Liberal or Restrictive Transfusion Strategy in Patients with Traumatic Brain Injury.

BACKGROUND: The effect of a liberal transfusion strategy as compared with a restrictive strategy on outcomes in critically ill patients with traumatic brain injury is unclear. METHODS: We randomly assigned adults with moderate or severe traumatic brain injury and anemia to receive transfusion of red cells according to a liberal strategy (transfusions initiated at a hemoglobin level of ≤10 g per deciliter) or a restrictive strategy (transfusions initiated at ≤7 g per deciliter). The primary outcome was an unfavorable outcome as assessed by the score on the Glasgow Outcome Scale-Extended at 6 months, which we categorized with the use of a sliding dichotomy that was based on the prognosis of each patient at baseline. Secondary outcomes included mortality, functional independence, quality of life, and depression at 6 months. RESULTS: A total of 742 patients underwent randomization, with 371 assigned to each group. The analysis of the primary outcome included 722 patients. The median hemoglobin level in the intensive care unit was 10.8 g per deciliter in the group assigned to the liberal strategy and 8.8 g per deciliter in the group assigned to the restrictive strategy. An unfavorable outcome occurred in 249 of 364 patients (68.4%) in the liberal-strategy group and in 263 of 358 (73.5%) in the restrictive-strategy group (adjusted absolute difference, restrictive strategy vs. liberal strategy, 5.4 percentage points; 95% confidence interval, -2.9 to 13.7). Among survivors, a liberal strategy was associated with higher scores on some but not all the scales assessing functional independence and quality of life. No association was observed between the transfusion strategy and mortality or depression. Venous thromboembolic events occurred in 8.4% of the patients in each group, and acute respiratory distress syndrome occurred in 3.3% and 0.8% of patients in the liberal-strategy and restrictive-strategy groups, respectively. CONCLUSIONS: In critically ill patients with traumatic brain injury and anemia, a liberal transfusion strategy did not reduce the risk of an unfavorable neurologic outcome at 6 months. (Funded by the Canadian Institutes of Health Research and others; HEMOTION ClinicalTrials.gov number, NCT03260478.).

Religiosity and spirituality in the prevention and management of depression and anxiety in young people: a systematic review and meta-analysis.

Historically, religion has had a central role in shaping the psychosocial and moral development of young people. While religiosity and spirituality have been linked to positive mental health outcomes in adults, their role during the developmental context of adolescence, and the mechanisms through which such beliefs might operate, is less well understood. Moreover, there is some evidence that negative aspects of religiosity are associated with poor mental health outcomes. Guided by lived experience consultants, we undertook a systematic review and quality appraisal of 45 longitudinal studies and 29 intervention studies identified from three electronic databases (Medline, PsycINFO and Scopus) exploring the role of religiosity and spiritual involvement (formal and informal) in prevention and management of depression and anxiety in young people aged 10 to 24 years. Most studies were from high-income countries and of low to moderate quality. Meta-analysis of high-quality longitudinal studies (assessed using Joanna Briggs Institute critical appraisal tools, n = 25) showed a trend towards association of negative religious coping (i.e., feeling abandoned by or blaming God) with greater depressive symptoms over time (Pearson's r = 0.09, 95% confidence interval (CI) -0.009, 0.188) whereas spiritual wellbeing was protective against depression (Pearson's r = -0.153, CI -0.187, -0.118). Personal importance of religion was not associated with depressive symptoms overall (Pearson's r = -0.024, CI-0.053, 0.004). Interventions that involved religious and spiritual practices for depression and anxiety in young people were mostly effective, although the study quality was typically low and the heterogeneity in study designs did not allow for a meta-analysis. The lived experience consultants described spirituality and religious involvement as central to their way of life and greatly valued feeling watched over during difficult times. While we require more evidence from low- and middle-income countries, in younger adolescents and for anxiety disorders, the review provides insight into how spirituality and religious involvement could be harnessed to design novel psychological interventions for depression and anxiety in young people.Review RegistrationThe systematic review was funded by Wellcome Trust Mental Health Priority Area 'Active Ingredients' 2021 commission and registered with PROSPERO 2021 (CRD42021281912).

