Impaired Health Research Articles

Stress profile of veterinarians in Switzerland: Young + female + employed = stressed?

The impairment of mental health among veterinary professionals has raised public awareness in recent years. The driving forces include a serious gap in veterinary services - with less available veterinary colleagues, especially in rural areas - and a general lack of veterinary graduates. This article presents the results of our first Swiss survey on psychological well-being in the veterinary profession. Our results are viewed both in the current context and in the context of developments that have already taken place in other medical disciplines. Results indicate higher levels of stress in veterinarians working as clinicians, in female colleagues, in veterinarians of younger age and veterinarians under employment. In the meantime, larger surveys such as the Vétos Entraide (https://vetos-entraide.com) were established in France and projects such as the Happy Vet project (https://happyvetproject.org) were launched in Switzerland for eg. the burnout prevention in the profession. However, the topic of «mental health» remains highly relevant in veterinary medicine and requires further research and measures, which should consider the identified predisposing factors, such as age and gender.

Orofacial pain and dysfunction in patients with special needs, with a focus on interdisciplinarity

Abstract People with special needs, like those with Down syndrome, Parkinson disease, or dementia, frequently suffer from orofacial pain conditions and dysfunction of the masticatory system. However, the accurate assessment of orofacial pain and dysfunction in such individuals is challenging. In this review, the complexities of assessing and managing orofacial pain and dysfunction in special needs populations will be described, along with their comorbid orofacial conditions like impaired oral health, salivary problems, and movement disorders of the masticatory system. In addition, the importance of maintaining or restoring a good quality of life will be highlighted, while the urgent need for oral care as part of palliative care will be stressed as well. To accomplish all this, interdisciplinary collaboration between medical doctors and dentists should be promoted in research, education, prevention, and care provision. Therefore, this review focuses specifically on this important topic.

Medical Psychiatric Challenges in the Treatment of Obsessive-Compulsive Disorder and Eating Disorders

This paper examines the intricate relationship between Obsessive-Compulsive Disorder (OCD) and eating disorders (EDs), focusing on their diagnostic criteria, comorbidity, shared characteristics, and the profound medical and psychiatric complications that arise from these conditions. OCD is characterized by intrusive obsessions and compulsions that significantly impact daily functioning, while EDs, including Anorexia Nervosa, Bulimia Nervosa, and Binge-Eating Disorder, involve severe disturbances in eating behaviors and body image. These disorders often co-occur, with up to 41% of individuals with EDs also suffering from OCD. The shared symptoms, such as obsessions, compulsions, avoidance behaviors, and perfectionism, highlight the complex interplay between OCD and EDs, complicating diagnosis and treatment. The medical complications associated with this comorbidity are severe and varied, affecting multiple organ systems. Gastrointestinal issues, proctological problems, oral health deterioration, cardiological dysfunction, electrolyte imbalances, kidney disorders, and hormonal dysregulation are common. Additionally, sleep disorders are prevalent, further exacerbating both psychiatric and physical health outcomes. Effective treatment requires a holistic approach that addresses the unique needs of each individual, with integrated care involving specialists across medical and mental health fields. This comprehensive approach is crucial to mitigating the devastating impact of OCD and EDs, improving overall well-being and quality of life for affected individuals.

The health of older caregivers in Spain: a matter of age or a matter of care?

