Support Options Research Articles

I have not come here because I have nothing better to do: The lived experience of presenting to the emergency department for people with a psychosocial disability and an NDIS plan-A qualitative study.

Almost 60 000 people have a psychosocial disability (PSD) and a National Disability Insurance Scheme (NDIS) plan. As PSD can be a fluctuating condition, people with a PSD and an NDIS plan, at times, may require crisis care and present to the emergency department (ED). This national study explored the experiences of people with a PSD and an NDIS plan when presenting to the ED. To understand the unique lived experience of people with a PSD and an NDIS plan, semi-structured interviews were conducted with 24 people between March and November 2022 and were analysed thematically. A lived experience advisory group was engaged as part of the research team. Participants were asked about their experiences in the ED including barriers to therapeutic care and what worked well. Participants reported emotional distress caused by receiving a biomedical rather than a person-centred mental health response. A previous mental health history overshadowed diagnostic decisions and most participants interviewed stated they would not choose to return to the ED. Half of the participants spoke of one presentation only where needs were met. Four main themes emerged from the data: (a) Diagnostic overshadowing; (b) Judgement and stigma; (c) Waiting without hope; and (d) If things went well. This study provides evidence of the unique lived experience of people with a PSD and an NDIS plan when presenting to the ED. The results highlight the need for clinicians in the ED to understand the complexity and nuances of supporting people with a PSD. Recommendations for a person-centred care approach are provided. Alternative support options for this group of people need to be explored.

Assessing deep soil mixing for excavation support in Sabkha soils: a numerical study

AbstractExcavation in Sabkha soils, found in coastal regions of Saudi Arabia, presents complex challenges in construction due to their unique geotechnical characteristics. These soils are known for their high compressibility, collapsibility, and variable sediment deposition, rendition them unsuitable for excavation without adequate support systems. As urbanization and industrial activities continue to expand into these areas, the demand for effective excavation support systems becomes gradually critical. This study investigates the feasibility of employing Deep Soil Mixing (DSM) as an excavation support system in Sabkha soils. Utilizing finite element analysis through PLAXIS 3D software, the behaviour of DSM walls in Sabkha soil under various conditions is rigorously simulated. The findings of this research establish that DSM walls can serve as an efficient excavation support system in Sabkha soils, provided that crucial factors, particularly excavation depth, are considered during the design phase. The study demonstrates that properly designed DSM walls, in combination with appropriate anchoring methods, can substantially reduce horizontal displacement and bending moments, ensuring the stability of excavations in Sabkha soils. The research highlights the need for further investigations into the cost-effectiveness of DSM walls in comparison to other excavation support options to evaluate the economic feasibility of using DSM in Sabkha soil applications.

Living With Endometriosis: A Reflexive Thematic Analysis Examining Women's Experiences With the Irish Healthcare Services.

Endometriosis is an incurable chronic condition associated with debilitating pain and subfertility, affecting 1 in 10 women. The current study aims to explore the perceptions and experiences of women with endometriosis regarding the diagnosis, support and treatment options available in Ireland. It will further determine whether additional supports or improvements are needed to care well and effectively for women with this disease in the Irish healthcare system. A qualitative study design was deemed most suitable. Twenty participants, women aged 18 and over with a diagnosis of endometriosis and experience of the Irish healthcare system, were recruited through purposeful sampling to complete semi-structured, one-to-one online interviews. Data was analysed using reflexive thematic analysis, and five themes were identified: 'dismissive attitudes normalising severe pain', 'inadequate health system', 'the impact of delayed diagnoses', 'lack of education and awareness' and 'navigating ignorance, taboo and societal views'. Insights into the experiences and needs of women diagnosed with endometriosis in Ireland were gained, and we discuss the implications of our findings for Irish healthcare services with reference to feminist health equity and recent national action plans. We propose a series of recommendations for patient-centred care models including increased access to training and education, as well as support for longer-term chronic pain management.

