Cefn Coed Hospital

One hundred and forty-seven mothers were screened for major depression at six to eight weeks post-partum. Using predetermined cut-off points, the Edinburgh Postnatal Depression Scale and the Beck scale were compared in their abilities to identify the 15% of subjects who had major depression according to DSM-III criteria. The sensitivity of Edinburgh scale was 95% and its specificity 93%. The performance of the Beck scale was markedly inferior, with a sensitivity of 68% and specificity of 88%.

Sadistic personality disorder (SPD) has been underresearched and often misunderstood in forensic settings. Furthermore, personality disorders in general are the subject of much controversy in terms of their classification (i.e., whether they should be categorical or dimensional). The Sadistic Attitudes and Behaviors Scale (SABS; Davies & Hand, 2003; O'Meara, Davies, & Barnes-Holmes, 2004) is a recently developed scale for measuring sadistic inclinations. Derived from this is the Short Sadistic Impulse Scale (SSIS), which has proved to be a strong unidimensional measure of sadistic inclination. Through cumulative scaling, it was investigated whether the SSIS could measure sadism on a continuum of interest, thus providing a dimensional view of the construct. Further, the SSIS was administered along with a number of other measures related to sadism in order to assess the validity of the scale. Results showed that the SSIS has strong construct and discriminant validity and may be useful as a screening measure for sadistic impulse.

In retired professional association football (soccer) players with a past history of repetitive head impacts, chronic traumatic encephalopathy (CTE) is a potential neurodegenerative cause of dementia and motor impairments. From 1980 to 2010, 14 retired footballers with dementia were followed up regularly until death. Their clinical data, playing career, and concussion history were prospectively collected. Next-of-kin provided consent for six to have post-mortem brain examination. Of the 14 male participants, 13 were professional and 1 was a committed amateur. All were skilled headers of the ball and had played football for an average of 26 years. Concussion rate was limited in six cases to one episode each during their careers. All cases developed progressive cognitive impairment with an average age at onset of 63.6 years and disease duration of 10 years. Neuropathological examination revealed septal abnormalities in all six post-mortem cases, supportive of a history of chronic repetitive head impacts. Four cases had pathologically confirmed CTE; concomitant pathologies included Alzheimer's disease (N = 6), TDP-43 (N = 6), cerebral amyloid angiopathy (N = 5), hippocampal sclerosis (N = 2), corticobasal degeneration (N = 1), dementia with Lewy bodies (N = 1), and vascular pathology (N = 1); and all would have contributed synergistically to the clinical manifestations. The pathological diagnosis of CTE was established in four individuals according to the latest consensus diagnostic criteria. This finding is probably related to their past prolonged exposure to repetitive head impacts from head-to-player collisions and heading the ball thousands of time throughout their careers. Alzheimer's disease and TDP-43 pathologies are common concomitant findings in CTE, both of which are increasingly considered as part of the CTE pathological entity in older individuals. Association football is the most popular sport in the world and the potential link between repetitive head impacts from playing football and CTE as indicated from our findings is of considerable public health interest. Clearly, a definitive link cannot be established in this clinico-pathological series, but our findings support the need for further systematic investigation, including large-scale case-control studies to identify at risk groups of footballers which will justify for the implementation of protective strategies.

BACKGROUND: An evidenced-based approach to psychiatry is playing an increasingly prominent role in treatment decision-making for individual patients and for populations. Many doctors are now critical of the emphasis being placed on "the evidence" and concerned that clinical practice will become more constrained. AIMS: To demonstrate that evidence-based medicine is not new, sources of evidence are limited and psychosocial aspects of medicine are neglected in this process. METHOD: Some of the literature is reviewed. Ideas and arguments are synthesised into a critical commentary. RESULTS: These are considered under four headings: evidence-based medicine is not new; what evidence is acceptable; the doctor as therapist; and the emergence of a new utilitarian orthodoxy. CONCLUSIONS: It is agreed that a degree of professional consensus is necessary. However, too great an emphasis on evidence-based medicine oversimplifies the complex and interpersonal nature of clinical care.

