Psychological state at the time of psychiatric genetic counseling impacts patient empowerment: A pre-post analysis.

Psychiatric genetic counseling (GC) has been associated with patient-reported increases in empowerment (perceived control, emotional regulation, and hope). We sought to evaluate the extent to which patients' psychological state at the time of GC is related to changes in empowerment. Participants with a history of major depressive disorder and/or bipolar disorder that had been refractory to treatment underwent psychiatric GC remotely from 2022 to 2023. GC was performed by four genetic counselors and included discussion of perceived causes of illness, multifactorial inheritance, and protective factors. Empowerment, depression, and anxiety were measured immediately prior to GC via online survey by the GCOS-16, PHQ-9, and GAD-7, respectively. Empowerment was re-assessed 2 weeks later. In total, 66/161 (41.0%) invited individuals completed both the baseline and follow-up surveys. Participants completing both surveys were 54.6% female, 84.8% white, and ranged in age from 22 to 78 years (mean = 54.8 years). Overall, a significant change in mean empowerment was not observed (p = 0.38); however, there were moderating effects by baseline psychological state. A multiple linear regression model incorporating PHQ-9, GAD-7 and baseline GCOS-16 score predicted change in empowerment with a large effect (F = 5.49, R2 = 0.21, p < 0.01). A higher score on the PHQ-9 was associated with decreases in empowerment from pre to post GC. Higher scores on the GAD-7 and lower baseline GCOS-16 scores were associated with increases in empowerment. Further, two-way ANOVA was conducted to assess change in empowerment between subgroups based on the level of anxiety and depression. Those with low depression and high anxiety reported significant increases in empowerment (F = 6.64, p = 0.01). These findings suggest that psychiatric GC may be especially helpful to individuals experiencing anxiety and low baseline empowerment. Alternative approaches may be needed to best meet the needs of those experiencing significant depression.

Evaluating Population-Level Interventions and Exposures for Suicide Prevention.

Evaluations of interventions targeting the population level are an essential component of the policy development cycle. Pre-post designs are widespread in suicide prevention research but have several significant limitations. To inform future evaluations, our aim is to explore the three most frequently used approaches for assessing the association between population-level interventions or exposures and suicide - the pre-post design, the difference-in-difference design, and Poisson regression approaches. The pre-post design and the difference-in-difference design will only produce unbiased estimates of an association if there are no underlying time trends in the data and there is no additional confounding from other sources. Poisson regression approaches with covariates for time can control for underlying time trends as well as the effects of other confounding factors. Our recommendation is that the default position should be to model the effects of population-level interventions or exposures using regression methods that account for time effects. The other designs should be seen as fall-back positions when insufficient data are available to use methods that control for time effects.

Interprofessional communication skills training to improve medical students' and nursing trainees' error communication - quasi-experimental pilot study.

BACKGROUND: Interprofessional communication is of extraordinary importance for patient safety. To improve interprofessional communication, joint training of the different healthcare professions is required in order to achieve the goal of effective teamwork and interprofessional care. The aim of this pilot study was to develop and evaluate a joint training concept for nursing trainees and medical students in Germany to improve medication error communication. METHODS: We used a mixed-methods, quasi-experimental study with a pre-post design and two study arms. This study compares medical students (3rd year) and nursing trainees (2nd year) who received an interprofessional communication skills training with simulation persons (intervention group, IG) with a control group (CG). Both cohorts completed identical pre- and post-training surveys using the German Interprofessional Attitudes Scale (G-IPAS) and a self-developed interprofessional error communication scale. Descriptive statistics, Mann-Whitney-U-test and Wilcoxon-test were performed to explore changes in interprofessional error communication. RESULTS: A total of 154 were medical students, and 67 were nursing trainees (IG: 66 medical students, 28 nursing trainees / CG: 88 medical students, 39 nursing trainees). After training, there were significant improvements observed in the "interprofessional error communication" scale (p < .001) and the "teamwork, roles, and responsibilities" subscale (p = .012). Median scores of the subscale "patient-centeredness" were similar in both groups and remained unchanged after training (median = 4.0 in IG and CG). CONCLUSIONS: Future studies are needed to find out whether the training sustainably improves interprofessional teamwork regarding error communication in acute care.

The Assessment of Long-Term Care Environments for Wayfinding Design.

