Needs-based Intervention Research Articles

“I don't care about my mental health because I have a physical disability”: A qualitative study on the mental healthcare-seeking behaviours of people with disabilities in Bangladesh

In Bangladesh, people living with disabilities are one of the most vulnerable groups, as they receive little or no assistance. They face numerous challenges regarding financial, social, and access to basic education and healthcare, which contribute to experiences of distress and mental health issues. However, there is limited research on the mental health needs of people with disabilities and the accessibility of mental health services in Bangladesh. This qualitative study addresses this gap by examining the mental healthcare-seeking behaviours of people with disabilities and challenges in care-seeking pathways and recommendations for devising an inclusive system in existing mental health services through key informant interviews and focus group discussions with 55 participants from four stakeholder groups. Findings highlight that limited mental health, literacy, stigma, and financial and logistical challenges, such as inaccessible transportation and distant facilities, hinder access to care. System-level barriers, including a lack of specialists and inadequate community-based services, further exacerbate the issue. Stakeholders recommended strengthening social support systems by providing disability identity cards, allowances, and access to inclusive education and employment opportunities. They also emphasized the need for awareness campaigns, better transportation options, and training for healthcare workers. Policymakers are urged to design culturally relevant needs-based interventions to improve mental healthcare pathways for people with disabilities while promoting multisectoral collaboration.

Psychometric Properties of Scales Assessing Psychosocial Determinants of Staff Compliance with Surgical Site Infection Prevention: The WACH-Study.

Psychosocial determinants influence healthcare workers' compliance with surgical site infection (SSI) preventive interventions. In order to design needs-based interventions promoting compliance, such determinants must first be assessed using valid and reliable questionnaire scales. To compare professional groups without bias, the scales must also be measurement-equivalent. We examine the validity/reliability and measurement equivalence of four scales using data from physicians and nurses from outside the university sector. Additionally, we explore associations with self-reported SSI preventive compliance. N = 90 physicians and N = 193 nurses (response rate: 31.5%) from nine general/visceral or orthopedic/trauma surgery departments in six non-university hospitals in Germany participated. A written questionnaire was used to assess the compliance with SSI preventive interventions and the determinants of compliance based on the Capability-Opportunity-Motivation-Behavior-Model. Psychometric testing involved single- and multiple-group confirmatory factor analyses, and explorative analyses used t-tests and multiple linear regression. The scales assessing individual determinants of compliance (capability, motivation, and planning) were found to be reliable (each Cronbach's α ≥ 0.85) and valid (each Root-Mean-Square-Error of Approximation ≤ 0.065, each Comparative-Fit-Index = 0.95) and revealed measurement equivalence for physicians and nurses. The scale assessing external determinants (opportunity) did not demonstrate validity, reliability, or measurement equivalence. Group differences were found neither in compliance (p = 0.627) nor determinants (p = 0.192; p = 0.866; p = 0.964). Capability (β = 0.301) and planning (β = 0.201) showed associations with compliance for nurses only. The scales assessing motivation, capability, and planning regarding SSI preventive compliance provided reliable and valid scores for physicians and nurses in surgery. Measurement equivalence allows group comparisons of scale means to be interpreted without bias.

A Multimodal Lifestyle Psychosocial Survivorship Program in Young Cancer Survivors

