Increasing chronic disease preventive care in community mental health services: clinician-generated strategies.

BACKGROUND: People with a mental health condition experience a high prevalence of chronic disease risk behaviours e.g., tobacco smoking and physical inactivity. Recommended 'preventive care' to address these risks is infrequently provided by community mental health services. This study aimed to elucidate, among community mental health managers and clinicians, suggestions for strategies to support provision of preventive care. METHODS: Three qualitative focus groups (n = 14 clinicians) were undertaken in one regional community mental health service to gather perspectives of barriers to preventive care provision, deductively coded against the domains of the Theoretical Domains Framework (TDF). Drawing on the learnings from the focus groups, individual interviews (n = 15 managers and clinicians) were conducted in two services to identify suggestions for strategies to increase preventive care. Strategies were inductively coded and mapped into TDF domains. RESULTS: Barriers were identified across a wide range of TDF domains, most notably knowledge and environmental context and resources. Nine strategies were identified across three themes: training, resources and systems changes; mapping to all 14 TDF domains. CONCLUSION: Future research seeking to increase implementation of preventive care may be guided by these findings. There is need for greater recognition and resourcing of preventive care as a priority and integral component of mental health treatment.

The interdisciplinary and psychosocial gap in cancer survivorship: A longitudinal study in a Latin American Cancer Center.

BACKGROUND AND OBJECTIVES: There is lack of information on the quality of care provided to the rapidly increasing population of cancer survivors in Latin America. Our study attempts to address this gap and to identify areas needed to be improved. METHODS: A random sample of 210 breast and colorectal cancer survivors were selected from a hospital-based registry in Chile. Cancer registry information, electronic chart review, and personal interviews were used to assess medical and nonmedical care over a 5-year period. Survivorship care practices were compared to a standardized reference based on the US Institute of Medicine domains and the American Cancer Association guidelines. RESULTS: Over 80% of breast and colorectal cancer survivors received appropriate medical care, ongoing testing surveillance and risk factors assessment. Only a third of survivors were assessed for psychosocial disorders and 25% of them received interdisciplinary care. Overall, 66.1% of breast and 58.6% of colorectal cancer survivors reached the expected quality level of cancer survivorship care according to the reference standard (p < .001). CONCLUSION: Medical care practices reached a high standard in a leading cancer center in Latin America. However, a much stronger psychosocial assessment and interdisciplinary care is needed to improve survivorship cancer quality care.

Effects of smoking on delayed neuropsychiatric sequelae in acute carbon monoxide poisoning: A prospective observational study.

ABSTRACT: Smoking is a well-known risk factor for cardio-cerebrovascular disease. However, several studies have reported the "smoker's paradox" whereby smokers have a better prognosis for cardio-cerebrovascular diseases. Similar to cardio-cerebrovascular diseases, hypoxia is one of the major mechanisms of injury in carbon monoxide (CO) poisoning. This study investigated the association between smoking and delayed neuropsychiatric sequelae (DNS) in acute CO poisoning.This study involved patients with CO poisoning treated at a university hospital in Bucheon, Korea between September 2017 and March 2020. The exclusion criteria were age <18 years, discharge against medical advice, loss to follow-up, persistent neurological symptoms at discharge, transfer from another hospital 24 hours after exposure, and transfer from another hospital after hyperbaric oxygen therapy. Logistic regression analysis was performed to find factors associated with DNS.Two hundred sixty three patients visited the hospital due to CO poisoning and of these, 54 were excluded. DNS was evaluated up to 3 months after discharge, and until this time, DNS occurred in 35 (16.8%) patients. And the incidence rate of DNS was lower in smokers than non-smokers (15, 12% vs 20, 23.8%, P = .040). Multivariable logistic regression analysis revealed that CO exposure time (odds ratio [OR] 1.003; confidence interval [CI] 1.001-1.005; P = .003), the Glasgow coma scale (GCS) (OR 0.862; CI 0.778-0.956; P = .005), and pack-years (OR 0.947; CI 0.903-0.993; P = .023) were statistically significant for DNS development.These results indicate that more pack-years smoked were associated with reduced risk of the development of DNS in acute CO poisoning, and that CO exposure time and GCS is a predictive factor for DNS occurrence.

Neuroprotective effect of hesperidin against emamectin benzoate-induced neurobehavioral toxicity in rats.