Hausarztpraxen und Pflegestützpunkte Hand in Hand in der Versorgung multimorbider Patient*innen: Welche Vorteile kann das bringen? – Eine qualitative Studie mit Hausärzt*innen und Medizinischen Fachangestellten

BackgroundCaring for an increasing number of multimorbid people is a challenge for general practices in Germany. A possible approach to ensure future care could be the cooperation between general practices and community care points, which have so far been a little-known option among general practitioners. The aim of this study was to investigate the benefits or additional burdens that, from the perspective of general practices, a cooperation between general practices and community care points would bring for both the general practitioners themselves and their patients. MethodsIn the mixed-methods study COMPASS II, general practices were able to refer multimorbid patients with social counselling needs to a community care point. Semi-structured guideline-based telephone interviews were conducted with nine general practitioners and nine medical practice assistants regarding the feasibility of cooperation with the community care points. The interviews were analysed using framework analysis. ResultsIn the qualitative interviews, the general practitioners and medical practice assistants reported that the community care points helped them save time by relieving them of social counselling tasks. The interviewees felt relieved by knowing that the community care points expertly take care of their patients' social concerns.From the perspective of the interviewees, multimorbid patients experienced changes in their care through the counselling in community care points, such as adjusting the level of care they require. Social counsellors provided patients and their relatives with an overview of the support options available.The majority of the interviewees did not feel that cooperating with the community care point put an additional burden on their patients or on themselves. Discussion and conclusionCooperation between general practices and community care points has the potential to improve care for multimorbid patients and reduce the workload burden on general practices. Community care points are legally anchored counselling services which general practitioners could increasingly involve in the care of patients with multimorbidity.

Abstract 13015: Sex Disparities in Outcomes of Adults With Cardiogenic Shock Using Impella; a Propensity-Matched Analysis

Introduction: Impella use is one of the mechanical circulatory support options in patients with cardiogenic shock (CS). While recent studies have associated a 47.3% short-term mortality in Impella support for CS, there is a lack of data on sex disparities in its use. We, therefore, conducted a retrospective analysis to analyze its impact. Hypothesis: We assessed the hypothesis that females and males have different outcomes following the use of Impella for CS. Methods: We explored the 2016-2020 National Inpatient sample for adults with CS and Impella use. Propensity matching was conducted for multiple patient and hospital characteristics. The differences in males and females for various complications were analyzed. Results: Our study initially found 57630 cases that matched our selection, with 41455(71.9%) males and 16175(28.1%) females. After propensity matching, Females showed a higher mean age (64.31 vs. 62.82 years, p<0.01), with a higher mean Charlson Comorbidity Index (CCI) score (4.50 vs. 4.25, p<0.01), but a shorter hospitalization ( 15.31 vs. 16.64 days). In addition, females showed higher odds of central line-associated bloodstream infection (CLABSI) (aOR 2.576, 95% CI 1.147-5.788, p=0.022), pulmonary embolism (PE) (aOR 1.544, 95% CI 1.077-2.213, p=0.018), respiratory failure/arrest (aOR 1.124, 95% CI 1.001-1.262, p=0.048) than males, while having lower odds of acute kidney injury (AKI) (aOR 0.727, 95% CI 0.648-0.815, p<0.01). No differences in stroke, sepsis, or death events were found between them. Conclusions: In conclusion, there are differences in outcomes between males and females following use of Impella for CS, as females expressed higher odds of CLABSI, PE, respiratory failure/arrest, and lower odds of AKI than males. Future randomized studies in clinical settings and addressing for limitations of our study (such as drug use and duration of various comorbidities) are warranted to improve outcomes between the two cohorts.