Abstract Introduction Informal care is crucial in Spain’s care system, with a rising number of caregivers aged 75 or older, yet studies on its health effects are lacking. This study aims to determine the differential impact of age and care-related variables on the health of older caregivers. Materials and methods This is a cross-sectional, national study with a sample of 3,870 informal caregivers from the Spanish 2020 Disability, Personal Autonomy and Dependency Survey. We performed a logistic regression where self-reported deterioration in caregiver health due to caregiving was the dependent variable and age (<75 vs. ≥ 75) was the independent variable. Caregivers’ sex, educational level (primary and lower or secondary and higher), income (<1,150 euros per month vs. ≥ 1,150), severe functional limitation of caregivers and care-receptors (yes or no), duration of care (< 8 years vs. ≥ 8 years), and daily hours of care were used as covariates. Results One in 6 caregivers was 75 or older (16,1%). Caregivers’ mean age was 58.4, and care-receptors’ 66.6 years. Women represented 63.0% of caregivers, and 42.8% of care-receptors. Up to 4.6% of caregivers had a severe limitation, and 43.7% of caregivers reported deterioration of their health due to caregiving. A greater perception of deterioration in caregiver health due to caregiving was associated with being 75 years or older (β = 0.34, p = 0.009). Covariates associated with caregivers’ health deterioration were being a woman (β = 0.77, p < 0.001), presence of severe limitation of care receptors (β = 0.58, p < 0.001), and increased daily hours of care (β = 0.01, p = 0.013). Caregivers’ severe limitation, level of education, income and years of care did not show a significant association with perception of health deterioration. Discussion Caregivers older than 75 years in Spain experience a key deterioration in their health associated with caregiving. This vulnerable population must be prioritized in health and social policies. Key messages • One out of 6 caregivers in Spain is aged 75 years or older. Caregiving impacts greatly in their health status. • Older caregivers is a vulnerable population that must be a priority for health and social services.

Air Pollution Reduces the Individuals’ Life Satisfaction Through Health Impairment

Abstract Background The impact of air pollution on individuals’ happiness and life satisfaction (LS), and its relationship to other factors became the focus of recent research. Though, the underlying mechanism of how air pollution impacts LS remains unclear. In this study, we examined the direct and indirect effect of air pollution on individuals’ LS through health mediation. Methods We used longitudinal individual-level data from “Understanding-Society: the UK Household-Longitudinal Study” on 59,492 individuals with 347,377 repeated responses across 11 years (2009-2019) that was linked to yearly concentrations of NO2, SO2, and particulate-matter (PM10, PM2.5) pollution. Generalized structural equation models with multilevel ordered-logistic regression were used to examine the direct effect of air pollution on LS and the indirect effect from health impairment. Results Higher concentrations of NO2 (coefficient = 0.009, 95%CI = 0.007,0.012, p < 0.001), SO2 (coefficient = 0.025, 95%CI = 0.017,0.034, p < 0.001), PM10 (coefficient = 0.019, 95%CI = 0.013, 0.025, p < 0.001), and PM2.5 (coefficient = 0.025, 95%CI = 0.017,0.033, p < 0.001) pollutants were associated with poorer health, while poorer health was associated with reduced LS (coefficient = -0.605, 95%CI = -0.614,-0.595, p < 0.001). Mediation path analysis showed that air pollution impacted individuals’ LS directly and indirectly. The percent of total effect mediated through health was 44.03% for NO2, 73.95% for SO2, 49.88% for PM10, and 45.42% for PM2.5 and the ratio of indirect to direct effect was 0.79 for NO2, 2.84 for SO2, 0.99 for PM10, and 0.83 for PM2.5. Conclusions Health plays a major mediating role in the relationship between air pollution and LS. To alleviate the impact of air pollution on LS, future strategies should focus on health promotion besides reducing air pollution emissions. Key messages • Air pollution is related to lower life satisfaction directly and indirectly through health impairment. • Strategies and policies aiming at reducing air pollution emissions and better health would improve the individual’s life satisfaction and lower the mental health burden.

