Specific Interventions Research Articles

Developing Physiotherapy in Primary Health Care: A First Snapshot from the Italian Metropolitan City of Milan.

Since the COVID-19 pandemic, the Italian National Health Service (NHS) has been undergoing a structural reform shifting focus from hospital-centered care to smaller, intermediate, or primary health facilities closer to the community (e.g., community hospitals and community houses). This reorganization should include rehabilitation and physiotherapy, but the actual spread of these services is still unclear. This study explored the number and characteristics of community-based physiotherapy services in the Metropolitan City of Milan (Italy). Between April and May 2024, we distributed a structured, anonymous online survey about community physiotherapy services and users to all Directors of the Health and Social Care Professions Departments (DAPSS) in the Metropolitan City of Milan. We used descriptive statistics to analyze the number of community houses offering physiotherapy services, the specific intervention areas, and access modalities. Six out of seven DAPSS Directors completed the survey (87%). Thirty-seven community houses were reported in the area, with fourteen of these offering physiotherapy services. In most of them, physiotherapy was a primary reason for access following a general practitioner's prescription. Five out of six responders reported that rehabilitation needs were mainly assessed by specialists in Physical and Rehabilitation Medicine, with physiotherapists involved in the assessment process in two cases. Physiotherapists primarily handled the intervention phase, dealing mainly with orthopedic and neurological conditions. DAPSS Directors noted that additional physiotherapy initiatives focusing on prevention will be implemented. Physiotherapy services are becoming available in the Metropolitan City of Milan. However, more efforts are needed to facilitate access and ensure tailored assessment and effective interventions, particularly in preventive care. Future investigations should help to better define the number and the characteristics of the patients who can most benefit from this type of care, the number of sessions they need, and with what types of intervention; it would be also necessary to better define the communication network in the area that allows doctors, health professionals, and patients to be informed about this possibility.

Characterization of Effect of Enterovirus D68 in 129/Sv Mice Deficient in IFN-α/β and/or IFN-γ Receptors.

Enterovirus D68 (EV-D68), a respiratory RNA virus in the family Picornaviridae, is implicated as a potential etiological agent for acute flaccid myelitis in preteen adolescents. The absence of a specific therapeutic intervention necessitates the development of an effective animal model for EV-D68. The AG129 mouse strain, characterized by the double knockout of IFN-α/β and IFN-γ receptors on the 129 genetic background, has been proposed as a suitable model for EV-D68. The goals of this study were to assess the effect of a nonmouse-adapted EV-D68 strain (US/MO/14-18947, NR-49129) in AG129 (IFN-α/β and IFN-γ receptors null), A129 (IFN-α/β receptor null), G129 (IFN-γ receptor null), and the 129 background strain (129S2/SvPasCrl) when infected intraperitoneally at 10 d of age. Both AG129 and A129 strains demonstrated similar clinical signs (paralysis, paresis, lethargy, dyspnea [characterized by prominent abdominal respiration], and morbidity requiring euthanasia) induced by EV-D68. While G129 and 129S2 strains also exhibited susceptibility to EV-D68, the severity of clinical signs was less than in AG129 and A129 strains, and many survived to the experimental endpoint. Histopathological and immunohistochemical data confirmed EV-D68 tropism for the skeletal muscle and spinal cord and suggest that the dyspnea observed in infected mice could be attributed, in part, to lesions in the diaphragmatic skeletal muscles. These findings contribute valuable insights into the pathogenesis of EV-D68 infection in this mouse model and provide investigators with key information on virus dose and mouse strain selection when using this mouse model to evaluate candidate EV-D68 therapeutics.

Socio-economic conditions affect health-related quality of life, during recovery from acute SARS-CoV-2 infection

