Sexual health experiences of women and non-binary people with early psychosis: qualitative study.

BACKGROUND: Women and gender-diverse people with early psychosis are at risk for suboptimal sexual health outcomes, yet little research has explored their sexual health experiences. AIMS: This study explored sexual health experiences and related priorities among women and gender-diverse people with early psychosis, to identify opportunities for improvements in sexual health and well-being. METHOD: Semi-structured individual qualitative interviews explored how patient participants (n = 19, aged 18-31 years, cisgender and transgender women and non-binary individuals) receiving clinical care from early psychosis programmes in Ontario, Canada, experienced their sexual health, including sexual function and behaviour. Thematic analysis was conducted, with triangulation from interviews/focus groups with clinicians (n = 36) who provide sexual and mental healthcare for this population. RESULTS: Three key themes were identified based on patient interviews: theme 1 was the impact of psychotic illness and its treatments on sexual function and activity, including variable changes in sex drive, attitudes and behaviours during acute psychosis, vulnerability to trauma and medications; theme 2 related to intimacy and sexual relationships in the context of psychosis, with bidirectional effects between relationships and mental health; and theme 3 comprised autonomy, identity and intersectional considerations, including gender, sexuality, culture and religion, which interplay with psychosis and sexual health. Clinicians raised each of these priority areas, but emphasised risk prevention relative to patients' more holistic view of their sexual health and well-being. CONCLUSIONS: Women and non-binary people with early psychosis have wide-ranging sexual health priorities, affecting many facets of their lives. Clinical care should incorporate this knowledge to optimise sexual health and well-being in this population.

The Disability-Related Education and Training Experiences of Perinatal Care Providers in Ontario.

We describe the disability-related education and training experiences of perinatal care providers in Ontario. Twenty perinatal care providers (e.g., obstetricians, midwives) participated in semi-structured interviews. Using a content analysis approach, we found most acquired disability-related training through their own initiative as opposed to education through professional training programs. Barriers to training included lack of data on disability and pregnancy and limited experiential learning opportunities. Providers recommended that future training focus on experiential learning and social determinants of health, with people with disabilities involved in developing and delivering training. These efforts are vital to optimize pregnancy outcomes for people with disabilities.

Rates of Mental Illness and Addiction among High-Cost Users of Medical Services in Ontario.

OBJECTIVE: To quantify the burden of mental illness and addiction among high-costing users of medical services (HCUs) using population-level data from Ontario, and compare to a referent group of nonusers. METHOD: We conducted a population-level cohort study using health administrative data from fiscal year 2011-2012 for all Ontarians with valid health insurance as of April 1, 2011 (N = 10,909,351). Individuals were grouped based on medical costs for hospital, emergency, home, complex continuing, and rehabilitation care in 2011-2012: top 1%, top 2% to 5%, top 6% to 50%, bottom 50%, and a zero-cost nonuser group. The rate of diagnosed psychotic, major mood, and substance use disorders in each group was compared to the zero-cost referent group with adjusted odds ratios (AORs) for age, sex, and socioeconomic status. A sensitivity analysis included anxiety and other disorders. RESULTS: Mental illness and addiction rates increased across cost groups affecting 17.0% of the top 1% of users versus 5.7% of the zero-cost group (AOR, 3.70; 95% confidence interval [CI], 3.59 to 3.81). This finding was most pronounced for psychotic disorders (3.7% vs. 0.7%; AOR, 5.07; 95% CI, 4.77 to 5.38) and persisted for mood disorders (10.0% vs. 3.3%; AOR, 3.52; 95% CI, 3.39 to 3.66) and substance use disorders (7.0% vs. 2.3%; AOR, 3.82; 95% CI, 3.66 to 3.99). When anxiety and other disorders were included, the rate of mental illness was 39.3% in the top 1% compared to 21.3% (AOR, 2.39; 95% CI, 2.34 to 2.45). CONCLUSIONS: A high burden of mental illness and addiction among HCUs warrants its consideration in the design and delivery of services targeting HCUs.

Omega-6 to Omega-3 Fatty Acid Ratio in Patients with ADHD: A Meta-Analysis.

