Adult Services Research Articles

Social Return on Investment of Musculoskeletal Physiotherapy in the National Health Service.

Social return on investment (SROI) may present a method for demonstrating the social value of healthcare interventions. It has not previously been measured in musculoskeletal (MSK) physiotherapy but is being used in the procurement and performance management of healthcare services. The aim of the study was to measure SROI in one provider of MSK physiotherapy in the United Kingdom's National Health Service (NHS). A retrospective single arm online survey-based service evaluation was carried out to calculate the SROI of an NHS adult MSK physiotherapy service using the Housing Association's Charitable Trust Social Value Calculator. 237 respondents (35.6%) completed the survey and a mean SROI of £4.13 for every £1 invested was demonstrated. There were sub-group variations based on symptom location and discharge location. This is the first time SROI has been calculated in an MSK physiotherapy setting. This service evaluation raises new questions about the variations observed in subgroups and the applicability of this methodology in individuals with MSK conditions who receive physiotherapy. MSK physiotherapy is an intervention which offers a positive SROI across a range of MSK conditions and contributes towards improved wellbeing. This is the first study to use the HACT Social Value Calculator when evaluating a physiotherapy service and further research is required to validate the results.

Services in Minoritized Autistic Adolescents and Adults Varying in Language Skills.

Racially and ethnically minoritized (minoritized) autistic individuals face intersectional disparities in service access in the transition to adulthood. Our understanding of disparities is limited by systematic exclusion from research and inadequate approaches to characterizing services. To address these gaps and effect advocacy, this study (1) examined services received, unmet service needs, and barriers in minoritized autistic adolescents and adults and (2) determined if language, NVIQ, and autism traits predict services when deployed as binary or continuous variables. Academic and community partners tailored community-based participatory research (CBPR) to a local context. Participants (N = 73, ages 13-30) completed a behavioral assessment protocol. Participants and caregivers provided information on services received, unmet service needs, and barriers to services. Data were analyzed using descriptive and regression. Participants received multiple services yet had multiple unmet service needs and barriers. Effects of services differed by approach. Language impairment, but not language scores, predicted receiving more services. High levels of autism traits and autism trait scores predicted more unmet service needs. While the number of services and unmet service needs was similar to prior work, differences in individual service variables and effects support attention to heterogeneity. Findings support intersectional approaches to CBPR and autism research.

Examining the effectiveness, feasibility, and acceptability of an advocacy program for Latinx families of transition-aged autistic youth.

To support Latinx families of autistic youth navigate school-based transition services and adult disability services, we provided a family advocacy program entitled, ASISTIR (Apoyando a nueStros hIjo/as con autiSmo obTener servIcios de tRansición; Supporting our Children with Autism to Obtain Transition Services). The ASISTIR program consisted of six, two-hour sessions and included the following topics: school-based transition planning, person-centered planning, Supplemental Security Income, Vocational Rehabilitation, and Home and Community-Based Medicaid Waiver. Twenty-nine Latinx family members completed the cohort-based ASISTIR program. After participating family members demonstrated increased knowledge of school-based transition planning and adult disability services. Participants also demonstrated increased empowerment and advocacy.

Rapid review of facilitating reflective practice groups with staff in adult inpatient mental health settings

ABSTRACT Reflective practice is poorly defined and often lacks distinction from other practices, such as clinical supervision. In the UK, the National Health Service (NHS) faces unparalleled challenges within the context of chronic underfunding, high staff attrition, and the recent global pandemic. Frontline staff are desperately trying to meet the demands of their roles and services are struggling to prioritise their professional development and wellbeing, further exacerbating these problems. This rapid review of the evidence sought to identify barriers and facilitators of Reflective Practice Groups (RPGs) within adult inpatient mental health services, using three databases. Two-hundred and one unique references were retrieved, yielding eight papers meeting the inclusion criteria. Barriers to facilitating RPGs included: practicalities; individual and team expectations; needs and competencies of facilitators; and organisational issues. Studies suggested solutions including facilitating RPGs off-ward to reduce disruptions and protect the space; increasing psychological safety by incorporating clear guidelines and expectations for attendees; and organisational support. The review highlighted universal challenges faced by healthcare professionals and organisations in facilitating and accessing RPGs. The review illustrates the paucity of research in this area, which may be due to nebulous definition and inconsistencies between different organisations. Implications for practice are discussed.