BackgroundRecovery from acute COVID-19 may be slow and incomplete: cases of Post-Acute Sequelae of COVID (PASC) are counted in millions, worldwide. We aimed to explore if and how the pre-existing Socio-economic-status (SES) influences such recovery.MethodsWe analyzed a database of 1536 consecutive patients from the first wave of COVID-19 in Italy (February-September 2020), previously admitted to our referral hospital, and followed-up in a dedicated multidisciplinary intervention. We excluded those seen earlier than 12 weeks (the conventional limit for a possible PASC syndrome), and those reporting a serious complication from the acute phase (possibly accounting for symptoms persistence). We studied whether the exposition to disadvantaged SES (estimated through the Italian Institute of Statistics’s model – ISTAT 2017) was affecting recovery outcomes, that is: symptoms (composite endpoint, i.e. at least one among: dyspnea, fatigue, myalgia, chest pain or palpitations); Health-Related-Quality-of-Life (HRQoL, as by SF-36 scale); post-traumatic-stress-disorder (as by IES-R scale); and lung structural damage (as by impaired CO diffusion, DLCO).ResultsEight-hundred and twenty-five patients were included in the analysis (median age 59 years; IQR: 50–69 years, 60.2% men), of which 499 (60.5%) were previously admitted to hospital and 27 (3.3%) to Intensive-Care Unit (ICU). Those still complaining of symptoms at follow-up were 337 (40.9%; 95%CI 37.5–42.2%), and 256 had a possible Post-Traumatic Stress Disorder (PTSD) (31%, 95%CI 28.7–35.1%). DLCO was reduced in 147 (19.6%, 95%CI 17.0–22.7%). In a multivariable model, disadvantaged SES was associated with a lower HRQoL, especially for items exploring physical health (Limitations in physical activities: OR = 0.65; 95%CI = 0.47 to 0.89; p = 0.008; AUC = 0.74) and Bodily pain (OR = 0.57; 95%CI = 0.40 to 0.82; p = 0.002; AUC = 0.74). We did not observe any association between SES and the other outcomes.ConclusionsRecovery after COVID-19 appears to be independently affected by a pre-existent socio-economic disadvantage, and clinical assessment should incorporate SES and HRQoL measurements, along with symptoms. The socioeconomic determinants of SARS-CoV-2 disease are not exclusive of the acute infection: this finding deserves further research and specific interventions.

Incorporating Patient Values in Large Language Model Recommendations for Surrogate and Proxy Decisions.

Surrogates, proxies, and clinicians making shared treatment decisions for patients who have lost decision-making capacity often fail to honor patients' wishes, due to stress, time pressures, misunderstanding patient values, and projecting personal biases. Advance directives intend to align care with patient values but are limited by low completion rates and application to only a subset of medical decisions. Here, we investigate the potential of large language models (LLMs) to incorporate patient values in supporting critical care clinical decision-making for incapacitated patients in a proof-of-concept study. We simulated text-based scenarios for 50 decisionally incapacitated patients for whom a medical condition required imminent clinical decisions regarding specific interventions. For each patient, we also simulated five unique value profiles captured using alternative formats: numeric ranking questionnaires, text-based questionnaires, and free-text narratives. We used pre-trained generative LLMs for two tasks: 1) text extraction of the treatments under consideration and 2) prompt-based question-answering to generate a recommendation in response to the scenario information, extracted treatment, and patient value profiles. Model outputs were compared with adjudications by three domain experts who independently evaluated each scenario and decision. Automated extractions of the treatment in question were accurate for 88% (n = 44/50) of scenarios. LLM treatment recommendations received an average Likert score by the adjudicators of 3.92 of 5.00 (five being best) across all patients for being medically plausible and reasonable treatment recommendations, and 3.58 of 5.00 for reflecting the documented values of the patient. Scores were highest when patient values were captured as short, unstructured, and free-text narratives based on simulated patient profiles. This proof-of-concept study demonstrates the potential for LLMs to function as support tools for surrogates, proxies, and clinicians aiming to honor the wishes and values of decisionally incapacitated patients.

Research Progress in Integrated Chinese and Western Medicine Health Management for School-Age Children with Asthma

Objective: The purpose of this study is to investigate the application of Chinese and Western medicine in the health management of school-age children with asthma and its research progress, with a view to providing a more comprehensive and effective management strategy for the clinic. Methods: Using the method of literature review, this study systematically searched and analyzed the relevant studies on the combination of Chinese and Western medicine in the health management of school-aged children with asthma in recent years, focusing on Chinese medicine treatment, Western medicine treatment, and the combined health management of Chinese and Western medicine. Results: Chinese medicine treatment, Western medicine treatment, and the health management mode of combining Chinese and Western medicine showed unique advantages in school-age asthmatic children. Through the comprehensive use of Chinese medicine’s diagnosis and treatment, Chinese medicine conditioning, Chinese medicine characteristic therapy, and Western medicine’s modern medical methods, it not only effectively relieved asthma symptoms but also significantly improved the quality of life of the children. At the same time, this management mode also focuses on the psychological guidance and family care of the children, forming an all-round and multi-level health management system. Conclusion: The health management strategy of combining Chinese and Western medicine has a broad application prospect in school-age asthmatic children, and its specific interventions and mechanisms of action should be further studied to provide more scientific and systematic guidance for clinical practice.

