Health Care Research Articles

The Development and Feasibility Testing of the Nurse-Led Transitioning Adolescents Off Cancer Treatment (TACT) Intervention.

To develop and assess the feasibility of a nurse-led intervention aimed at improving the transition from cancer treatment to survivorship for adolescents by providing personalised information and psychosocial and self-management support. Intervention development through co-creation with adolescent patients with cancer, their parents and health care professionals, based on the MRC framework and qualitative feasibility testing. The intervention development involved three steps: (a) identifying the problem through interviews with key stakeholders and by reviewing existing evidence on transition tools and practices; (b) designing the intervention through co-creation workshops with stakeholders and (c) assessing feasibility, acceptability and participants' experiences of the intervention through interviews with adolescents, parents, healthcare professionals and teachers. The Transitioning Adolescents with Cancer off Treatment (TACT) intervention was developed, and feasibility was tested between October 2021 and October 2022. TACT included two nurse-led consultations addressing transition concerns and a videoconference with local support networks to inform and activate stakeholders. Communication tools were developed and successfully used to address adolescents' needs, tailor information and support self-management. The nurse-led TACT intervention appears feasible and acceptable for clinical practice, with no major changes needed. Participants reported that the intervention helped prepare adolescent cancer patients to transition to survivorship by providing tailored information and psychosocial and self-management support. Despite high survival rates of childhood cancers and the growing awareness of the challenges adolescents and their families face when transitioning off treatment to survivorship, few interventions are available. The novel TACT intervention indicates that nurses are well-positioned to provide broad, tailored care addressing survivors' multi-faceted needs and challenges associated with this transition. Consolidated criteria for reporting qualitative research (COREQ). Adolescent survivors, their parents, nurses and physicians involved in their care contributed through co-creation groups, contributing feedback that shaped and refined the TACT intervention.

Patient Voices: Multimethod Study on the Feasibility of Implementing Electronic Patient-Reported Outcome Measures in a Comprehensive Cancer Center.

"Patient Voices" is a software developed to promote the systematic collection of electronic patient-reported outcome measures (ePROMs) in routine oncology clinical practice. This study aimed to assess compliance with and feasibility of the Patient Voices ePROM system and analyze patient-related barriers in an Italian comprehensive cancer center. Consecutive patients with cancer attending 3 outpatient clinics and 3 inpatient wards were screened for eligibility (adults, native speakers, and being able to fill in the ePROMs) and enrolled in a quantitative and qualitative multimethod study. Compliance, reasons for not administering the ePROMs, patients' interaction needs, and patient-perceived System Usability Scale (range 0-100) were collected; semistructured interviews were carried out in a subsample of patients. From June 2020 to September 2021, a total of 435 patients were screened, 421 (96.7%) were eligible, and 309 completed the ePROMs (309/421, 73.4%; 95% CI 69.8%-77.5%; mean age 63.3, SD 13.7 years). Organization problems and patient refusal were the main reasons for not administering the ePROMs (outpatients: 40/234, 17.1% and inpatients: 44/201, 21.9%). Help for tablet use was needed by 27.8% (47/169) of outpatients and 10.7% (15/140) of inpatients, while the support received for item interpretation was similar in the 2 groups (outpatients: 36/169, 21.3% and inpatients: 26/140, 18.6%). Average System Usability Scale scores indicated high usability in both groups (outpatients: mean 86.8, SD 15.8 and inpatients: mean 83.9, SD 18.8). Overall, repeated measurement compliance was 76.9% (173/225; outpatients only). Interviewed patients showed positive attitudes toward ePROMs. However, there are barriers to implementation related to the time and cognitive effort required to complete the questionnaires. There is also skepticism about the usefulness of ePROMs in interactions with health care professionals. This study provides useful information for future ePROM implementation strategies, aimed at effectively supporting the routine clinical management and care of patients with cancer. In addition, these findings may be relevant to other organizations willing to systematically collect PROMs or ePROMs in their clinical routines. ClinicalTrials.gov NCT03968718; https://clinicaltrials.gov/study/NCT03968718.

Strengthening Primary Health Care for Epidemic and Pandemic Response: A Scoping Review.

