Wellbeing Project Research Articles

Association of fish intake with all-cause mortality according to CRP levels or inflammation in older adults: a prospective cohort study

BackgroundThe relationship between inflammatory response, fish consumption, and mortality risk in older individuals is unclear. We investigated whether C-reactive protein (CRP) levels ≥ 0.1 mg/dL, fish intake, and inflammatory responses are associated with all-cause mortality risk in older adults.MethodsThis prospective cohort study included older adults aged 85–89 years from the Kawasaki Aging and Wellbeing Project, who did not require daily care. Cohort was recruited from March 2017 to December 2018 (follow-up ended on December 31, 2021). Dietary assessment was conducted using the Brief Self-Administered Diet History Questionnaire. Multivariate Cox proportional hazards regression was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) for all-cause mortality in the CRP ≥ 0.1 mg/dL group; the CRP < 0.1 mg/dL group was used for reference. Within CRP ≥ 0.1 and < 0.1 mg/dL groups, participants were categorized into tertiles of fish intake. HRs and 95% CIs for all-cause mortality in the other groups were estimated using the lower tertile group as a reference.ResultsThe study included 996 participants (mean [standard deviation] age, 86.5 [1.37] years; 497 [49.9%] women) with a median CRP level of 0.08 (interquartile range [IQR] = 0.04–0.16). There were 162 deaths during 4,161 person-years of observation; the multivariable-adjusted HR for all-cause mortality in the CRP ≥ 0.1 mg/dL group was 1.86 (95% CI, 1.32–2.62); P < 0.001. In 577 individuals with median (IQR) fish intake of 39.3 g/1000 kcal (23.6–57.6) and CRP level of < 0.1 mg/dL, the multivariable-adjusted HR for all-cause mortality in the higher tertile group of fish intake was 1.15 (0.67–1.97); P = 0.59, non-linear P = 0.84. In 419 individuals with median (IQR) fish intake of 40.7 g/1000 kcal (25.0–60.1) and CRP level of ≥ 0.1 mg/dL, the multivariate-adjusted HR for all-cause mortality in the higher tertile group of fish intake was 0.49 (0.26–0.92); P = 0.026, non-linear P = 0.38, P-value for interaction = 0.040.ConclusionsA negative association between fish intake and all-cause mortality was seen in older adults with elevated CRP levels, which is a mortality risk factor. While the results may be limited owing to stringent methods ensuring impartiality, they offer valuable insights for future research.Trial registrationUMIN000026053. Registered February 24, 2017.

The LAB school project: a socio-ecological investigation into the intersection between literacy, the arts and wellbeing in a rural early years classroom setting

This study examined the piloting of a literacy, arts and wellbeing (LAB) project in a rural school in Queensland, Australia. The research involved a Year 1 class (n = 24) participating in co-designed lessons with their classroom teacher and two visiting researchers from a regional university. These lessons were developed with literacy learning outcomes, arts-based approaches and positive education components in mind. Lesson observations and artefacts were collected to understand the children’s participation and development of the learning objectives. In addition, teacher interviews and researcher reflections provided feedback about the approach’s effectiveness. Data were analysed using an arts-based social engagement model to improve health. Evidence from this case study showed that language and literacy learning outcomes and wellbeing were strongly developed through the LAB approaches. More research is needed to know if a whole school LAB approach would benefit children across other settings.

Association Between Pain and Bullying in Australian Adolescents: A Secondary Analysis of Cross-Sectional Data From the Australian Child Wellbeing Project

