Specialized Health Care Services Research Articles

Does a specialized assessment improve vocational outcomes for people on sick leave with a suspected common mental disorder? Results from the Mental Health Assessment Study (MeHAS)

Background In Denmark, 50% of those on long-term sick leave are affected by common mental disorders (CMDs), and it has been argued that detection in primary care has been insufficient. The Mental Health Assessment Study (MeHAS) assesses if specialized mental health assessments can enhance return to work for this group. This study aimed to estimate the effect of a specialized mental health assessment for people on sick leave with a mental health disorder, on return to work and mental health care utilization. Methods and findings In this experimental study, sickness absentees were referred from a sick leave benefit management agency. Before intervention allocation, they had already received a standard health assessment in general practice. The intervention group received an additional specialized mental health assessment, while the control group did not. We compared the groups on several vocational outcome measures, the primary being proportion in work after one year. Other outcomes were weeks in work, time to return to work (RTW) and different measures of service utilization. We included 717 in the intervention group and 756 in the control group. On the primary outcome, proportion in work, we observed no differences between the groups at 12 months (53.9% vs. 58.7% in the control group, p = 0.133). Moreover, after one year, the control group showed faster RTW at 12-month follow-up (HR 0.79, p<0.001) and 3.1 more weeks in work (p<0.001). In the intervention group, participants received more hospital-based outpatient mental healthcare. Conclusion Providing a specialized mental health assessment was associated with fewer weeks in work and longer sick leave duration (secondary outcomes), but the proportion in work at 12-month follow-up (primary outcome) did not differ between the groups. The intervention was associated with a higher likelihood of receiving specialized mental healthcare services, perhaps because more needs were met. Given the substantial risk of selection bias, results should be treated with caution.

Use of telehealth to improve health outcomes for those with motor neuron disease: a mixed-methods systematic literature review

Background: Multidisciplinary care has been shown to improve the quality of life and extend survival for patients with motor neuron disease (pwMND). Several barriers to accessing care have been previously identified. Telehealth can potentially mitigate this by providing remote specialist healthcare services. Aims: Systematically review the existing literature to assess if and how telehealth can reduce barriers to access multidisciplinary team (MDT) care and improve health outcomes for pwMND. Methods: A mixed-methods, systematic literature review was conducted to identify evaluations of telehealth interventions. Telehealth interventions were evaluated using the Evaluating Digital Health Interventions Framework. Findings: A total of 293 articles were identified from the search and 16 studies met the criteria for inclusion in the review. Modes of telehealth delivery included video conferencing, app-based self-assessment and remote monitoring. Healthcare outcomes identified as being approved included accessibility, improved communication, timely interventions and satisfaction. Conclusion: Telehealth has the potential to mitigate barriers to access to specialist MDT and improve healthcare outcomes for pwMND. Patients’ preferences should always be considered in decision-making when considering available options.

Use of telehealth to improve health outcomes for those with motor neuron disease: a mixed-methods systematic literature review

Background: Multidisciplinary care has been shown to improve the quality of life and extend survival for patients with motor neuron disease (pwMND). Several barriers to accessing care have been previously identified. Telehealth can potentially mitigate this by providing remote specialist healthcare services. Aims: Systematically review the existing literature to assess if and how telehealth can reduce barriers to access multidisciplinary team (MDT) care and improve health outcomes for pwMND. Methods: A mixed-methods, systematic literature review was conducted to identify evaluations of telehealth interventions. Telehealth interventions were evaluated using the Evaluating Digital Health Interventions Framework. Findings: A total of 293 articles were identified from the search and 16 studies met the criteria for inclusion in the review. Modes of telehealth delivery included video conferencing, app-based self-assessment and remote monitoring. Healthcare outcomes identified as being approved included accessibility, improved communication, timely interventions and satisfaction. Conclusion: Telehealth has the potential to mitigate barriers to access to specialist MDT and improve healthcare outcomes for pwMND. Patients’ preferences should always be considered in decision-making when considering available options.