Epidemics strain healthcare systems and reduce care quality, making primary healthcare a crucial frontline component in combating pandemics. The aim of this paper was to explore the experiences of countries in strengthening primary health care to address epidemics and pandemics of infectious diseases. It was a scoping review conducted in 2024. The research was qualitative in nature. Multiple databases were searched including PubMed, Scopus, and ProQuest. Upon screening the references, the Boyatzis approach to thematic analysis was utilised to analyse and categorise the acquired data based on the fundamental building blocks of healthcare systems as presented by the World Health Organisation (WHO). Sixty-seven studies were included in the study, reporting widespread strategies and interventions implemented in primary healthcare systems around the globe. The majority of these strategies and interventions were within the context of service delivery, leadership/governance, and health workforce. The strategies and interventions implemented by primary healthcare systems worldwide during the pandemic crisis are extensive and varied. Further research is required to provide a comprehensive understanding of the potential impacts of such interventions. There are numerous strategies and interventions reported in the literature for epidemic and pandemic response, which healthcare policymakers and managers can utilise to improve patient care during times of crisis. The study examined challenges in primary healthcare during crises, such as pandemics. It identified various strategies and interventions aimed at addressing these challenges, primarily in service delivery, leadership/governance, and health workforce management. Healthcare policymakers and managers can leverage these findings to enhance patient care during crises. PRISMA 2020 guideline for review studies. No Patient or Public Contribution.

Minimally important change on the Columbia Impairment Scale and Strengths and Difficulties Questionnaire in youths seeking mental healthcare

BackgroundEvidence-based mental health requires patient-relevant outcome data, but many indicators lack clinical meaning and fail to consider youth perceptions. The minimally important change (MIC) indicator designates change as meaningful to...

Barriers and facilitators to the implementation of PHAROS, a perioperative pharmaceutical management intervention for older adults – a qualitative interview study from the perspective of healthcare providers

BackgroundNumber of drugs are increasing with older age and present a risk factor for various adverse health outcomes. A comprehensive medication therapy management (MTM) before admission for elective surgery may help reduce unnecessary and potentially inadequate medications (PIM) and thus improve patient health. Our goal was to evaluate the implementation of PHAROS, a perioperative MTM intervention study, from the perspective of health care providers. The PHAROS intervention aimed to improve medication appropriateness in older inpatients at the outpatient / inpatient interface.MethodsWe performed a qualitative interview study within a pilot intervention study comparing a comprehensive MTM with standard care in older inpatients (≥ 65 years) in Germany. Semi-structured interviews with health care professionals were performed from March to July 2021. The Consolidated Framework for Implementation Research (CFIR) was used to guide development of interview guide, data coding, analysis, and reporting of findings.ResultsTen health care professionals involved in the implementation of PHAROS were interviewed. Based on CFIR-constructs, facilitators included need for and meaningfulness of the intervention as well as positive and supportive cooperation within the project team. Implementation of MTM at the interface of inpatient to outpatient care before elective surgery was hampered by personal and organizational barriers as well as barriers resulting from broader health care structures in Germany. In particular, lack of documentation standards, missing compatibility with clinical workflow, difficulties in stakeholder engagement, as well as communication barriers between outpatient and inpatient care interfaces hindered implementation of the intervention.ConclusionsFurther studies should consider focusing on facilitators to pharmaceutical implementations such as transparent and clear communication structures between stakeholders, standardization of medication documentation, and intervention structures that are adapted to hospital workflows.Trial registrationhttps://drks.de Identifier: DRKS00014621, this study was part of the PHAROS study.

Real-world trends and future projections of the prevalence of cirrhosis and hepatic encephalopathy among commercially and Medicare-insured adults in the United States.