Development of mental health first aid guidelines for problem drinking: a Delphi expert consensus study in Argentina and Chile.

BACKGROUND: Among all psychoactive substances, alcohol consumption presents the most significant public health problem and is a leading risk factor for overall disease burden in Latin America. However, most people who meet criteria for a substance use disorder do not receive treatment in primary or secondary care sources. Community members can play a role in helping people to seek help as they are likely to encounter people experiencing problem drinking and recognize the signs. However, many do not have adequate mental health first aid knowledge or skills to provide help. We aimed to culturally adapt the existing English-language mental health first aid guidelines for helping someone with problem drinking for Argentina and Chile. METHODS: The Delphi consensus method was used to determine the importance of helping actions translated from the English-language guidelines and to add new actions suggested by expert panellists. The importance of each statement was rated by two expert panels. Panel one included people with lived experience (either their own or as a support person, n = 23) recruited in Argentina and panel two included health professionals (n = 31) recruited in Argentina and Chile. RESULTS: Overall, 165 helping actions were endorsed by panellists across two consecutive survey rounds. Endorsed items included 132 of the 182 items translated into Spanish from the English-language guidelines and 33 of the 61 new items generated from panellists' comments in the first survey round. CONCLUSIONS: While there were some similarities in recommended helping actions between English-speaking countries, and Argentina and Chile, key differences were seen in attitudes to low-risk drinking. While there was a relatively high level of agreement between health professionals and people with lived experience, some divergence of opinion was seen, particularly in the area of commitment to recovery as a condition for help. Future research should explore the implementation of the guidelines.

Acetic acid iontophoresis for recalcitrant scarring in post-operative hand patients.

STUDY DESIGN: Retrospective cohort comparison. INTRODUCTION: Using acetic acid iontophoresis (AAI) as a treatment modality significantly improved the functionality of hand in patients with recalcitrant scarring. METHODS: Open trigger finger release patients followed up exclusively at a hand clinic between 2009 and 2011 were analyzed. Group I recovered optimal total active range of motion (TAM) after 14 standard of care (SOC) therapy sessions but Group II (10 digits) could only reach optimal recovery after 7 additional AAI sessions. RESULTS: After SOC therapy, Group I's TAM recovery plateaued at 245 and Group II's at 219 (p < 0.01). After undergoing AAI, the TAM of Group II increased from 219 to 239 (p < 0.01). DISCUSSION: Clinical studies suggest that AAI can modify collagen structure in scars. AAI could be a novel non-surgical treatment for restoring functionality to areas affected by difficult, recalcitrant scars. CONCLUSION: AAI significantly improved the TAM of hand surgical patients who could not recover optimally with SOC therapy alone. LEVEL OF EVIDENCE: Level 3.

Redevelopment of mental health first aid guidelines for substance use problems: a Delphi study.

BACKGROUND: Substance use problems have a major impact on the physical and mental health of individuals, families and communities. Early intervention may have a positive effect on recovery and treatment outcomes for those with substance use problems, reducing related risk and harm. Separate mental health first aid guidelines on how a member of the public could assist someone experiencing or developing alcohol use and drug use problems in high income Western countries were developed using Delphi expert consensus in 2009 and 2011, respectively. This study aimed to synthesise and update these two original guidelines to reflect current evidence and best practice. METHODS: The Delphi expert consensus method was used to determine the inclusion of statements in the redeveloped guidelines. A questionnaire was developed using previously endorsed helping statements from the original guidelines on alcohol and drug use problems, as well as relevant content identified in systematic searches of academic and grey literature. Three panels of experts (people with lived experience, support people and professionals) rated statements over three consecutive online survey rounds to determine the importance of their inclusion in the guidelines. Statements endorsed by at least 80% of each panel were included. RESULTS: 103 panellists completed all three survey rounds. They rated 469 statements and endorsed 300 of these for inclusion in the redeveloped guidelines. CONCLUSIONS: This study has developed a broader and more comprehensive set of guidelines for how to support a person experiencing or developing a substance use problem. The redeveloped guidelines provide more detail on knowledge about and recognition of substance use problems, approaching and assisting people who want to change or are not ready to change, harm reduction, community-based supports and professional help, but have less on physical first aid actions. Mental Health First Aid International will use these guidelines in future updates of their training courses.