"We're Preventing People From Going Into the Most Expensive Level of Care in Every Way that We Can": Barriers and Recommendations for Use of Local Funds.

Most older Americans do not financially qualify for Medicaid and support provided through the Older Americans Act is quite limited. In response, Ohio has generated funds for services for older adults through the use of local county tax levy programs. Ohio currently leads the nation in the utilization and support of local levy funding, generating more than US$200 million annually. This study conducted qualitative descriptive interviews with 15 locally funded programs across the state. Thematic analysis revealed that local programs encounter an array of implementation barriers, including increased state and federal eligibility requirements, staffing issues, lack of access to services in rural locations, and low reimbursement rates. These barriers are coupled with added pressure from county officials to move individuals onto state-funded programs, rather than locally funded programs. This paper also provides recommendations for how these programs can be better supported to ensure their sustainability for the future.

Determinants of Poor Health Outcome Among Older Adults in India

Self-rated health (SRH) is a crucial indicator of overall health status, functionality, and mortality among older adults. This study examines the socio-economic correlates of health outcomes among older adults aged 45-59 in India using data from the Longitudinal Ageing Study of India Wave-I. Descriptive analysis, bi-variate analysis, and multivariate logistic regression were performed to investigate the factors that best explain and predict SRH. The results show that age, gender, place of residence, education, marital status, religion, social category, living arrangements, work status, income, multimorbidity, functional limitations, nutritional status, and health behaviours are significant determinants of poor SRH. Multimorbidity and functional limitations were found to be the principal determinants of poor SRH. The likelihood of reporting poor SRH increases with age, being female, living in rural areas, having lower education, being unmarried, divorced, or widowed, belonging to disadvantaged social categories, living with a spouse or others, not currently working, having lower income, being underweight, and engaging in risky health behaviours. The findings highlight the need to strengthen healthcare services for older adults in India, considering the ongoing demographic transition and the substantial proportion of poor SRH in this age group. Addressing the needs of older adults aged 45-59 can help the nation benefit from the demographic dividend.

Assessing the long-term care (LTC) service needs of older adults based on time-driven activity-based costing (TDABC)–a cross-sectional survey in central China

BackgroundThe global population’s aging has led to an increasing demand for long-term care (LTC), especially in developing countries like China. Comprehensive assessment of LTC service demands by including the time and cost analysis is crucial to inform the planning and financing of LTC resources, yet such research is lacking in China. Our research team has developed a quantitative index system of the medical and nursing services needs of older adults (QISMNSNE) based on the framework of Time-Driven Activity-Based Costing (TDABC), providing a valuable tool for measuring LTC service needs. This study aimed to assess the LTC service needs of older adults in China and the factors associated with such needs.MethodsA cross-sectional study was conducted in Changsha City, Hunan Province, China, from June 2021 to December 2022. A stratified multistage cluster sampling method was used to recruit 1,270 older adults from five nursing homes and three communities/streets in three regions of Changsha City. The LTC service needs were assessed by calculating the service time required from caregivers, nurses, and doctors and the total service time (min/d) using the QISMNSNE. Participants’ disability, activities of daily living (ADLs), mental status and social involvement (MSSI), and sensory and communication (SC) were assessed using standard scales. Generalized linear regression models were used to analyze factors associated with LTC service needs.ResultsThe participants had an average age of 76.41 ± 8.38 years, with 43.7% being female. The median service time required from caregivers, nurses, and doctors was 53.34 min/d, 3.66 min/d, and 0.33 min/d, respectively, and the total service time was 83.31 min/d. The generalized linear regression model identified the following factors that were associated with higher total service time: aged 75–84 years, living in nursing homes, income over 5000 per month, ADLs, MSSI (9 ~ 40), SC, and having 3 ~ 4 kinds of geriatric comorbidity (P < 0.05).ConclusionsOlder adults have a high need for LTC services, especially those provided by caregivers, indicating an urgent need to expand and improve LTC systems. The LTC service time needed is associated with multilevel factors encompassing socio-demographic, functional, and psychological aspects. This study offers preliminary insights into the needs, demands, and costs of LTC services for older adults and provides essential guidance for future planning and financing of LTC resources.