Efficacy of Cal-Cemex as bone substitute for tibial plateau fractures

BackgroundVarious factors influence treatment and outcomes in tibial plateau fractures. Bone defects are among them. Many materials have been proposed to address this problem: allograft, bone–cements and various bone substitutes (BSM). Cal-Cemex (β-tricalciophosphate and polymethylmethacrylate) is a new hybrid bi-component BSM. A retrospective multicenter study was conducted based on the clinical experience of three European Hospitals, to demonstrate its clinical effectiveness, versatility and safety.Materials and MethodsFrom December 2016 to March 2022, 45 displaced tibial plateau fractures were treated with internal fixation and augmentation using Cal-Cemex. The average age was 55.9 years. According to Schatzker classification, we included 13 type II, 24 type III, 3 type V and 4 type VI fractures. The postoperative follow-up (FU) consisted of clinical and radiological examinations at 6 and 12 weeks and 1 year after surgery. A CT scan was performed preoperatively and 1 year after surgery. Full weight bearing was permitted after less than 6 weeks. Clinical data were collected from patient charts, while functional data were evaluated using the Rasmussen knee function score, the KOOS score and the Hospital for Special Surgery knee rating score (HSS), to evaluate the range of motion, axis and functionality of the knee.ResultsThe average FU was 42.8 months. CT scans taken at 1 year demonstrated a good surface osteointegration without radiolucent lines or osteolysis with good evidence of interdigitation and even bone ingrowth. At 1-year FU, the mean Rasmussen score was 24.7, the mean KOOS score was 90.7 and the mean HSS was 89.9 and the average full weight-bearing period 34.9. No patients had hardware failure or fracture secondary displacement.DiscussionCal-Cemex combines biological features and good mechanical performances. It guarantees biocompatibility and osteoconductivity, although it is not fully reabsorbable; β-tricalciophosphate component gives macro- and microporosity that allow fluids to penetrate inside the material, to stimulate bone ingrowth.ConclusionsThe study suggests that Cal-Cemex is an option for tibial plateau fractures, where augmentation and support are necessary for early full weight bearing. The absence of major complications, ease of application, the possibility to cut and perforate this material support its extensive use in bone augmentation for trauma cases.

‘You must have lived it’: learning from the views of physiotherapists who worked during the COVID-19 pandemic

Background The COVID-19 pandemic has resulted in a total of 676 million cases of infection and 6.9 million deaths. During a pandemic, healthcare workers are exposed to psychological stressors such as high risk of infection, inadequate protection, and isolation, which could have implications for their wellbeing. Aims The purpose of this qualitative literature review carried out systematically was to examine the views of physiotherapists who worked with COVID-19 patients during the COVID-19 pandemic to identify how physiotherapy services might be better prepared for future pandemics. Methods A systematic search was carried out across four databases (CINAHL, MEDLINE, PsycINFO, SPORTDISCUS) to identify relevant studies. Studies were assessed for quality and data extracted and analysed using thematic synthesis. Results A total of 631 studies were identified through the search strategy and screened against the inclusion/exclusion criteria. Six papers met the inclusion criteria. Four themes were identified from the perspective of the physiotherapy participants: lack of resources; emotional impact; coping strategies and integration; and value within the multidisciplinary team. Conclusion Overall qualitative evidence around the views of physiotherapists who worked during the COVID-19 pandemic is limited. An insight into the views of participants may help healthcare organisations support physiotherapy services to be better prepared in the event of a future pandemic, specifically addressing the need to strengthen supply chains, advocating for physiotherapy as a profession in low-income counties and psychological resilience. Future research should focus on identifying the most effective support options and strategies to build psychological resilience before a crisis occurs.

