Management Of Health Conditions Research Articles

Development of a Web Application Based on Human Body Obesity Index and Self-Obesity Diagnosis Model Using the Data Mining Methodology

Measuring exact obesity rates is challenging because the existing measures, such as body mass index (BMI) and waist-to-height ratio (WHtR), do not account for various body metrics and types. Therefore, these measures are insufficient for use as health indices. This study presents a model that accurately classifies abdominal obesity, or muscular obesity, which cannot be diagnosed with BMI. Using the model, a web-based calculator was created, which provides information on obesity by predicting healthy ranges, and obesity, underweight, and overweight values. For this study, musculoskeletal mass and body composition mass data were obtained from Size Korea. The groups were divided into four groups, and six body circumference values were used to classify the obesity levels. Of the four learning models, the random forest model was used and had the highest accuracy (99%). This enabled us to build a web-based tool that can be accessed from anywhere and can measure obesity information in real-time. Therefore, users can quickly receive and update their own obesity information without using existing high-cost equipment (e.g., an Inbody machine or a body-composition analyzer), thereby making self-diagnosis convenient. With this model, it was easy to recognize and manage health conditions by quickly receiving and updating information on obesity without using traditional, expensive equipment, and by providing accurate information on obesity, according to body types, rather than information such as BMI, which are identified based on specific body characteristics.

The importance of faith-based mental healthcare in African urbanized sites.

This review highlights what current research says about how local beliefs and norms can facilitate expansion of mental healthcare to meet the large unmet need for services in Africa. In contemporary Africa, religious beliefs exert important influences on mental health as well as the way people with mental illnesses are viewed and cared for. Mental healthcare practices based on traditional and other religious beliefs, and offered by complementary and alternative health providers (CAPs), reflect the people's culture and are often preferentially sought by a majority of the population. Despite important differences in the worldviews of CAPs and biomedical mental healthcare practitioners in regard to causal explanations, there are nevertheless overlaps in the approaches of both sectors to the management of mental health conditions. These overlaps may provide a platform for collaboration and facilitate the scaling-up of evidence-based mental health services to underserved African populations, especially those residing in ever-expanding urban centres. Faith-based mental healthcare is an important but informal component of the mental health system in much of Africa. Collaboration between its practitioners and biomedical practice may help to bridge the large treatment gap for mental health conditions on the continent.

Burden and Determinants of Multimorbidity Among Women in Reproductive Age-Group: A Cross-Sectional Study Based in India

Background: Government of India is currently running several programs with a sole focus on women’s health during their child-bearing years. However, none of these programs incorporate management of chronic health conditions during the reproductive span (15-49 years). This issue is an emerging public health concern, and therefore, the present study aims to identify the patterns and correlates of multi-morbidity among women in their reproductive age-groups (15-49 years) in India. Methods: The study utilizes a nationally-representative cross-sectional data from the Demographic and Health Survey on 661,811 women in their reproductive age group of 15-49 years in India during 2015-16. The study uses the information of seven chronic morbidities, namely asthma, cancers, heart disease, diabetes, tuberculosis, hypertension, and thyroid disorder. Descriptive, bi-variate, and multivariate techniques were utilized to accomplish the study objective. Results: The findings show that 17.4 and 3.5 per 100 women in the reproductive age-group suffered from any one morbidity and multi-morbidity, respectively. Hypertension, diabetes, and thyroid disorders were commonly occurring chronic morbidities among women. The prevalence of having any one morbidity or multi-morbidity increased with age. Variables like religion, region, wealth, parity, menopause, consumption of tobacco and alcohol, Body Mass Index, and type of diet were found to be significantly related to the burden of multi-morbidity. The prevalence of multi-morbidity was found to be higher for the women who belong to the Southern, Eastern, and North-eastern region of India. Conclusions: Findings suggests the importance of multi-morbidity in the context of women in the reproductive age-group. Inclusion of chronic disease management strategies with Maternal and Child Health (MCH) services needs to be taken into consideration by the program and policy-makers. The annexation of social marketing approaches at the primary level of healthcare would assist the policy- makers in educating the women about the importance of leading a healthy lifestyle. Practicing dietary diversity can help in maintaining optimal estrogen level, which would further help in plummeting multi-morbidity rates among women in India.