“Going under the radar”: barriers to continuity in the rehabilitation trajectories of adults with acquired brain injury in North Norway

Purpose Acquired Brain Injury (ABI) is a major cause of disability, but rehabilitation services for adults with ABI discharged home remains deficient. This study explores barriers to continuity in the rehabilitation trajectories of this population in North Norway. Materials and methods Data were generated from focus groups consisting of individuals with ABI and family caregivers (n = 5) and healthcare professionals (n = 14). Purposeful sampling of participants (total n = 19) ensured diverse perspectives. A reflexive thematic analytical approach was applied to identify recurring themes. Results This study reveals significant misalignment between the support needs of home-dwelling adults with ABI and the existing healthcare system in North Norway. Four themes were identified: (1) A lack of awareness of patient rehabilitation needs in hospitals, (2) individuals with ABI slipping through the cracks during transitions, (3) constraints in municipal healthcare services’ capacity, and (4) unclear rehabilitation pathways for individuals with ABI. Conclusions Individuals with ABI need assistance navigating complex healthcare systems, gaining insight into their functional problems, and expressing needs and goals. The findings support calls for a paradigm shift in ABI rehabilitation, advocating for a transition from impairment-focused to reengagement-oriented practices as individuals with ABI transition from inpatient to home settings with increasingly stable residual impairments.

Case report - Survival after ECPR for adolescent arrhythmogenic arrest - ECPELLA (ECMO with Impella®)

Abstract Background The combined therapy with venoarterial extracorporeal membrane oxygenation (V-A ECMO) and Impella (ECPella) has been shown to improve survival in acute cardiogenic shock (CS) in adult patient. Only 3 paediatric cases have been reported in a multicentre study. Case summary We present our case, the first described to our knowledge in the UK, of a 15 year old adolescent of Afro-Caribbean descent, weight 75kg, who received E-CPR (extracorporeal cardiopulmonary-resuscitation) and ECPella implantation. The patient suffered a sudden cardiac arrest at home, his mother called for an ambulance who arrived within 10 minutes and commenced life support with a LUCAS device. He received 3 doses of adrenaline and 3 desynchronised shocks for an underlying rhythm of ventricular fibrillation (VF) after which ROSC was achieved. He was then transferred to his local hospital where he had another VF arrest with successful cardioversion and was then transferred to our institution where on arrival he had another VF arrest and received E-CPR (extracorporeal cardiopulmonary-resuscitation) and ECPella implantation under the institutional adult shock program within 3 hours of in-hospital cardiac arrest. Following weaning from ECPella the patient underwent cardiac and brain MRI and serial echocardiograms with complete recovery of ventricular function. After implantation of cardiac defibrillator, he was discharged home without neurological sequelae. He remains asymptomatic from a cardiac perspective, with a normal cardiac examination and with no neurological sequelae at 2 year follow up. Discussion This is the first case description of ECPella use in a child in the United Kingdom and highlighted the importance of timely institution of E-CPR on survival benefit in fatal CS. The outcome success of post-resuscitation ECPella strategy in this adolescent was through collaborative interprofessional engagement of multiple supra-specialists within acute cardiology and critical care across paediatric and adult services and alignment with the institutional adult shock program.

Transforming learning for adult protective services caseworker certification training: program evaluation of simulation training

ABSTRACT This study assesses the first statewide program to provide simulation training conducted via videoconference to all new caseworkers. The simulation training in Illinois was conducted at a mock house. A mock family played by standardized clients is physically present, and trainees participate remotely. The program evaluation team implemented a survey that asks trainees to rate their confidence in different skills at multiple timepoints, to appraise the quality of feedback and debriefing of the training team, and to write text responses to the questions regarding their learning experience. Analysis of quantitative data over the course of the training showed statistically significant linear increases in trainees’ confidence for all the 14 skills. Their text responses indicated that they received feedback they appreciated and felt they gained ability on a range of different skills. The simulation training makes a valued and effective contribution to the certification training.

Persistence of ADHD into adulthood and associated factors: a prospective study.