Development of the Mental Health Support Scale: A New Measure of Mental Health First Aid Behaviors.

Mental health first aid (MHFA) courses teach community members the knowledge and skills needed to recognize and respond to mental health problems until professional help is received or the crisis resolves. This study aimed to develop a reliable and valid measure of MHFA behaviors. A pool of actions that were recommended and not recommended were selected from MHFA guidelines and developed into two scales measuring either intended or provided support. Items were tested with a sample of 697 adults. Item response theory guided the selection of final items. The Mental Health Support Scale (MHSS) Intended version has 23 items across two subscales and the MHSS-Provided has 12 items across two subscales. These scales demonstrated convergent validity, discrimination between respondents with and without MHFA expertise, and acceptable measurement precision across a range of skill levels. Overall, findings suggest that the MHSS is a valid and useful measure of MHFA behaviors.

Sixteen years on the road: a mobile dental unit for vulnerable communities in Bradford.

Introduction As a means of targeting vulnerable populations to offer care outside the traditional clinical setting, mobile clinics exist that permit clinical teams to travel into the community to provide dental care.Aims To highlight some of the inequalities faced by vulnerable populations, to discuss the benefits of a mobile dental unit (MDU) and how it may address some of these inequalities, and to reflect on some of the achievements of the Bradford MDU.Vulnerable populations Vulnerable communities may include the homeless population, those affected by substance misuse, those suffering with mental health problems, asylum seekers, or an amalgamation. Such groups are likely to have lower expectations of healthcare and may not seek help until oral disease is advanced, with a large proportion likely to have already lost their teeth.Bradford MDU The MDU owned by Bradford Community Dental Service is unique in both its longevity of service and populations it serves, and has been providing an outreach dental service to the vulnerable populations of Bradford for the last 16 years. Whilst the COVID-19 pandemic suspended services during the thick of lockdown, the Bradford MDU is slowly re-opening its services, so the care received by these vulnerable populations is no longer compromised.

Review of Australian initiatives to reduce stigma towards people with complex mental illness: what exists and what works?

BACKGROUND: Australian national mental health policy outlines the need for a nationally coordinated strategy to address stigma and discrimination, particularly towards people with complex mental illness that is poorly understood in the community. To inform implementation of this policy, this review aimed to identify and examine the effectiveness of existing Australian programs or initiatives that aim to reduce stigma and discrimination. METHOD: Programs were identified via a search of academic databases and grey literature, and an online survey of key stakeholder organisations. Eligible programs aimed to reduce stigma towards people with complex mental illness, defined as schizophrenia, psychosis, personality disorder, or bipolar disorder; or they focused on nonspecific 'mental illness' but were conducted in settings relevant to individuals with the above diagnoses, or they included the above diagnoses in program content. Key relevant data from programs identified from the literature search and survey were extracted and synthesized descriptively. RESULTS: We identified 61 programs or initiatives currently available in Australia. These included face-to-face programs (n = 29), online resources (n = 19), awareness campaigns (n = 8), and advocacy work (n = 5). The primary target audiences for these initiatives were professionals (health or emergency), people with mental illness, family or carers of people with mental illness, and members of the general population. Most commonly, programs tended to focus on stigma towards people with non-specific mental illness rather than on particular diagnostic labels. Evidence for effectiveness was generally lacking. Face-to-face programs were the most well-evaluated, but only two used a randomised controlled trial design. CONCLUSIONS: This study identified areas of strength and weakness in current Australian practice for the reduction of stigma towards people with complex mental illness. Most programs have significant input from people with lived experience, and programs involving education and contact with a person with mental illness are a particular strength. Nevertheless, best-practice programs are not widely implemented, and we identified few programs targeting stigma for people with mental illness and their families, or for culturally and linguistically diverse communities, Aboriginal and Torres Strait Islander communities and LGBTIQ people. These can inform stakeholder consultations on effective options for a national stigma and discrimination reduction strategy.

Trends in vaccine-induced immunity to hepatitis B among Canadian street-involved youth.

