The mental health of Australians bereaved during the first two years of the COVID-19 pandemic: a latent class analysis.

BACKGROUND: The COVID-19 pandemic disrupted many areas of life, including culturally accepted practices at end-of-life care, funeral rites, and access to social, community, and professional support. This survey investigated the mental health outcomes of Australians bereaved during this time to determine how these factors might have impacted bereavement outcomes. METHODS: An online survey indexing pandemic and bereavement experiences, levels of grief, depression, anxiety, and health, work, and social impairment. Latent class analysis (LCA) was used to identify groups of individuals who shared similar symptom patterns. Multinomial regressions identified pandemic-related, loss-related, and sociodemographic correlates of class membership. RESULTS: 1911 Australian adults completed the survey. The LCA identified four classes: low symptoms (46.8%), grief (17.3%), depression/anxiety (17.7%), and grief/depression/anxiety (18.2%). The latter group reported the highest levels of health, work, and social impairment. The death of a child or partner and an inability to care for the deceased due to COVID-19 public health measures were correlated with grief symptoms (with or without depression and anxiety). Preparedness for the person's death and levels of pandemic-related loneliness and social isolation differentiated all four classes. Unemployment was associated with depression/anxiety (with or without grief). CONCLUSIONS: COVID-19 had profound impacts for the way we lived and died, with effects that are likely to ricochet through society into the foreseeable future. These lessons learned must inform policymakers and healthcare professionals to improve bereavement care and ensure preparedness during and following future predicted pandemics to prevent negative impacts.

Filters and hubs: shortening the distance to palliative care evidence.

Palliative care is an integral part of the care provided by GPs and other primary health care providers, and as Australia's population ages and the palliative care needs of patients with end stage organ failure are recognised, this area of care is likely to increase. Using a knowledge translation framework, two strategies have been used to develop resources to support those providing palliative care in the community. PubMed searches on a range of common palliative care topics and incorporating a palliative care filter provide an easy and validated mechanism to retrieve relevant literature. A 'GP Hub' offers knowledge, skills and practical advice for GPs who provide palliative care in the community. Both resources are freely available within the CareSearch website, ensuring immediate access to palliative care information and evidence when it is needed.

Evaluation of an online toolkit for carers of people with a life-limiting illness at the end-of-life: health professionals' perspectives.

Carers of people with a life-limiting illness report unmet information, practical, and emotional support needs, and are often unaware of services available to help improve preparedness, wellbeing, and reduce strain. CarerHelp is the first e-health toolkit that focuses on the information and support needs of carers of people with a life-limiting illness at the end-of-life, using a pathway approach. This study investigated the usefulness of CarerHelp, from the perspective of health professionals who care for these people. Through a 10-min online survey, health professionals provided feedback about their user experience and perceived usefulness of the website. Their expert opinion was sought to ascertain whether CarerHelp could increase carers' preparedness and confidence to support the person for whom they are caring and thereby improve carers' own psychological wellbeing. Health professionals also evaluated whether CarerHelp adequately raised awareness of support services available. CarerHelp was perceived as a useful resource for increasing preparedness for the caring role, including physical tasks and emotional support. Health professionals reported that CarerHelp would increase carers' knowledge of services, confidence to care and ability for self-care. Health professionals endorsed CarerHelp as a useful information source, guide for support, and would promote CarerHelp to clients and their families.

Multiple sources: mapping the literature of palliative care.

Palliative care is an increasingly important area of clinical practice and health service delivery. The heterogeneity of the patient population and the multidisciplinary nature of care draw on knowledge from many fields of clinical practice and academic enquiry. This has implications for the retrieval of evidence and literature and the spread of new knowledge in palliative care. This study shows that the CINAHL, Embase and PsycINFO bibliographic databases hold sizeable repositories of palliative care articles not indexed on Medline. It also highlights the number and range of journals publishing palliative care content. In 2005 alone, 1985 journals published 6983 items. These findings show the challenges for palliative care professionals in managing the complex evidence base for this diverse field of care and the importance of mechanisms that facilitate the identification of palliative care information. Dissemination strategies that ensure that new knowledge reaches the many audiences implicit in the range of journals publishing palliative care are also critical in supporting improvements in clinical practice and service delivery.

Temporal lobe regions on magnetic resonance imaging identify patients with early Alzheimer's disease.