Social justice considerations for occupational therapy: The role of addressing social determinants of health in unstably housed populations.

Populations of those experiencing homelessness in the United States expand beyond those living in shelters and on the streets. Many individuals living in poverty experience housing instability, as well as refugee populations who experience deprivation of social resources due to displacement. These populations are significantly affected by social determinants of health (SDOH). A current policy and literature review was completed to assess prominent SDOH impacting unstably housed populations in the United States, including refugees, encountered in occupational therapy practice. Review of evidence-based practice to address SDOH was completed to provide recommendations for practitioners across healthcare settings. A review of policy and its impact on those experiencing housing instability or recently resettled identifies several significant barriers to full occupational performance and health management. Several specific occupational therapy interventions exist to address these barriers and are in alignment with current practice. Occupational therapy practitioners across practice settings should consider how current housing status and social determinants of health may impact their clients' occupational performance and ability to manage health conditions.

Informatics and Artificial Intelligence Approaches that Promote Use of Integrative Health Therapies in Nursing Practice: A Scoping Review

Integrative health (IH) therapies are increasingly used to manage health conditions, but barriers hindering nurses from offering IH therapies persist. Informatics and artificial intelligence (AI) approaches have potential to promote nurses’ professional use of IH therapies. The purposes of this review are to (1) describe the state of the science of informatics and AI approaches promoting nurses’ use of IH therapies and (2) identify gaps in literature for future investigations. This systematic scoping review followed the systematic review guideline published by the Centre for Review and Dissemination. Five databases were used to retrieve relevant literature published between 2008 and 2018. Sixteen articles describing fourteen studies met predefined eligibility criteria and were reviewed. A descriptive numerical summary method and thematical analysis were used to synthesize the included literature. A fourfold typology emerged to label the informatics and AI approaches, including robots with AI, computer- and mobile-based applications, electronic communication using an information system, and information standards and standardized terminologies. The reviewed studies suggested that informatics and AI approaches could enhance the safety, accessibility, and communication of nursing IH therapies, as well as enable nursing IH data for IH-related knowledge discovery. Several gaps for future research were identified. There is a need of theory-informed research with more rigorous design and a larger scale to provide robust evidence for implementing existing applications and future innovations. Literature suggests progress toward use of informatics and AI approaches to support nurses’ professional use of IH therapies. Further high-quality and theory-informed research is needed regarding the applications used in conventional healthcare in supporting nurses’ use of IH therapies.

Anticipatory care planning intervention for older adults at risk of functional decline: study protocol for a primary care cluster feasibility randomised trial

BackgroundThe treatment and management of long-term health conditions is the greatest challenge facing health systems around the world today. Innovative approaches to patient care in the community such as Anticipatory Care Planning (ACP), which seek to help with the provision of high-quality comprehensive care to older adults at risk of functional decline, require evaluation. This study will evaluate one approach that will include primary care as the setting for ACP.Methods/designThis study will help to determine the feasibility for a definitive randomised trial to evaluate the implementation and outcomes of an ACP intervention. The intervention will be delivered by specially trained registered nurses in a primary care setting with older adults identified as at risk of functional decline. The intervention will comprise: (a) information collection via patient assessment; (b) facilitated informed dialogue between the patient, family carer, general practitioner and other healthcare practitioners; and, (c) documentation of the agreed support plan and follow-up review dates. Through a structured consultation with patients and their family carers, the nurses will complete a mutually agreed personalised support plan.DiscussionThis study will determine the feasibility for a full trial protocol to evaluate the implementation and outcomes of an (ACP) intervention in primary care to assist older adults aged 70 years of age or older and assessed as being at risk of functional decline. The study will be implemented in two jurisdictions on the island of Ireland which employ different health systems but which face similar health challenges. This study will allow us to examine important issues, such as the impact of two different healthcare systems on the health of older people and the influence of different legislative interpretations on undertaking cross jurisdictional research in Ireland.Protocol versionVersion 1, 17 September 2019.Trial registrationClinicaltrials.gov, ID: NCT03902743. Registered on 4 April 2019.