Describing cirrhosis and hepatic encephalopathy (HE) burden over time can inform clinical management and resource allocation. Using health care claims data, this observational study examined recent trends in the prevalence of cirrhosis and HE and associated health care resource utilization among commercially and Medicare-insured adults in the United States (US). Data from the MarketScan Commercial Claims and Encounters Database and 100% Medicare Research Identifiable Files were analyzed (2007-2020). Annual prevalence of cirrhosis, HE, overt HE (OHE) hospitalizations, and rifaximin ± lactulose use, and costs per hospitalization per year were calculated. Average year-over-year (YOY) changes in prevalence of cirrhosis and HE were estimated. Trends were extrapolated to 2030 using ordinary least-squares regression. From 2007 to 2020, the prevalence of cirrhosis increased by an average of 4.6% YOY in the Commercial population and 8.1% in the Medicare population; the prevalence of HE increased by 4.3% and 2.5%, respectively. Rates of OHE hospitalizations decreased from 27.5% to 5.5% (Commercial) and from 26.2% to 9.5% (Medicare), and rates of liver transplantation increased. Average payer costs (Commercial) and provider charges (Medicare) per OHE hospitalization increased (from $40,881 to $77,699 and from $45,913 to $74,894, respectively). Use of rifaximin ± lactulose showed an increasing trend during the observation period whereas lactulose use declined steadily. The health care burden of cirrhosis and HE in the US is increasing. Trends are projected to continue unless action is taken, such as improving medication access and developing policies addressing the contributing factors.

Understanding the growing burden of Malignant Pleural Effusion - epidemiology, health care utilization and cost, a Canadian perspective.

Malignant Pleural Effusion (MPE) is common in advanced malignancy. Data are needed on health care utilization and costs. This population-based retrospective cohort study included patients aged ≥18 years with an MPE diagnosed between January 1, 2004 and December 31, 2018. We described the incidence and prevalence of MPE from 2004 to 2018, and trends in hospital admissions, emergency department (ED) visits, and pleural-based procedures. In patients diagnosed with MPE from 2006 to 2016 we estimated 2-year health care costs (2018 US dollars) from the public payer perspective. The annual incidence and prevalence of MPE increased from 5,090 and 14,579 in 2004 to 6,977 and 23,204 in 2018, respectively. Annual mortality among prevalent patients decreased from 32% to 28%. In 2004, 57% of patients were hospitalized, decreasing to 50% in 2018. ED visits increased (59% to 61%). From 2004 to 2018, the number of patients who had insertions of thoracostomy tube (2,211 to 3,664) and tunnelled pleural catheter (383 to 1,164) increased. The number of patients receiving pleurodesis declined (565 to 284). No change occurred in the number of patients receiving video-assisted thoracoscopy (range 140 - 208/year). Between 2004 and 2016, 76,190 patients were diagnosed with MPE (mean age 71.2; 52% female). The median (interquartile range) health care cost during follow-up was $45,641 ($23,237-$86,700), with $19,753 ($9,590-$38,746) for inpatient hospitalization. Hospitalization and temporizing MPE procedures are associated with high costs. This population-based study may guide clinicians and policy makers to improve MPE management and reduce health care costs.

Impact of a Virtual Reality Intervention on Stigma, Empathy, and Attitudes Toward Patients With Psychotic Disorders Among Mental Health Care Professionals: Randomized Controlled Trial.

Previous studies have found that psychotic disorders are among the most stigmatized mental disorders. Of note, virtual reality (VR) interventions have been associated with improvements in attitudes and empathy and reduced stigma toward individuals with psychotic disorders, especially among undergraduates, but this has not been examined among mental health care professionals. We aimed to evaluate the effectiveness of a newly developed VR intervention for mental health care professionals to improve attitudes and empathy and reduce stigma toward people with psychotic disorders. We conducted a randomized controlled trial and recruited eligible mental health care professionals from a tertiary mental health care institution. Both arms (VR intervention and VR control groups) were evaluated at baseline, postintervention, and 1-month follow up. The evaluation included outcomes related to attitudes (modified attitudes toward people with schizophrenia scale), stigma (social distance scale, personal stigma scale), and empathy (empathetic concern subscale of the Interpersonal Reactivity Index). The experience with the VR intervention was assessed using a user satisfaction questionnaire, and qualitative feedback was gathered. Overall, 180 mental health care professionals participated and completed the study. Both groups showed improvements in attitude, social distance, and stigma scores but not the empathy score following the intervention. The VR intervention group had better user satisfaction than the VR control group. In addition, certain outcome measures were positively associated with specific factors including female gender, higher education level, certain job roles, years of work, and presence of loved ones with a mental disorder. Both the intervention and control VR groups of mental health care professionals showed improvements in attitudes, stigma, and social distance toward people with psychotic disorders. Future longitudinal studies may want to evaluate the impact of VR on caregivers and the public on these same and other outcome measures to reduce stigma and improve empathy toward individuals with psychotic disorders. clinicaltrials.gov NCT05982548; https://clinicaltrials.gov/study/NCT05982548.