OBJECTIVE: The goal of the study was to examine the volume of selected brain regions in a group of mildly impaired patients with Alzheimer's disease (AD). Five regions were selected for analysis, all of which have been reported to show substantial change in the majority of patients with AD at some time in the course of disease. DESIGN: Case-control study with the experimenter "blinded." SETTING: Hospital-based magnetic resonance imaging center. PARTICIPANTS: Fifteen subjects, eight patients with the diagnosis of probable dementia of the Alzheimer type made in concordance with National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association criteria and seven age-matched healthy control subjects. RESULTS: Three of the volumetric measures were significantly different between patients with AD and controls: the hippocampus, the temporal horn of the lateral ventricles, and the temporal lobe. Two of the measures did not significantly differentiate patients with AD and controls: the amygdala and the basal forebrain. A discriminant function analysis demonstrated that a linear combination of the volumes of the hippocampus and the temporal horn of the lateral ventricles differentiated 100% of the patients and controls from one another. CONCLUSIONS: The results suggest that the hippocampus and the temporal horn of the lateral ventricles may be useful as antemortem markers of AD in mildly impaired patients.

Comparative analysis of computed tomographic and magnetic resonance imaging scans in Alzheimer patients and controls.

Ten patients with Alzheimer's disease underwent computed tomography and magnetic resonance imaging at the same point in time. The mean Mini-Mental State examination score of the patients was 23, indicating that they were mildly impaired. Ten age-equivalent controls also obtained computed tomographic and magnetic resonance imaging scans. A semiautomated computer program analyzed nine comparable regions of interest on each set of scans. When regions of interest from both types of scans were combined in the same discriminant function analysis, the first two variables selected were from the magnetic resonance imaging data set, and they significantly differentiated 95% of the patients and controls.

Application of automated MRI volumetric measurement techniques to the ventricular system in schizophrenics and normal controls.

As an initial approach to computer-automated segmentation of cerebral spinal fluid (CSF) vs. brain parenchyma in MR scans, and the transformation of these data sets into volumetric information and 3D display, we examined the ventricular system in a sample of ten chronic schizophrenics with primarily positive symptoms and 12 normal subjects. While no significant differences were noted between groups on volumetric measures of ventricular brain ratio or lateral ventricle size, normals showed a pattern of left greater than right lateral ventricular volume asymmetry not present in the schizophrenics. Within the schizophrenic group, departure from the normal left greater than right pattern was highly correlated with thought disorder.

Estimates of Type A behavior do not predict perceived exertion during graded exercise.

Earlier studies have concluded that exercise tolerance during graded stress testing is overestimated in males showing the Type A Behavior Pattern (TABP) because of high motivation and suppressed ratings of perceived exertion (RPE). However, the studies used the Jenkins Activity Survey (JAS) to assess TABP and employed exercise protocols that were unstandardized or uninterpretable for clinical prescription. Because the JAS lacks validity for predicting the criterion Structured Interview (SI) for TABP, the usefulness of concurrent self-report estimates of TABP for predicting RPE during standard exercise testing warrants additional study. During clinical treadmill testing of 86 asymptomatic Caucasian men (45 +/- 9 yr), we examined three standard estimates of TABP (JAS, Bortner, Framingham) as predictors of: 1) the covariance (RPE') of RPE (Borg Category Scale) with VO2 (ml.kg-1.min-1) during 5 min of graded walking (5.47 km.h-1, 2.25%.min-1); 2) VO2 and RPE (11.6 +/- 2.2) at a preferred level of exertion (approximately 65% +/- 10% VO2PEAK); 3) VO2PEAK and RPE at VO2PEAK. Multiple linear regression analyses found no relations (P greater than 0.10) between estimates of TABP and treadmill responses. Discriminant analyses of Type A and Type B groups formed from tertiles consistent with population norms showed no differences (P greater than 0.01) for RPE of treadmill performance. Our findings question prior reports of RPE suppression associated with TABP estimates. We conclude that practically implementable estimates of TABP do not offer useful information for clinical predictions of RPE, preferred exertion level, or VO2PEAK in asymptomatic middle-aged Caucasian men.

Monitoring a good opportunity. Telemedicine grows as method to reach poorly served regions.

With its patients scattered throughout Central Texas--a region roughly the size of Massachusetts-Scott and White Memorial Hospital and Clinic, based in Temple, Texas, has turned to telemedicine to help bring healthcare to underserved areas. Gregory Hobbs, M.D., (left) Scott and White's director of telehealth, has overseen steady growth in the hospital's telemedicine services, which now support five clinics, five regional hospitals and five rural clinics outside of the network.

Coming of age. Disease management making a case for itself clinically and financially.

More providers are using a variety of approaches to patient care that fall under the nebulous term 'disease management.' Although it was slow to catch on, especially among physicians, interest has accelerated as both providers and payers see the benefits clinically and financially.

2000 up & comers.

They're well on their way to becoming all-stars in the healthcare industry. All age 40 or younger, they've already accomplished much in their careers. Modern Healthcare profiles a dozen managers and executives chosen as this year's team of Up & Comers. As one observer says, "They demonstrate in significant, tangible ways the impact an individual can have on the vision, mission and quality of healthcare services."