МЕТОДИЧНІ ТА ПРАКТИЧНІ АСПЕКТИ КРЕДИТНОЇ ПІДТРИМКИ ОНОВЛЕННЯ ОСНОВНИХ ЗАСОБІВ ПРОМИСЛОВИХ ПІДПРИЄМСТВ

Purpose. In market conditions of business, the competitiveness of enterprises is largely determined by the condition of their fixed assets. The need to replace outdated technologies and equipment with modern ones requires the availability of appropriate financial resources. Inadequacy of own internal sources of investment for the renewal of fixed assets encourages enterprises to widely use external, in particular, credit. At present, in the economic theory and practice of management, there is no clearly developed mechanism for investing in the renewal of fixed assets with the involvement of credit resources. Inadequate development of such issues as the choice of a profitable loan option, the optimal loan rate, the terms and conditions of loan repayment, calls for the development of methodical and practical approaches to effective investment in the renewal of the fixed assets of enterprises. Design/methodology/approach. The article uses the discounting method and the balance sheet method for calculating and analyzing the parameters of the process of attracting credit resources. The method of economic-mathematical modeling was used to study the influence of the use of borrowed funds in investing in the renewal of fixed assets on the pace of development of production potential. Findings. The article considers a number of problems of a methodological and practical nature regarding investment support for the renewal of fixed assets of enterprises, in particular with the involvement of credit resources. The parameters of the loan attraction process, which determine its effectiveness for the enterprise, are analyzed. The most important of these parameters include: the term of the loan; interest rate for the loan; loan payment amounts. To determine the size of the payment for the loan, the appropriate ratio based on the use of compound interest was considered. Derived dependencies for calculating the annual payment for the loan, the annual payment from one monetary unit of the loan, as well as the total amount of funds that must be paid for the entire period of the loan. The values of these parameters are calculated depending on the value of the credit rate and the credit term, which makes it possible to quantitatively assess their trends. The results of the calculations are presented in tabular form. The impact of attracting credit funds in investments for the renewal of fixed assets was studied by modeling this process. An approach to determining the marginal interest rate at which it is still profitable for the enterprise to attract loan funds is proposed. For this purpose, appropriate computer calculations were carried out. Calculations were carried out for the option of fixed assets renewal with own funds, as well as with the involvement of a loan at various interest rates. An important conclusion was made that the dynamics of production development depends on the relationship between the interest rate and the growth rate of capital investments in the basic version, when production development is carried out only at the expense of own investment funds. Practical implications. The methodical and practical results obtained in the research process can be used in the selection of credit support options for the renewal of fixed assets and the development of specific measures aimed at improving the investment activity of industrial enterprises. Originality/value. The article quantitatively evaluates the parameters of credit support for the fixed assets renewal of enterprises. By means of economic-mathematical modeling, the impact of attracting loan funds on the dynamics of changes in the production potential of the enterprise was analyzed.

Pelatihan Peningkatan Keterampilan Bahasa Inggris bagi Para Calon Imam Projo di Wisma Puruhita Klender, Keuskupan Agung Jakarta

Efforts to Improve English Skills for Priest Candidates in Jakarta were undertaken to enhance English proficiency and communication skills of Diocesan Priest Candidates. Conducted from September to December 2021 at Wisma Puruhita Klender, East Jakarta, the program employs interactive language learning methodologies led by qualified language instructors from Kwik Kian Gie School of Business Jakarta. The curriculum integrates practical application through real-life scenarios, case studies, and field visits to pastoral settings. Evaluation mechanisms encompass periodic tests, quizzes, and feedback sessions to ensure a comprehensive assessment of language acquisition and practical communicative abilities. Anticipated outcomes include improved English proficiency, enhanced communication skills, increased cultural competence, and a positive impact on pastoral work. Recognizing challenges such as diverse language backgrounds and time constraints, the program proposes tailored language support and flexible scheduling options. The conclusion envisions a cohort of priest candidates equipped with the linguistic and communicative tools necessary for impactful pastoral engagement within their diverse congregations. This initiative aspires to contribute to the growth and connectivity within religious communities in Jakarta, fostering inclusive communication and deepening the bonds between diocesan priest candidates and peoples they serve.