Health care and social benefits among long-term unemployed

Abstract Background There is limited knowledge on the diverse pathways behind long-term unemployment. It is considered that impaired health may lead to exclusion from working life, and that unemployment together with financial difficulties may impair health. In this study, we identify different pathways behind long-term unemployment, and analyse differences in health care and social benefits use based on the diverse pathways. This study contributes to the early identification and supportive efforts for those in risk of labour market marginalisation. Methods Those who had been mainly unemployed in years 2020 and 2021 were identified among all working age (18 to 64 years) Finnish citizens. Register data from Statistics Finland, the Social Insurance Institution of Finland and THL were combined for the analysis. Sequence analysis was conducted for individuals with main activity information for each observation years from 2013 until 2021 (n = 72,485, age 26 to 64 in year 2021). Results Those unemployed for two years were on average 49 years of age (38% women). Five clusters were identified based on the main activity over the nine observation years: unemployed (54%), students (3%), employed (23%), inactive (10%) and those returned to unemployment (10%). Health care attendance was most frequent among those in cluster inactive. Mental health diagnoses were most common among those in clusters inactive and students. Share of those with musculoskeletal diagnoses doubled from 2013 until 2021 among the previously employed. Yearly percentage of those with sickness absence (>10 days) varied from 5 to 13% based on a cluster and a year. Share of recipients of basic social assistance was relatively stable throughout the years in all clusters being highest among inactive (50 to 60%) and lowest among students (6 to 18%). Conclusions Information on labour market background might be useful for preventive efforts and while developing services and social security for those in long-term unemployment. Key messages • There exists diverse backgrounds behind long-term unemployment. • Labour market background should be considered while developing services for those in long-term unemployment.

Eco-anxiety: an additional burden for university students?

Abstract Background Eco-anxiety encompasses climate change anxiety, including global warming, as well as anxiety about a multiplicity of environmental disasters, which not be directly caused by climate change The objective is to assess eco-anxiety in healthcare and non healthcare students and investigate a relationship with health behaviour, mental health, and environmental opinion. Methods A cross-sectional study was conducted among voluntary university students in the Rouen University in Normandy, France. Volunteer healthcare students aged 18 years and older were included. Eco-anxiety was assessed with the Hogg Eco-Anxiety Scale (HEAS-13). Socio-demographics, health behavior, mental health and healthcare data were also collected. Results A total of 1,887 students were included with 74.3% of women and a mean age of 21.1 years (SD = 6.8). The HEAS-13 mean was 13.2 (SD = 2.6): affective symptoms 4.1 (SD = 2.7), eco-rumination 3.7 (SD = 2.4), behaviour 1.0 (SD = 1.5), and anxiety about one’s personal impact on the planet 4.4 (SD = 2.5). Respectively, 59.6% and 31.4% of students are moderately and very much involved in pro environmental-behaviour. 84.6% of students will consider environmental issues in their career choices. Eco-anxiety was associated with being a woman, being in curricula other than health, accommodation with roommates or in couple, use of cannabis, eating disorders, insomnia, emotional exhaustion, cynicism, depression, quality of life, and visiting a general practitioner for stress. Conclusions An high eco-anxiety was associated with impaired mental health and could be an additional burden for university students. Intervention options for those that do experience eco-anxiety and suffering can be as prescribing environmental action, mental health skills, and climate change resolution without imposing the burden of change solely on young people Key messages • A high eco-anxiety is prevalent among university. • The eco-anxiety impaired mental health that could be an additional burden for university students.

Predictors for psychosocial consequences of screening for liver diseases in Germany: a LASSO approach

Abstract Background Medical screening is extensively used across various disciplines for early disease detection and prevention of severe progression aiming to reduce disease-specific burden, improve quality of life and promote health. However, screening is debated due to unclear evidence of its overall benefits from a public health perspective. Screening is associated with improved health behavior and cost-effectiveness. However, studies identified adverse effects of screening like psychosocial burden. Most results originate from cancer screening and it is unclear whether they are transferable to other contexts. Within a research program, a systematic screening procedure to detect patients with liver cirrhosis at early stage in an asymptomatic general population was evaluated. In this study, we aimed to identify patient characteristics that predict and explain variance in psychosocial outcomes of screened patients. Methods This study analyzed data from 523 participants who underwent a systematic liver disease screening in Germany from Jan 2018 to Feb 2021. We used bootstrapped LASSO regression with 10-fold validation to evaluate the influence of various predictors on the outcomes measured by the Psychological Consequences of Screening Questionnaire (PCQ). The constructs measured by the PCQ are social, physical and emotional dysfunction associated with screening. Results We identified lower severity of comorbidities, higher subjective social status, stronger social support, older age, better critical health communication skills and higher health literacy as relevant predictors of lower psychosocial dysfunction, indicating their protective role in preventing psychosocial burden of screening. Conclusions From a public health perspective, medical screening offers should take into account patients’ individual context regarding their subjective social status, health impairments, personal social networks and health literacy skills to reduce post-screening psychosocial burden. Key messages • Social support, age, health literacy and higher subjective social status were positively associated with lower psychosocial consequences of liver screening. • The findings indicate that liver screening should be carried out, taking into account the individual’s situation and resources available.

