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Background Drugs and crime are linked and diversion from the criminal justice system into drug treatment is a well-established policy response. The point of arrest is a pivotal moment to initiate a drug-specific intervention. This paper assesses the impact of the introduction of drug testing on arrest (DToA) into a low crime area in England. Our mixed methods study analysed performance data collected by the National Drug Treatment Monitoring/Drug Test Recorder datasets and feedback from a series of semi-structured interviews with both clients and professionals. Results In total, 2210 people were tested 2861 times of which 42.0% (n = 928) tested positive. Of those, 3% subsequently engaged with effective treatment. However, throughout the criminal justice system, treatment engagements increased year on year from 20% (n = 77) to 26% (n = 131). Clients (n = 19) and professionals (n = 14) reported that DToA was an acceptable/tolerable addition to the treatment pathway. Interviews suggested that the point of arrest may help primary desistance from further offending. Conclusions The staggered introduction of the DToA made direct measure of impact difficult and there appears to have been a ‘displacement’ effect in response to the extra investment. However, DToA appears to have contributed towards an overall uplift in criminal justice drug treatment system performance activities (identification, assessment, referral etc.) and may have served to help strengthen care pathways. Barriers were noted about engagement with DToA by entrenched opiate users, suggesting that the effectiveness of DToA was limited within that group. This study is the first to investigate the impact of the introduction of DToA into a low crime area.

The purpose of this research paper is to explore the factors that influence Saudi users to adopt and use online video games. We developed a theoretical framework based on the Technology Adoption Model (TAM) to examine 6 hypotheses through a survey of 106 video game users. The results indicate that social norms, perceived enjoyment, and social interaction play a positive and significant role in influencing the perceived usefulness of online video games for end users. Also, price value, game quality, and internet speed were all factors that influence end-user perceived ease of use of online video games. Both perceived ease of use and perceived usefulness were all of the significant influence on the attitude to use online video games. Furthermore, perceived usefulness and attitude to use online video games influenced the behavioral intention to use online video games which in return influenced the actual use.

We review the current and potential uses of Geographic Information Software (GIS) and "spatial thinking" for understanding body disposal behaviour in times of mass fatalities, particularly armed conflict contexts. The review includes observations made by the authors during the course of their academic research and professional consulting on the use of spatial analysis and GIS to support Humanitarian Forensic Action (HFA) to search for the dead, theoretical and statistical considerations in modelling grave site locations, and suggestions on how this work may be advanced further.

Housing research and sociological research on ‘home’ has under-explored Houses in Multiple Occupation (HMOs) as a form of specific and relatively marginalised housing tenure. In this paper we utilise data collected through participant photography and interviews with vulnerable HMO residents in a seaside town to explore their experiences of homemaking in HMOs. Drawing on literatures on home, identity and wellbeing we explore how HMO residents create a home in the space in which they live and how where they live simultaneously moulds their sense of identity. Our analysis is based upon interviews with, and photographs taken by, HMO residents. We highlight how home is created and experienced in a setting where basic levels of privacy can be hard to maintain, where space is constrained, and where residents would often prefer to live elsewhere. The meaning of ‘home’ in a HMO is influenced by personal histories and circumstances, by the normative attitudes towards housing in the UK, as well as by the space itself. The impact that living in a HMO might have on a tenant's identity and as a consequence their wellbeing is therefore highly contextual – not solely due to the characteristics of the property itself and the stigma some associate with this housing type but as an outcome of how the tenants relate to the property given their own preferences, conditioning and previous housing experience. There was variation in the extent to which respondents wanted their room to reflect, project or build their identity.

Purpose – The purpose of this paper is to critically regard the concept of recovery from the perspective of substance misusing offenders. It intended to understand how these individuals came to define recovery by asking “what does recovery mean to you?” Design/methodology/approach – In total, 35 semi-structured interviews were undertaken with individuals with a history of heroin and crack cocaine use as well as convictions for a range of offences. Interviews took place in both prison and community settings, reflecting a spectrum of experience. Findings – Whilst the constellation of recovery varied, it was at times made up of the same “stars” – and some re-occurring themes emerged; recovery was transient, fragile and unpredictable, it was ongoing, lacking a definitive end, it was more than abstinence and often involved a total psychological overhaul, recovery was about reintegrating with society and feeling “normal”. Practical implications – Practitioners and services need to value the individual interpretations of recovery rather than being prescriptive around what it “should” look like. The components of recovery that were raised by participants permit specific recommendations for practice to be made. Originality/value – This study sought the perspectives of those actually affected by and experiencing drug treatment in the Criminal Justice System. It allowed participants to tell their story without preconceived ideas or hypotheses, putting their voice at the centre of the stage. The study uses feedback from the ground to make informed recommendations for practice.

