Secondary Services Research Articles

Service implications of the revised 2022 National Institute for Health and Care Excellence (NICE) follow-up guidelines for stage IA-IIC melanoma.

The 2022 National Institute for Health and Care Excellence melanoma guideline update made significant changes to follow-up. The aim of this study was to assess the impact these changes will have on a national melanoma cohort over a 5-year follow-up interval. Anonymized, individual-level, population-scale, linkable primary and secondary care National Health Service data for an 18-year interval (2000-2018) in Wales, UK were analysed. These data were used to predict the number of patients over a 10-year interval (2020-2030) that would be diagnosed with melanoma. Follow-up schedules for the 2015 and 2022 National Institute for Health and Care Excellence melanoma guidelines were then used to calculate the number of clinician-led appointments, the number of radiological investigations, and the total healthcare cost between 2025 and 2030, corresponding to a 5-year patient follow-up interval, for those with stage IA-IIC melanoma. Between 2025 and 2030 it is predicted that implementation of the 2022 guidelines would lead to 21 122 (range 19 194-23 083) fewer clinician-led appointments for patients with stage IA-IIC melanoma. However, there would be a significant increase in the number of radiological investigations (7812; range 7444-8189). These changes would lead to a €2.74 million (€1.87 million-€3.61 million) reduction in the total cost of follow-up over the interval 2025-2030. Melanoma follow-up guideline changes will result in a substantial reduction in the number of clinical follow-up appointments, but a significant additional burden to radiological services. The overall cost of follow-up at a national level will be reduced.

EMS during disaster: A case study on Syria Arab Red Crescent (SARC) EMS response during February 2023 earthquake

Background: On February 6, a magnitude 7.8 earthquake struck southern Turkey near the Syrian border. This was followed almost nine hours later by a magnitude 7.5 earthquake situated approximately 59 miles (95 kilometers) to the southwest. The earthquake had enormous effects on the cities of Aleppo, Latakia, Hama, and Idlib, causing significant destruction and the collapse of numerous structures as well as the devastation of water supplies. United Nations estimates that about 6 million people in government-controlled areas are affected. 200,000 people in the area around Aleppo alone have been made homeless. Overall, 170 sub-districts in 43 districts in ten governorates have been impacted by the earthquake. After more than 7,000 deaths and 10,400 injuries as a result of the earthquakes' effect, humanitarian operations in Syria have become much more challenging in the context of the region's ongoing civil conflict. The Syrian Arab Red Crescent (SARC) has a long history and high capacity in providing various health services. Before the earthquake, SARC was and remains the primary provider of humanitarian assistance and offers ongoing services across most of the country in the areas of ambulance services, disaster management, water and sanitation, health and medical services, including mental health, primary and secondary services, livelihoods, and early recovery, while also incorporating an inclusive approach to community services including psychological and protection support. In 2021, SARC signed a Memorandum of Understanding with the Ministry of Health (MoH) granting it a unique position to become the lead emergency medical service (EMS) provider across all of Syria. Methods: A case study of the SARC EMS response during the February 2023 earthquake was developed utilizing following data resources • Document review: SARC operation reports, situation reports on International federation of Red Cross & Red Crescent IFRC GO platform, lesson learned workshop report, SARC operation review workshop report • Key informant interview: SARC EMS director and EMS response team leaders Description: SARC EMS dispatch in Latakia, Aleppo, and Hama received the first calls at 4.20 a.m. on the 6th of February. EMS dispatch sent ambulances and activated forward assessment commanders, and within 10 minutes, a total of 22 ambulance cars were deployed to provide prehospital medical service and general assessment in the three governorates of Hama, Aleppo, and Latakia. During the first 24 hours, the assessment and services provided were challenged by the amount of destruction and the rabble. Some extractions were delayed due to a lack of appropriate search and rescue equipment. EMS centers in the affected governorate have been activating emergency status to provide 24/7 prehospital services to the affected population. Ambulance surge support was mobilized from Tartous to Latakia (5 ambulances) and from Homs to Hama. During the first week, SARC EMS was able to respond to 406 disaster-related requests in the three governorates: 111 critically ill patients were transferred to medical facilities, 41 patients were treated on site, and that was in addition to the non-disaster-related requests. By the end of the first month, EMS had provided prehospital service to 1034 beneficiaries, 1013 injured patients, 254 dead bodies transferred, and 45 patients treated without transfer. The earthquake-affected areas have shown a significant increase, doubling in Lattakia, 43% in Aleppo, and 15% in Hama, in the demand for EMS services up to 4 months after the earthquake. Until 15th of August SARC EMS has provided prehospital services to 5,029 cases in the affected areas, 2,387 injuries transferred and 2,388 cases treated at the place without transfer. SARC EMS service has conducted 36 community-based first aid training sessions for people in the affected areas, trained more than 780 lay people. Also, SARC has fostered the capacity of SARC EMS volunt

