Gut-Brain Axis Perspective on Negative Symptoms and Their Neighbors in Early Adolescence: Can We Move Care Upstream?

The current study investigated symptom network patterns in adolescents from a gut-brain-axis (GBA) biopsychosocial perspective. Our secondary analysis of data from the Adolescent Brain Cognitive Development Study assessed symptom relationships using network analysis to provide information about multivariate structural dependencies among 41 signs and symptoms. Cross-sectional EBICglasso symptom networks were evaluated to assess patterns associated with anhedonia and depressed mood. Significant differences were identified between symptom neighbors of anhedonia compared with depressed mood based on stratification by age. The GBA perspective revealed several symptom neighbors that could expand clinical assessment, diagnosing criteria, education, and interventions for adolescents at risk for, or with, anhedonia or depressed mood. Results speak to the unique impact of symptoms on health that are not interchangeable with other symptoms and do not have equal effects. Mental health nurses should consider a holistic and proactive precision health approach to improving health and well-being through evidence-based assessment of symptom associations. [Journal of Psychosocial Nursing and Mental Health Services, 61(7), 29-38.].

Integrating Maternal Depression Screening Into an Early Intervention Program: An Implementation Evaluation.

BACKGROUND: In all 50 states, early intervention (EI) services to improve long-term child cognitive and academic outcomes are provided to infants and toddlers with suspected or diagnosed developmental delays. When mothers of EI-enrolled children experience depressive symptoms, uptake of EI services can be compromised. AIMS: The purpose of the article is to present a depressive symptom screening intervention for mothers consisting of toolkit development for EI staff and families, symptom screening for mothers and follow-up protocol. To formally evaluate the implementation of the intervention, our research team followed the consolidated framework for implementation research (CFIR). METHODS: Participants were 12 EI service coordinators across two offices. Focus groups and individual interviews were used to develop the toolkit and education module. Through the five CFIR domains, we evaluated the implemented intervention in order to allow other teams to learn from our experiences. RESULTS: Our team successfully partnered with SCs to develop the intended deliverables. Still, the SCs found it challenging to conduct the screenings and reported mixed success. CONCLUSIONS: Preparation of EI SCs to integrate mental health screenings into their existing skillsets requires a high level of support from the research team, resulting in a rich understanding of the barriers-and potential rewards-for staff and families.

Model Integration: Can Understanding Biopsychosocial Gut-Brain Axis Mechanistic Pathways Improve our Clinical Reasoning in Primary Care?

INTRODUCTION: Most NPs practice in primary care settings. Cognitive tools to inform and advance NP understanding of biopsychosocial mechanisms can support early recognition, interdisciplinary collaboration, interventions, and prevention of negative outcomes. THEORY AND METHODS: We describe the development of a model to support NP consideration of gut-brain axis (GBA) evidence-based pathways, contributing variables, and related health outcomes. RESULTS: The model's outcomes are factors associated with homeostasis or disruption of biological, psychological, and social systems. DISCUSSION/CONCLUSION: This cognitive tool aims to support NP awareness of multi-domain GBA relationships to consider with differential diagnoses and clinical treatment of the "whole body system".

Parenting Interventions and Secondary Outcomes Related to Maternal Mental Health: A Systematic Review.

PURPOSE: Perinatal mood and anxiety disorders can have far reaching negative impact on both maternal mental health and child growth and development. Multimodal group parenting programs have been shown to improve maternal mental health symptoms however, they are often costly to provide and not accessible to many mothers, especially those mothers suffering from mental health symptoms. Therefore, the authors sought to answer the following question by undertaking a systematic review of the literature: are parenting interventions aimed at improving maternal-child interaction also a way to address mental health symptoms (i.e. depression, anxiety, stress) in mothers? METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. An online platform that supports the systematic review process and quality assessment according to Cochrane guidelines, Covidence, was used in conjunction with an adapted extraction tool to identify relevant studies and extract data for analysis. RESULTS: 11 articles were included in the qualitative synthesis. There was great heterogeneity between study interventions and measurement of outcomes for maternal mental health symptoms which precluded meta-analysis. CONCLUSION: Studies reviewed did not demonstrate consistent evidence to recommend that parenting interventions leads to improvement in maternal mental health symptoms for depression, anxiety or stress. However, there was evidence that participating in parenting programs does not worsen these symptoms and some encouraging evidence that alternative delivery methods, beyond face to face, could, with more research, lead to more financially feasible and sustainable models of delivery of these types of interventions in the future.

Adaptive Leadership in Parents Caring for their Children Born with Life-Threatening Conditions.

