Postoperative delirium: A tragedy for elderly cancer patients.

In this editorial, we comment on the article by Hu et al entitled "Predictive modeling for postoperative delirium in elderly patients with abdominal malignancies using synthetic minority oversampling technique". We wanted to draw attention to the general features of postoperative delirium (POD) as well as the areas where there are uncertainties and contradictions. POD can be defined as acute neurocognitive dysfunction that occurs in the first week after surgery. It is a severe postoperative complication, especially for elderly oncology patients. Although the underlying pathophysiological mechanism is not fully understood, various neuroinflammatory mechanisms and neurotransmitters are thought to be involved. Various assessment scales and diagnostic methods have been proposed for the early diagnosis of POD. As delirium is considered a preventable clinical entity in about half of the cases, various early prediction models developed with the support of machine learning have recently become a hot scientific topic. Unfortunately, a model with high sensitivity and specificity for the prediction of POD has not yet been reported. This situation reveals that all health personnel who provide health care services to elderly patients should approach patients with a high level of awareness in the perioperative period regarding POD.

Predictive modeling for post operative delirium in elderly.

Delirium, a complex neurocognitive syndrome, frequently emerges following surgery, presenting diverse manifestations and considerable obstacles, especially among the elderly. This editorial delves into the intricate phenomenon of postoperative delirium (POD), shedding light on a study that explores POD in elderly individuals undergoing abdominal malignancy surgery. The study examines pathophysiology and predictive determinants, offering valuable insights into this challenging clinical scenario. Employing the synthetic minority oversampling technique, a predictive model is developed, incorporating critical risk factors such as comorbidity index, anesthesia grade, and surgical duration. There is an urgent need for accurate risk factor identification to mitigate POD incidence. While specific to elderly patients with abdominal malignancies, the findings contribute significantly to understanding delirium pathophysiology and prediction. Further research is warranted to establish standardized predictive for enhanced generalizability.

The absence of formal work experience may affect the rate of cognitive decline in older adult women: findings from the health and retirement study.

Objective: This study investigated the relationship between years of employment and cognitive health among older non-Latinx Black, Latinx, and non-Latinx White women. We hypothesized that women who had never been formally employed (i.e., zero years of formal work experience) would exhibit a pronounced cognitive decline. Methods: Our study included 5,664 older adult women from the Health and Retirement Study (2010-2016) aged 65-101 (M = 75.41). Out of 5,664 participants, 850 identified as non-Latinx Black, 475 identified as Latinx, and 4,339 identified as non-Latinx White. Furthermore, 5,292 women indicated having a professional employment history of at least one year, whereas 372 women reported no formal work experience. The Telephone Interview for Cognitive Status-27 (TICS-27) was used to assess cognitive performance. Linear mixed effects models were conducted to assess whether employment history was associated with the rate of cognitive decline. Results: In all three racial and ethnic groups, lower age, higher education, greater number of years worked, fewer chronic conditions, and greater household income were associated with better cognitive performance at baseline (p < .05). Additionally, women who had not worked in any formal capacity had a lower baseline cognitive performance (p < .001) and a more extreme decline in cognitive performance over time (p = .04). Conclusion: In conclusion, we found that women without any formal work experience performed lower at baseline and experienced a steeper cognitive decline over time. These findings underscore the need to further explore the complex interrelationships between employment duration and cognitive trajectories, especially among older women and those from different racial and ethnic backgrounds.

The healthcare support program and healthcare utilization of older adults in ethnic minority areas in Vietnam.

