Jane Derges

Complaints about dog faeces as a symbolic representation of incivility in London, UK: a qualitative study

During a ‘Well London’ study, residents were asked about their neighbourhood and its environment. Above all other complaints, ‘dog poo’ was mentioned as a key concern. Despite low rates of infection and disease among the human population resulting from contact with canine faecal matter, the concerns of the public continue to rate it as a serious public health issue. Most public health studies, therefore, seek to identify processes of transmission and disease pathology as a method of addressing the problem. This study approaches the issue through a contextualised analysis of residents’ complaints, using anthropological theory to examine the symbolic representation of ‘dog poo’. Analysis of the interviews shows that these specific complaints were located among less easily defined or articulated experiences of social and environmental neglect, where neighbours were estranged from one another and local authorities seen as negligent. This approach has important implications for public health, as it provides not only a strong indicator of the level of dissatisfaction within some of Londons more disadvantaged neighbourhoods, but also identifies a need for policies that are grounded in cross-disciplinary research into the relationship between health, ‘wellbeing’ and experiences of marginalisation among urban populations.

Suicide and the Internet: Changes in the accessibility of suicide-related information between 2007 and 2014

BACKGROUND Following the ongoing concerns about cyber-suicide, we investigate changes between 2007 and 2014 in material likely to be accessed by suicidal individuals searching for methods of suicide. METHODS 12 search terms relating to suicide methods were applied to four search engines and the top ten hits from each were categorised and analysed for content. The frequency of each category of site across all searches, using particular search terms and engines, was counted. RESULTS Key changes: growth of blogs and discussion forums (from 3% of hits, 2007 to 18.5% of hits, 2014); increase in hits linking to general information sites - especially factual sites that detail and evaluate suicide methods (from 9%, 2007 to 21.7%, 2014). Hits for dedicated suicide sites increased (from 19% to 23%), while formal help sites were less visible (from 13% to 6.5%). Overall, 54% of hits contained information about new high-lethality methods. LIMITATIONS We did not search for help sites so cannot assess the balance of suicide promoting versus preventing sites available online. Social media was beyond the scope of this study. CONCLUSIONS Working with ISPs and search engines would help optimise support sites. Better site moderation and implementation of suicide reporting guidelines should be encouraged.

Searching for Suicide Methods

BACKGROUND Helium gas suicides have increased in England and Wales; easy-to-access descriptions of this method on the Internet may have contributed to this rise. AIMS To investigate the availability of information on using helium as a method of suicide and trends in searching about this method on the Internet. METHOD We analyzed trends in (a) Google searching (2004-2014) and (b) hits on a Wikipedia article describing helium as a method of suicide (2013-2014). We also investigated the extent to which helium was described as a method of suicide on web pages and discussion forums identified via Google. RESULTS We found no evidence of rises in Internet searching about suicide using helium. News stories about helium suicides were associated with increased search activity. The Wikipedia article may have been temporarily altered to increase awareness of suicide using helium around the time of a celebrity suicide. Approximately one third of the links retrieved using Google searches for suicide methods mentioned helium. CONCLUSION Information about helium as a suicide method is readily available on the Internet; the Wikipedia article describing its use was highly accessed following celebrity suicides. Availability of online information about this method may contribute to rises in helium suicides.

'Well London' and the benefits of participation: results of a qualitative study nested in a cluster randomised trial

Background Well London is a multicomponent community engagement and coproduction programme designed to improve the health of Londoners living in socioeconomically deprived neighbourhoods. To evaluate outcomes of the Well London interventions, a cluster randomised trial (CRT) was conducted that included a longitudinal qualitative component, which is reported here. The aim is to explore in depth the nature of the benefits to residents and the processes by which these were achieved. Methods The 1-year longitudinal qualitative study was nested within the CRT. Purposive sampling was used to select three intervention neighbourhoods in London and 61 individuals within these neighbourhoods. The interventions comprised activities focused on: healthy eating, physical exercise and mental health and well-being. Interviews were conducted at the inception and following completion of the Well London interventions to establish both if and how they had participated. Transcripts of the interviews were coded and analysed using Nvivo. Results Positive benefits relating to the formal outcomes of the CRT were reported, but only among those who participated in project activities. The extent of benefits experienced was influenced by factors relating to the physical and social characteristics of each neighbourhood. The highest levels of change occurred in the presence of: (1) social cohesion, not only pre-existing but also as facilitated by Well London activities; (2) personal and collective agency; (3) involvement and support of external organisations. Where the physical and social environment remained unchanged, there was less participation and fewer benefits. Conclusions These findings show interaction between participation, well-being and agency, social interactions and cohesion and that this modulated any benefits described. Pathways to change were thus complex and variable, but personal well-being and local social cohesion emerged as important mediators of change.