Medication Management of Patients With Cancer Undergoing Surgery From Preadmission to Discharge: A Mixed-Methods Systematic Review.

To identify and synthesise available evidence about regular medication management processes, from preadmission to discharge from hospital, in patients with cancer undergoing surgery. Mixed-methods systematic review. Studies published from inception of each database until February 2023 were screened, utilising four main search concepts. The JBI methodology for mixed-methods systematic review was followed in this review. MEDLINE, CINAHL, EMBASE, APA PsycINFO, Scopus and Web of Science. Eight out of 717 screened studies were included. Two themes related to patients' medication management were identified. Preoperative factors such as polypharmacy, potentially inappropriate medications, delirium-inducing medications and preoperative discontinuation-requiring medications were associated with several postoperative complications in patients with cancer. Additionally, pharmacist-led interventions and collaborative efforts between nurses and patients were shown to improve the medication management process across the perioperative pathway. This systematic review emphasises the necessity of effectively managing regular medication, especially before surgery, to mitigate postoperative complications in patients with cancer. It offers critical insights into how involving pharmacists and nurses enhances medication management outcomes, benefiting health care professionals and institutions aiming to optimise perioperative medication therapy. Enhancing patients' regular medication management through comprehensive reviews before surgery, and improving collaborative practices among pharmacists, nurses and patients via targeted interventions introduced by health care organisations, ensure safe medication use throughout the perioperative pathway. Improving regular medication management process can reduce risk of medication errors and adverse drug events and enhance postoperative outcomes. SWiM reporting guidelines. No patient or public contribution.

Life With Classic Congenital Adrenal Hyperplasia Due to 21-Hydroxylase Deficiency: Challenges and Burdens.

Congenital adrenal hyperplasia (CAH) is an autosomal recessive genetic condition requiring daily medication(s) and attention to details. In addition to daily medications and regular visits with healthcare providers, families may live with perpetual angst regarding unpredictable occurrences of acute adrenal insufficiency. Despite numerous barriers and challenges imposed by this chronic condition, caregivers and healthcare professionals can empower our patients to achieve a good quality of life. CAH is a global condition for which access to health care widely varies depending on local resources. Major treatment aims include good health, good quality of life, and achievement of personal goals for affected persons. To achieve these aims, patients, caregivers, and healthcare professionals interact to promote health maintenance and encourage positive outcomes for individuals with CAH. This article describes aspects of daily living with CAH through the perspective of 1 family and their healthcare team living in the United States. A young adult patient, nurse educator, and physicians provide their perspectives regarding patient health care, general well-being, and safety emphasizing that patients with CAH can thrive. Nevertheless, remembering and recognizing that many individuals with CAH live in areas with limited resources and enduring sociocultural barriers is essential. With access to knowledgeable healthcare providers, sufficient resources, and psychosocial support, "children with CAH can thrive and live normal lives." The future challenge is securing mechanisms to decrease the financial, sociocultural, and health access barriers in other communities throughout the world.

Artificial Intelligence Decision Support Systems in Resource-Limited Environments to Save Lives and Reduce Moral Injury.

Future military conflicts are likely to involve peer or near-peer adversaries in large-scale combat operations, leading to casualty rates not seen since World War II. Casualty volume, combined with anticipated disruptions in medical evacuation, will create resource-limited environments that challenge medical responders to make complex, repetitive triage decisions. Similarly, pandemics, mass casualty incidents, and natural disasters strain civilian health care providers, increasing their risk for exhaustion, burnout, and moral injury. As opposed to exhaustion and burnout, which can be mitigated with appropriate rest cycles and changes in workload, moral injury is a long-lasting and impairing condition with cognitive, emotional, behavioral, social, and spiritual repercussions. Exhaustion and burnout experienced by providers during COVID-19 correlated with increased disengagement and the desire to leave the health care field. Telemedicine and telementoring expands access to medical expertise, thereby reducing an inexperienced provider's stress levels and uncertainty and improving their confidence in care delivery. Artificial Intelligence Decision Support Systems (AIDeSSAIDeSS) may represent the next phase in clinical decision support systems across the continuum of care. These systems may help address both the anticipated scale of casualties in large-scale combat operations and the critical expertise gaps during future pandemics, mass casualty events, and natural disasters. This study advocates for urgent research at the intersection of high-stress, resource-limited care contexts that may cause moral injury in health care providers and the potential for AIDeSS to reduce that risk. Understanding these dynamics may yield strategies to mitigate psychological distress in medical responders, increase patient survival, and improve the health of our medical systems.