BackgroundAttention deficit hyperactivity disorder (ADHD) is one of the most prevalent disorders in child and adolescent psychiatry. The aims of this study are to describe the persistence of ADHD into adulthood and to explore factors associated with persistence.Methods: This is a prospective study conducted in a clinical sample of Spanish children and adolescents diagnosed with ADHD. After a baseline interview in which a battery of standardized scales was administered (e.g., Strengths and Difficulties Questionnaire (SDQ). A review of the digital medical history was carried out ten years after recruitment. The persistence of the ADHD diagnosis into adulthood and the end-point diagnoses were described. We carried out logistic regression to explore the factors associated with ADHD persistence.Results: Most of the patients (87.5%) kept the ADHD diagnosis into adulthood. Factors associated with ADHD persistence was high SDQ hyperactivity/inattention subscale scores at baseline (OR = 1.197), high scores on the SDQ peer relationship problems subscale (OR = 0.823), number of diagnoses at baseline (OR = 0.490).Conclusions: Our findings show that ADHD diagnosed in children often persists into adulthood. An appropriate transition between child and adolescent mental health services and adult services needs to be mapped out, as a large proportion of children with ADHD will continue to need mental health care during their adulthood.

Feasibility of Sexual Health and Contraceptive Web Services for Adolescents and Young Adults: Retrospective Study of a Pilot Program on Reunion Island.

Sexual health indicators for adolescents and young adults (AYAs) aged between 13 and 25 years are particularly poor on Reunion Island. Access to accurate information as well as sexual health and contraceptive services are vital to maintaining sexual well-being. Teleconsultations offer a promising approach to addressing the sexual health and contraceptive needs of AYAs who are more susceptible to engaging in unprotected sexual intercourse. However, the literature on digital sexual health services for this demographic group is limited. This study aims to describe the feasibility of a pilot sexual health and contraceptive teleconsultation web service used by AYAs on Reunion Island. A descriptive, retrospective study was conducted at the Reunion Island University Hospital Center using a convenient sample. Eligible participants were informed about the program through various communication channels, including seminars for health care professionals, radio broadcasts, posters, flyers, press articles, videos, and social media posts. AYAs accessed a web-based platform named SEXTUOZE from December 15, 2021, to September 30, 2022, that offered sexual health information and teleconsultations. Data collected included participant and teleconsultation characteristics, patient satisfaction, and the quality of completeness of medical records. A total of 22 teleconsultations were scheduled and 7 were completed, all via synchronous video communication (duration: median 35 min). Overall, 4731 sessions were generated on the SEXTUOZE website. Reasons cited for accessing the web services were to seek sexual health advice (8/22, 36%), receive an initial birth control prescription (12/22, 55%), and inquire about condom prescriptions (2/22, 9%). While teleconsultation use for sexual health was initially low, it rose toward the end of the study period. Considering all elements of the implementation theory, future research should design interventions that not only are more operative and tailored but also ensure their adoption and sustainability in various health contexts.

Implementation of an adult life-course vaccine review service, VaxCheck, in community pharmacy: A qualitative analysis

BackgroundCommunity pharmacists are well placed to identify and vaccinate unimmunized or under-immunized individuals who can put themselves and communities at risk of preventable disease. We designed and tested VaxCheck, a novel life-course vaccine review service that can be used to raise awareness and guide personal vaccination action plans, in community pharmacies in Ontario, Canada. ObjectiveTo understand the experiences of community pharmacists and staff directly involved with providing the VaxCheck service as part of initial testing. MethodsSemi-structured interviews were performed with pharmacy staff from nine pharmacies who participated in the study. Interviews were conducted at baseline and following each of three plan-do-study-act quality improvement cycles. Activities undertaken to perform VaxCheck were assessed. An inductive thematic analysis was performed to identify dominant themes and subthemes. Activities and descriptive codes were then correlated to the Consolidated Framework for Implementation Research (CFIR). Results26 interviews were conducted. Pharmacy staff described VaxCheck activities as spanning three stages: (1) Promotion/offering of VaxCheck, (2) Completing the VaxCheck, and (3) Enacting recommendations and follow-up. VaxCheck activities were compatible with workflow related to delivery of other vaccines and medication reviews. Thematic analysis found three considerations guided VaxCheck adoption: (1) Aligning VaxCheck with workflow through flexible integration, (2) Enabling patient-oriented vaccination services, and (3) Contributing to community healthcare provision. Data aligned with all CFIR domains with strengths noted in constructs from the “Innovation characteristics” and “Individuals” domains. Barriers to implementation were identified in “Inner setting”, “Outer setting” and “Process” domains, such as pharmacy workflow capacity, patient knowledge about vaccination, availability of vaccine records, and interactions with other healthcare providers. ConclusionCommunity pharmacists found VaxCheck to be a valuable, accessible service that was well-received by patients and supported adult vaccination reviews and individualized recommendations. VaxCheck was compatible with pharmacy workflow but needed additional resources for sustainability and promotion with stakeholders.