To understand the impact of urban violence and crime on HIV care delivery.Urban violence and crime can put pressure on the healthcare system and on nursing staff. Whilst there is research about the impact this has at the individual level, there is less research that places this in the context of the overall social eco-system.A qualitative design using inductive thematic analysis.Between July 2016 - February 2017, we conducted in-depth interviews with 10 nurses working in two neighbourhoods with high levels of violence in Cape Town, South Africa.The effects of crime and violence were evident at multiple levels resulting in participants feeling "safe and unsafe" in a context where people view crime as endemic. Resilience emerged as a key concept in the findings. Resilience was apparent at individual, community, and organizational levels and enabled continued delivery of HIV care.The findings demonstrate the potential role of resilience in the social eco-health system required to sustain delivery of HIV care in the midst of urban violence and gangsterism.This study examined the impact of and response to urban violence on HIV care delivery. The findings indicate that resilience manifests at all levels of the social eco-system. Understanding the mechanisms employed to cope with endemic violence helps to address these challenges in the study setting, but also has a much wider application to other areas with endemic urban violence and crime.目的: 了解城市暴力和犯罪对艾滋病毒护理服务的影响。 背景: 城市暴力和犯罪会给医疗保健制度和护理人员带来压力。虽然有关于这在个人层面上的影响研究,但很少有研究将这放在整个社会生态系统的背景下。 设计: 使用归纳型主题性分析的定性设计。 方法: 2016年7月至2017年2月期间,我们对在南非开普敦两个暴力高发区工作的10名护士进行了深度访谈。 结果: 犯罪和暴力的影响在多个层面都很明显,导致参与者在人们视犯罪为地方病的背景下感到“安全和不安全”。复原力成为调查结果中的一个关键概念。复原力在个人、社区和组织层面是显而易见的,并且能够持续提供艾滋病毒护理。 结论: 调查结果表明,在城市暴力和强盗主义的情况下,复原力在维持艾滋病毒护理服务所需的社会生态卫生系统中具有潜在作用。 影响: 本研究调查了城市暴力对艾滋病毒保健服务的影响和应对措施。研究结果表明,复原力体现于社会生态系统的各个层面。了解应对地方性暴力所采用的机制不仅有助于在研究背景下应对这些挑战,而且可更广泛地将其应用于其他地方性城市暴力和犯罪地区。.

Blockchain is the underlying technology of Bitcoin. It is considered a prospect by industries such as finance, education and healthcare, due to its decentralization and non-tampering features. In the current Education-Industry cooperation, substantive information asymmetry exists between universities and employing companies. Student credit systems and the historical information data chain need urgent establishment and maintenance. The paper makes use of the transparency and non-tampering features of the blockchain system to implement an Education-Industry cooperative system based on the blockchain Hyperledger framework. Using the Certificate Authority service and transactions in the Hyperledger framework, the system simulates the roles of universities and companies in the system, and enables universities and enterprises to share information transparently, which achieves information symmetry among student skill and knowledge information, demands of enterprise recruitment, and current market trends. This offers a significant attempt on the application of blockchain technology to Education-Industry cooperation as a pilot development for technology deployment.

Houses in multiple occupation (HMOs) in which tenants share facilities are housing an increasing proportion of vulnerable adults who have limited affordable housing options. However, knowledge about how these types of property are managed is limited. In this paper, we examine the governance function of HMO landlords from the perspective of landlords/landlord agents and the tenants that live within their properties. The landlord exercises control through formal and informal risk assessment of tenants and close surveillance of them. These control mechanisms may also involve direct or indirect provision of support and care to some tenants. This illustrates the complex relationship between care and control and the extent to which both are integral to the housing management of vulnerable tenants living in HMOs. We suggest that this dual function calls for a critical examination of what constitutes a ‘good landlord’.