Emamectin Benzoate (EMB) is an avermectin insecticide widely used in agriculture and veterinary medicine. Hesperidin (HSP) is a flavanone glycoside predominantly found in citrus fruits and has various beneficial health effects. The current research was conducted to study the neurobehavioral toxic effects of EMB in rats and also to evaluate the protective effect of HSP against these toxic effects. Sixty Sprague-Dawley rats were randomly divided into 4 equal groups: control group, EMB group, HSP group, and EMB + HSP group. EMB (8.8. mg/kg) and/or HSP (100 mg/kg) were administered daily by gavage for 8 weeks. The behavioral assessment demonstrated the adverse effects of EMB on the behavioral, motor, and cognitive brain functions. Exposure to EMB also decreased the activity of antioxidants (catalase and reduced glutathione) and increased the malondialdehyde level in nervous tissue. Moreover, EMB increased the level of inflammatory cytokines (tumor necrosis factor-α and interleukin-1ß) and decreased brain-derived neurotrophic factor (BDNF) levels in rats' brains. On the other hand, concurrent administration of HSP ameliorated the toxic effects of EMB as indicated by improvements in neural functions and reduction of oxidative stress and inflammation. The study concluded that exposure to EMB induces toxic effects in the brain of rats and that HSP has a protective effect against these toxic effects.

The interaction between tea polyphenols and host intestinal microorganisms: an effective way to prevent psychiatric disorders.

Tea polyphenols (TP) are the most bioactive components in tea extracts. It has been reported that TP can regulate the composition and the function of the intestinal flora. Meanwhile, intestinal microorganisms improve the bioavailability of TP, and the corresponding metabolites of TP can regulate intestinal micro-ecology and promote human health more effectively. The dysfunction of the microbiota-gut-brain axis is the main pathological basis of depression, and its abnormality may be the direct cause and potential influencing factor of psychiatric disorders. The interrelationship between TP and intestinal microorganisms is discussed in this review, which will enable us to better evaluate the potential preventive effects of TP on psychiatric disorders by modulating host intestinal microorganisms.

Exploration of Individual and System-Level Well-being Initiatives at an Academic Surgical Residency Program: A Mixed-Methods Study.

Importance: Physician well-being is a critical component of sustainable health care. There are few data on the effects of multilevel well-being programs nor a clear understanding of where and how to target resources. Objective: To inform the design of future well-being interventions by exploring individual and workplace factors associated with surgical trainees' well-being, differences by gender identity, and end-user perceptions of these initiatives. Design, Setting, and Participants: This mixed-methods study among surgical trainees within a single US academic surgical department included a questionnaire in January 2019 (98 participants, including general surgery residents and clinical fellows) and a focus group (9 participants, all clinical residents who recently completed their third postgraduate year [PGY 3]) in July 2019. Participants self-reported gender (man, woman, nonbinary). Exposures: Individual and organizational-level initiatives, including mindfulness-based affective regulation training (via Enhanced Stress Resilience Training), advanced scheduling of time off, wellness half-days, and the creation of a resident-driven well-being committee. Main Outcomes and Measures: Well-being was explored using validated measures of psychosocial risk (emotional exhaustion, depersonalization, perceived stress, depressive symptoms, alcohol use, languishing, anxiety, high psychological demand) and resilience (mindfulness, social support, flourishing) factors. End-user perceptions were assessed through open-ended responses and a formal focus group. Results: Of 98 participants surveyed, 64 responded (response rate, 65%), of whom 35 (55%) were women. Women vs men trainees were significantly more likely to report high depersonalization (odds ratio [OR], 5.50; 95% CI, 1.38-21.85) and less likely to report high mindfulness tendencies (OR, 0.17; 95% CI, 0.05-0.53). Open-ended responses highlighted time and priorities as the greatest barriers to using well-being resources. Focus group findings reflected Job Demand-Resource theory tenets, revealing the value of individual-level interventions to provide coping skills, the benefit of advance scheduling of time off for maintaining personal support resources, the importance of work quality rather than quantity, and the demoralizing effect of inefficient or nonresponsive systems. Conclusions and Relevance: In this study, surgical trainees indicated that multilevel well-being programs would benefit them, but tailoring these initiatives to individual needs and specific workplace elements is critical to maximizing intervention effects.

Population vs Individual Prediction of Poor Health From Results of Adverse Childhood Experiences Screening.

