Structural Interventions Research Articles

Optimizing Home Visit Records as a Way of Improving Quality of Care: A Quality Improvement Study.

Introduction Home visits are a key component of primary care in Portugal, designed for patients unable to visit medical facilities. However, logistical constraints often lead to incomplete real-time clinical records, impacting care quality and safety. This study aimed to improve the quality of home visit records through structural interventions and a continuous quality improvement approach. Methods This study was conducted in a Portuguese family health unit between February and December 2023. This retrospective study involved all home visits performed by physicians from October 2022 to October 2023. Using the Plan-Do-Study-Act (PDSA) methodology, records were assessed based on four parameters:accuracy of the "Assessment" section of the Subjective, Objective, Assessment, and Plan (SOAP) note (aligned with the International Classification of Primary Care, 2nd edition); Barthel scale documentation; updated list of problems; and updated list of chronic medication. Data were collected, analyzed descriptively, and presented at three time points: baseline evaluation (February 2023), intermediate evaluation (July 2023), and post-intervention evaluation (December 2023). Two interventions were made, including educational sessions and the introduction of physical support tools for record-keeping. The established quality-defining goal was toachieve compliance with all four parameters in at least 80% of records. Results At baseline, none of the 97 evaluated records met all criteria. After two interventions, compliance significantly improved. By the final evaluation, 74.7% of 95 records met all criteria, while no records failed entirely. Discussion Despite not fully achieving the predefined goal, interventions significantly enhanced record quality, ranging from 0% to 74.7% at the end of the study. These findings demonstrate the value of structural interventions and collaborative team efforts in improving home visit records. Despite significant progress in improving home visit records, there is still room for improvement. It is essential for healthcare professionals to continue enhancing record-keeping practices to improve the effectiveness of domiciliary care and patient outcomes. Conclusion This study highlights the importance of accurate clinical records for safe and effective domiciliary care. Continued commitment to structured record-keeping practices and further research is essential to sustain improvements and optimize patient outcomes.

Impact of Structural OD Interventions on Organizational Performance in Pakistan: A Mixed Methods Explanatory Sequential Research Approach

This mixed methods explanatory sequential research study investigated the impact of structural OD interventions on organizational performance. We used a stratified random probability technique for a quantitative analysis to select 800 firms from those listed with the Securities and Exchange Commission of Pakistan (SECP). We employed SPSS to conduct the regression analysis and calculated values of regression coefficient β, t-statistic, and p-values, adjusted R2 and F-statistic. We conducted the mediation analysis and Sobel and Goodman tests to confirm the mediation among variables. The confirmatory factor analysis (CFA) is conducted to tests how the measured variables represent the number of constructs. We conducted a focus group of ten OD experts to collect the qualitative data, conduct thematic analysis, and extracted useful themes. We merged the quantitative and qualitative findings. The study concluded that structural OD interventions are strategically important for organizational performance and employee development. The findings encouraged the corporate planners to create OD interventions that are both effective and perform strongly.

Socioeconomic inequality in the outcomes of a psychological intervention for depression for South Africans with a co-occurring chronic disease: A decomposition analysis.

Task-shared psychological interventions are effective for reducing the severity of depression symptoms, but differences in treatment outcome by socioeconomic status is uncertain. This study examines socioeconomic inequalities (SEI) in depression outcomes among people with HIV and/or diabetes who participated in a cluster randomised controlled trial in the Western Cape Province of South Africa. The trial took place at 24 primary care clinics randomised to deliver a task-shared psychological intervention or treatment as usual (TAU). The trial enrolled 1119 participants meeting criteria for probable depression. Depression symptom severity was evaluated at baseline and 24-month follow-up. Using a concentration index (CI), SEIs in depression were assessed for the intervention and TAU arms. Demographic and socioeconomic variables were used to decompose the CI to identify contributors to SEI. Results indicate poorer participants at the intervention arm have significantly worse 24-month outcomes than wealthier counterparts (CI=- 0.080; SE=0.025). Race (34.2%), unemployment (17.4%) and food insecurity (15%) were the main contributing factors. While policymakers need to invest in psychological interventions to reduce the burden caused by depression, this study suggests treatment outcomes may be different across the socioeconomic spectrum. Decomposition of these findings points to structural constraints, such as unemployment, as the key contributors towards poorer treatment outcomes. These findings suggest a need to combine psychological interventions with structural interventions that address the broader socio-economic determinants of mental health.