ObjectiveThis study aimed to describe the frequency, and the strength of the association, between bullying and pain in Australian schoolchildren. MethodsWe used nationally representative data from the 2014 Australian Child Wellbeing Project, comprised students aged 8 to 14 years from 180 schools. Weighted, multiple logistic regression models (adjusting for sex and school year) were constructed to quantify the association between weekly or more frequent bullying and weekly or more frequent pain. Estimates of association for the relationship between bullying and pain were reported as odds ratios (OR). ResultsThe sample was comprised of 5,440 schoolchildren (51.9% female). The prevalence rates of weekly or more frequent pain in the sample were headache (32.3%), backache (23.5%), and stomach ache (21.7%). Between 4.3% and 7.9% of participants reported weekly or more frequent bullying. In schoolchildren reporting bullying, the prevalence of pain ranged from 43.1% to 64.3%. Logistic regression modeling showed moderate-to-strong positive associations (OR, 2.1 [95% CI, 1.8-2.5] to 4.5 [95% CI, 3.7-5.6]) between the experiences of schoolchildren reporting any bullying type and any pain type. ConclusionAustralian schoolchildren who reported bullying were more likely to experience headache, stomach ache, and backache. The moderate-to-strong positive association is consistent with previous international studies that have examined the association between bullying and pain in young people. These findings have significant implications for clinicians who provide care for young people, as well as educators and healthcare policymakers, highlighting the important role of coexisting psychosocial factors in the management of adolescents who report pain.

Sleepless in the Pursuit of perfection: A longitudinal investigation of bidirectional relationships between insomnia and perfectionism in Adolescent males and females

Study objectivesPerfectionism is a possible risk factor for insomnia, yet longitudinal evidence of this relationship in adolescence is lacking. Cross-sectional evidence suggests the nature of the relationship may differ based on biological sex, and the form of perfectionism, since socially prescribed and self-oriented critical perfectionism are conceptualised as maladaptive for wellbeing, while self-oriented striving may be adaptive or neutral. This study aimed to investigate longitudinal bidirectional relationships between total perfectionism, and sub-forms of perfectionism (i.e., socially prescribed, self-oriented critical, self-oriented striving perfectionism), and symptoms of insomnia, over the course of mid-adolescence. Longitudinal models were examined for males and females separately. Methods434 adolescents (Mage = 14.25, SD = 0.56, range = 13–16, 52 % male) completed questionnaire measures of perfectionism (Child-Adolescent Perfectionism Scale) and insomnia (Insomnia Severity Index) on three annual occasions (at approximately 14, 15 & 16 years of age). Data were from the larger Risks to Adolescent Wellbeing (RAW) Project. ResultsBiological sex did not moderate the association between insomnia symptoms and any form of perfectionism. Cross-lagged panel models showed no longitudinal relationship between self-oriented striving, nor self-oriented critical perfectionism and insomnia symptoms for males or females. Higher total perfectionism predicted moderate increases in insomnia symptoms for males and females, but insomnia symptoms did not predict changes in total perfectionism. Socially prescribed perfectionism and insomnia symptoms predicted large and moderate increases in one another over time, respectively, forming a perpetuating cycle. ConclusionsResults suggest that perfectionism may be an important risk factor for insomnia symptoms in adolescents.

Strengthening wellbeing in schools after COVID-19: a pilot evaluation of an awareness based intervention for children and young people

ABSTRACT A National Wellbeing Project was developed following Covid-19 to promote wellbeing in children and young people (CYP). Two 8-week, awareness-based interventions, Breath-Body–Mind (BBM) and Creative Mindfulness (CM), were delivered by external facilitators over an 8-week period in primary and post-primary schools across 5 sites in the Republic of Ireland. A convergent mixed methods evaluation was conducted. Teachers completed the Emotional Regulation Checklist for CYP before and immediately post intervention. Focus groups and interviews were conducted with 40 CYP, 13 school staff and 6 programme staff. Linear mixed modelling showed a main effect of intervention on teacher reported (n = 172) emotional regulation and dysregulation in children; post-hoc test showed significant changes amongst those who engaged in BBM only. Stakeholders highlighted positive experiences of programme participation and intervention benefits, including new coping skills and improved regulation in classroom settings. Capacity building benefits for teachers and schools were also identified. The qualitative findings shed light on facilitators and challenges to programme success. Mental health challenges in CYP have increased post-Covid-19. The findings point to the potential utility of brief wellbeing-focused supports in promoting regulation and wellbeing in CYP, although further research is required. Factors influencing the success of school-based wellbeing interventions are discussed.

