Health Care Research Articles

Primary Care Organizational Support for Nurse Practitioner Practice and Emotional Health Care Delivery.

Nurse practitioners (NPs) are key to delivery of primary care services. However, poor organizational support for independent NP practice, such as lack of access to clinic resources, may lead to prioritizing patient physical health over emotional health. We investigated the relationship between organizational support for independent NP practice and emotional health care delivery. This was a secondary analysis of cross-sectional survey data collected from 397 NPs in 2017. We measured organizational support for independent NP practice using the independent practice and support subscale of the NP Primary Care Organizational Climate Questionnaire. Emotional health care delivery was measured by asking NPs how frequently they addressed emotional concerns of patients. We utilized multilevel mixed effects linear regression models, adjusting for NP and practice covariates. Controlling for NP age, gender, marital status, race, and ethnicity, along with practice setting and size, as the independent practice and support score increased, NPs reported addressing emotional concerns of patients more frequently (beta = 0.34, 95% confidence interval = 0.02-0.66, P = 0.04). This indicates that as organizations provided more support for independent NP practice, NPs were able to more frequently address emotional concerns of patients. Organizational support for independent NP practice is associated with addressing emotional concerns of patients. To support NP practice, primary care organizations should ensure that NPs manage patients independently and have access to ancillary staff and support for care management.

Pelvic floor muscle training for urinary incontinence in older adults: a best practice implementation project.

This project aimed to implement best practices for pelvic floor muscle training to manage urinary incontinence among older women in long-term care in Kerala, India. Urinary incontinence is a prevalent and distressing condition that affects a significant proportion of older adults and is characterized by involuntary loss of urine, leading to social embarrassment, decreased quality of life, and increased health care costs. It is more prevalent in women and is associated with dementia, limited mobility, and other comorbidities in long-term care. Pelvic floor muscle training is a first-line treatment option for urinary incontinence in older adults, given its potential to improve quality of life and reduce health care costs. This project was based on the JBI Evidence Implementation Framework. A baseline audit was conducted to evaluate current practice against best practices. After identifying barriers and implementing strategies, follow-up audits were conducted after 3 and 6 months. The baseline audit showed 0% compliance with all best practices. Barriers such as lack of knowledge and practice of pelvic floor exercises for urinary incontinence among participants and nurses; unknown cognitive status; and health emergencies were identified. Strategies including video-assisted training of pelvic floor muscle exercises, training calendars, and flip charts with instructions. The follow-up audits showed significant improvements in compliance. This project reduced urinary incontinence in the participants. Although two of the audit criteria did not reach 100% compliance by the end of 6 months, the stakeholders of the long-term care facility understood the importance of pelvic floor muscle training, which will be beneficial for future residents with urinary incontinence. http://links.lww.com/IJEBH/A211.

Mental health workers’ perspectives on the implementation of a peer support intervention in five countries: qualitative findings from the UPSIDES study

ObjectiveThe introduction of peer support in mental health teams creates opportunities and challenges for both peer and non-peer staff. However, the majority of research on mental health workers’ (MHWs) experiences...

Assessment of knowledge, attitude and practice to promote hand hygiene among undergraduate medical and nursing students in a teaching hospital

: A considerable number of epidemiological evidences proved that efficient hand hygiene practices has reduced the risk of infection cross-transmission in hospital facilities. Despite the effortlessness and simplicity of the practice, compliance with hand hygiene among health care workers has been relatively very less. There is a significant lack of evidence regarding infection control training among undergraduate medical and nursing students, hence it becomes essential to re-examine the efficacy of our hand hygiene sessions and conduct programs, CMEs, workshops frequently to keep health care workers sensitized and oriented towards hand hygiene.: The present study was undertaken to assess the overall exposure of medical and nursing students towards basic hand hygiene practices through a knowledge, attitude and practice questionnaire based cross- sectional study. 100 medical and 100 nursing students were grouped into good, moderate and poor categories, based on scores from the questions testing the overall knowledge of hospital acquired infections, attitude towards hand hygiene and actual practice at the field level.: The present study showed poor knowledge among medical and nursing students i.e 41% and 60% of the participants respectively. Nursing staff showed good attitude when compared to medical students (71% and 56%). Regardless of the knowledge, practice of hand hygiene was good in both the groups 59% of medical and 71% of nursing students. On the whole, in comparison nursing population displayed better results compared to undergraduate medical student population. Nevertheless, evidently showing unsatisfactory results among both the study groups in the grounds of knowledge.: Therefore, the study concludes that knowledge and exposure to hand hygiene practices should be improved in undergraduate curriculum for both medical and nursing students which provides an opportunity to correct the bed side hygiene practices of the future health care providers at the foundation level.