Protocol of investigations for the preliminary assessment of the structural safety of highway overpasses

This paper presents the results of a protocol of investigations that have been carried out on 15 overpasses, located along the highway A18 in Sicily (south of Italy) and built about fifty years ago, with the aim of achieving a preliminary evaluation of the structural safety of these overpasses. The investigated overpasses are characterized by a three-span deck consisting of a reinforced concrete slab and prestressed concrete girders. The girders of the central span are simply supported by two Gerber saddles located on cantilever girders at the two ends of the same span. The safety level of the overpasses is investigated by means of different activities that include visual inspection and computation of the class of attention of the overpasses according to the Italian Bridge Guidelines for the classification and the risk management, safety evaluation and monitoring of existing bridges, laboratory and in situ tests on materials, pachometric, georadar and video-endoscopic tests on structural details, and static load tests of the overpasses. The results of the static load tests have also been used to assess the accuracy of two numerical models of the overpasses. These models are elastic but characterised by different levels of accuracy and computational burden: while the first model is the well-established and simple Courbon-Albenga method, the second is a finite element model characterised by a more refined simulation of the response of slabs, longitudinal girders and crossbeams. The results of the investigations have been critically analysed and discussed to underline the ability of the protocol to reveal possible deficiencies of the overpasses and thus identify overpasses that are liable to structural interventions or more accurate and expensive investigations.

The Adaptation of French Comedy Before Italian Unification: A Study and Observations on the Italian Transposition of Eugène Scribe

Abstract In terms of theatrical experience, the Italian nineteenth century is a special case on the European scene. The activity of dramatic writing and the scenic realization of the peninsula depend on French dramaturgy and Parisian repertoires. With this contribution, and thanks to a small corpus of fifteen unpublished texts from the 1830s, I propose to analyse the manuscripts of the Italian translations of Eugène Scribe’s work. We will examine the linguistic, cultural and structural interventions practised by the actress-adaptor Gaetana Rosa in her Italian translation for the Compagnia Reale Sarda. We will discover that the constraints imposed by the geopolitical context and the economic constraints of the theatre strongly influence the translation process and the evolution of prose in Italy.

Effect Of Yogic Practices On Spiritual Intelligence Of Prospective Teachers

Background: Spiritual intelligence (SI) refers to the ability to access higher meanings, values, and purposes in life, influencing personal development and professional effectiveness. In the context of education, SI is vital for prospective teachers, as it enhances emotional regulation, self-awareness, and a deep connection to teaching practices. Previous studies suggest that yogic practices can contribute to the development of SI by promoting self-reflection, mindfulness, and emotional balance. This study investigates the impact of a structured yoga intervention on the spiritual intelligence of prospective teachers. Aim: The primary aim of this study is to assess the effect of an eight-week structured yoga intervention on the spiritual intelligence of prospective teachers at the Government College of Education, Chandigarh. Materials & Methods: A total of 60 prospective teachers were randomly assigned to either the experimental (n = 30) or control (n = 30) group. The experimental group participated in an eight-week yoga intervention, while the control group received no intervention. Spiritual intelligence was measured using the Spiritual Intelligence Scale developed by Dr. Dhar S. and Dr. Dhar U. (2010) at two points: before (pre-test) and after (post-test) the intervention. Discussion and Conclusion: The study concludes that Yogic practices significantly enhance spiritual intelligence among prospective teachers. These findings support the integration of Yoga into teacher education programs to foster personal growth and improve emotional and spiritual development. Future research could explore the long term effects of such interventions and their impact on teaching efficacy and student outcomes.

