Care Questionnaire Research Articles

Unmet care needs of patients with advanced cancer and their relatives: multicentre observational study

ObjectivesThe care needs of patients with advanced cancer and their relatives change throughout the disease trajectory. This study focused on the care-related problems and needs of patients with advanced cancer...

Measuring patients' experiences of continuity of care in a primary care context-Development and evaluation of a patient-reported experience measure.

Continuity of care is viewed as a hallmark of high-quality care in the primary care context. Measures to evaluate the quality of provider performance are scarce, and it is unclear how the assessments correlate with patients' experiences of care as coherent and interconnected over time, consistent with their preferences and care needs. To develop and evaluate a patient-reported experience measure of continuity of care in primary care for patients with complex care needs. The study was conducted in two stages: (1) development of the instrument based on theory and empirical studies and reviewed for content validity (16 patients with complex care needs and 8 experts) and (2) psychometric evaluation regarding factor structure, test-retest reliability, internal consistency reliability, and convergent validity. In all, 324 patients participated in the psychometric evaluation. The Patient Experienced Continuity of care Questionnaire (PECQ) contains 20 items clustered in four dimensions of continuity of care measuring Information (four items), Relation (six items), Management (five items), and Knowledge (five items). Overall, the hypothesized factor structure was indicated. The PECQ also showed satisfactory convergent validity, internal consistency, and stability. The PECQ is a multidimensional patient experience instrument that can provide information on various dimensions useful for driving quality improvement strategies in the primary care context for patients with complex care needs. Patients have participated in the content validation of the items.

What is known about patient-centered care application in post-surgical breast cancer patients?

Over the past two decades, patient-centered care has become internationally recognized as a dimension of high-quality health care. Recent research has shown that patient-centered care has many benefits, which are broadly categorized as patient experience and clinical and operational benefits. The study aimed at analyzing the correlation between the application of patient-centered care (PCC) and length of stay, patient satisfaction, and clinical outcome of post-surgical breast cancer patients. The study design was cross-sectional. A sample of 100 patients was determined and selected with the inclusion criteria. Data were collected using measuring tools comprising patient-centered care and patient satisfaction questionnaires as well as medical records to evaluate the length of stay and clinical outcomes. Bivariate analysis was conducted to analyze the correlation between patient-centered-care and length of stay (LOS), patient satisfaction, and the clinical outcomes of inpatients. A correlation was found between patient-centered care (PCC) application and patient satisfaction (p = 0.005), but no correlation was observed between PCC application and length of stay (LOS) (p = 0.176) as well as clinical outcome (p = 0.128). The application of patient-centered care can be attributed to patient satisfaction but is not correlated to length of stay and clinical outcome of post-surgical breast cancer patients. The hospital should create an accepted definition and commonly agreed set of dimensions used for the concept of operationalization and its measurement to implement PCC and improve overall patient satisfaction and clinical outcome and reduce the length of stay as expected.

Integration of Complementary Medicine in Supportive Cancer Care: Survey of Healthcare Providers’ Perspectives

Background: In recent years, it has been discovered that complementary and traditional medicine (CTM) use among cancer patients has increased. In order to successfully integrate these treatments into cancer care, it is critical to assess the viewpoints, foreseen obstacles and recommendations for CTM use in cancer patients from the perspective of healthcare practitioners (HCPs). Purpose: This study aimed to explore the perspectives of HCPs on CTM integration in cancer care, as well as perceived barriers and suggested recommendations to CTM use in oncology settings. Methods: A descriptive cross-sectional design was used to collect data from a sample of 240 healthcare providers (HCPs) using the Complementary and Traditional Medicine in Supportive Cancer Care Questionnaire. Results: Findings revealed that 49.6% of the participating HCPs reported that 50% of cancer patients had used CTM in the past year. Approximately 75% of HCPs perceived that the greatest motives for cancer patients to use CTM are to improve their well-being and QoL, in addition to have lower chemotherapy side effects. According to HCPs, patients resorted to diet/nutrition therapy and herbs the most during chemotherapy or advanced cancer and they would first consult a folk healer (48.8%), then an oncologist (31.7%) about CTM used modalities. The findings also revealed that HCPs perceived inadequate communication between CTM and conventional practitioners and oncologist skepticism and rejection of CTM as barriers to CTM integration. Conclusion: HCPs saw a need to improve communication between integrative physicians and cancer patients by focusing on the patients’ lifestyle and outlook, their well-being and their ability to function. Implications for Nursing: The findings showed that the majority of HCPs considered oncology nurses to have a crucial role in “participating in building CTM treatment plan”. Therefore, nurses need to take a leading role towards reducing the barriers of CTM integration in cancer care settings and involve in planning educational training programs focusing on the benefits and risks of using CTM and the best methods towards integrating CTM modalities for cancer patients.