The Living Well, Living Longer program: an integrated care strategy to improve the health of people living with severe mental illness.

Living Well, Living Longer (The Program) is an integrated care strategy to improve the physical health of people living with severe mental illness within a public mental health service. The significant life expectancy gap experienced by this cohort is largely attributed to higher rates of cardiovascular disease and modifiable risk factors. The Program addresses this by guiding people through the four stages of screening, detection, treatment initiation, and ongoing management of coexisting chronic health conditions. The Program adopted an integrated care approach to ensure the provision of appropriate and coordinated care across hospital and primary care services. Key care pathways include a cardiometabolic health assessment clinic, shared care with general practitioners, oral health services partnership and employment of peer support workers, dietitians, exercise physiologists, and smoking cessation to provide targeted community support and interventions. There has been strong engagement with the care pathways introduced since The Program's inception in 2013 and evaluation is currently underway to consider the impact on cardiometabolic health outcomes for participants. Critical to The Program's effectiveness has been engagement with lived experience expertise, multidisciplinary collaboration, and strong executive support. However, significant challenges persist amid an Australian public health crisis characterised by reducing rates of free primary healthcare access for people living with severe mental illness and enduring communication challenges between primary and secondary health services. With the implementation of MyMedicare and the imminent Single Digital Patient Record across NSW Health, we stand at a critical juncture. It is imperative to establish robust systems to enhance care for this vulnerable population.

Care pathways, prescribing practices and treatment outcomes in major depressive disorder and treatment-resistant depression: retrospective, population-based cohort study.

Despite the availability of effective therapies, many patients with major depressive disorder (MDD) develop treatment-resistant depression (TRD). To evaluate and compare prescribing patterns, contact with specialist services and treatment outcomes in patients with MDD and TRD. This was a retrospective analysis of linked primary and secondary care National Health Service data in the north-west London Discover-NOW data-set. Eligible patients were adults who had diagnostic codes for depression and had been prescribed at least one antidepressant between 2015 and 2020. A total of 110 406 patients were included, comprising 101 333 (92%) with MDD and 9073 (8%) with TRD. Patients with TRD had significantly higher risks of suicidal behaviour and comorbidities such as anxiety, asthma, and alcohol or substance misuse (all P < 0.0001). Citalopram, sertraline, fluoxetine and mirtazapine accounted for 83% of MDD and 71% of TRD prescriptions. Use of antidepressant switching (1% MDD, 7% TRD) and combination therapy (1%, 5%) was rare, whereas augmentation occurred more frequently in the TRD group (4%, 35%). Remission was recorded in 42 348 (42%) patients with MDD and 1188 (13%) with TRD (P < 0.0001), whereas relapse was seen in 20 970 (21%) and 4923 (54%), respectively (P < 0.0001). Mean times from diagnosis to first contact with mental health services were 38.9 (s.d. 33.6) months for MDD and 41.5 (s.d. 32.0) months for TRD (P < 0.0001). There appears to be a considerable difference between treatment guidelines for depression and TRD and the reality of clinical practice. Long-term treatment with single antidepressants, poor remission, and high relapse rates among patients in primary care highlight the need to optimise treatment pathways and access to newer therapies.