OBJECTIVES: The purpose of this article is to compare three different methods to assess the complexity of a long-term care (LTC) environment for wayfinding before and after an environmental design intervention. The methods include space syntax (SS), the Wayfinding Checklist (WC), and the Tool to Assess Wayfinding Complexity (TAWC). BACKGROUND: Wayfinding is important to maintain older adults' independent functioning. The design of environments can impact wayfinding ability by providing support; this can be via building structure or by environmental design features such as signage and landmarks. Few methods or tools have been scientifically validated to assess environments for wayfinding complexity. In order to compare environments in terms of complexity and to measure the impact of interventions, valid and reliable tools are necessary. METHODS: This article discusses the results of the use of three wayfinding design assessment tools using three routes in one LTC environment. The results of the three tools are discussed. RESULTS: SS analysis could quantitatively measure the complexity of routes using integration values, which indicates connectedness. The TAWC and the WC were able to measure differences in visual field scores pre- and postenvironmental intervention. There were limitations to each tool: the lack of psychometric properties for the TAWC and the WC, and the lack of ability to measure changes in design features within visual fields with SS. CONCLUSIONS: Multiple tools to assess environments for wayfinding design may be needed in studies that test environmental interventions. Future research is needed to provide psychometric testing for the tools.

A Systematic Literature Review on Healthcare Facility Evaluation Methods.

To present a systematic literature review on predesign evaluation (PDE), postoccupancy evaluation (POE), and evidence-based design (EBD); to delimit the concepts and relationships of these terms and place them in the building life cycle framework to guide their application and indicate a common understanding and possible gaps. The preferred reporting items for systematic reviews and meta-analyses protocol was used. Inclusion criteria cover texts that present a concept, method, procedure, or tool and use the example in healthcare services or other environments. The reports were excluded if there was no evidence of a relationship between the terms, if cited rhetorically, duplicated, or if an instrument was not related to at least one other term. The identification used Scopus and Web of Science and considered reports until December 2021 (search period). When extracting the evidence, formal quality criteria were observed and sentences and other elements were collected as evidence and tabulated to segment topics of interest. The searches identified 799 reports with 494 duplicates. In the selection, 53 records were selected from 305 obtained in 14 searches. The classification extracted concepts, relationships, and frameworks. Results indicate a consistent understanding of POE and EBD and a diffuse understanding of PDE. A summary of the three concepts including two frameworks is proposed. Situations are contextualized where these frameworks are used in specific areas of research. One of these frameworks provides a basis for classifying building assessment methods, procedures, and tools but does not detail the classification criteria. Thus, more detailed adjustments should be considered in specific studies.

The optimal pre-post allocation for randomized clinical trials.

BACKGROUND: In pre-post designs, analysis of covariance (ANCOVA) is a standard technique to detect the treatment effect with a continuous variable measured at baseline and follow-up. For measurements subject to a high degree of variability, it may be advisable to repeat the pre-treatment and/or follow-up assessments. In general, repeating the follow-up measurements is more advantageous than repeating the pre-treatment measurements, while the latter can still be valuable and improve efficiency in clinical trials. METHODS: In this article, we report investigations of using multiple pre-treatment and post-treatment measurements in randomized clinical trials. We consider the sample size formula for ANCOVA under general correlation structures with the pre-treatment mean included as the covariate and the mean follow-up value included as the response. We propose an optimal experimental design of multiple pre-post allocations under a specified constraint, that is, given the total number of pre-post treatment visits. The optimal number of the pre-treatment measurements is derived. For non-linear models, closed-form formulas for sample size/power calculations are generally unavailable, but we conduct Monte Carlo simulation studies instead. RESULTS: Theoretical formulas and simulation studies show the benefits of repeating the pre-treatment measurements in pre-post randomized studies. The optimal pre-post allocation derived from the ANCOVA extends well to binary measurements in simulation studies, using logistic regression and generalized estimating equations (GEE). CONCLUSIONS: Repeating baselines and follow-up assessments is a valuable and efficient technique in pre-post design. The proposed optimal pre-post allocation designs can minimize the sample size, i.e., achieve maximum power.

The availability and distribution of vaping retailers across Ontario neighbourhoods, 2016-2019.