Plant-derived bioactive compounds for the inhibition of biofilm formation: a comprehensive review.

Biofilm formation is a widespread phenomenon that impacts different fields, including the food industry, agriculture, health care and the environment. Accordingly, there is a serious need for new methods of managing the problem of biofilm formation. Natural products have historically been a rich source of varied compounds with a wide variety of biological functions, including antibiofilm agents. In this review, we critically highlight and discuss the recent progress in understanding the antibiofilm effects of several bioactive compounds isolated from different plants, and in elucidating the underlying mechanisms of action and the factors influencing their adhesion. The literature shows that bioactive compounds have promising antibiofilm potential against both Gram-negative and Gram-positive bacterial and fungal strains, via several mechanisms of action, such as suppressing the formation of the polymer matrix, limiting O2 consumption, inhibiting microbial DNA replication, decreasing hydrophobicity of cell surfaces and blocking the quorum sensing network. This antibiofilm activity is influenced by several environmental factors, such as nutritional cues, pH values, O2 availability and temperature. This review demonstrates that several bioactive compounds could mitigate the problem of biofilm production. However, toxicological assessment and pharmacokinetic investigations of these molecules are strongly required to validate their safety.

Psychiatric Mental Health Nurses' Perceptions and Experiences of Inpatient Mental Health Care Safety Culture in Saudi Arabia.

Although patient safety culture is gaining attention globally, more studies are needed to investigate its relevance to the nursing care of mental health (MH) patients. This study aimed to illustrate the perceptions and experiences of nurses who work in inpatient mental health care (IMHC) concerning the patient safety practices that are employed to avert safety hazards encountered during the provision of care in IMHC settings. Eighteen postgraduate students working as MH nurses in nonprofit hospitals comprised the study sample. The participants had a minimum of 2 years' nursing experience in IMHC settings. Each participant was interviewed individually using a guided interview technique. The inductive data underwent thematic analysis. Patient protection and a safety perspective were the overarching themes that emerged from the data. Three principal themes and 9 subthemes were illuminated: (a) patient care safety knowledge and background, (b) improving MH care, and (c) development of MH nursing care. The findings of this investigation may assist in providing guidance for the further research into and development of a patient safety culture appropriate for IMHC nursing practice, including increased structured educational experiences, judicious risk assessment, assignment of staff to include a mixture of skills and experience levels during assignments, use of standardized handoff procedures, engagement with multidisciplinary care providers, blame-free reflective information sharing and mentoring, and attention to the built environment with consideration of patient and staff safety needs.

Building an implementation strategy for community-based rehabilitation for mental health in Colombia.

Scientific evidence indicates that the community-based rehabilitation (CBR) model is recommended for recovery from mental disorders. However, this approach encounters barriers and often lacks implementation strategies. The aim of this study is to create a strategy for the implementation of CBR for mental health in Colombia through the identification of barriers and facilitators, together with the expected outcomes, from the perspective of mental health decision-makers in Colombia. This study adopts a qualitative descriptive approach, using focus group data collection methods and thematic analysis to code and analyze the data. A total of 208 individuals participated in the study, including mental health decision-makers and health care professionals. Intersectoral collaboration, contextualization, financial resources, and community commitment and autonomy were identified as barriers and facilitators. The element that was considered a priority for successful implementation was the contextualization of strategies. CBR needs to be strengthened through implementation science if these strategies are to be successfully developed and implemented in various contexts. http://links.lww.com/IJEBH/A210.

Long-Term Course of Remission and Recovery in Psychotic Disorders.

Understanding prognosis is critical to anticipating public health needs and providing care to individuals with psychotic disorders. However, the long-term course of remission and recovery remains unclear. In this study, the most common trajectories of illness course are described for a cohort of individuals followed for 25 years since first admission for psychosis. Participants are from the Suffolk County Mental Health Project, an epidemiological study of first-admission psychosis. Data for the present study was collected from six follow-ups, with 311 individuals assessed at the 25-year follow-up. Common patterns of remission and recovery were assessed in the baseline cohort of 591 individuals and the subsample from the 25-year follow up. In the baseline cohort and the 25-year subsample, the most common trajectory for individuals with schizophrenia spectrum disorders was no remission and no recovery. Among individuals with other psychotic disorders, in both the baseline and 25-year cohorts, the modal pattern was one of intermittent remission and recovery. Individuals with other psychotic disorders were more likely to experience stable remission (15.1%) and stable recovery (21.1%), outcomes that were rare among individuals with schizophrenia spectrum disorders (0% and 0.6%, respectively). The modal longitudinal pattern for individuals with other psychoses is one of multiple transitions into and out of symptomatic and functional recovery. Engagement in a long-term health care plan may help individuals detect and respond to these changes. Sustained remission and recovery are rare among people with schizophrenia spectrum disorders. Efforts should be directed toward developing more effective treatments for this population.