Treatment of Nonsocial Environmental Fear in a Service Dog UsingFluoxetineand Behavior Modification.

Training and maintaining a service dog requires extensive time and financial resources. The emotional bond between service dogs and their handlers poses unique challenges when dogs develop behavioral issues. We present a case of an otherwise healthy adult service dog exhibiting acute environmental fears, hindering her job performance. The dog's fear responses escalated in various settings, including school and home environments. Diagnostic evaluation ruled out medical pathology, leading to a diagnosis of nonsocial environmental fear and generalized anxiety. A multimodal treatment approach involving environmental management, antidepressant medication (fluoxetine), and behavior modification was implemented. Desensitization and counterconditioning protocols targeted specific triggers, such as shiny floors and elevators. Eight weeks after treatment initiation, the dog showed improvement, enabling a modified behavior treatment plan to be implemented as she gradually returned to work with reduced fear responses. Follow-up revealed sustained progress with additional dosage adjustment of fluoxetine.

Critical Analysis of Tools for Measuring Recovery-Oriented Practice in Mental Health Facilities: A Scoping Review

Background: To implement recovery-oriented practice, it is important to have instruments capable of evaluating such practice. A number of different questionnaires have been developed in recent years which measure recovery orientation in mental health services. Objective: To identify and analyze patient-reported experience measures (PREMs) reported in the literature that are related to recovery-oriented practice in mental health services. Methodology: This study followed the Joanna Briggs Institute methodology for scoping reviews. Searches were carried out in the Web of Science, CINAHL, Medline (via Pubmed), and SCOPUS databases and in grey literature repositories (Google Scholar, Opengrey, Dart-Europe, Teseo). Papers on recovery services for adults suffering from mental disorders (MDs) were included. Those focusing on addiction and intellectual disability care services were excluded. Results: Sixteen papers met the inclusion criteria. The selected PREMs mainly identified recovery-oriented systems, treatment, community integration and support as the dimensions addressed most frequently in questionnaires. The average number of items included in the questionnaires was found to be 54. With regard to psychometric properties, 62% of the papers evaluated reliability (internal consistency) and 56% provided some kind of evidence of validity. Conclusions: This review aims to give an overview of the existing instruments in the literature and to highlight the characteristics of each one of them. Several different PREMs exist which evaluate recovery-oriented practice. No instrument currently exists which could be described as a benchmark tool, but there are quite a few with good psychometric properties capable of producing data that are useful when evaluating clinical services.

Factors that influence the need for mental health services for older adults in Europe