This article explores how previous exposure to religious homonegativity features in the sense-making process following HIV diagnosis in a homogenous sample of six gay men living in Northern Ireland. Interpretive phenomenological analysis was used to identify two key overarching themes: Negotiating authenticity in unsafe space, which relates to the experience of negotiating same-sex attraction within religious environments, and Re-emergence of religious shame in diagnosis, which relates to the way in which the men made sense of diagnosis from the position of having been exposed to religious homonegativity earlier in their lives. Findings demonstrate how the men negotiated their sexual orientation within religious contexts and how a reconstruction of God was necessary to preserve an authentic sense of self. Despite reaching reconciliation, HIV was initially appraised within a retributive religious framework that served to temporarily reinforce previously learned shame-based models of understanding this aspect of the self.

The recently developed sociological concept of superdiversity provides a potentially interesting and useful way of developing an understanding of life in contemporary Europe. Here we report on research based on individual narratives about access to health care, as described by a range of people from very different sociocultural backgrounds in four European countries. This article notes the frequent appearance in first-person narratives of the need for navigational assistance in the form of knowledge, cultural competence and orientation that facilitate the identification and use of pathways to health care. Our dataset of 24 semi-structured interviews suggests that, in the context of needing health care, the feeling of being a 'stranger in a strange land' is common in people from a wide range of backgrounds. In social settings characterised by transnationalism and cultural heterogeneity, it is important to understand the need for navigational assistance, particularly at times of uncertainty, in the design and delivery of health services. The relationship between the inhabitants of contemporary Europe and the healthcare systems available in the places where they live is dominated by both complexity and contingency - and this is the cultural field in which navigation operates.

SummaryThe death of a patient by suicide can severely affect mental health professionals, particularly if it occurs despite major efforts to intervene. Notwithstanding the difficulties faced by clinicians, suicide prevention remains of paramount importance in order to help save lives. This article seeks to promote a pragmatic and compassionate biopsychosocial response using evidence-based interventions to reduce suicide. It introduces practical strategies that psychiatrists can use in everyday clinical practice, in particular the paradigm shift of suicide mitigation to help prevent suicide. We believe that every encounter with a suicidal person is an opportunity to intervene to reduce their distress and, potentially, to save a life. We believe that it is no longer acceptable for clinicians to state that if patients wish to kill themselves they can do so, in the absence of any attempt at a compassionate intervention.

Medical sociology has a poor track record of researching diversity in theoretically innovative ways. This paper notes usage of the term superdiversity in migration and urban studies, to ask about its utility in general and more specifically for researching the social production of health and illness. Referring to a multi-country interview study about healthcare seeking strategies, the need to understand the diversification of diversity and the challenges for multi-method health research are described. Six interviews each were conducted in Germany, Spain, Sweden and the UK, to give a diversity sample of 24 adults who described their strategies and practice when seeking healthcare. In discussing how far superdiversity can help to model socio-economic and cultural changes already identified as challenging health policy and service provision, the paper draws on case study material. The complex intersecting dimensions of population diversity to which superdiversity draws attention are undoubtedly relevant for commissioning and improving healthcare and research as well as policy. Whether models that reflect the complexity indicated by qualitative research can be envisaged in a timely fashion for quantitative research and questions of policy, commissioning and research re key questions for the superdiversity’s ongoing usefulness as a concept.

Nursing is undergoing radical and fundamental changes. The impact of Project 2000 and the recruitment and retention of professional staff have profound implications for the delivery of patient care. All this is taking place in a service under threat from the demographic 'black hole' - the dearth of young people who will work in the health service due to the low birth rate in the early 1970s. We believe the first level registered nurse (RN) has to assume a positive role if the profession is to play its full part in facing the challenges health care will bring in the future.

