BackgroundSuicidality and absconding from psychiatric care are two critical phenomena that complicate mental health care in developing countries. The aim of this study was twofold. First, to determine the prevalence of suicidality among absconders over two decades. Secondly, we set out to determine overall factors that influence the likelihood of having suicidal behaviors among absconders, as well as factors specific to each diagnosis.MethodsThis was a retrospective chart review of files of patients who absconded from inpatient psychiatric care at a tertiary psychiatric facility in southwestern Uganda between 2000 and 2020. A pre-tested electronic questionnaire was used for data abstraction of sociodemographic characteristics, documented suicidality, and other clinical variables. Data cleaning and analysis were conducted using STATA V.17. Logistic regression was performed for factors associated with suicidality.ResultsAmong the absconders, 9.5% exhibited suicidality. Factors that heightened the odds of suicidality among absconders included being divorced or separated (adjusted odds ratio [aOR] = 2.00, 95% Confidence Interval [CI]: 1.20–3.31, p = 0.007), having depression (aOR = 5.41, 95% CI: 2.47–11.82, p < 0.001), a history of substance use (aOR = 1.50, 95% CI: 1.01–2.23, p = 0.049), and experiencing violence before hospitalization (aOR = 1.83, 95% CI: 1.14–2.94, p = 0.013). In contrast, substance use disorder (aOR = 0.25, 95% CI: 0.10–0.62, p = 0.003) and having schizophrenic spectrum disorders (aOR = 0.35, 95% CI: 0.18–0.68, p = 0.002) were linked to a decreased likelihood of suicidality among those who absconded.ConclusionThis study reveals a high burden of suicidality among individuals who abscond, with important risk factors such as marital status, depression, and a history of experiencing violence. It was noted that substance use disorder and schizophrenia spectrum disorders are associated with a reduced suicide risk. This study shows a significant interplay between clinical and demographic factors in predicting suicidality.

Objectives This study uses a decolonized research approach to identify the sexual and reproductive health (SRH) priorities of adolescent women living in Freedom Park, Cape Town, South Africa. The history of colonialism and apartheid has a significant ongoing impact on the SRH of women in the community. The objectives of the research were for adolescent women to create a shared definition of SRH and identify SRH needs and priorities. Methods A qualitative, participatory action design guided by decolonized methodologies was employed. Community members co-developed a modified body mapping exercise, ensuring cultural appropriateness and participant privacy. This participatory tool was used to explore SRH issues, leveraging its ability to foster dialogue and self-expression in a safe and collaborative environment. Seven workshops were conducted, engaging 54 adolescent girls and young women (AGYW) aged 16–25. Participant body maps and narratives were analyzed with the community through thematic coding and visual interpretation. Results Participants defined SRH, and illustrated SRH body parts, outcomes, and priorities on their body maps. Five themes were identified when discussing priority SRH issues: reproductive health and sexual wellness, abuse and violence, mental health, support and knowledge, and social pressures. Participants identified the two SRH issues they most wanted to address in their community as gender-based violence (GBV) and adolescent pregnancy. The body mapping methodology fostered open discussion and provided insight into personal lived experiences. Conclusions This study highlights socio-economic factors, cultural context, and historical influences as intersecting root causes of SRH outcomes in Freedom Park. The participatory body mapping approach empowered AGYW to express their SRH needs and identify community-driven priorities. Findings underscore the importance of contextualized, culturally sensitive research methods in addressing complex health challenges. Future interventions should address GBV and adolescent pregnancy through community-led strategies to foster sustainable change.

BackgroundResearch results are often not communicated to study participants or others with relevant lived experience. Effective communication of research results would help study participants understand their contribution to research and could improve trust in research and likelihood of research participation. Few randomized controlled trials (RCTs), however, have compared the effectiveness of research communication tools, and it is not known which tools work best for different people. We will conduct the Scleroderma Patient-centered Intervention Network—Communicating Latest Evidence and Results (SPIN-CLEAR) trial series via the multi-national SPIN Cohort to compare tool effectiveness. Primary objectives of each RCT will be to compare tools based on (1) information completeness, (2) understandability, and (3) ease of use. We will additionally evaluate comprehension of key aspects of disseminated research; likelihood that participants would enroll in a similar future study; and, for all primary and secondary outcomes, outcomes by participant characteristics (gender, age, race or ethnicity, country, language, education level, health literacy).MethodsAn advisory team of people with systemic sclerosis (SSc, also known as scleroderma) participated in developing research questions, selecting outcomes, and designing the series of parallel-arm RCTs that will each compare two or more tools or tool variations to a plain-language summary comparator; the common comparator will facilitate across-trial comparisons. In each RCT, people with SSc and researchers will select a recent SSc research study to disseminate. Tools will be developed by experienced tool developers and people with SSc. SPIN Cohort participants (current N eligible = 1522 from 50 SPIN sites in Australia, Canada, France, UK, USA) and additional participants recruited via social media and patient organization partners who consent to participate will be randomized to a dissemination tool or plain-language summary comparator and complete outcomes. Analyses will be intent-to-treat and use linear regression models.DiscussionEach trial in the planned series of trials will build upon knowledge from previous trials. Results will contribute to the evidence base on how to best disseminate results to study participants and others with relevant lived experience.Trial registrationClinicalTrials.gov NCT06373263. Registered on April 17, 2024 (first trial in series).

