RESUMO
OBJECTIVE: To perform a systematic review of completion rates of cardiac rehabilitation (CR) in adults aged 18 to 50 yr and describe how core components were reported, measured, and tailored to those under 50 yr. REVIEW METHODS: Database search of MEDLINE, Embase, Emcare, PsycINFO, CINAHL, Scopus, and the Cochrane Library based on keywords, including articles from January 1, 1990. The last search was performed on April 21, 2023. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses protocol, eligible articles contained adults (aged between 18 and 50 yr) who had participated in a CR program. SUMMARY: Out of the articles screened (n = 24,517), 33 reports across 31 independent studies were considered eligible (n = 1958 patients aged ≤50 yr). Cardiac rehabilitation completion rates ranged from 64% to 100%; however, only 5 studies presented a completion rate definition. The length of the program ranged from 7 d to 20 wk, with most (65%) ranging between 6 and 12 wk. While the studies included in this systematic review indicated relatively high rates of completing CR, these are likely to overrepresent the true completion rates as few definitions were provided that could be compared to completion rates used in clinical practice. This systematic review also found that all interventions prescribed exercise (eg, aerobic alone or combined with resistance training or yoga) but had very limited inclusion or description of other integral components of CR (eg, initial assessment and smoking cessation) or how they were assessed and individualized to meet the needs of younger attendees.
RESUMO
INTRODUCTION: Retaining nurses in the workforce is an urgent concern in healthcare. Emergency nurses report high levels of stress and burnout, however, there is no gold standard of how to measure these responses. This study aims to measure stress, burnout, and fatigue in emergency nurses using biomarkers and psychometric instruments. Biomarkers will be used to better understand nurses' levels of stress and burnout and to assess the feasibility of using biomarkers as a viable stress measurement tool in a real-world setting. METHODS AND ANALYSIS: A two stage cross-sectional design to measure stress, burnout and fatigue in emergency nurses while they work is proposed. All registered and enrolled nurses working in the emergency department from four hospitals in Australia will be invited to participate. Validated psychometric tools will be used in stage 1 to measure depression, anxiety, acute stress, chronic stress, burnout and fatigue. Biomarkers comprising hair cortisol, saliva alpha amylase and heart rate variability will be collected as an objective measure of stress and burnout in stage 2 over one working shift per participant. Written consent will be sought for stage 2 where nurses will provide one hair sample, wear a heart rate sensor and be asked to collect their saliva at three different time points of one shift. Data analysis will measure the domains of acute stress, chronic stress and burnout and explore relationships and correlation between psychometric measures and biomarkers. ETHICS AND DISSEMINATION: Ethics approval obtained from the Human Research Ethics Committee of the Hunter New England Local Health District (approval number: HREC/2020/ETH01684) and University of Newcastle HREC (H-2022-0169). Results will be reported in peer-reviewed publications using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Public dissemination will occur by presenting at conferences and to the participating local health district.
Assuntos
Esgotamento Psicológico , Enfermeiras e Enfermeiros , Humanos , Estudos Transversais , Estudos de Viabilidade , Fadiga/diagnóstico , BiomarcadoresRESUMO
PURPOSE: The aim was to increase cardiac rehabilitation (CR) uptake using a novel intervention, Rehabilitation Support Via Postcard (RSVP), among patients with acute myocardial infarction discharged from two major hospitals in Hunter New England Local Health District (HNELHD), New South Wales, Australia. METHODS: The RSVP trial was evaluated using a two-armed randomised controlled trial design. Participants (N=430) were recruited from the two main hospitals in HNELHD, and enrolled and randomised to either the intervention (n=216) or control (n=214) group over a six-month period. All participants received usual care; however, the intervention group received postcards promoting CR attendance between January and July 2020. The postcard was ostensibly written as an invitation from the patient's admitting medical officer to promote timely and early uptake of CR. The primary outcome was CR attendance at outpatient HNELHD CR services in the 30-days post-discharge. RESULTS: Fifty-four percent (54%) of participants who received RSVP attended CR, compared to 46% in the control group; however this difference was not statistically significant (odds ratio [OR]=1.4, 95% confidence interval [CI]=0.9-2.0, p=0.11). Exploratory post-hoc analysis among four sub-groups (i.e., Indigeneity, gender, age and rurality), found that the intervention significantly increased attendance in males (OR=1.6, 95%CI=1.0-2.6, p=0.03) but had no significant impact on attendance for other sub-groups. CONCLUSIONS: While not statistically significant, postcards increased overall CR attendance by 8%. This strategy may be useful to increase attendance, particularly in men. Alternative strategies are necessary to increase CR uptake among women, Indigenous people, older people and people from regional and remote locations.