Plain English summary Plain English summary Public involvement is required for applied health research funded in the UK. One of the largest funders, the National Institute of Health Research (NIHR), makes it clear that it values the knowledge of patients and the public. As a result, there are now many resources to make sure that the public voice is included in decision-making about research. However, there is concern that the public voice still has limited impact on research decision-making. This article asks to what extent has power shifted from the scientific research community to the public? It looks at how much power and impact patients and members of the public have about research by asking: How do the public contribute to deciding which research areas and which research projects should be funded? How do they influence how the research is carried out? The article argues that there is evidence that the public voice is present in research decision-making. However, there is less evidence of a change in the power dynamic between the scientific research community and the public. The public involved in research are not always equal partners. The scientific research community still has the loudest voice and patients and the public do not always feel sufficiently empowered to challenge it. Abstract Public involvement in applied health research is a pre-requisite for funding from many funding bodies. In particular the National Institute of Health Research (NIHR) in the UK, clearly states that it values lay knowledge and there is an expectation that members of the public will participate as research partners in research. As a result a large public involvement infrastructure has emerged to facilitate this. However, there is concern that despite the flurry of activity in promoting public involvement, lay knowledge is marginalised and has limited impact on research decision-making. This article asks to what extent has power shifted from the scientific research community to the public? It discusses the meaning of power and models of public involvement and examines the development of public involvement in applied health research. It identifies public involvement in a range of decision-making: identifying priority areas for commissioning research; making decisions about which projects are funded; decisions about details of research design. Whilst there is evidence that the public voice is present in the composition of research proposals submitted to NIHR and in the decision-making about which projects are funded and how they are carried out, there is less evidence of a change in the power dynamic manifest in social relations between the scientific research community and the public. As a result the biomedical model remains dominant and largely unchallenged in research decision-making.

Objective: To examine the relationship between the social and economic impact of multiple sclerosis (MS) and levels of MS-related disability upon households in the following domains: household composition, housing modification, employment, standard of living, children, intimate and close relationships, and social life. Methods: A national sample of people with MS (pwMS) ( n = 920), consisting of members of the MS Society and those accessing the MS Society website, completed a cross-sectional survey to generate quantitative and qualitative data. Results: Over three-quarters of the sample reported that MS had impacted on at least some areas of daily life. The reported impact increased significantly in a linear fashion in each domain with increasing disability, as measured by an activities of daily living index, although there was a discernible 'levelling off' in terms of impact in some domains among those at the higher levels of disability and dependency. Analysis of the qualitative data suggests that this impact can be conceptualized as a gradual process of 'restricting choices' and 'limiting independence' for both pwMS and their households. Discussion: MS restricts social and economic opportunities for pwMS and those who they live with. These findings extend the literature to households to illustrate the impact of MS not only on pwMS but also on their partners, children and other family members.

People with chronic or terminal diseases not only have to face the biophysical consequences but also the social impact of illness. The social impact or stigma associated with HIV/AIDS is high due to its infectivity and association with deviant behaviour. Social interaction with health professionals is critical for subsequent social adjustment to possession of a discreditable disease, including HIV. This paper examines the subjective reports of 61 people with HIV within this context and identifies processes of stigmatisation in health care settings. In agreement with surveys of health care workers, fear of contagion is identified as the principal source of negative reactions towards people with HIV in health care settings. Issues of confidentiality and the response of people with HIV to stigma in health care settings are also discussed. It is concluded that, although the biomedical model in which health professionals are trained ignores the social impact of disease, HIV-related stigma in health care settings in Scotland is declining as health professionals become familiar with treating people with HIV.

Non-medical prescribing has undergone radical changes in recent years, and there is clearly a need to evaluate its impact on practice. The study reported in this article focused on one county in the south-east of England. A two-part strategy was adopted: a questionnaire was distributed to all nurses who held the non-medical prescribing qualification; and interviews conducted with a variety of nurses, pharmacists, doctors and managers. An earlier paper ( Avery et al, 2007 ) focused on the extent to which effectiveness of non-medical prescribing was associated with the doctor–nurse relationship, but this article examines its impact for all the stakeholders involved. The findings suggested that, in a number of areas, patient throughput was increasing, nurses and doctors were re-assessing their roles, and that the qualification enhanced personal feelings of job satisfaction and autonomy. Moreover, although patients were not directly involved in the study, the overall perception was that they too were experiencing satisfaction with a system that enabled speedier access to treatment.