OBJECTIVES: To characterize the distribution of vaping retailers and examine the association between neighbourhood income and vaping retailer availability in Ontario prior to and after regulatory changes to the vaping market in 2018. METHODS: We quantified vaping access by number of vaping retailers for 19,964 dissemination areas (DAs) in Ontario and percentage of schools near a vaping retailer. We used mixed-effects regression models to examine the associations between vaping access and neighbourhood income in 2018 and 2019. RESULTS: Between 2016 and 2019, the number of vaping retailers in Ontario increased by 22.6% (5999 to 7355), despite a mild drop from 2016 to 2018. In 2019, 59.7% of urban neighbourhoods had one or more vaping retailers within 1000 m of their geographic centre, and 79.4% of elementary, 82.8% of secondary, and 84.2% of post-secondary schools had at least one within 1000 m. Neighbourhood income was associated with access to vaping retailers, with a greater number in low-income regions. In 2019, neighbourhoods in the lowest income quintile had over twice the number of vaping retailers per capita within 1000 m compared to the highest income quintile (adjusted incidence rate ratio 2.40; 95% CI 2.24-2.58). Increases over time in access to vaping retailers did not differ by geographic region, neighbourhood income quintile, or school type. CONCLUSION: We observed a substantial increase in access to vaping retailers in Ontario including proximity to elementary and secondary schools following the 2018 provincial marketing regulations and federal nicotine regulations. Access to vaping was greatest in low-income neighbourhoods and may contribute to established inequities in vaping-related adverse events.

RéSUMé: OBJECTIFS: Caractériser la répartition des détaillants de vapotage et examiner l'association entre le revenu du quartier et la disponibilité des détaillants de vapotage en Ontario avant et après les modifications réglementaires du marché du vapotage en 2018. MéTHODES: Nous avons quantifié l'accès au vapotage selon le nombre de détaillants de vapotage pour 19 964 aires de diffusion (DA) en Ontario et le pourcentage d'écoles à proximité d'un détaillant de vapotage. Nous avons utilisé des modèles de régression à effets mixtes pour examiner les associations entre l'accès au vapotage et le revenu du quartier en 2018 et 2019. RéSULTATS: Entre 2016 et 2019, le nombre de détaillants de vapotage en Ontario a augmenté de 22,6 % (5 999 à 7 355), malgré une légère baisse de 2016 à 2018. En 2019, 59,7 % des quartiers urbains avaient un ou plusieurs détaillants de vapotage à moins de 1 000 m de leur centre géographique, et 79,4 % des écoles élémentaires, 82,8 % des écoles secondaires et 84,2 % des écoles postsecondaires en avaient au moins un détaillant à moins de 1 000 m. Le revenu du quartier était associé à l'accès aux détaillants, avec plus de détaillants dans les régions à faible revenu. En 2019, les quartiers du quintile de revenu le plus bas comptaient plus de deux fois plus de détaillants de vapotage par habitant dans un rayon de 1 000 m par rapport au quintile le plus élevé (rapport de taux d'incidence ajusté 2,40; IC à 95 % 2,24-2,58). Les augmentations au fil du temps de l'accès aux détaillants de vapotage ne différaient pas selon la région géographique, le quintile de revenu du quartier ou le type d'école. CONCLUSION: Nous avons observé une augmentation significative de l'accès aux détaillants de vapotage en Ontario, y compris la proximité des écoles primaires et secondaires à la suite des nouvelles réglementations provinciales sur le marketing et de la réglementation fédérale sur la nicotine en 2018. L'accès au vapotage était le plus élevé dans les quartiers à faible revenu et pourrait contribuer aux inégalités par rapport aux événements indésirables lié au vapotage et tabac.

[Implementation of a nurse practitioner role in inpatient surgery: A mixed-methods study in a pre-post design]. / Implementierung einer "Nurse Practitioner"-Rolle in der stationären Chirurgie.