Assessment of Oral Histology Knowledge and Its Application in Clinical Orthodontics, Operative Dentistry, Oral Medicine, and Oral Surgery

Objective: This study aims to assess the knowledge of oral histology among fifth-year dental students in Iraq and evaluate its relevance to various clinical dental disciplines, including orthodontics, operative dentistry, oral medicine, and oral surgery. Methods: A cross-sectional survey was conducted from February to May 2024 among dental students from both public and private institutions in Iraq. Participants were recruited through targeted online advertisements on platforms such as Telegram, WhatsApp, and Facebook. Results: The results compare clinical and basic knowledge between younger and older dental students. Younger students scored higher in understanding basic concepts like structural changes in the periodontal ligament, bone remodeling, tooth eruption enamel structure, cavity design and surgical interventions. However, older students excelled in clinical areas such as maxillofacial development, orthodontic appliances, and developmental anomalies. Conclusion: This study provides insights into the perceived value of oral histology education among dental students and its application in clinical practice. The findings may be encouraging early clinical involvement while reinforcing basic science concepts can lead to a more well-rounded and confident dental workforce.

Household-specific barriers to citizen-led flood risk adaptation

Adaptation is essential to mitigate the effects of climate change, such as increasing flood risk. In response to widespread maladaptation, citizen-led approaches are increasingly championed, whereby people on the frontline of climate change determine their own objectives and strategies of adaptation. Enabling equitable and effective citizen-led adaptation requires an understanding of the barriers for different groups of people but this is currently lacking, especially in low- and middle-income countries. Using responses to a co-produced household survey (n = 286) in Tamale, Ghana, we show that barriers to citizen-led adaptation interventions (n = 11) differ between households which we relate to important components of adaptive capacity. Overall, awareness, education, and networks are the most important barriers, but resources and time are important for poor households of fewer members. Barriers also differ between interventions and overall structural interventions are preferred over behavioural. This work can inform policies and actions to support effective and equitable citizen-led adaptation.

Identifying Soil Erosion-Prone Areas in the Wadi Haly Catchment, Saudi Arabia Using Morphometric Analysis and Watershed Features

Soil erosion has several significant impacts on human and environmental activities that make it an important topic with significant worldwide ramifications. Analyzing morphometric indices provides essential insights into watershed geomorphology, which is key to forecasting and assessing diverse natural hazard dynamics. To ensure effective and sustainable watershed management and resource distribution, it is essential to identify critical catchments or prioritize sub-catchments. In this study, morphometric analysis and prioritization were applied to 15 sub-catchments within the Wadi Haly catchment to identify the one most susceptible to soil erosion. This research focuses on the analysis of 15 sub-catchments within the Wadi Haly catchment in Saudi Arabia, utilizing GIS tools alongside various parameters to guide both short- and long-term catchment management. A combined parameter, developed from several morphometric indices for each sub-catchment, was used to classify the Wadi Haly catchment into three levels of soil erosion risk. The results show that sub-catchments 1, 7, 11, 12, and 13, with areas of 694.1 km², 517.87 km², 677.99 km², 200.39 km², and 326.55 km², respectively, are contributing significantly to erosion in the region. In contrast, sub-catchments 3, 8, 9, 10, and 15 exhibit minimal erosion impact. To mitigate severe erosion, strategies such as contour farming, terracing, the use of filter strikes, as well as various structural or non-structural interventions could be applied.

