Functional somatic symptoms in Emergency Department frequent presenters.

BACKGROUND: Patients with Functional Somatic Symptoms (FSS) are frequently encountered within healthcare settings such as Emergency Departments (ED). There is limited research regarding characterisation and frequency of FSS within frequent presenters to ED and no previous Australian evidence. This study aims to fill this gap. METHODS: A retrospective, single-centre study of frequent ED presenters over a 6-month period was undertaken. Patients with > 3 re-presentations/month were reviewed for the presence of FSS using Stephenson and Price's (Stephenson DT, Price JR. Medically unexplained physical symptoms in emergency medicine. Emerg Med J. 2006;23(8):595.) categorisation of FSS. Patients were divided into three groups - FSS, possible FSS (pos-FSS) and non-FSS. The characteristics of these groups were compared using descriptive statistics (chi-square tests, Welch's ANOVA). Person-time at risk during the 6-month study period was estimated for patients in each group and incidence of ED presentation for each group was then calculated. Psychological distress indicators for ED presenters with FSS, as noted by the treating clinician, were also analysed. RESULTS: 11% (71/638) of frequent ED presenters were categorised as having FSS and 72% (458/638) as having possible FSS (Pos-FSS). Mean ED presentations in the FSS group during the study period were significantly higher than in the non-FSS and Pos-FSS groups (p < 0.01). Anxiety was found to be the primary psychological distress indicator associated with ED presentations with FSS. CONCLUSION: We found that, amongst frequent ED presenters, patients with FSS presented significantly more frequently to ED than those without FSS. We propose revising the model of care for FSS in ED to promote appropriate referral to therapy services as a possible demand reduction strategy to improve patient care and efficiency in ED.

Climate Change is an Emerging Threat to Perinatal Mental Health.

OBJECTIVE: In this discussion, we build the case for why climate change is an emerging threat to perinatal mental health. METHOD: A search of current literature on perinatal and maternal mental health and extreme weather events was conducted in PubMed/MEDLINE and Web of Science databases. Only articles focusing on maternal mental health were included in this narrative review. RESULTS: The perinatal period represents a potentially challenging timeframe for women for several reasons. Necessary role adjustments (reprioritization), changes in one's ability to access pre-birth levels (and types) of social support, fluctuating hormones, changes in body shape, and possible complications during pregnancy, childbirth, or postpartum are just a few of the factors that can impact perinatal mental health. Trauma is also a risk factor for negative mood symptoms and can be experienced as the result of many different types of events, including exposure to extreme weather/natural disasters. CONCLUSION: While the concepts of "eco-anxiety," "climate despair," and "climate anxiety" have garnered attention in the mainstream media, there is little to no discussion of how the climate crisis impacts maternal mental health. This is an important omission as the mother's mental health impacts the family unit as a whole.

Understanding and optimising gratitude interventions: the right methods for the right people at the right time.

OBJECTIVE: Gratitude has consistently been associated with various beneficial health-related outcomes, including subjective wellbeing, positive mental health, and positive physical health. In light of such effects, positive psychology researchers and practitioners have often implemented gratitude interventions in an attempt to build individuals' orientations toward appreciation and thankfulness. Recent meta-analyses and reviews have revealed, however, that these interventions often have mixed effects on gratitude or other health outcomes. With this issue in mind, we aimed to identify (a) contextual considerations that may impact the effectiveness of these approaches, and (b) recommendations for the optimisation of gratitude interventions. METHODS AND MEASURES: Seventeen mental health professionals or experienced health psychology researchers engaged in semi-structured interviews to address the research questions. RESULTS: Thematic analysis of the data resulted in three contextual themes-cultural considerations, personal characteristics, and life experience-that were discussed as factors likely to influence intervention effectiveness. With respect to recommendations, participants highlighted the importance of encouraging deep engagement in gratitude tasks, consistent repetition of those tasks, and the value of interpersonal expressions of gratitude. CONCLUSION: Discussion is centred on suggestions for future research on gratitude and on implications for the implementation of gratitude interventions.

Student Employment Models for Undergraduate Nurses and Midwives in Australia: A Scoping Review.

Introduction: Evidence has shown that throughout their undergraduate years, many nursing and midwifery students obtain paid employment in a wide variety of clinical and non-clinical positions. Across Australia, inconsistencies exist in the models of clinical employment available to these student groups. Previous Australian studies have described the employment of undergraduate nursing and midwifery students in regulated and unregulated clinical roles. No studies have reported on the various regulated roles available to both student nurses and midwives in Australia. The purpose of this scoping review is to identify and synthesize evidence related to nursing and/or midwifery students employed in regulated and unregulated clinical roles in Australia. Methods: This scoping review utilized published recommendations for data screening, abstraction, and synthesis. One of the authors, a librarian, undertook systematic searches in CINAHL Complete (1937-present), Emcare on Ovid (1995-present), Scopus (1969-present), and Ovid MEDLINE(R) (including Epub Ahead of Print, In-Process, and In-Data-Review & Other Non-Indexed Citations, 1946-present). The initial searches were completed in April 2019 and repeated in March 2021 and May 2022 to identify any new literature. Manual searching of reference lists in the included papers was also undertaken, together with selected organizational websites. The extracted data included the lead author, date, title, study design, study sample and location, and key findings. Results: From the 53 items retrieved, 23 peer-reviewed studies met the inclusion criteria and were included in the review. All items were published between 2011 and 2022. Only four of the studies focused upon student midwives. Undergraduate nursing and midwifery students in Australia obtain paid employment in a variety of regulated and unregulated clinical roles. Conclusion: The literature reported here demonstrates that there are differing models, nomenclature, educational requirements, and pay scales in place for student employment in clinical roles across Australian states and territories.