Background Harmful use of alcohol is the fifth leading risk factor for global burden of disease, disability and death. While the level of alcohol consumption varies around the world, it causes numerous preventable health and social issues in many countries and around 3.3 million deaths per year globally. In the UK alcohol consumption is decreasing; by contrast, alcohol consumption in Sri Lanka has been rapidly increasing over recent years. However, in both settings alcohol misuse represents a major public health concern. Therefore, it is important to evaluate existing alcohol control policies or contextual factors affecting alcohol consumption in these settings and to identify existing data sources that can be used for alcohol control policy evaluation. This thesis aimed to investigate the suitability of existing data sources in the UK, identify potentially suitable measures and use those measures to evaluate the impact of Licensing Act 2003 in England, which allowed flexible opening hours including 24-hour drinking at on-trade premises in England and Wales from November 2005 onwards. This thesis further aimed to apply the lessons learned from the UK to Sri Lankan context, identifying potential data sources and using these to evaluate the effect the end of conflict in 2009 on alcohol consumption in Sri Lanka. Methods A range of sources of data on alcohol consumption and consequences in the UK were reviewed to identify those appropriate for alcohol control policy evaluation, and in particular for time series analysis which requires consistent data collected at regular intervals for a long period of time. The suitability of UK primary care data on alcohol consumption was assessed by identifying the proportion of patients with a record of alcohol consumption status in the last year, as well as ever since their registration with a practice. The quality of alcohol consumption measures collected by English national surveys was assessed by comparing them with the international guidelines for measuring alcohol consumption in population surveys. Existing data sources on alcohol consumption and consequence in Sri Lanka were also identified and reviewed to identify their suitability for alcohol control policy evaluation. Interrupted time series analysis was then conducted on these measures to establish the effect of the Licensing Act 2003 on alcohol consumption among adults (age≥16) in England, and the end of the conflict on recorded alcohol consumption among adults (age≥15) living in the areas that were not directly affected by the conflict in Sri Lanka. Findings In the UK, there are numerous sources of alcohol consumption and consequence data. However, few provide frequently collected data from large samples over long time periods for time series analysis. The recording of alcohol consumption in primary care remains low, particularly when recent recording within a given year is considered. Moreover, alcohol consumption recording in primary care is higher among at-risk groups such as women in child bearing age, older men and women who are likely to have an illness linked to alcohol. Therefore, primary care data are currently unsuitable for alcohol control policy evaluation. Comparison of the alcohol data collected in English national surveys with recommendations from international guidelines showed that they have failed to maintain the consistency of data collection over time and to collect information on some of the key alcohol consumption measures such as the frequency of binge drinking. However, Health Survey for England (HSE) measured alcohol consumption on the heaviest drinking day of the last week consistently over time and this measure was available on a quarterly basis for a nationally representative sample. Interrupted time series analysis of HSE heaviest drinking day data from 2001 to 2013 showed that prior to the implementation of the Act alcohol consumption among adult male and female drinkers remained constant at around 8.3 units and 5.5 units of alcohol respectively. After the Act, there has been a gradual decline (less than 0.03 units per quarter) in the heaviest drinking day consumption among both male and female drinkers in England. However, it is difficult to attribute this decline in consumption to the Licensing Act as there was no step change in the consumption soon after the Act and the decline in heaviest drinking day consumption was small and gradual over a period of seven years. When compared with the UK, Sri Lanka has a limited number of data sources on alcohol consumption and alcohol consequences. The Department of Excise alcohol sales database was