There is a lack of trials examining the effect of counseling interventions for child, adolescent, and younger adult (CAYA) cancer survivors. To assess lifestyle habits and the psychosocial situation of CAYAs to determine the efficacy of needs-based interventions in the CARE for CAYA program (CFC-P). The CFC-P was conducted as a multicenter program in 14 German outpatient clinics, mainly university cancer centers. Recruitment began January 1, 2018; a randomized clinical trial was conducted until July 15, 2019; and intervention was continued as a longitudinal cohort study until March 31, 2021. Data preparation was conducted from April 1, 2021, and analysis was conducted from August 14, 2021, to May 31, 2022. Herein, predefined confirmatory analyses pertain to the RCT and descriptive results relate to the overall longitudinal study. Data analysis was based on the full analysis set, which is as close as possible to the intention-to-treat principle. A comprehensive assessment determined needs in physical activity, nutrition and psychooncology. Those with high needs participated in 1 to 3 modules. In the RCT, the IG received 5 counseling sessions plus newsletters, while the control group CG received 1 counseling session. The primary outcome was the change in the rate of CAYAs with high needs at 52 weeks. Secondary outcomes were feasibility, modular-specific end points, satisfaction, quality of life, and fatigue. Of 1502 approached CAYAs aged 15 to 39 years, 692 declined participation. Another 22 CAYAs were excluded, resulting in 788 participants. In the randomized clinical trial, 359 CAYAs were randomized (intervention group [IG], n = 183; control group [CG], n = 176), and 274 were followed up. In the RCT, the median age was 25.0 (IQR, 19.9-32.2) years; 226 were female (63.0%) and 133 male (37.0%). After 52 weeks, 120 CAYAs (87.0%) in the IG and 115 (86.5%) in the CG still had a high need in at least 1 module (odds ratio, 1.04; 95% CI, 0.51-2.11; P = .91). Both groups reported reduced needs, improved quality of life, reduced fatigue, and high satisfaction with the CFC-P. In this randomized clinical trial, the implementation of a lifestyle program in this cohort was deemed necessary, despite not meeting the primary outcome. The interventions did not alter the rate of high needs. The results may provide guidance for the development of multimodal interventions in the follow-up care of CAYAs. German Clinical Trial Register: DRKS00012504.

Profiles of met and unmet care needs in the oldest-old primary care patients with depression – results of the AgeMooDe study

BackgroundUnmet care needs have been associated with an increased risk of depression in old age. Currently, the identification of profiles of met and unmet care needs associated with depressive symptoms is pending. Therefore, this exploratory study aimed to identify profiles of care needs and analyze associated factors in oldest-old patients with and without depression. MethodsThe sample of 1092 GP patients aged 75+ years is based on the multicenter study “Late-life depression in primary care: needs, health care utilization and costs (AgeMooDe)”. Depression (i.e. clinically meaningful depressive symptoms) was determined using the Geriatric Depression Scale (GDS) (cutoff score ≥ 4). Needs of patients were assessed using the Camberwell Assessment of Need for the Elderly (CANE). Associated sociodemographic and clinical factors were examined, and latent class analysis identified the need profiles. ResultsThe main result of the study indicates three need profiles: ‘no needs’, ‘met physical needs’, and ‘unmet social needs’. Members of the ‘met physical needs’ (OR = 3.5, 95 %-CI: 2.5–4.9) and ‘unmet social needs’ (OR = 17.4, 95 %-CI: 7.7–39.7) profiles were significantly more likely to have depression compared to members of the ‘no needs’ profile. LimitationsBased on the cross-sectional design, no conclusions can be drawn about the causality or direction of the relationships between the variables. ConclusionsThe study results provide important insights for the establishment of needs-based interventions for GPs. Particular attention should be paid to the presence of unmet social needs in the oldest-old GP patients with underlying depressive symptoms.

Evaluation of a patient-centered communication skills training for nurses (KOMPAT): study protocol of a randomized controlled trial