An app for informal care : User experiences and obstacles from the perspective of family caregivers

Atarget group for digital services are people who are involved in informal care arrangements. Family caregivers often undertake the organization and coordination of care, which is associated with ahigh need for information. The study examined the extent to which family caregivers perceive the use of amobile digital application as facilitating day to day care, in particular regarding information needs. Amarket-ready mobile smartphone app was used by 16informal caregivers over several months. Qualitative interviews were conducted to investigate which app features are being used in real informal care situations and which are perceived as added value. The analysis was carried out with content analysis according to Kuckartz. The app was sporadically used and satisfaction with the information it provides depends on the care situation itself. The participants see added value and facilitation through the app mainly at the beginning of acare situation. They expressed the wish for requirements that have not yet been integrated, e.g., regional information or individual adaptations. For digital support options to develop the desired potential, those involved in informal care must be aware of them at an early stage. Further prerequisites for care apps to be perceived as added value by the target group are atrustworthy presentation of the contents, the customizability and that they are up to date.

Neuroprotection Is in the Air-Inhaled Gases on Their Way to the Neurons.

Cerebral injury is a leading cause of long-term disability and mortality. Common causes include major cardiovascular events, such as cardiac arrest, ischemic stroke, and subarachnoid hemorrhage, traumatic brain injury, and neurodegenerative as well as neuroinflammatory disorders. Despite improvements in pharmacological and interventional treatment options, due to the brain's limited regeneration potential, survival is often associated with the impairment of crucial functions that lead to occupational inability and enormous economic burden. For decades, researchers have therefore been investigating adjuvant therapeutic options to alleviate neuronal cell death. Although promising in preclinical studies, a huge variety of drugs thought to provide neuroprotective effects failed in clinical trials. However, utilizing medical gases, noble gases, and gaseous molecules as supportive treatment options may offer new perspectives for patients suffering neuronal damage. This review provides an overview of current research, potentials and mechanisms of these substances as a promising therapeutic alternative for the treatment of cerebral injury.

Short-term disengagement from early intervention service for first-episode psychosis: findings from the “Parma Early Psychosis” program

PurposeService disengagement is a major concern for “Early Intervention in Psychosis” (EIP). Indeed, identifying predictors of engagement is crucial to maximize mental healthcare interventions in first-episode psychosis (FEP). No Italian study on this topic has been reported to date. Thus, the aims of this investigation were: (1) to examine short-term disengagement rate in an Italian population of FEP patients treated within an EIP service across a 1-year follow-up period, and (b) to assess the most relevant predictors of disengagement in the first year of treatment.MethodsAll participants were young FEP help-seeking patients, aged 12–35 years, enrolled within the “Parma Early Psychosis” (Pr-EP) protocol. At baseline, they completed the Positive And Negative Syndrome Scale (PANSS), the Health of the Nation Outcome Scale (HoNOS) and the Global Assessment of Functioning (GAF) scale. Univariate and multivariate Cox regression analyses were used.Results496 FEP individuals were enrolled in this research. Across the follow-up, a 16.5% prevalence of short-term disengagement was found. Particularly robust predictors of service disengagement were poor baseline treatment non-adherence, living with parents and the presence of brief psychotic disorder or schizophreniform disorder at entry.ConclusionAbout 16% of FEP patients disengaged the Pr-EP program within the first year of treatment. A solution to reduce disengagement and/or to favor re-engagement of these subjects might be to remain on EIP program caseloads allowing the option for low-intensity support and monitoring, also via remote technology.

Rates and predictors of service disengagement in adolescents with first episode psychosis: results from the 2-year follow-up of the Pr-EP program

Service disengagement is a major concern for “Early Intervention in Psychosis” (EIP). Indeed, understanding predictors of engagement is important for the effectiveness of mental health interventions, to improve outcome and quality of life, also in adolescents with first episode psychosis (FEP). No specific European investigation on this topic in adolescence has been reported in the literature to date. The aim of this study was to investigate service disengagement rate and predictors in an Italian sample of FEP adolescents treated within an EIP program during a 2-year follow-up period. All participants were adolescents help-seekers (aged 12–18 years) enrolled in the “Parma Early Psychosis” (Pr-EP) program. At baseline, they completed the Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF) scale. Univariate and multivariate Cox regression analyses were performed. 71 FEP adolescents were recruited in this research. During the 2 years of our follow-up, a 25.4% prevalence rate of service disengagement was found. Particularly robust predictors of disengagement were lower baseline acceptance of psychosocial interventions, substance abuse at entry, and lower baseline PANSS “Disorganization” factor score. Approximately, 1/4 of our FEP adolescents disengaged from the Pr-EP program during the first 2 years of treatment. A possible solution to decrease disengagement and to favor re-engagement of these young individuals might be to provide the option of low-intensity monitoring and support, also via remote technology.