In Canada, universal and publicly funded hepatitis B immunization programs have been available since 1998 in all provinces and territories. This present study estimates the proportion of having vaccine-induced immunity to hepatitis B virus (HBV) infection and its associated determinants among street-involved youth aged at 15-24 years old in Canada using the data collected by the Enhanced Surveillance of Canadian Street Youth. Vaccine-induced immunity was identified by blood test results of anti-HBc negative and anti-HBs positive. Of the 4,035 participants included in this study, the overall proportion of those with vaccine-induced immunity to HBV was 51.7% during the study period compared to over 90% among the general adolescent population. The proportion of street-involved youth immunized with HBV vaccine increased from 34.7% in 1999 to 64.4% in 2005. Immunity was higher among females (aOR = 1.43, 1.17-1.75) and among those with a reported history of sexually transmitted infection (aOR = 1.30, 1.03-1.63). The proportion of youth with the immunity decreased as age increased (aOR = 0.78, 0.76-0.81, per year increase). Despite an overall increase in the proportion of Canadian street-involved youth with vaccine-induced immunity to HBV, the proportion was still significantly lower than that observed in the general adolescent population. This highlights the need to improve the access to basic health care and the immunization programs to HBV for street-involved youth through creative outreach programs and other multi-faceted approaches.

Offering mental health first aid to a person after a potentially traumatic event: a Delphi study to redevelop the 2008 guidelines.

BACKGROUND: Trauma has a major impact on the mental health and wellbeing of people globally. Friends, family and members of the public are often well positioned to provide initial assistance if someone is experiencing extreme distress following a potentially traumatic event. Expert consensus guidelines for high income, Western countries on how to do this were published in 2008. The aim of the current study was to re-develop these guidelines to ensure they are current and reflect best practice. METHODS: The Delphi consensus method was used to determine which helping statements should be included in the guidelines. Helping statements were derived from a systematic search of literature that considered how a member of the public could help someone experiencing extreme distress following a potentially traumatic event. Two expert panels, comprising 28 mental health professionals with expertise in managing trauma and 26 consumer advocates, rated each statement. Statements were accepted for inclusion in the guidelines if they were endorsed by at least 80% of each panel. RESULTS: Out of 183 statements, 103 were endorsed as appropriate helping actions in providing assistance to someone experiencing extreme distress following a potentially traumatic event. These statements were used to form the re-developed guidelines. CONCLUSION: This study has resulted in a more comprehensive set of guidelines than the original version, with the endorsement of 103 helping actions, compared to 65 previously. The updated guidelines better represent the complexities of experiencing trauma and the considered approach required when providing first aid after a potentially traumatic event. The additional guidance on providing initial assistance, talking about the trauma, offering short-term assistance and seeking appropriate professional help reflects current knowledge. A notable addition is the inclusion of content on how a first aider can assist after a disclosure of abuse. The guidelines are available to the public and will inform future updates of Mental Health First Aid training courses.

Predictors of pertussis outbreak in urban and rural municipalities of Saskatchewan, Canada.

OBJECTIVES: Increased numbers of pertussis cases in September 2015 led to the declaration of an outbreak in the Saskatoon Health Region (SHR). SHR (population approximately 350,000) is a geographic area in central Saskatchewan consisting of both urban and rural municipalities. The purpose of this study was to describe the epidemiology and identify possible predictors of the outbreak. METHODS: Confirmed cases of pertussis in SHR from 2010 to 2015 were extracted from the integrated Public Health Information System (iPHIS) database. Univariate and bivariate analyses and a comparison of the two outbreaks were conducted. Poisson regression modelling was used to estimate incidence rate ratios (IRRs) of factors associated with pertussis infection. OUTCOMES: Two outbreaks between 2010 and 2015. Factors associated with the 2015 outbreak were residence in rural areas (IRR = 18.67, 95% CI 11.82-29.49; 11.37, 95% CI 6.40-20.21; and 6.31, 95% CI 3.43-11.62) for Humboldt, Watrous, and Rosthern areas, respectively, compared to the City of Saskatoon, and among children 11-14 years of age (IRR = 3.11, 95% CI 1.67-5.79) compared to children under 5 years of age. Unvaccinated persons had increased risk (IRR = 1.60, 95% CI 1.07-2.38). Multiple interventions, including enhanced contact tracing, supplemental immunization clinics, and cocooning, were employed in the 2015 outbreak. CONCLUSION: Pertussis is a cyclical disease with outbreaks occurring every 3 to 5 years. Teenagers have increased risk of disease compared to younger children, likely due to waning immunity. Rural residents had a higher incidence of disease, possibly due to clusters of conscientious objectors. Control efforts require recognition of waning immunity and unvaccinated susceptibles.