Impact of COVID-19 measures on psychosocial outcomes in Austria – a qualitative vignette study

Abstract During the COVID-19 pandemic, Austria implemented frequent and restrictive containment measures. We aimed to explore the perspectives of individuals affected by political and epidemiological decisions in Austria, particularly in Vienna and Lower Austria. A qualitative vignette-based study conducted from July to Oct 2023 utilized two hypothetical future pandemic scenarios to prompt in-depth discussions in semi-structured interviews with Austrian residents about their perspectives, either private or from the fields of healthcare, education, citizen representation, business, research, public health and politics. Interview data was analysed using a thematic analysis approach. To ensure results’ rigor and accuracy, we followed the COREQ guideline and included two citizen research partners. This project is funded by WWTF (Grant ID: LS22071). Preliminary thematic analysis from 28 interviewees (53.6% female) aged 19-77 (mean 53.0 years) shows that the negative effects of school closures was a major concern among participants. Despite diverging points of view on other topics, there was a broad consensus that school closures would have negative consequences, such as unstable educational modalities impairing young people’s individual development, decreasing psychosocial support in their peer groups, leading to long-term educational losses, not only for individuals but also for society as a whole, and having a negative impact on economic growth, social justice and innovation. The participants also described a lack of evidence for the necessity of the frequent school closures during the pandemic as had happened in Austria and suggested a different approach in a future pandemic. Further topics were the deterioration of mental health, incentives instead of mandatory measures, more transparent communication by authorities, agreement between experts and researchers, reducing uncertainties regarding pandemic management, compliance by the general public and democratic social cohesion. Key messages • Addressing the multi-faceted impact of a pandemic requires a comprehensive approach that considers mental health, social justice, communication and social cohesion alongside containment measures. • This work represents a learning from the COVID-19 pandemic. From the conclusions of this study, recommendations can be derived to be better equipped in future pandemics.

Loneliness and the prevalence of injuries, falls and fractures in older people

Abstract The feeling of being alone (loneliness) experienced by older people contributes to deterioration of health, reduced physical and mental fitness, or inability to continue life roles. Loneliness may lead to behaviors that increase the risk of accidents, falls, and fractures, which are particularly dangerous in old age. The aim of this study was to assess the relationship between loneliness and the prevalence of injuries, falls, and fractures in older people. The studied group consisted of 464 people (48% men), aged 62-86 years (mean: 71.6, SD: 6.3), who participated in the Polish part of the HAPIEE Study (Health Alcohol and Psychosocial Factors in Eastern Europe); random subsample examined in 2019-2020. Trained nurses interviewed respondents in their homes. The 3-item UCLA scale (range 3-9, cut-off point≥6) was used to assess loneliness. Data on injuries or accidents in previous 10 years, falls in previous 12 months, history of wrist, hip fracture or undergoing joint surgery/alloplastic was recorded. Multivariable logistic regression analysis was used. There were 460 participants included in the analysis. In 34 participants (7.3%) UCLA score was ≥6. In the previous 10 years, 95 respondents (20.5%) reported an injury or accident, 77 (16.6%) fell in previous 12 months. There were 6 (1.3%) respondents with history of hip fracture, 48 (10.3%) with history of wrist fracture, and 35 (7.5%) with history of joint surgery/alloplastic. No statistically significant relationship between loneliness and the prevalence of injuries, falls and fractures in older residents was found neither in the crude models nor after adjustment for covariates (age, sex, BMI, marital status, having offspring). Loneliness did not predict injuries, falls, and fractures in older urban residents. It seems that perception of being alone is weaker determinant of health as a measure not fully reflecting objective social isolation, which may actually have a greater impact on falls and injuries. Key messages • 1/5 of older people have experienced any injury or accident and 17% reported to have fallen in the previous year. • Loneliness did not predict injuries, falls, and fractures in older urban residents.