Maximal covering location with partial coverage for second-level specialized health care services

The lack of access to Second-level Health Care Services (SHCS) in developing countries is primarily due to the scarcity of facilities and the limited investment of resources in the public sector. Access to these services directly relates to the distance the population travels to these facilities. In that sense, a maximal covering location problem can be helpful to maximize the impact of decisions related to the location of new SHCS. In this paper, we propose a model to guide the location of additional sites where second-level services can be installed in a network of public hospitals. The partial coverage and variable radius are considered in the problem to assess a large territory with different characteristics and population densities. The system is composed of multiple institutions that supply differentiated varying levels of coverage concerning their own demand and external demand. The objective of the problem is to improve the demand coverage in the system by locating new sites, since there are already sites offering different services. A case study in the Mexican public health system is conducted to assess four specialized SHCS. The obtained results evidence for the benefit of using optimization tools in the resource planning of SHCS.

The journey of patients with lung cancer: The gap between symptom onset and treatment.

e23119 Background: Prompt access to health care services is a priority in public health policies. The aim of this study was to map the journey of patients (pts) diagnosed with lung cancer (LC) and determine the time interval (TI) from symptom onset (SO) to treatment initiation and assess the impact on survival. Methods: A retrospective cohort study was conducted at the University Hospital of Larissa. Pts’ demographic and disease-related data were captured from medical records. The TI from SO to first doctor visit (StD), SO to first oncologist visit (StO), diagnosis to treatment initiation (DtT) and SO to treatment initiation (StT) were estimated. Overall survival (OS) was defined as the TI between treatment initiation and the date of death or the date of last follow-up. OS were estimated using the Kaplan–Meier analysis and the comparisons were computed with the log-rank test. Results: Overall, 251 sequential pts with metastatic LC were included in the study. Pts’ mean age was 71 years (range 35-88). The majority were men (82%) and 24%, 32%, 28% and 16% were diagnosed with small cell lung cancer (SCLC), squamous cell (SCC), adenocarcinoma (ADC) and large cell (LCC) LC, respectively. The median StD and StO was 32 (0-212) days and 102 (11-608) days, respectively. No difference was detected across genders, age ( > or < 70), family history of cancer or not, and area of residence (rural, urban). The median StT and DtT was 123 (30-851) days and 26 (1-105) days, respectively, with this time intervals being shorter among pts with SCLC compared to pts with non-small cell LC (NSCLC) ( p: 0.006 and p< 0.001, respectively). Pts with sort StT intervals had significantly improved OS, compared to pts with longer StT intervals (SCLC p:0.044, NSCLC p:0.004). Conclusions: To the best of our knowledge, this is the first study aiming to determine specific TI from SO to treatment initiation for pts with LC in Greece and assess the potential impact on OS. Our data revealed a substantially prolonged StT (~4months) that is associated with worse survival rates. This indicates a need to improve public awareness of LC symptoms, enable pts’ access to specialized health care services and facilitate earlier diagnosis and treatment.

Variations in healthcare utilization for mental health problems prior to suicide by socioeconomic status: a Norwegian register-based population study

BackgroundSuicide poses a major public health challenge, claiming around 650 lives annually in Norway. There is limited understanding of mental healthcare utilization patterns preceding suicide, particularly relating to socioeconomic status (SES). This study analyzes mental health service use among Norwegian citizens aged 20–64 from 2009 to 2021, emphasizing disparities related to SES.MethodsThis is a population-wide registry-based study. We include mental health consultations with both primary and specialist healthcare services, and investigate patterns of service use regarding educational attainment, employment status and income and compare this to the population in general. All suicides in the period (N = 4731) are included in the study. The aim is to investigate potential discrepancies in service use the year and month preceding suicide, seeking to enhance targeted preventive interventions.ResultsOur results show significant variations in healthcare use for mental health problems the last year preceding suicide, according to the components of SES, for both men and women. Those with higher education utilize the mental healthcare services prior to suicide to a higher degree than men and women with high school education or less, whereas employed men and men with high income level have significantly lower mental healthcare usage prior to suicide both the last year and month compared to the non-employed men and men with low-income level. Employed women also had a lower mental healthcare usage, whereas the results regarding income are not significant for women.ConclusionMental healthcare use prior to suicide varies across the SES components. Notably, the SES groups exhibit heterogeneity, with gendered patterns. Targeted interventions for low consultation rates among employed men, and men with high income and lower education are needed, while women, and men in at-risk groups, such as the non-employed and those with low income, demonstrate higher mental healthcare utilization, warranting comprehensive suicide prevention measures.