Barriers to Receiving Follow-up Care Among Childhood Cancer Survivors.

Little is known on why adherence to follow-up care in childhood cancer survivors (CCS) is lacking. This study characterized barriers to adherence to follow-up care among CCS, identified sociodemographic correlates of barriers, and examined whether barriers to follow-up care relate to health-related quality of life. Adult CCS (N=84) were anonymously surveyed via REDCap using the Barriers to Care Questionnaire (BCQ) and the Quality of Life Scale-Cancer Survivor (QOL-CS). Both descriptive and correlation analyses were conducted. The median BCQ total score was 88.5 (interquartile ranges:78.4 to 95.7), with the greatest barriers reported in the Skills (eg, ease of navigating the healthcare system) and Pragmatism subscales (eg, cost). There was a statistically significant correlation between the BCQ total score and the QOL-CS total score (rs=0.47, P <0.0001) and the physical, psychological, and social QOL-CS subscales (all P 's<0.05). The results found that barriers to follow-up care for CCS are mostly related to cost and appointment logistics, and that more barriers to care is associated with lower health-related quality of life among CCS. Identifying barriers to follow-up care is the first step in improving adherence, which would allow for earlier detection of late effects of cancer therapy and thereby result in reductions in morbidity and mortality.

Adolescent mentalizing and childhood emotional abuse: implications for depression, anxiety, and borderline personality disorder features.

There is preliminary evidence that childhood emotional abuse (CEA) is a risk factor for adolescent mentalizing difficulties (Uncertainty/Confusion about mental states) and borderline personality features and that Uncertainty/Confusion about mental states mediate the relationship between CEA and adolescent borderline personality features, but these findings need replication. Furthermore, no previous studies have examined the relationship between adolescent mentalizing deficits, anxiety, and depression in the context of CEA. This study examined the associations between CEA, adolescent borderline personality features, depression and anxiety symptoms and tested a pathway model where Uncertainty/Confusion about mental states mediates the relationships between CEA and adolescent borderline personality features, depression and anxiety symptoms. A clinical sample of 94 adolescents completed the Reflective Function Questionnaire for Youth (RFQY) to assess mentalizing, the Childhood Experiences of Care and Abuse Questionnaire (CECA-Q), the Borderline Personality Disorders Features Scale (BPFS-C), and the Beck Youth Inventories for Depression (BDI-Y) and Anxiety (BAI-Y). Uncertainty/Confusion about mental states partially mediated the relationship between CEA and borderline traits as well as anxiety. In addition, there was an indirect effect where CEA predicted Uncertainty/Confusion about mental states, which then predicted depression. The findings are consistent with the mentalizing model of psychopathology and provide new evidence that Uncertainty/Confusion about mental states might be a critical mentalizing deficit that characterizes the associations between CEA and adolescent BPD features and depression and anxiety symptoms. Uncertainty/Confusion may be a transdiagnostic risk factor for adolescent psychological distress and dysfunction. We discuss the clinical implications.

Investigating associations between social determinants, self-efficacy measurement of sleep apnea and CPAP adherence: the SEMSA study.