Palliative Care Survey: Awareness, Knowledge and Views of the Styrian Population in Austria.

No population-based data on awareness and knowledge of palliative care currently exist in Austria. We therefore conducted a survey to determine the general awareness and knowledge of palliative care in Styria, a federal state in Austria. We also asked participants to imagine what services they would need as a patient or family member, where they themselves would like to receive such services, and what fears they imagined patients with a terminal illness would have. A descriptive cross-sectional survey consisting of 18 questions that address several aspects of palliative care was carried out in the adult population of Styria, Austria, from October 2019 to March 2020. A total of 419 questionnaires were analyzed, whereby 70.3% of respondents had at least heard of palliative care. Of these, significantly more were female, had a university degree and were aged 50 to 64. The main goal of palliative care was chosen correctly by 67.1% of participants, with the proportion of correct answers increasing in line with education and reaching 82.0% among university graduates. Overall, 73.2% believed that the greatest need of terminally ill persons was a reduction in physical suffering, whereas the greatest perceived need of relatives was the availability of specialist care around the clock. About one-third believed that the greatest fear of palliative patients was that of death, which was chosen significantly more often by men than women. If terminally ill, some 39% of respondents would wish to be looked after at home by professional carers, and women and people that had completed high school chose this answer significantly more often. The most desired service that should be provided to patients and relatives was home pain management at 69.9%, followed by time off for family caregivers at 58.0%. This item was chosen significantly more often by women. To facilitate the care of severely ill patients at home, it would make sense to develop targeted information campaigns. These should also attempt to deliver targeted information to less informed groups of people, such as young, poorly educated men, in order to raise their awareness of the difficulties and challenges of providing care to terminally ill patients and thus increase the acceptance of support options.

Changes of gut microbiota under different nutritional methods in elderly patients with severe COVID-19 and their relationship with prognosis.

The clinical progression of individuals afflicted with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection exhibits significant heterogeneity, particularly affecting the elderly population to a greater extent. Consequently, the association between nutrition and microbiota has garnered considerable interest. Hence, the objective of this study was to gather clinical data pertaining to the influence of diverse nutritional support interventions on the prognosis of geriatric patients with COVID-19, while additionally examining the fecal microbiota of these individuals to assess the repercussions of microecological alterations on their prognostic outcomes. A total of 71 elderly patients diagnosed with severe COVID-19 were included in this study. These patients were subsequently divided into two groups, namely the enteral nutrition (EN) group and the parenteral nutrition (PN) group, based on the type of nutritional support therapy they received after admission. The occurrence of complications was observed in 10.4% of patients in the EN group, whereas it was significantly higher at 69.6% in the PN group (P<0.001). Furthermore, the 60-day mortality rate was 2.1% (1/48) in the EN group, while it was notably higher at 30.4% (7/23) in the PN group (P=0.001). To identify the independent predictors of 60-day mortality, stepwise logistic regression analysis was employed. Among different bacterial groups, Enterococcus_faecium (18.19%) and Pseudomonas_aeruginosa (1.91%) had higher average relative abundance in the PN group (P<0.05). However, the relative abundance of Ruminococcus was higher in the EN group. Further Spearman correlation analysis showed that Enterococcus_faecium was positively correlated with poor clinical prognosis, while Ruminococcus was negatively correlated with poor clinical prognosis. This study shows that the changes in the composition of intestinal flora in elderly COVID-19 patients receiving different nutritional support strategies may be related to different clinical outcomes. The abundance of Enterococcus_faecium in elderly COVID-19 patients receiving PN is significantly increased and is closely related to poor clinical outcomes. It highlights the potential of microbiome-centric interventions to mitigate and manage COVID-19 in older adults with different nutritional support options.

Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock.

Cardiogenic shock (CS) is a clinical condition characterized by inadequate tissue perfusion in the setting of low cardiac output. CS is the leading cause of death following acute myocardial infarction (AMI). Several temporary mechanical support devices are available for hemodynamic support in CS until clinical recovery ensues or until more definitive surgical procedures have been performed. Veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) has evolved as a powerful treatment option for short-term circulatory support in refractory CS. In the absence of randomized clinical trials, the utilization of ECMO has been guided by clinical experience and based on data from registries and observational studies. Survival to hospital discharge with the use of VA-ECMO ranges from 28-67%. The initiation of ECMO requires venous and arterial cannulation, which can be performed either percutaneously or by surgical cutdown. Components of an ECMO circuit include an inflow cannula that draws blood from the venous system, a pump, an oxygenator, and an outflow cannula that returns blood to the arterial system. Management considerations post ECMO initiation include systemic anticoagulation to prevent thrombosis, left ventricle unloading strategies to augment myocardial recovery, prevention of limb ischemia with a distal perfusion catheter in cases of femoral arterial cannulation, and prevention of other complications such as hemolysis, air embolism, and Harlequin syndrome. ECMO is contraindicated in patients with uncontrolled bleeding, unrepaired aortic dissection, severe aortic insufficiency, and in futile cases such as severe neurological injury or metastatic malignancies. A multi-disciplinary shock team approach is recommended while considering patients for ECMO. Ongoing studies will evaluate whether the addition of routine ECMO improves survival in AMI patients with CS who undergo revascularization.

“I think it is woven through me, and sadly that means it is woven through our family life”: the experiences and support needs of mothers with eating disorders

BackgroundEating disorders may disrupt parenting, and there is evidence to suggest that the children of parents with eating disorders are at greater risk for the development of eating disorders themselves. This study sought to broaden and extend current understandings of the lived experiences of mothers who have eating disorders.MethodA qualitative study using thematic analysis was conducted. Eighteen mothers living in the UK, USA, and Australia took part in semi-structured online interviews. Participants were mothers to at least one child aged two years or older, had received a lifetime diagnosis of one or more eating disorders, and reported experiencing symptoms since becoming a parent.ResultsData were analysed using an inductive approach to reflexive thematic analysis. Four major themes, each with subthemes, were identified. These were: parenthood as a double-edged sword; the eating disorder impacts on parenting; blame and burden; and seeking support.ConclusionsThe lived experiences of mothers indicate a complex relationship between eating disorders and parenthood. While parenting can impact eating disorders, eating disorders can also impact parenting, in a range of ways that extend beyond the domains of food, eating and the body. There is a pressing need for the development of specialised, non-judgemental support options for parents with eating disorders and their families.

Reflection of Secondary School Management Key Competencies in the Slovak Republic

The study deals with the identification of problematic areas within the management of general education high schools in the Slovak Republic and analyses the dependence between the most problematic areas of school management with regard to the length of management practice and the types of managerial training. The questionnaire method was used as part of the research investigation. The research sample consisted of leading pedagogical staff (106 respondents) working at state grammar schools in Slovakia.The analysis of the results has showed that for employees in management positions the area of legal management of the school is primarily problematic. The second most problematic area is economic management.The authors expect that the results of the research will not only contribute to raising awareness of the areas of school management but will also provide additional information about director’s competencies and further encourage the responsible authorities to consider other options for methodical support.

Investigating perspectives on e-health interventions to enhance maternal mental well-being: Results of a stakeholder interview.