Analysis of various types of new energy storage revenue models in China

In the current environment of China's vigorous development of energy storage, it is essential to carry out research on the benefits and economic evaluation of new energy storage. This paper establishes a framework for analyzing the revenue models of various types of energy storage under different scenarios. The framework complements the lack of previous studies on energy storage regulation under power generation systems such as wind power and coal power. In addition, a variety of scenarios were developed for the application of energy storage in the spot market, secondary service market, capacity market and user-side trading market. The results show that the case study energy storage plant has the highest revenue in the spot market, followed by the capacity market, and relatively low revenue in the secondary service market, while the leasing service can also bring a lot of revenue for the energy storage plant and thus become one of the more promising energy storage revenue models in the future.

THE RELATIONSHIP BETWEEN ORGANIZATIONAL TRUST AND WHISTLEBLOWING TENDENCY: A STUDY ON HEALTH PROFESSIONALS

Mistakes made in the health sector can have life-threatening negative consequences. In order to reduce these errors and to identify their sources, whistleblowing is used as an important tool. In this study, it is aimed to determine the relationships between the organizational trust perceptions of health professionals and their whistleblowing tendencies. Quantitative research method and quantitative research design were used in the research. The universe of the research consisted of all health professionals working in a training and research hospital providing secondary health care services in Istanbul. Convenience sampling method was preferred in the study. The data were collected via the internet survey technique (using google forms infrastructure). The total number of questionnaires that were evaluated and used in the analysis of the data is 400. SPSS and AMOS package programs were used in the analysis of the data. Descriptive analysis, correlation analysis and structural equation modeling were applied in the research. The mean whistleblowing tendency of the health professionals participating in the study was found to be 3.84±0.51. When examined in terms of sub-dimensions; the official whistleblowing tendency dimension had the highest mean (4.29±0.73) and the lowest mean (2.47±0.92) was the confidential whistleblowing tendency dimension. According to the results of confirmatory factor analysis, it has been determined that there is a positive relationship between the organizational trust perceptions of health professionals and their whistleblowing tendencies, and the organizational trust perceptions of health professionals affect their attitudes towards whistleblowing tendencies in a statistically significant and positive way. This study is important in that health professionals can report negative situations and then reduce the negative situations that may happen due to being a whistleblower and create an organizational trust environment that will turn into a corporate culture.

The Implication of Mothers’ Full-Time Labour Force Participation on Early Childcare and Outcome: A Case Study of Dar Es Salaam, Tanzania

In the last two decades, in Tanzania, female labour force participation outside the home has grown significantly along with their male counterparts challenging the traditional view that women are reproducers and producers in the home-based economy. Full-time employment leads to higher levels of self-esteem, autonomy, and independence, which may influence sensitivity in caregiving. Many mothers also participate in multiple roles which might limit exclusive time for childcare necessary for the development of healthy children. Qualitative methods were used to collect data both from workplaces and homes. Purposive sampling was utilized to identify 42 full-time working mothers with children under the age of five. In-depth interviews, non-participant observation and documentary reviews were used to gather data which was then analysed thematically. The findings indicate that employment imbues women self-esteem, autonomy and independence which improve sensitivity. Children gain from improved nutrition, health services, and access to better secondary care services. However, balancing family demands was difficult, and this affected the nature of maternal care of children. Work-family conflict demands were the main source of stress in mothers, which was detrimental on children's wellbeing. The study recommends that families should devise mechanisms for investing quality time with children, and develop crèches for early childcare in order to mitigate the rising challenges of working and raising healthy and secure children in an urban setting.

The Moderating Effect on Community Intention to Believe in Excellent Islamic Schools Education

This research aims to describe and test the independent variables of attitude, subjective norms and self-efficacy, which can influence people's motivation to send their children to excellent Islamic primary and secondary Schools with two moderating variables, Trust and Service involvement. The research design is quantitative survey research. The sampling technique was carried out by purposive sampling. The research respondents were a community in Klaten Regency who intended to send their children to a number of excellent Islamic primary and secondary Schools, with a total number of 110 respondents. The Structural Equation Model test is used in research to simultaneously test the relationship between variables. The results of the validity, reliability and goodness of model tests are declared fit and proven that there is a direct influence of attitude values, subjective norms and cell-efficacy on intentions. The moderating test of the trust and service-involvement variables can strengthen the emotional norm attitude and self-efficacy variables on parents' choices to send their children to excellent Islamic schools. In the future, excellent Islamic schools must maintain or further increase public trust in the quality of learning services. The increasing rate of excellent Islamic primary and secondary education services leads to increasing competitive excellence.