Abstract Background Mental health is an integral component of health, and affects close to a 100 million Europeans. Little is known about the predictors of older adult’s mental health demand among health systems in European countries. This study is based on the Andersen’s Behavior Model, that predicts that predisposing characteristics, enabling factors, and behavioral factors, influence need or demand factors of healthcare services. Aim This study has two overall objectives: (i) to investigate the determinants of older adults’ mental health services demand; and (ii) examine the relationship between predisposing characteristics, and enabling resources, with services demand. Methods Data from Wave 9, of the of the cross-national panel dataset of the Survey of Health, Ageing and Retirement in Europe (SHARE) were examined using a sample of 47, 345 older adults. Analysis: The Omnibus test was used to evaluate the fit model and Multinomial Logistics Regression were performed to test the null hypothesis that predisposing characteristics, enabling resources, and behavioral factors are not predictors of need or demand. Findings Predisposing characteristics such as gender (b=-.43, s.e.=.017, p&amp;lt;.001) and age (b=-1.96, s.e.=2.2, p&amp;lt;.001), and enabling factors such as homecare (b = 2.40, s.e.=0.1, p&amp;lt;.001), social support (b=-.26, s.e.=0.012, p&amp;lt;.001), financial support receiving (b=.51, s.e.=.086, p&amp;lt;.001), income (b=.09, s.e.=.009, p&amp;lt;.001), and behavioral factors such as use of technology are predictors of mental health services need or demand [Chi-Square= 3319.58, df = 15 and p &amp;lt;.001]. Implications for Policy and Practice Initiatives for the care of older adults should not only aim to increase access to care services for sub populations such as older adults with mental health but also consider enabling resources such as financial and social support and behavioral factors such as use of technology. Key messages • Demand for mental health services for older adults are influenced by predisposing, enabling and behavioral factors. • Investing in financial services, social support and technology may reduce the demand for mental health services among older adults.

JA ImpleMENTAL Implementing the Belgian Best Practice on Community Mental Health system Reform

Abstract Mental health challenges affect more than one in six people across the EU. In order to support Member States to proceed with mental health care system transformation and suicide prevention JA ImpleMENTAL, was initiated on the request of Member States, on October 2021 under the European Union 3rd Health Program. The JA consists of 39 organizations from 21 countries, more than 180 persons are working. Two advisory bodies support the consortium and provide their insights and expertise, a stakeholder forum with 10 key European Organizations in Mental Health including EUPHA Mental Health Section and WHO Europe and OECD, and the Member State Policy Committee which ensures the involvement of ministries and enables the practices to be embedded in health systems. Within the 11 countries implementing pilots under the Belgium model using a common Implementation Strategy, a total 163 activities are implemented under the 5 following key areas: 62 on structural measures needed for the establishment of local networks promoting a user’s centered, human’s right based recovery approach, 43 for the development and/or transformation of mental health services, 22 on training &amp; capacity building in support of the reform and cultural change, 22 on continuous communication, information and awareness raising, and 13 on data collection, monitoring and evaluation. An analysis of MS pilot action plans shows that most service transformation efforts have concentrated on: defining care pathways for people at risk and for those with mild to severe mental health conditions including smooth transition from child and adolescent to Adult Mental Health services, as well as from inpatient to community services, the nomination of case managers for assisting individuals to their recovery process the development of individual service plans, the Involvement of users in various layers of service delivery including peer support and the provision of assertive treatment through mobile units.

Marfan syndrome in children: large, single centre experience on management and outcome

Abstract Introduction Beta-blockers (BBs) and angiotensin receptor blockers (ARBs) have been proved to decrease the growth rate of the aortic root in Marfan patients, we describe our single centre experience at a large tertiary paediatric institution. Methods This is a retrospective longitudinal study of a large, paediatric only, Marfan cohort through review of medical notes for clinical data and treatment and assessment of serial echocardiograms. Results 167 patients were included, mean age at first assessment was 4.05 ± 3.12 years, 86 (51.50%) were males. 41 pts (24.55%) had a de novo FBN1 mutation. A 35.32% had a cysteine loss mutation. Median follow up was 9.54±4.37 years. 2 patients had a clinical and molecular diagnosis of early-onset Marfan, they both underwent mitral valve surgery in infancy and one of them died at 7 years old. No other deaths or acute aortic events in our cohort until transition to adult services at 18 years old. Of the entire study population 12 pts (7.2%) underwent aortic surgery at a median age of 13±7.02 years, 1 patient had a mitral valve repair. Chemoprophylaxis (currently only evaluated in a subgroup of our youngest 65 patients) was offered to all patients, 27.69% declined medicines. The remining 47 subjects are on treatment which was started at a mean age of 4.88 ±2.96 years, surveillance data available for a mean follow up of 2.75±2.41 years. 50 received BB (58.50% atenolol [average dose 0.79 mg/kg/day] and 19.15% bisoprolol [average dose 0.087 mg/kg/day]), 5 (8.51%) losartan [average dose 0.763 mg/kg/day], and 10 (15.38%) double therapy with BB and ARBs. The Sinus of Valsalva (SOV) z-scores, as assessed on echocardiograms and normalised according to Lopez dataset, showed a reduction over time in children treated with chemoprophylaxis (see figure 1). SOV mean z-score at starting treatment was 3.38 ± 2.06 which reduced to 2.79± 1.81, however, differences were not statistically significant (paired T-student p-value 0.078). In non-treated patients, initial SOV z-score was 1.89 ± 1.05. When comparing evolution there was a trend towards decreased average SOV z-score over the years in the treated group, not seen in the non-treated patients (see figure 2). No statistical differences in the SOV z-score reduction change were found when comparing different treatment groups (ANOVA p-value 0.851), but a tendency to more profound decrease in the losartan groups was observed. Reduction in blood pressure or heart rate did not differ amongst the treatment groups. Conclusions We present one of the largest single centre reviews on management of paediatric Marfan patients. Our data confirm a decrease in SOV z-score with chemoprophylaxis in a real-world cohort. This is in line with current evidence and corroborates clinical practice.SOV Z-SCORE EVOLUTION AFTER TREATMENTSOV Z-SCORE GROUP AVERAGE CHANGE

