The influence of economic policies on social environments and mental health.

Despite increased advocacy and investments in mental health systems globally, there has been limited progress in reducing mental disorder prevalence. In this paper, we argue that meaningful advancements in population mental health necessitate addressing the fundamental sources of shared distress. Using a systems perspective, economic structures and policies are identified as the potential cause of causes of mental ill-health. Neoliberal ideologies, prioritizing economic optimization and continuous growth, contribute to the promotion of individualism, job insecurity, increasing demands on workers, parental stress, social disconnection and a broad range of manifestations well-recognized to erode mental health. We emphasize the need for mental health researchers and advocates to increasingly engage with the economic policy discourse to draw attention to mental health and well-being implications. We call for a shift towards a well-being economy to better align commercial interests with collective well-being and social prosperity. The involvement of individuals with lived mental ill-health experiences, practitioners and researchers is needed to mobilize communities for change and influence economic policies to safeguard well-being. Additionally, we call for the establishment of national mental wealth observatories to inform coordinated health, social and economic policies and realize the transition to a more sustainable well-being economy that offers promise for progress on population mental health outcomes.

Malgré une meilleure sensibilisation et des investissements accrus dans les systèmes de santé mentale à travers le monde, les progrès en matière de réduction du degré de prévalence des troubles mentaux demeurent très limités. Dans le présent document, nous estimons que, pour réaliser des avancées au niveau de la santé mentale des populations, il est impératif de s'attaquer aux sources de cette détresse collective. En adoptant une perspective systémique, force est de constater que les politiques et structures économiques constituent les causes potentielles d'une mauvaise santé mentale. Les idéologies néolibérales, qui privilégient l'optimisation économique et la croissance ininterrompue, contribuent à promouvoir l'individualisme, l'insécurité professionnelle, la pression pesant sur les travailleurs, le stress parental, l'isolement social et un large éventail de facteurs associés à une dégradation de la santé mentale. Nous insistons sur la nécessité de faire appel à des chercheurs et défenseurs actifs dans ce domaine, afin de jouer un rôle dans la politique économique en attirant l'attention sur les implications pour le bien-être et la santé mentale. Nous plaidons pour une transition vers une économie du bien-être visant à rapprocher les intérêts commerciaux de la prospérité sociale et collective. L'intervention de personnes ayant été confrontées à des troubles mentaux, de praticiens et de chercheurs est nécessaire pour mobiliser les communautés en faveur d'un changement et influencer les politiques économiques pour préserver le bien-être. Par ailleurs, nous militons pour la création d'observatoires nationaux de la santé mentale qui serviront à orienter des politiques économiques, sociales et sanitaires coordonnées, mais aussi à favoriser l'évolution vers une économie du bien-être plus durable, laissant entrevoir une amélioration de la santé mentale au sein de la population.

A pesar del aumento de la promoción y las inversiones en sistemas de salud mental en todo el mundo, los avances en la reducción de la prevalencia de los trastornos mentales han sido limitados. En este documento, sostenemos que para lograr avances significativos en la salud mental de la población es necesario abordar las fuentes fundamentales de la angustia compartida. Mediante una perspectiva sistémica, las estructuras y políticas económicas se identifican como la posible causa de los problemas de salud mental. Las ideologías neoliberales, que priorizan la optimización económica y el crecimiento continuo, contribuyen al fomento del individualismo, la inseguridad laboral, el aumento de las exigencias a los trabajadores, el estrés parental, la desconexión social y una gran variedad de manifestaciones bien reconocidas que perjudican la salud mental. Insistimos en la necesidad de que los investigadores y los defensores de la salud mental se impliquen cada vez más en el discurso de la política económica para atraer la atención sobre las implicaciones para la salud mental y el bienestar. Pedimos un cambio hacia una economía del bienestar para alinear mejor los intereses comerciales con el bienestar colectivo y la prosperidad social. Para movilizar a las comunidades en favor del cambio e influir en las políticas económicas con el fin de salvaguardar el bienestar, es necesaria la participación de personas que han padecido enfermedades mentales, profesionales e investigadores. Además, pedimos la creación de observatorios nacionales de bienestar mental que sirvan de base a las políticas sanitarias, sociales y económicas coordinadas y permitan la transición a una economía del bienestar más sostenible, que ofrezca perspectivas de progreso en los resultados de salud mental de la población.