The prospective Self-Efficacy Measure for Sleep Apnea study (SEMSAS) is investigating thresholds for health literacy, self-efficacy and precariousness at obstructive sleep apnea (OSA) diagnosis to predict CPAP adherence. This paper describes the study protocol and presents baseline data from the ongoing study. Eligible individuals had confirmed OSA and were referred to a homecare provider for continuous positive airway pressure (CPAP) therapy initiation. Data on patient characteristics and comorbidities were collected, along with baseline evaluations of self-efficacy [15-item Self-Efficacy Measure for Sleep Apnea tool (SEMSA-15)], precariousness [Deprivation in Primary Care Questionnaire (DipCareQ)], and health literacy (Health Literacy Questionnaire). CPAP adherence over 12 months of follow-up will be determined using remote monitoring of CPAP device data. The primary objective is to define an optimal SEMSA-15 score threshold to predict CPAP adherence at 3- and 12-month follow-up. Enrollment of 302 participants (71% male, median age 55 years, median body mass index 31.6 kg/m2) is complete. Low self-efficacy (SEMSA-15 score ≤ 2.78) was found in 93/302 participants (31%), and 38 (12.6%) reported precariousness (DipCareQ score > 1); precariousness did not differ significantly between individuals with a SEMSA-15 score ≤ 2.78 versus >2.78. Health literacy was generally good, but was significantly lower in individuals with versus without precariousness, and with low versus high self-efficacy. SEMSAS is the first study using multidimensional baseline assessment of self-efficacy, health literacy and precariousness, plus other characteristics, to determine future adherence to CPAP, including CPAP adherence trajectories. Collection of follow-up data is underway.

Translation, Adaptation, and Validation of the Malay Version of the Barriers to Access to Care Questionnaire for Assessing the Barriers to Seeking Mental Health Care Among the Health Workforce in the East Coast Region of Peninsular Malaysia.

Background Mental health problems among the health workforce are a significant concern worldwide, including in Malaysia. Unfortunately, some health workforce may perceive various barriers or challenges that prevent them from seeking help. Identifying and addressing these barriers is crucial for enhancing mental health services and support. The Barriers to Access to Care Evaluation (BACE-3) questionnaire is a valuable tool that can be used for assessing these barriers among health workers. However, a validated Malay version is needed. Therefore, this study aims to translate, adapt, and validate the original version of Barriers to Access to Care Evaluation (BACE-3) into the Malay version (MBACE). Methods A rigorous process of translation and adaptation was followed to develop the Malay version of the BACE-3 questionnaire (MBACE). A cross-sectional study was conducted to assess the psychometric properties of the questionnaire, with purposive sampling employed to recruit 188 participants from various job categories, including doctors, nurses, pharmacists, and non-clinical staff, such as health assistants and clerks. The analysis was conducted using the R software version 4.2.2 (R Foundation, Vienna, Austria). Construct validity was determined using confirmatory factor analysis (CFA). To assess the convergent validity, internal consistency, and reliability of the instrument, measures such as the average variance extracted (AVE), composite reliability (CR), and Cronbach's alpha values were calculated. Results During the CFA process, two items with a factor loading less than 0.5 (items 15 and 16) were removed to improve the convergent validity and model fit. The CFA results revealed that the 2-factor model MBACE had good construct validity (root mean square error of approximation (RMSEA) = 0.053; comparative fit index (CFI) = 0.939; Tucker-Lewis fit index (TLI) = 0.934). The internal consistency was supported by Cronbach's alpha values ranging from 0.92 to 0.94 for the stigma factor and non-stigma factor. The average variance extracted (AVE) and composite reliability (CR) values further supported the questionnaire's reliability and convergent validity. Conclusion The translated and adapted 28-item MBACE questionnaire is a valid and reliable tool for assessing the barrier to seeking professional mental health care among the Malaysian health workforce. This instrument has the potential to aid in the development of targeted interventions to promote mental health help-seeking behavior and enhance the well-being of the Malaysian health workforce.

Satisfaction with Homeopathic Service and Care for Persons with Spinal Cord Injury

Background: The aim of the study was to investigate the satisfaction of individuals with spinal cord injury (SCI) with a homeopathic service at an SCI rehabilitation center. Patients and Methods: A cross-sectional questionnaire study was performed at an SCI rehabilitation center in Switzerland. It included patients with chronic SCI who presented themselves to a homeopathic service offered by the hospital in a 12-months period. The participants filled in standardized questionnaires in German: “Measure Yourself Medical Outcome Profile” (MYMOP), Treatment Satisfaction Questionnaire for Medication (TSQM-9), the European Project on Patient Evaluation of General Practice Care (EUROPEP) questionnaire, and a self-administered questionnaire. Results: The data of 14 patients were analyzed. Symptom severity as well as bother by the symptoms that led to homeopathic treatment decreased under homeopathic treatment (severity: from 4.3 to 3.3; bother: from 4.2 to 2.9) and remained lower over time (severity: 2.6; bother: 2.7), suggesting a sustained effect. Irrespective of the test instrument used, satisfaction rates were higher for homeopathic service than for homeopathic medication, which was rated as successful by 50% of the participants. Conclusion: Persons with SCI suffering from secondary complications of SCI who accessed homeopathic care reported high satisfaction rates with the service. Therefore, homeopathic service can be considered as an additive measure in persons with SCI suffering from recurrent symptoms.