Peripartum mental disorders are highly prevalent conditions and associated with adverse outcomes for the mother, the infant and the whole family. Despite the high burden, help-seeking is low. E-mental health interventions could overcome help-seeking barriers and thus improve perinatal mental health. However, usage and adherence are rather low. This study aims to assess attitudes and needs of different stakeholder groups and to identify relevant topics to develop an intervention meeting the needs of pregnant and postpartum women and thus, increasing utilization and adherence. Therefore, semi-structured interviews and focus groups with pregnant women (n = 3), mothers (n = 4), women who have suffered from a postpartum mood disorder in the past (n = 5), gynaecologists (n = 5), and midwives (n = 5) were conducted. All interviews were audio-recorded, transcribed verbatim, and analyzed using a thematic analysis. Almost half of the stakeholders reported previous experiences with e-mental health services. Anonymity, flexibility, promoting help-seeking, or bridging waiting-time for treatment as usual were regarded as the main benefits. Concerns regarding the usefulness of e-mental health interventions, absence of face-to-face contact or lack of integration into routine care were considered as barriers. With regard to the desired program content, six main topics were identified: pregnancy and puerperium, peripartum mood swings and disorders, support options, self-care, partnership, and fatherhood. Regarding preferred characteristics of e-mental health programs, stakeholders mentioned customizability, individual guidance, evaluation of user-feedback and continuous adoption, as well as a responsive and user-friendly design. Overall, online interventions for perinatal mental health were mainly considered as beneficial. Stakeholders underlined the high need for education regarding the use and effectiveness of e-mental health, to overcome concerns and obstacles and improve acceptability. Furthermore, developing customizable and individually-guided interventions were considered as promising to increase utilization of and adherence to e-mental health interventions.

Mobile Health Hearing Aid Acclimatization and Support Program in Low-Income Communities: Feasibility Study.

The most common management option for hearing loss is hearing aids. In addition to devices, patients require information and support, including maintenance and troubleshooting. Mobile health (mHealth) technologies can support hearing aid management, acclimatization, and use. This study developed an mHealth acclimatization and support program for first-time hearing aid users and subsequently implemented and pilot-tested the feasibility of the program. The program was facilitated by community health workers (CHWs) in low-income communities in South Africa. This study aimed to evaluate the feasibility of an mHealth acclimatization and support program supported by CHWs in low-income communities. An application-based acclimatization and support was adapted and translated for use in low- and middle-income countries. This program was delivered in the form of 20 different voice notes accompanied by graphical illustrations via WhatsApp or 20 different SMS text messages. The program was provided to first-time hearing aid users immediately after a community-based hearing aid fitting in March 2021 in 2 low-income communities in the Western Cape, South Africa. The 20 messages were sent over a period of 45 days. Participants were contacted telephonically on days 8, 20, and 43 of the program and via open-ended paper-based questionnaires translated to isiXhosa 45 days and 6 months after the program started to obtain information on their experiences, perceptions, and accessibility of the program. Their responses were analyzed using inductive thematic analysis. A total of 19 participants fitted with hearing aids received the mHealth acclimatization and support program. Most participants (15/19, 79%) received the program via WhatsApp, with 21% (4/19) of them receiving it via SMS text message. Participants described the program as helpful, supportive, informative, sufficient, and clear at both follow-ups. A total of 14 participants reported that they were still using their hearing aids at the 6-month follow-up. Three participants indicated that not all their questions about hearing aids were answered, and 5 others had minor hearing aid issues. This included feedback (n=1), battery performance (n=1), physical fit (n=2), and issues with hearing aid accessories (n=1). However, CHWs successfully addressed all these issues. There were no notable differences in responses between the participants who received the program via WhatsApp compared with those who received it through SMS text message. Most participants receiving WhatsApp messages reported that the voice notes were easier to understand, but the graphical illustrations supplemented the voice notes well. An mHealth acclimatization and support program is feasible and potentially assists hearing aid acclimatization and use for first-time users in low-income communities. Scalable mHealth support options can facilitate increased access and improve outcomes of hearing care.