identified as the only data source that can be used for alcohol control policy evaluation in Sri Lanka. However, these population-level data cannot be used to identify the characteristics of people who drink and patterns of drinking such as binge drinking. Interrupted time series analysis showed that recorded alcohol consumption among Sri Lankans living in areas that were not directly affected by the armed conflict increased markedly after the end of the conflict in 2009, with a dramatic acceleration in the trend of adult per capita consumption. Annual adult per capita alcohol consumption among Sri Lankans increased from 1.59 litres of pure alcohol in 1998 to 2.56 litres of pure alcohol in 2013. Prior to the end of war in 2009 adult per capita alcohol consumption was increasing by 0.051 litres of pure alcohol per year (95% CI 0.029-0.074, p < 0.001). After 2009, it increased by 0.154 litres per year (95% CI 0.082-0.226, p=0.001). it increased by 0.166 litres of pure alcohol per year (95% CI 0.095-0.236, p < 0.001), almost a three-fold increment in the increase per year compared to the trend prior to the end of the conflict. Beer consumption showed the highest per capita growth compared with other beverages. Conclusions This thesis identified the existing data sources that can be used for alcohol control policy evaluation purposes in two settings; UK and Sri Lanka. It has highlighted the further improvements required in existing alcohol consumption related data sources in both countries and discussed the potential of applying lessons learned from the UK context to Sri Lankan context. Despite the current trend in alcohol consumption, both countries experience a significant public health burden due to alcohol misuse. Therefore, both countries will require formulation and implementation of new policy measures. However, Sri Lanka does not have high-quality individual level alcohol consumption data to support the monitoring and evaluation of alcohol control policies. Therefore, this thesis has emphasised the need to generate high-quality alcohol consumption data in Sri Lanka and carry out monitoring and evaluation of alcohol control policies to tackle the alcohol-related burden.

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Thesis of (M.A.)--University of Alberta, 2009. / Title from pdf file main screen (viewed on August 25, 2009). "Fall, 2009." At head of title: University of Alberta. A thesis submitted to the Faculty of Graduates Studies and Research in partial fulfillment of the requirements for the degree of Master of Arts, Department of Sociology, University of Alberta. Includes bibliographical references.

The prevalence of childhood overweight is a major social and public health issue, and primary assessment should focus on early and middle childhood, because weight gain in these phases constitutes a strong predictor of subsequent negative outcomes. Studies on community samples have shown that growth curves may follow linear or non-linear trajectories from early to middle childhood, and can differ based on sex. Overweight children may exhibit a combination of physiological and psychosocial issues, and several studies have demonstrated an association between overweight and internalizing/externalizing behavior. Nevertheless, there is a dearth of longitudinal studies on depressive and aggressive symptoms in children with high BMI. This study adopted a growth curve modeling over three phases to: (1) describe BMI trajectories in two groups of children aged 2±8 (overweight and normal weight) from a community sample; (2) describe the developmental trajectories of children's aggressive and depressive symptoms from 2 to 8 years of age. Results indicate higher BMI in 2-year-old girls, with males catching up with them by age 8. While overweight females' BMIs were consistently high, males' increased at 5 and 8 years. The mean scores for aggressive symptoms at T1 (2 years of age) were the same in all subjects, but a significant deviation occurred from T1 to T2 in both samples, in divergent directions. With regards to children's depressive symptoms, the two groups had different starting points, with normal weight children scoring lower than overweight youths. Overweight females showed lower depressive scores than overweight males at T1, but they surpassed boys before T2, and showed more maladaptive symptoms at T3. This study solicits professionals working in pediatric settings to consider overweight children's psychopathological risk, and to be aware that even when children's BMI does not increase from 2 to 8 years, their psychopathological symptoms may grow in intensity.