BackgroundTo ensure high quality of nurses’ communication as part of patient-centered care, training of communication skills is essential. Previous studies indicate that communication skills trainings can improve communication skills of nurses and have a positive effect on emotional and psychological burden. However, most show methodological limitations, are not specifically developed for nurses or were developed for oncological setting only.MethodsThis study aims to evaluate the effectiveness of a needs-based communication skills training for nursing professionals and to derive indications for future implementation. A two-armed randomized controlled trial including components from both effectiveness and implementation research will be applied. Additionally, a comprehensive process evaluation will be carried out to derive indications for future implementation. Nurses (n=180) of a university medical center in Germany will be randomized to intervention or waitlist-control group. The intervention was developed based on the wishes and needs of nurses, previously assessed via interviews and focus groups. Outcomes to measure effectiveness were selected based on Kirkpatrick’s four levels of training evaluation and will be assessed at baseline, post-training and at 4-weeks follow-up. Primary outcome will be nurses’ self-reported self-efficacy regarding communication skills. Secondary outcomes include nurses’ communication skills assessed via standardized patient assessment, knowledge about patient-centered communication, mental and work-related burden, and participants’ satisfaction with training.DiscussionTo our knowledge, this is the first study systematically evaluating the effectiveness of a patient-centered communication skills training for nursing professionals in Germany. Results will yield insight whether a needs-based intervention can improve nurses’ self-efficacy regarding communication skills and other secondary outcomes.Trial registrationClinical trial registration number: NCT05700929, trial register: ClinicalTrials.gov (date of registration: 16 November 2022).

Trends in the prevalence and social determinants of stunting in India, 2005–2021: findings from three rounds of the National Family Health Survey

ObjectivesTo assess social determinants of stunting and the shifts in contributions of socio-demographic factors to national prevalence trends in India between 2005 and 2021.MethodsWe leveraged data from three rounds of...

Enhancing Learning Outcomes in Garments Trade: A Needs-based Intervention Approach for Students

The study focused on the development and validation of Strategic Intervention Materials (SIMs) to enhance the least mastered skills of Grade 10 Garments Trades students. It covered topics on Sewing Machine Operations, Preparation and Cutting of Materials and Assembling the Blouse and Skirts. The Strategic Intervention Materials were validated by five (5) technical experts.. A 5-point rubric scale and interpretation based on the Standard criteria issued by the Department of Education (DepEd) Bureau of Secondary Education in 2005 was used in rating the materials. Descriptive statistics, particularly frequencies, percentages and means were used in the analysis and interpretation of data. The study was conducted at the Ilocos Norte College of Arts and Trades (INCAT) in Laoag City. This research employed universal sampling. The Grade 10students specializing in Garments Trades of INCAT for the school years 2013-2014, 2014-2015 and 2015-16 were used as respondents for the first phase of the study to analyze their least mastered competencies based on the results of their NC II certification. The sample consisted of 238 students, purely females, who are enrolled in Garments Trade for school years 2013-2014 (73 students), 2014-2015 (100 students) and 2015-2016 (65 students). Results of experts’ validation and evaluation revealed that the guide card, activity card, assessment card, enrichment card and reference card of three SIMs developed were found to be valid. The developed SIMs have met the standards set by DepEd in developing such materials and are valid to enhance students least mastered skills along Garments Trade.

The Double Burden of Work and Life and Turnover Intention Among Migrant Garment Workers: A Case Study From an Industrial Zone in Vietnam

This study aims to determine the prevalence and associated factors of turnover intention among interprovincial migrant workers in garment companies in a rapidly urbanizing area of Vietnam. This study employed a mixed method approach, beginning with in-depth interviews with 12 migrant garment workers to develop survey instruments, which were then used in a quantitative survey. The survey recruited and interviewed 328 inter-provincial migrant workers working in garment factories using a social mapping sampling method. Multivariable backward stepwise logistic regression analysis was used to investigate factors associated with worker turnover intention. The results show a high prevalence of turnover intention (46.3%) among the survey participants. High psychological demand (OR = 2.5, 95% CI [1.4, 4.4], p < .001), low job control, income dissatisfaction (OR = 3, 95% CI [1.5, 6], p < .01), migration intention (OR = 13, 95% CI [7, 24], p < .001) and male gender (OR = 2.5, 95% CI [1.3, 4.8], p < .01) are factors significantly associated with turnover intention among migrant workers. This study provides a model for understanding migrant laborers’ turnover intentions in the garment industry, as well as critical data for developing needs-based intervention programs for this vulnerable group, such as appropriate resettlement strategies and the creation of a healthy working environment, both of which could play essential roles in the garment industry’s workforce retention.