Improving the Implementation of Family-Centered Care Within the Neonatal Care Unit: Empowering Parents to Participate in Infant Care.

Internationally, approximately 15 million babies are born prematurely every year. In New Zealand, 1 neonatal ward may care for 1000 infants annually. Family-centered care (FCC) is a philosophy used in neonates to enhance positive outcomes for infants, parents, and staff by recognizing the strengths and needs of infants and their families. This research assessed how a neonatal environment could be improved to ensure parents feel welcomed and empowered to participate in their infant's care. Survey data from 67 health professionals and 51 parents of infants who received neonatal care for more than 7 days. Four in-depth interviews with parents and 5 with health professionals. A mixed-methods research design was used. Phase 1 collected quantitative data using the Family-Centered Care Questionnaire. Phase 2 composed of face-to-face interviews with health professionals and parents. Implementing FCC practices to improve health outcomes for infants, parents, and staff is important. Recommendations for improvement were formulated from the themes. The perspectives of parents and health professionals have enabled the development of recommendations to improve the implementation of FCC practice in the neonatal environment. These may lead to better parental experience and improved infant health outcomes.

Transcriptional Modulation of Stress-Related Genes in Association with Early Life Stress Exposure and Trauma-Focused Psychotherapy in Treatment-Resistant Depression Patients

Early life stress (ELS) is associated with treatment-resistant depression (TRD), and trauma-focused psychotherapy benefits TRD patients exposed to ELS. We explored peripheral modulations of stress-response genes (nuclear receptor subfamily 3 group C member 1[NR3C1], FK506-binding protein 5[FKBP5], and serum/glucocorticoid-regulated kinase 1 [SGK1]) in relation to ELS and symptom changes during psychotherapy. Forty-one TRD patients participated and 21 patients underwent trauma-focused psychotherapy, comprising eye movement desensitization and reprocessing or trauma-focused cognitive behavioral therapy. We used the Montgomery-Åsberg Depression Rating Scale, the Beck Depression Inventory-II and the Beck Anxiety Inventory for symptom evaluation, the Childhood Experience of Care and Abuse Questionnaire for ELS assessment, and the quantitative reverse transcription polymerase chain reaction (RT-qPCR) for transcript analysis. We found higherNR3C1andFKBP5baseline mRNA levels in patients with maternal neglect. Trauma-focused psychotherapy induced modifications in transcripts’ levels and symptom amelioration along psychotherapy correlated with genes’ modulations. Transcript levels for all genes were higher in patients relapsing after 24 weeks.

Challenges to medication adherence with intranasal corticosteroid irrigations.

The purpose of this study was to investigate real-world adherence to intranasal corticosteroid irrigations using pharmacy data and assess factors associated with low adherence. Patients undergoing treatment with corticosteroid irrigations for any diagnosis during a 2-year period were prospectively recruited. Subjects completed a one-time set of questionnaires including the Barriers to Care Questionnaire (BCQ), 22-item Sino-Nasal Outcome Test (SNOT-22), and a questionnaire assessing their experience with corticosteroid irrigations. Pharmacy data was used to calculate the medication possession ratio (MPR), a measure of medication adherence graded from 0 to 1. Seventy-one patients were enrolled. Patient diagnoses included chronic rhinosinusitis (CRS) without nasal polyps (n=37), CRS with nasal polyps (n=24), or a non-CRS diagnosis, most commonly chronic rhinitis (n=10). The MPR for the overall group was 0.44±0.33. Just 9.9% of patients had a perfect MPR of 1. Despite low MPR, only 19.7% of patients reported problems taking the medication when directly asked. Lower education resulted in lower MPR (unstandardized B=0.065, p=0.046). Increasing BCQ score, indicating higher barriers to care, was associated with lower MPR (unstandardized B=-0.010, p=0.033). The lower the MPR, the worse the patient SNOT-22 scores (unstandardized B=-15.980, p=0.036). Adherence to corticosteroid irrigations was low and patients underreported issues with their medication. Education and barriers to care were associated with lower adherence, which, in turn, was associated with worse sinonasal quality of life.