Over the past few decades, Vietnam has experienced a substantial improvement in health outcomes, providing an example of a low-income country that has achieved a major success in public health despite the lack of resources. However, inequalities in access to healthcare services persist among the poor, ethnic minorities, and other vulnerable groups. To address this issue, the Vietnamese government implemented a healthcare support program in ethnic minority areas in 2013. We examine the effects of this program on healthcare utilization among older individuals aged 55-74. Employing a difference-in-differences approach and data from the Vietnam Household Living Standards Survey from 2008 to 2018, we find that the program has a positive effect on inpatient visits at public health facilities. However, the program has no impact on outpatient visits. Additional analysis reveals that the program increases outpatient visits at commune health stations and inpatient visits at district hospitals. There is also suggestive evidence of a switch from private to public facilities. Our results suggest that providing healthcare resources to disadvantaged areas can increase healthcare utilization of older people, which can, in turn, improve their health outcomes.

Mapping a psychosocial syndemic among methamphetamine-using sexual minority men living with HIV.

INTRODUCTION: While research with sexual minority men (SMM) has focused on disparities related to HIV, substance use and mental health, synergistic psychosocial pathways driving these epidemics remain underexplored. We used syndemic theory to assess how psychosocial factors sustain methamphetamine use and hinder recovery efforts for SMM living with HIV. METHODS: A triangulation of network analyses and constructivist grounded theory approaches is utilised to elucidate pathways through which psychosocial factors influence methamphetamine use among this population. Survey data (N = 129) are used for quantitative analyses and a purposive sub-sample (n = 24) was recruited for semi-structured interviews for qualitative analyses. FINDINGS: The network analysis revealed two statistically significant bivariate associations: between post-traumatic stress disorder and depression symptoms (b = 0.37, SD = 0.07, 95% confidence interval [0.23, 0.49]) and between depression symptoms and negative affect (b = 0.26, SD = 0.07, 95% confidence interval [0.12, 0.38]). Findings from the constructivist grounded theory analysis supplement the network analysis by offering a nuanced take on how negative affect, post-traumatic stress disorder, and depression symptoms operate synergistically to promote methamphetamine use and impede recovery efforts. DISCUSSION AND CONCLUSIONS: Participants relay experiences of using methamphetamine to cope with these psychosocial factors through avoidance, escapism, mood elevation, and numbing of emotions. Findings suggest that centring these psychosocial factors may inform more effective, holistic interventions for this high-priority population.

Outness, Acceptance, and Victimization: A Longitudinal Study of Depressive Symptoms and Suicidality of Lesbian, Gay, and Bisexual and Transgender and Gender Diverse Youth.

PURPOSE: LGBTQ+ youth are at higher risk for poorer mental health. Studies are typically cross-sectional and categorize cisgender lesbian, gay, and bisexual (LGB) and transgender and gender diverse (TGD) youth as a combined group (i.e., LGBTQ+). There is a need for longitudinal studies that examine differences between LGB and TGD youth for a better understanding of their mental health needs. METHODS: Data come from a 4-wave longitudinal community-based study collected between 2011 and 2015. Hierarchical Linear Models examined trajectories of depressive symptoms and suicidality, comparing LGB and TGD youth. Between-person and within-person associations were examined, accounting for cumulative experiences of victimization, outness to family, and family acceptance in association with depressive symptoms and suicidality. RESULTS: The study included a diverse sample of 543 LGB and 118 TGD youth. Although TGD youth had, overall, higher levels of depression and suicidality, both LGB and TGD youth experienced improvement in mental health. Youth who were more out and accepted in family were less depressed and suicidal than youth who were less out and accepted in family. Within individuals, when youth become more out and accepted in family, they concurrently reported less depressive symptoms. The accumulation of victimization experiences was associated with higher levels of depression and suicidality, and more depression for youth across time. DISCUSSION: TGD youth face higher stigmatization than LGB youth, contributing to poorer mental health and disparities. Findings suggest that both LGB and TGD youth develop resilience despite victimization, and many find support within their families to cope with stigma.

The rise of anti-trans laws and the role of public health advocacy.