The definition of a community paramedic: An international consensus

Community paramedicine is a globally evolving model of care where paramedics provide community-based, preventative and primary healthcare services. With increased global interest and adaptation of the community paramedicine model, there is a lack of a clear definition of the role of a community paramedic. This study sought to come to an international consensus on the definition of a community paramedic. A four-phase Delphi methodology was utilised to achieve a global consensus on the definition of a community paramedic. A systematic approach to expert identification was performed and reported in line with the Conducting and REporting of DElphi Studies standard. A total of 94 community paramedicine experts were identified and 76 experts consented to involvement in this Delphi. Response rate ranged from 81.6% (Phase 1) to 63.1% (Phase 2). Participants expressed the importance of community paramedic definition having components attributed to primary health care, health promotion, chronic disease management and advanced clinical assessment. Participants expressed that these are essential components of the community paramedic skill set, which distinguishes the role from other frontline paramedics. A final consensus with 91% agreement on the definition of a community paramedic was achieved. The four-phase Delphi achieved consensus on the definition of a community paramedic as follows: A community paramedic provides person-centred care in a diverse range of settings that address the needs of the community. Their practice may include the provision of primary health care, health promotion, disease management, clinical assessment and needs-based interventions. They should be integrated with interdisciplinary healthcare teams which aim to improve patient outcomes through education, advocacy and health system navigation. The adoption of the global consensus on the definition of a community paramedic will enhance efforts to promote the value of this specialist role, enabling a better understanding of how a community paramedic contributes to the wider healthcare system. [Media: see text]

Prevalence and factors associated with substance use among university students in South Africa: implications for prevention

BackgroundSubstance use is an important public health concern in many countries across the globe. Among the general public, institutions of higher learning have developed a reputation for inducing new substance use among students. In addition to socio-demographic factors, substance use and abuse among university students often appear to be related to psychological stressors typically related to the demand to adapt to the new environment and the pressures associated with academia. The purpose of this study was to identify the prevalence of, and factors associated with substance use among university students.MethodsThis quantitative study employed convenience sampling to recruit university students who were 18 years and older from a university in the Western Cape. The study made use of self-administered online questionnaires, which participants completed via SurveyMonkey. The sample consisted of 2915 students. Descriptive statistics were used to describe and provide the prevalence and overview of the demographic characteristics of the respondents. Associations between variables were explored using Chi-square and Mann–Whitney U tests.ResultsThe main findings revealed a substance use prevalence rate of 62.7%. The most prominent substances used by students were alcohol (80.6%), cannabis (46%), and ecstasy (5.3%). The study further revealed clear associations between students’ substance use and mental health. Students who reported substance use at university reported higher depression and anxiety scores than those who did not. However, findings reveal no significant association (p = 0.233) between being a substance user and a nonsubstance user and students' respective self-perceived stress scores.ConclusionResults show the majority of sampled students had started using substances (both alcohol and other substances) only after entering university. The results call into question seminal findings relating to substance use and the university environment. The novel findings of this study could serve as a baseline input to inform policymakers, programme developers, service providers, parents, and other stakeholders who are involved in the design and implementation of more effective awareness, prevention and, needs-based intervention services.

Diet self-management: A qualitative study of college students' experiences and perspectives.

Overweight and obesity among college students have become an emergent public health concern, which may be effectively prevented by diet self-management (DSM). The purpose of this explorative study was to explore college students' experiences and perspectives on diet self-management (DSM), as well as its influencing factors. Thirty-three college students were recruited from different universities in China. A qualitative method was used to conduct semi-structured interviews with audio recording to explore their DSM experience and factors that influence DSM. Data were analyzed using thematic analysis to develop themes related to DSM. In the perception of what "good DSM" means, three themes and ten subthemes were identified: characteristics of good DSM (including 5 subthemes: regularity, balanced diet, no picky eating, good eating habits, and scientificity), method of good DSM (including three subthemes: self-control, adjusting, and making plans), and content of good DSM (including two subthemes: nutrition management and safety management). The influencing factors of DSM can be categorized into four levels of themes and 34 subthemes: individual, family, school, and social levels. The results of this qualitative research highlighted the complexity and multi-dimension of DSM and its influencing factors. Our findings may help to inform diverse and needs-based intervention approaches to improve DSM and promote healthy diet among college students so as to prevent overweight and obesity.