Bridging the evidence-to-practice gap: exploring dental professionals' perspectives on managing oral health during pregnancy in Tasmania, Australia.

Poor oral health is associated with adverse health, social and economic consequences for pregnant women. While dental professionals promote good oral health within the dental practice context, more broadly, women in the antenatal period face poor oral health outcomes. Therefore, this study explored dental professionals' perceptions of their role in managing the oral health of pregnant women and identified the barriers and facilitators to improving maternal oral health. This study employed a descriptive qualitative method utilizing semi-structured interviews. Convenience and snowball sampling were used to recruit 13 dental professionals from Tasmania, Australia, comprising dentists (n = 10), oral health therapists (n = 2) and dental therapist (n = 1). Interviews were audio-recorded, transcribed verbatim and analysed using inductive thematic analysis. Three major themes were constructed from the interviews: (1) dental professionals' oral health care of women during pregnancy; (2) perceived challenges to maternal oral health; and (3) proposed strategies to improve maternal oral health. Findings suggest dental professionals' competence in maternal oral health, but that several barriers, such as dental care access and maternal factors, hinder oral health outcomes. To address these barriers, oral health policies that support interprofessional collaboration, professional training and evaluation of existing community oral health programmes are needed. © 2024 Australian Dental Association.

Reinforcing decellularized small intestine submucosa with cellulose acetate nanofibrous and silver nanoparticles as a scaffold for wound healing applications.

The formation of chronicwounds accounts for considerable costs in health care systems. Despite theseveral benefits of decellularized small intestinal submucosa (SIS) as anappropriate scaffold for different tissue regeneration, it has shortcomings such as lack of antibacterial features and inappropriate mechanical properties for skin tissue regeneration. We aimed to examine the efficacy and safety of decellularized SIS scaffold enhanced with cellulose acetate (CA) and silver (Ag) nanoparticles (NPs) for healing full-thickness wounds. The scaffolds wereprepared by decellularizing bovine SIS and electrospinning CA/Ag nanoparticles and characterized using a transmission electron microscope (TEM), scanning electronmicroscope (SEM), tensile testing, and X-ray diffraction. In vivo evaluations were performed using full-thickness excisions covered with sterile gauze as the control group, SIS, SIS/CA, and SIS/CA/Ag scaffolds on the dorsum of twenty male Wistar rats divided into four groups randomly with 21-days follow-up. All in vivo specimens underwent Masson's trichrome (MT) staining for evaluation of collagen deposition, transforming growth factor-β (TGF-β) immunohistochemistry (IHC), and Haematoxylin Eosin (H&E) staining. The IHC and MT data were analyzed with the ImageJ tool by measuring the stained area. The TEM results revealedthat Ag nanoparticles are successfully incorporated into CA nanofibers. Assessment of scaffoldshydrophilicity demonstrated that the contact angle of SIS/CA/Ag scaffold was the lowest. The in vivoresults indicated that the SIS/CA/Ag scaffold had the most significant wound closure. H&E staining of the invivo specimens showed the formation of epidermal layers in the SIS/CA/Ag group on day 21. The percentage of the stained area of MT and TGF-β IHC staining's was highest in the SIS/CA/Ag group. The decellularizedSIS/CA/Ag scaffolds provided the most significant wound closure compared toother groups and caused the formation of epidermal layers and skin appendages. Additionally, the collagen deposition and expression of TGF-β increased significantly in SIS/CA/Ag group.

Perceptions of Primary Care Among Women in Treatment for Opioid Use Disorder: A Qualitative Study.