Fifty-six children in two groups were discharged within 24 hours of an uncomplicated appendicectomy. While the children in the first group ( N = 21) were visited by a nurse at home within 24 hours of discharge, the second group ( N = 35) just received telephone calls. The cohort was evaluated by telephone interviews two weeks after discharge. All children fulfilling the discharge standards were discharged safely within 24 hours of surgery. Any physical complaints post-discharge were considered minor. The nurses were able to provide reassurance to the families, give advice and deal with minor problems. As a result the families felt safe and reassured, and in only one case did the fragility of parental confidence become obvious. This study has demonstrated the safety of discharging these children within 24 hours of surgery and the value to nursing contacts in enabling the families to care for their children at home.

Chronic illness such as multiple sclerosis (MS) is often associated with 'biographical disruption', a concept that is derived from qualitative narrative analyses examining how people make sense of their illness in the context of their lives [Bury, M. (1982). Chronic illness as biographical disruption. Sociology of Health and Illness, 4, 167-182]. This paper attempts to operationalise the idea of disruption to one's life trajectory in quantitative analysis by examining the social, economic and emotional disruption associated with MS. A number of studies have suggested that it impacts negatively on employment, income and sexual relationships; however previous research has been based upon samples of people with MS (pwMS), with a dearth of studies comparing pwMS with the general population. This study reports a systematic comparison of MS and non-MS households to enable the impact of MS to be quantified in terms of household composition and marital status; household income; economic activity; and to determine whether biographical disruptions such as relationship breakdown or unemployment are more or less prevalent among those affected by MS compared to the general population. The MS sample came from randomly selected members of the UK MS Society (n=783) and those accessing the MS Society website (n=133). Data for the general population came from the 2001/02 British General Household Survey (GHS). Cases from the MS Society sample were matched using propensity scoring with cases from the GHS. The results of the matched analysis show that both men and women with MS are significantly less likely to be employed than those in the general population and are significantly more likely to have a 'below average' household income, despite the fact that they are in a higher social class and have higher educational levels than people in the general population. Differences between the MS and GHS samples in terms of marital status become non-significant when socio-demographic variables are controlled for using propensity scoring. This study provides robust evidence on how MS impacts on and disrupts the life of the person with MS and their household in terms of income and employment.

This paper reports a study that was commissioned to evaluate non-medical prescribing in one health authority in the south-east of England. A questionnaire was distributed to all nurses and pharmacists who held a non-medical prescribing qualification, and this was followed up by semi-structured interviews with nurses, pharmacists, doctors and managers. The findings confirmed that the majority of respondents were very experienced, and that they were making good use of the qualification. In addition, there were clear signs that patient care was being enhanced, but this was more evident when there was a close working relationship with the doctor. In the absence of this relationship, there is a need for the organization to develop a clear strategy for the implementation of non-medical prescribing, which should incorporate the views of all key stakeholders.

This article is based on an analysis of narratives of 26 offenders with mental health problems living in the United Kingdom. It explores the impact of an ascribed dangerous status and the construction of the self as moral and responsible in response to this label with reference to the literature on denial, deviance disavowal and other “techniques of neutralization” and Goffman's presentation of self. Two dominant strands are identified in relation to the construction of moral self-hood: “Not my fault” and “Good at heart” narratives. “Techniques of neutralization” are widely drawn on, particularly denial of responsibility in the “Not my fault” narratives that seek to explain anti-social behavior with reference to external forces such as a hostile environment inhibiting their ability to control their lives. In contrast, “Good at heart” narratives draw on the essentially good and moral nature of the inner-self. Both are used as evidence of sharing and adhering to moral norms in order to present an acceptable and credible self.

This article describes a follow-up study of 232 individuals who underwent psychiatric assessment by a Criminal Justice Mental Health Team (CJMHT) in 2001/2002, and also draws upon in-depth interviews conducted with 26 of the cohort. At assessment many people are identified with substance misuse problems, as homeless and with a history of psychiatric contact but in the main their problems are of insufficient severity to merit diversion to psychiatric hospital. The study mapped service contact, housing and offending in the 12 months following assessment and compared this to the 12 months prior to assessment, and found increased levels of service contact but also increased levels of offending and no decrease in homelessness. Thus assessment by the CJMHT brought few discernible advantages for the majority of clients. This was also the perception of the 26 clients who were interviewed. Their own perceptions of their lifestyle and the support that they deemed most valuable are described to identify means of enhancing the efficacy of court assessment.