Determinants of polydoctoring among multimorbid older adults; a cross‐sectional study in an urban area of Japan

AbstractBackgroundMultimorbidity increases with age, leading to various adverse outcomes, including higher mortality, care dependency, hospitalizations, and healthcare costs. Polydoctoring, managing a patient with multimorbidity by multiple healthcare providers, can be a risk of fragmented care and increased healthcare expenditures. This study aims to identify patient‐related factors contributing to polydoctoring in older adults with multimorbidity.MethodsThis study is a cross‐sectional study using baseline data from the Kawasaki Aging and Wellbeing Project. Participants were residents of Kawasaki City aged 85–89 years, without disability in basic activities of daily living, and being able to visit study site. The regularly visited facilities (RVF) index was employed to quantify polydoctoring. Polydoctoring was defined as having two or more RVFs. Poisson regression analysis was conducted to assess the association between polydoctoring and patient demographics, including types of chronic conditions and socioeconomic factors.ResultsA total of, 968 participants with multimorbidity were analyzed. Increased RVF was significantly associated with eye diseases (rate ratio [RR] 1.27, 95% confidence interval [CI] 1.12–1.44), osteoporosis (RR 1.22, 95% CI 1.08–1.38), prostate diseases (RR 1.22, 95% CI 1.07–1.40), and osteoarthritis (RR 1.16, 95% CI 1.05–1.27). No significant correlation was found with educational status or financial hardship.ConclusionThe study indicated that certain chronic conditions are linked to increased polydoctoring among multimorbid older adults in Japan. However, most of those conditions are considered to be within a scope of family medicine/general practice. Training general practitioners to manage these conditions could reduce healthcare costs and the treatment burden, indicating a direction for future healthcare policy and medical education.

Is cultural appropriateness culturally specific? Intersectional insights from a community-based participatory mental health intervention study conducted with diverse cultural groups.

Growing evidence supports the importance of culturally appropriate mental health interventions, yet it is not always feasible to develop culturally grounded interventions or adapt existing interventions for each cultural group. In addition, these approaches do not recognize the multiple intersecting aspects of culture and identity that individuals, families, and communities possess. Thus, an essential question is whether culturally appropriate mental health interventions have to be culturally specific. We address this question by examining processes of the Refugee Well-being Project (RWP), a community-based mental health intervention for refugees resettled in the United States, which included people from multiple cultural groups (Afghanistan, Great Lakes region of Africa, Iraq, and Syria) and was grounded in common experiences of forcibly displaced people from marginalized backgrounds. RWP incorporates a practice-based concept of culture, an intersectional view of identity, and a multilevel approach to address postmigration stressors. Semistructured qualitative interviews were conducted with 290 participants at preintervention, followed by interviews at three timepoints with a purposively selected subsample (n = 66). Additional interviews (n = 101) were conducted with refugee and student partners. Four themes demonstrated key principles for creating culturally appropriate interventions with diverse groups: (a) recognize cultural complexity in practice; (b) focus on how racism and discrimination are experienced in everyday life; (c) de-center dominant US culture; and (d) create an egalitarian, inclusive space to put principles into action. We conclude that mental health interventions implemented with multiple, diverse groups can be culturally appropriate and effective without being culturally specific.

Risk and protective correlates of suicidality in the military health and well-being project