Importance: Adverse childhood experiences (ACEs) are well-established risk factors for health problems in a population. However, it is not known whether screening for ACEs can accurately identify individuals who develop later health problems. Objective: To test the predictive accuracy of ACE screening for later health problems. Design, Setting, and Participants: This study comprised 2 birth cohorts: the Environmental Risk (E-Risk) Longitudinal Twin Study observed 2232 participants born during the period from 1994 to 1995 until they were aged 18 years (2012-2014); the Dunedin Multidisciplinary Health and Development Study observed 1037 participants born during the period from 1972 to 1973 until they were aged 45 years (2017-2019). Statistical analysis was performed from May 28, 2018, to July 29, 2020. Exposures: ACEs were measured prospectively in childhood through repeated interviews and observations in both cohorts. ACEs were also measured retrospectively in the Dunedin cohort through interviews at 38 years. Main Outcomes and Measures: Health outcomes were assessed at 18 years in E-Risk and at 45 years in the Dunedin cohort. Mental health problems were assessed through clinical interviews using the Diagnostic Interview Schedule. Physical health problems were assessed through interviews, anthropometric measurements, and blood collection. Results: Of 2232 E-Risk participants, 2009 (1051 girls [52%]) were included in the analysis. Of 1037 Dunedin cohort participants, 918 (460 boys [50%]) were included in the analysis. In E-Risk, children with higher ACE scores had greater risk of later health problems (any mental health problem: relative risk, 1.14 [95% CI, 1.10-1.18] per each additional ACE; any physical health problem: relative risk, 1.09 [95% CI, 1.07-1.12] per each additional ACE). ACE scores were associated with health problems independent of other information typically available to clinicians (ie, sex, socioeconomic disadvantage, and history of health problems). However, ACE scores had poor accuracy in predicting an individual's risk of later health problems (any mental health problem: area under the receiver operating characteristic curve, 0.58 [95% CI, 0.56-0.61]; any physical health problem: area under the receiver operating characteristic curve, 0.60 [95% CI, 0.58-0.63]; chance prediction: area under the receiver operating characteristic curve, 0.50). Findings were consistent in the Dunedin cohort using both prospective and retrospective ACE measures. Conclusions and Relevance: This study suggests that, although ACE scores can forecast mean group differences in health, they have poor accuracy in predicting an individual's risk of later health problems. Therefore, targeting interventions based on ACE screening is likely to be ineffective in preventing poor health outcomes.

Associations of cigarette smoking with psychiatric disorders: evidence from a two-sample Mendelian randomization study.

We conducted a two-sample Mendelian randomization study to determine the association of smoking initiation with seven psychiatric disorders. We used 353 independent single-nucleotide polymorphisms associated with cigarette smoking initiation as instrumental variables at genome-wide significance threshold (p < 5 × 10-8) from a recent genome-wide association study in 1,232,091 European-origin participants. Summary-level data for seven psychiatric disorders, including anxiety, bipolar disorder, insomnia, major depressive disorder, posttraumatic stress disorder, suicide attempts, and schizophrenia, was obtained from large genetic consortia and genome-wide association studies. The odds ratios of genetically predicted smoking initiation were 1.96 for suicide attempts (95% CI 1.70, 2.27; p = 4.5 × 10-20), 1.69 for post-traumatic stress disorder (95% CI 1.32, 2.16; p = 2.5 × 10-5), 1.54 for schizophrenia (95% CI 1.35, 1.75; p = 1.6 × 10-10), 1.41 for bipolar disorder (95% CI 1.25, 1.59; p = 1.8 × 10-8), 1.38 for major depressive disorder (95% CI 1.31, 1.45; p = 2.3 × 10-38), 1.20 for insomnia (95% CI 1.14, 1.25; p = 6.0 × 10-14) and 1.17 for anxiety (95% CI 0.98, 1.40; p = 0.086). Results of sensitivity analyses were consistent and no horizontal pleiotropy was detected in MR-Egger analysis. However, the associations with suicide attempts, schizophrenia, bipolar disorder, and anxiety might be related to possible reverse causality or weak instrument bias. This study found that cigarette smoking was causally associated with increased risks of a number of psychiatric disorders. The causal effects of smoking on suicide attempts, schizophrenia, bipolar disorder and anxiety needs further research.

Evaluation of the efficacy of Chinese herbal medicine and acupuncture for the prevention of mental disorders in interstitial cystitis patients: A nationwide population-based study.

Traditional Chinese medicine (TCM) is commonly used for urinary symptoms in Eastern countries. Since there are few effective treatments available for patients with interstitial cystitis/bladder pain syndrome (IC/BPS), the psychological burden leads to increased healthcare-seeking behavior. Some patients may therefore seek TCM treatment for related urinary symptoms. Due to limited clinical research evaluating the effects of TCM on IC/BPS, we conducted a nationwide population-based cohort study to investigate the relationship between TCM and mental disorders among these patients. The IC/BPS cohort and its matched non-IC/BPS comparison cohort were recruited from the National Health Insurance (NHI) Research Database between 2000 and 2011. Patients with the use of Chinese herbal medicine (CHM) granules or acupuncture over 90 days per year were enrolled as the TCM users. Multivariable Cox proportional hazards models were used to evaluate the hazard ratio (HR) of mental disorders related to interstitial cystitis. The incidence of mental disorders in the 2 cohorts was assessed with Kaplan-Meier curves. A total of 1123 patients with IC/BPS and 4492 matched non-IC/BPS subjects were included in this study. The IC/BPS cohort demonstrated higher incidence rate of mental disorders than the cohort without IC/BPS (adjusted HR: 2.21, 95% confidence interval [CI]: 1.73-2.81). There was no statistically significant difference in the risk of mental disorders between IC/BPS patients with and without CHM granules or acupuncture treatment (adjusted HR: 0.99, 95% CI: 0.58-1.68). Our results indicated that CHM and acupuncture showed insignificant efficacy in the prevention of mental disorders in IC/BPS patients.