Objectives: Among different factors, diet patterns seem to be related to depression. The aim of this study was to evaluate the association between the consumption of fruits and/or vegetables and depressive symptoms. Methodology/Principal findings: A secondary data analysis was conducted using information from a population-based survey from 25 regions from Peru. The outcome was the presence of depressive symptoms according to the Patient Health Questionnaire (cutoff 15 to define major depressive syndrome); whereas the exposure was the self-reported consumption of fruits and/or vegetables (in tertiles and using WHO recommendation 5 servings/day). The association of interest was evaluated using Poisson regression models controlling for the complex-sample survey design and potential confounders. Data from 25,901 participants were analyzed, mean age 44.2 (SD: 17.7) and 13,944 (54.0%) women. Only 910 (3.8%; 95%CI: 3.5%–4.2%) individuals reported consuming 5 servings of fruits and/or vegetables/day; whereas 819 (2.8%; 95%CI: 2.5%–3.1%) had depressive symptoms. Those in the lowest tertile of fruits and/or vegetables consumption had greater prevalence of depressive symptoms (PR = 1.88; 95% CI: 1.39–2.55) than those in the highest tertile. This association was stronger with fruits (PR = 1.92; 95%CI: 1.46–2.53) than vegetables (PR = 1.42; 95%CI: 1.05–1.93) alone. Conclusions: An inverse relationship between consumption of fruits and/or vegetables and depressive symptoms is reported. Less than 5% of subjects reported consuming the amount of fruits and vegetables recommended by the WHO. There is a need to implement strategies to promote better diet patterns with potential impact on mental health. © 2017 Wolniczak et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

The decisions made by Mental Health Professionals (MHPs) are of utmost significance for providing the highest quality care to service users. The assessment of risk is one of the pivotal processes that MHPs undertake frequently, as per government policy guidelines, and in order to safeguard patients and the public. Although Risk Assessment Proformas (RAPs) consume a proportion of MHP time and resources, very little research has been undertaken to address factors that might affect their most optimal utilisation in practice. Previous literature suggests that medical decisions, like decision making of other kinds, is fraught with difficulty including being susceptible to the influence of cognitive biases, pre-decisional affect, overconfidence, and subjectively held attitudes towards organisational policies and regulations. Specifically, the presentation of risk information can influence decisions. It has also been suggested that anxiety has the capacity to elicit risk aversive responses, and that overconfidence and negative attitude may lead to complacency in undertaking policy-led responsibilities and produce non-compliance for the same. However, much of what is known about medical decision making has been gleaned from outside of context of mental health. As such, the current programme of research aimed to explore decision making in mental health settings and with a view to raise awareness of the complexity of decision making amongst MHPs. The implementation of quantitative and qualitative techniques (studies 1 and 2) revealed negative attitudes from psychiatrists towards Risk Assessment Proformas (RAPs), which are essentially structured decision making aids. Psychiatrist, compared to other MHPs, spent less time completing RAPs, which may reflect their differing attitudes towards their usefulness, something that was consistently emphasised during in-depth qualitative exploration. It was also found that experience was an additional differentiating factor between MHPs. Relationships between experience and other factors such as anxiety, confidence and complacency were found via conversations with MPHs, experience members of staff being less inclined to provide comprehensive and detailed accounts of service user risk in RAPs. This is problematic since although there is, in the UK, a policy led requirement that RAPs are completed for each service user, it is clear that there are inter-professional variations in how RAPs are being used and this acts to inhibit the best information sharing between all those involved in patient care. Following previous work in the area of cognitive bias and its influence upon general and medical decisions, a clinical vignette was also developed (study 3) to establish whether the presentation of risk information influences psychiatric admission decisions. The current findings supported previous work in that decisions were susceptible to the framing effect. The findings here, and previously in the literature, reveal a necessity for MHPs to be informed of bias in decision making in an attempt to improve objectivity in risk assessment practices. The unearthing of the framing effect also further signals the need for proper use of RAPs, where many MHPs may not be using them to their full potential - i.e. an aid to the systematic consideration of a range of information about a service user. The final part of the thesis (study 4) turned to the piloting of an educational module incorporating content around the factors affecting decision making in an attempt to raise awareness amongst MHPs. The rationale being better awareness of the complexity of decision making may act to enhance decision making processes. Pre and post intervention analyses revealed an improvement of baseline to follow-up knowledge of decision making bias and statistical concepts and this knowledge was maintained to a moderate level at four weeks follow-up. Although individuals maintained their susceptibility to the framing effect, the bias was less prevalent