APPLICATION OF FAMILY CENTERED CARE (FCC)

The role of the family in the theoretical system is as a caregiver for sick family members. Family involvement in client care is applied in care known as the Family Centered Care concept. The application of Family Centered Care can increase knowledge and attitudes of families in the care of clients who are hospitalized. The purpose of the study was to determine the level of application of Family Centered Care. The research method used is a descriptive study. The research sample was 100 respondents. The sampling technique used is accidental sampling. The data collection tool used is a family centered care questionnaire. The research analysis used univariate analysis in the form of a frequency distribution. The results showed that the application of family centered care was in the good category as many as 71 respondents (71%), and in the medium category as many as 29 respondents (29%). From the results of the study, it was stated that nurses had involved the family in care, where the family participated in making decisions on support plans, recovery and helping patients not to be anxious. The conclusion is that the application of family centered care is in the good category.

Nurses' napping practices and their effects on sleepiness, fatigue, well-being, and quality of nursing care

Background &amp; Aim: Napping is one of the evidence-based countermeasures to fatigue and decreased alertness during night shift work. We aimed to understand night shift nurses' napping practices and study the effectiveness of different nap lengths on sleepiness, fatigue, well-being, and the quality of nursing care.&#x0D; Methods &amp; Materials: A comparative descriptive design was used. Data were self-reported by 305 nurses using the Questionnaire on Night Shift Napping Practices, the Karolinska Sleepiness Scale, the Fatigue Visual Analog Scale, the Everyday Feeling Questionnaire, and the Quality of Nursing Care Questionnaire. Data collection was done over 4 months between August and November 2022. Frequency tables, Mean, and standard deviation were used to describe data, and One-way analysis of variance (ANOVA) was used for means comparisons.&#x0D; Results: About 40% of the nurses reported that they took naps during their night shifts. The majority (82.92%) reported that they napped for more than 45 minutes (N= 305). Napping was found to significantly reduce sleepiness (P= 0.002) and fatigue (P= 0.001) and improve the quality of nursing care (P= 0.03). The group who napped for more than 45 minutes reported significantly reduced levels of sleepiness (P= 0.02) and fatigue (P= 0.01) when compared to the group who either didn’t nap or napped for less than 45 minutes.&#x0D; Conclusion: This study suggests that implementing nap interventions for nurses on night shift can be an effective method to reduce sleepiness and fatigue, and improve patient care.

Measuring attitudes, motivations and barriers to presymptomatic dementia testing

AbstractBackgroundThe increasing biomarkers testing and new methods of presymptomatic screening for dementia have risen questions like: Should people get tested? Would they want to know whether they will get this fatal, untreatable disease? This has picked the demand for a well‐structured counseling program for dementia screening. In this direction, it is important to meet the needs of the target group; however, not much is known about people with a family history of dementia attitudes about testing, the motivations and barriers, and the expectations relevant to future counseling programs about testing for dementiaMethodThis study was comprised of a validation study of a new psychometric tool and a cross‐sectional survey to assess the attitudes, buries and motivations to dementia testing. The content of the questionnaire was based on (1) a literature review, (2) the Perceptions Regarding Investigational Screening for Memory in Primary Care (PRISM‐PC) Questionnaire (M. Boustani et al., 2008), (3) a board of Clinical expert opinions. Two hundred eight (208) people enrolled in this cross sectional study. Participants came from Greece, ages ranged from 18‐70 (M = 35.5, SD = 5.7). and the majority of the sample was female (93.3%). Psychometric properties were assessed through construct validity (principal component analysis) and internal consistency (Cronbach’s alpha).ResultExploratory factor analyses revealed the presence of four factors. The first factor labelled as “Perceived harms of testing”, the second “Acceptance of testing”, the third “Perceived benefits of testing”) and the fourth factor “Need of knowledge”. The reliability of each factor separately was satisfactory to very satisfactory (.70‐.87). Cronbach’s alpha coefficient for all the final 25 items of the initial questionnaire was good (Cronbach’s α = 0.82), suggesting very satisfactory internal consistency.ConclusionThis is the first study that created a questionnaire for measuring the attitudes of Greek people towards dementia and genetic screening. Capturing data via this questionnaire might help clinicians, policymakers, and health services researchers in dementia understand better peoples’ perspectives related to the pros and cons of dementia screening and develop effective counseling programs and prevention strategies.