Extrahepatic Manifestations of Chronic Viral C Hepatitis.

Hepatits C virus (HCV) infection has been largely associated with extrahepatic comorbidities such as diseases related to dysregulation of the immune system, neuropsychiatric disorders, and cardiometabolic alterations. These clinical consequences, together with experimental evidence, suggest a potential (in)direct effect of HCV, contributing to the pathogenesis of these diseases. Various studies have reported a positive effect of viral eradication on occurrence and outcomes of extrahepatic diseases. These observations and the availability of safe and effective direct antiviral agents further underline the need to search for virological eradication in all infected individuals independent of the severity of the liver disease.

Lineamientos para el cuidado de la salud mental: dirigido a proveedores de salud. Pandemia COVID-19 / Mental Health Care Guidelines: For Health Providers. COVID-19 pandemic

El documento refleja la preocupación del MSPAS respecto a las necesidades psicológicas ante la gravedad de la pandemia, del personal de salud de todo el país. Da cuenta de que en algunos casos trabajan con los mínimos recursos personales para poder afrontar los retos del trabajo, así como otras circunstancias que les pueden generar estrés, soledad, inseguridad, etc. Por ello emite una serie de recomendaciones para apoyarlos. El documento en sí refleja los estados anímicos de los trabajadores de salud, especialmente en el personal de primera línea de atención a pacientes comprometidos con coronavirus. El objetivo es: fortalecer a proveedores de salud de recursos internos y estrategias de afrontamiento, para la mitigación de trastornos mentales en los proveedores de salud que atienden la pandemia de COVID ­ 19.

Before, during and after: Trauma-informed care in burns settings.

Trauma-informed care (TIC) is a model for the relationship of care between service users and service providers that recognises the importance of trauma, past and present, on that person's experiences, vulnerabilities and recovery. Burn injuries are a complex area of healthcare where trauma and the mental health disorders associated with trauma can both precede and proceed a burns injury with complications for recovery. Incorporating a model of TIC in the assessment and treatment of burns patients will proactively work to mitigate and arrest trauma responses, mental disorders and their sequelae in this population. With reference to the existing TIC knowledge base, we propose development of a model for the TIC of burns patients divided into three stages; before, during and after initial engagement with the patient. In the before stage, TIC will require clinical-level change, organisational integration, training and time. In the during stage, five elements are identified; creating safety, screening, collaborative inclusion of the patient in the intervention and recovery planning process, psychoeducation of the patient and supporters, and the use of peer-led services. In the after stage, patients need to be proactively supported through outreach and follow-up. Implementation of a trauma-informed model of care for burns injury patients provides significant opportunities to burns services and benefits towards their patients' recovery.

Developing a smartphone application to support social connectedness and wellbeing in young people with cystic fibrosis.

BACKGROUND: Young people with cystic fibrosis (CF) may be at increased risk of social isolation and mental illness. This study aimed to design and evaluate the usability and acceptability of a smartphone application (app) to support the social connectedness and wellbeing of young people living with CF. METHODS: Young people with CF aged 12-17 years (N = 22) were recruited from two paediatric hospitals in Australia. Study participants tested the CF app for six weeks before responding to an online survey about the app's usability and acceptability. A subsample of participants (n = 20) discussed the app's strengths and weaknesses during 11 online group interviews. RESULTS: During the six-week testing period, 77% of participants used the app at least once a week and 82% accessed the app from a smartphone. Usability of the CF app was rated high. Most participants agreed the app was easy to use (86%) and felt comfortable using it (96%). Acceptability of the app was moderate. 77% of participants agreed they would recommend the app to others. Recommendations to improve the app's functionality and acceptability included locating the chatroom within the app rather than redirecting users to a web browser and allowing users to personalise images, wellness tips and videos. CONCLUSIONS: This study developed and tested a highly usable, and moderately acceptable, smartphone app to improve the psychosocial health of young people living with CF. Future research will test the efficacy of the CF app on users' social connectedness and wellbeing.