The recent surge in anti-trans laws and policies in Canada and the United States has important public health implications, particularly for trans and gender-expansive (TGE) youth. This legislation has the potential to exacerbate minority stress experienced by TGE youth, who already experience higher rates of depression, anxiety, and suicide than their cisgender peers. Social gender affirmation, including respecting affirmed names and pronouns, can reduce the risk of adverse mental health outcomes in TGE youth. However, recent laws requiring parental consent for affirmed names and pronouns in schools can cause additional distress and harm for TGE youth, especially those who lack family support. Public health professionals have a critical role to play in countering the harmful effects of anti-trans legislation by better understanding TGE youth and their needs, advocating for trans rights, supporting trans-led community organizations, and strengthening trans-affirming mental health services.

RéSUMé: Les récentes lois et directives anti-trans au Canada et aux États-Unis ont des conséquences importantes sur la santé publique, en particulier pour les jeunes personnes trans et de genre expansif (TGE). Cette législation risque d'exacerber le stress minoritaire chez les jeunes TGE, qui connaissent déjà des taux de dépression, d'anxiété et de suicide plus élevés que leurs pairs cisgenres. L'affirmation du genre au niveau social, y compris le respect des noms et pronoms affirmés, peut réduire le risque d'effets néfastes sur la santé mentale des jeunes TGE. Cependant, les lois récentes exigeant le consentement des parents pour les noms et pronoms affirmés dans les écoles peuvent causer une détresse et un préjudice additionnels pour les jeunes TGE, en particulier ceux qui n'ont pas le soutien de leur famille. Les professionnels de la santé publique ont un rôle essentiel à jouer pour contrer les effets néfastes des lois anti-trans en comprenant mieux les jeunes TGE et leurs besoins, en défendant les droits des personnes trans, en soutenant les organisations communautaires dirigées par des personnes trans et en renforçant les services de santé mentale transaffirmatifs.

Clients' perceptions of motivational interviewing with couples: A qualitative examination of male couples' statements to counselors in session.

The past two decades have seen expanding interest in the application of Motivational Interviewing (MI) with couples. Thus far, literature detailing the development of MI with couples has focused primarily on elucidating counseling processes and techniques or on evaluating intervention effects. To date no published studies have examined client-perceptions of the counseling process in MI with couples. This study involved qualitative analysis of 55 sessions from 24 couple (48 individuals) who received short (3-session) courses of MI with couples in the context of a randomized controlled trial. All participants identified as cisgender male and were 18 or older. In each couple, at least one partner was aged 18 to 29, HIV negative, and reported drug use in the past 30 days. Analysis revealed that client couples attributed the benefits of MI with couples to the expectancy-related effects s (merely structuring time to talk) and common factors (the presence of the counsellor as a non-judgmental observer). Clients also conveyed appreciation for techniques and activities that enhanced dyadic functioning through communication skill building and the identification of shared values. Finally, clients appreciated the opportunity to discuss drug use and sexual behavior in an integrated way. Findings indicate the utility of counselor-delivered behavioral interventions. They also align with recent formulations of the counselor's role in MI with couples as well as the introduction of facilitating dyadic functioning as a distinct process. Finally, they highlight the potential value of training counselors to address the intersection of drug use, sexual risk, and sexual pleasure in sessions. These dimensions of practice receive inconsistent attention across counseling training program curricula.

Lifetime and Daily Weight Stigma among Higher Weight Sexual Minority Women: Links to Daily Weight-based Concerns, Avoidance, and Negative Affect.