Implementation of a nurse practitioner role in inpatient surgery: A mixed-methods study in a pre-post design Abstract: Background: The study describes the introduction and testing of a Nurse Practitioner role in acute inpatient surgery in a Swiss hospital over a year. Using a Nurse Practitioner can improve continuity of care, quality of care and patient safety. Aim: The short-term outcome of such a role in the field of inpatient surgery is shown after one year. The target variables included nine measurement criteria. Method: The evaluation was carried out using a mixed-method approach, partly in a pre-post comparison. Quantitatively, the number of patients being looked after, the discharge time, interprofessional cooperation, the duration of stay, disruptions to everyday life and the availability of the discharge documents were recorded. The qualitative recording included the experience of the participants. Results: The results of the evaluation indicate an added value of the new role. Indications can be found in the continuity of care and amenability in medical issues of the participants, as well as in the optimization of patient processes. The legally undefined situation in Switzerland proved to be difficult. Conclusions: The strengths of this role were increasing continuity of care, improving responsiveness in medical issues for patients and caregivers, as well as optimizing patient processes and patient safety. The legal requirements regarding competencies currently make it difficult to use NPs in the inpatient sector.

Palliative care delivery at nursing homes before and after an educational intervention from professionals' perspective: A pre-post design.

BACKGROUND: The principles of palliative care were developed in hospices and specialised palliative care units and have not been sufficiently adapted to and evaluated in nursing homes. Therefore, an educational intervention from an interprofessional education perspective was performed within the project Implementation of Knowledge-Based Palliative Care in Nursing Homes. The aim of this study was to evaluate professionals' experience of palliative care delivery before and after the educational intervention. METHODS: The educational intervention for nursing home professionals consisted of five 2-h seminars over 6 months at 20 nursing homes. The intervention and control groups consisted of 129 and 160 professionals from 30 nursing homes respectively. The questionnaire 'Your experience of palliative care' was completed 1 month before (baseline) and after (follow-up) the intervention. Descriptive and inferential statistics were calculated. RESULTS: The positive effects at follow-up concerned the use of a valid scale for grading symptoms, attendance to the needs of next of kin (including bereavement support), documentation of older persons' wishes regarding place to die and conversations about their transition to palliative care and about how they were treated. CONCLUSIONS: This study demonstrates a promising interprofessional educational model. However, the paucity of improvements brought to light at follow-up indicates a need for research directed towards a revision of this model. Supervision of professionals during palliative care delivery is one suggestion for change.

Navigating COVID-19 and related challenges to completing clinical trials: Lessons from the PATRIOT and STEP-UP randomized prevention trials.

BACKGROUND/AIMS: High follow-up is critical in randomized clinical trials. We developed novel approaches to modify in-person visits and complete follow-up during COVID-19. Since these strategies are broadly applicable to circumstances wherein follow-up is difficult, they may help in contingency planning. The objective of this article is to develop and evaluate new approaches to replace detailed, in-person study visits for two trials focused on preventing diabetic foot complications. METHODS: A quasi-experimental pre-post design compared approaches for follow-up during COVID-19 to approaches pre-COVID-19. Study subjects were outpatients at two Veterans Affairs Medical Centers. Following a research "hold," research resumed in February 2021 for Self-monitoring, Thermometry and Educating Patients for Ulcer Prevention (STEP UP) (n = 241), which focused on preventing recurrent foot ulcers, and in April 2021 for Preventing Amputation by Tailored Risk-based Intervention to Optimize Therapy (PATRIOT) (n = 406), which focused on preventing pre-ulcerative and ulcerative lesions. To complete data collection, we shortened visits, focused on primary and secondary outcomes, and conducted virtual visits when appropriate. For STEP UP, we created a 20-min assessment process that could be administered by phone. Since PATRIOT required plantar photographs to assess foot lesions, we conducted short face-to-face visits. We explored differences and assessed proportion completing visit, visit completion/100 person-months and compared COVID-19 to pre- COVID-19 using unadjusted risk ratios, incidence rate ratios, all with associated 95% confidence intervals (CIs). Finally, we report time-to-visit curves. RESULTS: In both studies, participants whose follow-up concluded pre- COVID-19 seemed older than those whose follow-up concluded during COVID-19 (PATRIOT: 68.0 (67.2, 68.9) versus 65.2 years (61.9, 68.5); STEP UP: 67.5 (66.2, 68.9) versus 65.3 (63.3, 67.3)). For STEP UP, we completed 91 visits pre- COVID-19 (37.8% (31.6%, 44.2%)) and 63 visits during COVID-19 (78.8% (68.2%, 87.1%)). This was over 1309 person-months pre-COVID-19, and over 208.8 person-months during COVID-19; the visit completion rate/100 person-months were: pre-COVID-19 7.0 (5.6, 8.5), COVID-19 30.2 (23.2, 38.6); risk ratio: 2.1 (1.7, 2.5); and incidence rate ratio 4.3 (3.1, 5.9). Similarly, for PATRIOT, we completed 316 visits pre-COVID-19 (77.8% (73.5%, 81.8%)) and 27 assessments during COVID-19 (84.4% (67.2%, 94.7%)). This was over 1192.7 person-months pre-COVID-19 and 39.3 person-months during COVID-19. The visit completion rate/100 person-months in PATRIOT were: pre-COVID-19 2.7 (2.4, 3.0), COVID-19 6.9 (4.5, 10); risk ratio 1.1 (0.9, 1.3); incidence rate ratio 2.6 (1.8, 3.8). For both studies, the follow-up curves began separating at < 2 months. CONCLUSIONS: We achieved higher completion rates during COVID-19 compared to pre-COVID-19 by modifying visits and focusing on primary and secondary outcomes. These strategies prevent excessive missing data, support more valid conclusions, and improve efficiency. They may provide important alternative strategies to achieving higher follow-up in randomized clinical trials.