Designing interventions for sustainable change in a real-world laboratory

AbstractReal-world laboratories (RWL) aim to support transformations for sustainable urban development by producing outputs with practical and scientific relevance. To achieve these aims, the local community of which the RWL is a part should be in close collaboration from the start of a project. RWLs offer spaces for ‘thinking outside the box’ and for experimenting with new ideas through concrete interventions into the life world of the community. We provide methodological guidance for researchers on how to design interventions in RWLs that both affect change on the ground and contribute to scientific knowledge. This includes addressing issues important to local communities and generating transformation knowledge about how sustainable urban development can be actualised. We use the case of a project-based master’s course within an RWL in the city of Zurich in Switzerland to demonstrate how the use of design thinking supported the development of needs-based interventions, curbing emissions from food consumption while aiming to generate scientifically relevant output. We conclude that further improvements in methodology are needed in order to test the effectiveness of interventions. However, the outputs of the approach show its potential both for having an impact in the real world and building on existing academic concepts for advancing transformation knowledge.

Stressors and Information-Seeking by Dialysis and Transplant Patients During COVID-19, Reported on a Telephone Hotline: A Mixed-Methods Study

Rationale & ObjectiveIn early 2020, we activated a telephone hotline, the coronavirus disease 2019 (COVID-19) Kidney or Transplant Listening and Resource Center, to learn more about the impact of the COVID-19 pandemic on the stress and information-seeking behaviors of dialysis and transplant patients.Study DesignA mixed-methods study including semi-structured, qualitative interviews probing about emotional, health, and financial challenges experienced and quantitative surveys assessing depression and anxiety levels and information-seeking behaviors.Setting & Participants99 participants (28 dialysis patients; 71 transplant patients), varying by race and ethnicity (Hispanic, 25.3%; White, 23.2%; Asian, 24.2%; Black, 24.2%), shared their COVID-19 pandemic experiences and information-seeking behaviors by telephone. Interviews and surveys were conducted from June 17, 2020, to November 24, 2020.Analytical ApproachQualitative themes were identified using thematic analysis. Frequencies were calculated to assess levels of depression and anxiety using the Patient Health Questionnaire for Depression and Anxiety and types of information-seeking behaviors.Results7 themes and 16 subthemes emerged. Themes of commonly reported stressors include postponing medical visits; decreased accessibility of getting medication; difficulty in receiving up-to-date, patient-focused health information and dialysis supplies; and delays in medical appointments. Other stressors include losses of health insurance and income, and increased vigilance in behaviors to avoid contracting COVID-19. 15 participants had moderate to severe anxiety and depression symptoms and reported more frequent and severe panic attacks after the COVID-19 pandemic. Participants sought emotional support from family, friends, and faith communities. They also commonly obtained information from news media and reported needing more transplant-specific updates about COVID-19, and frequent communication from their kidney and transplant specialists.LimitationsThis convenience sample of individuals willing to share their experiences through a telephone hotline may not generalize to all dialysis and transplant patients; stressors related to the COVID-19 pandemic for these patients continue to change.ConclusionsAs the impact of the pandemic continues, needs-based interventions tailored for the kidney and transplant community, including access to mental health resources, education, and support for care transitions, should continue.