Holistic Sexual-Reproductive Healthcare Services and Needs for Queer Individuals: Healthcare Providers' Perspectives.

There are ongoing debates and controversies about whether genderqueer individuals have specific sexual-reproductive healthcare services and needs (SRHSNs). This study intended to identify and explore queer-specific SRHSNs among healthcare providers (HCPs) in Gauteng Province, South Africa. This was an exploratory sequential mixed-methods study, and this article focuses on the qualitative findings of that investigation. Thirty-three HCPs were purposively sampled, and semi-structured one-on-one interviews were used to collect data between September and November 2023. The data were analyzed using thematic content analysis (TCA). The results of this study revealed nine main themes: a crucial need for inclusive healthcare facilities; a need for psychological, counseling, and therapeutic support in sexual and reproductive healthcare; access to sexual-reproductive education and integrating support; suggested reproductive health services for queer sexual wellness; improved accessibility and particular queer reproductive healthcare; optimizing services related to human immunodeficiency virus (HIV), pre-exposure prophylaxis (PrEP) access, and sexually transmitted illness (STI) treatment; genderqueer persons' parenthood aspirations and empowerment; the safe availability of intimacy tools; and navigation transitions. A holistic and inclusive healthcare approach that fits psychological support, comprehensive sexual-reproductive education, and specialized services to accommodate the unique needs of queer individuals should be implemented and made easily accessible.

Understanding service preferences among consensually non-monogamous individuals seeking sexual healthcare

Despite consensually non-monogamous people being a minority population with specific healthcare needs, research on this group is minimal, especially in relation to sexual healthcare. This study explores the motivations behind consensually non-monogamous individuals’ choices of sexual healthcare service options. Qualitative survey data was collected from 67 consensual non-monogamists and analysed using thematic analysis. Two key themes captured participants’ perspectives on the selection of sexual healthcare services. ‘Feeling Comfortable’ highlighted preferences for sexually inclusive clinics and LGBT+- focused services due to perceived better quality of care and comfort. ‘Practicalities’ emphasised convenience, proximity and the availability of STI testing options as critical factors influencing service selection. Accordingly, this research provides insight into the specific sexual healthcare service needs, desires and motivations of those who are consensually non-monogamous. Suggestions are made for increased training and awareness when working with relationship diverse patients.

Bioanthropological and Biomechanical Perspectives on Skeletal Senescence Variation: A Literature Review

Background: Senescence is the deterioration of the body’s biological and physiological function throughout later life. Senescent populations are more prone to diseases, though other than osteoporosis, skeletal senescence is a less discussed topic in Indonesia. Furthermore, a global and national increase in the aging population showed that they will be a major group in society, thus raising the urgency to review this matter. This study aims to comprehend the physiological and biomechanical mechanisms of skeletal senescence, as well as senescent variations in a certain sex or population affinity. Literature Review: Age-related skeletal cellular death and imbalance contribute to bone damage in elders. Senescence also affects skeletal biomechanics, expressed in increased bone porosity and brittleness. Stresses in aged bone risk straining above its elastic limit and causing fractures due to its inability to tolerate stresses. The loss of sex hormones is related to skeletal senescence, especially in females, though the effects of testosterone on skeletal senescence are underresearched. Dietary change, estrogen replacement therapy, and calcitonin consumption are effective measures in reducing the effects of osteoporosis. Variations were found in the bone aging process in different populations, especially regarding bone mineral density loss in white, African-American, Asian, and Hispanic populations. Summary: Specific population-based healthcare services in geriatrics and gerontology are highly suggested to ensure inclusive healthcare for every aged individual. Due to the minimum data about bone aging in Indonesia (other than osteoporosis), the authors encourage data procurement on local populations to create more suitable medical guidelines for elders in Indonesia.