Food security status of Suchana-participating households in north-eastern rural Bangladesh.

Despite achieving remarkable progress, food insecurity remains a major public health challenge in Bangladesh, and severe food insecurity status has not been reduced in susceptible areas and vulnerable regions in Bangladesh. Wetlands that are susceptible to flooding can be found in Bangladesh's north-eastern Sylhet division. Suchana, a large-scale nutrition programme, implemented nutrition-specific and sensitive interventions in poor and very poor households in Sylhet and Moulvibazar districts in the north-eastern region of Bangladesh. The aim of this article is to assess the association between the Suchana intervention and household food security status among poor and very poor households in north-eastern rural Bangladesh using the Suchana baseline and endline survey databases. The baseline survey was conducted between November 2016 and February 2017, while the endline survey was undertaken 3 years later, during the same months. The outcome variable in this analysis was household food security status, which was measured using the Food and Nutrition Technical Assistance's Guideline. Descriptive statistics were used to summarize the data; after controlling for the union as a cluster and relevant covariates, a multiple multinomial logistic regression model was used to estimate the independent effect of the Suchana intervention as an exposure. Overall, 14.0% of households were food secure at the baseline survey (intervention: 14.1%, control: 14.0%) and 22.0% were food secure (intervention: 26.6%, control: 20.2%) at the endline survey. For households in the intervention area in comparison to the control area, the odds of being moderately food insecure [aOR: 1.36 (1.05, 1.76), p < 0.05], mildly food insecure [aOR: 1.83 (1.33, 2.51), p < 0.001], or food secure [aOR: 2.21 (1.47, 3.33), p < 0.001] compared to being severely food insecure was significantly higher. Thus, we infer that the 3 years of Suchana intervention marginally increased household food security status among the socio-economically disadvantaged population in north-eastern rural Bangladesh. If concerns regarding gender equity, women's education, and income-generating activities are addressed, the population could experience even greater benefits in food security. In order to overcome these challenges, all stakeholders including programme implementers and policymakers should work together to implement the appropriate measures.

The Healthcare Workspace: Understanding the Role of Decentralized Nursing Stations, Corridors, and Huddle Spaces as Locations for Teamwork in a Neonatal Intensive Care Unit.

OBJECTIVE: The goal of this research was to understand the use of decentralized nursing stations (DNS), corridors, and huddle stations as places for teamwork and multidisciplinary care in the neonatal intensive care unit (NICU). BACKGROUND: This article shares outcomes from a pre- and post-occupancy evaluation that assessed a NICU moving from an open-bay model to a new single-family room (SFR) unit comprised of six, 12-bed neighborhoods. This interdisciplinary research team draws upon the practical expertise of a NICU Patient Care Manager and researchers in Design and Communication to illuminate the research process, results, and lessons learned. METHODS: A multi-methodological design, approved by the institutional review board, was employed that utilized an electronically distributed pre- and post-move survey of staff and observational counts of face-to-face interactions. RESULTS: Survey results indicate NICU staff have statistically significant higher perceptions of job satisfaction, stress and well-being, and design satisfaction among a variety of professionals after moving to a SFR, decentralized unit design. Consistent with the literature, staff did not have significantly higher perceptions of the decentralized NICU relative to teamwork. Observations revealed frequency of conversations primarily at DNS followed by corridors and huddle stations. When examining the multidisciplinary makeup, outcomes were reversed with huddle spaces holding the largest percentage of conversations. On average, there were 2.72 individuals involved in these interactions, with the corridor seeing the largest average of group sizes. CONCLUSION: The outcomes of this study demonstrate that neutral spaces such as corridors and centralized huddle stations should be considered as locations for strategic collaboration and multidisciplinary care.