Epidemiological analysis of Chlamydia trachomatis and Neisseria gonorrhoeae in Saskatoon Health Region.

BACKGROUND: The incidence rates of Chlamydia trachomatis (Ct) and Neisseria gonorrhoeae (GC) in Saskatoon Health Region are approximately double the national average. A descriptive study was designed to try to determine why. METHODS: The objectives of the study were: (1) to determine whether or not the introduction of a new detection method that is less invasive and more sensitive led to more tests being ordered and a higher percentage of positive cases; (2) to determine what percentage of physicians and STI clinic nurses notified Public Health within 72 hours of suspected Ct or GC; (3) to determine what percentage of physicians and STI clinic nurses listed sexual contact information; and (4) to compare recurrence rates between patients treated by physicians and STI clinic nurses. RESULTS: The number of tests ordered for Ct and GC increased substantially from 10,425 in 1998 to 28,885 in 2003, while the percentage of positive cases decreased from 7.2% to 3.6%. Only 1.3% of physicians and 9.1% of STI clinic nurses notified Public Health within 72 hours of a suspected case. 51.2% of physicians listed sexual contact information in comparison to 85.4% of STI clinic nurses. Recurrence rates of Ct or GC within one year of initial treatment were 26% lower for patients treated by STI clinic nurses (5.7%) than for physicians (7.2%). CONCLUSIONS: There is a need for additional education for health care providers in the management of sexually transmitted infections in Saskatoon Health Region.

Prediction of human cases of West Nile virus by equine cases, Saskatchewan, Canada, 2003.

In 2003, an outbreak of West Nile virus (WNV) occurred in Saskatchewan, Canada from July to September. One-hundred thirty-three horse cases and 947 human cases were recorded and data were analyzed retrospectively for evidence of clustering to determine if clinical infection in the horse population could be used to estimate human risk of infection with WNV. Kulldorff's scan statistic was used to identify spatial-temporal clusters in both the human and horse cases. In most areas, human clusters were not preceded by horse clusters. In one area, a significant cluster of horse cases preceded human cases by 1 week; however, 1 week does not provide sufficient time for human-health authorities to act and provide advance warning for the public.

Project Post Intensive Care eXercise (PIX): A qualitative exploration of intensive care unit survivors' perceptions of quality of life post-discharge and experience of exercise rehabilitation.

Patients who survive critical illness often report deterioration in health related quality of life. This has not been shown to improve following post-intensive care unit (ICU) self-directed exercise. The Post Intensive Care eXercise (PIX) study demonstrated improved objectively measured fitness following a supervised exercise programme following critical illness and also suggested beneficial effects on physical and mental health. The qualitative arm of the PIX study reported here utilised focus groups to explore in more detail recovery from critical illness, quality of life following hospital discharge, perceptions of the exercise programme and it's impact on perceived well-being. Sixteen participants (eight of whom underwent the supervised exercise programme) were allocated to four psychologist lead focus groups. Themes identified after hospital discharge centred on social isolation, abandonment, vulnerability and reduced physical activity. However, patients in the exercise group described exercise training as motivating, increasing energy levels and sense of achievement, social interaction and confidence. This study adds to the sparse literature on the patient experience post critical illness. It supports the improvements in physical and mental health suggested with exercise in the PIX study and would support further research in relation to the effects of supervised exercise and rehabilitation programmes post critical illness. It recommends that future comparative outcome studies in this patient population also include interview-based assessment as part of assessment of quality of life and an individual's functional status.

Assessment of student competency in a simulated speech-language pathology clinical placement.