Assuntos
Reabilitação Cardíaca , Infarto do Miocárdio , Masculino , Humanos , Feminino , Idoso , Assistência ao Convalescente , Alta do Paciente , AustráliaRESUMO
Importance: Treatment of ST-segment elevation myocardial infarction (STEMI) in rural settings involves thrombolysis followed by transfer to a percutaneous coronary intervention-capable hospital. The first step is accurate diagnosis via electrocardiography (ECG), but one-third of all STEMI incidents go unrecognized and hence untreated. Objective: To reduce missed diagnoses of STEMI. Design, Setting, and Participants: This cluster randomized clinical trial included 29 hospital emergency departments (EDs) in rural Australia with no emergency medicine specialists, which were randomized to usual care vs automatically triggered diagnostic support from the tertiary referral hospital (management of rural acute coronary syndromes [MORACS] intervention). Patients presenting with symptoms compatible with acute coronary syndromes (ACS) were eligible for inclusion. The study was conducted from December 2018 to April 2020. Data were analyzed in August 2021. Intervention: Triage of a patient with symptoms compatible with ACS triggered an automated notification to the tertiary hospital coronary care unit. The ECG and point-of-care troponin results were reviewed remotely and a phone call was made to the treating physician in the rural hospital to assist with diagnosis and initiation of treatment. Main Outcomes and Measures: The proportion of patients with missed STEMI diagnoses. Results: A total of 6249 patients were included in the study (mean [SD] age, 63.6 [12.2] years; 48% female). Of 7474 ED presentations with suspected ACS, STEMI accounted for 77 (2.0%) in usual care hospitals and 46 (1.3%) in MORACS hospitals. Missed diagnosis of STEMI occurred in 27 of 77 presentations (35%) in usual care hospitals and 0 of 46 (0%) in MORACS hospitals (P < .001). Of eligible patients, 48 of 75 (64%) in the usual care group and 36 of 36 (100%) in the MORACS group received primary reperfusion (P < .001). In the usual care group, 12-month mortality was 10.3% (n = 8) vs 6.5% (n = 3) in the MORACS group (relative risk, 0.64; 95% CI, 0.18-2.23). Patients with missed STEMI diagnoses had a mortality of 25.9% (n = 7) compared with 2.0% (n = 1) for those with accurately diagnosed STEMI (relative risk, 13.2; 95% CI, 1.71-102.00; P = .001). Overall, there were 6 patients who did not have STEMI as a final diagnosis; 5 had takotsubo cardiomyopathy and 1 had pericarditis. There was no difference between groups in the rate of alternative final diagnosis. Conclusion and Relevance: The findings indicate that MORACS diagnostic support service reduced the proportion of missed STEMI and improved the rates of primary reperfusion therapy. Accurate diagnosis of STEMI was associated with lower mortality. Trial Registration: anzctr.org.au Identifier: ACTRN12619000533190.
Assuntos
Síndrome Coronariana Aguda , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Síndrome Coronariana Aguda/tratamento farmacológico , Síndrome Coronariana Aguda/terapia , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Fatores de TempoRESUMO
OBJECTIVE: To explore the experiences and perceptions of staff regarding the use of individualised music for people with dementia living in residential aged care. METHODS: A qualitative descriptive methodology was used. Methods included a focus group and face-to-face interviews, open-ended responses to a pre-post survey and relevant clinical notes about older participants' responses. Qualitative content analysis was used to analyse data. RESULTS: There were four themes: (1) transcendental reminiscing, the calm, the joy and the elation; (2) optimism, excitement and the snowball effect; (3) pitching in for older person, it is not rocket science and the hurdles; and (4) music beyond the intervention. CONCLUSIONS: Overall, the individualised music was a generally positive experience. While some older participants reported discomfort with the use of headphones, staff concerns related to care and accessibility of music equipment.
