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1.
BMC Res Notes ; 14(1): 320, 2021 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-34419155

RESUMO

OBJECTIVES: Peer support is rapidly being introduced into mental health services internationally, yet peer support interventions are often poorly described, limiting the usefulness of research in informing policy and practice. This paper reports the development of a peer support intervention that aims to improve outcomes of discharge from inpatient to community mental health care. People with experiential knowledge of using mental health services-peer workers and service user researchers-were involved in all stages of developing the intervention: generating intervention components; producing the intervention handbook; piloting the intervention. RESULTS: Systematic review and expert panels, including our Lived Experience Advisory Panel, identified 66 candidate intervention components in five domains: Recruitment and Role Description of Peer Workers; Training for Peer Workers; Delivery of Peer Support; Supervision and Support for Peer Workers; Organisation and Team. A series of Local Advisory Groups were used to prioritise components and explore implementation issues using consensus methods, refining an intervention blueprint. A peer support handbook and peer worker training programme were produced by the study team and piloted in two study sites. Feedback workshops were held with peer workers and their supervisors to produce a final handbook and training programme. The ENRICH trial is registered with the ISRCTN clinical trial register, number ISRCTN 10043328, and was overseen by an independent steering committee and a data monitoring committee.


Assuntos
Transtornos Mentais , Serviços de Saúde Mental , Aconselhamento , Humanos , Pacientes Internados , Transtornos Mentais/terapia , Saúde Mental , Revisões Sistemáticas como Assunto
2.
BMC Psychiatry ; 20(1): 534, 2020 11 11.
Artigo em Inglês | MEDLINE | ID: mdl-33176729

RESUMO

BACKGROUND: Peer support is being introduced into mental health services internationally, often in response to workforce policy. Earlier systematic reviews incorporate different modalities of peer support (i.e. group and one-to-one), offer inconsistent evidence of effectiveness, and also indicate substantial heterogeneity and issues of quality in the evidence base at that time. An updated review, focussed on one-to-one peer support, is timely given current policy interest. This study aims to systematically review evidence for the effectiveness of one-to-one peer support interventions for adults using mental health services, and to explore heterogeneity in peer support interventions. METHOD: We searched MEDLINE, PsycINFO, Embase, CINAHL and Cochrane databases from inception until 13 June 2019. Included studies were assessed for risk of bias, and meta-analyses conducted where multiple trials provided usable data. RESULTS: Twenty-three studies reporting nineteen trials were eligible, providing data from 3329 participants. While seven trials were of low to moderate risk of bias, incomplete reporting of data in many studies suggested bias in the evidence base. Peer support interventions included peer workers in paraclinical roles (e.g. case manager), providing structured behavioural interventions, or more flexible support for recovery. Meta-analyses were conducted for eleven outcomes, with evidence that one-to-one peer support may have a modest positive impact on self-reported recovery and empowerment. There was no impact on clinical symptoms or service use. Analyses of heterogeneity suggest that peer support might improve social network support. CONCLUSIONS: One-to-one peer support in mental health services might impact positively on psychosocial outcomes, but is unlikely to improve clinical outcomes. In order to better inform the introduction of peer support into mental health services, improvement of the evidence base requires complete reporting of outcome data, selection of outcomes that relate to intervention mechanisms, exploration of heterogeneity in the implementation of peer support and focused reviews of specific types of one-to-one peer support. TRIAL REGISTRATION: Prospero identifier: CRD42015025621 .


Assuntos
Serviços de Saúde Mental , Adulto , Aconselhamento , Humanos , Grupo Associado , Apoio Social
3.
Emerg Med Australas ; 32(4): 676-678, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32358907

RESUMO

OBJECTIVE: To review domestic and family violence (DFV) and non-lethal strangulation (NLS) presentations to an ED with 24-h social work. METHODS: Retrospective cohort study of 12 months of DFV presentations comparing demographics, perpetrator relationship, social work review, injuries and NLS incidence and assessment. RESULTS: Women represent 90% of DFV presentations. In 26% of DFV presentations NLS was identified, with 47.5% clinically assessed appropriately. Social work did not review 34% of DFV presentations, 64% due to no referral. CONCLUSIONS: Social work referral for DFV is regularly missed despite 24-h access. Assessment of NLS in ED requires improvement and standardised national guidelines.

