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This article develops the concept of wrongful depathologization, in which a psychiatric disorder is simultaneously stigmatized (because of sanist attitudes towards mental illness) and trivialized (as it is not considered a \u201cproper\u201d illness). We use OCD as a case study to argue that cumulatively these two effects generate a profound epistemic injustice to OCD sufferers, and possibly to those with other mental disorders. We show that even seemingly positive stereotypes attached to mental disorders give rise to both testimonial injustice and wilful hermeneutical ignorance. We thus expose an insidious form of epistemic harm that has been overlooked in the literature.
\n \n\n \n \nJaspers identifies empathic understanding as an essential tool for grasping not the mere psychic content of the condition at hand, but the lived experience of the patient. This method then serves as the basis for the phenomenological investigation into the psychiatric condition known as \u2018Phenomenological Psychopathology\u2019. In recent years, scholars in the field of phenomenological psychopathology have attempted to refine the concept of empathic understanding for its use in contemporary clinical encounters. Most notably, we have Stanghellini\u2019s contribution of \u2018second-order\u2019 empathy and Ratcliffe\u2019s \u2018radical empathy\u2019. Through this paper, we reject the pursuit of a renewed version of \u2018empathic understanding\u2019, on the grounds that the concept is fundamentally epistemically flawed. We argue that \u2018empathic understanding\u2019 risks (1) error, leading to misdiagnosis, mistreatment and an overall misunderstanding of the experience at hand, (2) a unique form of epistemic harm that we call \u2018epistemic co-opting\u2019 and (3) epistemic objectification. To conclude, we propose that empathic understanding ought to be replaced with a phenomenological account of Fricker\u2019s virtuous listening.
\n \n\n \n \nIntroductionA trauma-informed approach (TIA) means working with awareness that people\u2019s histories of trauma may shape the way they engage with services, organisations or institutions. Young people with adverse childhood experiences may be at risk of retraumatisation by organisational practices in schools and universities and by employers and health agencies when they seek support. There are limited evidence-based resources to help people working in the public sector to work with adolescents in trauma-informed ways and the needs of adolescents have not been central in resource development. This study contributes to public sector capacity to work in trauma-informed ways with adolescents by codesigning and evaluating the implementation of a youth-informed organisational resource.Methods and analysisThis is an Accelerated Experience-based Co-design (AEBCD) Study followed by pre\u2013post evaluation. Public sector organisations or services, and adolescents connected with them, will collaboratively reflect on lived experience data assembled through creative arts practice, alongside data from epidemiological national data sets. These will present knowledge about the impact of adverse childhood experiences on adolescents\u2019 mental health (stage 1). Collaboratively, priorities (touch points) for organisational responses will be identified (stage 2), and a low-burden resource will be codesigned (stage 3) and offered for implementation (stage 4) and evaluation (stage 5) in diverse settings. The study will provide insights into what adolescents and public sector organisations in the UK want from a TIA resource, the experience of services/organisations in implementing this and recommendations for resource development and implementation.Ethics and disseminationThe UK National Health Service Health Research Authority approved this study (23/WM/0105). Learning will be shared across study participants in a workshop at the end of the study. Knowledge products will include a website detailing the created resource and a youth-created film documenting the study process, the elements of the codesigned resource and experiences of implementation. Dissemination will target academic, healthcare, education, social care, third sector and local government settings via knowledge exchange events, social media, accessible briefings, conference presentations and publications.
\n \n\n \n \nPURPOSE/BACKGROUND: Visual acuity (VA) screening in children primarily detects low VA and amblyopia between 3 and 6\u2009years of age. Photoscreening is a low-cost, lower-expertise alternative which can be carried out on younger children and looks instead for refractive amblyopia risk factors so that early glasses may prevent or mitigate the conditions. The long-term benefits and costs of providing many children with glasses in an attempt to avoid development of amblyopia for some of them needs clarification. This paper presents a framework for modeling potential post-referral costs of different screening models once referred children reach specialist services. METHODS: The EUSCREEN Screening Cost-Effectiveness Model was used together with published literature to estimate referral rates and case mix of referrals from different screening modalities (photoscreening and VA screening at 2, 3-4\u2009years and 4-5\u2009years). UK 2019-20 published National Health Service (NHS) costings were used across all scenarios to model the comparative post-referral costs to the point of discharge from specialist services. Potential costs were compared between a) orthoptist, b) state funded ophthalmologist and c) private ophthalmologist care. RESULTS: Earlier VA screening and photoscreening yield higher numbers of referrals because of lower sensitivity and specificity for disease, and a different case mix, compared to later VA screening. Photoscreening referrals are a mixture of reduced VA caused by amblyopia and refractive error, and children with amblyopia risk factors, most of which are treated with glasses. Costs relate mainly to the secondary care providers and the number of visits per child. Treatment by an ophthalmologist of a referral at 2\u2009years of age can be more than x10 more expensive than an orthoptist service receiving referrals at 5\u2009years, but outcomes can still be good from referrals aged 5. CONCLUSIONS: All children should be screened for amblyopia and low vision before the age of 6. Very early detection of amblyopia refractive risk factors may prevent or mitigate amblyopia for some affected children, but population-level outcomes from a single high-quality VA screening at 4-5\u2009years can also be very good. Total patient-journey costs incurred by earlier detection and treatment are much higher than if screening is carried out later because younger children need more professional input before discharge, so early screening is less cost-effective in the long term. Population coverage, local healthcare models, local case-mix, public health awareness, training, data monitoring and audit are critical factors to consider when planning, evaluating, or changing any screening programme.