Expansion of Integrated Care in Brazil: the experience of reorganizing the healthcare network in Santana de Parnaíba.

During 2018/2019, the State Department of Health of São Paulo in partnership with the International Center for Integrated Care delivered an integrated care pilot project- Transforming Together. The aim was to co-design and deliver a more integrated system in the North Coast Region and to build the capability of key players in the region and state to sustain the change. The demonstrator project generated knowledge transfer in 2020/2021 through an InterAmerican Development Bank webinar and publications to encourage other municipalities to develop integrated care networks. With their acquired knowledge and experience, a team of local consultants have spread the change methodology to another region.&#x0D; In 2022 a new integrated care project was launched in Santana de Parnaíba-SP, a municipality in the metropolitan region of São Paulo with around 145,000 inhabitants, an HDI of 0.814 and GDP per capita of 12.500 dollars. Primary and secondary care services are already strong, referring patients to the regional network only for tertiary services, and a new hospital is scheduled to open in 2023. The project aims to fully integrate this hospital within the healthcare network and with other sectors.&#x0D; The work plan, co-designed with the municipality, has three workstreams aligned to provision of services and care for the population: a diagnostic phase; technical support for managers; and a ‘train the trainers’ educational programme to build workforce competencies for integrated care. For the diagnostic phase, municipal services were visited, health and social care service data was analyzed and a novel Day of Care Survey applied to understand the current hospital inpatient profile. Workshops with managers from different sectors explored the concepts of integrated care, supported them to map local care pathways and to self assess the maturity of their network using the Scirocco self-assessment instrument. After agreeing the educational programme outline and selecting participants, learning cycles began in July 2022. Six thematic sessions focus on: Integrated Care and Innovation; Management and Assistance Models; Leadership; Participatory Policies; Effective Work Processes; and Governance. The sessions include masterclasses by international experts via videoconference.&#x0D; &#x0D; By November 2022, more than 100 health and social care workers have participated. They have had the opportunity to deepen their knowledge on integrated care, strengthen relationships with colleagues from other services/sectors, understanding the importance of working together between all the actors involved in the care of a person to improve their health and well-being. Managers have a growing understanding of how to tackle the main barriers to people centered integrated care, and how working together across sectors is still deficient. Scirocco tool scores reflected knowledge, certainty and readiness for integrated care.&#x0D; This initiative highlights how implementation can be transferred successfully from one context to another.&#x0D; By using international expertise to build local knowledge and leadership, we have demonstrated a methodology that builds capability for integrated care in the Brazilian system and a support programme that is transferable to different regions in São Paulo state. Scale up of the Transforming Together integrated approach across all states is necessary to strengthen the Brazilian public health system.&#x0D;

A framework for evaluating the implementation and maintenance of integration within the youth mental health system.

Given the global burden of disease of youth mental disorders, there remains a need to examine how to improve care for this population. Integrated care has been posited as a potential solution, but there is limited evidence on how best to design, staff, and evaluate different models of integrated care for youth mental health. This oral paper presents the findings of a narrative synthesis of the evidence on integrated models of mental healthcare for young people aged 12 to 25 within PubMed, SCOPUS, and PsycINFO databases. Our literature review aimed to: (1) define and summarise the literature on integrated models of mental healthcare for children and young people, and (2) evaluate the effectiveness of integrated models of youth mental healthcare in enhancing mental health outcomes, quality of life, satisfaction with care, and improving health service delivery in young people aged 12-25 years. To be included in our review, studies were English language peer-reviewed and grey literature from January 2001 – October 2021, which included systematic and/or scoping reviews that assess integrated mental healthcare for children and young people aged 12 to 25 years and studies evaluating models of integrated mental healthcare for children and young people using intervention and comparator groups (included in meta-analysis). To synthesise this literature, we generated intial inductive themes describing components of integrated care shared across the youth mental health system including, collaborative care, person centred care, population and evidence-based care, and governance and financing. We incorporated these themes within a deductive framework adapted from the World Health Organisation health system building blocks. These building blocks include service delivery; workforce; information systems and communication; products and technology; and finance along with the cross-cutting themes of leadership, governance, and policy and values. We then mapped these core components of integrated care onto the six intensity levels of integrated care developed by Heath and colleagues providing an overview of how integrated care can be operationalised in terms of health service building blocks. This framework can form a basis for the development of well-articulated models of youth integrated mental health pathways, assisting services identify what operational changes are needed to best implement and sustain integrated care in their own context. Planned future work involving this framework includes using it to map the integration of primary, secondary, tertiary, public, and private youth mental health services within the Australian health system.