Background: The difficulties in engaging and treating individuals with comorbid psychiatric problems and substance misuse has been acknowledged as a growing problem likely to have implications for treatment.Aims: This study compared service use in clients with single and comorbid diagnoses from Adult Mental Health (AMH) and Drug and Alcohol services (DAS).Methods: A retrospective matched case-control study of a sample of service users of a mental health Trust in East Anglia drawn across AMH (n = 400) and DAS (n = 190). Odds ratios were estimated and used to test for differences in client groups with respect to uptake of community services, formal and informal in-patient services, “out-of-hours” services and engagement with statutory services.Results: Marked differences were observed in terms of service use between clients of AMH who had a single diagnosis of severe, chronic or recurrent psychiatric problems and clients of AMH who had additional substance misuse problems. Differences were less pronounced b...

This paper discusses methodological issues arising in the initial stages of a larger epidemiological case-control study. Practitioners from both Generic Mental Health and Substance Misuse Services (n = 170) were asked to identify which of their clients, from a time-limited caseload (n = 2341), had comorbid mental health and substance misuse problems. Although practitioners were provided with a definition of 'singly diagnosed' and 'dually diagnosed', it became apparent that these definitions were applied pragmatically, depending on the nature of the client's primary problem and the agency they were presenting to. Issues raised include the time period in which a client was considered to have a concurrent mental health problem and substance misuse, how a 'mental health problem' was defined and whether a personality disorder should be categorized as a 'mental health problem'. There was also some disagreement about whether clients who were being treated primarily by Substance Misuse Services, but were also taking prescribed antidepressants, implicitly had a 'mental health problem'. We raise these methodological issues, as they have implications for determining the prevalence of 'dual diagnosis' and the subsequent provision of services.

Care professionals were interviewed regarding the extent, nature and victims of inappropriate sexual behaviour of 46 men with learning disabilities, and an adapted form of a version of the Structured Anchored Clinical Judgement risk assessment protocol (SACJ-Min: Hanson and Thornton, 2000) was completed for each. Risk judgements were unrelated to objective risk, as assessed by the SACJ-Min, to seriousness or frequency of sexual offending, to treatment outcome, or to a wide variety of other factors examined. The variables most strongly associated with risk judgements were the presence of a child victim and criminal convictions for inappropriate sexual behaviour, both of which, paradoxically, were perceived to decrease the risk of reoffending. Respondents were confident that existing management arrangements were effective in decreasing the risk of reoffending, and that the more intensely clients were supervised, the greater was the decrease in risk. However, level of supervision was unrelated to objective r...

Background: Previous campaigns to combat stigma emphasise the need for people who do not have mental health problems to behave in a non-stigmatising socially inclusive way towards those who do. Less attention has been given to the role of people with mental health problems in the construction of stigma or the impact it has upon them. Aim: To enhance services' contribution to supporting their clients in dealing with stigma, this study explores the nature and impact of stigma from the perspective of the lived experience of mental health service users. Method: In-depth interviews with 27 Caucasian service users Results: All respondents, whatever their diagnosis, reported being affected by stigma. Fear of stigma was found to be more commonplace (reported by 25 respondents) and more restrictive than overt discrimination (reported by 14 respondents). Conclusion: It is suggested that traditional campaigns that highlight discrimination may have a negative impact on the mentally ill because they highlight the prev...

This article examines the mode of understanding and experiences of family relationships of Chinese migrant women in Britain. In contrast to much existing research work on the patterns and experiences of postwar settlement of unskilled Chinese male labourers in Britain, the focus here is on the life stories of 41 Chinese women with different migration trajectories and varying economic and cultural capital. Their oral testimonies reveal Chinese women's diverse expectations and experiences of migrant family relationships and their different strategies to achieve self-fulfillment both within and outside the confines of the migrant family. For some women, migration brings opportunities for a fulfilling and independent lifestyle. They are successful in negotiating their way around and sometimes out of their initial familial and social position. For others, they bear the disproportionate cost and labour of familial strategies of advancement and remain vulnerable to the most constraining aspects of diasporic existence.