in those who knew of its presence before taking part in the study. Overall the findings give some support to the use of education as an approach to raising awareness about decision making processes in MHPs, although what remains to be seen is whether such education acts to bring about changes in behaviour - for example, different use of RAPs. The PhD programme suggests that MHPs are just as susceptible to cognitive biases, such as the framing effect, as has been demonstrated in both general population and other groups of health practitioners. At the same time, attitudes to RAPs differ depending on exact job role, which psychiatrist being least likely to spend time on their completion and reporting them as a tool for noting decisions reached as opposed to an aid to the process. This acts reduce the quality and quantity of reported information shared with colleagues about a service user. It is possible that MHP behaviour aligns with general attitude-behaviour models, such as the Theory of Planned Behaviour. As such, whilst the current work has demonstrated that educational interventions may act to improve awareness of decision making processes and their influences, further research would benefit from considering if these types of approach affect actual behaviour. For example, improved used of RAPs as decision-aids, reduced susceptibility to framing effects, consciousness around how information is represented in RAPs given knowledge of how the information may be used by others.

This thesis aims to investigate and illuminate lived experiences, cultural representations, and organizational conditions that influence the way therapists in Swedish psychiatry receive and treat migrant women. This overall aim is pursued through two distinct but interlinked part-studies. The aim of the first of these is to examine migrant women’s perceptions of mental (ill-) health along with their actual experiences of therapy in Swedish psychiatry. The aim of the second part is to describe and explain how therapists, in their organizational work conditions, interpret and experience their professional encounters with migrant women.   The thesis is based on qualitative interviews with twelve migrant women and eleven therapists in psychiatry. The result show that the migrant women experience health and mental health through a sense of belonging. Non-belonging, isolation and estrangement will point to the other direction i.e. not having health. The migrant women may gain a sense of belonging to society through therapy. However there are also obstructions on this path to belonging. The therapists, in psychiatry, seeing migrant women are doing emotion work comparable to physical labor. As the production is expected to increase due to marketing principles it puts a demand of acceleration on the therapists emotion work. They, thus have to find strategies to manage their emotion work. Everyday resistance thus becomes a way to gain emotional energy and to avoid emotional numbing and burnout. It is also gives openings to be content with their work with their patients and thereby to be able to offer an adequate reception of migrants into treatment in psychiatry. The thesis contributes to the gap in research by focusing on the borderlands between migrant women’s lived experiences of social suffering and the receiving therapists’ possibility to meet their migrant patients’ request. / This thesis aims to investigate and illuminate lived experience and organizational conditions that influence the way therapists in Swedish psychiatry receive and treat migrant women. This overall aim is divided into two separate but interlinked part-studies. The main body of the thesis is based on interviews with migrant women as well as therapists in psychiatry. The result show that the migrant women are searching for belonging in the host society. One way of searching for belonging is through therapy in psychiatry. However the work pace in health care and psychiatry is increasing and the therapists are struggling with giving a decent reception of migrants. In order to manage the heavy emotion work the therapists oppose the accelerating work pace by doing resistance in their everyday work. This thesis contributes to gap in research on the borderlands between lived experiences of social suffering odf migrant women as well as the lived experiences of the work conditions that make it possible to care for another person

Yes / Risk factors associated with depression in athletes include biological sex, physical pain, and history of sport-related concussion (SRC). Due to the well-documented benefits of sport and physical activity on mental health, athletes and non-athletes were recruited to assess any differences. Beyond this, athletes were also grouped by sport-type (contact/non-contact sports) due to the increased prevalence of pain and SRC in contact sports. To our knowledge, there has been no research on how these factors influence the likelihood of depression. In the current study, 144 participants completed a short survey on the above factors and the Center for Epidemiological Studies Depression Scale. Sixty-two of these reported a history of concussion. Logistic regression revealed all the above predictors to be significantly associated with the depression scale. Individuals that had previously sustained SRC, were experiencing greater physical pain and females were more likely to display poor mental health. However, we provide further evidence for the benefits of engaging in sport and physical activity as those that took part in sport were less likely to report depression. Therefore, this study provides a simple risk metric whereby sportspeople can make a better informed choice of their sporting participation, making their own cost/reward judgement.

