104
387.15
3.72
185

Publication History View all

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Lack of cultural competence in care contributes to poor experiences and outcomes from care for migrants and racial and ethnic minorities. As a result, health and social care organizations currently promote cultural competence of their workforce as a means of addressing persistent poor experiences and outcomes. At present, there are unsystematic and diverse ways of promoting cultural competence, and their impact on clinician skills and patient outcomes is unknown. We developed and implemented an innovative model, cultural consultation service (CCS), to promote cultural competence of clinicians and directly improve on patient experiences and outcomes from care. CCS model is an adaptation of the McGill model, which uses ethnographic methodology and medical anthropological knowledge. The method and approach not only contributes both to a broader conceptual and dynamic understanding of culture, but also to learning of cultural competence skills by healthcare professionals. The CCS model demonstrates that multidisciplinary workforce can acquire cultural competence skills better through the clinical encounter, as this promotes integration of learning into day-to-day practice. Results indicate that clinicians developed a broader and patient-centred understanding of culture, and gained skills in narrative-based assessment method, management of complexity of care, competing assumptions and expectations, and clinical cultural formulation. Cultural competence is defined as a set of skills, attitudes and practices that enable the healthcare professionals to deliver high-quality interventions to patients from diverse cultural backgrounds. Improving on the cultural competence skills of the workforce has been promoted as a way of reducing ethnic and racial inequalities in service outcomes. Currently, diverse models for training in cultural competence exist, mostly with no evidence of effect. We established an innovative narrative-based cultural consultation service in an inner-city area to work with community mental health services to improve on patients' outcomes and clinicians' cultural competence skills. We targeted 94 clinicians in four mental health service teams in the community. After initial training sessions, we used a cultural consultation model to facilitate 'in vivo' learning. During cultural consultation, we used an ethnographic interview method to assess patients in the presence of referring clinicians. Clinicians' self-reported measure of cultural competence using the Tool for Assessing Cultural Competence Training (n = 28, at follow-up) and evaluation forms (n = 16) filled at the end of each cultural consultation showed improvement in cultural competence skills. We conclude that cultural consultation model is an innovative way of training clinicians in cultural competence skills through a dynamic interactive process of learning within real clinical encounters.
    Journal of Psychiatric and Mental Health Nursing 11/2013; DOI:10.1111/jpm.12124
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Well-being is an important health outcome and a potential national indicator of policy success. There is a need for longitudinal epidemiological surveys to understand determinants of well-being. This study examines the role of personal social support and psychosocial work environment as predictors of well-being in an occupational cohort study. Social support and work characteristics were measured by questionnaire in 5182 United Kingdom civil servants from phase 1 of the Whitehall II study and were used to predict subjective well-being assessed using the Affect Balance Scale (range -15 to 15, SD = 4.2) at phase 2. External assessments of job control and demands were provided by personnel managers. Higher levels of well-being were predicted by high levels of confiding/emotional support (difference in mean from the reference group with low levels of confiding/emotional support = 0.63, 95%CI 0.38-0.89, ptrend<0.001), high control at work (0.57, 95%CI 0.31-0.83, ptrend<0.001; reference low control) and low levels of job strain (0.60, 95%CI 0.31-0.88; reference high job strain), after adjusting for a range of confounding factors and affect balance score at baseline. Higher externally assessed work pace was also associated with greater well-being. Our results suggest that the psychosocial work environment and personal relationships have independent effects on subjective well-being. Policies designed to increase national well-being should take account of the quality of working conditions and factors that facilitate positive personal relationships. Policies designed to improve workplaces should focus not only on minimising negative aspects of work but also on increasing the positive aspects of work.
    PLoS ONE 11/2013; 8(11):e81115. DOI:10.1371/journal.pone.0081115
  • BMJ (online) 10/2013; 347:f5752. DOI:10.1136/bmj.f5752
  • [Show abstract] [Hide abstract]
    ABSTRACT: The birthplace of the specialty of psychiatry was in the asylum, which was created to divert patients from workhouses where the most disadvantaged and destitute people with mental illness were to be found. The current welfare reforms are endangering the welfare and livelihood of the most disadvantaged of our patients. These reforms in the authors' opinion are related more to the historical cycle of societal attitude to homeless people than to seeing them as the undeserving poor. This is particularly true since the current economic crisis was not caused by the poor, so it is very unfair that our poorest patients should suffer most as a result of the welfare reforms.
    International Journal of Social Psychiatry 04/2013; 60(1). DOI:10.1177/0020764012463303
  • [Show abstract] [Hide abstract]
    ABSTRACT: Not Available
    The British journal of psychiatry: the journal of mental science 03/2013; 202:237-238. DOI:10.1192/bjp.202.3.237a
  • [Show abstract] [Hide abstract]
    ABSTRACT: Few prospective studies have examined the relationship between social support and psychological distress and depressive symptoms in adolescents. The aims of this study were to test whether social support is protective against psychological distress and depressive symptoms in an ethnically diverse population of adolescents and whether differences in support are reflected by ethnic differences in psychological distress and depressive symptoms. Based on a longitudinal survey of 821 adolescents, this study found low levels of social support from family members was prospectively associated with depressive symptoms (OR = 2.25, 95% CI 1.43-3.54). Compared with White UK pupils, Black pupils were less likely to display psychological distress (OR = 0.21, 95% CI 0.09-0.51). However, social support did not explain the ethnic variations in psychological distress. Family environment may be a more consistent source of support compared with support from peers. The lower risk of psychological distress among Black pupils compared to White pupils requires further investigation.