Assessing Preparedness of Labor and Delivery Personnel in Transferring to a New Unit.

OBJECTIVES: This case study intends to examine how staff characteristics, training methods, and duration of training impact overall staff preparedness and comfortability when transitioning to a new Labor and Delivery. BACKGROUND: A new medical facility offers an opportunity for greater capacity and expanding services, but it also poses new challenges for staff. Success in this transition depends on how quickly the staff can adapt to their new environment and how prepared they are to deliver high-quality care to patients. METHODS: An optional survey was conducted to determine the staff's confidence in their training using a 5-point Likert-type scale. RESULTS: After responses were collected, a paired samples two-sided t test revealed that there was no statistically significant change in the confidence and preparedness for staff. CONCLUSIONS: With this overall outcome, medical facilities will have more discernment on ways to improve their employees' trust and confidence in performing their tasks and providing care while in a new environment. This will then be reflected in the care given toward patients in the future.

Statistical analysis of two arm randomized pre-post designs with one post-treatment measurement.

BACKGROUND: Randomized pre-post designs, with outcomes measured at baseline and after treatment, have been commonly used to compare the clinical effectiveness of two competing treatments. There are vast, but often conflicting, amount of information in current literature about the best analytic methods for pre-post designs. It is challenging for applied researchers to make an informed choice. METHODS: We discuss six methods commonly used in literature: one way analysis of variance ("ANOVA"), analysis of covariance main effect and interaction models on the post-treatment score ("ANCOVAI" and "ANCOVAII"), ANOVA on the change score between the baseline and post-treatment scores ("ANOVA-Change"), repeated measures ("RM") and constrained repeated measures ("cRM") models on the baseline and post-treatment scores as joint outcomes. We review a number of study endpoints in randomized pre-post designs and identify the mean difference in the post-treatment score as the common treatment effect that all six methods target. We delineate the underlying differences and connections between these competing methods in homogeneous and heterogeneous study populations. RESULTS: ANCOVA and cRM outperform other alternative methods because their treatment effect estimators have the smallest variances. cRM has comparable performance to ANCOVAI in the homogeneous scenario and to ANCOVAII in the heterogeneous scenario. In spite of that, ANCOVA has several advantages over cRM: i) the baseline score is adjusted as covariate because it is not an outcome by definition; ii) it is very convenient to incorporate other baseline variables and easy to handle complex heteroscedasticity patterns in a linear regression framework. CONCLUSIONS: ANCOVA is a simple and the most efficient approach for analyzing pre-post randomized designs.

COVID-19 pandemic effects in people with Autism Spectrum Disorder and their caregivers: Evaluation of social distancing and lockdown impact on mental health and general status.

Among the difficulties associated with Autism Spectrum Disorder (ASD) are those related to adaptation to changes and new situations, as well as anxious-depressive symptoms frequently related to excessive environmental requirements. The main objective of this research is to study the psychological impact of the lockdown due to the social emergency situation (COVID-19) in children/adolescents and adults diagnosed with ASD. Participants were 37 caregivers of children/adolescents with ASD, also 35 ASD adults and 32 informants. Evaluation was conducted through a web survey system and included standardized clinical questionnaires (CBCL and SCL-90-R), which were compared with results before lockdown start, and a brief self-reported survey addressing the subjective perception of changes in daily functioning areas. The results revealed a reduction of psychopathological symptoms in both age groups, but only reaching statistical significance in the adult group, except for Somatization, Anxiety, and Obsessive-Compulsive domains. ASD severity Level 2 showed greater improvement after lockdown onset in the children/adolescent group when compared to ASD Level 1 participants. Younger adults (18-25 yoa) reported greater improvement than older adults (=>25 yoa). Survey results indicate an improvement of feeding quality and a reduction in the number of social initiations during the lockdown. Adult ASD participants perceived a decrease in stress levels after the lockdown onset, whereas caregivers reported higher stress levels at the same point in both age groups. Limitations included the small number of participants and a heterogeneous evaluation window between measures. Pyschopathological status after two months of social distancing and lockdown seems to improve in ASD young adult population.