Experiences of childbirth care among immigrant and non-immigrant women: a cross-sectional questionnaire study from a hospital in Norway

BackgroundImmigrant women have higher risks for poor pregnancy outcomes and unsatisfactory birth experiences than the general population. The mechanisms behind these associations remain largely unknown, but they may result from differential care provided to immigrant women or unsatisfactory interactions with health providers. This study aimed to investigate immigrant and non-immigrant women's experiences of health care during childbirth, particularly assessing two dimensions: perceived general quality of care and attainment of health care needs during childbirth.MethodsThis was a cross-sectional study carried out over 15 months in 2020 and 2021, and data were collected from a self-completed questionnaire. The labour and birth subscale from the Experience of Maternity Care questionnaire was used to assess the primary outcome of care experiences. A total of 680 women completed the questionnaire approximately within two days after birth (mean 2.1 days) at a hospital in Trondheim, in central Norway. The questionnaire was provided in eight languages.ResultsThe 680 respondents were classified as immigrants (n = 153) and non-immigrants (n = 527). Most women rated their quality of care during childbirth as high (91.5%). However, one-quarter of the women (26.6%) reported unmet health care needs during childbirth. Multiparous immigrant women were more likely than multiparous non-immigrant women to report that their health care needs were unmet during childbirth (OR: 3.31, 95% CI: 1.91–5.72, p < 0.001, aOR: 2.83, 95% CI: 1.53–5.18, p = 0.001). No other significant differences between immigrant versus non-immigrant women were found in subjective ratings of childbirth care experiences. Having a Norwegian-born partner and a high level of Norwegian language skills did not influence the immigrant women's experience of childbirth care.ConclusionsOur findings indicate that many women feel they receive high-quality health care during childbirth, but a considerable number still report not having their health care needs met. Also, multiparous immigrant women report significantly more unmet health care needs than non-immigrants. Further research is required to assess immigrant women's childbirth experiences and for health care providers to give optimal care, which may need to be tailored to a woman's cultural background and individual expectations.

Gambaran Intervensi Family Centered Care pada Pasien Balita di RS Perkebunan Wilayah Karesidenan Besuki Raya

The implementation of family-centered care in pediatric hospitals in developed countries has been well-standardized. But, in Indonesia, it can be implemented with the possibility to be realized ideally is not easy because of many health workers do not understand family-centered care properly. The purpose of this study is to describe the application of Family Centered Care in toddler patients in inpatient rooms conducted by nurses. This research is a descriptive study with a cross-sectional approach using a purposive sampling technique. The study was conducted at Kaliwates General Hospital, Jember Klinik Hospital and Elizabeth Situbondo Hospital Data collection was performed using a Family Centered Care questionnaire. Data Collection was carried out from September 2019 to December 2019. The study Participants were 98 families selected by purposive sampling technique. Data were collected techniques using in-depth interviews and documentation. The results showed that the majority of families (83.7%) were good. Nurses can be good counselors and educators in meeting the needs of families and children in the hospital to have a good cooperative relationship between family and nurses. Nurses can improve the quality of their services by understanding more deeply about family needs and strengths.