Use and outcomes of dual antiplatelet therapy for acute coronary syndrome in patients with chronic kidney disease: insights from the Canadian Observational Antiplatelet Study (COAPT).

Chronic kidney disease (CKD) increases the risk of adverse outcomes in acute coronary syndrome (ACS). The optimal regimen of dual antiplatelet therapy (DAPT) post-percutaneous coronary intervention (PCI) in CKD poses a challenge due to the increased bleeding and clotting tendencies, particularly since patients with CKD were underrepresented in randomized controlled trials. We examined the practice patterns of DAPT prescription stratified by the presence of CKD. The multicentre prospective Canadian Observational Antiplatelet Study (COAPT) enrolled patients with ACS between December 2011 and May 2013. The present study is a subgroup analysis comparing type and duration of DAPT and associated outcomes among patients with and without CKD (eGFR < 60 ml/min/1.73 m2, calculated by CKD-EPI). Patients with CKD (275/1921, 14.3%) were prescribed prasugrel/ticagrelor less (18.5% vs 25.8%, p = 0.01) and had a shorter duration of DAPT therapy versus patients without CKD (median 382 vs 402 days, p = 0.003). CKD was associated with major adverse cardiovascular events (MACE) at 12 months (p < 0.001) but not bleeding when compared to patients without CKD. CKD was associated with MACE in both patients on prasugrel/ticagrelor (p = 0.017) and those on clopidogrel (p < 0.001) (p for heterogeneity = 0.70). CKD was associated with increased bleeding only among patients receiving prasugrel/ticagrelor (p = 0.007), but not among those receiving clopidogrel (p = 0.64) (p for heterogeneity = 0.036). Patients with CKD had a shorter DAPT duration and were less frequently prescribed potent P2Y12 inhibitors than patients without CKD. Overall, compared with patients without CKD, patients with CKD had higher rates of MACE and similar bleeding rates. However, among those prescribed more potent P2Y12 inhibitors, CKD was associated with more bleeding than those without CKD. Further studies are needed to better define the benefit/risk evaluation, and establish a more tailored and evidence-based DAPT regimen for this high-risk patient group.

Respite needs of families receiving palliative care.

AIM: The care of a child with a life-limiting condition proves an emotional, physical and financial strain on the family that provides care for their child. Respite care is one way which allows carers to receive some relief and support in the context of this burden of care. The provision of and the requirements for respite in this context is poorly understood. This survey aims to describe the types of respite care families receive, the respite that they would ideally receive and the barriers that prevent this. METHODS: A cohort of 34 families cared for by the Paediatric Palliative Care Service in Queensland were approached to participate in a 20-question survey about their current respite preferences for future respite, with 20 surveys returned. RESULTS: Three of the families (15%) reported receiving no respite in the previous 12 months. Families who received respite received a combination of formal respite (a structured care provider) and informal respite (family or friends). Ten families (50%) reported that they would want the time of respite changed. Barriers to receiving adequate respite included complexity of care of the child, financial barriers and lack of a respite provider. CONCLUSIONS: There is disparate provision of respite care with the main perceived barrier to attaining 'ideal respite' being the lack of a provider able to meet the complex care needs of their child. The provision of respite across diversity in geography; medical condition; social and cultural needs remains a challenge.

Do high aspirations lead to better outcomes? Evidence from a longitudinal survey of adolescents in Peru.