COVID-19 Pandemisi Sırasında Obsesif-Kompulsif Bozukluk Belirtilerinin Şiddetindeki Artışa İlişkin Hastaların Algısı

Objective: This study aimed to examine how patients with obsessive-compulsive disorder perceived changes in their symptoms during the COVID-19 pandemic and what factors influenced those changes. Materials and Methods: The sample of the study consists of 262 individuals diagnosed with obsessive-compulsive who were reached through social media between 08.04.2021 and 08.10.2021. A descriptive information form and a 41-item questionnaire based on the Padua Inventory were used to collect the data. Results: During the pandemic, anxiety about not being able to access cleaning products and doctors/therapists was high in the patients who reported a rise in disease symptoms. During the pandemic, 79% of the sample reported an increase in symptoms of obsessive-compulsive disorder. Conclusion: It is essential to conduct regular screenings of patients with obsessive-compulsive disorder by the psychiatric nurses in the rehabilitation services team. These patients should be encouraged to express their concerns, and any psychological stress or distress should be identified. When necessary, patients should be referred to secondary care services for further assistance.

Barriers and facilitators to opioid deprescribing among Advanced Nurse Practitioners: A qualitative interview study.

To explore the experiences primary care Advanced Nurse Practitioners have had in relation to deprescribing opioids in chronic non-malignant pain. A qualitative interview study. Primary care Advanced Nurse Practitioners were recruited from across the Northern Ireland GP Federations. Data collection for this study took place between April and June 2022. In total, 10 semi-structured online interviews were conducted. Interviews were audio and visually recorded, transcribed verbatim and interpreted using a thematic analysis framework. The COREQ criteria were used to guide the reporting of this study. The Advanced Nurse Practitioners experienced several challenges associated with opioid deprescribing and the implementation of current chronic pain guidelines. The main barriers identified were difficulties engaging patients in deprescribing discussions, a lack of availability of supportive therapies and poor access to secondary care services. The barriers identified directly impacted on their ability to deliver best practice which resulted in a sense of professional powerlessness. The experiences of the Advanced Nurse Practitioners demonstrate that opioid deprescribing in patients with chronic pain is challenging, and implementation of current chronic pain guidelines is difficult. This study contributes to existing literature on the topic of reducing opioid prescribing and as far as the authors are aware, is the first study to examine the experiences of primary care advanced nurse practitioners in this context. These findings will be of interest to other primary care practitioners, and prescribers involved in the management of chronic non-malignant pain. No patient or public contribution.

P147: Internet-delivered guided self-help Acceptance and Commitment Therapy for family carers of people with dementia (iACT4CARERS)