Does import trade liberalization worsen residents’ health? Evidence from China

Health is important to human capital and national sustainable development. Based on the latest Chinese Family Panel Studies (CFPS), this paper uses the IVprobit model to test the impact of import trade liberalization on residents’ health from the micro-individual perspective and further explores its mechanism. The results indicate that import trade liberalization brings hidden health costs, and that the negative effects on the health of people in eastern China or rural areas, people with a low education background, people under 60 years of age, and women are more significant. In areas with more serious environmental pollution, the health deterioration effect of expanding imports is more obvious. Increasing green coverage and optimizing the quality of public services can effectively alleviate this negative impact. Import trade liberalization does not affect residents’ health through income gap, therefore when carrying out import trade liberalization the government should pay greater attention to the health status of the specified groups, adopt various means to improve the ecological and living environments, reduce pollution emissions, optimize the supply of public services, and ultimately improve residents’ overall health level.

Climate Change Impacts on Respiratory Health: Bridging Inequalities in Children and Adults

Abstract Respiratory diseases rank as the third leading global cause of mortality, with climate change exacerbating their prevalence and severity. Wild fires, floods, extreme heat events, infectious diseases, urban air pollution and aeroallergen exposure contribute to respiratory health deterioration. Vulnerable populations, including individuals with pre-existing lung conditions and children, bear a disproportionate burden of these effects. We centrepiece the connection of climate change to respiratory health inequalities, while bridging the evidence gap regarding increasing extreme heat and cold events, ambient and indoor air pollution exposure with significant ramifications on respiratory health. Specifically, we will showcase research on the tailored, multidisciplinary NCD prevention package named FRESHAIR4Life, targeting air pollution exposure in mid- to late adolescents from disadvantaged populations. Given the high burden of non-communicable diseases (NCDs) and air pollution exposure as major contributors, urgent preventive interventions are required, particularly in disadvantaged populations. Initiating preventive interventions during adolescence is considered an optimal window of opportunity for long-term health benefits. Furthermore, we will present a robust evidence base delineating climate change’s impact on lung health among vulnerable European populations. We will discuss how narratives on climate-induced lung health issues are co-created with affected communities and stakeholders to facilitate policy translation. The aim of these presentations is to break silos among health professionals, fostering collaboration from the respiratory community to the public health community. Through lung health collaborations we seek to deepen understanding and catalyze action to address the intersection of climate change, respiratory health, and inequalities, ultimately working towards a healthier and more equitable health for all.

Prevention of mechanical valve thrombosis with a combination of the factor Xa inhibitor edoxaban plus aspirin in swine: intermediate results from the EdoValves project

Abstract Background Patients with an implanted mechanical heart valve (MHV) currently have a contraindication to the use of non-vitamin K antagonist oral anticoagulants (NOACs) based on the unfavorable results of the RE-ALIGN trial with dabigatran. We hypothesized that the combination of a Factor Xa inhibitor, acting upstream of thrombin generation, plus aspirin, may effectively prevent valve thrombosis, providing a much more friendly and viable alternative to vitamin K antagonists for such patients. We tested this in a swine model with a recently implanted mechanical valve prosthesis in the mitral position, combining the most unfavorable conditions promoting mechanical valve thrombosis, based on (a) the implanting position; (b) recent surgery; (c) the high thrombogenicity of the animal model. The study was approved by the Animal Ethics Committee of the University of Pisa and the Italian Ministry of Health and conducted according to Good Clinical Practices for Animal Experiments. Methods 17 farm male pigs, weighing ≈30 kg at the beginning, underwent cardiac surgery under general anesthesia and with extracorporeal circulation to receive a 25 mm or 27 mm bileaflet Corcym Bicarbon mechanical heart valve replacement in the mitral position. Pigs were given 1 mg/kg enoxaparin immediately after surgery and started with the oral daily administration of edoxaban 1 mg/kg (30 mg, then escalated to 60 mg with the animal growth) + aspirin 100 mg, both given as crushed tablets with a food pellet since the animal awakening from anesthesia. An initially planned warfarin control group was quickly abandoned because of the extreme difficulty of controlling warfarin activity. Animals were submitted to blood sampling and transthoracic echocardiography at least twice in the follow-up when uneventful for up to three months or in case of health deterioration. The autopsy was performed by a certified pathologist after each spontaneous death or procured sacrifice. Results (Figure 1): Excluding 5 peri-operative deaths, 12 animals survived surgery. Of those, 6 died within the second month: pulmonary edema occurred in 3 cases, due to prosthesis-mismatch in the growing animals; pulmonary infection occurred in 1 subject; heart failure due to valve thrombosis occurred in 2 cases. Six swine were full-term survivors in good health status up to the 3-month planned observational time. No hemorrhagic events were ever documented. Conclusion The combination of edoxaban + aspirin effectively avoided valve thrombosis events in 10 out of 12 (83%) analyzable animals and was safe from bleeding complications. The study is ongoing up to a predicted sample size of ≥20 animals. If further confirmed, these data may open the possibility of an alternative to vitamin K antagonists in humans with the fixed-dose drug combination here used, without the need for continuous anticoagulation monitoring and with expected greater safety.Figure 1