Australian military and veteran's mental health care part 1: an introduction to cultural essentials for clinicians.

This article aims to define the cultural specificity of Australian military and veterans, and introduce some of the essential clinician knowledge, skills and attitudes required for effective cultural competence in the management of mental health (MH) conditions in this population. Military culture has the defining characteristics of the military as an organisation with a formal structure, as a cultural group governed by norms and shared values, and as a social group that provides people with identities. Key requirements for cultural competence introduced here are basic knowledge of the military structure, norms and identity; clinical skills including basic assessment and awareness of the commonly occurring MH disorders; and an exploration of attitudes of both the clinician and the military or veteran patient. Further research is needed, particularly in terms of assessing clinician's cultural competence.

Comparing the Impact of Primary Care Practice Design in Two Inner City UK Homelessness Services.

Background: Specialist homeless primary health care services in the United Kingdom have arisen from the need for bespoke approaches to providing health care for people experiencing homelessness but descriptions of the design characteristics of homeless health services together with associated long-term condition (LTC) prevalence, health care utilization, and prescribing remain unexplored, thereby limiting our understanding of potential impact of service configuration on outcomes. Aim: Description of specialist homeless general practitioner services in Glasgow and Edinburgh, in terms of practice design (staff, skill mix, practice systems of registration, and follow-up); and exploration of the potential impact of differences on LTC prevalence, health care utilization, and prescribing. Method: Patient data were collected from computerized general practitioner records in Glasgow (2015, n = 133) and Edinburgh (2016, n = 150). Homeless health service configuration and anonymized patient data, including demographics, LTCs service utilization, and prescribing were summarized and compared. Results: Marked differences in infrastructure emerged between 2 practices, including the patient registration process, segmentation versus integration of services, recording systems, and the availability of staff expertise. Patient characteristics differed in terms of LTC diagnoses, health care utilization and prescribing. Higher rates of recorded mental health and addiction problems were found in Edinburgh, as well as higher rates of physical LTCs, for example, cardiovascular and respiratory conditions. There were significantly higher rates of consultations with nurses and other staff in Edinburgh, although more patients had consultations with pharmacists in Glasgow. Medication adherence was low in both cohorts, and attendance at referral appointments was particularly poor in Glasgow. Conclusion: Service design and professional skill mix influence recording of LTCs, service uptake, and identification and management of health conditions. Service configuration, professional skill mix, and resources may profoundly affect diagnoses, utilization of health care, and prescribing. Attention to homeless service design is important when providing care to this disadvantaged patient group.

'We're just seen as people that give out the methadone…': exploring the role of community pharmacists in the opioid substitution treatment team.

INTRODUCTION People receiving opioid substitution treatment are a vulnerable population who experience significant health inequities and stigma, but have regular interactions with community pharmacists. Many pharmacists now work collaboratively with other health providers to ensure effective and safe use of medicines, as well as being involved in the prevention and management of chronic health conditions. AIM To explore the role of New Zealand community pharmacists in the provision of opioid substitution treatment and how they perceive their role as part of the wider opioid substitution treatment team. METHODS Semi-structured video interviews with a purposive sample of 13 diverse pharmacists explored their current practices in providing opioid substitution treatment, and their perceived role in the treatment team. Interviews were audio-recorded and transcribed verbatim. Data were coded and analysed using an inductive thematic approach. RESULTS This study found that pharmacists are providing accessible support to a population with known barriers to accessing health care. However, participants also identified challenges with communication and a perceived lack of understanding of the pharmacist role as barriers to collaboration with the wider opioid substitution treatment team. DISCUSSION Collaboration within health-care teams has been shown to improve health outcomes, and pharmacists are well placed to provide health-care services as well as offer valuable insight into clients' mental and physical wellbeing. Improved communication channels that facilitate information sharing, as well as the opioid substitution treatment team's recognition of a pharmacist's role, may facilitate collaboration and, in turn, improve the quality of health care provided to this vulnerable population.