Background and objective:Despite the high prevalence of anxiety and depression, many family carers of people living with dementia are not able to access timely psychological support due to various barriers such as lack of respite care and a shortage of skilled therapists. Online treatments have the potential to improve access, and also scalability, reducing inequalities in access to care. This uncontrolled feasibility study aimed to evaluate whether it is feasible to deliver internet- delivered guided self-help Acceptance and Commitment Therapy (iACT4CARERS) within primary and secondary care services in the UK, and whether the intervention is acceptable to family carers of people living with dementia.Method:Family carers of people living with dementia presenting with mild to moderate anxiety or depression were recruited through healthcare services and public advertisements. Participants were offered eight, guided, self-help online ACT sessions adapted for the needs of family carers. Participants were also allocated a therapist who responded to questions to support their completion of each weekly session. Participants completed questionnaires assessing anxiety, depression and other outcomes before and after the intervention. They were also invited to attend an individual semi-structured interview to provide feedback on iACT4CARERSE at the end of the study.Results:Seventy-nine participants attended the screening session over six months, and 33 eligible participants (age range 47-85) received iACT4CARERS. Further, 70% of participants completed seven or all eight sessions, and 27% of participants were lost to follow-up, but none of the reasons for early withdrawal was related to the intervention. There was preliminary evidence of improvements in anxiety, depression and psychological flexibility, particularly in anxiety, which demonstrated an average reduction of 26% on the GAD7 anxiety scale. The results of qualitative interviews suggested that iACT4CARERS is acceptable to family carers. Positive carer experiences were particularly facilitated by the relatedness of the contents, increased feelings of connectedness and the user-friendliness of the online platform.Conclusion:The feasibility study provided evidence for the feasibility and acceptability of iACT4CARERS. This feasibility study led to an ongoing full-scale randomised controlled trial testing the clinical and cost effectiveness of iACT4CARERS. Recent developments of the iACT4CARERS project will be discussed.

Randomised controlled trial of automated VR therapy to improve positive self-beliefs and psychological well-being in young people diagnosed with psychosis: a study protocol for the Phoenix VR self-confidence therapy trial

IntroductionThe confidence of young people diagnosed with psychosis is often low. Positive self-beliefs may be few and negative self-beliefs many. A sense of defeat and failure is common. Young people...

A Service Evaluation of the Implementation of E-sign for Homecare Prescriptions in Secondary Care

Abstract Introduction Homecare Medicine Services allow patients with chronic conditions, reliant on specialist medicines prescribed by secondary care, to manage their symptoms at home rather than requiring regular attendance to a hospital for treatment1. The Royal Cornwall Hospital NHS Trust (RCHT) manages over 3000 patients on homecare services across a range of specialties. Traditional homecare processes required prescriptions to be printed on paper at the hospital, signed by hand by a prescriber and then securely couriered to the homecare provider for processing. The secondary care Electronic Prescription Service (EPS) is coming but in the interim a solution was commissioned by the National Homecare Medicines Committee to improve processes, reduce administrative burden, and improve the timeliness of prescriptions for direct patient benefit. The product selected was E-sign (E-Sign (UK) Ltd) which allows prescriptions, as PDF files, to be signed with an advanced electronic signature and tracked through a managed workflow compliant with applicable legislation2. Working collaboratively with Sciensus we introduced E-sign in March 2022. In the last year we have processed approximately 3500 prescriptions via this process. We sought to evaluate E-sign prior to wider adoption within the Trust. Aim To evaluate the acceptability, benefits or drawbacks of the new E-sign process for prescribers and patients. Methods In January 2022 (pre- implementation) we audited 100 homecare prescriptions recording the time between prescribing on our electronic prescribing system (ePMA) and collection by the Sciensus courier. Post-implementation data was gathered by comparing the time of prescribing on ePMA and time of release to Sciensus on the E-sign workflow for 142 prescriptions in May 2023. Data was analysed in Microsoft Excel and a T-test was used to test significance. A short survey was sent to all prescriber and pharmacist users of the E-sign system (12) to evaluate the speed, flexibility and ease of use of the system. As this project falls under the definition of a service evaluation, according to UK NHS Research Ethics Committees, formal ethical approval was not required, it was registered with the Trust’s clinical audit database. Results There was a statistically significant (p &amp;lt; 0.05) decrease in the average time taken for prescription transmission, from 200 hours pre-implementation to 25 hours post-implementation. All respondents to the survey (N=8) agreed it was easier to use than the manual system and would recommend it to colleagues. Most (75%) felt the system was faster and more flexible than the paper system. 50% believed it improved the service to patients. All respondents would recommend the system to their colleagues. Discussion/Conclusion The E-sign system has brought benefits to prescribers and ultimately patients. Prescriptions are now transferred significantly more quickly to homecare providers, and the risk of lost prescriptions is removed. E-sign has allowed for service transformation; we now have prescribers who work entirely remotely using E-sign. Future developments will include collaborating with additional homecare providers, including a new patient workflow, and migrating to EPS when available. Study limitations were due to the sample size of prescribers available for survey.