Using a novel panel survey of relatively poor urban Peruvian adolescents, we explore the link between educational aspirations and propensity to invest in the future. Aspirations comprise hope and agency. We find remarkably high educational aspirations, even among relatively poor individuals and adolescents who were exposed to negative shocks, suggesting high levels of resilience. We also find high occupational aspirations and aspirations to migrate. High-aspiration respondents were also more likely to invest in their education and avoid risky behaviors. These are associations as we do not have enough data to establish causality, although we were able to control for within-person traits. Aspirations are stable over time and positively associated with personality traits such as self-efficacy and life satisfaction, which help explain their persistence over time. Our findings complement those of other recent studies that highlight the role of personality traits in addition to cognitive skills in long-term educational, health, and socioeconomic outcomes.

The Mid-Life Dip in Well-Being: a Critique.

A number of studies-including our own-find a mid-life dip in well-being. Yet several papers in the psychology literature claim that the evidence of a U-shape is "overblown" and if there is such a thing that any such decline is "trivial". Others have claimed that the evidence of a U-shape "is not as robust and generalizable as is often assumed," or simply "wrong." We identify 409 studies, mostly published in peer reviewed journals that find U-shapes that these researchers apparently were unaware of. We use data for Europe from the Eurobarometer Surveys (EB), 1980-2019; the Gallup World Poll (GWP), 2005-2019 and the UK's Annual Population Survey, 2016-2019 and the Census Bureau's Household Pulse Survey of August 2021, to examine U-shapes in age in well-being. We find remarkably strong and consistent evidence across countries of statistically significant and non-trivial U-shapes in age with and without socio-economic controls. We show that studies cited by psychologists claiming there are no U-shapes are in error; we reexamine their data and find differently. The effects of the mid-life dip we find are comparable to major life events such as losing a spouse or becoming unemployed. This decline is comparable to half of the unprecedented fall in well-being observed in the UK in 2020 and 2021, during the Covid19 pandemic and lockdown, which is hardly "inconsequential" as claimed.

Coping with COVID-19: Differences in hope, resilience, and mental well-being across U.S. racial groups.

OBJECTIVES: To explore if the COVID-19 pandemic revealed differences across racial groups in coping, resilience, and optimism, all of which have implications for health and mental well-being. METHODS: We collect data obtained from four rounds of a national sample of 5,000 US survey respondents in each round from April 2020 to February 2021. Using logistic regression and fixed effects models, we estimate the pandemic impacts on COVID-19 related concerns, social distancing behaviors, and mental health/life satisfaction and optimism for racial/income groups. RESULTS: Despite extreme income and health disparities before and during the COVID-19 outbreak, Blacks and Hispanics remain more resilient and optimistic than their White counterparts. Moreover, the greatest difference in resilience, optimism and better mental health-is found between poor Blacks and poor Whites, a difference that persists through all four rounds. CONCLUSIONS: These deep differences in resilience have implications for the long-term mental health of different population groups in the face of an unprecedented pandemic. Better understanding these dynamics may provide lessons on how to preserve mental health in the face of public health and other large-scale crises.

Which health conditions cause the most unhappiness?

This paper assesses the effects of different health conditions on happiness. Based on new data for Latin America, we examine the effects of different conditions across age, gender, and income cohorts. Anxiety and pain have stronger effects than physical problems, likely because people adapt better to one-time shocks than to constant uncertainty. The negative effects of health conditions are very large when compared with the effects of income on happiness. And, while higher peer income typically elicits envy, better peer health provides positive signals for life and health satisfaction. Health norms vary widely across countries.

The geography of desperation in America: Labor force participation, mobility, place, and well-being.

There are deep divisions between Americans with opportunities and hope for the future and those left behind. We explored this earlier using metrics of reported well-being and found deep desperation - and an association with premature death - among less than college educated whites. This contrasts with more hope for the future among Black and Hispanics, despite worse objective conditions. Here we extend these findings and focus on workers out of the labor force (OLF), their low well-being, and their lack of geographic mobility. The well-being of this group varies substantially across age, gender, and race. We find that those in prime age fare worse than other age groups; within prime age respondents, women report higher well-being than men, and among prime age males, whites report significantly lower well-being, worse health, and higher pain than minorities. Prime age OLF respondents - especially white males - report worse health than those in other labor market categories, suggesting that their dropout is partly due to bad health. Individuals in counties with a higher percentage of respondents still in their childhood census tracts have poorer health and little hope. Those in counties with higher percentages of adults in their parents' homes have even worse well-being and health. The state of these cohorts - and their tendency to stay in the places they grew up rather than move - is one potential explanation for the declining levels of geographic mobility in the U.S.