Effects of needs-based education for prenatal anxiety in advanced multiparas: a randomized controlled trial

BackgroundPrenatal anxiety is a common concern which may have adverse effects on maternal and infant health outcomes. Studies addressing needs-based education interventions for prenatal anxiety are limited.AimTo explore the effects of needs-based education on alleviating prenatal anxiety among advanced multiparas when compared with routine prenatal health education.MethodsA total of 86 advanced multiparas were randomized into the intervention group (n = 43) or the control group (n = 43) in this study. The control group received routine prenatal care. The intervention group received five needs-based education programs presented by trained researchers. The Pregnancy-related Anxiety Questionnaire was used to evaluate changes in anxiety level of participants. Concurrent physiological parameters, including blood pressure, heart rate and non-stress test were also measured.ResultsScores on the Pregnancy-related Anxiety Questionnaire of the intervention group were significantly lower than those of the control group (t = 4.21, P < 0.05). Systolic blood pressure (t = 3.64, P < 0.05) and heart rate (t = 2.39, P < 0.05) of the intervention group were also significantly lower than the control group whereas no differences were noted in diastolic blood pressure and non-stress test.ConclusionA needs-based education program is an effective intervention strategy to allay prenatal anxiety in advanced multiparas.Trial registrationThe trial was retrospectively registered in the Chinese Clinical Trial Registry as number ChiCTR2100047552.

Violence, runaway, and suicide attempts among people living with schizophrenia in China: Prevalence and correlates.

BackgroundPeople living with schizophrenia are at higher risk of disruptive behaviors, including violence, running away from home, and suicide attempts, which often co-occur and are highly correlated, yet seldom studied together. The current study investigated the frequency and correlates of disruptive behaviors among a Chinese community sample of individuals living with schizophrenia.MethodsA cross-sectional study was conducted among 400 individuals living with schizophrenia from 12 communities. Data about disruptive behaviors in the past 2 months was collected using self-designed questionnaires. Clinical characteristics including psychiatric symptoms, depression, anxiety, disability, and functioning were collected by internationally standardized assessment instruments.ResultsAbout one-fifth (21%) of the subjects had experienced at least one form of disruptive behavior in the past 2 months. Violence was the most commonly reported (17.25%), which included damaging property (15%) and physical violence toward others (7.5%); followed by running away (6.5%), and suicide attempts (4%). Logistic regression analysis suggested that medication non-adherence (OR = 4.96, 95% CI [1.79–13.72]), involuntary hospital admission (OR = 5.35, 95% CI [2.06–13.87]), depression (OR = 2.34, 95% CI [1.07–5.10]), and lower social functioning (OR = 0.97, 95% CI [0.93–0.99]) were independently associated with a higher risk of disruptive behaviors.ConclusionsThe overlap among three forms of disruptive behaviors warrants them to be assessed and studied together in clinical, research, and policy fields. The significant association between disruptive behaviors with medication non-adherence, involuntary admission, depression, and lower social functioning indicates the need for integrated, targeted, and needs-based intervention programs to be developed for the prevention and treatment of these disruptive behaviors.

The Development of a Rapid Classification Scale for Sleep Quality in Community-Dwelling Older Adults - The Yilan Study, Taiwan.

ObjectivePoor sleep quality is prevailing, deleterious, but heterogeneous in older adults. This study aimed to develop a simplified instrument to screen and classify poor sleep quality in community-dwelling older adults, by which stepped care with needs-based interventions could be implemented.MethodsCohorts of adults aged 65 years and older were used to develop the Rapid Classification Scale for Sleep Quality (RCSSQ). Poor sleep quality was defined with the Pittsburgh Sleep Quality Index (PSQI). Established subgroups of poor sleep quality in the development dataset (n = 2622) were used as the criterion standard. Two independent validation datasets (n = 964 and 193, respectively) were used to examine the external validity. Questions in the PSQI were examined by the stepwise multinomial logistic regressions to determine the optimal numbers of items in the RCSSQ. On the premise of item parsimony and instrument validity, the optimal combination of reduced items was determined.ResultsIn the development dataset, the 4-item RCSSQ (RCSSQ-4) was the optimal predictive model. In terms of internal validity, the accuracy rates to identify PSQI-defined poor sleep quality and its subgroups in the developmental dataset by the RCSSQ-4 were 89.0% and 79.9%, respectively. Meanwhile, the RCSSQ-4 also had good external validity in the validation datasets to detect PSQI-defined poor sleep quality (accuracy rates: 89.1–90.7%). Furthermore, the profiles of PSQI component scores and comorbid conditions for the predicted subgroups in the validation dataset were comparable with the criterion standard.ConclusionThe RCSSQ-4 is a valid instrument for screening and subgrouping poor sleep quality in community-dwelling older adults. The RCSSQ-4 may help guide tailored interventions under the context of stepped care in the community.