4.
Medicine (Baltimore) ; 99(10): e19192, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150057

RESUMO

INTRODUCTION: In the period shortly after discharge from inpatient to community mental health care, people are at increased risk of self-harm, suicide, and readmission to hospital. Discharge interventions including peer support have shown potential, and there is some evidence that community-based peer support reduces readmissions. However, systematic reviews of peer support in mental health services indicate poor trial quality and a lack of reporting of how peer support is distinctive from other mental health support. This study is designed to establish the clinical and cost effectiveness of a peer worker intervention to support discharge from inpatient to community mental health care, and to address issues of trial quality and clarity of reporting of peer support interventions. METHODS: This protocol describes an individually randomized controlled superiority trial, hypothesizing that people offered a peer worker discharge intervention in addition to usual follow-up care in the community are less likely to be readmitted in the 12 months post discharge than people receiving usual care alone. A total of 590 people will be recruited shortly before discharge from hospital and randomly allocated to care as usual plus the peer worker intervention or care as usual alone. Manualized peer support provided by trained peer workers begins in hospital and continues for 4 months in the community post discharge. Secondary psychosocial outcomes are assessed at 4 months post discharge, and service use and cost outcomes at 12 months post discharge, alongside a mixed methods process evaluation. DISCUSSION: Clearly specified procedures for sequencing participant allocation and for blinding assessors to allocation, plus full reporting of outcomes, should reduce risk of bias in trial findings and contribute to improved quality in the peer support evidence base. The involvement of members of the study team with direct experience of peer support, mental distress, and using mental health services, in coproducing the intervention and designing the trial, ensures that we theorize and clearly describe the peer worker intervention, and evaluate how peer support is related to any change in outcome. This is an important methodological contribution to the evidence base. TRIAL REGISTRATION: This study was prospectively registered as ISRCTN 10043328 on November 28, 2016.


Assuntos
Transtornos Mentais/terapia , Alta do Paciente , Transferência de Pacientes/economia , Grupo Associado , Serviços Comunitários de Saúde Mental , Análise Custo-Benefício , Humanos , Transtornos Mentais/psicologia , Qualidade de Vida , Fatores de Risco , Medicina Estatal , Reino Unido
5.
Emerg Med Australas ; 31(6): 930-934, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31423709

RESUMO

OBJECTIVE: A retrospective audit of presentations to a tertiary trauma centre reviewing the demographics of electric scooter injuries in the first 2 months of the scooter-share scheme, which was commenced in Brisbane in November 2018. METHODS: Electric scooter-associated presentations to the Royal Brisbane and Women's Hospital Emergency and Trauma Centre from November 2018 to January 2019 were identified. Data collected included patient demographics, type and location of injuries, helmet use, alcohol consumption, length of stay and disposition. Estimates of costs associated with electric scooter presentation were also obtained. RESULTS: Fifty-four electric scooter encounters were included during the 2-month period. Helmets were worn in 46% and was associated with reduced risk of head injury (odds ratio (OR) 0.18, P = 0.029). Alcohol was involved in 27% although this did not impact on admission rates (OR 1.25, P = 0.83) or operative management (OR 2.14, P = 0.42). Contusions/abrasions and fractures/dislocations were the most common types of injury, whereas upper limb and minor head injuries were the most common sites of injury. Most patients were discharged home (87%), with 74% completing their emergency visit in under 4 h. Six patients required operative management and 15 patients needed outpatient follow-up. There were no deaths. Average patient cost per presentation was $542 and ranged from $285 to $1345. CONCLUSIONS: The findings characterised injury patterns and costs associated with electric scooters in our ED. Given the increasing popularity of electric scooters as an alternate form of transportation, our study may help to inform public policy for future injury prevention.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Veículos Automotores , Centros de Traumatologia , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Fontes de Energia Elétrica , Feminino , Dispositivos de Proteção da Cabeça/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , New South Wales/epidemiologia , Estudos Retrospectivos , Fatores de Risco
6.
J Clin Endocrinol Metab ; 100(11): 4172-80, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26401592

RESUMO

CONTEXT: Adiponectin levels (ADPN) are lower in individuals with central obesity and cardiometabolic diseases. Conversely, studies have shown paradoxical hyperadiponectinemia (HA) in metabolically healthy obese (MHO) individuals of non-European descent. Moreover, individuals with higher sc to visceral adipose tissue (ie, higher peripheral adiposity) distribution have higher ADPNs. However, it is not known whether metabolically healthy individuals have predominantly peripheral adiposity along with higher ADPNs. OBJECTIVE: This study aimed to evaluate the association of ADPN and adiposity distribution with metabolic health in white individuals. DESIGN AND SETTING: This was a cross-sectional study of members of "Take Off Pounds Sensibly" weight loss club and their relatives. PARTICIPANTS: We recruited 2486 (72% women, 61% obese) individuals. They were defined as metabolically healthy by absence of hypertension, diabetes, and dyslipidemia; and they were further classified into metabolically healthy nonobese (MHNO), metabolically unhealthy nonobese (MUNO), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO). Waist-to-hip ratios (WHRs) were used as markers of adiposity distribution. Insulin resistance was measured using homeostasis model assessment. RESULTS: Among the four groups, MHNO had the lowest WHRs (higher peripheral adiposity) and highest ADPN, and MUO had highest WHRs (higher central adiposity) and lowest ADPN (P < .001). Among both nonobese and obese, metabolically healthy individuals had higher ADPN than metabolically unhealthy individuals (P < .05) after adjustment for age, sex, and body mass index. MHNO also had lower WHRs compared with MUNO (P < .01). Although WHRs were lower among MHO compared with MUO, the difference was not significant. In addition, nonobese and obese individuals with HA (defined using sex-specific cutoffs) had lower homeostasis model assessment and dyslipidemia compared with individuals without HA. CONCLUSIONS: Higher ADPN and lower WHRs (higher peripheral adiposity) are associated with better metabolic health in both nonobese and obese white individuals. These results suggest that ADPN and peripheral adiposity play a key role in determining the metabolic health independent of body mass index.


