It's not what you hear, it's the way you think about it: appraisals as determinants of affect and behaviour in voice hearers.

BACKGROUND: Previous studies have suggested that beliefs about voices mediate the relationship between actual voice experience and behavioural and affective response. METHOD: We investigated beliefs about voice power (omnipotence), voice intent (malevolence/benevolence) and emotional and behavioural response (resistance/engagement) using the Beliefs About Voices Questionnaire - Revised (BAVQ-R) in 46 voice hearers. Distress was assessed using a wide range of measures: voice-related distress, depression, anxiety, self-esteem and suicidal ideation. Voice topography was assessed using measures of voice severity, frequency and intensity. We predicted that beliefs about voices would show a stronger association with distress than voice topography. RESULTS: Omnipotence had the strongest associations with all measures of distress included in the study whereas malevolence was related to resistance, and benevolence to engagement. As predicted, voice severity, frequency and intensity were not related to distress once beliefs were accounted for. CONCLUSIONS: These results concur with previous findings that beliefs about voice power are key determinants of distress in voice hearers, and should be targeted specifically in psychological interventions.

Disease, deficit or denial? Models of poor insight in psychosis.

OBJECTIVE: To examine the evidence for the three kinds of aetiological model that dominate the current literature on poor insight in psychosis: clinical models, the neuropsychological model, and the psychological denial model. METHOD: Studies pertaining to one or more of these aetiological models were identified, reviewed and critically evaluated. RESULTS: There is little support for clinical models, partly because they lack testable hypotheses. Several studies reveal a positive relationship between insight and executive function, which may be related to frontal lobe dysfunction. However, the extent to which this relationship is specific and independent of general cognitive impairment remains unclear. There is tentative evidence to support the psychological denial model. Recent data combining the latter two approaches suggest that multiple factors contribute to poor insight. CONCLUSION: Integration of different aetiological models is necessary for a fuller understanding of insight in psychosis. Future research should assess multiple aetiological mechanisms in single investigations.

Mortality among a cohort of United Kingdom steel foundry workers with special reference to cancers of the stomach and lung, 1946-90.

OBJECTIVE: The aim was to describe cause specific mortality among steel foundry workers and to determine if any part of the experience may be due to occupation. DESIGN: Historical prospective cohort study. SETTING: Nine steel foundries in England and one in Scotland. SUBJECTS: 10,438 male production employees first employed in the period 1946-65 and with a minimum period of employment of one year. MAIN OUTCOME MEASURES: Observed and expected numbers of deaths for the period 1946-90. RESULTS: Compared with the general population of England and Wales, standardised mortality ratios (SMRs) for all causes and all neoplasms were 115 (observed deaths (Obs) 3976) and 119 (Obs 1129) respectively. Statistically significant excesses were found for cancer of the stomach (Obs 124, expected deaths (Exp) 92.5, SMR 134, 95% confidence interval (95% CI) 111-160) and cancer of the lung (Obs 551, Exp 378.3, SMR 146, 95% CI 134-158). A raised SMR (153) was also found for non-malignant diseases of the respiratory system. Classifications of jobs attracting either higher dust or higher fume exposures did not usefully predict these increased SMRs. Poisson regression was used to investigate risks of mortality from all cancers, cancer of the stomach, cancer of the lung, and non-malignant diseases of the respiratory system associated with duration of employment in the foundry area, the fettling shop, the foundry area/fettling shop, and the industry in general. Monotonic dose-response relations were not found, although there were positive trends for lung cancer and employment in the foundry area/fettling shop (1.0, 1.21, 1.44, 1.26) and for diseases of the respiratory system and employment in the fettling shop (1.0, 1.37, 1.18, 1.35). CONCLUSIONS: Confident interpretation of the causes of the raised SMRs was not possible. There was limited evidence of an occupational role in the excesses of lung cancer and diseases of the respiratory system. Smoking history was shown, in an indirect way, to be an unlikely explanation.

Alberta's suicide prevention training programs: a retrospective comparison with Rothman's developmental research model.

Developmental research is used to transform existing knowledge into applied programs. A social research and development (R&D) method, developed by Rothman for the human service professions, is compared with the method used to develop the Suicide Prevention Training Programs in Alberta, Canada. A retrospective review compares the development of these programs, which have since been implemented both nationally and internationally, with Rothman's model; discusses social R&D as a transformation methodology; and draws conclusions about the probable success of using developmental research methods in the human services. The review finds that the Alberta method closely paralleled the phases of Rothman's model. Results show that the transformation of knowledge about suicide into widely disseminated suicide prevention training programs can be attributed to the application of social R&D principles. The study concludes that the use of developmental research methods to establish human service programs should increase the probability of their success.

Cancer mortality in a cohort of United Kingdom steel foundry workers: 1946-85.

The mortality experienced by a cohort of 10,491 United Kingdom steel foundry workers during the period 1946-85 has been investigated. These workers were all male operatives first employed in any one of the 10 participating foundries in 1946-65; all had worked in the industry for a minimum period of one year. Compared with the general population of England and Wales, statistically significant excesses relating to cancer mortality were found for cancer of the stomach (E = 77.4, O = 106, SMR = 137) and cancer of the lung (E = 229.2, O = 441, SMR = 147). A statistically significant deficit was found for cancer of the brain (E = 19.4, O = 10, SMR = 51). Involvement of occupational exposures was assessed by the method of regression models and life tables (RMLT). This method was used to compare the duration of employment in the industry, in "dust exposed" jobs, in "fume exposed" jobs, in foundry area jobs, in fettling shop jobs, and in foundry area or fettling shop jobs, of those dying from cancers of the stomach and lung with those of all matching survivors. The RMLT analyses provided evidence of an occupational involvement in the risk of death from lung cancer from work in the foundry area or fettling shop, and weaker evidence of an occupational involvement in the risk of death from stomach cancer from work in the foundry area.