The incidence of post-natal depression is high, and dramatic changes in steroid hormones and prolactin occur in the post-partum period. In an attempt to correlate these events, 147 mothers, six to eight weeks after delivery of a healthy infant, completed standard psychological tests, including the Edinburgh, Montgomery-Asberg, and Raskin scales. They also provided matched samples of plasma for assay of cortisol, oestradiol, progesterone and prolactin, and saliva for assay of cortisol and progesterone. All steroid concentrations were within the appropriate normal ranges. Of the mothers, 14.9% were depressed on all three scales. Significant correlations were seen between depression ratings and salivary progesterone and prolactin. In bottle-feeders, salivary progesterone was positively associated with depression, whereas in breast-feeders it was negatively associated. Plasma prolactin levels were inappropriately low in depressed breast-feeders. These data indicate that differing therapies may be appropriate for depression in breast- and bottle-feeders.

BACKGROUND: It is recommended that young people should engage in 60 min of moderate-to-vigorous activity (MVPA) a day for health benefits, but few teenagers actually meet this recommendation. Policy-makers play a vital role in designing physical activity initiatives, but they generally do this with little or no input from the intervention recipients. This study explores the recommendations made by teenagers to improve activity provision, uptake and sustainability of physical activity engagement for both themselves and their peers. METHODS: Thirteen focus groups were carried out in seven secondary schools in South Wales, United Kingdom. Participants (n = 78) were recruited from a larger mixed-method randomised control trial, which involved the implementation of a voucher scheme to promote physical activity in teenagers (aged 13-14). Thematic analysis was undertaken to identify key issues from the perspective of the teenage participants. RESULTS: Six key recommendations were identified following analysis of the focus groups: i) Lower/remove the cost of activities without sacrificing the quality, ii) Make physical activity opportunities more locally accessible, iii) Improve the standards of existing facilities, iv) Make activities more specific to teenagers v) Give teenagers a choice of activities/increase variety of activity and vi) Provide activities that teenage girls enjoy (e.g., fun, sociable and not competitive sport). Throughout the focus groups, the increased opportunity to participate in unstructured activity was a key recommendation echoed by both boys and girls in all themes. CONCLUSION: There is a disconnect between what is available and what teenagers want to do. Policy-makers and those involved in physical activity delivery (e.g., schools, local council and local activity providers) should include young people in designing interventions and facilities to ensure they are meeting the needs of this age group and providing the right opportunities for teenagers to be active. That is unstructured, local, low cost, fun, sociable opportunities and the right facilities to be active.

This review explores literature relevant to understanding the psychological well-being of people who have an interest in sexual sadomasochism (SM). It focuses on evaluating the traditional psychiatric and psychodynamic perspectives of SM, which conceptualize SM practitioners as being psychologically unwell. The empirical information reviewed is inconsistent with a number of aspects of the traditional theories of SM. The validity of conceptualizing the majority of SM practitioners as being psychologically unwell is questioned and the negative psychological impact that these traditional theories can have on SM practitioners is noted. The implications for professionals' working with SM-practicing clients is considered.

'Dementia care mapping' (DCM) is a method of assessing care standards as received by dementia victims. Through the application of this tool, short-comings in care practice can be highlighted in the hope of achieving improvements. The method was employed by the Elderly Mentally III (EMI) unit of a National Health Service trust in South Wales. Baseline evaluations were undertaken on each of the EMI wards containing dementia patients, and reports delivered to the appropriate members of staff. Mean care scores for the unit as a whole were found to lie in the "good' category, as defined by the method. Staff training in the underlying principles of DCM will be followed by re-evaluations of care standards to evaluate the outcome of the attempts made to engender improvements.