Long-term mental health impairments in survivors of critical illness

Abstract Background Survivors of critical illness frequently suffer from long-term disabilities, including physical, cognitive, and mental impairments (post-intensive care syndrome). However, long-term studies are scarce and healthcare services for critical illness survivors are limited, not only in Germany. Therefore, we followed-up on anxiety, depression, and post-traumatic stress disorder (PTSD) during post-intensive care unit (ICU) rehabilitation and up to 1 year after critical illness onset. Methods Patients at Schoen Clinic Bad Aibling in Germany were eligible for this prospective cohort study after receiving ≥5 days of mechanical ventilation. The Hospital Anxiety and Depression Scale (HADS; subcategory score ≥8) was conducted after ICU discharge (V1), at discharge from inpatient rehabilitation (V2) and 1 year after critical illness onset (V3). The Impact of Event Scale-6 (score ≥1.75) was conducted to assess PTSD at V3. Multiple logistic regressions were performed. Results We included 250 patients (62±14 years, 34% female, median stay on ICU 55 days, median duration of rehabilitation 65 days). 10% died before V3. Anxiety decreased during rehabilitation (effect size r = 0.35, p<.001), but increased again until V3 (r = 0.42, p<.001). At V3, 54% suffered from anxiety. Depression also decreased during rehabilitation (r = 0.46, p<.001), and increased again until V3 (r = 0.39, p<.001). At V3, 44% showed depressive symptoms and 38% suffered from PTSD. COVID-19 diagnosis was associated with increased anxiety (p<.001), depression (p=.068), and PTSD at V3 (p=.028), compared to non-COVID-19 patients. Furthermore, longer duration of mechanical ventilation was associated with increased anxiety (p=.041) and depression (p=.019) at V3. Conclusions Mental health impairments frequently occur in critical illness survivors, and they seem to worsen after rehabilitation. As these impairments can significantly impact daily functioning and quality of life, tailored healthcare services are urgently needed. Key messages • Anxiety, depression, and PTSD are frequent in critical illness survivors, even 1 year after critical disease onset. This calls for tailored healthcare services. • Patients with COVID-19 and longer mechanical ventilation suffer from more severe mental health impairments.

Dementia risk factors and cognitive function in a nationwide population-based sample aged 65+