Assuntos
Adiponectina/sangue , Doenças Metabólicas/sangue , Obesidade/sangue , Adiposidade , Índice de Massa Corporal , Estudos Transversais , Citocinas/sangue , Diabetes Mellitus Tipo 2/complicações , Dislipidemias/sangue , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Resistência à Insulina , Lipídeos/sangue , Masculino , Obesidade/terapia , Relação Cintura-Quadril , Perda de Peso
7.
Transl Res ; 164(4): 270-7, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24811003

RESUMO

Thirty percent of obese individuals are metabolically healthy and were noted to have increased peripheral obesity. Adipose tissue is the primary source of adiponectin, an adipokine with insulin-sensitizing and anti-inflammatory properties. Lower adiponectin levels are observed in individuals with obesity and those at risk for cardiovascular disease. Conversely, higher levels are noted in some obese individuals who are metabolically healthy. Our objective was to determine whether abdominal adiposity distribution, rather than body mass index (BMI) status, influences plasma adiponectin level. A total of 424 subjects (female, 255) of Northern European ancestry were recruited from "Take Off Pounds Sensibly" weight loss club members. Demographics, anthropometrics, and dual-emission x-ray absorptiometry of the whole body, and computed tomography scan of the abdomen were performed to obtain total body fat content and to quantify subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT), respectively. Laboratory measurements included fasting plasma glucose, insulin, lipid panel, and adiponectin. Age- and gender-adjusted correlation analyses showed that adiponectin levels were negatively correlated with BMI, waist circumference, triglycerides, total fat mass, and VAT. A positive correlation was noted with high-density lipoprotein cholesterol and fat-free mass (P < 0.05). SAT-to-VAT ratios were also significantly associated with adiponectin (r = 0.13, P = 0.001). Further, the best positive predictors for plasma adiponectin were found to be SAT-to-VAT ratios and gender by regression analyses (P < 0.01). Abdominal adiposity distribution is an important predictor of plasma adiponectin and obese individuals with higher SAT-to-VAT ratios may have higher adiponectin levels.


Assuntos
Adiponectina/sangue , Adiposidade/fisiologia , Adulto , Envelhecimento , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Triglicerídeos
8.
Hypertension ; 43(5): 1146-51, 2004 May.
Artigo em Inglês | MEDLINE | ID: mdl-14993199

RESUMO

Multiple studies have identified resting heart rate as a risk factor for cardiovascular disease independent of other cardiovascular disease risk factors (such as dyslipidemia and hypertension). Previous studies have examined heart rate in hypertensive individuals, but little is known about the genetic determination of resting heart rate in a normal population. Therefore, our objective was to perform a genome screen on a population containing normotensive and hypertensive individuals. We performed variance decomposition linkage analysis using maximum likelihood methods at approximately 10 cM intervals in 2209 individuals of predominantly North European ancestry. We estimated the heritability of resting heart rate to be 26% and obtained significant evidence of linkage (logarithm of the odds [LOD]=3.9) for resting heart rate on chromosome 4q. This signal is in the same region as a quantitative trait locus (QTL) for long QT syndrome 4 and a QTL for heart rate in rats. Within the 1-LOD unit support interval, there are 2 strong candidates: ankyrin-B and myozenin 2.


Assuntos
Cromossomos Humanos Par 4/genética , Frequência Cardíaca/genética , Locos de Características Quantitativas/genética , Animais , Anquirinas/genética , Antropometria , Proteínas de Transporte/genética , Estudos de Coortes , Europa (Continente)/etnologia , Grupo com Ancestrais do Continente Europeu/genética , Feminino , Humanos , Hipertensão/epidemiologia , Hipertensão/genética , Funções Verossimilhança , Escore Lod , Masculino , Pessoa de Meia-Idade , Proteínas Musculares/genética , Ratos , Fatores de Risco , Fatores Sexuais , Triglicerídeos/sangue , Estados Unidos/epidemiologia
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