Underutilization of primary care and receipt of preventive health services have been reported among women with opioid use disorder. The aim of this study was to describe perceptions of primary care among women in treatment for opioid use disorder. Between May and June 2022, 27 women who were receiving treatment for opioid use disorder from one opioid treatment program participated in this study. Participants completed one data collection session which involved a brief questionnaire followed by a semi-structured interview. Participants were asked questions about their overall experience with primary care as well as perceived facilitators and barriers to primary care utilization and quality. Interview transcripts were analyzed using an inductive thematic approach. Three themes emerged from the interviews within the domain of "Facilitators to Primary Care," including: (1) coordination of care, (2) continuity of care, and (3) relationship with health care providers. Four themes emerged from the interviews within the domain of "Barriers to Primary Care," including: (1) perceived judgment from health care providers, (2) childcare needs, (3) issues related to location, and (4) issues related to time. Approaches to primary care that help alleviate barriers to care and highlight the aspects of care that are valued may improve quality and utilization of care, thus enhancing the health and well-being of a vulnerable population.

A comparative study on knowledge, awareness and perception of contraception among rural and urban population in Punjab

In developing countries like India, a lack of awareness about contraceptive methods often leads to misconceptions, limited choices, and improper family planning. This knowledge gap not only disrupts maternal and child health complications but also disrupts the economy of society and the nation. Therefore, the purpose of this study was to investigate the knowledge, awareness and perception of contraception among the rural and urban population in Punjab.This observational study conducted in the Department of Obstetrics and Gynecology at a tertiary health care centre, in Punjab, India. A total of 500 women were evaluated with the help of a pre-designed questionnaire to address knowledge, awareness, and perception of contraception among the rural and urban population in Punjab. The statistical analysis was performed by using SPSS Windows, version 28. In the present study, a total of 492 participants were included, of whom 387 were from rural areas and 105 were from urban areas. This study revealed, 100% of participants were aware of contraception. In terms of the source of information, social circles were identified as the primary channel (46.34%), followed by the media (33.94%), health workers (16.87%), and educational institutes (2.85%).This study highlights contraceptive methods, including condoms, oral contraceptives, and intrauterine devices (IUDs), as primary choices. Therefore, it's important to bridge the gap between awareness and action. Hence, this study, advocate the awareness program on interventions to ensure everyone can access effective family planning resources without barriers.

The antecedents of oral care in nursing facilities - a qualitative interview study among supervisor nurses.

This qualitative study describes the views of supervisor nurses related to antecedents of oral care in Finnish nursing facilities. In the six largest cities in Finland, 19 supervisor nurses were interviewed and asked five semi-structured questions related to the antecedents of oral care in the units. The interviews were analyzed using inductive content analysis. Qualitative content analysis revealed five main categories: awareness of nurses (3 categories, 9 subcategories), attitude and motivation (3 categories, 10 subcategories), supporting quality of life and health (4 categories, 11 subcategories), the meaning of oral health in the unit (3 categories, 10 subcategories), and the role of the supervisor nurse in oral health care (4 categories, 14 subcategories). The awareness of nurses regarding oral health was in most cases good. Nurses' attitudes towards oral health and their motivation to oral care vary but were mostly good. Nurses were aware that oral care enhances the quality of life. The role of the supervisor nurse in organizing oral care was crucial. The performed analysis identified five main categories to describe antecedents for oral care in Finnish nursing facilities. The categories that needed to be improved were knowledge and attitude, and motivation related to oral care.

Residents’ willingness towards first-contact with primary health care under uncertainty in healthcare: a cross-sectional study in rural China

ObjectiveTo estimate Chinese rural residents’ willingness degree of initially contacting primary healthcare (PHC) under uncertainty in healthcare and to explore its influencing factors.SettingThis study collected primary data from rural residents...

Retropubic Versus Transobturator Midurethral Slings at Time of Colpocleisis.

This study aimed to evaluate if there is a difference between outcomes when retropubic or transobturator midurethral sling surgery is performed at the time of colpocleisis. The purpose of this study was to compare the surgical outcomes of the retropubic midurethral sling (RP-MUS) versus the transobturator midurethral sling (TO-MUS) in women who underwent concomitant colpocleisis, specifically 2-year MUS failure and 1-year lower urinary tract symptoms (LUTSs). A secondary aim was to identify factors associated with these surgical outcomes. All cases of concomitant MUS and colpocleisis within a closed, integrated health care delivery system were reviewed between April 1, 2010, and March 31, 2020. Postoperative MUS failure was defined as (1) postoperative stress urinary incontinence symptoms and/or (2) additional anti-incontinence surgery. Postoperative LUTSs were defined as (1) MUS lysis and/or (2) overactive bladder requiring management with a new treatment. Of the 558 women included, 454 (81%) received RP-MUS and 104 (19%) received TO-MUS. Cohort demographics were similar. Neither MUS failure (7% RP-MUS and 9% TO-MUS, P = 0.450) nor LUTSs (7% RP-MUS and 12% TO-MUS, P = 0.171) were significantly different between RP-MUS and TO-MUS. In multivariable analysis, age was found to be significantly associated with LUTSs (odds ratio 0.29, 95% confidence interval 0.09-0.93, P = 0.038 among 70-74-year-olds; odds ratio 0.28, 95% confidence interval 0.09-0.83, P = 0.022 among 75-79-year-olds). At the time of colpocleisis, both RP-MUS and TO-MUS were highly successful and associated with a low incidence of LUTSs, including MUS lysis. The findings of this large study support RP-MUS and TO-MUS as similarly effective anti-incontinence options at time of colpocleisis.