Teacher Attitudes and Collaboration towards the Concept of Student-Centered Lesson

The article is based on a needs assessment carried out at Telavi Public School N7 to understand teachers' attitudes towards student-centered learning strategies. In particular, it examines how intensively and effectively student-centered approaches are integrated into the teaching process and how teachers interact with each other in student-centered learning. The study was carried out in the 2018-2019 academic year, but the inspiration for the study was the Directorate's informal participation in the educational process during the 2017-2018 academic year. A mixed type of study with quantitative and qualitative methods was used to test the hypotheses. To further investigate the problem and identify a common need, teachers from Telavi State School No. 7, as well as elementary and secondary school students, participated in the study. The interventions were carried out after the completion of the first phase of the study. Observing and analyzing teacher activities helped us assess the effectiveness of our problem-solving and needs-based interventions. The study highlights the fact that creating a collaborative atmosphere between teachers has a positive effect on the learning process. The study found the importance of fostering a culture of collaboration among teachers through the use of diverse resources, activities and challenging classroom assignments. Students' views, opinions and feelings about such lessons were also determined. As a result of the analysis, conclusions were drawn that allow recommendations to be made for identifying and solving similar problems and needs.

A psychological needs-based intervention to facilitate adjustment and improve wellbeing in newly admitted aged care residents: three illustrative case studies

ABSTRACT Objective Moving into residential aged care (RAC) is recognised as a major life transition and is associated with adjustment difficulties and depression for many older adults. We developed the Programme to Enhance Adjustment to Residential Living (PEARL) to assist newly admitted residents to adjust to their new environment through the introduction of tailored strategies that meet their psychological needs for autonomy, relatedness, and competence. Method The structure and content of PEARL is described. Clinical information via three cases are presented to illustrate how the programme facilitates the adjustment and psychological wellbeing of residents following their transition to RAC. Results The cases highlight the potential benefit of individualised approaches to address the psychological needs of new residents and demonstrate how staff can be assisted to facilitate these needs through a simple, brief intervention. Conclusions PEARL is a structured step by step programme that can be used by clinicians working in this field. While additional empirical data evaluating the efficacy and cost-effectiveness of this intervention is required, PEARL offers promise as a non-pharmacological approach to address the current high rates of distress and mental health disorders in RAC. KEY POINTS What is already known about this topic: (1) Mental health concerns among older adults in permanent residential aged care are common, and many newly admitted residents find it difficult to adjust to an institutional environment. (2) Newly admitted residents should have the opportunity to receive adequate support to meet their psychological needs; however, currently, these needs are poorly met. (3) Previous research has identified factors that can contribute to better adjustment to residential aged care however, there are limited evidenced based programmes that support and assist residents during this transition. What this topic adds: (1) PEARL is a five session, structured, tailored intervention that enables clinicians to collaborate with admitted residents and facility staff in an attempt to meet residents’ psychological needs and assist in facilitating their adjustment to residential aged care. (2) Clinical information including the structure and content of PEARL is provided including case studies to illustrate the implementation of the programme. (3) While the clinical approach underpinning PEARL is simple, it represents a major departure from standard care that is potentially feasible for wide-spread use.

Cognitive Behavioral Therapy for Prodromal Stage of Psychosis-Outcomes for Transition, Functioning, Distress, and Quality of Life: A Systematic Review and Meta-analysis.

