Psychosocial assessment tools for children and young people aged 5-18 years: A rapid review of the literature.

AIM: Schools are a key platform for health promotion and a point of connection to local health-care services, with an almost universal reach across the child and adolescent population. This study sought to determine whether validated psychosocial assessment tools exist for a school-based nursing program that would assist in providing an initial health assessment to identify and understand the needs of children and young people referred to the nurse, with the outcome of appropriate connection to external health and wellbeing services. METHODS: Rapid evidence assessment methodology was utilised to identify validated tools that could identify psychosocial concerns in children and young people aged 5-18 years. We identified articles from peer-reviewed journals via three electronic bibliographic databases (PubMed, Embase and CINAHL). We then extended the search for evidence through a search of the grey literature. RESULTS: From 3963 peer-reviewed articles found in the database search, 10 relevant peer-reviewed publications met inclusion criteria. In combination with 12 grey literature sources, 33 tools were identified. These included self-report tools (typically for children aged 11 years and older), parent-report and teacher-report tools. We identified the six most promising psychosocial assessment tools. However, there was limited description about implementation within school-based nursing programs. CONCLUSIONS: Several tools exist that show promise in assisting school-based nursing programs to conduct preliminary psychosocial assessments for children and young people. The introduction of any tools into practice would require implementation guidance and evaluation, including how and when they should be used, and when referral and follow-up is required.

Genome-wide analysis of blood lipid metabolites in over 5000 South Asians reveals biological insights at cardiometabolic disease loci.

BACKGROUND: Genetic, lifestyle, and environmental factors can lead to perturbations in circulating lipid levels and increase the risk of cardiovascular and metabolic diseases. However, how changes in individual lipid species contribute to disease risk is often unclear. Moreover, little is known about the role of lipids on cardiovascular disease in Pakistan, a population historically underrepresented in cardiovascular studies. METHODS: We characterised the genetic architecture of the human blood lipidome in 5662 hospital controls from the Pakistan Risk of Myocardial Infarction Study (PROMIS) and 13,814 healthy British blood donors from the INTERVAL study. We applied a candidate causal gene prioritisation tool to link the genetic variants associated with each lipid to the most likely causal genes, and Gaussian Graphical Modelling network analysis to identify and illustrate relationships between lipids and genetic loci. RESULTS: We identified 253 genetic associations with 181 lipids measured using direct infusion high-resolution mass spectrometry in PROMIS, and 502 genetic associations with 244 lipids in INTERVAL. Our analyses revealed new biological insights at genetic loci associated with cardiometabolic diseases, including novel lipid associations at the LPL, MBOAT7, LIPC, APOE-C1-C2-C4, SGPP1, and SPTLC3 loci. CONCLUSIONS: Our findings, generated using a distinctive lipidomics platform in an understudied South Asian population, strengthen and expand the knowledge base of the genetic determinants of lipids and their association with cardiometabolic disease-related loci.

Health information needs and dissemination methods for individuals living with ischemic heart disease: A systematic review.

OBJECTIVES: This review aimed to identify the health information needs and preferred approaches to receive health information of individuals with Ischaemic Heart Disease (IHD). METHODS: A systematic review was conducted. Relevant literature, published in English (January 2011 to October 2021), was identified across six databases. Guided by Coulter et al.'s framework for developing patient information materials, thematic analysis was performed. The findings were presented in tables and prose. RESULTS: Fifty-nine studies were included. Eleven themes summarised the information needs of individuals with IHD. Each theme was supported with subthemes. Forty-five studies included information on preferred methods of dissemination. CONCLUSIONS: Our review has characterised the diverse information needs of individuals living with IHD and dissemination methods for outreach to this population. Such insights inform healthcare providers in formulating patient-centred educational interventions to empower patients to undertake successful behavioural modification. PRACTICE IMPLICATIONS: Patient education should be personalised and delivered according to individuals' risks for IHD and modifiable risk factors. The use of web-based dissemination of patient education has gained popularity among healthcare providers but sub-optimal adherence to these web-based interventions limits behavioural modification. Adding elements of in-person patient education session to complement web-based interventions may be more propitious to effecting behavioural modification.

Transdiagnostic clustering of self-schema from self-referential judgements identifies subtypes of healthy personality and depression.