Yes / The COVID-19 pandemic and associated restrictions caused major disruption globally, shedding light on the unprecedented strain upon the mental health and wellbeing of individuals around the world. Poor mental health in the pandemic is reported to be greater in women, with mothers being at increased risk. It is unclear whether there are differences in the impact of mental wellbeing on some ethnic groups over others. The aim of this study was to explore the experiences of British Muslim Pakistani women with family responsibilities during the COVID-19 pandemic, two years on from the first lockdown. Methods Qualitative interviews with women were conducted via telephone using a semi-structured topic guide. The sample included 25 British Muslim Pakistani women with family responsibilities, both English and non-English speaking. Women lived in households that ranged in number and included extended family. Key themes were determined using thematic analysis. Results Results were grouped under three themes. These were (1) Community, cultural and religious contributors to poor mental wellbeing, (2) religious and cultural mediators of mental distress, and (3) perceived positive impact on lifestyle. British Muslim Pakistani women were psychologically distressed by the high rates of virus transmission and deaths in their communities and at the prospect of older members of their extended family developing the virus. The impact of restrictions on fundamental religious and cultural interactions further exacerbated poor mental wellbeing in this population. Religion, community social capital and larger household structures were all effective coping strategies for British Muslim Pakistani women. Positive impacts of the pandemic included becoming closer to family and faith, and increased work/life harmony. Conclusions An exploration of religious and cultural coping mechanisms should be used to inform future national pandemic preparedness plans, as well as effective strategies for building and maintaining social capital. This may increase adherence to physical distancing and other protective behaviours in populations. / Department of Health, United Kingdom, NIHR200166

OBJECTIVE: Generalized anxiety disorder (GAD) during pregnancy is associated with several adverse maternal and perinatal outcomes. A reliable and valid screening tool for GAD should lead to earlier detection and treatment. Among pregnant Peruvian women, a brief screening tool, the GAD-7, has not been validated. This study aims to evaluate the reliability and validity of the GAD-7. METHODS: Of 2,978 women who attended their first perinatal care visit and had the GAD-7 screening, 946 had a Composite International Diagnostic Interview (CIDI). The Cronbach's alpha was calculated to examine the reliability. We assessed the criterion validity by calculating operating characteristics. The construct validity was evaluated using factor analysis and association with health status on the CIDI. The cross-cultural validity was explored using the Rasch Rating Scale Model (RSM). RESULTS: The reliability of the GAD-7 was good (Cronbach's alpha = 0.89). A cutoff score of 7 or higher, maximizing the Youden Index, yielded a sensitivity of 73.3% and a specificity of 67.3%. One-factor structure of the GAD-7 was confirmed by exploratory and confirmatory factor analysis. Concurrent validity was supported by the evidence that higher GAD-7 scores were associated with poor self-rated physical and mental health. The Rasch RSM further confirmed the cross-cultural validity of the GAD-7. CONCLUSION: The results suggest that the Spanish-language version of the GAD-7 may be used as a screening tool for pregnant Peruvian women. The GAD-7 has good reliability, factorial validity, and concurrent validity. The optimal cutoff score obtained by maximizing the Youden Index should be considered cautiously; women who screened positive may require further investigation to confirm GAD diagnosis. / : This research was supported by an award from the Eunice Kennedy Shriver Institute of Child Health and Human Development (R01-HD-059835) at the National Institutes of Health (NIH). The NIH had no further role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication / Revisión por pares