Patient responsiveness as a safewards fidelity indicator: a qualitative interview study on an acute psychiatric in-patient ward

BackgroundThe Safewards model aims to reduce conflict and use of containment on psychiatric wards. To evaluate the implementation of Safewards and understand why it is effective in some settings but not in others, it is important to assess the level of implementation fidelity. To do this, the Safewards Fidelity Checklist (SFC) is often used, which focuses on objective visual observations of interventions but does not include patient responsiveness. The latter is a key indicator of implementation fidelity and includes engagement, relevance, acceptability and usefulness. The aim of the present study was to investigate the fidelity of Safewards implementation on an acute psychiatric ward from the perspective of patient responsiveness.MethodThe study was conducted on a ward for patients with mainly affective disorders. To assess the general level of fidelity the SFC was used together with a detailed ward walkthrough. Ten patients were interviewed with a focus on patient responsiveness to each of the seven interventions implemented on the ward. Data were analysed using qualitative descriptive analysis.ResultsThe findings indicate high implementation fidelity, which was reflected in the SFC assessment, walkthrough and patient responsiveness. Patients gave examples of improvements that had happened over time or of the ward being better than other wards. They felt respected, less alone, hopeful and safe. They also described supporting fellow patients and taking responsibility for the ward climate. However, some patients were unfamiliar with a ward where so much communication was expected. Several suggestions were made about improving Safewards.ConclusionsThis study confirms previous research that patient responsiveness is an important factor for achieving fidelity in a prevention programme. The patients’ descriptions of the acceptability, relevance and usefulness of the specific interventions reflected to a high degree the objective visual observations made by means of the SFC and ward walkthrough. Patient engagement was demonstrated by several suggestions about how to adapt the interventions. There is potential to obtain valuable input from patients when adapting Safewards in practice. This study also presents many examples of practical work with these interventions and the effects it can have on patients’ experiences of care.

Understanding Major Depressive Disorder in Singapore: Insights from the second Singapore Mental Health Study (SMHS 2016)

BackgroundMajor Depressive Disorder (MDD) poses significant public health challenges globally and in Southeast Asia, with substantial impairment and disease burden. Understanding its prevalence and associated risk factors is crucial for effective intervention. MethodsThis study aims to describe the prevalence shifts, correlates, and comorbidities of MDD in Singapore. Data were collected from the second Singapore Mental Health Study (SMHS 2016), a national cross-sectional survey comprising 6126 adult residents. The WHO Composite International Diagnostic Interview assessed MDD and comorbidities. Statistical analyses, including logistic regression, were conducted to examine the associations and trends. ResultsThe lifetime weighted prevalence of MDD in SMHS 2016 was 6.2 %, with an overall increase from 5.8 % in 2010. Significant associations were found between MDD and age, marital status, and comorbid physical disorders. Young adults and divorced/separated individuals exhibited higher MDD prevalence. Chronic pain was significantly associated with MDD. LimitationsThe study's cross-sectional design limits causal inference, and selective non-response might affect prevalence estimates. However, the study benefits from a large, nationally representative sample and standardized methodologies. ConclusionsYoung and middle-aged adults, and divorced/separated individuals demonstrate elevated MDD prevalence, warranting targeted interventions. Individuals with comorbidities, particularly chronic pain, constitute a high-risk and vulnerable population. Comprehensive assessment and treatment plans should involve multidisciplinary teams and integrated care approaches to better address the complex needs of these individuals. Our study also highlights specific interventions for schools, families, communities, and workplaces. Despite Singapore's relatively low prevalence compared to Western nations, MDD remains cross-culturally valid emphasizing the need for early intervention and preventive public health measures.