Social determinants of health and health outcomes in older cancer survivors.

Today, two-thirds of all cancer survivors are at least 65years old. Older cancer survivors have complex care needs, and addressing their social determinants of health (SDoH) is critical for improving and managing survivorship outcomes for this uniquely vulnerable population, yet research specifically examining these associations remains limited and emergent. To this end, we describe the emergent body of evidence on the associations between SDoH domains and older cancer survivors' outcomes. Despite the limited investigations of SDoH on the health outcomes of older cancer survivors, there were measures representing all domains of SDoH - health care access and quality, education access and quality, neighborhood and built environment, social and community context, and economic stability. We reviewed another determinant, Digital Environment and Engagement, as they are highly relevant to older cancer survivors' care. Studies primarily investigated outcomes such as the use of or delays in treatment and variables related to care coordination. Generally, poorer access to resources such as income, social networks, and quality health care facilities predicted poorer health outcomes. We reviewed studies that revealed that SDoH significantly impacts older cancer survivors' health outcomes. Our description informs future interventions and policies to improve their care.

Hospitalizations of the older adults with and without dementia during the last two years of life: the impact of comorbidity and changes from 2002 to 2017

BackgroundMultimorbidity creates challenges for care and increases health care utilization and costs. People with dementia often have multiple comorbidities, but little is known about the role of these comorbidities in hospitalizations.AimsThis study examines the frequency of hospitalizations during the last two years of life in older adults with and without dementia, the impact of comorbidities on hospitalizations, and their time trends.MethodsThe data came from national registers and covered all persons 70 and above who died in Finland in 2002–2017. The effect of dementia and comorbidities on hospitalizations in the last two years of life was determined using binary logistic regression and negative binomial regression.ResultsAt all levels of comorbidity, people with dementia were less likely to be hospitalized and had a lower number of hospitalizations than people at the same level of comorbidity but no dementia. Hospitalizations were strongly associated with multimorbidity. During the study period, the overall hospitalization rates from home and LTC have declined.DiscussionThe declining trend of hospitalization during the 15-year study period should be interpreted in the context of the health and long-term care system.ConclusionAmong people with dementia, comorbidities were the main driver for hospitalizations. Regardless of the number of comorbidities, people with dementia were hospitalized less often than people without dementia in last two years of life. It remains unclear whether the lower hospitalization rate is due to the improved ability to care for people with dementia outside the hospital or to the lack of sufficient medical care for them.

Exploring performance profiles of home health care agencies: A two-stage analytical approach.

Public reporting of home health care agencies' performance metrics, including patient satisfaction, care processes, and health outcomes, aims to inform customer decisions and encourage agencies to improve the quality of services. However, there is limited research that examines the heterogeneous performance of home health care agencies. The aim of this study was to analyze the performance of home health care agencies by identifying distinct subgroups of agencies with similar performance profiles and describing the relationships between agency characteristics and such subgroups. We propose a two-stage analytical approach employing unsupervised machine learning methods. First, clustering analysis is applied to performance measures, allowing the partitioning of agencies into homogeneous subgroups based on similarities in performance. Then, association rule mining is used to uncover the relationships between cluster assignments and agency characteristics. The two-stage analytical approach identified four clusters with significantly different performance profiles and agency characteristics: cost-efficient agencies with high patient satisfaction (Cluster 1), high-cost agencies with high-quality care (Cluster 2), urban agencies with low patient satisfaction (Cluster 3), and small agencies with low-quality care (Cluster 4). This study contributes to understanding agency performance in the U.S. home health care industry. By identifying distinct subgroups of agencies and understanding the factors influencing their performance, we can enhance home health care services' overall quality and effectiveness. Our study uncovered diverse performance profiles and associated characteristics among home health care agencies, highlighting the need for tailored strategies and targeted interventions to improve the quality of care across clusters. Health care administrators and policymakers should consider cluster-specific recommendations.