The U Shape of Happiness: A Response.

We write in response to an article published in this journal, "The U Shape of Happiness Across the Life Course: Expanding the Discussion," by Galambos, Krahn, Johnson and Lachman. The authors claim that "support for the purported U shape is not as robust and generalizable as is often assumed" and "we believe the conclusion that happiness declines from late adolescence to midlife (the first half of the U shape) is premature, and possibly wrong." We respectfully disagree. The authors' main evidence is based on summaries of 33 articles; they find 12 to have U shapes, seven to have none, and 14 to be mixed. We found that most of these articles are misclassified: Four of them are ineligible for inclusion, 25 find a U, and four are mixed. We then identified a further 353 articles, including 329 in peer-reviewed journals, that all found U shapes that were not identified in the literature review. This is a major omission. We also present our own evidence of midlife nadirs in well-being using around eight and a half million individual observations from nationally representative surveys for the United States and Europe. The midlife low occurs in the mid-40s and its drop is equivalent to roughly three quarters of the unprecedented drop observed in well-being during the COVID-19 pandemic.

Building brain capital.

Brains are indispensable drivers of human progress. Why not invest more heavily in them? We seek to place Brain Capital at the center of a new narrative to fuel economic and societal recovery and resilience.

Health Care Professionals' Reports of Cancer Pain Cues Among Older People With Delirium: A Qualitative-Quantitative Content Analysis.

CONTEXT: Health care professionals (HCPs) currently judge pain presence and intensity in patients with delirium despite the lack of a valid, standardized assessment protocol. However, little is known about how they make these judgments. This information is essential to develop a valid and reliable assessment tool. OBJECTIVES: To identify pain cues that HCPs report to judge pain in patients with delirium and to examine whether the pain cues differed based on patient cognitive status and delirium subtype. METHODS: Mixed qualitative-quantitative design. Doctors and nurses were recruited. All participants provided written informed consent, and before the recorded interview, demographic information was collected; then participants were asked to describe their practices and beliefs regarding pain assessment and management with older patients who are cognitively intact and patients with delirium. Interviews were transcribed verbatim and coded for pain cues. Coded data were imported into SPSS software (IBM SPSS Statistics Version 24; IBM Corporation, Armonk, NY) to conduct bivariate analyses. RESULTS: The pain cue self-report was stated more often for intact than for delirium patients (χ2 [1; N = 106] = 22.56; P < 0.001). HCPs stated yelling (χ2 [2; N = 159] = 11.14; P = 0.004), when describing pain in hyperactive than in hypoactive and mixed delirium patients; and significantly more HCPs stated grimace (χ2 [2; N = 159] = 6.88; P = 0.03), when describing pain in hypoactive than hyperactive and mixed patients. CONCLUSION: This study outlines how HCPs conduct pain assessment in patients who are delirious and, also, identifies pain behavior profiles for the subtypes of delirium.

Emigration, remittances, and the subjective well-being of those staying behind.

We offer the first global perspective on the well-being consequences of emigration for those staying behind using several subjective well-being measures (evaluations of best possible life, positive affect, stress, and depression). Using the Gallup World Poll data for 114 countries during 2009-2011, we find that having family members abroad is associated with greater evaluative well-being and positive affect, and receiving remittances is linked with further increases in evaluative well-being, especially in poorer contexts-both across and within countries. We also document that having household members abroad is linked with increased stress and depression, which are not offset by remittances. The out-migration of family members appears less traumatic in countries where migration is more common, indicating that people in such contexts might be able to cope better with separation. Overall, subjective well-being measures, which reflect both material and non-material aspects of life, furnish additional insights and a well-rounded picture of the consequences of emigration on migrant family members staying behind relative to standard outcomes employed in the literature, such as the left-behind's consumption, income, or labor market outcomes.