Increasing demand and crowding in emergency departments (EDs) remain persistent challenges for healthcare systems worldwide. A portion of these visits is avoidable, indicating they could have been effectively managed in non-ED care settings. There has been increased attention on paramedics redirecting avoidable visits to community-based care before ED transport. However, limited evidence exists to identify which patients might be suitable for non-ED care models, particularly based on prehospital clinical presentations. This study aimed to examine the patient characteristics associated with avoidable and potentially avoidable ED visits prior to ED transport. We conducted a cohort study using linked data from Hamilton Paramedic Services and a Canadian academic hospital between January 2022 and January 2024. ED visit records were classified using the Emergency Department Avoidability Classification into three classes: avoidable, potentially avoidable and not avoidable, and matched with their paramedic care reports. We used Firth's binary logistic regression to identify primary concerns associated with avoidable or potentially avoidable ED visits, reported as ORs with 95% CIs controlling for multiple comparisons using a false discovery rate of 0.10. Among the 23 891 ED visits analysed, 4.9% were classified as avoidable, 16.8% as potentially avoidable and 21.7% as either avoidable or potentially avoidable. Patients were primarily young-to-middle aged, presenting with a low medical acuity, taking fewer prescribed medications regularly and having stable vital signs within normal ranges. Primary concerns associated with these ED transports included social problems (OR 16.7, 4.5-95.5), anxiety (OR 15.0, 4.0-75.1), cough or congestion (OR 12.5, 3.2-65.4), lacerations (OR 11.0, 3.3-62.0) and minor problems (OR 7.8, 2.2-39.3). Our findings highlight key patient characteristics and primary concerns that could inform paramedics to identify patients suitable for non-ED care models. Incorporating evidence-based criteria into paramedic decision-making could support the safe and effective implementation of alternative care models, which could potentially reduce ED visitation and promote optimal healthcare resource distribution.

Anxiety and anxiety-related disorders are, as a group, the most common mental health conditions and are more common among women compared with among men. It is now evident that these disorders affect one in five pregnant and postpartum people and are more common than depression. For some disorders (e.g., obsessive-compulsive disorder), there is also evidence of an elevated risk for their development and exacerbation during perinatal periods. In this article, we review the literature pertaining to anxiety and anxiety-related disorders during the perinatal period. We also provide information related to pregnancy-specific anxiety and fear of childbirth constructs that exist outside of diagnostic classification but are particularly important in the perinatal context. We review the scope, prevalence, and etiology of these disorders as well as comorbidity, screening, assessment, and treatment. We conclude with an overview of some of the key gaps in knowledge and recommendations for future research.

Background:Electrical stimulation (ES) applied for 1 hour following surgical intervention enhances axonal regeneration and functional outcomes. Clinical implementation, however, has been hindered due to the lack of appropriately designed stimulators.Methods:This multicenter, prospective, open-label study aimed to demonstrate the safety and device feasibility of a novel, single-use stimulator for implementing perioperative ES therapy in a variety of upper extremity surgical procedures. Patients undergoing surgical intervention for upper extremity nerve injury, neuropathy, or lesions were included. An investigational version of a novel therapeutic peripheral nerve stimulator was used to deliver 1-hour ES therapy perioperatively. Safety was assessed by the cumulation of adverse events. Patient tolerance to ES therapy was obtained during the treatment, and pain was also assessed at the first postoperative visit. Device usability questionnaires were completed by the study surgeons.Results:A total of 25 patients were enrolled. There were no related adverse events or adverse device effects. Implementation of the device took less than 5 minutes in the operating room in most cases. Bipolar stimulation was preferred, with a mean ± SD stimulus level of 2.2 ± 0.7 mA, and therapy was well tolerated. The mean first postoperative pain score was 1.2 out of 10. Surgeons indicated that perioperative implementation of the therapeutic peripheral nerve stimulator was easy and did not cause major disruptions to the clinical workflow.Conclusions:Perioperative application of 1-hour ES therapy is a feasible, safe, and promising approach to enhancing peripheral nerve regeneration as an adjunct to surgical intervention.