Hydrokinetic energy applications within hydropower tailrace channels: Implications, siting, and U.S. potential

Hydropower tailrace channels are unique and attractive locations for hydrokinetic energy harvesting due to fast currents, scheduled flow releases, proximity to existing structural and electrical infrastructures, and low risk of additional environmental impacts. However, energy-extracting devices create flow resistance, inducing a small but measurable water level increase which may diminish the available hydraulic head and reduce hydropower generation, defeating the initial value proposition. This study combines a one-dimensional momentum balance approach with the backwater equation for surface-varying open channel flow to analyze the water level increase and determine the optimal turbine siting distance that maximizes the net power production (balancing hydropower loss vs. hydrokinetic gain), as a function of the channel hydraulic conditions and the hydrokinetic turbine characteristics. Finally, using a subset of sites from the U.S. hydropower fleet, we provide a high-level estimation of the hydrokinetic potential available in tailraces in the United States and discuss two case studies. This work advocates for the adoption of hydrokinetic turbines downstream of dams as an opportunity to increase energy production at existing plants and Non-Powered Dams (NPDs) with minimal structural intervention, and, alternatively, as viable sites for large-scale field testing for hydrokinetic devices.

Electrochemical Sensing for HIV Integrase Activity Detection Employing G4/Hemin Dnazyme

Introduction; HIV (human immunodeficiency virus) remains a major global public health issue, having claimed 40.4 million [32.9–51.3 million] lives so far with ongoing transmission in all countries globally. The World Health Organization (WHO) recommends a combination prevention approach [1], which uses a mix of biomedical, behavioral, and structural interventions, to have the greatest sustained impact on reducing new infections. Among the various strategies includes pre-exposure prophylaxis (PrEP), where people at risk of contracting HIV take antiretroviral medication in order to reduce the risk of HIV acquisition. To be effective, PrEP requires maintaining high adherence to antiretroviral medications, represented by HIV integrase inhibitors (INSTIs) [2]. Therefore, knowing an individual’s blood INSTI concentration is important to improve their adherence and to adjust individual dosage/administration methods accordingly for effective treatment. Currently, the HIV-1 Integrase assay kit is available, which is based on the monitoring of HIV-integrase DNA strand elongation activity. Using this assay, blood concentration of HIV-integrase inhibitors can be substantially monitored. However, the current procedures are complicated and require specific instruments, which make it difficult to apply for point-of-care testing and personal use. Accordingly, there is a growing interest in exploring alternative analytical methods to detect HIV-integrase activity that offer advantages such as reduced sample volume requirements, simplified procedures, and portability. In this presentation, we report the development of an electrochemical sensor for HIV integrase activity detection employing G4/hemin DNAzyme, focusing on the unique enzymatic reaction of HIV integrase, which will be utilized for the detection of inhibitors as well as the screening of novel inhibitors. Methods; The sensing principle of this sensor is based on the unique properties of HIV integrase, which recognizes the terminal regions of HIV genomic DNA and can integrase a dsDNA derived from HIV genomic DNA (Donor DNA) with any dsDNA (target DNA) [3]. To detect this activity, we designed target DNA sequence harboring DNAzyme sequence in the 5’ end, which shows peroxidase activity [4]. Accordingly, the amount of target DNA integrated into donor DNA can be monitored by peroxidase activity derived from DNAzyme, which is the subject of the electrochemical monitoring. Results and Discussion; Firstly, we evaluated the function of hemin aptamer-fused target DNA as a substrate of HIV integrase using fluorescence dye labeled hemin aptamer-fused target DNA. As a result, the fluorescence intensity increased depending on HIV integrase, so hemin aptamer-fused target DNA works as a substrate of HIV integrase. Secondly, we evaluated the peroxidase activity of the complex of hemin aptamer-fused target DNA. As a result, the complex retained peroxidase activity, indicating that the hemin aptamer-fused target DNA/hemin works as DNAzyme. The electrochemical detection of HIV integrase activity based on hemin aptamer-fused target DNA/hemin by chronoamperometry will be presented.

The Effect of a Structural Wellness Intervention on ID Fellows and Faculty

The Effect of a Structural Wellness Intervention on ID Fellows and Faculty

Community Versus Facility-Based Services to Improve the Screening of Active Hepatitis C Virus Infection in Cambodia: The ANRS 12384 CAM-C Cluster Randomized Controlled Trial-Protocol for a Mixed Methods Study.