Suicidality disproportionately affects Veterans, and in 2020 the Military Health and Well-Being Project was conducted in part to study the link between risk and protective constructs with suicidality among Veterans. In the present study, we investigate the relative contribution of risk (i.e., military self-stigma, daily stress, combat exposure, substance use, traumatic brain injury, and moral injury) and protective constructs (i.e., social integration, social contribution, public service motivation, purpose and meaning, and help-seeking) with suicidality. Using cross-sectional Pearson correlation and linear regression models, we studied the independent and relative contribution of risk and protective correlates in a sample of 1469 Veterans (male: n = 985, 67.1 %; female: n = 476, 32.4 %; transgender, non-binary, prefer not to say: n = 8, 0.5 %). When we investigated protective constructs individually as well as simultaneously, social contribution (β = −0.39, t = −15.59, p < 0.001) was the strongest protective construct against suicidality. Social integration (β = −0.13, t = −4.88, p < 0.001) additionally accounted for significant reduction in suicidality when all protective constructs were considered together. When we investigated the contribution of risk constructs towards suicidality, moral injury was most strongly associated with suicidality (r = 0.519, p < 0.001), yet when studied simultaneously for their relative contribution none of the constructs accounted for a significant amount of the variance in suicidality (|t|s ≤ 1.98, ps ≥ 0.07). These findings suggest that among Veterans it is possible that social contribution is protective against suicidality and could be a possible treatment target for the prevention or reduction of suicidality among Veterans.

Promoting the Wellbeing of Physiotherapy Students on Placement:

The current healthcare workforce crisis in the United Kingdom has highlighted the need to equip graduates with the skills to maintain their personal wellbeing whilst working in increasingly pressurised environments. The Placement Wellbeing Project (PWP) is an intervention designed to support the wellbeing of physiotherapy students during studies, while on placement and as they enter the workforce. This action research project used a single group, repeated measures design. Ethical approval was gained from the [redacted] ethics committee. On recruitment, participants were given the Placement Wellbeing Toolkit [toolkit link available but redacted as not anonymous to author or organisation] and took part in a pre-placement peer group discussion and a post-placement de-briefing session. Outcomes were measured using the Placement Coping Scale (PCS) and the General Self-Efficacy Scale. Significant improvements were observed in the total PCS score (Friedman's test χ2(2) = 19.75, p = 0.000) and all individual items of the PCS from baseline to post-placement. Post hoc analysis detected significant improvements between baseline and pre-placement total PCS scores (p = 0.005). Total GSE scores improved significantly from baseline to final measure (Wilcoxon sum-rank test Z = 2.105, p =.035). To develop a resilient future workforce we need to ensure that students are well prepared for challenges and supported to maintain their wellbeing on placement. The results of this study indicate that physiotherapy students may benefit from interventions to develop positive coping strategies for placement.

Youth Group Wellbeing Project for Adolescents Impacted by the March 15 Attacks – Protocol for a Pilot Randomised Waitlist-Controlled Trial

Youth Group Wellbeing Project for Adolescents Impacted by the March 15 Attacks – Protocol for a Pilot Randomised Waitlist-Controlled Trial

From multilevel to trans-level interventions: A critical next step for creating sustainable social change to improve mental health.

Eliminating mental health disparities requires simultaneously addressing numerous determinants of health, including social inequities. Although emphasis on multilevel change is growing, interventions typically involve separate efforts or people focusing on each level. We propose a trans-level conceptual model for mental health intervention that simultaneously facilitates change across multiple intersecting levels with four guiding principles: (1) emphasis on structural change; (2) involvement of people experiencing health and social inequities in achieving structural change by addressing the necessary preconditions of access to resources for basic needs, community membership and belonging, and knowledge or information to participate in social change efforts; (3) valuing and building on the expertise and strengths of individuals, families, and communities experiencing health inequities; and (4) dismantling unequal power dynamics of helping relationships through a focus on mutual learning and support and cocreation of change. Tracing the trajectory of a 23-year community-based mental health intervention partnership (the Refugee and Immigrant Well-Being Project), we illustrate the trans-level intervention model and describe its impact on individual mental health and sustainable change at multiple levels. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Designing and Developing a Medical-Legal Partnership to Address Cancer Patients' Health-Harming Legal Needs

Summary: The Georgetown University's Cancer Legal Assistance and Well-being Project launched in 2020 as a medical-legal partnership that works with health care providers at a Washington, D.C. safety-net hospital to treat the health-harming legal needs of historically and intentionally marginalized patients with cancer.