OBJECTIVE: Omega-3 and omega-6 fatty acids have been shown to be deficient in individuals with attention deficit/hyperactivity disorder compared to controls (Hawkey & Nigg, 2014). Clinical trials of omega-3 and omega-6 supplements as treatment for ADHD have demonstrated minimal efficacy (Bloch & Qawasmi, 2011; Gillies, Sinn, Lad, Leach, & Ross, 2011; Hawkey & Nigg, 2014; Puri & Martins, 2014; Sonuga-Barke et al., 2013). Existing trials have analyzed omega-3 and omega-6 separately although the tissue ratio of these fatty acids (n6/n3) may be more important than absolute levels of either. The objective of this study was to determine the relationship between blood n6/n3 and arachidonic acid to eicosapentaenoic acid (AA/EPA), to ADHD symptoms. METHOD: A systematic literature review identified original articles measuring blood n6/n3 or AA/EPA ratio in children and youth with ADHD, compared to controls without ADHD. Three databases were searched. Blood n6/n3, and AA/EPA ratios were compared between individuals with ADHD and controls. Results were pooled across studies using quantitative synthesis. RESULTS: Five articles met inclusion criteria for the meta-analysis. The pooled mean difference between patients with ADHD and controls was 1.97 (0.90-3.04) for n6/n3 (n=5 studies, I(2) 83%) and 8.25 (5.94-10.56) for AA/EPA (n=3 studies, I(2) 0%). CONCLUSIONS: Children and youth with ADHD have elevated ratios of both blood n6/n3 and AA/EPA fatty acids compared to controls. Thus an elevated n6/n3, and more specifically AA/EPA, ratio may represent the underlying disturbance in essential fatty acid levels in patients with ADHD. These findings have implications for the development of future interventions using essential fatty acids to treat ADHD, and for the use of these ratios as biomarkers for titrating and monitoring ADHD treatment with essential fatty acids.

OBJECTIF: Les acides gras omega-3 et omega-6 se sont révélés être déficients chez les personnes souffrant du trouble de déficit de l'attention avec hyperactivité (TDAH) comparativement aux sujets témoins (Hawkey et Nigg, 2014). Les essais cliniques sur les suppléments d'omega-3 et d'omega-6 comme traitement du TDAH ont démontré une efficacité minimale (Bloch et Qawasmi, 2011; Gillies, Sinn, Lad, Leach, et Ross, 2011; Hawkey et Nigg, 2014; Puri et Martins, 2014; Sonuga-Barke et al., 2013). Les essais existants ont analysé les omega-3 et omega-6 séparément, bien que le ratio tissulaire de ces acides gras (n-6/n-3) puisse être plus important que les niveaux absolus de chacun. L'objectif de cette étude était de déterminer la relation entre le n-6/n-3 sanguin et le ratio acide arachidonique sur acide eicosapentaénoïque (AA/EPA), et les symptômes du TDAH. MÉTHODE: Une revue systématique de la littérature a identifié les articles originaux mesurant le n-6/n-3 sanguin ou le ratio AA/EPA chez les enfants et les adolescents souffrant du TDAH, comparativement aux sujets témoins sans TDAH. Trois bases de données ont été recherchées. Le n-6/n-3 sanguin et les ratios AA/EPA ont été comparés entre les personnes souffrant du TDAH et les sujets témoins. Les résultats ont été totalisés entre les études à l'aide d'une synthèse quantitative. RÉSULTATS: Cinq articles satisfaisaient aux critères d'inclusion de la méta-analyse. La différence moyenne totalisée entre les patients souffrant de TDAH et les sujets témoins était de 1,97 (0,90­3,04) pour n-6/n-3 (n = 5 études, I2 83 %) et de 8,25 (5,94­10,56) pour AA/EPA (n = 3 études, I2 0 %). CONCLUSIONS: Les enfants et les adolescents souffrant du TDAH ont des ratios élevés tant du n-6/n-3 sanguin que des acides gras AA/EPA, comparativement aux sujets témoins. Donc, un ratio n-6/n-3 élevé, et plus spécifiquement le ratio AA/EPA, peuvent représenter la perturbation sous-jacente des niveaux d'acides gras essentiels chez les patients souffrant de TDAH. Ces résultats ont des implications pour le développement de futures interventions utilisant des acides gras essentiels pour traiter le TDAH, et pour l'utilisation de ces ratios comme biomarqueurs pour titrer et surveiller le traitement du TDAH avec les acides gras essentiels.