Assuntos
Demência , Música , Idoso , Demência/diagnóstico , Demência/terapia , Grupos Focais , Humanos , Pesquisa QualitativaRESUMO
OBJECTIVES: Bangladesh has achieved notable success in improving maternal health by increasing women's access to good quality and low-cost maternal health care (MHC) services. However, the health system of Bangladesh has earned criticism for not ensuring equitable MHC access for all women, particularly for Indigenous women in the Chittagong Hill Tracts (CHT). Little is known about Indigenous communities' perspectives on these inequalities in MHC service access in the CHT. Therefore, this study aimed to explore Indigenous communities' perspectives on challenges and opportunities for improving MHC service access in the CHT. DESIGN: This qualitative descriptive study was conducted in two sub-districts of Khagrachhari between September 2017 and February 2018. Eight Indigenous key informants from three Indigenous communities (Chakma, Marma and Tripura) were recruited via snowballing and purposive techniques and participated in face-to-face, semi-structured interviews. Key informants comprised community leaders and health care providers. Data were analysed thematically using Nvivo12 software. RESULTS: Findings suggest that distance, poor availability of resources and infrastructure, lack of community engagement in the design of health interventions, Indigenous cultural beliefs, misconceptions about MHC services, and maltreatment from health care providers were the key barriers to accessing MHC services; all are interconnected. Indigenous women faced humiliation and maltreatment from MHC staff. Failure to provide a culturally-safe environment suggests a lack of cultural competency among health staff, including Indigenous staff. CONCLUSION: Findings suggest that cultural competency training for all health care providers is needed to improve cultural appropriateness and accessibility of services. Refresher training and undisrupted supply of basic MHC services for front-line care providers will benefit the entire community and will likely be cost-effective for the government. Designing health programmes through extensive community consultation is essential.
Assuntos
Serviços de Saúde do Indígena , Serviços de Saúde Materna , Bangladesh , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Saúde Materna , Gravidez , Pesquisa QualitativaRESUMO
BACKGROUND: Suicide rates are higher in rural Australia than in major cities, although the factors contributing to this are not well understood. This study highlights trends in suicide and examines the prevalence of mental health problems and service utilisation of non-Indigenous Australians by geographic remoteness in rural Australia. METHODS: A retrospective study of National Coronial Information System data of intentional self-harm deaths in rural New South Wales, Queensland, South Australia and Tasmania for 2010-2015 from the National Coronial Information System. RESULTS: There were 3163 closed cases of intentional self-harm deaths by non-Indigenous Australians for the period 2010-2015. The suicide rate of 12.7 deaths per 100,000 persons was 11% higher than the national Australian rate and increased with remoteness. Among people who died by suicide, up to 56% had a diagnosed mental illness, and a further 24% had undiagnosed symptoms. Reported diagnoses of mental illness decreased with remoteness, as did treatment for mental illness, particularly in men. The most reported diagnoses were mood disorders (70%), psychotic disorders (9%) and anxiety disorders (8%). In the six weeks before suicide, 22% of cases had visited any type of health service at least once, and 6% had visited two or more services. Medication alone accounted for 76% of all cases treated. CONCLUSIONS: Higher suicide rates in rural areas, which increase with remoteness, may be attributable to decreasing diagnosis and treatment of mental disorders, particularly in men. Less availability of mental health specialists coupled with socio-demographic factors within more remote areas may contribute to lower mental health diagnoses and treatment. Despite an emphasis on improving health-seeking and service accessibility in rural Australia, research is needed to determine factors related to the under-utilisation of services and treatment by specific groups vulnerable to death by suicide.
Assuntos
Serviços de Saúde Mental/estatística & dados numéricos , Saúde Mental/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , População Rural/estatística & dados numéricos , Suicídio/psicologia , Suicídio/estatística & dados numéricos , Adulto , Austrália , Feminino , Humanos , Masculino , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Estudos RetrospectivosRESUMO
INTRODUCTION: Seclusion use is high in forensic mental health settings and is associated with avoidable physical and psychological harm. The use of seclusion causes significant distress and trauma for those secluded and women in these settings are particularly vulnerable. This study protocol aims to identify factors associated with the use of seclusion and the experience of seclusion for women in forensic mental health settings. METHODS AND ANALYSIS: This study will use a prospective mixed-methods design. Quantitative data on the frequency and duration of seclusion and potential explanatory demographic and clinical variables will be collected prospectively from consecutive medical records of women admitted to a forensic mental health service over a 2-year period. Data will be analysed using descriptive statistics and logistic regression techniques. Qualitative data will be collected from individual face-to-face semistructured interviews with women who have experienced seclusion about the reason for seclusion, whether they agreed with the reason for seclusion, their experience of the seclusion event and the seclusion environment and support provided while in seclusion using qualitative description methods. Data will be analysed using thematic analysis. ETHICS AND DISSEMINATION: Ethical approval has been granted by the University of Newcastle Human Research Ethics Committee (H-2019-0122) and organisational support granted from the participating forensic mental health service. Participation will be voluntary and written informed consent is required. Results will be disseminated via the first author's doctoral thesis, in peer-reviewed journals and at conferences. Results will inform recommendations for policy, and evidence for timely and specific interventions to support the reduction of seclusion for women in forensic mental health settings.