The interdependence of caring, safety, and health in correctional settings: Analysis of a survey of security staff in a large county jail system

The health of incarcerated populations is intertwined with the health of security staff, but the social mechanisms, and especially the specific interventions, that might mitigate these health harms are underexplored. We examine one possible mechanism of interrelated health harms: whether and how jail security staff are willing and able to care for mentally ill detainees. We hypothesize that the attitudes of security staff towards care affect the well-being of everyone in a jail setting—staff, as well as detainees. Analyzing 539 anonymous respondent surveys administered to a stratified cluster sample of security staff working in a large U.S. county jail system, we (1) describe the prevalence of a perceived duty to care and availability of caring resources among security staff and (2) analyze whether variations in a duty to care and caring resources predict outcomes associated with staff and detainee well-being. Across five maximum likelihood models estimated, both perceived duty to care and availability of caring resources are significantly associated with collaborative relationships with medical staff, increased perceptions of personal safety, decreased frequency of hostile encounters, and better self-reported health outcomes. Our models explain 20 percent of the variation in self-reported health outcomes (R2 = .20), a meaningful effect of care on security personnel's well-being. Our findings suggest security staff have an often-overlooked duty to care akin to that experienced by healthcare staff. Among healthcare staff, dual loyalty trainings have successfully amplified caring duties relative to security duties; similar trainings for security staff might better leverage their caring duties to improve both staff and detainee well-being.

Student teachers’ reactions to formative teacher and peer feedback

ABSTRACT Research on students’ perceptions of feedback in higher education has largely focused on students’ general preferences, with little insight into the kind of feedback that students experience. Against this backdrop, the current study investigates students’ reactions to a specific intervention which aimed, using research-informed strategies, to promote teacher and peer formative feedback with two groups of students at a teacher education institution in Norway. The qualitative analysis of 188 written reflections revealed that the students were overwhelmingly positive towards teacher feedback. Peer feedback was valued, though less favourably, suggesting that the role of peer feedback in higher education may need to be reconceptualised to recognise its strengths and acknowledge its limits. Opportunities to engage in feedback dialogue with their instructors were not exploited by the students, leading to the conclusion that such processes may need to be more formally structured and initiated by course instructors.

Precision medicine for obesity: current evidence and insights for personalization of obesity pharmacotherapy.

Obesity is a chronic and complex disease associated with increased morbidity, mortality, and financial burden. It is expected that by 2030 one of two people in the United States will have obesity. The backbone for obesity management continues to be lifestyle interventions, consisting of calorie deficit diets and increased physical activity levels, however, these interventions are often insufficient to achieve sufficient and maintained weight loss. As a result, multiple patients require additional interventions such as antiobesity medications or bariatric interventions in order to achieve clinically significant weight loss and improvement or resolution of obesity-associated comorbidities. Despite the recent advances in the field of obesity pharmacotherapy that have resulted in never-before-seen weight loss outcomes, comorbidity improvement, and even reduction in cardiovascular mortality, there is still a significant interindividual variability in terms of response to antiobesity medications, with a subset of patients not achieving a clinically significant weight loss. Currently, the trial-and-error paradigm for the selection of antiobesity medications results in increased costs and risks for developing side effects, while also reduces engagement in weight management programs for patients with obesity. The implementation of a precision medicine framework to the selection of antiobesity medications might help reduce heterogeneity and optimize weight loss outcomes by identifying unique subsets of patients, or phenotypes, that have a better response to a specific intervention. The detailed study of energy balance regulation holds promise, as actionable behavioral and physiologic traits could help guide antiobesity medication selection based on previous mechanistic studies. Moreover, the rapid advances in genotyping, multi-omics, and big data analysis might hold the key to discover additional signatures or phenotypes that might respond better to a certain intervention and might permit the widespread adoption of a precision medicine approach for obesity management.

Emerging Nurse Billing and Reimbursement Models.

To explore and make recommendations to implement direct billing and reimbursement models for nursing care in the United States. Nurses make up the largest group of healthcare professionals and within hospitals, nurses represent approximately a quarter of all resources and associated costs of patient care. This care is mostly hidden in daily room and board charges. The authors surveyed the recent and historical literature related to costing and billing for nursing care. These results were synthesized and led to the recommendation of several new models to cost, bill, and pay for nursing care provided by nurses who are not currently billing for their services. Two basic billing models are proposed: the 1st is to remove nursing care out of the current daily room or facility-based charges and allocate nursing care time provided to each patient during each day of stay. The 2nd is to expand existing Current Procedural Terminology codes to bill for specific activities and interventions by nurses in all settings where nursing care is delivered. It is feasible to implement the proposed methods to identify patient-level nursing intensity, cost, services, and interventions provided by individual nurses in all healthcare settings.