In Cambodia, hepatitis C constitutes a significant public health challenge, particularly among older adults (>45 years) for whom prevalence is estimated to be 5%. To facilitate the elimination of hepatitis C among the general population, enhancing access to screening and treatment is imperative. In this regard, the evaluation of community-based screening programs emerges as a crucial step toward improving health care accessibility. This study aims to assess the comparative efficacy of a community-based versus a facility-based approach in enhancing the uptake of hepatitis C antibody testing among the general population older than 40 years of age in Cambodia. The CAM-C (Community Versus Facility-Based Services to Improve the Screening of Active Hepatitis C Virus Infection in Cambodia) study uses a cluster-randomized controlled trial design across two Cambodian provinces to compare community-based and facility-based hepatitis testing interventions. Sampling involves a multistage cluster approach, targeting individuals older than 40 years of age due to their higher prevalence and risk of chronic hepatitis complications. This study incorporates a qualitative analysis of acceptability and a cost-effectiveness comparison. Interventions include facility-based testing with subsequent referral and community-based testing with direct in-home assessments. Follow-up for positive cases involves comprehensive management and potential direct-acting antiviral treatment. This study aims to identify a significant increase in testing uptake, requiring the screening of 6000 individuals older than 40 years of age, facilitated by a structured sampling and intervention approach to minimize contamination risks. The final protocol including the quantitative, qualitative, and cost-effectiveness part of the study was registered and was approved in 2019 by the National Ethical Cambodian for Health Research. Inclusions were completed by mid-2024, with analyses starting in May 2024. Using a mixed methods approach that combines a robust methodology (cluster-randomized controlled trial) with a cost-effectiveness analysis and qualitative research, such a study should provide invaluable information to guide the Ministry of Health in its hepatitis C virus screening strategy and move toward elimination. ClinicalTrials.gov NCT03992313; https://clinicaltrials.gov/study/NCT03992313. DERR1-10.2196/63376.

Augmented Reality and Computational Simulations for the Preprocedural Planning of Transcatheter Aortic Valve Replacement After Previous Transcatheter Mitral Valve Replacement

Transcatheter aortic valve replacement (TAVR) has become the preferred treatment for patients with aortic stenosis (AS) at high surgical risk. However, TAVR is challenging in patients with a pre-existing mitral valve prosthesis, such as a transcatheter mitral valve replacement (TMVR), due to the likelihood of device interference. This study explores the feasibility and safety of performing TAVR in a patient with a pre-existing TMVR procedure using 3D printing, augmented reality (AR) and computational simulations to optimize preprocedural planning. Computational modeling allowed predictions of the spatial relationship between the TAVR and TMVR devices. The simulation output was therefore used as input for augmented visualization of the device interference. The 3D printing of an anatomical replica was used to physically simulate the procedure, ensuring that no significant interference would occur during heart function. The results demonstrated a safe distance of 6.4 mm between the TAVR and TMVR devices, and no functional interference was observed during simulated cardiac cycles. The use of AR in the operating room enhanced the understanding of device positioning, offering a new dimension of precision of the complex cardiovascular intervention. This study concludes that integrating AR, 3D printing, and computational simulations into preprocedural planning for high-risk structural intervention can significantly improve procedural outcomes by enhancing accuracy, safety, and operator confidence.

Intimate partner violence in the context of infertility: voices from women seeking assisted reproductive technology treatment and clinicians' perspectives.