Background: Weight stigma is associated with a range of adverse health outcomes (e.g., disordered eating). Women, sexual minorities, and higher-weight individuals are at increased risk of experiencing weight stigma, but little is known about its influence on emotions, cognitions, and behaviors in real-world contexts, particularly among multiply marginalized individuals such as higher-weight sexual minority women (SMW). The current study examined how lifetime and daily weight stigma experiences relate to momentary weight/shape concerns, size-based avoidance, and negative affect in this population. Methods: Fifty-five higher-weight (BMI > 25 kg/m2) SMW completed a baseline survey and a five-day Ecological Momentary Assessment protocol (five prompts per day) assessing weight stigma events, weight/shape concerns, size-based avoidance, and negative affect. Results: Greater frequency of lifetime weight stigma experiences was significantly associated with greater odds of engaging in size-based avoidance at least once during the 5-day period. Reporting momentary weight stigma events at any given prompt was significantly associated with greater odds of reporting momentary weight/shape concerns, but not negative affect, at the same prompt. Greater frequency of lifetime weight stigma experiences was also marginally associated with greater odds of reporting momentary weight/shape concerns at any given prompt. Conclusions: Both lifetime and momentary experiences of weight stigma are linked to negative consequences (e.g., weight/shape concerns, size-based avoidance) among higher-weight SMW. Although structural interventions are needed to reduce weight stigma at its source, individual interventions can help higher-weight SMW to cope with weight stigma in ways that may reduce its negative consequences.

Research Priorities in Pediatric Asthma Morbidity: Addressing the Impacts of Systemic Racism on Children with Asthma in the United States. An Official American Thoracic Society Workshop Report.

Background: In the United States, Black and Latino children with asthma are more likely than White children with asthma to require emergency department visits or hospitalizations because of an asthma exacerbation. Although many cite patient-level socioeconomic status and access to health care as primary drivers of disparities, there is an emerging focus on a major root cause of disparities-systemic racism. Current conceptual models of asthma disparities depict the historical and current effects of systemic racism as the foundation for unequal exposures to social determinants of health, environmental exposures, epigenetic factors, and differential healthcare access and quality. These ultimately lead to biologic changes over the life course resulting in asthma morbidity and mortality. Methods: At the 2022 American Thoracic Society International Conference, a diverse panel of experts was assembled to identify gaps and opportunities to address systemic racism in childhood asthma research. Panelists found that to examine and address the impacts of systemic racism on children with asthma, researchers and medical systems that support biomedical research will need to 1) address the current gaps in our understanding of how to conceptualize and characterize the impacts of systemic racism on child health, 2) design research studies that leverage diverse disciplines and engage the communities affected by systemic racism in identifying and designing studies to evaluate interventions that address the racialized system that contributes to disparities in asthma health outcomes, and 3) address funding mechanisms and institutional research practices that will be needed to promote antiracism practices in research and its dissemination. Results: A thorough literature review and expert opinion discussion demonstrated that there are few studies in childhood asthma that identify systemic racism as a root cause of many of the disparities seen in children with asthma. Community engagement and participation in research studies is essential to design interventions to address the racialized system in which patients and families live. Dissemination and implementation studies with an equity lens will provide the multilevel evaluations required to understand the impacts of interventions to address systemic racism and the downstream impacts. To address the impacts of systemic racism and childhood asthma, there needs to be increased training for research teams, funding for studies addressing research that evaluates the impacts of racism, funding for diverse and multidisciplinary research teams including community members, and institutional and financial support of advocating for policy changes based on study findings. Conclusions: Innovative study design, new tools to identify the impacts of systemic racism, community engagement, and improved infrastructure and funding are all needed to support research that will address impacts of systemic racism on childhood asthma outcomes.

A Rare Case of Untreated Wilson's Disease in a Teen With Lethal Exit: Morphological Findings From an Autopsy Study.