Exploring the knowledge and skills for effective family caregiving in elderly home care: a qualitative study.

Family caregivers play a crucial role in providing physical, emotional, and social support to the elderly, allowing them to maintain their independence and stay in their preferred living environment. However, family caregivers face numerous challenges and require specific knowledge and skills to provide effective care. Therefore, understanding the knowledge and skills required for effective family caregiving in elderly home care is vital to support both the caregivers and the elderly recipients. The research was carried out in Mekelle City, Ethiopia, utilizing the phenomenology study design and purposive sampling technique. A total of twenty-two in-depth interviews were conducted. Individuals with experience in providing care for elderly people in their homes were targeted. Data was gathered through the use of an open-ended guide, transcribed word-for-word, inputted into ATLAS.ti8 software, and translated. Codes and themes were then extracted from the transcribed data, and a thematic analysis was performed. To minimize personal biases, the collected data were coded independently by the data collection assistants and the PI. The analysis was carried out by authors who were not involved in the data collection process. The interviews were conducted in a quiet place. A total of 22 in-depth interviews were conducted as part of this research. The results indicated that although the participants had knowledge about common health problems experienced by older people, they were uninformed about how to manage these conditions at home and were unaware of specialized healthcare resources for the elderly. Furthermore, they had limited knowledge about suitable exercise routines, strategies to prevent falls, and home healthcare practices for older individuals. On the other hand, they exhibited a solid comprehension and awareness of abusive behaviors specifically directed at older adults. The results emphasized the importance of enhancing education and training for family caregivers in handling elderly health issues, raising awareness about specialized healthcare services catered to the elderly, improving understanding of activities of daily living (ADLs) and fall prevention, and offering inclusive training in healthcare tasks related to elder care. Participants should receive comprehensive education and training programs to enhance their knowledge and skills in managing these conditions. Efforts should also be made to raise awareness about the availability of geriatric hospitals or specialized nurses for the elderly. Participants need to be educated about suitable exercise routines for the elderly and fall prevention strategies. Healthcare skills training is also necessary for participants, focusing on activities such as wound dressing, vital sign monitoring, and establishing a specific schedule for changing positions.

Understanding Adolescent Gynecological Issues: A Cross-Sectional Study at a Tertiary Care Center.

Adolescence is a crucial phase in a woman's life, as it signifies the beginning of her reproductive journey. During this time, there are notable variations in sexual development and a sense of caution that can present challenges for healthcare providers. The rationale for studying adolescent gynecological problems lies in the need to understand and address the unique reproductive health challenges faced by young girls. By investigating these issues, researchers and healthcare professionals can develop effective strategies for prevention, early detection, and treatment of gynecological conditions in adolescents. This knowledge is crucial for promoting the overall well-being and reproductive health of young girls, ensuring they receive appropriate care and support during this critical stage of development. This study focuses on identifying the most common gynecological issues in teenagers, exploring the root causes, examining the available treatment options, and understanding how they are managed at a tertiary care facility. Methods: This cross-sectional observational study took place at a tertiary care center and focused on gynecological issues in adolescent females who sought care at the gynecology department from January 2016 to December 2022. The study participants were categorized into three groups: early adolescence (10-13 years), middle adolescence (14-16 years), and late adolescence (17-19 years) for analysis. Ethical approval was obtained for this hospital-based research, which involved examining, investigating, and treating the study participants. Out of the 49,700 new female patients, 2000 (4.02%) fell within the specified age range. The average age of the participants was 16.87±2.16, and the majority of them sought help for menstrual issues (63.45%), followed by abdominal discomfort (15.6%) and vaginal discharge (7.2%). Menstrual disorders were the most common concern, with dysmenorrhea and puberty menorrhagia being prevalent issues. Abdominal pain was caused by various factors, such as urinary tract infections, ovarian tumors, pelvic inflammatory disease, endometriosis, and endometrial tuberculosis. The majority of cases were treated conservatively, with only a small percentage requiring surgical intervention. The significance of early detection and intervention in addressing gynecological issues among adolescents is highlighted in the findings of this research, underscoring the necessity for specialized healthcare services that cater to the specific needs of this demographic. Adolescent gynecology plays a crucial role in safeguarding the reproductive health and overall well-being of young women, emphasizing the importance of seeking assistance proactively.