Association of polydoctoring and mortality among persons over 85 years with multimorbidity: a prospective cohort study in Japan.

Polydoctoring can increase the risk of care fragmentation among patients with multimorbidity, but its impact on health outcomes remains unclear. To determine the effects of polydoctoring, as measured by the regularly visited facilities (RVF) indicator, on patient outcomes among older individuals with multimorbidity. Data from the ongoing prospective cohort study, Kawasaki Aging and Wellbeing Project (KAWP), was utilised in this study. Among the 1026 KAWP participants aged 85-89 years, those with two or more chronic conditions were enrolled in this study. Care fragmentation and polydoctoring was evaluated using the RVF, which is a new indicator that measures the number of medical facilities consistently involved in a patient's care. Based on RVF, mortality was analysed using the Cox proportional hazards model, with adjustments for age, sex, frailty, and number of comorbidities. A significant reduction in mortality rates was observed in participants with an RVF of ≥3 and 2-4 comorbidities (hazard ratio [HR] 0.43, 95% confidence interval [CI] = 0.18 to 0.99, P value = 0.048). However, no significant difference in mortality based on RVF was observed for those with ≥5 comorbidities. Notably, individuals with ≥5 comorbidities and an RVF of 0 had a significantly higher HR for death (HR 2.68, 95% CI = 1.05 to 6.84, P value = 0.039). In older patients with multimorbidity, polydoctoring may reduce mortality in patients with ≤4 coexisting conditions, but it does not significantly impact mortality in those with ≥5 conditions. These findings provide insights for healthcare decision making in managing older patients with multimorbidity.

Protocol of the study: Multilevel community-based mental health intervention to address structural inequities and adverse disparate consequences of COVID-19 pandemic on Latinx Immigrants and African refugees.

The NIMH-funded Multilevel Community-Based Mental Health Intervention to Address Structural Inequities and Adverse Disparate Consequences of COVID-19 Pandemic on Latinx Immigrants and African Refugees study aims to advance the science of multilevel interventions to reduce the disparate, adverse mental health, behavioral, and socioeconomic consequences of the COVID-19 pandemic that are a result of complex interactions between underlying structural inequities and barriers to health care. The study tests three nested levels of intervention: 1) an efficacious 4-month advocacy and mutual learning model (Refugee and Immigrant Well-being Project, RIWP); 2) engagement with community-based organizations (CBOs); and 3) structural policy changes enacted in response to the pandemic. This community-based participatory research (CBPR) study builds on long-standing collaboration with five CBOs. By including 240 Latinx immigrants and 60 African refugees recruited from CBO partners who are randomly assigned to treatment-as-usual CBO involvement or the RIWP intervention and a comparison group comprised of a random sample of 300 Latinx immigrants, this mixed methods longitudinal waitlist control group design study with seven time points over 36 months tests the effectiveness of the RIWP intervention and engagement with CBOs to reduce psychological distress, daily stressors, and economic precarity and increase protective factors (social support, access to resources, English proficiency, cultural connectedness). The study also tests the ability of the RIWP intervention and engagement with CBOs to increase access to the direct benefits of structural interventions. This paper reports on the theoretical basis, design, qualitative and quantitative analysis plan, and power for the study.

Repetitive Negative Thinking Mediates the Relationship Between Sleep Disturbance and Symptoms of Generalized Anxiety, Social Anxiety, Depression, and Eating Disorders in Adolescence: Findings From a 5-Year Longitudinal Study

