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The purpose of this paper is to demonstrate the innovative application of an Appreciative Inquiry (AI) approach for the design and implementation of organizational stress management interventions, alongside a case study of the successful design and implementation of the approach. By utilizing the AI methodology to develop a “local stress theory” for the participating organization, the authors propose a model which can be utilized in other similar organizations.

Stage 1: 35 participants completed up to ten daily logs by answering four positively framed questions regarding their working day. Stage 2: semi-structured interviews (n=13). The interview schedule was designed to further elaborate log findings, and begin looking into feasible organizational changes for improvement of stress. Stage 3: two focus groups (Stage 3, total 13 employees) verified interventions from logs and interviews and discuss how these can be implemented.

The log phase identified two key themes for improvement: managerial/organizational support and communication. From these, interviews and focus groups led to workable proposals for simple but likely effective changes. The authors reported findings to management, emphasizing organizational change implementation, and these were subsequently implemented.

The study demonstrated the effectiveness of AI to identify and implement relatively simple but meaningful changes. The AI cycle was completed but allocating lengthy follow-up time for evaluation of outcomes was not possible, although initial responses were favorable. There are also issues of generalizability of the findings.

This is the among first studies to utilize an AI approach for the design of stress management interventions.

Malcolm Ramsay's article looked at the empowerment of older people through good advice and information. Continuing this theme in our next article, Carol Munn‐Giddings et al describe a unique project that has equipped older people with the necessary research skills to go after the information themselves and is giving them the confidence to directly shape local services. Providers and commissioners ‐ beware!

Current treatment guidelines for anxiety disorders, including panic disorder (PD), recommend either medication or cognitive behavioural therapy (CBT). There is currently a call through the Layard Report for significant investment to increase the availability of CBT resources. However, there are reported limitations to both medication and CBT in the treatment of anxiety, and it appears prudent to consider additional methods of treatment that may offer effective interventions. One such intervention is based around the evidence of altered sensitivity within a number of physiological body systems in anxiety patients (particularly those with PD), all of which are influenced in their function by habitual lifestyle behaviours. A randomised controlled trial compared a 16‐week occupational therapy‐led lifestyle intervention and routine general practice (GP) care for PD. At 20 weeks, 14 symptoms with ‘moderate’ to ‘very severe’ ratings were assessed in 36 GP and 31 lifestyle‐intervention patients. Composite symptom profiles, similar at baseline, were produced. The GP intervention produced modest improvements in most symptoms. The lifestyle intervention overall produced greater symptomatic relief (Wilcoxon signed ranks test, P= 0.008). The physiological and cognitive symptom profile also changed more with lifestyle intervention. Occupational therapists have developed their interventions based on their understanding of everyday occupation. Habitual lifestyle behaviours are characterised as being recurrent elements of everyday occupation and are, therefore, legitimate targets for occupational therapy interventions. They provide a vehicle through which to encourage patients to regain understanding and control of their own anxiety symptoms.

Complex collaborative interventions are increasingly applied for stress management but outcomes are inconsistent. “Collaboration” is most highly developed in participatory action research (PAR). Future research might be guided by understanding features integral to successful PAR designs. The purpose of this paper is to present a review of PAR studies which had predominantly positive outcomes, in order to identify features of their designs.

In total, 48 collaborative intervention studies (1982‐2010) were identified, and filtered according to positive outcomes (improved working environment, job performance, absenteeism, and stress levels), and PAR criteria for stakeholder engagement: 11 studies from six countries were selected for scoping review.

Organization size and sector was not important for PAR, but the extent of uptake of an intervention/change is and a “unit” of up to 100 employees was engaged in most of the studies reviewed. Study aims should not be over‐ambitious. Long‐term involvement of “change agents” or “action groups” in close communication with a steering group appears most effective in engaging employees over a long period of time, ideally 12+ months. Self‐report scales dominated evaluations (21 different scales; range 1‐7 per study) but this strategy is challenged by impacts of organizational change and staff turnover on response rates. Comparison with a non‐intervention group appears to strengthen the evaluation, but PAR also provides an opportunity to implement an innovative strategy sensitive to the workplace situation. PAR provides scope to engage managers as participants. The participatory process was least effective where this was unsuccessful.

PAR has high potential for the engagement of management, and identification of a rigorous evaluation strategy, that would facilitate the efficacy of collaborative designs.

Insights are provided into characteristics of highly collaborative, and demonstrably effective, PAR designs.

Principles of epigenesis that provide a foundation for research into chronic medical disorders are increasingly being applied in the context of mental health. The purpose of this paper is to consider recent research evidence for epigenetic influences in the pathogenesis of depression, and the putative links with stress biology during exposure to chronic stress, with the aim of placing this into a context of potential new therapeutics.

Substantive reviews published during the last ten years were identified in a search of the Pubmed database in September 2010 using the terms “epigenetics” or “epigenesis” with “mental health”, “mood disorder”, “depression”, stress', “chronic stress” or “environment”, supplemented by hand‐searching of citations in the reviews.