Variables and Outcomes in Patient Room Design: A Study of Design Hypotheses.

OBJECTIVE: Research was conducted to evaluate the correlation between design hypotheses and performance outcomes in single-occupancy patient rooms. BACKGROUND: Health environments host complex interactions between patients and clinicians, and patient rooms offer a unique lens to understanding the impact of design on interactions and outcomes. This places importance on articulating, measuring, and assessing design hypotheses. This study of documented strategies and measured outcomes in patient room design investigates the relationship between design variables and clinical interactions. METHODS: Design hypotheses were identified for the strategic approach to four key elements of patient room design: the room configuration, charting location, personal protective equipment (PPE) supply, and mobile supply cart. Researchers collected observational data from existing and newly constructed patient rooms in order to evaluate performance outcomes related to design hypotheses. RESULTS: Observation data supported hypotheses behind three of the four design components and revealed greater insight into how design variables impacted interactions in patient rooms. CONCLUSIONS: The study identified a distinction between "fixed" design elements, such as the configuration of the patient room, and "dynamic" elements such as the design of the mobile cart. This was more prevalent in evaluating the use of supply carts and PPE cabinets, which may be more influenced by training, while the room configuration and charting location require little training to benefit both clinicians and patients. This study points to the value of research that evaluates correlations between design hypotheses and outcomes in healthcare design.

Comparison of perinatal outcomes in facilities before and after Global Network's Helping Babies Breathe Implementation Study in Nagpur, India.

BACKGROUND: The Helping Babies Breathe (HBB) educational program focuses on training of first-level birth attendants in neonatal resuscitation skills for the first minute of life (The Golden Minute). Pre-post studies of HBB implementation in sub-Saharan Africa and Asia have shown reductions in facility-based very early neonatal mortality and stillbirth rates. However, the Global Network pre-post HBB Implementation Study (GN-HBB-IS) found no difference in day 7 perinatal mortality rates (PMR-D7) among births to women participating in the Global Network's Maternal and Newborn Health Registry. To address potential differences in perinatal outcomes in births occurring in facilities that implemented HBB vs. all births occurring in the communities served by facilities that implemented HBB, we compared day-1 perinatal mortality rates (PMR-D1) among births occurring pre and post HBB implementation in facilities in Nagpur, India, one of the 3 sites participating in the GN-HBB-IS. METHODS: We hypothesized that there would be a 20% decrease in the Nagpur facility based PMR-D1 in the 12 months post GN HBB implementation from the pre-period. We explored pre-post differences in stillbirth rates (SBR) and day-1 neonatal mortality rates (NMR-D1). RESULTS: Of the 15 facilities trained for the GN-HBB-IS, 13 participated in the Nagpur HBB Facility Study (Nagpur-HBB-FS). There were 38,078 facility births in the 12 months before the GN-HBB-IS and 40,870 facility births in the 12 months after the GN-HBB-IS. There was 11% overlap between the registry births analyzed in the GN-HBB-IS and the facility births analyzed in the Nagpur-HBB-FS. In the Nagpur-HBB-FS, there was a pre-post reduction of 16% in PMR-D1 (p = 0.0001), a 14% reduction in SBR (p = 0.002) and a 20% reduction NMR-D1 (p = 0.006). CONCLUSIONS: In the Nagpur-HBB-FS, PMR-D1, stillbirths and NMR-D1 were significantly lower after HBB implementation. These benefits did not translate to improvements in PMR-D7 in communities served by these facilities, possibly because facilities in which HBB was implemented covered an insufficient proportion of community births or because additional interventions are needed after day 1 of life. Further studies are needed to determine how to translate facility-based improvements in PMR-D1 to improved neonatal survival in the community. TRIAL REGISTRATION: The Global Network HBB Implementation Study (GN-HBB-IS) was registered at ClinicalTrials.gov: NCT01681017 .

The association between alcohol access and alcohol-attributable emergency department visits in Ontario, Canada.