Sleep problems commonly co-occur alongside generalized and social anxiety, depression, and eating disorders in young people. Yet it is unclear if sleep disturbance conveys risk for these social-emotional disorders across early to middle adolescence and whether repetitive negative thinking (RNT) mediates this association. In this study, we examined longitudinal relationships between sleep (morning/eveningness, school-night sleep duration, and sleepiness), general and presleep RNT, and symptoms of generalized and social anxiety, depression, and eating disorders across 5 years. As part of the wider Risks to Adolescent Wellbeing Project, these constructs were assessed in a cohort of 528 youths over six annual waves of data collection, spanning ages 11 to 16. Cross-lagged panel models that examined direct, indirect, and bidirectional associations showed that worse adolescent sleep predicted increases in symptoms of generalized anxiety, social anxiety, depression, and eating disorders across each wave directly and indirectly through general and presleep RNT. Symptoms of social-emotional disorders did not predict worsening in sleep. Results suggest that sleep disturbance and RNT should be targeted simultaneously in the prevention and treatment of social-emotional disorders in adolescence, although limitations around the use of self-report and nondiagnostic symptom measures are noted.

Developing the “Moorditj Moort Boodja (Solid Family and Country) on the ground community relational framework for Aboriginal research engagement” in Western Australia: The Next Generation Aboriginal Youth Well-being Cohort Study

Indigenous research frameworks are key to enhancing cultural safety for participants, while facilitating capacity building for Indigenous researchers. Indigenous frameworks can address and balance out the potential harms of western research methods. This methodology article describes the experiences of an Indigenous research team in Western Australia (WA) and the developed research framework titled Moorditj Moort Boodja (Solid Family and Country) for the Next Generation Aboriginal Youth Well-being Project in WA. This project engaged 830 young Indigenous participants between 10 and 24 years of age from WA. This project collected key health data from youth and caregivers and resulted in the development and implementation of the On the Ground Community Relational Framework for research engagement. This article adds to the knowledge on cultural safety for Indigenous participants and researchers undertaking Indigenous focused research.

Loneliness partially mediates the relation between substance use and suicidality in Veterans

ABSTRACT America has experienced a rapid increase in loneliness, substance use, and suicidality. This increase is particularly deleterious for Veterans, who, as compared to nonmilitary-connected civilians, experience elevated rates of loneliness, substance use, and suicidality. In this project we investigated the link between loneliness, substance use, and suicidality, paying particular attention to the mediational role of loneliness between substance use and suicidality. 1,469 Veterans (male, n = 1004, 67.2%; female, n = 457, 32.3%; transgender/non-binary/prefer not to say, n = 8, 0.5%) answered online surveys in the Mental Health and Well-Being Project. Items assessed participants on psychosocial antecedents of health and wellness. Pearson correlations and mediational models were used to determine if loneliness, substance use, and suicidality were related and if loneliness mediated the link between substance use and suicidality. Results indicated that loneliness, substance use, and suicidality were significantly and positively related (rs = .33–.42, ps < .01). Additionally, loneliness partially mediated the link between substance use and suicidality (β = .08 [.06–.10]), suggesting that, within the context of substance use in Veterans, loneliness may account for significant variance in suicidality. Together findings suggest the Veterans Health Administration should support, fund, and study community engagement activities that could reduce the development or intensity of substance use, loneliness, and suicidality in Veterans.

Best Practices in Advancing Family Well-Being in Asia: A Multimethod Qualitative Study

Family has been recognized as the basic unit of society. Strengthening family functioning and enhancing family well-being through promoting family-oriented policies that based on evidence that demonstrates the effectiveness and practicalities of interventions are important. However, the planning and evaluation of existing programs is not universally agreed upon due to a lack of guiding evaluation framework and different cultural contexts. This study aims to identify best practices and consolidate social impacts of programs that support family well-being in the Asian Region, data was drawn on the Wofoo Asian Award for Advancing Family Well-Being Project (3A Project), initiated by the Consortium of Institutes on Family in the Asian Region (CIFA). A multimethod qualitative study was conducted, including a review of documents on the 3A Project, documents submitted by a total of forty awarded projects, and four in-depth interviews with team leaders of awarded projects. All data were analyzed in parallel and triangulated in the interpretation of findings. Informed by the logic model of program development and evaluation, this study discovered six overarching best practices ― PIE-ISI ― were identified: (i) Project rationales; (ii) Implementation; (iii) Evaluation; (iv) Innovation; (v) Sustainability and replicability; and (vi) Institutional synergy.