Evaluation of heroin-assisted treatment in Norway: protocol for a mixed methods study

BackgroundOpioid agonist treatment (OAT) for patients with opioid use disorder (OUD) has a convincing evidence base, although variable retention rates suggest that it may not be beneficial for all. One of the options to include more patients is the introduction of heroin-assisted treatment (HAT), which involves the prescribing of pharmaceutical heroin in a clinical supervised setting. Clinical trials suggest that HAT positively affects illicit drug use, criminal behavior, quality of life, and health. The results are less clear for longer-term outcomes such as mortality, level of function and social integration. This protocol describes a longitudinal evaluation of the introduction of HAT into the OAT services in Norway over a 5-year period. The main aim of the project is to study the individual, organizational and societal effects of implementing HAT in the specialized healthcare services for OUD.MethodsThe project adopts a multidisciplinary approach, where the primary cohort for analysis will consist of approximately 250 patients in Norway, observed during the period of 2022–2026. Cohorts for comparative analysis will include all HAT-patients in Denmark from 2010 to 2022 (N = 500) and all Norwegian patients in conventional OAT (N = 8300). Data comes from individual in-depth and semi-structured interviews, self-report questionnaires, clinical records, and national registries, collected at several time points throughout patients’ courses of treatment. Qualitative analyses will use a flexible inductive thematic approach. Quantitative analyses will employ a wide array of methods including bi-variate parametric and non-parametric tests, and various forms of multivariate modeling.DiscussionThe project’s primary strength lies in its comprehensive and longitudinal approach. It has the potential to reveal new insights on whether pharmaceutical heroin should be an integral part of integrated conventional OAT services to individually tailor treatments for patients with OUD. This could affect considerations about drug treatment even beyond HAT-specific topics, where an expanded understanding of why some do not succeed with conventional OAT will strengthen the knowledge base for drug treatment in general. Results will be disseminated to the scientific community, clinicians, and policy makers.Trial registrationThe study was approved by the Norwegian Regional Committee for Medical and Health Research Ethics (REK), ref.nr.:195733.

Access to specialized health care services among older Canadians.

Canada is experiencing rapid population aging, which has a wide range of implications, including an increased need for health care services. However, very few studies have examined use of specialized health care services (e.g., visits to medical specialists, non-emergency tests, and surgeries) among older Canadians. Data from the Canadian Health Survey on Seniors - 2019/2020 were used to examine specialized health care service use among older Canadians. Latent class analysis was calibrated using a nationally representative sample of 39,047 Canadians aged 65 years or older to identify distinct patterns of need factors related to health care service use. Multivariable logistic regression, stratified by gender, was used to examine the association of predisposing characteristics, enabling resources, and need factors with specialized health care service use. In 2019/2020, an estimated 2.6 million older Canadians (43.4%) visited medical specialists, 1.4 million (23.2%) got non-emergency tests, and 0.6 million (10.4%) had non-emergency surgeries. Among those, 15.6% reported experiencing difficulties accessing services. Women were less likely than men to have visited medical specialists and have received non-emergency tests. Lower education was consistently associated with lower odds of specialized health care service use. Individuals in the multimorbidity, high stress-multimorbidity-disability, and poor physical and mental health classes were more likely than those in the comparatively healthy class to use specialized health care services and to experience difficulties accessing them. Findings of this study highlight gender differences and the importance of considering multidimensional need factors - ranging from physical health to mental health to psychosocial factors - in examining use of specialized health care services.