Structured professional judgment guides (SPJs) have gained acceptance for the prediction of future violence. We conducted a prospective study of 44 psychiatric inpatients with a variety of mental health problems to test whether the Short-Term Assessment of Risk and Treatability (START; Webster, Martin, Brink, Nicholls, & Middleton, 2004) was able to predict a range of problem behaviors. We obtained outcome behaviors from the nursing record for a period of up to 6 months after the assessment. For all types of behavior tested (violence to others, self-harm, self-neglect, and being victimized), the clinical judgment of risk based on the START was a good predictor. However, the actuarial scores on the Strength and Risk scales of the START were only useful for the prediction of violence. The results provide a strong evidence base for the use of START to predict a range of problem behaviors, and confirms that the START should be used as an adjunct to clinical decision making and not with a blind adherence to the actuarial scores. The difference in efficacy between START used in an actuarial manner and as a SPJ suggests that schemes using other items may prove more effective in guiding the clinician to assess and managing these risks.

The idea of trying to replace the irregular major fits of epilepsy by convulsions, artificially induced under controlled conditions of time and place, is an eminently reasonable one; but there has so far been no systematic investigation of the therapeutic possibilities of this procedure. The present work, which has been carried out over a period of two years, is intended to clear the ground for such a study; and this report includes an account of the effect of electrical convulsion therapy not only on the frequency of the fits, but also on the psychotic symptoms which were associated with the epilepsy in many of the patients.

MEPS Marine Ecology Progress Series Contact the journal Facebook Twitter RSS Mailing List Subscribe to our mailing list via Mailchimp HomeLatest VolumeAbout the JournalEditorsTheme Sections MEPS 248:279-292 (2003) - doi:10.3354/meps248279 The Burry shellfishery and oystercatchers: using a behaviour-based model to advise on shellfishery management policy Andrew D. West1,*, John D. Goss-Custard2, Selwyn McGrorty1, Richard A. Stillman1, Sarah E. A. le V. dit Durell1, Barry Stewart3, Peter Walker4, David W. Palmer4, Philip J. Coates5 1Centre for Ecology and Hydrology Dorset, Winfrith Technology Centre, Winfrith Newburgh, Dorchester 8ZD, United Kingdom 230 The Strand, Topsham, Exeter EX3 0AY, United Kingdom 336 Pencaecrown Road, Penyrheol, Gorseinon, Swansea SA4 4FU, United Kingdom 4The Centre for Environment, Fisheries and Aquaculture Science, Lowestoft Laboratory, Pakefield Road, Lowestoft NR33 0HT, United Kingdom 5South Wales Sea Fisheries Committee, Queens Buildings, Cambrian Place, Swansea SA1 1TW, United Kingdom *Email: adwt@ceh.ac.uk ABSTRACT: The Burry inlet, South Wales, supports a licensed cockle Cerastoderma edule fishery and occasional mussel Mytilus edulis fishery. It is also an important overwintering ground for oystercatchers Haematopus ostralegus. In recent years mussels have settled over parts of some cockle beds, preventing cockle fishery there and leading to a request by shellfishers to remove this Œmussel crumble¹. Conservation managers, however, were concerned that the mussel crumble might be providing a high-quality food source for the oystercatchers, making its removal detrimental to the birds. A behaviour-based model of oystercatcher feeding on cockles and mussels was parameterised for the inlet and its predictions tested against the distribution of birds across the shellfish beds and the amount of time they spent feeding. The model was then used to explore whether the birds were currently food-limited and what would be the effects on their mortality rate and body condition if the mussel crumble were to be removed, thereby re-exposing underlying cockle beds. The model predicted successfully the proportion of birds feeding on the different types of food and the number of hours birds spent feeding on neap tides. It was predicted that, at current bird population sizes, there would have to be a 50% reduction in shellfish stocks and the areas of shellfish beds from 2000-01 levels to cause noticeable extra emigration or mortality. A given area of mussel bed was predicted to be able to support more birds than the same area of cockle bed, but the greater area of the cockle beds meant that they were more important than mussels in determining the number of birds supported by the inlet. The simulated removal of mussel crumble to expose underlying cockles had no effect on predicted bird mortality and body condition at 2000-01 shellfish stock levels. However, there were circumstances under which the mussel crumble was predicted to increase the inlet¹s capacity to support birds, particularly when the area of existing cockle and mussel beds was substantially reduced. KEY WORDS: Shellfishery management · Behaviour-based model · Oystercatcher · Cockle · Mussel Full text in pdf format PreviousNextExport citation RSS - Facebook - Tweet - linkedIn Cited by Published in MEPS Vol. 248. Online publication date: February 20, 2003 Print ISSN: 0171-8630; Online ISSN: 1616-1599 Copyright © 2003 Inter-Research.