Wilson's disease (WD) is an autosomal recessive genetic disorder caused by more than 50 different mutations in the APT7B gene. A defect in the gene product results in copper accumulation mainly in the liver, basal ganglia in the brain, cornea, kidneys, and heart, leading to dysfunction and eventually organ failure. We present a case of a 15-year-old male with a minority background who did not receive any form of treatment and ultimately succumbed to the disease. He was previously hospitalized due to suspected autoimmune-mediated acute liver failure (ALF) with positive antinuclear autoantibodies. Abdominal ultrasound revealed uneven contours and diffusely abnormal structure of the liver, interpreted as liver cirrhosis (LC), and splenomegaly. In view of WD as a potential differential diagnosis, a genetic consultation recommended the performance of genetic testing. The patient received symptomatic and corticosteroid therapy and was discharged from the hospital with improved general status. Three days later, the teen experienced deterioration and was readmitted to the hospital in a critical state. Reanimation measures had a temporary effect and ultimately exitus letalis was registered. The autopsy study revealed mixed micronodular and macronodular LC, chronic steatohepatitis, hepatosplenomegaly, ascites, icterus, gynecomastia, telangiectasias, subcutaneous hemorrhages, absence of male pattern body hair, hypogonadism, and chronic calculous cholecystitis as a result of untreated WD. Complications of the main disease appeared to be hepatorenal syndrome, severe bilateral purulent-hemorrhagic pneumonia probably with mixed etiology, acute cardiac failure with congestive changes in all internal organs, pleural and pericardial effusions, pulmonary edema, and cerebral edema with tonsillar herniation. The ATP7B gene sequencing supported the clinical diagnosis and the autopsy suspicion of WD, showing that the boy was homozygous for an H1069Q mutation.

Loneliness and pain among community-dwelling middle-aged and older Black, Latino, and White adults in the United States.

Background: Prior research has demonstrated a strong and independent association between loneliness and pain, but few studies to date have explored this relationship in racially and ethnically diverse groups of midlife and older adults. We drew on the diathesis stress model of chronic pain and cumulative inequality theory to examine the relationship of loneliness and the presence and intensity of pain in a nationally representative sample of Black, Latino, and White adults aged 50 or older in the United States. Methods: Data were from Wave 3 of the National Social Life, Health, and Aging Project (n = 2,706). We used weighted logistic and ordinary least squares regression analyses to explore main and interactive effects of loneliness and race and ethnicity while adjusting for well-documented risk and protective factors (e.g., educational attainment, perceived relative income, inadequate health insurance, perceived discrimination) and salient social and health factors. Results: Almost half (46%) of the participants reported feeling lonely and 70% reported the presence of pain. Among those who reported pain (n = 1,910), the mean intensity score was 2.89 (range = 1-6) and 22% reported severe or stronger pain. Greater loneliness was associated with increased odds of pain presence (AOR = 1.154, 95% CI [1.072, 1.242]) and higher pain intensity (ß = 0.039, p < 0.01). We found no significant interaction effects involving Black participants. However, Latino participants who reported greater loneliness had significantly higher levels of pain (ß = 0.187, p < 0.001) than their White counterparts with similar levels of loneliness. Discussion: Loneliness is an important correlate of pain presence and intensity and may have a stronger effect on pain intensity among Latino adults aged 50 or older. We discuss clinical and research implications of these findings, including the need for more fine-grained analyses of different types of loneliness (e.g., social, emotional, existential) and their impact on these and other pain-related outcomes (e.g., interference). Our findings suggest a need for interventions to prevent and manage pain by targeting loneliness among middle-aged and older adults, particularly Latino persons.

Relationships of Physical Activity and Type 2 Diabetes With Cognition in Mexican Americans and Non-Hispanic Whites.

Problem, Research Strategy, and Findings: Low physical activity (PA) and Type 2 diabetes are associated with cognitive aging and Alzheimer's disease, but the evidence is inconsistent and particularly limited by ethnicity. The purpose of this study was to examine the relationships of PA and Type 2 diabetes with cognition in Mexican Americans and non-Hispanic Whites. The study was a cross-sectional analysis of the Health and Aging Brain Study-Health Disparities (n = 1,982-2,000 after removing outliers). Predictors included Rapid Assessment of Physical Activity and hemoglobin A1c (HbA1c). Episodic memory was assessed by Weschler Memory Scale-Third Edition Logical Memory and Spanish-English Verbal Learning Test, executive function by Weschler Memory Scale-Third Edition Digit Span and Digit Symbol Substitution Test, verbal fluency by FAS and animal naming, and global cognition by the Mini-Mental State Examination. Results show that aerobic PA and HbA1c were not associated with domain-specific, or global cognition, but strength/flexibility PA was associated with FAS (b = 0.404, 95% CI [0.023, 0.761]). Higher aerobic PA was associated with greater verbal fluency for Mexican Americans (b = 0.294, 95% CI [0.96, 0.497]) only. HbA1c was negatively associated with Mini-Mental State Examination (b = 0.838, 95% CI [0.008, 1.656]). For low HbA1c, the association between aerobic PA and Digit Symbol Substitution Test was significant for non-Hispanic Whites (b = 0.838, 95% CI [0.008, 1.656]) in comparison to Mexican Americans. Takeaway for Practice: The relationships between PA, Type 2 diabetes, and cognition vary by cognitive domains and ethnicity. Increasing aerobic activities may be particularly important for Mexican Americans who have elevated HbA1c to potentially improve fluency or executive function.