Assuntos
Transtornos Mentais , Serviços de Saúde Mental , Feminino , Humanos , Transtornos Mentais/terapia , Saúde Mental , Isolamento de Pacientes , Estudos ProspectivosRESUMO
OBJECTIVES: To explore and map the evidence for virtual reality and artificial intelligence in simulation for the provision of pain education for pre and post registration nurses. DESIGN: A scoping review of published and unpublished research from 2009 to 2019. DATA SOURCES: Nine electronic databases and hand-searching of reference lists. REVIEW METHODS: Studies were included if virtual reality or artificial intelligence interventions were used for education on pain care provision in nursing. Data were extracted and charted using an extraction tool and themes were explored using narrative analysis. RESULTS: The review process resulted in the inclusion of four published studies. All studies used mixed methods and used artificial intelligence within clinical simulations as an intervention. No studies using virtual reality for pain education met the inclusion criteria. Participants of three studies were undergraduate nursing students in universities and participants in the fourth study were registered nurses within a hospital. Outcomes measured were user acceptance of the technology and feasibility in all studies. The context was hospital located and focused on acute pain episodes, with one exception being sickle cell pain. Three studies had adult patients and the other pediatric patients. The exclusion of input from a patient perspective was notable, as was a lack of interdisciplinary involvement. CONCLUSION: Nurses are integral to the assessment and management of pain in many care settings requiring comprehensive communication and clinical skills. There is a paucity of research on the use of virtual reality or artificial intelligence in pain education for nurses. Current studies are preliminary in nature and/or pilot studies. Further empirical research, with robust design is required to inform nursing education, practice, and policy, thereby supporting the advancement of nursing pain education.
Assuntos
Bacharelado em Enfermagem , Estudantes de Enfermagem , Realidade Virtual , Adulto , Inteligência Artificial , Criança , Humanos , DorRESUMO
OBJECTIVE: To estimate the prevalence of facility delivery knowledge and access during childbirth amongst Indigenous women in the Chittagong Hill Tracts, Bangladesh and to identify factors associated with facility delivery service utilisation. DESIGN: A cross-sectional study design using a structured self-report survey. SETTING: Two Upazilas (subdistricts) of Kharachhari hill district of the Chittagong Hill Tracts. PARTICIPANTS: Indigenous women of reproductive age (15-49 years) within 36 months of delivery. MEASUREMENTS AND FINDINGS: A modified national survey about accessing maternal health services, including delivery services was administered to all Indigenous women that met eligibility, guided by community leaders. Data collected included socio-demographic characteristics and reproductive history. Main outcome variables were the proportion of women having prior knowledge about and access to facility delivery services for childbirth in the three years prior to the survey. Secondary outcomes were sources of information about facility delivery services, decision making about delivery place, and factors associated with knowledge and attendance at facility delivery services. Factors associated with knowledge and attendance were estimated using logistic regression with results reported as adjusted odds ratios and 95% confidence intervals. With an 89% response rate, a total of 438 Indigenous women (220 Chakma, 100 Marma, 118 Tripura) participated in the survey, and 75% were aged 16-29 years. Relatives played a vital role as a source of information about delivery services (59%). Nearly three-quarters (73%) were aware of facility delivery services, however, prevalence of accessing delivery services was 33% (n = 143; 95% CI 0.28-0.37). Relatives were the key decision-makers for accessing facility delivery services (60%). Independent factors associated with knowledge about facility delivery were higher household income (AOR 5.3, 95%CI 2.2-13); having knowledge of nearest health care facilities (AOR 5.8, 95%CI 3.0-11); and attending antenatal care visits during last pregnancy (four or more AOR 3.1, 95% CI 1.3-7.2 and one to three visits AOR 2.7, 95% CI 1.5-5.0). Independent factors associated with accessing facility delivery services at childbirth were attending antenatal care visit; having access to media; higher level of education of partners; and residing at Khagrachhari Sadar compared to Matiranga subdistrict. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Indigenous women in Chittagong Hill Tracts, Bangladesh have sub-optimal knowledge of, and attendance at, facility delivery services for childbirth. Maternal health related interventions should target Indigenous women in order to educate and motivate them to access facility delivery services at childbirth. Rigorous research is needed to explore Indigenous cultural practices related to childbirth that might influence their access to facility delivery services.