Background Fourteen clients with learning disabilities referred for anger management were randomly assigned to a treatment group and a waiting-list control group. Methods Treatment consisted of nine 2-h group sessions, using brainstorming, role-play and homework. Topics addressed included: the triggers that evoke anger; physiological and behavioural components of anger; behavioural and cognitive strategies to avoid the build-up of anger and for coping with anger-provoking situations; and acceptable ways of displaying anger (assertiveness). The intervention was evaluated using two inventories of anger-provoking situations, which were completed independently by both clients and carers. Results Clients in the treated group improved, on both self- and carer-ratings, relative to their own pre-treatment scores, and to the control group post-treatment. The within-group improvement corresponds to a ‘moderate’ (0.68 SD) effect size, whereas the between-group improvement corresponds to a ‘large’ (1.76 SD) effect size. The degree of improvement during treatment was strongly correlated with Verbal IQ. Clients in the treated group showed further improvement relative to their own pre-treatment scores at 3-month follow-up. Conclusions The treatment was effective in decreasing anger, in this randomized controlled trial of routine clinical practice.

Objectives: To identify the relationship between 'inappropriate' attendance at an accident and emergency department (AED) by adults registered with local general practices and their use of primary care. Methods: A case-control study matched for age, sex, distance from the AED, social class and registered general practice and set in a single AED and two health centres in South Essex. The participants were a total of 452 patients over 15 years old from the two health centres classified as having attended the AED 'inappropriately' in 1997 as identified by a modified Sheffield process method, and 452 controls. The predictive variables were measures of utilisation in the year 1997, including number of contacts in primary care, referral and investigation costs. Measures of morbidity were collected as potential confounders. These included a recorded history of anxiety or depression in the year 1997, or being in receipt of repeat prescriptions in that year. Results: The rate of 'inappropriate' attendance was 16.8% {95% confidence interval (CI): 15.7-18.0}. All measures of utilisation and markers of anxiety and depression were significantly positively associated with 'inappropriate' attendance, but there was no association with markers of chronic morbidity. Only the number of general practitioner (GP) appointments ( P < 0.0001) and out-of-hours advice calls ( P < 0.0001) were independently correlated with 'inappropriate' attendance in a conditional logistic regression. 'Inappropriate' attendees had approximately twice as many GP appointments and 10 times as many out-of-hours telephone contacts with the GP. Conclusions: GP-registered, 'inappropriate' attendees at AEDs utilise primary care services more than matched controls; this pattern of service utilisation appears to be unrelated to chronic physical illness. Thus, simply providing new, directly accessible primary health care services may not significantly reduce AED use.

A number of quantitative studies of people with severe mental illness show that, as with the general population, supportive social relationships are associated with well-being but the nature and causation of this association are unclear. To enhance services' contribution to the social support needs of their clients, this study explores the association qualitatively from the perspective of the lived experience of 27 mental health service users. Social contacts were reported to be both protective and damaging to mental health and it was common for close social relationships in particular to be both supportive and harmful. Loneliness was reported to be a problem, and almost all social contact was valued and perceived as better than none at all. Mental health problems led to changes in network composition and lack of balance in relationships, and this was sometimes difficult to reverse. Clinical implications of the findings are discussed.

Summary Increasing referrals of parents with learning disabilities or with possible learning disabilities to a small clinical psychology department prompted an audit and service review. Numbers of referrals had increased from two in 1995 to 13 in 1997. Only three out of the 32 children of referred parents were not subject to some form of intervention resulting from the 1989 Children Act. Twenty-three distinct teams of professionals were identified as being involved with the referred families. The clinical psychology department had limited resources, and consequently, developed a service that allowed for the restriction in finance and personnel. The service was developed within a four-tier model. This included workshops and a consultation service for professionals involved with these families, a parenting assessment service, legal work, and a parents' group that addressed parenting skills and personal development. The present authors believe that this model serves as a useful framework for other small departments, but that a dedicated special parenting service for vulnerable parents remains the ideal.