Recovery following discharge from intensive care: What do patients think is helpful and what services are missing?

Recovery following critical illness is complex due to the many challenges patients face which influence their long-term outcomes. We explored patients' views about facilitators of recovery after critical illness which could be used to inform the components and timing of specific rehabilitation interventions. To explore the views of patients after discharge from an intensive care unit (ICU) about their recovery and factors that facilitated recovery, and to determine additional services that patients felt were missing during their recovery. Qualitative study involving individual face-to-face semi-structured interviews at six months (n = 11) and twelve months (n = 10). Written, informed consent was obtained. [Ethics approval 17/NI/0115]. Interviews were audiotaped, transcribed and analysed using template analysis. Template analysis revealed four core themes: (1) Physical activity and function; (2) Recovery of cognitive and emotional function; (3) Facilitators to recovery; and (4) Gaps in healthcare services. Patient reported facilitators to recovery include support and guidance from others and self-motivation and goal setting, equipment for mobility and use of technology. Barriers include a lack of follow up services, exercise rehabilitation, peer support and personal feedback. Patients perceived that access to specific healthcare services was fragmented and where services were unavailable this contributed to slower or poorer quality of recovery. ICU patient recover could be facilitated by a comprehensive rehabilitation intervention that includes patient-directed strategies and health care services.

AI APPLICATIONS IN SCREENING AND DIAGNOSIS OF DIABETIC RETINOPATHY IN RURAL SETTINGS

Diabetic retinopathy (DR) remains a significant cause of vision impairment and blindness, particularly in rural settings where access to specialized healthcare services is limited. The integration of artificial intelligence (AI) holds promise in revolutionizing the screening and diagnosis of DR, offering a scalable solution to bridge the gap in healthcare disparities. This systematic review synthesizes existing literature on AI applications tailored for screening and diagnosing diabetic retinopathy in rural areas. Through a comprehensive search across various databases, including PubMed, IEEE Xplore, and Google Scholar, a total of 88 studies meeting the inclusion criteria were identified. These studies encompassed a range of AI techniques, including deep learning algorithms, machine learning models, and image processing methods, deployed in diverse rural healthcare settings globally. The findings reveal that AI-based systems demonstrate high accuracy, sensitivity, and specificity in detecting diabetic retinopathy from fundus images, thereby enabling early identification and timely intervention. Moreover, the scalability and cost-effectiveness of these AI solutions make them particularly suitable for resource-constrained rural environments. However, several challenges persist, including the need for robust validation studies, integration with existing healthcare infrastructure, and addressing ethical and regulatory concerns. Additionally, considerations regarding data privacy, patient acceptance, and healthcare provider training are crucial for the successful implementation of AI-driven DR screening programs in rural settings. This systematic review underscores the transformative potential of AI technologies in improving access to diabetic retinopathy screening and diagnosis in rural areas. Future research should focus on addressing the identified challenges and optimizing AI systems to enhance their efficacy and accessibility in underserved communities.
 Keywords: AI, Rural, Diagnosis, Diabetic, Retinopathy, Rural, Review.

The role of digitalization, infrastructure, and economic stability in tourism growth: A pathway towards smart tourism destinations

AbstractThis study shows the impact of information and communication technology (ICT), inflation, economic growth, foreign direct investment (FDI), infrastructural development, and financial development on the global tourism index across all income groups. We use a generalized method of moments technique, novel index of tourism, and ICT in 130 countries from 1995 to 2019. The empirical results infer an increase in tourism due to sustained growth in ICT (all panels), economic growth (all panels), FDI (all panels), financial development (all panels), and infrastructure development (all panels). This study highlights the importance of increasing 4G networking in remote areas and introducing reliable mobile applications to promote smart tourism, which involves setting up a Tourist Information Centre to guide tourists in terms of traveling, accommodation, food, shopping, parking, history of specific places, healthcare services, weather forecasting, and emergencies. The central bank could ensure price stability by using different tools of monetary and fiscal policy while encouraging FDI and ICT infrastructure in the tourism industry, especially in developing countries. Tourism is directly associated with foreign exchange earnings, which in turn increases the financial strength of an economy. Besides, prioritizing investment in infrastructure, particularly in sanitation and waste management, drinking water supply, clean fuel management, and generation of electricity, could bolster tourism. The contribution of this study employs multiple indicators in the form of a composite index (i.e., global tourism index, ICT index, and infrastructure index). In addition, we have developed a global ICT index using several related indicators.