Community heals: Lessons from qualitative narratives of first-generation college students.

Background: First-generation college students struggle to navigate the college experience. Prior research suggests that social capital plays a critical role in college success such that students benefit from building networks of support within the university.Objective: We investigated whether social capital, in the form of engagement with university services, had positive implications for college students' mental health and academic performance, particularly for first-generation college students.Methods: We conducted semi-structured interviews with both first- and continuing-generation students attending a Hispanic Serving Institution to gain a qualitative, in-depth understanding of the extent to which students took advantage of university services, and whether such engagement promoted their mental health and academic success. Results: Narratives revealed that first-generation students felt uniquely overwhelmed and could benefit from building connections and seeking support. Students emphasized the positive impact of community connections.Conclusion: University-wide programming focused on community building may improve first-generation students' college experience.

Perceived risks and benefits of telePrEP interventions: An interview study with rural sexual minority men in Texas.

PURPOSE: Many rural areas lack brick-and-mortar HIV prevention resources despite the increasing rates of HIV. Although online HIV pre-exposure prophylaxis (PrEP) programs can potentially increase uptake among rural sexual minority men (SMM), their attitudes and preferences regarding telehealth-based PrEP (telePrEP) programming are uncertain. This qualitative study examined rural SMM's perceived risks and benefits of participating in a hypothetical telePrEP program. METHODS: Twenty rural SMM living in Texas completed a semi-structured online videoconferencing interview between April 12 and June 14, 2023. Data were analyzed with reflexive thematic analysis. FINDINGS: Four themes were constructed: (1) telePrEP interventions increase accessibility but completely online services might be inadequate; (2) telePrEP and mail-order interventions are convenient but face challenges; (3) telePrEP interventions need to address confidentiality and privacy within the context of the sociopolitical climate; and (4) telePrEP interventions need to address trustworthiness and transparency. CONCLUSIONS: Overall, our results indicate that rural SMM perceive telePrEP interventions that provide at-home and telehealth PrEP, HIV testing, and HIV care services as beneficial. However, overall utility and acceptability depend on perceptions of privacy, confidentiality, trustworthiness, and transparency. Given the HIV prevention and treatment service deserts in which many rural SMM live, telePrEP interventions must purposefully demonstrate how their operations and data will remain safe and secure. Further work should explore contextual or situational factors that influence the willingness and acceptability of rural SMM to participate in online HIV prevention intervention research studies.

Adult stakeholders' perspectives on supporting or undermining the mental health of sexual and gender minoritised adolescents.