\n \n\n \n \nThis chapter seeks to advance two central claims: 1) that the therapy-enhancement distinction is not an absolute one; and 2) that the social model of disability can be applied as at least one possible criterion for evaluating the ethics of enhancement. First, I address the limits of the therapy-enhancement distinction by showing that some accepted forms of therapy are indeed enhancements in their own right. The line between enhancement and therapy in medicine is therefore not clear-cut, but nor is the difference between enhancement and disability straightforward either, as I argue. I discuss how some forms of apparent enhancement may in fact make people disabled from a social point-of-view, for they would not be able to function well in a society \u201cfine-tuned\u201d towards the current average range of abilities. Enhancement is therefore a slippery notion, and one that brings into relief questions of equity and of oppression. If enhancement is meant to be a key stepping stone on the path towards a posthuman condition, as some claim, then the ambiguous nature of enhancement surely throws into the question the coherence of the \u201cpost\u201d in \u201cposthuman.\u201d
\n \n\n \n \nThis essay will reflect on the importance of Catholic social teaching in public health ethics, especially in the context of the global COVID-19 pandemic. Catholic social teaching will be presented as being continuous with Catholic moral teaching\u2014while the latter sets out norms and prohibitions often in relation to individual agents and their actions, the Church\u2019s social doctrine invites us to think of the community and social dimension of the moral good. To illustrate this continuity of doctrine, I will argue that the COVID-19 pandemic has shown a need for a serious evaluation of the relationship between public health and the common good, in light of the far-reaching and long-lasting public health measures that have been used around the world, such that the good of health has dominated considerations of almost all other aspects of life.
\n \n\n \n \nBACKGROUND: We examined the course of illness over a 12-month period in a large, international multi-center cohort of people with a first-episode schizophrenia spectrum disorder (FES) in a naturalistic, prospective study (PSYSCAN). METHOD: Patients with a first episode of schizophrenia, schizoaffective disorder (depressive type) or schizophreniform disorder were recruited at 16 institutions in Europe, Israel and Australia. Participants (N\u00a0=\u00a0304) received clinical treatment as usual throughout the study. RESULTS: The mean age of the cohort was 24.3\u00a0years (SD\u00a0=\u00a05.6), and 67\u00a0% were male. At baseline, participants presented with a range of intensities of psychotic symptoms, 80\u00a0% were taking antipsychotic medication, 68\u00a0% were receiving psychological treatment, with 46.5\u00a0% in symptomatic remission. The mean duration of untreated psychosis was 6.2\u00a0months (SD\u00a0=\u00a017.0). After one year, 67\u00a0% were in symptomatic remission and 61\u00a0% were in functional remission, but 31\u00a0% had been readmitted to hospital at some time after baseline. In the cohort as a whole, depressive symptoms remained stable over the follow-up period. In patients with a current depressive episode at baseline, depressive symptoms slightly improved. Alcohol, tobacco and cannabis were the most commonly used substances, with daily users of cannabis ranging between 9 and 11\u00a0% throughout the follow-up period. CONCLUSIONS: This study provides valuable insight into the early course of a broad range of clinical and functional aspects of illness in FES patients in routine clinical practice.
\n \n\n \n \nOBJECTIVE: To determine the effectiveness of mindfulness-based programmes (MBPs) on the mental health of elite athletes. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Eight online databases (Embase, PsycINFO, SPORTDiscus, MEDLINE, Scopus, Cochrane CENTRAL, ProQuest Dissertations & Theses and Google Scholar), plus forward and backward searching from included studies and previous systematic reviews. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies were included if they were randomised controlled trials (RCTs) that compared an MBP against a control, in current or former elite athletes. RESULTS: Of 2386 articles identified, 12 RCTs were included in this systematic review and meta-analysis, comprising a total of 614 elite athletes (314 MBPs and 300 controls). Overall, MBPs improved mental health, with large significant pooled effect sizes for reducing symptoms of anxiety (hedges g=-0.87, number of studies (n)=6, p=0.017, I 2=90) and stress (g=-0.91, n=5, p=0.012, I 2=74) and increasing psychological well-being (g=0.96, n=5, p=0.039., I 2=89). Overall, the risk of bias and certainty of evidence was moderate, and all findings were subject to high estimated levels of heterogeneity. CONCLUSION: MBPs improved several mental health outcomes. Given the moderate degree of evidence, high-quality, adequately powered trials are required in the future. These studies should emphasise intervention fidelity, teacher competence and scalability within elite sport. PROSPERO REGISTRATION NUMBER: CRD42020176654.
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