AT: Asynchronous Teleconsultation for Health Centers in Rural Areas of Peru

AT: Asynchronous Teleconsultation for Health Centers in Rural Areas of Peru

Trajectories of Body Mass Index and Risk for Diabetes Complications and All-Cause Mortality in Finnish Type 2 Diabetes Patients.

We aimed to assess how longitudinal body mass index (BMI) trajectories are associated with diabetes complications and all-cause mortality in Finnish patients with type 2 diabetes (T2D). In this cohort study, electronic health records from public primary and specialized healthcare services in all 13 municipalities of North Karelia, Finland, were utilized. This study included a total of 889 adults with newly diagnosed T2D in 2011 or 2012 (mean age at baseline 62.0 years). Individual BMI trajectories from the T2D diagnosis until 2014 were estimated and grouped by growth mixture modeling (GMM). Hazard ratios (HRs) with 95% confidence intervals (CIs) for microvascular complications, macrovascular complications, any diabetes complications, and all-cause mortality from 2015 to 2022 across BMI trajectory groups were estimated using Cox regression models. Three distinct BMI trajectory groups were identified using GMM and labeled as follows: "stable" (n = 774, 87.1%), "decreasing" (n = 87, 9.8%), and "increasing" (n = 28, 3.1%). During a median follow-up of 8 years, there were 119 (13.3%) patients with microvascular complications, 187 (21.0%) with macrovascular complications, 258 (29.0%) with any diabetes complications, and 180 (20.2%) deaths. Compared with the "stable" BMI, the "increasing" BMI was associated with an increased risk of microvascular complications (HR = 2.88, 95% CI: 1.32 to 6.28), macrovascular complications (HR = 2.52, 95% CI: 1.17 to 5.43), and any diabetes complications (HR = 2.21, 95% CI: 1.16 to 4.20). The "decreasing" BMI was associated with an increased risk of all-cause mortality (HR = 1.90, 95% CI: 1.14 to 3.15), compared to the "stable" BMI. Our findings underscore the significance of continuous BMI monitoring and weight management in patients with T2D. Tailored treatments are crucial for efficiently preventing weight gain and reducing the risk of diabetes complications.

Harnessing the Power of Mobile Phone Technology: Screening and Identifying Autism Spectrum Disorder With Smartphone Apps.

Integrating smartphone applications into screening and identifying autism spectrum disorder (ASD) represents a promising and innovative frontier within healthcare. This forward-looking paper examines the current landscape of ASD screening apps, shedding light on their potential advantages and addressing and navigating significant challenges. One of the most compelling aspects of these apps lies in their potential to democratize access to ASD screening, effectively breaking down geographical barriers. By using the widespread availability of smartphones, these apps make it possible for individuals, caregivers, and healthcare providers to engage in early ASD screening from virtually anywhere. This accessibility is especially crucial in underserved areas or regions with limited access to specialized healthcare services. Moreover, these apps offer a degree of objectivity that traditional screening methods may need help to match. By relying on data-driven algorithms and machine learning, they can provide a more impartial assessment of a child's behavior, minimizing the potential for subjective bias. This objectivity, combined with the ability to monitor and assess a child's development over time, empowers caregivers with valuable insights into their child's progress. However, as with any technological advancement in healthcare, integrating smartphone apps for ASD screening is not without its share of ethical and privacy considerations. Ensuring informed consent is obtained, especially when collecting data from children, is complex and critical. Striking the right balance between collecting necessary data and protecting an individual's privacy requires careful thought and transparent communication. Additionally, the "digital divide" represents a challenge that needs to be acknowledged and addressed. Not all individuals and families have equal access to smartphones or the technological literacy required to use these apps effectively. This disparity in access must be considered when developing and implementing app-based screening solutions to prevent exacerbating existing healthcare inequalities. Nevertheless, the future of ASD screening apps holds significant promise. Advancements in technology, including integrating advanced sensors, wearables, augmented reality, and machine learning, can further enhance the accuracy and depth of screening. Interdisciplinary collaboration between researchers, developers, clinicians, and educators is crucial to ensure that these apps are effective, culturally sensitive, and user-friendly. Furthermore, integrating these apps into broader healthcare systems, including electronic health records and telehealth platforms, can streamline the screening process and enable a more seamless transition from screening to diagnosis and intervention.