Summary Testifying in court to sexual abuse is always stressful and can be particularly problematic for a witness with learning disabilities (LDs). The present case report illustrates the assessment of capacity in relation to issues such as consent, competence and ability to withstand court procedures of a witness with LDs who alleged abuse by her paid carer. It describes the support offered to her by a number of agencies, including the police, and the health and social services. Finally, new legislation is described that might enable vulnerable witnesses, including some people with LDs, to give their best evidence in criminal proceedings.

The satisfaction of health service users is an increasingly important concern to service providers, yet there is little guidance about how it should be assessed. This study compares three different methods of collecting service users’ views (postal questionnaire; face-to-face interview; focus groups) to identify the strengths, weaknesses, usefulness, and what the service user thinks of each method.

This paper reports on a trial of vaginal products that were distributed and used by 131 women and 21 men in south west Uganda. It focuses specifically upon the issue of female control in heterosexual relationships and examines whether methods which are ostensibly under women's control, will in practice give women greater control of their sexual health. Participants were invited to select two from a range of vaginal products that included the female condom, contraceptive sponge, film, tablets, foam and gel, and use each for five weeks and their favourite product for a further three months. They were interviewed up to seven times over a five-month period. Although the women perceived that a major advantage of the products (with the exception of the female condom) was that they could be used secretly, less than 40% were using the products without their partner's knowledge after one week and this proportion declined over time with only 22% using the products secretly after ten weeks. In the main male partners were told as women felt it their duty to inform them. In general the women were very much more positive about the products than they were about the male condom, as were the men. A contributory factor to their popularity among women was the greater control they gave them. Even though, use of these products in practice often involved negotiation with male partners, the fact that use was contingent on women's action was empowering and increased somewhat their ability to control their sexual health.

We aimed to assess the acceptability of a variety of formulations of female-controlled methods of protection against HIV and STDs among men and women in south-western Uganda. Pilot interviews were carried out with 50 men and 55 women and 25 focus group discussions (FGDs) were held with 138 women and 42 men. The female condom, foaming tablets, sponge, foam, gel and film were demonstrated to 146 women and 35 of their male partners, who then tried out 2 of the products. They were interviewed 7 times during the course of 5 months. At the end experiences were evaluated during a second series of FGDs. Sixty-five (45%) women completed the trial. The main reasons for non-completion were related to geographical mobility. Product preference after the initial demonstration was similar to that at the end of the trial. The most popular formulations were the sponge (25% of the women), foaming tablets (23%), and the female condom (19%). The foam was of medium popularity (16%). The gel (9%) and film (7%) were least popular. Ten per cent of the women and 14% of the men reported products interfering with sexual enjoyment; 24% of the women and 67% of the men said products increased enjoyment. 'Dry sex' is not popular in this area and increased lubrication was an important determinant of acceptability. Age, level of education and location did have some effect on preference. Although secrecy was a dominant theme in the FGDs, 87% of the women had informed their partners by the end of the trial. The products were generally well received. Female control was an important issue for both sexes. Male attitudes were ambivalent because female ownership of products increased women's control. Although they have clear preferences, women appear to accept the products generally and might use a single available product just as readily if choice was limited, as long as it conforms to general cultural preferences, such as those relating to wet/dry sex.

The targeting of scarce mental health resources is currently organised around three broad areas: treating severe mental illness; reducing suicide; and obviating risk to the wider community. High priority clients are those who present with either psychotic symptoms, or who are perceived to be high risk to self or others. This study examined records of emergency assessments at a mental health trust in the south‐east of England over a three‐month period (n = 336) to see whether clients with these characteristics are more likely than others to be offered hospital admission or treatment. It was found that clients presenting with psychosis are much more likely to be offered admission than those assessed as non‐psychotic, that those assessed as a suicide risk are also significantly more likely to be offered admission, and that those assessed as presenting a risk to the public at large are no more likely to be admitted than those presenting no risk. This investigation indicates that the emergency service of the trust studied is addressing the first two target areas, but may be under‐performing in the third.

Even before the White and Green Papers, courses to help with parenting skills were gaining in popularity. Educational psychologists are becoming increasingly involved in running such programmes, In this Spotlight,Mary DeanandIvana Klimesdescribe a preschool parenting programme developed with Kate Schnelling and the Pre-School Teacher Counselling Team in Oxford City.