Assuntos
Acessibilidade aos Serviços de Saúde/normas , Povos Indígenas/psicologia , Serviços de Saúde Materna/normas , Atenção Primária à Saúde/métodos , Adolescente , Adulto , Bangladesh , Estudos Transversais , Feminino , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Povos Indígenas/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Gravidez , Prevalência , Atenção Primária à Saúde/estatística & dados numéricos , Autorrelato , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: Mental health peer support workers draw on lived experience to provide benefit to people experiencing mental distress. People living in rural areas are less likely than their urban counterparts to seek professional help for psychological distress. The aim of this study was to explore the perceived value of rural peer support workers as facilitators to rural mental health help-seeking. DESIGN: Data were gathered through a cross-sectional survey distributed by a social media boosted post. SETTING: A total of 349 "small" rural towns in New South Wales as defined by the Modified Monash Model classification system as MMM5. PARTICIPANTS: A total of 765 adult, rural residents completed the survey. MAIN OUTCOME MEASURE(S): Participants were asked to select, from a list of potential facilitators, those which they felt would make mental health help-seeking easier or harder. RESULTS: Study participants felt that a help provider with lived experience of mental illness or distress would make mental health help-seeking easier. Similarly, rural life experience in a help provider was thought to facilitate help-seeking. Participants also believed that flexible and informal meeting settings would make it easier to seek help for mental distress. CONCLUSIONS: Engaging rural mental health peer support workers in a flexible/informal setting, as a complement to conventional health service provision, may increase rural help-seeking for mental distress. Increased mental health help-seeking is likely to have a positive impact on instances of serious mental illness.
Assuntos
Comportamento de Busca de Ajuda , Serviços de Saúde Mental , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Grupo Associado , Saúde da População Rural , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New South Wales , População RuralRESUMO
OBJECTIVE: To summarise the evidence regarding the impact of individualised music listening on persons with dementia. METHODS: Six electronic databases (CINAHL, Medline, ProQuest, PsycINFO, Music Periodicals and Cochrane) were searched up to July 2018 for randomised controlled trials (RCTs) evaluating the efficacy of individualised music listening compared to other music and non-music-based interventions. RESULTS: Four studies were included. Results showed evidence of a positive impact of individualised music listening on behavioural and psychological symptoms of dementia (BPSDs) including agitation, anxiety and depression and physiological outcomes. Evidence for other outcomes such as cognitive function and quality of life was limited. CONCLUSIONS: The limited evidence suggests individualised music listening has comparable efficacy to more resource-intensive interventions. However, there was a small number of RCTs and some outcomes were evaluated by a single study. This limits the conclusions drawn, warranting more RCTs evaluating other outcomes beyond the BPSDs.
Assuntos
Demência/psicologia , Musicoterapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Afeto , Ansiedade/prevenção & controle , Demência/fisiopatologia , Depressão/prevenção & controle , Humanos , Agitação PsicomotoraRESUMO
Disproportionate rates of suicide in rural Australia in comparison to metropolitan areas pose a significant public health challenge. The dynamic interrelationship between mental and physical health, social determinants, and suicide in rural Australia is widely acknowledged. Advancement of this knowledge, however, remains hampered by a lack of adequate theory and methods to understand how these factors interact, and the translation of this knowledge into constructive strategies and solutions. This paper presents a protocol for generating a comprehensive dataset of suicide deaths and factors related to suicide in rural Australia, and for building a program of research to improve suicide prevention policy and practice to better address the social determinants of suicide in non-indigenous populations. The two-phased study will use a mixed-methods design informed by intersectionality theory. Phase One will extract, code, and analyse quantitative and qualitative data on suicide in regional and remote Australia from the National Coronial Information System (NCIS). Phase Two will analyse suicide prevention at three interrelated domains: policy, practice, and research, to examine alignment with evidence generated in Phase One. Findings from Phase One and Two will then be integrated to identify key points in suicide prevention policy and practice where action can be initiated.