Outpatient Practice of Lipid-Lowering Therapy Prescription (According to the ARGO-3 Study)

Aim. To study the frequency of prescriptions of various types of lipid-lowering therapy and their effectiveness in outpatient clinical practice based on the results of a questionnaire of primary care physicians.Material and methods. The study was performed in 2022 in 75 constituent entities of the Russian Federation with the participation of 1117 doctors working in outpatient clinics. Most of the doctors had work experience of 10-20 years or more. Doctors of polyclinics (therapists and cardiologists, etc.) before the start of the study received instructions, questionnaires for filling out, developed by the National Atherosclerosis Society. The frequency of prescriptions by primary care physicians of various types of lipid-lowering therapy and their effectiveness in terms of the frequency of achieving target levels of low-density lipoprotein cholesterol (LDL-C) was studied based on the results of a questionnaire.Results. Monotherapy with statins was prescribed in 55.2% of cases, free combination of rosuvastatin with ezetimibe – in 17.2%, single pill combination of rosuvastatin with ezetimibe – in 23.2%, combination therapy with PCSK9 inhibitors – in 4.1% of cases. Target levels of LDL-C ˂ 1.8 mmol/l and ˂ 1.4 mmol/l were achieved with statin monotherapy in 42.6% and 28.2% of cases, respectively, free combination of rosuvastatin with ezetimibe – in 61.7% and 39 .5%, a fixed combination of rosuvastatin with ezetimibe – in 67.8% and 48.5%, combination therapy with PCSK9 inhibitors – in 96.8% and 92.8% of cases.Conclusion. The single pill combination of rosuvastatin with ezetimibe is more effective in achieving target levels of LDL-C compared with statin monotherapy and therapy with free combination of statin with ezetimibe. Despite the fact that the target values of LDL-C when prescribing a combination with PCSK9 inhibitors were achieved in 96.8% and 92.8% of cases, they were used quite rarely at the outpatient stage of treatment in the Russian Federation.

Making post-war urban neighbourhoods healthier: involving residents’ perspectives in selecting locations for health promoting urban redesign interventions

ABSTRACT Post-war urban neighbourhoods in industrialised countries have been shown to negatively affect the lifestyles of their residents due to their design. This study aims at developing an empirical procedure to select locations to be redesigned and the determinants of health at stake in these locations, with involvement of residents’ perspectives as core issue. We addressed a post-war neighbourhood in the city of Groningen, the Netherlands. We collected data from three perspectives: spatial analyses by urban designers, interviews with experts in local health and social care (n = 11) and online questionnaires filled in by residents (n = 99). These data provided input for the selection of locations to be redesigned by a multidisciplinary team (n = 16). The procedure yielded the following types of locations (and determinants): An area adjacent to a central shopping mall (social interaction, traffic safety, physical activity), a park (experiencing green, physical activity, social safety, social interaction) and a block of low-rise row houses around a public square (social safety, social interaction, traffic safety). We developed an empirical procedure for the selection of locations and determinants to be addressed, with addressing residents’ perspectives. This procedure is potentially applicable to similar neighbourhoods internationally.

Cannabis use as a potential mediator between childhood adversity and first-episode psychosis: results from the EU-GEI case–control study

AbstractBackgroundChildhood adversity and cannabis use are considered independent risk factors for psychosis, but whether different patterns of cannabis use may be acting as mediator between adversity and psychotic disorders has not yet been explored. The aim of this study is to examine whether cannabis use mediates the relationship between childhood adversity and psychosis.MethodsData were utilised on 881 first-episode psychosis patients and 1231 controls from the European network of national schizophrenia networks studying Gene–Environment Interactions (EU-GEI) study. Detailed history of cannabis use was collected with the Cannabis Experience Questionnaire. The Childhood Experience of Care and Abuse Questionnaire was used to assess exposure to household discord, sexual, physical or emotional abuse and bullying in two periods: early (0–11 years), and late (12–17 years). A path decomposition method was used to analyse whether the association between childhood adversity and psychosis was mediated by (1) lifetime cannabis use, (2) cannabis potency and (3) frequency of use.ResultsThe association between household discord and psychosis was partially mediated by lifetime use of cannabis (indirect effect coef. 0.078, s.e. 0.022, 17%), its potency (indirect effect coef. 0.059, s.e. 0.018, 14%) and by frequency (indirect effect coef. 0.117, s.e. 0.038, 29%). Similar findings were obtained when analyses were restricted to early exposure to household discord.ConclusionsHarmful patterns of cannabis use mediated the association between specific childhood adversities, like household discord, with later psychosis. Children exposed to particularly challenging environments in their household could benefit from psychosocial interventions aimed at preventing cannabis misuse.