Challenges in transitioning from adolescent to Adult Mental Health Services for young adults with ADHD in Italy: an observational study.

Ensuring a successful transition to Adult Mental Health Services (AMHS) is fundamental for attention deficit/hyperactivity disorder (ADHD) patients to prevent adverse scenarios in adults (e.g., psychiatric disorders, substance or alcohol abuse). Yet, most European nations do not have appropriate transition guidelines and still fail to adequately support transition processes. This study aims to enquire about the current transition paths in Italy and the perceived experiences of the patients and their clinicians. The present observational study collected 36 interviews with young adults with ADHD who turned 18 between 2017 and 2021. Simultaneously, two questionnaires were filled in by the clinicians (both from paediatric and AMHS) who were involved in their transition paths. These tools collected information about the transition process, the services that cared for the young adults and well-being indicators such as impairment in daily life, employment status and the presence of sentinel events (e.g., critical stage accesses to the emergency room or hospitalizations). Successful and failed referrals were analysed. A referral to an AMHS was attempted for 16 young adults (8 before age 18 and 8 when turning 18), and 8 patients (22.2% overall) were successfully taken into the care of the AMHS. Twenty patients were not referred since it was deemed unnecessary (N = 6) or because of the lack of specialized services or compliance (N = 14). At the time of the interview, only nine participants were still under AMHS care. Of eleven individuals with a high need for care (identified by the level of impairment, support needs or sentinel events), five were not followed by a mental health professional at the time of the interview. For the majority of ADHD young adults, a transition path was never started or completed. While this is partly due to mild levels of impairment, in many cases it was difficult to find a service that could care for the adult patient. Only one out of four young adults are successfully transferred to AMHS care. Creating or improving evidence-based transition guidelines should be a priority of the public health system to ensure healthcare for as many patients as possible. The results of this study will converge towards the need for recommendations for the transition of services from adolescence to adulthood for young people with ADHD for Italian clinical practice.

Prospective analysis of sex differences and factors associated with suicidal thoughts and behaviours in young people from the MILESTONE Italian sample

Suicide is a significant leading cause of death among young people, particularly those struggling with mental disorders. The present study utilised data from 230 young people (aged 16–18 years) undergoing a transitional care process from Child and Adolescent Mental Health Services to Adult Mental Health Services within the MILESTONE European project (2014–2019), a longitudinal cluster randomised controlled trial. The objectives of this study were to monitor temporal patterns of general health and social functioning over two years, to detect sex differences, and to identify factors associated with Suicidal Thoughts and Behaviours (STB) at the first and last time points. The results demonstrate a decrease in STB over the two-year follow-up period among all participants. Females exhibited a higher prevalence of STB across all time points, whereas males only exhibited STB at the nine-month follow-up. The most influential factors associated with STB were previous suicide attempts and mood disorders at baseline, and mood disorders and relational problems at the end of follow-up. These findings emphasise the importance of monitoring STB and informing young people undergoing a transitional care period about its key risk factors. Moreover, sex differences in STB suggest the need for different preventive strategies for males and females.