Research Review: Integrated healthcare for children and young people in secondary/tertiary care - a systematic review.

BACKGROUND: Children and young people (CYP) with comorbid physical and/or mental health conditions often struggle to receive a timely diagnosis, access specialist mental health care, and more likely to report unmet healthcare needs. Integrated healthcare is an increasingly explored model to support timely access, quality of care and better outcomes for CYP with comorbid conditions. Yet, studies evaluating the effectiveness of integrated care for paediatric populations are scarce. AIM AND METHODS: This systematic review synthesises and evaluates the evidence for effectiveness and cost-effectiveness of integrated care for CYP in secondary and tertiary healthcare settings. Studies were identified through systematic searches of electronic databases: Medline, Embase, PsychINFO, Child Development and Adolescent Studies, ERIC, ASSIA and British Education Index. FINDINGS: A total of 77 papers describing 67 unique studies met inclusion criteria. The findings suggest that integrated care models, particularly system of care and care coordination, improve access and user experience of care. The results on improving clinical outcomes and acute resource utilisation are mixed, largely due to the heterogeneity of studied interventions and outcome measures used. No definitive conclusion can be drawn on cost-effectiveness since studies focused mainly on costs of service delivery. The majority of studies were rated as weak by the quality appraisal tool used. CONCLUSIONS: The evidence of on clinical effectiveness of integrated healthcare models for paediatric populations is limited and of moderate quality. Available evidence is tentatively encouraging, particularly in regard to access and user experience of care. Given the lack of specificity by medical groups, however, the precise model of integration should be undertaken on a best-practice basis taking the specific parameters and contexts of the health and care environment into account. Agreed practical definitions of integrated care and associated key terms, and cost-effectiveness evaluations are a priority for future research.

Mindfulness-Based Interventions for University Students: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.

BACKGROUND: University students are expressing an increased need for mental health support. Mindfulness-based interventions (MBIs) are being integrated into university stress-reduction programmes globally. We conducted a comprehensive systematic review and meta-analysis of randomised controlled trials (RCTs) assessing MBI effects on university students' mental and physical health. METHODS: We searched nine databases, including grey literature and trial registries. Two independent reviewers extracted data following a prospective public protocol. RESULTS: Fifty-one RCTs were included. In comparison with passive controls, and when measured shortly after intervention completion, MBIs improve distress, anxiety, depression, well-being, rumination, and mindfulness with small to moderate effect sizes, with no benefit found for blood pressure, sleep, life satisfaction, resilience, worry, and thought suppression. Evidence for self-compassion is inconclusive. Effects last beyond three months for distress and mindfulness, with no data on other outcomes. Compared with active control groups, MBIs significantly improve distress and state anxiety, but not mindfulness, depression, well-being, affect, trait anxiety, or emotion regulation. Results were robust to adjustment for multiple testing, but RCTs' risk of bias is generally high. Moderator analyses did not find differential intervention effects according to intervention duration, delivery mode, or sub-populations. CONCLUSIONS: MBIs may be helpful to students but higher-quality research is needed.

Multiple sclerosis: pregnancy and motherhood.

Although at any time in the UK there are about 20,000 women with multiple sclerosis (MS) who may be considering having children, very little is known about their experiences or about those who have had children after the onset of disease. Using semi structured interviews, we explored the childbearing experiences of nine women with MS in order to better understand their expectations, needs and concerns associated with pregnancy, childbirth and mothering. A major concern for women with MS was theirs and their babies' health and future wellbeing, especially how pregnancy can impact their long term MS prognosis and how the condition would affect their ability to look after the baby. In conclusion we suggest that midwives with special interests in MS could be a key source of information and ongoing support.

Training needs survey of midwives, health visitors and voluntary-sector breastfeeding support staff in England.

This study, which was part of a learning needs assessment of health professionals in England, reports a survey of the training needs of healthcare practitioners in breastfeeding support skills. Respondents rated their competence on 26 breastfeeding support skills, importance of update, actual and potential helpfulness of training, and accessibility in the next 2 years. Perception of organizational barriers to breastfeeding support and practitioners' knowledge of policies and guidance on breastfeeding were measured. Data are reported on 549 healthcare practitioners, mostly midwives and health visitors working for public health services, and some voluntary-sector practitioners, 58% had worked with women and their infants for more than 10 years, and 56% were currently spending at least 25% of their working time providing direct care to breastfeeding women. Those already competent were most likely to want more updating. Those with longer experience of breastfeeding support were more competent on three of the four competence subscales. Relationships between self-assessed competence and current intensity of breastfeeding experience were inconsistent. Respondents preferred training with a practical component. Respondents had poor knowledge of evidence-based policy, and only 51% had access to a breastfeeding policy. Organizational barriers to breastfeeding support were experienced by all, and especially by those with fewer years of experience (t = -2.32, d.f. = 547; P = 0.02) and those currently spending less time supporting breastfeeding women (t = -10.35, d.f. = 547; P < 0.0001). Core training is relevant to all practitioners, and practice-based training with access to evidence-based policies is required.