Anxiety and Depression Associated with Anal Sexual Practices among HIV-Negative Men Who Have Sex with Men in Western China.

This study aimed to explore the prevalence and influencing factors of anxiety and depression among human immunodeficiency virus negative (HIV-negative) men who have sex with men (MSM) based on anal sex roles, so as to provide a scientific basis for the management of mental health conditions. Data were obtained from the baseline in a cohort study with a two-year follow-up period in western China. The Self-Rating Anxiety Scale and Center for Epidemiological Studies Depression Scale were used to assess anxiety and depression symptoms, respectively. The prevalence of anxiety and depression in 1771 MSM was 26.03% and 37.83%. Among them, 182 anal sex role “0” MSM who only had receptive anal sex with men reported the highest prevalence of anxiety and depression (31.32% and 46.15%), 467 anal sex role “1” MSM who only had insertive anal sex with men (22.27% and 32.76%), and 1122 anal sex role “0.5” MSM who engaged equally in both insertive and receptive anal sex intercourse with men (26.74% and 38.59%), respectively. Logistic regression analysis revealed that the influencing factors of anxiety include anal sex role “0”/”0.5”, low educational level, female sexual partners, frequently searching partners on the Internet, sexually transmitted diseases (STD) diagnosed by doctors, and no HIV counseling. Anal sex role “0”/”0.5”, rural area, casual male partners, female partners, STD diagnosed by doctors, frequently searching partners on the Internet, no HIV counseling, no condom use, and daily alcohol use were found to be associated with depression. In conclusion, early identification and intervention of anxiety and depression symptoms in HIV-negative MSM should be carried out, especially for anal sex role “0” MSM. Furthermore, key intervention and psychological counseling should be taken into consideration for MSM with a low education level, high-risk behaviors, and high-risk perceptions.

Effect of Social Media Used by Medical Professionals in Facilitating the Treatment of Chronic Illnesses

The objective of this research is to describe the effect of social media use by medical professionals in facilitating the treatment of chronic illnesses in chronically ill individuals. This study focuses on the prominent social media used by medical professionals and the way it is used to manage health conditions of chronically ill individuals.

Health Literacy and Self-Rated Health among Homeless Adults.

Poor health literacy reduces the efficacy of behavior change interventions, hampers management of health conditions, and attenuates understanding of the prevention and treatment of diseases. Poor health literacy has also been linked to fair/poor self-rated health in domiciled samples; however, there is a paucity of studies on the relation amongst homeless adults, who bear a disproportionate burden of disease and disability and require high level of care and access to health services. Here, we examined the association between health literacy and self-rated health among a convenience sample of homeless adults. Participants were recruited from six homeless-serving agencies in Oklahoma City (N = 575; 63% men, Mage = 43.6±12.3). Logistic regression was used to assess the association between health literacy (confidence completing medical forms: extremely/quite a bit vs somewhat/little bit/not at all) and self-rated health (poor/fair vs good/very good/excellent) controlling for age, subjective social status, education, race, sex, income, health insurance, employment, social security recipient status, diabetes diagnosis, high blood pressure diagnosis, and high cholesterol diagnosis. In the adjusted model, health literate homeless individuals had greater odds of endorsing good/very good/excellent self-rated health compared to those somewhat/a little bit/not at all confident completing medical forms (AOR = 2.02, [CI95% = 1.35-3.02]). Interventions targeted at adjusting reading level and comprehensibility of health information are needed for homeless individuals with poor/limited health literacy, which may ultimately impact their self-rated health. Shelters and homeless-serving agencies could host classes focused on practical skills for enhancing health literacy and/or provide navigation services.