Alcohol screening and brief interventions for adults and young people in health and community-based settings: a qualitative systematic literature review

BackgroundSystematic reviews of alcohol screening and brief interventions (ASBI) highlight the challenges of implementation in healthcare and community-based settings. Fewer reviews have explored this through examination of qualitative literature and fewer still focus on interventions with younger people.MethodsThis review aims to examine qualitative literature on the facilitators and barriers to implementation of ASBI both for adults and young people in healthcare and community-based settings. Searches using electronic data bases (Medline on Ovid SP, PsychInfo, CINAHL, Web of Science, and EMBASE), Google Scholar and citation searching were conducted, before analysis.ResultsFrom a total of 239 papers searched and screened, 15 were included in the final review; these were selected based on richness of content and relevance to the review question. Implementation of ASBI is facilitated by increasing knowledge and skills with ongoing follow-up support, and clarity of the intervention. Barriers to implementation include attitudes towards alcohol use, lack of structural and organisational support, unclear role definition as to responsibility in addressing alcohol use, fears of damaging professional/ patient relationships, and competition with other pressing healthcare needs.ConclusionsThere remain significant barriers to implementation of ASBI among health and community-based professionals. Improving the way health service institutions respond to and co-ordinate alcohol services, including who is most appropriate to address alcohol use, would assist in better implementation of ASBI. Finally, a dearth of qualitative studies looking at alcohol intervention and implementation among young people was noted and suggests a need for further qualitative research.

Eloquent bodies: conflict and ritual in northern Sri Lanka.

It is increasingly apparent that hostilities continue in the aftermath of war and conflict, where presuppositions of peace and safety are rarely reflected on the ground. In Sri Lanka, the 2002 ceasefire agreement between the Sri Lankan government and the Liberation Tigers of Tamil Eelam (LTTE) has recently collapsed. This collapse developed slowly over a period of several years, beginning with cautious optimism before descending into deep pessimism with increasingly high levels of violence brought about by the absence of any real progress. Efforts to rebuild and reintegrate both rural and urban communities in the north of the country have had to take place within an atmosphere of silence, suspicion and a marked escalation towards the renewed outbreak of war. This article, following sixteen months of fieldwork in the northern Jaffna peninsula, examines how Tamil youths – many of whom were imprisoned and tortured during the war – have transformed a well-known ritual that has seen a dramatic increase since occupation of the far north by government troops in 1996. The ritual, previously an act of devotion to a popular Tamil god, Murugan, has transformed into a demonstration of strength and youthful challenge. This article examines how toleration of ritual pain can be contrasted with the pain and suffering of war, and articulated not only for the self, but also for the entire community.

Suicide and self-harm related internet use in patients presenting to hospital with self-harm: a cross-sectional study

Abstract Background Evidence that the internet might be being used in planning suicidal acts, promoting suicidal behaviour, and accessing help, adds a new dimension to suicide prevention. Yet research into the frequency and type of internet use before suicide is lacking. We investigated self-harm related to internet use among patients who presented to hospital with self-harm. Methods Data on self-harm presentations to the emergency departments of an adult hospital (Jan 1, 2013, to Dec 31, 2015) and a childrens hospital (Sept 1, 2013, to Nov 30, 2015) in a large city in the South West of England were obtained from a local self-harm surveillance register. Patients who had psychosocial assessments (65% of adult and 82% of childrens hospital presentations) were asked during the assessment about internet use associated with their presentation. Beck Suicide Intent (BSI) scale was used to assess suicidal intent. Multivariable logistic regression models were performed to investigate the association between internet use and sociodemographic characteristics, clinical characteristics, and repeat presentation within 6 months. The self-harm register has ethics approval. Findings 1192 first presentations to the adult hospital (mean age 35 years, SD 14·7) and 312 to the childrens hospital (14, 1·1) had data recorded about internet use, age, and sex. Prevalence of self-harm related to internet use was 8·4% (n=100) among adult presentations (8·9% men, 8·0% women) and 26·0% (n=81) among childrens presentations (26·3% boys, 25·9% girls). In both samples, self-harm related to internet use was associated with high intent (BSI >8) (odds ratio for adults 2·6, 95% CI 1·6–4·4; children 2·0, 0·9–4·3) but not repeat presentation (0·9, 0·5–1·8; 0·6, 0·2–1·3). Interpretation The findings indicate that self-harm related to internet use is likely to become increasingly relevant as the internet-native generation matures and might be a proxy marker for intent. The inclusion of questions about internet use in clinical self-harm assessments could provide an alternative means by which to explore complex issues. More generally, assessments may require updating in light of technological advancements. However, further research, which differentiates between types of internet use and explores the impact of asking about internet use, is necessary. Funding None.