Epigenetic mechanisms are both heritable and acquired, and their impact on the underlying genome helps explain individual vulnerability and patterns of occurrence of depression.

The paper shows that this relatively new field of research is in its infancy, and the influence of adverse environments (i.e. stressors) on genetic/epigenetic predisposition has promise for the advent of novel therapeutics based on epigenetic manipulation.

This paper aims to generate knowledge about relevant evaluation topics that align with and represent the unique character of the midwifery programme for students living in the rural and remote areas of Scotland.

The first two central concepts of Practical Participatory Evaluation (P-PE) framed the research design: the data production process and (2) the knowledge co-construction process. The data were collected using a semi-structured approach via online discussions, dialogues and email-based consultation among programme stakeholders. A structural analysis was performed: the units of meaning (what was said) were extracted, listed and quantified in units of significance (what the texts were talking about), from which the key topics for evaluation emerged.

A community of 36 stakeholdersengaged in the discussions, dialogues and consultations. The stakeholders identified 58 units of significance. Fifteen subthemes were constructed in five main themes: student profile, student well-being, E-pedagogy, student journey/transition from being a nurse to becoming a midwife and learning in (an online) geographically remote and isolated area. The themes, or topics of evaluation, are dynamic functions and underlying mechanisms of the commonly used evaluation measures student progress and student evaluation.

This P-PE is a single-site study, focusing on a unique programme consisting of a specific group of students living and studying a specific geographic area, affecting the transferability of the findings.

In collaboration with stakeholders, parameters to evaluate the uniqueness of the programme in addition to higher education institution routinely collected data on student progress and satisfaction were systematically identified. The themes highlight that if student progress and satisfaction were the only evaluation parameters, knowledge and understanding of the contributing factors to (un)successfulness of this unique online midwifery programme could be missed.

Research on job precarity and job instability have largely neglected the labor market trajectories in which these employment and non-employment situations are experienced. This study addresses the mechanisms of volatility and precarity in observed work histories of labor market entrants using the National Longitudinal Survey of Youth of 1997. Several ideal-typical post-education pathways are modeled for respondents entering the labor force between 1997 and 2010, with varying indicators and degrees of precarity. A series of predictive models indicate that women, racial-ethnic minorities, and lower social class labor market entrants are significantly more likely to be exposed to the most precarious early careers. Moreover, leaving the educational system with a completed associate’s, bachelor’s, or post-graduate degree is protective of experiencing the most unstable types of career pattern. While adjusting for these individual-level background and education variables, the findings also reveal a form of “scarring” as regional unemployment level is a significant macro-economic predictor of experiencing a more hostile and turbulent early career. These pathways lead to considerable earnings penalties 5 years after labor market entry.

The purpose of this paper is to examine the levels of clinician burnout in a community forensic personality disorder (PD) service, and explores how burnout may arise and be minimised within a service of this nature.

A mixed methods approach was utilised, assessing levels of burnout and making comparisons with a comparable previous study. Focus group data regarding burnout and suggestions for reducing the risk of burnout were analysed using thematic analysis.

Levels of burnout were generally found to be higher in the current sample when compared with the generic PD services. Qualitative data suggest that working in a forensic PD setting may pose a range of additional and complex challenges; these are explored in detail. Minimising burnout might be achieved by developing resilience, utilising humour, team coherence and ensuring that breaks are taken, and developing one’s own strategies for “releasing pressure”.

The risk for burnout in clinicians working with offenders with PD may be higher than other groups of mental health clinicians. Despite this, attempts to minimise burnout can be made through a range of practical strategies at the individual, team and organisational level.

This is the first project to assess levels of burnout specifically in a team of clinicians working with offenders with PD, and offers an exploration of how burnout may manifest and how it can be managed in this unique area of mental health.

Homelessness has many causes and also is stigmatized in the United States, leading to much misunderstanding of its causes and what policy solutions may ameliorate the problem. The problem is of course getting worse and impacting many communities far removed from the West Coast cities the authors examine in this study. This analysis examines the socioeconomic variables influencing homelessness on the West Coast in recent years. The authors utilize a panel fixed effects model that explicitly includes measures of healthcare access and availability to account for the additional health risks faced by individuals who lack shelter. The authors estimate a spatial error model (SEM) in order to better understand the impacts that systemic shocks, such as the COVID-19 pandemic, have on a variety of factors that directly influence productivity and other measures of welfare such as income inequality, housing supply, healthcare investment, and homelessness.

Some twenty years ago, however, the realisation came that the economy of the animal body calls for the activities of substances with functions apparently akin, in many respects at least, to those of the hormones, which the body itself is nevertheless unable to produce, and therefore must receive them in its food. The indispensable functions of these, like those of the hormones, are adequately fulfilled by extraordinarily small amounts of each one. These food constituents yield therefore no appreciable supply of energy, nor do they serve in any ordinary sense as structural materials. Their presence like that of the hormones is necessary rather for the normal progress of active events. They have dynamic functions. I am alluding, of course, to the vitamins.