Simulator Development for Radial Artery Gasometry Collection

Introduction - The collection of arterial gasometry is a common procedure, mainly in inpatient setting (1). Thus, analysing and monitoring arterial blood gas play an important role in diagnosing and managing health conditions (2). The development of a simulator can help professionals improving radial artery gasometry collection. However, there are a number of high cost simulators which may turns the learning difficult (3). Mainly in public Universities, which lack enough resources and financing, in low and middle-income countries, the sources for high cost simulators may be impeditive. It is responsibility of the institutions that still cares about students’ formation to develop low costs solutions that could be copied as example for any other university in the same situation. In this setting, we aimed to develop a low costs simulators prototype that could be manufactured for any other institution. The first project was the gasometry collection simulator in radial artery. Usually, the gasometry is responsibility of a resident. Therefore, it is essential the resident previous training to perform the procedure in the best way before a real situation. The objective of this project was the development of a gasometry collection simulator in radial artery and a training protocol for undergraduate students and resident physicians. Methods - The industrial silicon is an easy manipulation and low-cost material and, therefore, it was chosen for simulate a hand and wrist. The silicone was moulded in a common procedure latex glove. It was used a nº 10 silicon nasoenteral catheter to simulate artery because it mimics the diameter of an adult real radial artery and allows multiple punctures, turning the device more durable. An assistant performed intermittent pressure to a 20 mL syringe coupled to the catheter to simulate the arterial pulse, both in inspection and palpation. The simulation scene was prepared as a clinical case where the examined resident was asked to perform a radial artery gasometry collection. The checklist evaluated the resident attitude (presentation, procedure explanation for the patient and permission asking to proceed), the choice of necessary material, Allen’s test description, and finally the gasometry collection by use of the simulator. During the procedure, all the parameters necessary to the puncture were evaluated, such as pulse palpation, puncture site and angle, collection volume, compression after taking off the needle, and bandage. Results - Five standardized simulators were manufactured, at a cost of 25€ each one, for a pilot study. Experienced professionals tested and approved all models before authorizing the use in a large scale with undergraduate medical students (interns). It was evaluated 107 interns from 5th year of graduation, 55% male. In a first test, only 40% of 107 interns performed Allen’s test before the gasometry collection, 65% chose correctly the necessary material for the procedure, and 72% performed correctly the puncture in the simulator. Conclusion - The development and manufacture of the gasometry collection simulator for procedure in the radial artery is feasible at a reasonable cost (25 € each). The use of simulation may improve medical education in the means that allow the repetition without a patient risk and does not have to be expensive (4).

A Continuous User Authentication System Based on Galvanic Coupling Communication for s-Health

Smart health (s-health) is a vital topic and an essential research field today, supporting the real-time monitoring of user’s data by using sensors, either in direct or indirect contact with the human body. Real-time monitoring promotes changes in healthcare from a reactive to a proactive paradigm, contributing to early detection, prevention, and long-term management of health conditions. Under these new conditions, continuous user authentication plays a key role in protecting data and access control, once it focuses on keeping track of a user’s identity throughout the system operation. Traditional user authentication systems cannot fulfill the security requirements of s-health, because they are limited, prone to security breaches, and require the user to frequently authenticate by, e.g., a password or fingerprint. This interrupts the normal use of the system, being highly inconvenient and not user friendly. Also, data transmission in current authentication systems relies on wireless technologies, which are susceptible to eavesdropping during the pairing stage. Biological signals, e.g., electrocardiogram (ECG) and electroencephalogram (EEG), can offer continuous and seamless authentication bolstered by exclusive characteristics from each individual. However, it is necessary to redesign current authentication systems to encompass biometric traits and new communication technologies that can jointly protect data and provide continuous authentication. Hence, this article presents a novel biosignal authentication system, in which the photoplethysmogram (PPG) biosignal and a galvanic coupling (GC) channel lead to continuous, seamless, and secure user authentication. Furthermore, this article contributes to a clear organization of the state of the art on biosignal-based continuous user authentication systems, assisting research studies in this field. The evaluation of the system feasibility presents accuracy in keeping data integrity and up to 98.66% accuracy in the authentication process.