Using the internet for suicide-related purposes: Contrasting findings from young people in the community and self-harm patients admitted to hospital

Despite accelerating interest in the impact of the internet on suicidal behaviour, empirical work has not captured detailed narratives from those who engaged in suicide-related internet use. This study explored the suicide-related online behaviour of two contrasting samples of distressed users, focusing on their purpose, methods and the main content viewed. In-depth interviews were conducted in the UK between 2014–2016 with i) young people in the community; and ii) self-harm patients presenting to hospital emergency departments. Data were analysed using methods of constant comparison. Suicide-related internet use varied according to the severity of suicidal feelings. In the young people sample, where severity was lower, use was characterised by disorganised browsing without clear purpose. A range of content was ‘stumbled upon’ including information about suicide methods. They also pursued opportunities to interact with others and explore online help. Self-harm patients were a higher severity group with a history of suicidal behaviour. Their use was purposeful and strategic, focused around ‘researching’ suicide methods to maximise effectiveness. They made specific choices about content viewed; many consulting factual content in preference to user generated accounts, while help content and communication was avoided. Findings indicate further action is necessary to improve online safety. Also, novel online help approaches are needed to engage individuals experiencing suicidal crisis. Awareness of the nature of suicide-related internet use and how this may reflect the status of an individual’s suicidal thinking could be beneficial to clinicians to promote safety and indicate risk.

‘DrinkThink’ alcohol screening and brief intervention for young people: a qualitative evaluation of training and implementation

Abstract Background Alcohol Screening and Brief Intervention (ASBI) helps reduce risky drinking in adults, but less is known about its effectiveness with young people. This article explores implementation of DrinkThink, an ASBI co-produced with young people, by health, youth and social care professionals trained in its delivery. Methods A qualitative evaluation was conducted using focus groups with 33 staff trained to deliver DrinkThink, and eight interviews with trained participants and service managers. These were recorded, transcribed and a thematic analysis undertaken. Results DrinkThink was not delivered fully by health, youth or social care agencies. The reasons for this varied by setting but included: the training staff received, a working culture that was ill-suited to the intervention, staff attitudes towards alcohol which prioritized other health problems presented by young people, over alcohol use. Conclusions Implementation was limited because staff had not been involved in the design and planning of DrinkThink. Staffs’ perceptions of alcohol problems in young people and the diverse cultures in which they work were subsequently not accounted for in the design. Co-producing youth focused ASBIs with the professionals expected to deliver them, and the young people whom they target, may ensure greater success in integrating them into working practice.

Suicide and Self-Harm Related Internet Use

Background: The rise in Internet use adds a new dimension to suicide prevention. We investigated suicide/self-harm (S/Sh)-related Internet use among patients presenting to hospital with self-harm. Method: We asked 1,198 adult and 315 child and adolescent patients presenting to hospital following self-harm in a city in South West England about Internet use associated with their hospital presentation. Associations between Internet use and sociodemographic and clinical characteristics were investigated using multivariable logistic regression models. Focus groups with clinicians explored the acceptability and utility of asking about Internet use. Results: The prevalence of S/Sh-related Internet use was 8.4% (95% CI: 6.8–10.1%) among adult hospital presentations and 26.0% (95% CI = 21.3–31.2%) among childrens hospital presentations. In both samples, S/Sh-related Internet use was associated with higher levels of suicidal intent. Mostly, clinicians found it acceptable to ask about Internet use during psychosocial assessments and believed this could inform perceptions of risk and decision-making. Limitations: It is unclear whether the findings in this study are applicable to the general self-harm patient population because only those who had psychosocial assessments were included. Conclusion: S/Sh-related Internet use is likely to become increasingly relevant as the Internet-native generation matures. Furthermore, Internet use may be a proxy marker for intent.