Abstract Background Cognitive function is fundamental to healthy aging and independent living. As there is no cure for dementia, prevention of risk factors (e. g. physical inactivity, obesity, hypertension, diabetes, social isolation, depression) is crucial. The aim of our study was to analyze selected dementia risk factors and their association with cognitive function in people aged 65 years and older. Methods Cross-sectional data from the nationally representative examination Study on Health of Older People in Germany (Gesundheit 65+) conducted between 2022-2023 by the Robert Koch Institute (n = 1.493; 48% women; mean age 78.8 years). Cognitive function was assessed by the Letter Digit Substitution Test (LDST), a measure of general speed of information processing, and of the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) 10-word list delayed recall (WLR), a measure of memory. Weighted associations between age, sex, education, dementia risk scores and z-standardized test scores were examined using linear regression analysis. Results Higher age, male sex and lower level of education were significantly associated with lower z-scores in both tests (all p < 0.001). In separate models, all adjusted for age, sex and education, social isolation was associated with lower performance on both LDST (ß=-0.22; 95% confidence interval -0.42, -0.01) and CERAD WLR (ß=-0.21; -0.41, -0.01); depressive symptoms were associated with lower LDST z-scores (ß=-0.40; -0.67, -0.13), and physical inactivity with lower CERAD WLR z-scores (ß=-0.12; -0.24, -0.01). Obesity, hypertension, and diabetes were not significantly associated with any test. Conclusions Our findings from this nationwide general population study of old and very old adults show a clustering of reduced cognitive function with social isolation, symptoms of mental health impairments, and physical inactivity in old age which call for coordinated intersectoral health promotion and prevention activities. Key messages • The clustering of reduced cognition with dementia risk factors calls for intersectoral health actions. • Limitations in cognition should only be defined by age-, sex-, and education-specific norms.

Patient Experiences of Patient-Initiated Brief Admission in Psychiatric Care: A Systematic Review.

Patient-initiated brief admission (PIBA) is an innovative psychiatric care intervention that gives patients the autonomy to initiate a short admission (approximately 1-3 days) to psychiatric inpatient care. This intervention is structured around a mutual agreement between the patient and their care provider that outlines the specific structure and content of their care. Unlike regular psychiatric admissions, healthcare professionals do not review the patient's decision for admission during PIBA. Similar interventions have been developed globally to reduce the need for long inpatient admissions and compulsory care by enhancing patient autonomy, promoting active participation in care, and empowering patients to recognise early signs of mental health deterioration. The objective of this systematic review was to explore the experiences of PIBA among individuals with mental health disorders. A systematic review was conducted using qualitative articles sourced from the PubMed, CINAHL, and PsycINFO databases. A total of thirteen original articles were included in the review, encompassing 186 patients. Research demonstrates that PIBA significantly impacts patients' care experiences in various ways. Access to PIBA gives patients the opportunity to take a break from daily stressors, which has proven significant in interrupting the cycle of worsening symptoms and negative thoughts. Furthermore, when the care environment is characterised by trust and respect, patients experience an increased sense of freedom, which contributes to a more effective recovery process. PIBA provides patients with a sense of safety and offers the possibility of a more functional daily life. Healthcare professionals'attitude and care provision also significantly influences patients' experiences. Central to a positive patient experience are a warm reception, attentiveness, and active listening. PIBA can not only change patients' perceptions of healthcare but, more importantly, fosters a transformative view of themselves as active participants in their own well-being. Knowledgeable healthcare professionals are crucial for the successful implementation of this intervention. By offering dignity and warmth alongside safety, PIBA addresses a critical gap in patient mental health care.

Loneliness and Problematic Internet Use in Adolescents: The Mediating Role of Dissociation

Background/Objectives. Problematic Internet uUse (PIU) is a multifaceted syndrome characterized by excessive or poorly controlled preoccupations, urges, or behaviors regarding Internet use leading to significant impairments in daily life and mental health. Previous research has separately related PIU to loneliness and dissociation, both in adults and adolescents. The aim of the present study is to analyze the mutual relationship between PIU, loneliness, and dissociation in an adolescent sample, in particular evaluating the indirect effect of dissociation on the relationship between loneliness and PIU. Methods. A cross-sectional design was used with 243 Italian high school students (69.1% females), from year 9 to 13 (age: M = 17.1, SD = 1.4 years), who participated in the study from January to June 2020. They completed measures of PIU (Generalized Problematic Internet Use Scale-2), loneliness (UCLA Loneliness Scale), and dissociation (Adolescent Dissociative Experiences Scale). Socio-demographic and contextual variables were also collected (i.e., age, gender, type of school, school year, sport practice, hobby engagement, assessment before/during the COVID-19 pandemic). Data were analyzed using regression, Pearson’s correlation, and mediation analysis. Results. Severe PIU was observed in 8.6% of the sample. None of the socio-demographic and contextual variables had a significant effect on PIU. Positive medium-sized correlations were observed between PIU, loneliness, and dissociation. Mediation analyses showed an indirect effect of loneliness on PIU through dissociation. Conclusions. Feelings of loneliness may significantly exacerbate adolescents’ PIU by increasing their dissociative tendency. Understanding this dynamic is crucial for developing targeted interventions to address both loneliness and dissociation in efforts to mitigate PIU among adolescents.