BACKGROUND: The Hirsch index, often used to assess research impact, suffers from questionable validity within the context of General Surgery, and consequently adapted bibliometrics and altmetrics have emerged, including the r-index, m-index, g-index and i10-index. This study aimed to assess the relative value of these novel bibliometrics in a single UK Deanery General Surgical Consultant cohort. METHOD: Five indices (h, r, m, g and i10) and altmetric scores (AS) were calculated for 151 general surgical consultants in a UK Deanery. Indices and AS were calculated from publication data via the Scopus search engine with assessment of construct validity and reliability. RESULTS: The median number of publications, h-index, r-index, m-index, g-index and i10-index were 13 (range 0-389), 5 (range 0-63), 5.2 (range 0-64.8), 0.33 (range 0-1.5), 10 (range 0-125) and 4 (range 0-245), respectively. Correlation coefficients of r-index, m-index, g-index and i10-index with h-index were 0.913 (p < 0.001), 0.716 (p < 0.001), 0.961 (p < 0.001) and 0.939 (p < 0.001), respectively. Significant variance was observed when the cohort was ranked by individual bibliometric measures; the median ranking shifts were: r-index - 2 (- 46 to + 23); m-index - 6.5 (- 53 to + 22); g-index - 0.5 (- 24 to + 13); and i10-index 0 (- 8 to + 11), respectively (p < 0.001). The median altmetric score and AS index were 0 (range 0-225.5) and 1 (range 0-10), respectively; AS index correlated strongly with h-index (correlation coefficient 0.390, p < 0.001). CONCLUSIONS: Adapted bibliometric indices appear to be equally valid measures of evaluating academic productivity, impact and reach.

The Philosophy for Children in Schools Project (P4CISP) is a research project to monitor and evaluate the impact of Philosophy for Children (P4C) on classroom practices. In this paper the impact of P4C on the thinking skills of four children aged 10 is examined. Standardised tests indicated the children had below-average reading ages. The pupils were video recorded while engaged in discussion of questions they formulated themselves in response to a series of texts in preparation for a community of philosophical enquiry. Group discussions were analysed, paying attention to verbal and non-verbal communication. We argue that reading scores do not necessarily indicate inability to engage in literate thinking. When dialogic approaches are used and pupils are given opportunities to work in small groups to formulate their own questions and evaluate their potential for generating enquiry, they demonstrate their ability to use higher-order language skills. Dialogic approaches can challenge the hegemonic impact of standardised testing that dominates modern schooling. A dialogic approach to teaching listens to pupil voice and has the potential to change how adults view children and contribute to an epistemological paradigm shift away from positivism towards dialogism.

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In the interest of road safety, driving license holders who suffer from a medical condition likely to affect fitness to drive must notify the Driver and Vehicle Licensing Agency (DVLA) and not drive. The Secretary of State for the Environment, Transport and the Regions (of the Department for the Environment, Transport and the Regions, DETR) has the responsibility, via his Medical Advisers at the Drivers Medical Unit of the DVLA, to ensure that all licence holders are fit to drive.