Assuntos
População Rural , Suicídio/psicologia , Austrália , Humanos , Projetos de Pesquisa , Determinantes Sociais da Saúde , Prevenção do SuicídioRESUMO
BACKGROUND: Intensive care unit nurses are critical for managing mechanical ventilation. Continuing education is essential in building and maintaining nurses' knowledge and skills, potentially improving patient outcomes. AIMS: The aim of this study was to determine whether continuing education programmes on invasive mechanical ventilation involving intensive care unit nurses are effective in improving patient outcomes. METHODS: Five electronic databases were searched from 2001 to 2016 using keywords such as mechanical ventilation, nursing and education. Inclusion criteria were invasive mechanical ventilation continuing education programmes that involved nurses and measured patient outcomes. Primary outcomes were intensive care unit mortality and in-hospital mortality. Secondary outcomes included hospital and intensive care unit length of stay, length of intubation, failed weaning trials, re-intubation incidence, ventilation-associated pneumonia rate and lung-protective ventilator strategies. Studies were excluded if they excluded nurses, patients were ventilated for less than 24 h, the education content focused on protocol implementation or oral care exclusively or the outcomes were participant satisfaction. Quality was assessed by two reviewers using an education intervention critical appraisal worksheet and a risk of bias assessment tool. Data were extracted independently by two reviewers and analysed narratively due to heterogeneity. RESULTS: Twelve studies met the inclusion criteria for full review: 11 pre- and post-intervention observational and 1 quasi-experimental design. Studies reported statistically significant reductions in hospital length of stay, length of intubation, ventilator-associated pneumonia rates, failed weaning trials and improvements in lung-protective ventilation compliance. Non-statistically significant results were reported for in-hospital and intensive care unit mortality, re-intubation and intensive care unit length of stay. CONCLUSION: Limited evidence of the effectiveness of continuing education programmes on mechanical ventilation involving nurses in improving patient outcomes exists. Comprehensive continuing education is required. RELEVANCE TO CLINICAL PRACTICE: Well-designed trials are required to confirm that comprehensive continuing education involving intensive care nurses about mechanical ventilation improves patient outcomes.
Assuntos
Enfermagem de Cuidados Críticos/educação , Educação Continuada em Enfermagem , Unidades de Terapia Intensiva , Respiração Artificial/métodos , Respiração Artificial/enfermagem , Cuidados Críticos , Mortalidade Hospitalar , Humanos , Tempo de Internação , Respiração Artificial/mortalidadeRESUMO
Limited longitudinal research has examined relationships between depression and injury, particularly in rural contexts. This paper reports cross-sectional and longitudinal analyses from the Australian Rural Mental Health Study (ARMHS) exploring relationships between "probable depression" episodes and unintentional injury. Participants completed four surveys over five years. Multivariate logistic regressions were employed to assess the causal effect of prior depression episodes on subsequent injury risk. Of 2621 baseline participants, 23.3% experienced a probable depression episode recently and 15.9% reported a serious injury during the previous 12 months. Factors associated with a 12-month injury at baseline included male gender, being unemployed or unable to work, being involved in a serious incident, hazardous alcohol use, and having experienced a recent depression episode. Longitudinal analyses revealed that probable depression was significantly associated with subsequent unintentional injury (OR 1.68, 99%CI 1.20-2.35), as was male gender (OR 1.39, 99%CI 1.06-1.82), while alcohol consumption did not mediate these relationships. Campaigns to reduce the impact of mental illness should consider unintentional injuries as a contributor, while injury prevention initiatives may benefit from addressing mental health issues. Such strategies are particularly important in rural and remote areas where injuries are more common and mental health services are less readily available.