Impact of sacral colpopexy on in vivo vaginal biomechanical properties.

OBJECTIVE: The purpose of this study was to determine if sacral colpopexy has an impact on in vivo vaginal biomechanical properties. STUDY DESIGN: Thirty-five participants who underwent sacral colpopexy were enrolled in this prospective clinical trial. In vivo vaginal biomechanical properties, including elasticity, viscoelasticity, and vaginal stiffness index, as well as symptom severity questionnaires (pelvic floor distress inventory-short form) and Pelvic Organ Prolapse Quantification (POP-Q) examination, were performed preoperatively and 6 weeks postoperatively. RESULTS: Thirty-two participants completed the study. Six weeks after sacral colpopexy participants demonstrated a decrease in prolapse related symptoms (POPDI-6 score, 39.8 vs 9.0, P < .00001) and 97% demonstrated anatomical cure of their prolapse. At 6 weeks follow-up participants demonstrated an increase in elasticity (2.26 vs 3.43, P < .00001), viscoelasticity (1.55 vs 4.08, P < .000001), and vaginal stiffness index (108.65 vs 164.50, P < .01). CONCLUSION: These findings suggest that sacral colpopexy increases in vivo vaginal biomechanical properties, as well as decreasing anatomical and symptom-related severity of pelvic organ prolapse.

Proteomic techniques identify urine proteins that differentiate patients with interstitial cystitis from asymptomatic control subjects.

OBJECTIVE: The purpose of this study was to identify differences in urine proteins between patients with interstitial cystitis (IC) and asymptomatic control (AC) subjects with the use of proteomic techniques. STUDY DESIGN: Nine patients with IC and their age-, race-, and sex-matched AC subjects volunteered a urine specimen. Urine proteins were separated with the use of 2-dimensional polyacrylamide gels. Differing proteins underwent digestion and matrix-assisted laser desorption ionization-time of flight mass spectrometry. Computer-assisted data analysis was used to identify the corresponding protein. Differences in urine protein responses between patients with IC and AC subjects were evaluated by the Mann-Whitney U test to account for the nonnormal frequency distribution of the parameter estimate or chi-square when data were bimodal. RESULTS: Four proteins differed significantly between patients with IC and AC subjects. The AC subjects had a greater concentration of a uromodulin (P = .019) and two kininogens (P = .023, .046). The patients with IC had a greater concentration of inter-alpha-trypsin inhibitor heavy chain H4 (P = .019). CONCLUSION: These urine protein isoforms may be biomarkers for IC.

Local neighbors as positives, regional neighbors as negatives: Competing channels in the relationship between others' income, health, and happiness.

That well-being is decreasing in others' income is termed the "relative income hypothesis" (RIH) by scholars of subjective well-being (SWB) and has substantial empirical support. Some studies, however, present evidence of both positive and negative explanatory channels in the relationship between others' income and SWB. We develop a theoretical framework integrating four distinct channels through which neighbors' income can affect utility: public goods, cost of living, expectations of future income, and direct effects (RIH or altruism). We estimate the relationship with SWB data from the U.S. Gallup-Healthways Well-Being Index and median-income data from the American Community Survey for ZIP codes and MSAs. The relationship is proximity-dependent: positive (negative) when using ZIP-code (MSA) median income as reference income, suggesting that positive (negative) channels dominate locally (regionally) and reconciling the literature's seemingly divergent results. These findings are consistent across SWB measures and many health-related indices. Additional analyses support the public-goods and cost-of-living channels.

A Retrospective Review of Resuscitation Planning at a Children's Hospital.