OBJECTIVES: To explore adult stakeholders' perspectives on what supports or undermines the mental health of sexual and gender minoritised adolescents (SGMA) in everyday life in order to better understand how to foster supportive psychosocial environments for SGMA. DESIGN: Descriptive qualitative study design, using framework analysis. METHODS: Semi-structured interviews were conducted remotely with 16 UK-based adult stakeholders which included parents of SGMA, health and social care professionals, community-based professionals, and professionals who commission services related to adolescent health and well-being. RESULTS: Nine themes were identified that represented barriers and enablers of fostering psychosocial environments that are supportive of SGMA mental health. Example barrier themes include SGMA 'facing chronic and acute safety threats and stress', 'psychological responses to social connection losses and navigating alienation', 'digital exposure and online risk and vulnerability' and 'conflicting messages, resulting divisions and adult distancing'. Example enablers include 'exploring, owning, and changing (personal) identities', 'advocating alongside adolescents whilst containing oneself as the adult in the situation' and 'personally fostering adolescents' psychological safety and inclusion'. CONCLUSIONS: Adult stakeholders report that SGMA are often exposed to environments hostile to key aspects of their identity which then by extension undermines their mental health. These experiences can threaten their sense of safety and evolving identity. Practitioners in particular should be aware of the stressors relating to SGMA identity and minoritisation experiences in order to develop the psychological safety and sense of inclusion needed for SGMA to trust in the relationship and the support offered.

Healthcare professionals' experiences of delivering pain science education to adults from ethnically minoritised groups.

BACKGROUND: Pain Science Education (PSE) seeks to increase patients understanding of their pain, to improve clinical outcomes. It has been primarily developed and tested within western cultures. There is a lack of research exploring its use with people from ethnically minoritised groups. OBJECTIVE: To explore Healthcare Professionals (HCPs) experiences of delivering PSE to people with persistent pain from ethnically minoritised groups. METHODS: In this qualitative study semi-structured interviews were carried out with a convenience sample of 14 HCPs who routinely deliver PSE to patients from ethnically minoritised groups. The interviews were analysed using reflexive thematic analysis. RESULTS: Three themes were identified: 1) Biomedical model or disengagement, 2) Pain is a taboo topic, and 3) The importance of cultural competence. Participants believed that people from ethnically minoritised groups disengaged with PSE sooner in comparison to non-ethnically minoritised groups and this was rooted in a strong biomedical understanding of pain and preference for biomedical treatments. Addressing patients' beliefs was deemed difficult as participants felt that pain was considered a taboo amongst some ethnically minoritised groups and HCPs lacked sufficient training in cultural competency to confidently address their pain-related misconceptions. CONCLUSIONS: Overall, HCPs found that many people from ethnically minoritised groups held strongly biomedical views and/or a cultural reluctance to discuss pain. These factors made pain discussions challenging leading to disengagement from PSE and a preference for passive care. Cultural competency training and access to culturally competent PSE resources may facilitate engagement with PSE for people from ethnically minoritised background.

How Do Persons With Disabilities and/or Complex Health Conditions Perceive Oral Health? A Qualitative Study.

OBJECTIVES: This qualitative study aimed to explore the experience and perception of the mouth, oral health, functioning and the social environment amongst adults with disabilities and complex health conditions. METHODS: Purposive sampling using the maximum variation strategy was performed to select participants with a wide range of experiences in terms of demographics, disability and health conditions. Consent was sought, and semi-structured interviews were conducted, recorded and transcribed verbatim. Within the interpretivist tradition, a phenomenological approach was used to describe the lived, contextualised experience of people in relation to their mouths, as described by participants. Thematic analysis was undertaken. RESULTS: Eighteen participants with disabilities and complex health conditions were interviewed. Twelve individuals had an intellectual disability. Three main themes were identified: perception of the mouth and oral health; symptomatic perceptions and responses to oral health problems; and inter-relationships between the mouth, oral health and the socio-medical environment. The mouth had a central place in the lives of the participants, but its importance was only recognised when oral health problems interfered with daily life, function, social relationships, family life or autonomy. Certain social determinants of health were identified: social exclusion, financial insecurity, lack of autonomy, nutrition and negotiation of services. Oral problems were perceived as an additional burden to those with disabilities or complex health conditions. CONCLUSION: This study provided insight into the daily lives of adults with disabilities and complex health conditions. It helps to fill the gaps in the existing literature regarding the perceptions of the mouth and oral health, connecting oral function, general health and social environment for this population. TRIAL REGISTRATION: This study was registered into ClinicalTrials.gov (NCT04815434).