Assuntos
Depressão/epidemiologia , Saúde Mental , População Rural/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Adulto , Idoso , Consumo de Bebidas Alcoólicas/epidemiologia , Austrália/epidemiologia , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: The aim of the study was to determine how much of the association between obesity, measured by body mass index (BMI), and cognition in older persons is mediated through inflammation, fasting plasma glucose, and hypertriglyceridemia. METHODS: Anthropometrics, high-sensitivity C-reactive protein (CRP), fasting plasma glucose, and serum triglycerides were measured in 3,256 community-dwelling individuals aged 55-85 years residing in Newcastle, New South Wales, Australia. Audio recorded cognitive screen (ARCS) was used to assess multiple cognitive domains. RESULTS: Mediation analyses showed very modest but significant direct mediation effects, whereby obesity was associated with better cognitive function after adjusting for potential confounders (controlled direct effect ≈ 1/500 point increase in the total ARCS score per 1.0-kg/m2 increase in BMI). There were significant indirect negative mediation effects from BMI to cognition mediated through CRP, that is, increased BMI was associated with increased CRP which was associated with decreased cognition (natural indirect effect -0.20 unit; 95% confidence interval [CI] -0.39, -0.02), and through fasting plasma glucose, that is, increased BMI was associated with increased fasting plasma glucose which was associated with decreased cognition (natural indirect effect -0.12 unit; 95% CI -0.24, -0.01], but not through serum triglycerides. CONCLUSIONS: There is a weak positive association between obesity and cognitive performance in older persons, which is partially antagonized by inflammation and elevated fasting plasma glucose, but not hypertriglyceridemia. Further studies are needed to elucidate whether this is due to selection bias, or truly reflects biologically complex and counter balancing pathways involved in obesity.
Assuntos
Glicemia/metabolismo , Transtornos Cognitivos/sangue , Hipertrigliceridemia/sangue , Obesidade/sangue , Idoso , Idoso de 80 Anos ou mais , Antropometria , Biomarcadores/sangue , Índice de Massa Corporal , Proteína C-Reativa/metabolismo , Feminino , Humanos , Inflamação/sangue , Masculino , Pessoa de Meia-Idade , New South Wales , Fatores de RiscoRESUMO
Disengagement from services is common before suicide, hence identifying factors at treatment presentation that predict future suicidality is important. This article explores risk profiles for suicidal ideation among treatment seekers with depression and substance misuse. Participants completed assessments at baseline and 6 months. Baseline demographics, psychiatric history, and current symptoms were entered into a decision tree to predict suicidal ideation at follow-up. Sixty-three percent of participants at baseline and 43.5% at follow-up reported suicidal ideation. Baseline ideation most salient when psychiatric illness began before adulthood, increasing the rate of follow-up ideation by 16%. Among those without baseline ideation, dysfunctional attitudes were the most important risk factor, increasing rates of suicidal ideation by 35%. These findings provide evidence of factors beyond initial diagnoses that increase the likelihood of suicidal ideation and are worthy of clinical attention. In particular, providing suicide prevention resources to those with high dysfunctional attitudes may be beneficial.
Assuntos
Transtorno Depressivo/diagnóstico , Transtorno Depressivo/psicologia , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/psicologia , Ideação Suicida , Tentativa de Suicídio/psicologia , Adulto , Comorbidade , Transtorno Depressivo/terapia , Diagnóstico Duplo (Psiquiatria)/métodos , Diagnóstico Duplo (Psiquiatria)/psicologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/terapia , Tentativa de Suicídio/prevenção & controleRESUMO
BACKGROUND: This study examines the long-term outcomes of lifetime trauma exposure, including factors that contribute to the development of PTSD, in a sample of rural adults. METHODS: In 623 rural community residents, lifetime trauma exposure, PTSD, other psychiatric disorders and lifetime suicidal ideation were assessed using the World Mental Health Composite International Diagnostic Interview. Logistic regressions were used to examine relationships between potentially traumatic events (PTEs) and lifetime PTSD and other diagnoses. RESULTS: 78.2% of participants reported at least on PTE. Rates were broadly comparable with Australian national data: the most commonly endorsed events were unexpected death of a loved one (43.7%); witnessing injury or death (26.3%); and life-threatening accident (19.3%). While the mean age of the sample was 55 years, the mean age of first trauma exposure was 19 years. The estimated lifetime rate of PTSD was 16.0%. Events with the strongest association with PTSD were physical assault and unexpected death of a loved one. Current functioning was lowest among those with current PTSD, with this group reporting elevated psychological distress, higher mental health service use, a greater number of comorbidities, and lower perceived social support. Respondents with a past PTE but no PTSD history were generally similar in terms of their current wellbeing to those with no lifetime PTE. CONCLUSIONS: PTEs may have diverse psychological and social consequences beyond the development of PTSD. Ensuring that adequate support services are available in rural areas, particularly in the period immediately following a PTE, may reduce the long-term impact of traumatic events.