Social and Emotional Learning Interventions for Preadolescents and Adolescents: Assessing the Evidence Base.

The social and emotional learning (SEL) framework is widely recognized as being effective for developing social and emotional competencies among students of all ages. However, the evidence for specific intervention models with older student populations is less established. The objective of this systematic review was to rate the evidence supporting the effectiveness of SEL interventions aimed at improving mental health outcomes among preadolescents and adolescents. A search of major databases, gray literature, and evidence base registries was conducted to identify studies published from 2008 to 2022 that assessed the effects of SEL interventions on mental health outcomes among students ages 10-19 years. The authors rated the evidence for SEL interventions as high, moderate, or low based on established rating criteria. In total, 25 articles reporting on 17 original research studies were reviewed. Sixteen intervention models were assessed, with 11 resulting in improved mental health symptoms; however, no intervention was evaluated in a large enough number of studies to surpass a low evidence rating. Some studies reported cost benefits and high effectiveness of an intervention with students from diverse racial-ethnic or low socioeconomic backgrounds. SEL interventions can improve mental health outcomes among preadolescents and adolescents. Additional research is needed to strengthen the evidence base for specific intervention models.

Effectiveness of digital interventions to reduce school-age adolescent sexual risks: A systematic review.

The increase in risky sexual behaviors among adolescent students has sparked alarm and has become an area of research interest. As adolescents prioritize confidentiality and accessibility, digital interventions are becoming increasingly relevant in sex education. We therefore posed the following research question: Are digital application interventions effective to prevent risky sexual behaviors in school adolescents? A systematic peer review was conducted between January and December 2023 in five databases (PubMed, Web of Science, Scopus, EMBASE, and PsycINFO) without restricting for language or year of publication. We included randomized control trials or quasi-experimental studies that measured the effectiveness of interventions targeting young people aged 10-19 years or their parents and developed in a school setting. Interventions aimed at young people with intellectual disabilities, learning difficulties, or any disease requiring a specific intervention were excluded. The search ultimately yielded 27 studies covering a total of 18 digital interventions that demonstrated positive effects, not maintained over time, on knowledge, attitudes, and behaviors, although the latter to a lesser extent. We have found very interesting digital interventions with effects, among others, on knowledge, attitudes, and contraceptive use in adolescents. In general, digital interventions have positive effects on knowledge and attitudes, but it is more difficult to modify behaviors with strictly digital interventions or combined with complementary face-to-face sessions or group class activities. We thus believe that digital interventions are adequate to reduce adolescent sexual risk behaviors, and our systematic review facilitates the implementation of these interventions by sharing existing digital interventions that have had positive effects, as well as the main characteristics a digital intervention should possess to reduce sexually risky behaviors in adolescents. Digital interventions with adolescents improve sexual behaviors and can be a valuable resource in education on this topic due to their accessibility and confidentiality, two key points for young people.

Characterization of Psychopathology in Latin American Adolescents Using a Web-Based Screening Tool: Cross-Sectional Study.