The Mental Treatment Act of 1930 has brought within the purview of the mental hospital that large class of psychoneurotic and “early psychotic” patients who formerly drifted despairingly in the wilderness between orthodox medicine and the quack. The purpose of this paper is to show how an attempt is being made in this hospital to deal with this heterogeneous class of patients by means of psychotherapy, carried out by the ordinary medical staff of the hospital, without interference with their routine duties.

Evidence suggests a complex relationship between substance misuse, mental health, and violence in forensic populations, however, the majority of existing research and interventions focus on these factors individually. This paper reports an evaluation of the first module of an integrated poly-substance misuse group delivered within a medium secure mental health hospital, which was designed to address these factors collectively. Qualitative and quantitative approaches were used to assess participant's subjective views of the program and to gather pre and post quantitative measurement of change. The concordance between self report and observer reports was explored. Recommendations for the development of the treatment and for further evaluation and research are discussed.

INTRODUCTION: Ankle fractures in sport are common. Their optimal management is unclear, as is when patients can return to their sports activities. This systematic review provides a contemporary assessment of the literature on return to sports following acute traumatic ankle fractures managed both operatively and non-operatively. SOURCES OF DATA: We systematically searched Pubmed, Google Scholar, the Cochrane Library, EMBASE and CINAHL using the terms 'ankle fractures', 'ankle injuries', 'athletes', 'sports', 'return to sport', 'return to activity', 'operative management', 'non-operative management'. AREAS OF AGREEMENT: Thirteen retrospective studies fulfilled the inclusion criteria. The methodological quality of the studies was generally poor. The proportion of patients returning to sporting activity was high. In some studies, a quicker return to sporting activity was demonstrated in patients managed non-operatively. AREAS OF CONTROVERSY: The time to return to sporting activity and level of performance post-treatment are not universally recorded, and the optimal time to return to sport remains to be confirmed. GROWING POINTS: Conservative management for stable or undisplaced fracture may result in a higher proportion of patients returning to sport more quickly. AREAS TIMELY FOR DEVELOPING RESEARCH: Randomized controlled trials should compare conservative to surgical treatment for appropriately chosen fracture patterns. Future studies should routinely report the timing of return to sport, the level of performance reached, and the time to achieve this.

Background: This study aimed to analyse the degree of relative variation in specialty-specific competencies required for certification of completion of training (CCT) by the UK Joint Committee on Surgical Training. Methods: Regulatory body guidance relating to operative and non-operative surgical skill competencies required for CCT were analysed and compared. Results: Wide interspecialty variation was demonstrated in the required minimum number of logbook cases (median 1201 (range 60-2100)), indexed operations (13 (5-55)), procedure-based assessments (18 (7-60)), publications (2 (0-4)), communications to learned associations (0 (0-6)) and audits (4 (1-6)). Mandatory courses across multiple specialties included: Training the Trainers (10 of 10 specialties), Advanced Trauma Life Support (6 of 10), Good Clinical Practice (9 of 10) and Research Methodologies (8 of 10), although no common accord was evident. Discussion: Certification guidelines for completion of surgical training were inconsistent, with metrics related to minimum operative caseload and academic reach having wide variation.

Aims and Method To identify the questions patients most commonly ask their psychiatrist. For 200 consecutive psychiatric patient consultations, answers to the invitation, “Do you have any questions you wish to ask me?” were recorded along with diagnosis. The most frequently asked questions were noted and compared across patient groups. Results Most patients wanted to know when medication could be reduced or stopped. Some patients asked for more medication. Concerns about side-effects and fitness to drive were also common. A high proportion of patients (21–57%) asked no questions. Clinical Implications Psychiatrists must be prepared to answer questions effectively on the necessity and benefits of long term medication. These may be useful facts to include in a patient information leaflet. Side-effects of medication should also be taken seriously. Many patients lead impoverished social lives, with low levels of interpersonal interaction. This may be a barrier to participation in the clinical interview, and diminish the likelihood of posing questions.