Markets and Medical Decisions

ABSTRACT This essay argues for two conclusions. First, clinical decision-making is not best thought of as analogous to the purchase of other services, such as car repair. Health-care decision-making is far more difficult, collaborative, emotionally fraught, and subject to cognitive distortions. Second, the provision of health care should not be delegated to unregulated markets. Unlike other markets, there is no reason to expect health-care market outcomes to be efficient or fair or to promote individual freedom, properly conceived. Markets may play an important role in implementing an allocation of healthcare, but they are not an ethically acceptable alternative to determining what that allocation should be.

Breast Cancer Risk After Bariatric Surgery and Influence of Insulin Levels: A Nonrandomized Controlled Trial.

Obesity and insulin are risk factors for breast cancer, and retrospective studies suggest bariatric surgery reduces breast cancer risk in women. However, long-term prospective data on breast cancer risk after bariatric surgery and the role of baseline insulin levels are lacking. To examine if bariatric surgery is associated with breast cancer incidence in women and if treatment benefit is modified by baseline insulin levels. The Swedish Obese Subjects (SOS) study was a nonrandomized intervention trial designed to investigate the long-term effects of bariatric surgery on obesity-related mortality and morbidity. Study recruitment took place between 1987 and 2001, and median (IQR) follow-up time was 23.9 years (20.1-27.1) years. The study was conducted at 25 public surgical departments and 480 primary health care centers in Sweden and included 2867 women aged 37 to 60 years and with body mass index 38 or greater (calculated as weight in kilograms divided by height in meters squared). In the surgery group (n = 1420), 260 women underwent gastric banding, 970 vertical banded gastroplasty, and 190 gastric bypass. The remaining contemporaneously matched control individuals (n = 1447) received usual obesity care. Breast cancer, the main outcome of this secondary report, was not a predefined outcome in the SOS study. Breast cancer events were identified in the Swedish National Cancer Registry. The study population comprised 2867 women with a mean (SD) age of 48.0 (6.2) years. During follow-up, there were 154 breast cancer events, 66 in the surgery group and 88 in the usual care group, and a decreased risk of breast cancer was observed in the bariatric surgery group (hazard ratio [HR], 0.68; 95% CI, 0.49-0.94; P = .019; adjusted HR, 0.72; 95% CI, 0.52-1.01; P = .06). The surgical treatment benefit on breast cancer risk was greater in women with baseline insulin levels above the median 15.8 μIU/L (HR, 0.48; 95% CI, 0.31-0.74; P = .001; adjusted HR, 0.55; 95% CI, 0.35-0.86; P = .008) compared to those below (HR, 0.95; 95% CI, 0.59-1.53; P = .84; adjusted HR, 1.01; 95% CI, 0.61-1.66; P = .97; interaction P = .02). This prospective clinical trial indicated a reduced risk of breast cancer after bariatric surgery in women with obesity. The surgical treatment benefit was predominantly seen in women with hyperinsulinemia. ClinicalTrials.gov Identifier: NCT01479452.

Liquid crystalline elastomer self-oscillating fiber actuators fabricated from soft tubular molds.