Resuscitation plans (RP) are an important clinical indicator relating to care at the end of life in paediatrics. A retrospective review of the medical records of children who had been referred to the Royal Children's Hospital, Brisbane, Australia who died in the calendar year 2011 was performed. Of 62 records available, 40 patients (65%) had a life limiting condition and 43 medical records (69%) contained a documented RP. This study demonstrated that both the underlying condition (life-limiting or life-threatening) and the setting of care (Pediatric Intensive Care Unit or home) influenced the development of resuscitation plans. Patients referred to the paediatric palliative care (PPC) service had a significantly longer time interval from documentation of a resuscitation plan to death and were more likely to die at home. All of the patients who died in the paediatric intensive care unit (PICU) had a RP that was documented within the last 48 h of life. Most RPs were not easy to locate. Documentation of discussions related to resuscitation planning should accommodate patient and family centered care based on individual needs. With varied diagnoses and settings of care, it is important that there is inter-professional collaboration, particularly involving PICU and PPC services, in developing protocols of how to manage this difficult but inevitable clinical scenario.

Systemic and vaginal biomechanical properties of women with normal vaginal support and pelvic organ prolapse.

OBJECTIVE: The objective of the study was to compare the biomechanical properties of vaginal and systemic skin in women with and without pelvic organ prolapse. STUDY DESIGN: In this cross-sectional study, 25 women with pelvic organ prolapse and 23 age-matched women with normal pelvic support were recruited from an office setting. A Cutometer MPA 580 and DermaLab skin probe were used to measure systemic biomechanical parameters and a 1.5 mm offset DermaLab skin probe was used for vaginal biomechanical measurements. RESULTS: There were no significant differences in the baseline demographic, obstetrical, or gynecologic information between the 2 groups. There were no significant differences in the systemic biomechanical parameters between the 2 groups. Women with pelvic organ prolapse had significantly more extensible vaginal skin than women with normal pelvic support (initial stiffness index 7.3 vs 10.9 kpa, final stiffness index 5.9 vs 10.7 kpa; all P values less than .01). Furthermore, vaginal extensibility was related to pelvic organ prolapse quantification stage in a linear fashion. CONCLUSION: Our findings suggest that local, rather than systemic, alterations in biomechanical skin properties are associated with pelvic organ prolapse.

Expression profiling using a hexamer-based universal microarray.

We describe a transcriptional analysis platform consisting of a universal micro-array system (UMAS) combined with an enzymatic manipulation step that is capable of generating expression profiles from any organism without requiring a priori species-specific knowledge of transcript sequences. The transcriptome is converted to cDNA and processed with restriction endonucleases to generate low-complexity pools (approximately 80-120) of equal length DNA fragments. The resulting material is amplified and detected with the UMAS system, comprising all possible 4,096 (4(6)) DNA hexamers. Ligation to the arrays yields thousands of 14-mer sequence tags. The compendium of signals from all pools in the array-of-universal arrays comprises a full-transcriptome expression profile. The technology was validated by analysis of the galactose response of Saccharomyces cerevisiae, and the resulting profiles showed excellent agreement with the literature and real-time PCR assays. The technology was also used to demonstrate expression profiling from a hybrid organism in a proof-of-concept experiment where a T-cell receptor gene was expressed in yeast.

A new multidisciplinary approach to integrating best evidence into musculoskeletal practice.

RATIONALE: The effective integration of research evidence into everyday clinical practice continues to be an important challenge. AIMS: The group aimed to answer locally relevant clinical question and produce recommendations for practice based on the best available evidence. METHODS: Through a new initiative, a multidisciplinary group with a specific interest in musculoskeletal disease has been established in order to help address this problem. The group consists of clinical and academic professionals including physiotherapists, occupational therapists, nurses, clinical researchers and information technology librarians representing the health economy. RESULTS: Results from the group's activities are shared locally through presentations and clinical algorithms and nationally through conference presentations and the National Electronic Library for Health. CONCLUSION: As well as clinical recommendations, other benefits of the group have been improved networking, enhanced continual professional development and identifying areas in need of further research.