The interplay between infertility and intimate partner violence (IPV) is a pressing global health issue, yet qualitative evidence on this phenomenon is limited. In order to measure and prevent IPV, it is pivotal to explore and integrate perceptions and experiences from those women with infertility themselves on IPV definition and its phenomenal manifestations in the context of infertility. This study is undertaken as part of a year-long ethnographic research based ata reproductive medicine center in Beijing, China from July 2022 to July 2023. Individual interviews with women attending ART outpatient clinics and with clinicians involved in infertility treatment were conducted. Grounded Theory methodology was used to guide data analysis, which entailed a three-step analytical approach. A total of 37 women and five clinicians were interviewed. Incomplete conceptualization of IPV and high mental stress among patients were evident. IPV against women with infertility has been shown to be a specific and severe form of IPV. The phenomenal manifestation of IPV in the context of infertility often takes the form of psychological abuse, including stonewalling, threats of divorce, and non-compliance with ART treatment. The study revealed that the burden of fertility disproportionately falls on women, often intensified by the involvement of other family and cultural norms, exacerbating gender inequalities and IPV risks. Findings from this study calls for an immediate and comprehensive response in healthcare practice. IPV screening, health education, and structural interventions should be introduced to prevent and mitigate this issue.

A Strategy for Optimization of Self‐Care in the Treatment of Children and Young People After Liver Transplantation: A Qualitative Study

ABSTRACTBackgroundTo optimize self‐care in the treatment of children and young people (CYP) after liver transplantation, intervention by healthcare professionals is necessary for both the CYP and their parents. Increasing evidence supports a comprehensive intervention strategy with dedicated individual time, but data on specific ways of involvement are limited. We explored specific and structured intervention strategies within the healthcare system in Japan to optimize self‐care in treatment for CYP after liver transplantation by describing the best practices discussed by healthcare providers.MethodsWe conducted semi‐structured interviews with six RN clinical transplant coordinators from six different facilities in Japan. We inquired about their collaborative interventions with other healthcare professionals for CYP after liver transplantation. Each interview was audio‐recorded, and anonymized transcripts were qualitatively coded and analyzed.ResultsOur findings revealed interventions to optimize self‐care in CYP after liver transplantation, involving three core categories: invest in future young people, grounding autonomy from the start, employ a patient‐centered approach to optimizing self‐care in CYP after liver transplant, and optimize the environment as an enabling factor for self‐care through CYP stage.ConclusionsThis study emphasizes a holistic approach to optimizing self‐care in CYP after liver transplantation by integrating normative development with transplant therapy demands. It focuses on two key age groups: early childhood and adolescence, within a life course perspective.

Evaluating the continued significance of dam-induced vigorous downstream channel erosion in the context of projected climate change: a case study from Peninsular India

ABSTRACT Although erosion has naturally been driven by rainfall patterns, human activities have increasingly influenced erosion rates in recent times. However, as climate change alters precipitation, future erosion control may once again depend primarily on climate. The primary goal of this investigation was to ascertain whether the issue of escalated erosion, typically linked to downstream dam effects, could diminish in significance due to projected climatic shifts later in this century. An erosion potential index (Ep), formulated as the ratio of the mass of sediment influx from upstream to the frequency of the sediment-carrying flow events, was computed on a tributary of the Godavari River, located downstream of a dam. Using the Soil & Water Assessment Tool (SWAT), virtual experiments were conducted to distinguish the impacts of the dam from projected climate changes on river geomorphology. Two control scenarios were created using the current climate data and simulated regulated and unregulated states of the basin. Employing climate projections and various mitigation scenarios (SSPs) for the 2060s and 2090s, this study estimated Ep values exclusively under future climatic conditions in an unregulated state of the basin. Results indicate that, in the unregulated state without the existence of the upstream dam, future climate impacts on erosion outweigh the current effects of the dam, underscoring the growing influence of climate on geomorphology. It suggests that existing structural interventions may lose their geomorphic significance in the face of future climate conditions.

Long-Term Impact of the Bloor Viaduct Suicide Barrier on Suicides in Toronto: A Time-Series Analysis: Effet à long terme de la barrière anti-suicide du viaduc Bloor sur les suicides à Toronto : une analyse chronologique.