Characteristics Associated With School Health Services for the Management of Chronic Health Conditions.

It is unknown how health services staff (school nurse or school physician) or school characteristics are associated with the number of services provided for chronic health conditions in schools. Using data from the 2014 School Health Policies and Practices Study, four services (identification or school-based management, tracking, case management, and referrals) were analyzed using a multivariable ordered logistic regression. Approximately 57.2% of schools provided all four, 17.5% provided three, 10.1% provided two, 5.8% provided one, and 9.4% did not provide any such services. Schools with a school nurse were 51.5% (p < .001) more likely to provide all four, and schools with access to consult with a school physician were 15.4% (p < .05) more likely, compared to schools without one. Schools comprised of mostly racial/ethnic minority students (less than or equal to 50% non-Hispanic White) were 14.7% (p < .05) less likely to provide all four, compared to schools with greater than 50% White students.

Is there association between stress and periodontitis?

This study estimated the association between stress and periodontitis. A cross-sectional study was conducted with a sample of 621 individuals. Information about individuals was obtained through a questionnaire. Stress was evaluated using the Perceived Stress Scale. The diagnosis of periodontitis was based on a complete periodontal examination including clinical attachment level, probing depth, and bleeding on probing. Prevalence ratios (PR), crude and adjusted, and their respective 95% confidence intervals (95%CI) were estimated by Poisson regression analysis. In the final sample, 48.47% (301) of the individuals were classified as having stress, of which, 23.92% (72) had the diagnosis of periodontitis. Association measurements between stress and probing depth ≥ 4mm (PRadjusted = 1.28, 95%CI [1.04 to 1.58]), stress and clinical attachment level ≥ 5mm (PRadjusted = 1.15, 95%CI [1.01 to 1.31]), and stress and periodontitis (PRadjusted = 1.36, 95%CI [1.01 to 1.83]) showed that the frequency of these outcomes among those exposed to stress was 15-36% higher than those without the condition of stress, after adjustment for age, sex, schooling level, current smoking habit, pulmonary disease, and body mass index. The findings showed positive association between exposure to stress and the presence of periodontitis, reaffirming the need to prevent and control stress. Although there are limitations in this study, the results showed that an association exists between stress and periodontitis, signaling the necessity of a multidisciplinary attention when considering the psychological status in the management of oral and general health conditions of the individual.

Nursing practice in inpatient rehabilitation: A narrative review (Part 1)

Aim: To review research literature examining the practice of nursing in inpatient rehabilitation. This paper presents one of the two main themes identified in this narrative review, namely the nature of nursing practice in inpatient rehabilitation. Design: A narrative review and critical appraisal of qualitative, quantitative and mixed methods studies. Data sources: A search of the relevant literature published 2004-2017 was carried out in CINAHL, Medline, Scopus, PsycINFO, Joanna Briggs Institute EBP Database, Pubmed, Health Collection and Health and Society Database, Embase, and AMED databases. Review methods: A total of 33 out of 2,815 papers identified in the search met the inclusion criteria for this review. A narrative review of the papers was undertaken by synthesising the key findings and grouping them into concepts and emergent themes. Findings: This paper presents one of the two main themes identified in this narrative review, namely the nature of nursing practice in inpatient rehabilitation. Under this theme three sub-themes were evident - nurse-initiated care, nursing care to support patient goals, and emotional care to support biographical adjustment. Conclusion: The review highlights how nurses work to support patients' goal achievement, but also shines a bright light on nursing's role in the management of patients' health conditions and the provision of emotional support.

Quality assessment of kidney cancer clinical practice guidelines using AGREE II instrument: A critical review.