Characters of Actors Implementing the Internal Quality Assurance System (SPMI) in Secondary Education Services (Study Of Good And Poor Performing High Schools In Kupang City)

This research chose the high school level because it is the last level before entering higher education (PT), which is different from the vocational school level, where apart from going to PT, you can also directly enter the world of work or industry. The city of Kupang was chosen because it is still a barometer of education in NTT Province. This research used a qualitative approach with 81 informants. Primary and secondary data were obtained through interviews, observation and literature review. Data were analyzed using techniques from Miles, Huberman, and Saldana (2014), which included data condensation, data presentation, and drawing conclusions or verification. The research results show that the characters of the actors implementing the Internal Quality Assurance System (SPMI) in secondary education services at high schools in Kupang City, whether performing well or poorly, were analyzed using the grid model from Bryson (2004). Findings show that: High Interest – Low Power (Subjects): Teachers involved in the school education quality assurance team (TPMPS) at SMAN 2 Kupang and SMAN 6 Kupang do not understand their role in the Team. High Interest – High Power (Players): Supervisors from the provincial education office and school principals as managers in educational units do not know the SPMI team but know the school development team (TPS) at SMAN 2 and the curriculum development team (TPK) at SMAN 6 Kupang. Low Interest – High Power (Context Setters): Committees and administration understand their role as directors and administrative staff but do not know the TPK team. Low Interest – Low Power (Crowd): Students and their parents are not required to be involved in implementing SPMI but must bear the costs of education and are entitled to the best educational services.

Transdiagnostic Ecological Momentary Intervention for Improving Self-Esteem in Youth Exposed to Childhood Adversity

Targeting low self-esteem in youth exposed to childhood adversity is a promising strategy for preventing adult mental disorders. Ecological momentary interventions (EMIs) allow for the delivery of youth-friendly, adaptive interventions for improving self-esteem, but robust trial-based evidence is pending. To examine the efficacy of SELFIE, a novel transdiagnostic, blended EMI for improving self-esteem plus care as usual (CAU) compared with CAU only. This was a 2-arm, parallel-group, assessor-blinded, randomized clinical trial conducted from December 2018 to December 2022. The study took place at Dutch secondary mental health services and within the general population and included youth (aged 12-26 years) with low self-esteem (Rosenberg Self-Esteem Scale [RSES] <26) exposed to childhood adversity. A novel blended EMI (3 face-to-face sessions, email contacts, app-based, adaptive EMI) plus CAU or CAU only. The primary outcome was RSES self-esteem at postintervention and 6-month follow-up. Secondary outcomes included positive and negative self-esteem, schematic self-beliefs, momentary self-esteem and affect, general psychopathology, quality of life, observer-rated symptoms, and functioning. A total of 174 participants (mean [SD] age, 20.7 [3.1] years; 154 female [89%]) were included in the intention-to-treat sample, who were primarily exposed to childhood emotional abuse or neglect, verbal or indirect bullying, and/or parental conflict. At postintervention, 153 participants (87.9%) and, at follow-up, 140 participants (80.5%), provided primary outcome data. RSES self-esteem was, on average, higher in the experimental condition (blended EMI + CAU) than in the control condition (CAU) across both postintervention and follow-up as a primary outcome (B = 2.32; 95% CI, 1.14-3.50; P < .001; Cohen d-type effect size [hereafter, Cohen d] = 0.54). Small to moderate effect sizes were observed suggestive of beneficial effects on positive (B = 3.85; 95% CI, 1.83-5.88; P < .001; Cohen d = 0.53) and negative (B = -3.78; 95% CI, -6.59 to -0.98; P = .008; Cohen d = -0.38) self-esteem, positive (B = 1.58; 95% CI, 0.41-2.75; P = .008; Cohen d = 0.38) and negative (B = -1.71; 95% CI, -2.93 to -0.48; P = .006; Cohen d = -0.39) schematic self-beliefs, momentary self-esteem (B = 0.29; 95% CI, 0.01-0.57; P = .04; Cohen d = 0.24), momentary positive affect (B = 0.23; 95% CI, 0.01-0.45; P = .04; Cohen d = 0.20), momentary negative affect (B = -0.33; 95% CI, -0.59 to -0.03, P = .01, Cohen d = -0.27), general psychopathology (B = -17.62; 95% CI, -33.03 to -2.21; P = .03; Cohen d = -0.34), and quality of life (B = 1.16; 95% CI, 0.18-2.13; P = .02; Cohen d = 0.33) across postintervention and follow-up. No beneficial effects on symptoms and functioning were observed. A transdiagnostic, blended EMI demonstrated efficacy on the primary outcome of self-esteem and signaled beneficial effects on several secondary outcomes. Further work should focus on implementing this novel EMI in routine public mental health provision. Dutch Trial Register Identifier:NL7129(NTR7475).

