Development of a model of interprofessional support interventions to enhance brace adherence in adolescents with idiopathic scoliosis: a qualitative study.

PURPOSE: Brace treatment for adolescent idiopathic scoliosis is recognized as effective if the brace is worn as prescribed (20 to 23 hrs/day). Because of its negative biopsychosocial impact on adolescent patients' quality of life, brace adherence is a common problem (average bracewear of 12 hrs/day). The purpose of this paper is to develop an interprofessional support intervention model to enhance brace adherence in adolescents with scoliosis. METHODS: We enrolled 9 health professionals working with braced patients to participate in individual interviews. Interview guides were built following the Information-Motivation-Strategy Model (DiMatteo et al., Health Psychol Rev 6:74-91, 2012) and the Interprofessional Care Competency Framework (Education UoTCfI, Toronto Acad Health Sci Network, 2017). Thematic analysis was performed to identify the most relevant concepts for designing the intervention model. A panel of 5 clinical experts was recruited to review and validate the intervention model. RESULTS: Participants suggested educational, motivational, functional, psychological and interprofessional teamwork strategies to improve the support provided to patients and parents and potentially increase brace adherence. Using the emerging themes and their relationships, we designed an Interprofessional Adherence Support (IPAS) intervention model that identifies the actors, activities, structure and intended impacts of the intervention. According to the expert panel, the IPAS model is highly relevant to respond to the brace adherence problem and has potential for implementation in practice. CONCLUSION: We designed an interprofessional support intervention model based on professional perspectives in response to the brace adherence problem in adolescents with scoliosis. Plans for implementation of the IPAS model at our scoliosis clinic are under development and considered essential for improving brace treatment outcomes.

Universal interventions for suicide prevention in high-income Organisation for Economic Co-operation and Development (OECD) member countries: a systematic review.

INTRODUCTION: To examine the effectiveness of universal suicide prevention interventions on reducing suicide mortality in high-income Organisation for Economic Co-operation and Development (OECD) member countries. METHODS: We implemented a comprehensive search strategy across three electronic databases: MEDLINE (Ovid), PsycINFO (Ovid) and Embase (Ovid). All studies using time-series, retrospective, prospective, pre-post or cross-sectional study designs were included. Studies were required to examine suicide mortality as the outcome of interest. To help organise the results, studies were grouped into six broad categories of universal interventions consistent with the World Health Organization (WHO) Comprehensive Mental Health Action Plan. A narrative synthesis of results was used to describe the findings. RESULTS: Of the 15 641 studies identified through the search strategy, 100 studies were eligible in the following categories: law and regulation reforms (n=66), physical barriers (n=13), community-based interventions (n=9), communication strategies (n=4), mental health policies and strategies (n=7), and access to healthcare (n=1). Overall, 100% (13/13) of the included physical barrier interventions resulted in a significant reduction in suicide mortality. Although only 70% (46/66) of the law and regulation reform interventions had a significant impact on reducing suicide, they hold promise due to their extended reach. Universal suicide prevention interventions seem to be more effective at reducing suicide among males than females, identifying a need to stratify results by sex in future studies. CONCLUSIONS: These findings suggest that universal suicide prevention interventions hold promise in effectively reducing suicide mortality in high-income OECD countries.

Hypertriglyceridemia is associated with insulin levels in adult cystic fibrosis patients.

BACKGROUND: Recent studies have identified hypertriglyceridemic cystic fibrosis patients (CF-TG). However, whether hypertriglyceridemia is associated with an altered metabolic profile remains unknown. OBJECTIVE: To characterize CF-TG and determine whether triglycerides (TG) levels are associated with metabolic alterations. METHODS: 210 adult CF subjects from the Montreal Cystic Fibrosis Cohort without known diabetes were included in the analysis. All subjects underwent an OGTT to assess glucose tolerance, insulin secretion (insulin AUC) and insulin sensitivity (Stumvoll index). Fasting lipid profiles, pulmonary function (%FEV1) and BMI were determined. Hypertriglyceridemia (TG>1.7mmol/L) was observed in 20 CF patients. These subjects were matched for age, sex and glucose tolerance category with 20 CF patients (CF-normal-TG) and 20 healthy controls that had TG levels below 1.7mmol/L. Pearson correlations were performed in the complete study sample (n=210) to examine the associations between TG levels and other parameters. RESULTS: The prevalence of hypertriglyceridemia was 9.5%. Compared to CF-normal-TG, CF-TG subjects displayed significantly higher %FEV1, insulin AUC (AUC0-120, AUC0-30, AUC30-120), cholesterol levels and a higher ratio of total cholesterol to HDL-cholesterol. Pearson analysis demonstrated that TG levels were associated with BMI, %FEV1, fasting insulin, insulin AUC0-120 and AUC30-120, Stumvoll index, cholesterol levels and the ratio of total cholesterol to HDL-cholesterol. All these correlations remained significant after correction for BMI except %FEV1. CONCLUSION: TG levels are associated with a mild alteration of the metabolic profile. Whether these changes will increase the long-term risk of CF patients in developing cardiometabolic complications remains to be investigated.