Introduction: The heterogeneity of depressive and anxiety disorders complicates clinical management as it may account for differences in trajectory and treatment response. Self-schemas, which can be determined by Self-Referential Judgements (SRJs), are heterogeneous yet stable. SRJs have been used to characterize personality in the general population and shown to be prognostic in depressive and anxiety disorders. Methods: In this study, we used SRJs from a Self-Referential Encoding Task (SRET) to identify clusters from a clinical sample of 119 patients recruited from the Institute of Mental Health presenting with depressive or anxiety symptoms and a non-clinical sample of 115 healthy adults. The generated clusters were examined in terms of most endorsed words, cross-sample correspondence, association with depressive symptoms and the Depressive Experiences Questionnaire and diagnostic category. Results: We identify a 5-cluster solution in each sample and a 7-cluster solution in the combined sample. When perturbed, metrics such as optimum cluster number, criterion value, likelihood, DBI and CHI remained stable and cluster centers appeared stable when using BIC or ICL as criteria. Top endorsed words in clusters were meaningful across theoretical frameworks from personality, psychodynamic concepts of relatedness and self-definition, and valence in self-referential processing. The clinical clusters were labeled "Neurotic" (C1), "Extraverted" (C2), "Anxious to please" (C3), "Self-critical" (C4), "Conscientious" (C5). The non-clinical clusters were labeled "Self-confident" (N1), "Low endorsement" (N2), "Non-neurotic" (N3), "Neurotic" (N4), "High endorsement" (N5). The combined clusters were labeled "Self-confident" (NC1), "Externalising" (NC2), "Neurotic" (NC3), "Secure" (NC4), "Low endorsement" (NC5), "High endorsement" (NC6), "Self-critical" (NC7). Cluster differences were observed in endorsement of positive and negative words, latency biases, recall biases, depressive symptoms, frequency of depressive disorders and self-criticism. Discussion: Overall, clusters endorsing more negative words tended to endorse fewer positive words, showed more negative biases in reaction time and negative recall bias, reported more severe depressive symptoms and a higher frequency of depressive disorders and more self-criticism in the clinical population. SRJ-based clustering represents a novel transdiagnostic framework for subgrouping patients with depressive and anxiety symptoms that may support the future translation of the science of self-referential processing, personality and psychodynamic concepts of self-definition to clinical applications.

Integrated analyses of growth differentiation factor-15 concentration and cardiometabolic diseases in humans.

Growth differentiation factor-15 (GDF15) is a stress response cytokine that is elevated in several cardiometabolic diseases and has attracted interest as a potential therapeutic target. To further explore the association of GDF15 with human disease, we conducted a broad study into the phenotypic and genetic correlates of GDF15 concentration in up to 14,099 individuals. Assessment of 772 traits across 6610 participants in FINRISK identified associations of GDF15 concentration with a range of phenotypes including all-cause mortality, cardiometabolic disease, respiratory diseases and psychiatric disorders, as well as inflammatory markers. A meta-analysis of genome-wide association studies (GWAS) of GDF15 concentration across three different assay platforms (n=14,099) confirmed significant heterogeneity due to a common missense variant (rs1058587; p.H202D) in GDF15, potentially due to epitope-binding artefacts. After conditioning on rs1058587, statistical fine mapping identified four independent putative causal signals at the locus. Mendelian randomisation (MR) analysis found evidence of a causal relationship between GDF15 concentration and high-density lipoprotein (HDL) but not body mass index (BMI). Using reverse MR, we identified a potential causal association of BMI on GDF15 (IVW pFDR = 0.0040). Taken together, our data derived from human population cohorts do not support a role for moderately elevated GDF15 concentrations as a causal factor in human cardiometabolic disease but support its role as a biomarker of metabolic stress.

The impact of intergenerational financial transfers on health and wellbeing outcomes: A longitudinal study.

This paper estimates the impacts of intergenerational financial transfers on the physical health, mental health and perceived financial security of Australian males and females. We distinguish between two key sources of intergenerational financial transfers - inheritances and inter vivos parental cash transfers. Taking nationally representative data from the 2001-2015 Household, Income and Labour Dynamics in Australia Survey, we develop a two-stage modelling strategy that controls for potential bias in reported health and wellbeing responses that arise due to unobserved heterogeneity. In the first stage, propensity score matching is applied to achieve matched treatment and control groups, where the former is comprised of intergenerational financial transfer beneficiaries while the latter is made up of non-beneficiaries with a matched set of characteristics to the beneficiaries. This is followed by the application of regression models that further control for unobservable heterogeneity, so that the coefficients on the intergenerational financial transfer predictors can be attributed to the effect of the transfers on health and wellbeing. We do not find systematic evidence of a causal link between receipt of intergenerational financial transfers and health and wellbeing outcomes. This applies to both inheritances and inter vivos parental cash transfers, and for both males and females.