Assuntos
População Rural , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Ideação Suicida , Adulto , Idoso , Austrália/epidemiologia , Comorbidade , Feminino , Humanos , Modelos Logísticos , Masculino , Transtornos Mentais/epidemiologia , Saúde Mental , Serviços de Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Fatores de TempoRESUMO
BACKGROUND: Meta-analyses indicate 50% of cases of depression are not detected by GPs. It is important to examine patient and GP characteristics associated with misclassification so that systems can be improved to increase accurate detection and optimal management for groups at risk of depression. OBJECTIVE: To examine patient and GP characteristics associated with GP misclassification of depression for patients classified by the Patient Health Questionnaire-9 as depressed. METHODS: A cross-sectional study within general practices in two states of Australia. GPs completed a one-page paper and pencil survey indicating whether they thought each patient was clinically depressed. Patients completed a computer tablet survey while waiting for their appointment to provide demographic information and indicate depression status. Chi-square analyses were used to determine whether patient and GP characteristics were associated with a false-negative and false-positive result. The probability of misclassification was modelled using Generalized Estimating Equations to account for clustering of patients. RESULTS: Fifty GPs from 12 practices participated. GPs completed surveys for 1880 patients. Younger patients aged 25-44, and those with a health care card were less likely to have a false-negative assessment. Patients with 0-3 GP visits in the past 12 months, and those with private health insurance were less likely to have a false-positive assessment. GPs who worked five sessions or fewer per week were more likely to make false-positive assessments.
Assuntos
Transtorno Depressivo/diagnóstico , Erros de Diagnóstico/estatística & dados numéricos , Clínicos Gerais/estatística & dados numéricos , Pacientes/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Austrália , Estudos Transversais , Transtorno Depressivo/classificação , Feminino , Humanos , Seguro Saúde/classificação , Seguro Saúde/economia , Seguro Saúde/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Havaiano Nativo ou Outro Ilhéu do Pacífico , Razão de Chances , Inquéritos e Questionários , População Branca , Adulto JovemRESUMO
BACKGROUND: Rural and remote Australians face a range of barriers to mental health care, potentially limiting the extent to which current services and support networks may provide assistance. This paper examines self-reported mental health problems and contacts during the last 12 months, and explores cross-sectional associations between potential facilitators/barriers and professional and non-professional help-seeking, while taking into account expected associations with socio-demographic and health-related factors. METHODS: During the 3-year follow-up of the Australian Rural Mental Health Study (ARMHS) a self-report survey was completed by adult rural residents (N = 1,231; 61% female; 77% married; 22% remote location; mean age = 59 years), which examined socio-demographic characteristics, current health status factors, predicted service needs, self-reported professional and non-professional contacts for mental health problems in the last 12 months, other aspects of help-seeking, and perceived barriers. RESULTS: Professional contacts for mental health problems were reported by 18% of the sample (including 14% reporting General Practitioner contacts), while non-professional contacts were reported by 16% (including 14% reporting discussions with family/friends). Perceived barriers to health care fell under the domains of structural (e.g., costs, distance), attitudinal (e.g., stigma concerns, confidentiality), and time commitments. Participants with 12-month mental health problems who reported their needs as met had the highest levels of service use. Hierarchical logistic regressions revealed a dose-response relationship between the level of predicted need and the likelihood of reporting professional and non-professional contacts, together with associations with socio-demographic characteristics (e.g., gender, relationships, and financial circumstances), suicidal ideation, and attitudinal factors, but not geographical remoteness. CONCLUSIONS: Rates of self-reported mental health problems were consistent with baseline findings, including higher rural contact rates with General Practitioners. Structural barriers displayed mixed associations with help-seeking, while attitudinal barriers were consistently associated with lower service contacts. Developing appropriate interventions that address perceptions of mental illness and attitudes towards help-seeking is likely to be vital in optimising treatment access and mental health outcomes in rural areas.