Informational Sources About Breastfeeding Associated with Breastfeeding Initiation: Insights into Racial Disparities.

Background: Breastfeeding provides essential nutrition and disease protection for infants while reducing the risk of type 2 diabetes and breast cancer in mothers. Despite these benefits, significant racial and ethnic disparities exist in breastfeeding initiation, particularly among Black women. This study examines racial differences in the receipt of breastfeeding information from varying sources and their association with breastfeeding initiation. Methods: Data were obtained from the Phase 8 Core Pregnancy Risk Assessment Monitoring System for 2016-2020 (n = 163,724). The analysis focused on comparing the likelihood of breastfeeding initiation (yes/no) across racial groups and the impact of receiving breastfeeding information from varying clinical (mother's doctor/nurse/baby's doctor, etc.) and social sources (support group/family/friends, etc.). Univariate and multivariable analysis was conducted in SAS 9.4. Results: Black women consistently exhibited lower odds of breastfeeding initiation compared with other racial groups, across all informational sources. The study found that while information from both clinical and social sources increased breastfeeding initiation overall, Black women remained less likely to initiate breastfeeding than White women (p < 0.0001). Conclusion: Systemic barriers, including racism and bias in health care, contribute to the racial disparities in breastfeeding initiation. Culturally tailored interventions and improved health care provider training are necessary to address these gaps. Future efforts should aim to bridge the divide between clinical and social breastfeeding information sources to improve breastfeeding rates among minority women.

Agingassociated challenges to persons living with HIV/AIDS in Vietnam: integrated perspectives from multiple stakeholders

ABSTRACT This study examined the aging-associated health and care needs among the HIV population in Vietnam, integrating perspectives from healthcare professionals, PLWH, and their caregivers. Qualitative data were collected through five focus group interviews involving ten PLWH, nine caregivers, and eight healthcare providers in Hanoi, Vietnam, in March 2023. Thematic analyses uncovered recurring patterns and themes across the three participant groups. PLWH reflected diverse experiences, showing mental health struggles, aging-related concerns, and a lack of preparation due to health challenges or unexpected longevity. Resilience and optimism are also manifested in PLWH. Caregivers demonstrated crucial roles, including bridging care, medication adherence, and financial and emotional support. Both PLWH and caregivers expressed a desire for education on HIV and aging. Healthcare providers reported mental and physical health changes among aging PLWH, such as insomnia, forgetfulness, and memory deterioration. They noted a lack of resources and called for comprehensive training across medical staff to enhance the well-being of the aging PLWH. This study demonstrates the complicated age-associated needs among PLWH in Vietnam and underscores the need for policy and practice innovations to address aging-related cognitive, mental health, and long-term care concerns.

What are the training and support needs for homelessness hostel staff supporting older residents with memory and cognitive problems? A qualitative study

BackgroundAn increasing number of older people are experiencing homelessness and memory problems, many of whom are supported in temporary hostel accommodation. This can be a challenge for hostel staff who may not have adequate training and support but who often support those with significant memory impairment in their day-to-day work. The study aimed to investigate the training and support that hostel staff require to meet the needs of older hostel residents experiencing memory and cognitive problems, and thus enhance hostel resident quality of life and well-being, considering what additional knowledge, skills, and support hostel staff need to achieve this.MethodsIn this qualitative study, we conducted inductive reflexive thematic analysis of semi-structured interviews with health and social care practitioners (n = 17) and hostel staff and managers (n = 15). Participants were recruited from six homelessness hostels, one specialist care home, and National Health and Local Authority Services in England.ResultsWe identified three main themes: (a) Emotional and psychoeducational support needs within hostel staff teams, including training on memory and cognitive problems, responsive behaviours, communication strategies, and reflective spaces for hostel staff to manage their emotional responses (b) Training and support needs to deliver a person-centred approach, including tools and support packages to enhance hostel residents’ independence, multidisciplinary meetings to evaluate hostel residents’ needs, and communication strategies tailored to hostel residents’ understanding and (c) Support to facilitate collaboration with external agencies, including training on professional language, capacity assessment, dementia case studies, improved communication skills to bring external services into hostels, and reflective practices to advocate for hostel residents with dual diagnoses.ConclusionsThe present study highlights how hostel staff could benefit from targeted training in emotional support, person-centred approaches for older hostel residents with memory and cognitive problems, and collaboration with external services. Overall, the current study contributes to understanding of the need for tailored training and support methods within hostels to provide higher quality support to a population that is frequently overlooked.