The self-oscillation of objects that perform continuous and periodic motions upon unchanging and constant stimuli is highly important for intelligent actuators, advanced robotics, and biomedical machines. Liquid crystalline elastomer (LCE) materials are superior to traditional stimuli-responsive polymeric materials in the development of self-oscillators because of their reversible, large and anisotropic shape-changing ability, fast response ability and versatile structural design. In addition, fiber-shaped oscillators have attracted much interest due to their agility, flexibility and diverse oscillation modes. Herein, we present a strategy for fabricating fiber-shaped LCE self-oscillators using soft tubes as molds. Through the settlement of different configuration states of the soft tubes, the prepared fiber-shaped LCE oscillators can perform continuous rotational self-oscillation or up-and-down shifting self-oscillation under constant light stimuli, which are realized by photoinduced repetitive self-winding motion and self-waving motion, respectively. The mechanism of self-oscillating movements is attributed to the local temperature oscillation of LCE fibers caused by repetitive self-shadowing effects. LCE self-oscillators can operate stably over many oscillating cycles without obvious performance attenuation, revealing good robustness. Our work offers a versatile way by which LCE self-oscillators can be conveniently designed and fabricated in bulk and at low cost, and broadens the road for developing self-oscillating materials for biological robotics and health care machines.

The added value of virtual reality to parent–child interaction therapy: a qualitative study with parents and therapists

BackgroundVirtual reality (VR) is one of the most rapidly growing technological advancements being studied, developed, and implemented in mental health care. It offers a wide array of possibilities that go beyond the traditional ways of providing mental health care services. Many interventions require clients to learn new skills in order for change to occur. Relevant to this study, behavioral parent-training (BPT) interventions are focused on the acquisition of parenting skills in order to change child behavior. VR was added to the Parent–Child Interaction Therapy (PCIT) – a known BPT intervention — as an additional practice tool. In the present study, which is part of a larger study, the qualitative experiences of (PCIT-)VR from both parents’ and therapists’ perspectives are evaluated, as well as their suggestions for implementation.MethodSemi-structured interviews were conducted with eleven parents. Five therapists participated in a focus group and three additional semi-structured interviews were conducted with therapists. To analyze, a combination of deductive and inductive thematic analysis was used.ResultsResponses from interviews were divided into three categories: (1) parents’ evaluation, (2) therapists’ evaluation, and (3) suggestions for implementation from both parents and therapists. Next to a positive overall experience with PCIT, a large number of parents were also positive about the addition of VR to treatment. Both parents and therapists experienced VR as a useful additional practice tool. The additional practice in VR led to a boost in confidence in using positive parenting skills. There were mixed experiences regarding the ease and immersion of the tool. Suggestions for implementation from both parents and therapists were to make the tool more appealing and realistic, to vary more in VR modules and to improve certain practical aspects.ConclusionAdding VR to PCIT is still a pioneering piece of technology within PCIT. The value of this VR tool lies in the provision of the possibility to practice with skills outside of the therapeutic encounter, which has the potential to instill confidence in using those skills. Given the positive experiences regarding PCIT-VR, it is important to further develop the VR tool. We believe that ultimately, PCIT-VR can potentially serve as a customized way for parents to practice what they are taught during the treatment.

Concentrated transdiagnostic and cross-disciplinary micro-choice based group treatment for patients with depression and with anxiety leads to lasting improvements after 12 months: a pilot study

BackgroundA concentrated transdiagnostic and micro choice-based group treatment for patients with depression and anxiety has previously shown to yield significant reduction in symptoms and increased level of functioning from pre to 3-month follow-up. In the present study, we report the results after 12 months follow-up.MethodsThis was a non-randomized clinical intervention pilot study, conducted in line with a published protocol. Sixty-seven consecutively referred patients, aged 19–47 (mean age 32.5, SD = 8.0) were included and completed treatment. All had a severity of their problems that entitled them to care in the specialist public mental health care. Self-reported age at onset of symptoms was 17.6 (SD = 7.9) years. Mean number of prior treatment courses was 3.5 (SD = 3.3; range 0–20). The main objective was to assess the treatment effectiveness by questionnaires measuring relevant symptoms at pre-treatment, 7 days-, 3 months-, 6 months- and at 12-months follow-up.ResultsValidated measures of functional impairment (WSAS), depression (PHQ9), anxiety (GAD7), worry (PSWQ), fatigue (CFQ), insomnia (BIS) and illness perception (BIPQ) improved significantly (p < .0005) from before treatment to 12 months follow-up, yielding mostly large to extremely large effect sizes (0.89–3.68), whereas some moderate (0.60–0.76). After 12 months, 74% report an overall improvement in problems related to anxiety and depression. Utilization of specialist, public and private mental health care was reported as nonexistent or had decreased for 70% of the patients at 12-month follow up.ConclusionsThe concentrated, micro-choice based group treatment approach yielded a highly clinically significant reduction in a wide range of symptoms already one week after treatment, and the positive results persisted at 12-month follow-up.Trial registrationClinicalTrials.gov Identifier: NCT05234281, first posted date 10/02/2022.