Testing the effectiveness and acceptability of online supportive supervision for mental health practitioners in humanitarian settings: a study protocol for the caring for carers project.

Local humanitarian workers in low and middle-income countries must often contend with potentially morally injurious situations, often with limited resources. This creates barriers to providing sustainable mental health and psychosocial support (MHPSS) to displaced individuals. Clinical supervision is an often neglected part of ensuring high-quality, sustainable care. The Caring for Carers (C4C) project aims to test the effectiveness and acceptability of online group-based supportive supervision on the well-being of MHPSS practitioners, as well as service-user-reported service satisfaction and quality when working with displaced communities in Türkiye, Syria, and Bangladesh. This protocol paper describes the aim, design, and methodology of the C4C project. A quasi-experimental, mixed-method, community-based participatory research study will be conducted to test the effectiveness of online group-based supportive clinical supervision provided to 50 Syrian and 50 Bangladeshi MHPSS practitioners working with Syrian and Rohingya displaced communities. Monthly data will be collected from the practitioners and their beneficiaries during the active control (six months) and supervision period (16 months over two terms). Outcomes are psychological distress (Kessler-6), burnout (the Copenhagen Burnout Inventory), compassion fatigue, compassion satisfaction, and secondary traumatic stress (Professional Quality of Life Scale), perceived injustice, clinical self-efficacy (Counseling Activity Self-Efficacy Scale), service satisfaction, and quality (Client Satisfaction Questionnaire and an 18-item measure developed in this project). A realist evaluation framework will be used to elucidate the contextual factors, mechanisms, and outcomes of the supervision intervention. There is a scarcity of evidence on the role of clinical supervision in improving the well-being of MHPSS practitioners and the quality of service they provide to displaced people. By combining qualitative and quantitative data collection, the C4C project will address the long-standing question of the effectiveness and acceptability of clinical supervision in humanitarian settings.

Spatiotemporal influence of built environment on intercity commuting trips considering nonlinear effects

Understanding the attraction and generation of intercity commuting is important in estimating the demand for intercity travel, supporting improving transportation services, and coordinating intercity development. Although numerous studies have investigated the characteristics of intercity commuting, the existing literature on the relationship between intercity commuting and the built environment remains limited. In this study, we propose a feasible quantitative approach to quantitatively analyze the impact of the built environment on intercity commuting by utilizing multi-source data. An empirical study of commuting from Tianjin to Beijing is conducted. The results show that the model considering both spatial heterogeneity and nonlinearity has the highest prediction accuracy compared to traditional models. Moreover, the employment density has the greatest impact on the attraction of intercity commuting, while primary and secondary education services significantly contribute to the generation of intercity commuting. Our proposed modeling, findings, and discussions provide a foundation for policymakers and contribute to regional planning.

Severe mental illness and the perimenopause

Hormonal fluctuations in the perimenopause are associated with an array of physical and psychological symptoms. Those with pre-existing mental disorders may experience changes to their symptoms and response to treatment during the perimenopausal and postmenopausal periods and may also be at risk of poorer longer-term physical health outcomes in menopause. The transition towards menopause may be compounded by the oestradiol-suppressing effect of many psychotropics on the hypothalamopituitary–gonadal axis. A collaborative approach between primary care and secondary mental health services is an opportunity for proactive discussion of symptoms and support with management of the perimenopause. This may involve lifestyle measures and/or hormone replacement therapy, which can both lead to improvements in well-being and mental and physical health.