Postpartum depression in relation to chronic diseases and multimorbidity in women’s mid-late life: a prospective cohort study of UK Biobank

BackgroundMaternal short-term outcomes of postpartum depression (PPD) were widely examined, but little is known about its long-term association with multiple chronic diseases (multimorbidity) in women’s later life. This study aims to assess the association of PPD with chronic diseases and multimorbidity in women’s mid-late life.MethodsThis prospective cohort study included female participants in UK Biobank who attended online follow-up assessment and reported their history of PPD. A total of 36 chronic diseases were assessed and multimorbidity was defined as the co-existence of two or more of these diseases. Participants were followed from the baseline recruitment to the onset of two or more chronic diseases, death, or the end of follow-up (2023). Logistic regression models, Cox proportional hazard models, quasi-Poisson mixed effects models, and linear mixed models were conducted to examine the association of PPD with chronic diseases and multimorbidity at baseline and during follow-up.ResultsAmong all 54,885 participants, 5106 (9.3%) participants experienced PPD, 13,928 (25.4%) participants had multimorbidity at baseline, and 14,135 (25.8%) participants developed two or more diseases during a median follow-up of 15 years. Women with a PPD history had higher odds of having multimorbidity at baseline (odds ratio = 1.35, 95% confidence interval [CI] = 1.27–1.44) and higher risk of developing multimorbidity during follow-up (hazard ratio = 1.13, 95% CI = 1.08–1.20). PPD was associated with increased number of chronic diseases, with the relatively new-onset number of diseases during follow-up being 8% higher for those with PPD (relative risk = 1.08, 95% CI = 1.05–1.12). Chronic diseases also accumulated at a faster annual rate for women with a history of PPD (b = 0.009, 95% CI = 0.007–0.011), compared to those without. We observed no interaction or mediation effects of physical activity, smoking, alcohol drinking, and dietary factors on the association between PPD and multimorbidity; however, women’s body mass index at baseline contributed to the association, with the mediation proportion of 6.38% (2.56–10.20%).ConclusionsPPD was associated with higher risks of chronic diseases and multimorbidity in women’s mid-late life. This finding supports the importance of perinatal and postpartum mental health care, and its role in the prevention of chronic diseases and multimorbidity throughout women’s life course.

Quality Improvement for Pediatric Acute Mental Health Care: Opportunities and Challenges.

Quality Improvement for Pediatric Acute Mental Health Care: Opportunities and Challenges.

Prediction models for post-traumatic stress disorder in family members of ICU patients: A systematic review.

Several predictive models have been developed for post-traumatic stress disorder (PTSD) in intensive care unit (ICU) family members. However, significant differences persist across related studies in terms of literature quality, model performance, predictor variables and scope of applicability. This study aimed to systematically review risk prediction models for PTSD in family members of ICU patients, to make recommendations for health care professionals in selecting appropriate predictive models. China National Knowledge Infrastructure, VIP database, Wanfang database, SinoMed, PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library, Embase and OVID were searched from inception to 1 May 2024. Two independent researchers conducted literature screening, data extraction and applied a risk of bias assessment tool for predictive models to evaluate included studies. The systematic review was registered on PROSPERO (registration number: CRD42024560815). Seventeen studies were included, with sample sizes ranging from 32 to 2734. Incidence rates of outcomes ranged from 1.6% to 63.6%. The most frequently used predictors were relative's female sex, longer duration of ICU stay, patient's death in the ICU and type of relationship with the patient. Two models reported area under the receiver operating characteristic curve (AUC) values ranging from 0.73 to 0.74; only three models reported calibration, and one study conducted internal validation. Overall, the 17 studies showed good applicability but exhibited a high risk of bias, particularly in data analysis. Research on predictive models for PTSD risk in family members of ICU patients is in the developmental stage. Future studies should validate existing models or develop high-performance localized predictive models. PTSD can have a significant impact on the families of ICU patients, making early identification of high-risk populations essential for health care professionals to implement timely interventions.