A suicide prevention barrier was installed at Toronto's Bloor Viaduct bridge in 2003. It was associated with short-term location substitution, possibly mediated by media effects that did not persist over 1 decade. The long-term impact of the barrier is unknown. We examined rates of suicides by jumping from the Bloor Viaduct, other bridges and by other methods using coroner's records in Toronto (1998-2020). We used interrupted time-series Poisson regression analyses to model changes in quarterly bridge-related suicides after barrier installation. A secondary analysis explored the potential substitution effects of suicide by other methods. Of 5219 suicides from 1998 to 2020, 303 were by jumping from bridges. After controlling for covariates, installation of the Bloor Viaduct suicide barrier was associated with a 49% step decrease in bridge-related suicide in the next quarter in Toronto (incidence rate ratio [IRR] = 0.51, 95% CI, 0.30 to 0.86) with no rebound increase in bridge-related suicide during the subsequent 17 years after the original drop (IRR = 0.99, 95% CI, 0.96 to 1.03). There was also no associated change in suicides by other methods after the barrier (IRR = 1.04, 95% CI, 0.90 to 1.20). Contrary to initial findings, these results indicate an enduring suicide prevention effect of the Bloor Viaduct suicide barrier. They support the long-term utility of structural interventions at high-frequency sites for suicide.

Physical activity and sedentary behaviour interventions for people living with both frailty and multiple long-term conditions and their informal carers: a scoping review and stakeholder consultation.

This scoping review mapped evidence on physical activity (including structured exercise) and sedentary behaviour interventions (interventions to reduce sedentary behaviour) in people living with both frailty and multiple long-term conditions (MLTCs) and their informal carers. Ten databases and grey literature were searched from 2000 to October 2023. Two reviewers screened studies and one extracted data. Results were shared with three stakeholder groups (n = 21) in a consultation phase. After screening, 155 papers from 144 studies (1 ongoing) were retained. The majority were randomised controlled trials (86, 55%). Participants' mean age was 73 ± 12years, and 73% were of White ethnicity. MLTC and frailty measurement varied widely. Most participants were pre-to-moderately frail. Physical health conditions predominated over mental health conditions.Interventions focused on structured exercise (83 studies, 60%) or combined interventions (55 studies, 39%). Two (1%) and one (0.7%) focused solely on habitual physical activity or sedentary behaviour. Adherence was 81% (interquartile range 62%-89%) with goal setting, monitoring and support important to adherence. Carers were only involved in 15 (11%) studies. Most interventions reported positive outcomes, primarily focusing on body functions and structures. A modest volume of evidence exists on multicomponent structured exercise interventions, with less focus on habitual physical activity and sedentary behaviour. Interventions report largely positive effects, but an updated systematic review is required. The field could be advanced by more rigorous characterisation of MLTCs, socioeconomic status and ethnicity, increased informal carer involvement and further evaluation of habitual physical activity and sedentary behaviour interventions.

Gratitude despite unease among Swedish male forensic psychiatric patients with substance use disorders: an interview study

ABSTRACT Purpose Forensic psychiatric inpatient care in Sweden is characterized by strict regulations and adherence to court-mandated rules, with a median care time of 7 years. Comorbity has significant clinical implications, impacting health and well-being, violent behaviour and criminal recidivism, and prolonging inpatient stays. This study investigated the individual experiences and perspectives of Swedish patients in forensic psychiatric care with substance use (SU) disorders, focusing on past, present and future orientations. Methods Ten male forensic psychiatric inpatients were individually interviewed following a semi-structured interview guide. A qualitative content analysis was conducted to inductively analyse the participants’ experiences. The study adhered to the Standards for Reporting Qualitative Research. Results Under the main theme of “embracing harmony in opposition”, three categories emerged: (1) unveiling the beginning of SU and its impact on navigating challenges in care, (2) exploring current confined care and gratitude despite unease and (3) yearning for a somewhat normal life. Conclusions Participants’ subjective perspectives underscored the importance of factors such as forensic nurses/healthcare providers in forensic psychiatry considering the patients’ life narratives, their aspirations for the future, their need for a secure environment and patient—staff relationships. These findings highlight the need for structural interventions that emphasize the importance of tailored and comprehensive health plans within rehabilitation.