This study aimed to provide insight into the efficacy of cognitive-behavioral therapy for psychosis (CBTp) in patients with "clinical high risk of psychosis (CHR-P)". Major scientific databases were searched up to April 17, 2020. Randomized controlled trials in CHR-P individuals, comparing CBTp with needs-based interventions (NBI, including treatment as usual or nonspecific control treatment) were included, following PRISMA guidelines. The primary outcome (efficacy) was transition to psychosis by 6 months, 12 months, 24 months, and over 24 months. Secondary outcomes were change in attenuated psychotic symptoms, depression, distress, improvements in functioning, and quality of life. Ten randomized controlled studies met inclusion criteria. The comparisons included 1128 participants. CBTp was significantly more efficacious in reducing rate of transition to psychosis by 6 months (after post-hoc sensitivity analysis) (relative risk [RR] = 0.44, 95% confidence interval [CI]: 0.26, 0.73), 12 months (RR = 0.44, 95% CI: 0.30, 0.64), 12 months (RR = 0.46, 95%CI: 0.30, 0.69), and over 24 months (RR = 0.58, 95% CI: 0.35, 0.95) after treatment, compared with those receiving NBI. CBTp was also associated with more reduced attenuated psychotic symptoms by 12 months (SMD = -0.17, 95% CI: -0.33, -0.02) and by 24 months (SMD = -0.24, 95% CI: -0.43, -0.06). No beneficial effects on functioning, depression, quality of life, or distress were observed favoring CBTp. CBTp is effective in reducing both psychosis transition rates and attenuated psychotic symptoms for the prodromal stage of psychosis. It is a promising intervention at the preventative stage.

"Fit for work and life": an innovative concept to improve health and work ability of employees, integrating prevention, therapy and rehabilitation.

ObjectivesTo set up a comprehensive health programme for employees, with needs-based allocation to preventive and rehabilitative measures; and to evaluate the effects of the programme on work ability and sick leave.DesignProspective single-group observational study.MethodsEmployees of a university hospital were invited to participate in needs-based interventions of preventive or rehabilitative character. Allocation followed screening questionnaires, anamnesis and clinical examination. The selection of a preventive or rehabilitative measure appropriate to the needs of the patient followed screening questionnaires, anamnesis and clinical examination. Preventive offers can include back training courses, water gymnastics or stress management exercises. Rehabilitative measures can include 3-6 weeks in- or outpatient rehabilitation or one week intensive outpatient rehabilitation. The main outcome parameters were work ability and sick leave duration.ResultsAt this time of the project included 1,547 participants, who applied voluntarily to enter the programme. The mean age of participants was 44.3 years (standard deviation (SD) 10.3 years), and 72.0% were female. Needs-based allocation to a prevention (n=1,218) or a rehabilitation group (n=329) was effective, and enabled formation of 2 groups with different needs. Overall, more than half of the employees participating in the programme reported sick leave within the last 3 months. Participants in the preventive measures group reported significantly lower duration of sick leave than those in the rehabilitation group. Employees in the rehabilitation group had significantly lower work ability (Work Ability Index (WAI) 30.4 vs 36.6), but higher effects at 6-month follow-up (WAI 33.4 (standardized effect size (SES) 0.51) vs 37.9 (SES 0.17)). In the prevention group mean sick leave reduced significantly from 1.9 to 1.3 weeks (p < 0.001) during the previous 3-month period, whereas in the rehabilitation group it reduced from 2.7 to 1.5 (p < 0.001) weeks.ConclusionImplementation of the comprehensive health programme was successful, using the multimodal infrastructure of a university hospital. Allocation to suitable interventions in occupational health programmes following screening, anamnesis and clinical examination is an appropriate way to meet participants’ needs. The programme resulted in improved work ability and less sick leave.LAY ABSTRACTOccupational health programmes are important to improve and maintain employees’ health and work ability. Each employee has an individual need for measures, and meeting those needs can be the key to improving their situation. Allocation to different preventive or, if necessary, rehabilitative measures, in the comprehensive programme “Fit for Work and Life”, was performed by a doctor after obligatory consultation. This ensured the best possible effects of the invested resources. Participants allocated to rehabilitation measures had lower initial work ability and higher sick leave durations, but showed higher improvements in outcome parameters than participants in the preventive group.