PURPOSE: The purpose of this study was to chronicle the adaptive challenges and adaptive work, including emerging leadership behaviors, recounted over time by the parents of very young children diagnosed before birth with life threatening conditions. DESIGN AND METHODS: A descriptive, follow-up study design was used for the current study. Following the original grounded dimensional analysis study completed in 2012, the corpus for this analysis was collected in 2014. In-depth, audio-recorded interviews were conducted with 15 families (8 couples, 7 mothers). The 15 children, born with cardiac, abdominal, and cerebrospinal anomalies, were 14 - 37 months or deceased at follow-up. A directed content analysis of transcribed verbatim interviews was structured by the Adaptive Leadership framework. RESULTS: Parents described behaviors that indicated a non-linear development towards adaptive leadership as they accomplished the adaptive work within intra- and interpersonal domains that was necessary to address challenges over time. Not all parents described abilities and/or a willingness to mobilize others to do adaptive work, suggesting that adaptive leadership remained an unrealized potential. CONCLUSIONS: Understood as a complex adaptive system, parents of medically at-risk children hold potential for development towards adaptive leadership and collaborative partnership within the family and with healthcare providers. PRACTICE IMPLICATIONS: Due to improved survival rates, parents face ongoing challenges related to their children's unpredictable and often chronic health needs. Study findings illustrate parents' adaptive work and leadership behaviors, which can inform nursing assessments, as well as the type and timing for intervention.

Mothers' Perspectives on Managing the Developmental Delay of a Child With Considerations for Contextual Influences and Maternal Functioning.

Developmental delay in very young children is trending upward. Maternal depressive symptoms are known to negatively impact child development and may also impact family management of the child's condition. Research on family management guided this second phase of a sequential mixed methods study. The purpose of this study was to explore mothers' perceptions of family management of their children's developmental delays. Mothers of very young children who received early intervention services were interviewed. A team-based content analysis approach revealed key findings: (a) views of the child that were not holistic, (b) condition management ability was informed by what the mother thought her child needed, (c) views of condition impact were related to adapting to possible child outcomes and experiences of isolation, and (d) parental/caregiver mutuality was impaired by conflict. Understanding perceptions of family management and influence of depressive symptoms in this context is essential to extend assessment and intervention.

Manifesto for a healthy and health-creating society.

Brexit and the troubled state of the NHS call for re-thinking the UK's approach to health. The EU referendum vote reveals deep social divisions as well as presenting the country with important decisions and negotiations about the future. At the same time, health problems are growing; the NHS faces severe financial constraints and appears to lurch from crisis to crisis, with leaving the European Union likely to exacerbate many problems including staffing issues across the whole sector. However, new scientific developments and digital technology offer societies everywhere massive and unprecedented opportunities for improving health. It is vital for the country that the NHS is able to adopt these discoveries and see them translated into improved patient care and population health, but also that the UK benefits from its capabilities and strengths in these areas.

Clinical safety of England's national programme for IT: a retrospective analysis of all reported safety events 2005 to 2011.

OBJECTIVE: To analyse patient safety events associated with England's national programme for IT (NPfIT). METHODS: Retrospective analysis of all safety events managed by a dedicated IT safety team between September 2005 and November 2011 was undertaken. Events were reviewed against an existing classification for problems associated with IT. The proportion of reported events per problem type, consequences, source of report, resolution within 24h, time of day and day of week were examined. Sub-group analyses were undertaken for events involving patient harm and those that occurred on a large scale. RESULTS: Of the 850 events analysed, 68% (n=574) described potentially hazardous circumstances, 24% (n=205) had an observable impact on care delivery, 4% (n=36) were a near miss, and 3% (n=22) were associated with patient harm, including three deaths (0·35%). Eleven events did not have a noticeable consequence (1%) and two were complaints (<1%). Amongst the events 1606 separate contributing problems were identified. Of these 92% were predominately associated with technical rather than human factors. Problems involving human factors were four times as likely to result in patient harm than technical problems (25% versus 8%; OR 3·98, 95%CI 1·90-8.34). Large-scale events affecting 10 or more individuals or multiple IT systems accounted for 23% (n=191) of the sample and were significantly more likely to result in a near miss (6% versus 4%) or impact the delivery of care (39% versus 20%; p<0·001). CONCLUSION: Events associated with NPfIT reinforce that the use of IT does create hazardous circumstances and can lead to patient harm or death. Large-scale patient safety events have the potential to affect many patients and clinicians, and this suggests that addressing them should be a priority for all major IT implementations.