Association of Spouses’ Sensory Loss with Depressive Symptoms, Self-Reported Health, and Functional Disability Among Middle-Aged and Older Adults in China: A Cross-Sectional Study

ABSTRACT Objective To investigate cross-sectional associations between spouses’ sensory loss and depressive symptoms, self-rated health, and functional disability. Methods We included 10,410 individuals from the China Health and Retirement Longitudinal Study. We used the cross-sectional design and determined hearing loss, vision loss, and dual sensory loss by self-reports. We assessed depressive symptoms using the Center for Epidemiological Studies Depression Scale. We assessed self-reported health status using one item. Functional disability was defined as having difficulties in activities of daily living (ADL) and instrumental activities of daily living (IADL). Results Individuals with spouses’ dual sensory loss had a higher prevalence of depressive symptoms (45.19%), ADL (17.31%), and IADL impairments (21.97%) and a lower rate of self-rated good health (20.78%) than those with no or single loss. Spouse’s sensory loss was associated with depressive symptoms, self-rated health, ADL, and IADL impairments (p < .05). Husbands’ ADL impairments were associated with wives’ vision loss (p < .05). Wives’ IADL impairments were associated with husbands’ hearing loss (p < .05). Conclusions Spouses’ sensory loss was related to depressive symptoms, self-rated health, ADL, and IADL impairments. There was a gender specificity in the effect of spousal vision loss or hearing loss on ADL and IADL impairments.

Development and validation of an electronic frailty index in a national health maintenance organization.

Frailty constitutes a major factor that puts the elderly at risk of health and functional deterioration. To develop and validate an Electronic Frailty Index based on electronic data routinely collected in the HMO. A retrospective cohort of the HMO members. 120,986 patients, aged 65 years and over at the beginning of 2023. A cumulative frailty index including 36 medical, functional, and social deficits. One-year all-cause mortality or hospitalization. One-year hazard ratios were estimated for composite outcome of mortality or hospitalization using multivariable hierarchical Cox regression. The mean EFI score increased with the Social Security Nursing Benefit. Compared to fit patients, mild, moderate, and severe frailty patients had 2.07, 3.35, and 4.4-fold increased risks of mortality or hospitalization, after controlling for covariates. The findings showed that the Electronic Frailty Index version we created is valid in predicting mortality or hospitalization. In addition, the Electronic Frailty Index converged with an independent measurement produced by National Social Security.

Discrimination and health outcomes in England's black communities amid the cost-of-living crisis: evaluating the role of inflation and Bank Rates

ABSTRACT This study utilised longitudinal data from Black History Month events in London from 2021 to 2023. Novel findings revealed that increased inflation and Bank Rates, related to the cost-of-living crisis, were associated with greater discrimination and deteriorations in both general and mental health for Black individuals. Moreover, it was found that during the cost-of-living crisis period, i.e. 2022–2023, discrimination was more adversely related to general and mental health deterioration compared to the period before the cost-of-living crisis, i.e. 2021. In addition, women, non-native individuals, non-heterosexual individuals, the unemployed, economically inactive individuals, those with lower educational attainment, and older individuals experienced higher levels of discrimination and reduced general and mental health compared to reference groups. The findings of the study contribute to the literature by demonstrating the intertwined associations of macroeconomic deteriorations and discrimination with the health of the Black community, and its subgroup differences, providing a basis for targeted policies.