Background:Evidence-based guidelines are expected to provide clinicians with explicit recommendations on how to manage health conditions and bridge the gap between research and clinical practice. However, the existing practice guidelines(CPGs) vary in quality. This study aimed to evaluate the quality of CPGs of kidney cancer.Methods:We systematically searched PubMed, Embase, China Biology Medicine disc, and relevant guideline websites from their inception to April, 2018. We identified CGPs that provided recommendations on kidney cancer; 4 independent reviewers assessed the eligible CGPs using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. The consistency of evaluations was calculated using intraclass correlation coefficients (ICC).Results:A total of 13 kidney cancer CGPs were included. The mean scores for each AGREEII domain were as follows: scope and purpose—76.9%; clarity and presentation—76.4%; stakeholder involvement—62.8%; rigor of development—58.7%; editorial independence—53.7%; and applicability—49.4%. Two CPGs were rated as “recommended”; 8 as “recommended with modifications”; and 3 as “not recommended.” Seven grading systems were used by kidney cancer CGPs to rate the level of evidence and the strength of recommendation.Conclusions:Overall, the quality of CPGs of kidney cancer is suboptimal. AGREE II assessment results highlight the need to improve CPG development processes, editorial independence, and applicability in this field. It is necessary to develop a standardized grading system to provide clear information about the level of evidence and the strength of recommendation for future kidney cancer CGPs.

Management of mental health conditions in refugee youth: An overview for the psychiatric-mental health nurse practitioner.

In 2017, there were a total of 70 million forcibly displaced individuals or refugees, worldwide. Unfortunately, over 50% of refugees are under the age of 18 years. Refugee youth are at-risk for a variety of mental health conditions. The purpose of this report is to provide psychiatric-mental health nurse practitioners (PMHNPs) with an understanding of unique cultural implications in refugee youth, risk factors towards the development of psychiatric illness, and means to identify those at-risk for sequelae or those meeting diagnostic criteria. Also presented are foundational treatment and management implications to ensure the provision of culturally sensitive and efficacious care to this unique population. Utilizing PubMed, CINAHL, and PsycINFO, a literature review was conducted to identify relevant publications pertaining to mental health issues in refugee youth spanning from 2013 to present. Reference lists of identified articles were also searched. A variety of risk and protective factors are discussed, spanning from premigration, during flight, and postsettling periods. PMHNPs must be proficient in screening and diagnosis of mental health conditions in refugee youth and implementation of pharmacological and psychotherapeutic interventions. PMHNPs must also be well versed in community-based resources that can be utilized to promote optimal outcomes.

Implementation of an augmented stepped mental health care service in Australian primary care: a mixed method study

ABSTRACT Objective: StepCare is an online, stepped mental healthcare service in general practice which identifies adults with common mental disorders, recommends evidence-based treatments and monitors symptoms and risk, with feedback to the patient and GP. Previous data suggested that StepCare was acceptable and feasible, assisting GPs to identify and manage patients’ depression and anxiety. Areas for improvement were recommended by GPs, practice staff and patients. StepCare was accordingly upgraded and a new implementation strategy was introduced, consistent with the Australian Government's reform agenda. This study aimed to evaluate the augmented StepCare and new implementation model. Methods: Two Primary Health Networks (PHNs) and 22 general practices took part. The StepCare team trained and supported PHN staff to implement the Service in their general practices. PHN staff, GPs, practice staff and patients rated the acceptability, feasibility and effectiveness of StepCare. New cases at screening and patients’ symptom change over 12 weeks were measured. Implementation facilitators and barriers were also investigated. Results: The majority of PHN staff, GPs, practice staff and patients rated StepCare as acceptable and feasible, GPs reported it assisted their identification and management of common mental health conditions and most patients indicated they would recommend it to a friend. 37% of patients reporting symptoms at screening were new cases. Patients’ depression symptoms reduced significantly by 12 weeks. Discussion: Augmented StepCare is able to identify new cases and produce clinical change within routine general practice. It also has the potential to be implemented by PHNs with assistance from the StepCare team.