Mental health problems and suicide ideation are common in adolescents. Early detection of these issues could prevent the escalation of mental health-related symptoms in the long term. Moreover, characterizing different profiles of prevalent symptoms in conjunction with emotional regulation strategies could guide the design of specific interventions. The use of web-based screening (WBS) tools has been regarded as a suitable strategy to timely detect symptomatology while improving the appeal, cost, timeliness, and reach of detection in young populations. However, the evidence regarding the accuracy of these approaches is not fully conclusive. The study aims (1) to examine the capability of a WBS to identify adolescents with psychiatric symptoms and suicidality and (2) to characterize the mental health profiles of a large sample of adolescents using WBS. A total of 1599 Latin American Spanish-speaking adolescents (mean age 15.56, SD 1.34 years), consisting of 47.3% (n=753) female, 98.5% Chilean (n=1570), and 1.5% Venezuelan (n=24) participants, responded to a mental health WBS. A randomized subsample of participants also responded to the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). McNemar χ2 and receiver-operating characteristic curves tested the detection accuracy of WBS contrasted with the MINI-KID. Latent profile analyses explored the symptomatic and emotional regulation profiles of participants. Both measures showed an adequate level of agreement (area under the curve per symptom domain ranging from 0.70 to 0.89); however, WBS yielded a higher prevalence than MINI-KID for all psychiatric symptoms, except suicide ideation and depression. Latent profile analyses yielded 4 profiles-one of them presented elevated psychopathological symptoms, constituting 11% of the sample (n=175). Rumination (odds ratio [OR] 130.15, 95% CI 51.75-439.89; P<.001), entrapment (OR 96.35, 95% CI 29.21-317.79; P<.001), and defeat (OR 156.79, 95% CI 50.45-487.23; P<.001) contributed significantly to the prediction of latent profile memberships, while cognitive reappraisal did not contribute to the prediction of any latent profile memberships, and expressive suppression was only associated to profile-2 membership. WBS is acceptable for the timely detection of adolescents at risk of mental health conditions. Findings from the symptomatic and emotional regulation profiles highlight the need for comprehensive assessments and differential interventions.

Physiotherapeutic Interventions for Patients With Rare Genetic Muscle-Wasting Disorders: A Systematic Review andMeta-Analysis.

Patients with rare genetic muscle-wasting disorders (MWDs) often experience significant motor function impairments, making effective management strategies crucial for improving their quality of life. This systematic review and meta-analysis aimed to evaluate the impact of physiotherapeutic interventions on motor outcomes in this patient population. A comprehensive literature search was conducted to identify randomized controlled trials (RCTs) and cohort-based studies that assessed physiotherapeutic interventions in patients with rare genetic MWDs. The primary outcome measure was the 6-minute walk test (6MWT). A random effects model was employed to calculate the mean difference (MD) and 95% confidence interval(CI). Nine studies were selected for inclusion, and most demonstrated observable improvement in different facets of individuals with MWDs using physiotherapy. The meta-analysis of RCTs showed that physiotherapy statistically improved 6MWT performance (MD: -35.25 meters; 95% CI: -54.14 to -16.37) with low heterogeneity (Tau² = 0.00; Chi² = 0.48, df = 2, P = 0.79; I² = 0%). Similarly, the cohort-based studies demonstrated an overall MD (MD: -10.00; 95% CI: -11.07 to -8.93), with low heterogeneity (Tau² = 0.00; Chi² = 0.01, df = 1, P = 0.94; I² = 0%). Both analyses indicated significant improvements in 6MWT performance (RCTs: Z = 3.66, P = 0.0003; cohort-based: Z = 18.26, P < 0.00001). Physiotherapeutic interventions significantly enhanced motor function in patients with rare genetic MWDs, as evidenced by improved 6MWT performance. Exercise and intensive physiotherapy programs were particularly effective, although the benefits varied depending on the specific intervention and patient population. These findings support incorporating tailored physiotherapeutic strategies in MWD management to improve motor outcomes and overall quality of life.

Behaviour setting transformation methodology, filling in the gaps of the conventional architectural design process.

This article recounts 6 years of empirical research in a humanitarian context on spatial behaviour using the behaviour settings theory. This research journey details the shortcomings of conventional architectural processes and the subsequent development of a human-centred behaviour setting methodology that drives behaviour change for adaptable spaces. The research work puts Barker's theory of behaviour settings into practice to show its significant methodological abilities in shaping behaviours through spaces. While the original theory was solely an analytical account of existing behaviours in certain settings, this study marks the first pragmatic exploration of the theory into both residential and refugee contexts. The methodology that is subsequently proposed is a complementary tool to account for the deficiencies of conventional architectural design processes. A method that enables one to fully immerse themselves in the environment, recognize specific architectural interventions, assess their effects and reiterate. It is a proposal for humanizing architecture, sympathizing its processes and personalizing its results for the users of any space. This article is part of the theme issue 'People, places, things, and communities: expanding behaviour settings theory in the twenty-first century'.

Potentially avoidable mortality among adults with intellectual disability.

