial LSD use and ‘change’ through LSD use were confirmed by the participant sample. No noteworthy differences between psychometric scores of the LSD-using group and those of the general population (as suggested by normative data comparisons) were found, possibly due to methodological limitations, especially considering the highly subjective nature of the LSD experience and its effects. The determining role of extra-pharmacological variables or ‘set and setting’ in the outcome of LSD use suggested in earlier literature was re-validated. Knowledge on their specific components was enriched, and a potentially significant value for adopting a flexible, adaptable and solution-focused mind-set in order to better manage the effects of LSD was highlighted. Due to the highly selected nature of the participant sample, present findings should serve as suggestions for further research in order to clarify the aforementioned issues and to make explicit the mechanisms by which they operate. The complex nature of LSD, its use and its effects have been re-confirmed here. It is imperative that the current knowledge base on the substance is enriched before LSD is introduced in a clinical psychology professional context.