Clinical education programs in speech-language pathology enable the transition of students' knowledge and skills from the classroom to the workplace. Simulated clinical learning experiences provide an opportunity to address the competency development of novice students. This study reports on the validation of an assessment tool designed to evaluate speech-language pathology students' performance in a simulated clinical placement. The Assessment of Foundation Clinical Skills (AFCS) was designed to link to concepts and content of COMPASS(®): Competency Assessment in Speech Pathology, a validated assessment of performance in the workplace. It incorporates units and elements of competency relevant to the placement. The validity of the AFCS was statistically investigated using Rasch analysis. Participants were 18 clinical educators and 130 speech-language pathology students undertaking the placement. Preliminary results support the validity of the AFCS as an assessment of foundation clinical skills of students in this simulated clinical placement. All units of competency and the majority of elements were relevant and representative of these skills. The use of a visual analogue scale which included a pre-Novice level to rate students' performance on units of competency was supported. This research provides guidance for development of quality assessments of performance in simulated placements.

Qualitative investigation of barriers to accessing care by people who inject drugs in Saskatoon, Canada: perspectives of service providers.

BACKGROUND: People who inject drugs (PWID) often encounter barriers when attempting to access health care and social services. In our previous study conducted to identify barriers to accessing care from the perspective of PWIDs in Saskatoon, Canada: poverty, lack of personal support, discrimination, and poor knowledge and coordination of service providers among other key barriers were identified. The purpose of the present investigation was to explore what service providers perceive to be the greatest barriers for PWIDs to receive optimal care. This study is an exploratory investigation with a purpose to enrich the literature and to guide community action. METHODS: Data were collected through focus groups with service providers in Saskatoon. Four focus groups were held with a total of 27 service providers. Data were transcribed and qualitative analysis was performed. As a result, concepts were identified and combined into major themes. RESULTS: Four barriers to care were identified by service providers: inefficient use of resources, stigma and discrimination, inadequate education and the unique and demanding nature of PWIDs. Participants also identified many successful services. CONCLUSION: The results from this investigation suggest poor utilization of resources, lack of continuing education of health care providers on addictions and coping skills with such demanding population, and social stigma and disparity. We recommend improvements in resource utilization through, for example, case management. In addition, sensitivity training and more comprehensive service centers designed to meet PWID's complex needs may improve care. However, community-wide commitment to addressing injection drug issues will also be required for lasting solutions.

Characterizing the acceptability of a vaccine for West Nile virus by public health practitioners.

This study examines health care personnel's knowledge of West Nile virus (WNv) and attitudes towards a proposed chimeric yellow fever/WNv vaccine within the province of Saskatchewan. Telephone and in-person interviews with medical health officers and public health nurses provided information with which to assess the acceptability of implementing vaccination as a component for prevention of WNv within the province with the highest number of WNv cases to date in western Canada. The majority of health care professionals felt confident in the potential efficacy of vaccination for prevention of WNv but suggested that targeted vaccination programs could be most effective.

Five large Chinese biomedical bibliographic databases: accessibility and coverage.

BACKGROUND: Much biomedical research is now undertaken in China. METHODS: Five large biomedical databases originating from China (CBM, CMCC, CNKI, VIP and WANFANG) are described and their utility and accessibility investigated. RESULTS: These databases index 2500 journals largely not familiar to MEDLINE users. Free access, search features, record selection, ease of downloading and cost of subscription varies considerably between databases. CONCLUSION: Searches in all databases benefit from the use of simplified Chinese and all provide links to full text articles. Less than 6% of the 2500 journals in the five databases were listed as being indexed for MEDLINE.

Searching the Polish Medical Bibliography (Polska Bibliografia Lekarska) for trials.

BACKGROUND: The Polish Medical Bibliography (Polska Bibliografia Lekarska) contains 350 000 records dating from 1979. These records from the fields of medicine, nursing, dentistry, health care systems and preclinical sciences are from nearly 300 biomedical journals published in Poland. METHODS: We systematically searched the Polish Medical Bibliography Part II (1996-2006) CD-ROM (July 2006) using both English and Polish phrases for randomized trials, manually checked results and, for the trials identified in this way, sought these on medline and embase. RESULTS: Systematic searching identified records of 680 randomized trials from all areas of health care. Nearly 40% of these were not found on either medline or embase. CONCLUSIONS: The Polish Medical Bibliography should be of interest to health care information specialists concerned with comprehensive searches for trials.