BACKGROUND AND AIMS: The availability of alcohol through retail outlets is associated with alcohol-related harms, but few studies have demonstrated a causal relationship. We investigated the association between alcohol availability and alcohol-attributable emergency department (ED) visits in the province of Ontario during a period of deregulation of controls on the number of alcohol outlets. DESIGN: Cross-sectional and pre-post design SETTING AND PARTICIPANTS: The study used data from two time-periods: pre-deregulation (2013-14) and post-deregulation (2016-17), to compare rates of ED visits for 513 defined geographic regions in Ontario Canada, called Forward Sortation Areas (FSAs). MEASUREMENTS: The primary outcome was the age-standardized rates of alcohol-attributable ED visits. We compiled a list of all alcohol retail outlets in Ontario during 2014 and 2017 and matched them to their corresponding FSA. We fitted mixed-effects Poisson regression models to assess: (a) the cross-sectional association between number of outlets and hours of operation and ED visits; and (b) the impact of deregulation on ED visits using a difference-in-difference approach. FINDINGS: Alcohol-attributed ED visits increased 17.8% over the study period: more than twice the rate of increase for all ED visits. Increased hours of operation and numbers of alcohol outlets within an FSA were positively associated with higher rates of alcohol-attributable ED visits. The increase in ED visits attributable to alcohol was 6% (incident rate ratio = 1.06; 95% confidence interval = 1.04-1.08) greater in FSAs that introduced alcohol sales in grocery stores following deregulation compared with FSAs that did not. CONCLUSIONS: Deregulation of alcohol sales in Ontario, Canada in 2015 was associated with increased emergency department visits attributable to alcohol.

Overall survival in patients with glioblastoma before and after bevacizumab approval.

OBJECTIVE: Glioblastoma (GBM) is an aggressive disease with limited therapeutic options. While bevacizumab was approved in 2009 for the treatment of patients with progressive GBM, its impact on overall survival (OS) remains unclear. Using US population-based cancer registry data (SEER), this study compared OS of patients diagnosed with GBM before and after bevacizumab approval. METHODS: Adult patients from SEER with a GBM diagnosis were divided into two cohorts: patients diagnosed in 2006-2008 (pre-bevacizumab cohort, n = 6,120) and patients diagnosed in 2010-2012 (post-bevacizumab cohort, n = 6,753). Patients were included irrespective of the treatments received. OS post-diagnosis was compared between the study cohorts utilizing Kaplan-Meier analyses and multivariate Cox proportional hazards regression. RESULTS: Among 12,873 patients with GBM, the median age was 62 years, 41% were women, 31% underwent gross total resection, and 75% received radiation therapy. Survival was stable within the 2006-2008 period (median survival = 9 months for each year), but increased after year 2009 (median survival = 10 and 11 months for years 2010/2011 and 2012, respectively). The adjusted hazard of death was significantly lower in the post-bevacizumab approval cohort (hazard ratio = 0.91, p < .01). CONCLUSIONS: The results of this large population-based study suggested an improvement in OS among patients with a GBM diagnosis in 2010-2012 compared to 2006-2008. While the cause of this improvement cannot be proven in a retrospective analysis, the timing of the survival increase coincides with the approval of bevacizumab for the treatment of patients with progressive GBM, indicating a possible benefit of bevacizumab in this population.

[The Treatment of Infants and Toddlers with their Parents in an Outpatient Unit for Infant Psychiatry]. / Die Behandlung von Säuglingen und Kleinkindern mit ihren Eltern in einer kinderpsychiatrischen Spezialsprechstunde.

The Treatment of Infants and Toddlers with their Parents in an Outpatient Unit for Infant Psychiatry This article presents an integrative treatment model for infants and toddlers between zero to three years and their parents by integrating different complementary psychotherapeutic perspectives. Between 2012 and 2014 a total of 214 children between zero and three years have been treated, the diagnostic and process data of 53 % (N = 113) of the children were evaluable. The parents have been consulted in the beginning, at the end and six months post-treatment with different questionnaires concerning distress of the children and of the parents as well as regarding the social and the emotional behavior of the toddlers. The psychotherapists filled in different instruments at the beginning and at the end of the treatment. Our research demonstrates that a clearly conceptualized intervention has a measurable and persistent positive effect on the symptoms of the children, on the parent-child-relationship and on the wellbeing of the parents.