Persons with intellectual disabilities (ID) face pronounced health disparities. The aim of this study was to describe premature mortality by causes of death and avoidable mortality among persons with ID compared to the general Danish population. This study is based on a Danish nationwide cohort of adults (aged 18-74 years) with ID (n = 57663) and an age- and sex-matched reference cohort (n = 607 097) which was established by linkage between several registers. The cohorts were followed in the Register of Causes of Death between 2000 and 2020. Causes of death were categorized into preventable, treatable, or unavoidable deaths using the OECD/Eurostat classification and furthermore categorized into specific interventions. We compared the observed and expected number of deaths by calculating standardized mortality ratio (SMR). Among persons with ID the number of deaths was 9400 whereof 5437 (58%) were avoidable. SMR for preventable deaths, e.g. by reducing smoking and alcohol intake or by vaccination, was 2.62 (95% CI, 2.51-2.73), and SMR for treatable deaths, e.g. by earlier diagnosis and treatment, was 6.00 (5.72-6.29). Unavoidable mortality was also six-fold increased (SMR = 6.03; 5.84-6.22). Preventable deaths were higher for persons with mild ID compared to severe ID, while treatable and unavoidable mortality were highest for persons with severe ID. The study confirmed that persons with ID have an amplified risk of mortality across all categories. There is a need for competence development of social care and healthcare personnel and reasonable adjustment of health promotion programs and healthcare services for people with ID.

Sleep disturbances in type 1 diabetes and mitigating cardiovascular risk.

Cardiovascular disease (CVD) is a major cause of morbidity and mortality in persons with type 1 diabetes (T1D). Despite control of known cardiovascular (CV) risk factors and better glycemic management, persons with T1D still face heightened CVD risk, suggesting additional contributing factors. Sleep has recently been recognized as a CV risk factor, however; the role of sleep in CVD specifically in T1D population has only started to emerge. Extensive evidence suggests that persons with T1D often encounter sleep disturbances. This review aims to comprehensively explore the relationship between sleep disturbances and CVD in T1D, and proposed possible mediators including glycemic control which has been studied more extensively, and less studied factors such as blood pressure, lipid metabolism, and weight management. Stress and self-care behaviors likely also play a role in the relationship between sleep disturbances and CVD. The evidence regarding sleep interventions in the context of T1D in mitigating these CV risk factors has recently been shown in early, small-scale studies. Sleep assessments should be a part of standard of care in persons with T1D. Further research should focus on understanding the impact and mechanistic pathways of sleep disturbances on CV risk, and developing T1D specific sleep interventions to reduce CVD burden in this population.

Critical assessment and intervention in young patients with neurological emergencies

Neurological emergencies in young patients require prompt recognition and intervention to avert irreversible damage or death. These emergencies encompass acute conditions such as strokes, traumatic brain injuries, status epilepticus, and infections like meningitis. Recent advancements in neuroimaging, including portable MRI, have significantly improved diagnostic capabilities. Management protocols are evolving, with notable progress in treatments such as intravenous thrombolysis and mechanical thrombectomy for acute ischemic stroke. For status epilepticus, the timely administration of antiepileptic drugs is vital. Furthermore, addressing conditions like myasthenic crisis and acute intracranial hypertension involves specific interventions such as plasmapheresis, IV immunoglobulin, and targeted ventilation strategies. Delirium management in hospitalized patients highlights the importance of a multidisciplinary approach, incorporating both pharmacological and non-pharmacological treatments. Education and continuous professional development are essential to keep healthcare providers abreast of the latest diagnostic and therapeutic advancements. This review synthesizes current practices in the assessment and intervention of neurological emergencies, emphasizing the importance of timely, evidence-based management to improve patient outcomes.

Power of Writing in Community

This essay explores how writing in community for EdD students can be pivotal in helping them succeed in their academic journey. Considering existing research, three UC Davis CANDEL EdD (Capital Area North Doctorate in Educational Leadership) students and recent alumni use a case study approach to highlight the ways writing in community was instrumental to their own journeys and enhanced their sense of belonging. This essay highlights the challenges faced by the EdD students, especially during the Covid-19 pandemic. They leaned into the transformative power of writing in community and use vignettes to detail their personal experiences. They showcase the power of critical friendship that encouraged vulnerability and connection within their group and catapulted them towards dissertation completion. The essay also recommends institutional support for specific interventions to further writing in community in all EdD programs.