    Journal of Adolescence 01/2013; 36(2). DOI:10.1016/j.adolescence.2013.01.001
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE: Depression is common in cancer patients and detrimentally affects patients' quality of life. Both depression and stress are associated with raised inflammatory marker levels. This prospective study of cancer patients focuses on childhood trauma, recent life events and inflammatory marker levels as risk factors for high post-surgery depressive symptoms. METHODS: Ninety cancer patients (56 head and neck, 34 colorectal) completed the Hospital Anxiety and Depression Scale, pre-surgery and six, 12 and 24 weeks post-surgery. Recent life events and childhood trauma were assessed at six and 12 weeks respectively. Blood samples were taken pre- and one and six weeks post-surgery to measure C-reactive protein (CRP) and pro-inflammatory cytokine levels. RESULTS: Childhood trauma and recent life events were risk factors for higher depressive symptom levels. In colorectal cancer patients, baseline CRP levels were associated with depressive symptom levels at six (p=0.008) and 12 weeks (p=0.038). Baseline and six week Tumour Necrosis Factor-alpha (TNFα) levels were significantly associated with higher depressive symptoms at later time points after adjusting for cancer-related variables. Childhood trauma was positively associated with TNFα and CRP levels in colorectal cancer patients. The associations between inflammatory markers and depressive symptoms were not significant after adjusting for childhood trauma. LIMITATIONS: Small sample size. CONCLUSIONS: Raised inflammatory mediator levels may be risk factors for depressive symptoms in colorectal cancer patients and thus worth considering as a potential therapeutic target. These pilot data support recent findings demonstrating long-term effects of childhood adversity on adult health.
    Journal of Affective Disorders 07/2012; 143(1-3). DOI:10.1016/j.jad.2012.05.023
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The authors examined whether air pollution at school (nitrogen dioxide) is associated with poorer child cognition and health and whether adjustment for air pollution explains or moderates previously observed associations between aircraft and road traffic noise at school and children's cognition in the 2001-2003 Road Traffic and Aircraft Noise Exposure and Children's Cognition and Health (RANCH) project. This secondary analysis of a subsample of the United Kingdom RANCH sample examined 719 children who were 9-10 years of age from 22 schools around London's Heathrow airport for whom air pollution data were available. Data were analyzed using multilevel modeling. Air pollution exposure levels at school were moderate, were not associated with a range of cognitive and health outcomes, and did not account for or moderate associations between noise exposure and cognition. Aircraft noise exposure at school was significantly associated with poorer recognition memory and conceptual recall memory after adjustment for nitrogen dioxide levels. Aircraft noise exposure was also associated with poorer reading comprehension and information recall memory after adjustment for nitrogen dioxide levels. Road traffic noise was not associated with cognition or health before or after adjustment for air pollution. Moderate levels of air pollution do not appear to confound associations of noise on cognition and health, but further studies of higher air pollution levels are needed.
    American journal of epidemiology 07/2012; 176(4):327-37. DOI:10.1093/aje/kws012
  • [Show abstract] [Hide abstract]
    ABSTRACT: Reducing stigma associated with mental illness is an important aim of medical education, yet evidence indicates that medical students' attitudes toward patients with mental health problems deteriorate as they progress through medical school. Authors examined medical students' attitudes to mental illness, as compared with attitudes toward other medical illness, and the influence of the number of years spent in medical school, as well as of several key socio-demographic, ethnic, and cultural variables. A group of 760 U.K. medical students completed a nationwide on-line survey examining their attitudes toward patients with five conditions (pneumonia, depression, psychotic symptoms, intravenous drug use, long-standing unexplained abdominal complaints), using the Medical Condition Regard Scale (MCRS). Students were also asked whether they had completed the psychiatry rotation or had personal experience of mental disorders themselves or among their friends or family members. They were also asked about their ethnic group (using U.K. national census categories), religious affiliation, and how important religion was in their lives. Independent-samples t-tests and one-way ANOVA were used to compare differences between groups on the MCRS. Students showed the highest regard for patients with pneumonia and lowest regard for patients with long-standing, unexplained abdominal complaints. Although attitudes toward pneumonia were more positive in fifth-year students than in first-year students, attitudes toward unexplained chronic abdominal pain were worse in fifth-year students than in first-year students. Personal experience of mental health treatment, or that among family and friends, were associated with less stigmatizing attitudes. Men showed more stigmatization than women for nearly all conditions; Chinese and South Asian students showed more stigmatizing attitudes toward delusions and hallucinations than their white British counterparts. Medical students in this survey showed the lowest regard for patients with unexplained abdominal pain, and these attitudes were worse in the most experienced medical students. Students' gender, culture and direct or indirect experience of mental illness influenced stigmatizing attitudes.
    Academic Psychiatry 05/2012; 36(3):197-204. DOI:10.1176/appi.ap.10110159
  • Evidence-based nursing 04/2012; 15(4):125. DOI:10.1136/ebnurs-2011-100294
Information provided on this web page is aggregated encyclopedic and bibliographical information relating to the named institution. Information provided is not approved by the institution itself. The institution’s logo (and/or other graphical identification, such as a coat of arms) is used only to identify the institution in a nominal way. Under certain jurisdictions it may be property of the institution.