Preparing for the ‘Blues’: Building Midwives’ Capacity for the Delivery of Perinatal Mental Health Care and Services in Ghana

Background: There is limited empirical evidence on the use of standardized and validated assessment tools such as PHQ-9 and GAD-7 by midwives in Ghana to screen perinatal women for symptoms of anxiety and depression and provide the needed support accordingly. Preliminary studies have reported a lack of sufficient knowledge, skills, and preparedness among medical staff, including midwives for the task of screening pregnant women for mental health disorders [21]. This study intends to inform midwives of the availability of tools to assist them make appropriate diagnostic impression of depression and anxiety and to provide a clear pathway to support the perinatal women in their care. Overall, the aim of this study is to promote the exchange of ideas and collaboration among stakeholders to ensure that the training and practice of midwifery in Ghana become more robust and meet global standards. Additionally, it is meant to inform, prepare competent, resourceful, knowledgeable, and most importantly adaptable midwives who can contribute to and promote the overall health of the women in their care. Objective: To address the gap in maternal mental health practice by equipping midwives with the requisite knowledge and skills on the use of globally validated and reliable assessment tools for depression and anxiety to support the perinatal women in their care. Methods: The study involved different two sections. In the first section, a structured questionnaire was used to collect data from 319 participants (midwives) to explore their knowledge on perinatal depression and anxiety assessment tools whiles the second component involved equipping midwives with the requisite mental health assessment skills through a two-week seminar that was organised and facilitated by the research team. Feedback on the level of confidence, suitability, and competence as well as the resourcefulness of the use of the tools was collected from participants (midwives) after three (3) months. The study was conducted in selected hospitals across all 16 regions in Ghana. The regions have several government and private hospitals that provide primary and specialised health care services to the public. They include teaching hospitals, regional hospitals, municipal hospitals, district hospitals as well as clinics within the sub-districts. Basic descriptive quantitative analysis was used based on frequency tables, pie chart and graphical illustration to interpret the data. Results: The study revealed that lack of resources and inadequate capacity-building to practically equip midwives are a major setback for the delivery of perinatal mental health services. It also identified perceived discrimination and stigmatisation on the part of the perinatal women as a major barrier in the provision of maternal mental health services. However, the participants demonstrated having adequate knowledge on the impact of perinatal anxiety and depression on birth and maternal outcomes. Nonetheless, there remains a huge deficit in their ability to use the validated and reliable assessment tools in recognizing clinical cues related to anxiety and depression among perinatal women. Surprisingly, over 50% of the midwives were unfamiliar with the commonly used assessment tools for depression and anxiety such as the GAD-7 and PHQ-9. Additionally, nearly 40% of the participants lack the requisite assessment skills for assessing perinatal anxiety and depression. In furtherance, over 97% of the participants demonstrated an appreciable level of confidence in terms of using the PHQ-9 and the GAD-7 following the post-assessment tool seminar. Conclusion: Perinatal mental health should be made a critical component of perinatal care, with midwives being well situated to recognize the manifestations of deteriorating mental health among the perinatal women in their care and provide the needed support and required level of supervision. It is therefore imperative to train midwives on basic mental health assessment skills and encourage them to incorporate mental health care into the delivery of routine perinatal care and services.