The TT-AT trauma protocol piloted in different international settings: Zambia, UK, Italy

ABSTRACT Background Art therapists have worked with traumatised individuals from the very beginning. Nevertheless, the effectiveness of art therapy in the treatment of Post Traumatic Stress Disorder (PTSD) and Complex Post Traumatic Stress Disorder (C-PTSD) is not yet evidence-based. Studies suggest innovative treatments should describe clearly both the intervention, in order to facilitate replication, and the treatment targets, in order to facilitate assessment and research. Context In the ‘Trauma Treatment through Art Therapy’ (TT-AT) protocol, the intervention is described clearly, and the treatment targets are the six client symptom clusters listed by the International Society for Traumatic Stress Studies (ISTSS): (1) emotion regulation; (2) relationships with others; (3) relationship with self; (4) awareness of trauma; (5) distancing; (6) resources. The intervention consists of six sessions, one for each symptom and related need. Approach The TT-AT protocol – that was developed and piloted in Tanzania – is now being applied in three other countries (Zambia, the UK and Italy). Outcomes The group participants in the three countries followed the six themes easily. Some shared the history of traumas, even though verbal sharing was optional, and sometimes for the first time hidden traumas of the past. After the intervention they described being able to leave the past in the past, feeling stronger in the present, and more hopeful about their future. Conclusions and implications for research The TT-AT protocol can be replicated easily and it has clear treatment targets. This makes it suitable for use in research. Plain-language summary This article reports on the implementation of an innovative trauma treatment intervention (the TT-AT protocol) in three countries: Zambia, the UK and Italy. The format is group art therapy and all the participants are women with a history of traumatic experience presenting with a variety of PTSD and C-PTSD symptoms. The six art therapy workshops addressed the six symptoms listed by the International Society of Traumatic Stress Studies (ISTSS). The groups are: (a) a group of six medical students in Zambia; (b) a group of five in a community mental well-being project in the UK; (c) a group of four private practice clients in Italy. The article illustrates the art therapy process in each group. The participants moved through three stages, from the initial strengthening phase to the stage of becoming more aware of their trauma, to the final stage of trusting their own resources. Feedback shows improvements in dealing with their past and in coping with present life challenges. This report suggests that the protocol is suitable to be applied to diverse countries and cultures.

Measurement of polydoctoring as a crucial component of fragmentation of care among patients with multimorbidity: Cross-sectional study in Japan.

Care fragmentation, characterized by the uncoordinated involvement of multiple healthcare providers, leads to inefficient and ineffective healthcare, posing a significant challenge in managing patients with multimorbidity. In this context, "polydoctoring," where patients see multiple specialists, emerges as a crucial aspect of care fragmentation. This study seeks to develop an indicator to assess polydoctoring, which can subsequently enhance the management of multimorbidity. Baseline survey data from the Kawasaki Aging and Wellbeing Project (KAWP) involving independent community-dwelling older adults aged 85-89 were utilized in this cross-sectional study. Polydoctoring measure was defined as the number of regularly visited facilities (RVFs). The association of RVF with the Fragmentation of Care Index (FCI) and the outcome measures of polypharmacy and ambulatory care costs were examined as indicators of care fragmentation. The analysis comprised 968 participants, with an average of 4.70 comorbid chronic conditions; 65.3% of the participants had two or more RVFs, indicating polydoctoring. A significant correlation between RVF and FCI was observed. Modified Poisson regression analyses revealed associations between higher RVF and increased prevalence ratio of polypharmacy. Likewise, a higher RVF was associated with higher outpatient medical costs. RVF was significantly correlated with FCI, polypharmacy, and higher outpatient medical costs. Unlike complex indices, RVF is simple and intuitively comprehensible. Further research is needed to evaluate the impact of care fragmentation on patient outcomes, considering factors such as RVF thresholds, patient multimorbidity, and social support. Understanding the influence of polydoctoring can enhance care quality and efficiency for patients with multimorbidity.