Work ability, age and intention to leave aged care work.

AIM: To describe the work ability of mature age women workers in Australia's aged care sector, and to explore the relationship between ageing, work ability and intention to leave. METHOD: Logistic regression techniques were applied to a sample of 2721 responses to a survey of mature age women workers in the aged care sector. RESULTS: Mature age women working in the Australian aged care sector have relatively high levels of work ability by international standards. Furthermore, their work ability remains high in their 50s and 60s, in contrast to some prevailing stereotypes. However, work ability is a key determinant of intention to leave in key occupational groups. CONCLUSION: Our findings challenge some prevailing stereotypes about the work ability of mature age workers. However, they lend support for the development of retention strategies, which incorporate programs that target low work ability.

Retaining workers in an ageing population: insights from a representative aged and community care organisation.

AIM: To provide new measures of employee retention in the aged care sector and to identify how employment retention varies across key groups of workers in the sector. METHOD: The techniques of survival analysis were applied to staff record data from a representative provider of aged and community care services. RESULTS: We showed that 63% of carer employment spells end within 2 years. Fifty-seven per cent of nurse employment spells ended within this time period. Employment retention was poorest among young recruits, men and workers on casual contracts. CONCLUSION: The high rates of staff turnover add substantial costs and risks to aged care organisations and should be the focus of workforce strategies. Casual employment is one potential contributory factor. However, the role of wages and other working conditions should also be examined. Given the importance of mature-age women in the sector, strategies should focus on their circumstances and needs.

Impact of an antimicrobial stewardship programme on patient safety in Singapore General Hospital.

Whilst studies have shown that antimicrobial stewardship programmes (ASPs) can effectively reduce antibiotic utilisation, cost of care and even antimicrobial resistance rates, ASPs should avoid the perception that the goal is primarily to reduce antibiotic purchases and costs, instead of focusing on improving the quality of care. In addition, to address the concern of primary physicians who deemed that ASPs' choices of antibiotics were often inadequate, the impact of ASPs on patient safety should be monitored and evaluated. The aim of this study was to analyse the impact of ASP interventions on patient safety in Singapore General Hospital (SGH), a 1559-bed, large, acute, tertiary-care hospital in Singapore. A retrospective database review of data on ASP interventions issued between October 2008 and September 2010 was performed. The database maintained by the ASP team detailed patients' demographic data as well as outcomes of issued interventions. The ASP recommended 1256 interventions in a total of 1249 admissions in six departments. Shorter average length of stay (mean ± standard deviation 19.4 ± 19.9 days vs. 24.2 ± 24.2 days) was observed among patients of physicians who accepted ASP suggestions compared with patients of physicians who rejected ASP interventions (P<0.01). ASP interventions did not alter all-cause mortality (P=0.191). In addition, the number of infection-related re-admissions (P<0.001) and the 14-day re-infection rate (P=0.009) were higher among patients whose physicians rejected ASP interventions. In conclusion, interventions recommended by the ASP in SGH were safe and were associated with a reduction in the duration of hospital stay, 14-day re-infection rate and infection-related re-admissions.

Self-provision in retirement: quantitative evidence on older Australians' expectations and experiences.

OBJECTIVES: To explore factors that correlate with expectations and experiences of self-provision in retirement. METHODS: A regression modelling approach is adopted using a national survey that contains data on the retirement expectations and experiences of older Australians. RESULTS: Older Australians approaching retirement are more likely to expect to be self-funded in retirement if they possess high qualification levels, stable employment and have healthy levels of wealth holdings. Divorced or separated older women are more likely to expect to be welfare-reliant than other groups. The presence of children, disabilities and residence outside major cities do not affect prospective retirees' expectations of being primarily self-funded in retirement, but they do impact negatively on actual self-provision in retirement. Forced retirement will significantly decrease the probability of self-provision in retirement. CONCLUSIONS: Policy reforms that focus on increasing employment opportunities for women after child-bearing and promoting retirement choice will reduce welfare reliance among older Australians.