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1.
Article in English | MEDLINE | ID: mdl-38963517

ABSTRACT

Social anxiety is common in childhood and potentially transitions into clinical disorders including depression. The present study aimed to examine the effectiveness of an indicated prevention program for children screened in routine care. Data came from the PROMPt project, a prospective implementation study (10/2018-09/2022) that explored a novel care chain, starting with screening with the Strengths and Difficulties Questionnaire (SDQ) as part of regular health check-ups, followed by indicated assignment and participation in a prevention program. Questionnaires assessing anxiety and depression symptoms were administered shortly after screening or before program participation (T0), six months after screening or after program participation (T1) and at a follow-up, six months after T1 (T2). Children who participated in a group cognitive-behavioral social skills program (TT; n = 145) were compared using mixed model analyses with non-participating children who were either screened as normal (NOR; n = 894) or refused program participation despite indication (NoTT; n = 67). TT scores improved from T0 to T1 compared to NOR and NoTT (anxiety ß = -0.71 and ß = -0.71, social anxiety ß = -0.46 and ß = -0.52, depression ß = -0.52 and ß = -0.73). Improvement was maintained at T2. Moderation analyses showed a trend toward greater benefit for participants with higher baseline scores. Indicated prevention can improve anxiety and depression symptoms in children identified by screening in routine care. Systematic screening and targeted prevention may positively affect mental health of children on a population level.

2.
BMC Psychiatry ; 24(1): 362, 2024 May 14.
Article in English | MEDLINE | ID: mdl-38745267

ABSTRACT

BACKGROUND: Obsessive-compulsive disorder (OCD) is characterized by persistent, unwanted thoughts and repetitive actions. Such repetitive thoughts and/or behaviors may be reinforced either by reducing anxiety or by avoiding a potential threat or harm, and thus may be rewarding to the individual. The possible involvement of the reward system in the symptomatology of OCD is supported by studies showing altered reward processing in reward-related regions, such as the ventral striatum (VS) and the orbitofrontal cortex (OFC), in adults with OCD. However, it is not clear whether this also applies to adolescents with OCD. METHODS: Using functional magnetic resonance imaging, two sessions were conducted focusing on the anticipation and receipt of monetary reward (1) or loss (2), each contrasted to a verbal (control) condition. In each session, adolescents with OCD (n1=31/n2=26) were compared with typically developing (TD) controls (n1=33/ n2=31), all aged 10-19 years, during the anticipation and feedback phase of an adapted Monetary Incentive Delay task. RESULTS: Data revealed a hyperactivation of the VS, but not the OFC, when anticipating both monetary reward and loss in the OCD compared to the TD group. CONCLUSIONS: These findings suggest that aberrant neural reward and loss processing in OCD is associated with greater motivation to gain or maintain a reward but not with the actual receipt. The greater degree of reward 'wanting' may contribute to adolescents with OCD repeating certain actions more and more frequently, which then become habits (i.e., OCD symptomatology).


Subject(s)
Anticipation, Psychological , Magnetic Resonance Imaging , Obsessive-Compulsive Disorder , Reward , Ventral Striatum , Humans , Adolescent , Obsessive-Compulsive Disorder/physiopathology , Obsessive-Compulsive Disorder/psychology , Obsessive-Compulsive Disorder/diagnostic imaging , Male , Female , Anticipation, Psychological/physiology , Ventral Striatum/physiopathology , Ventral Striatum/diagnostic imaging , Young Adult , Child , Prefrontal Cortex/physiopathology , Prefrontal Cortex/diagnostic imaging , Motivation/physiology
4.
Article in German | MEDLINE | ID: mdl-37921872

ABSTRACT

BACKGROUND: Mental health problems usually have their onset in childhood. Undiagnosed, they may progress into mental disorders. Despite their effectiveness, existing preventive programs have been rarely used. We aimed to examine to what extent the establishment of a care chain can identify children at high risk at an early stage and assign them to preventive interventions. In addition, prevention program participation was assessed. METHODS: In a prospective implementation study, the Strengths and Difficulties Questionnaire was administered as a screening instrument to families during regular pediatric health examinations (U9-U11, child age 5-10 years). Families received feedback directly from the pediatrician, and in the case of borderline abnormal emotional or behavioral problems, a recommendation for an indicative prevention program. Program indication was additionally determined in an entry examination prior to program participation. RESULTS: In the area of Dresden (Germany), n = 46 (38.7%) pediatricians participated in the project. In n = 28 pediatric practices, n = 3231 (86.4%) families participated in the screening and n = 864 (26.7%) children received a prevention recommendation. Of the families, n = 118/864 (13.7%) self-registered for the prevention programs, n = 215/624 (35.5%) showed interest after being contacted by the study teamn. Through other pathways, n = 139 families requested participation. Clinical evaluation interviews to assess prevention indication were conducted in n = 337 children (n = 461; via all entry pathways). Finally, n = 237 (n = 337) children participated in an indicated prevention program. CONCLUSION: Expanding screening to mental health problems during regular health checkups is feasible, useful, and widely accepted. In order to implement a care chain, a supply structure should be established to enable referral to and uptake of preventive interventions.


Subject(s)
Health Promotion , Schools , Humans , Child , Child, Preschool , Prospective Studies , Germany , Pediatricians
5.
Nurse Pract ; 48(9): 40-46, 2023 09 01.
Article in English | MEDLINE | ID: mdl-37643145

ABSTRACT

ABSTRACT: Intimate partner violence (IPV) is a significant public health issue associated with substantial morbidity and mortality. NPs are ideally positioned to screen for and intervene in IPV, thereby mitigating the health risks IPV carries for women, infants, and young children. Safety planning and appropriate referrals to community-based resources are critical components of addressing IPV.


Subject(s)
Intimate Partner Violence , Child , Infant , Humans , Female , Child, Preschool , Public Health , Referral and Consultation
6.
J Clin Med ; 12(7)2023 Mar 24.
Article in English | MEDLINE | ID: mdl-37048570

ABSTRACT

(1) Background: 1-2% of children and adolescents are affected by Obsessive-Compulsive Disorder (OCD). The rigid, repetitive features of OCD and an assumed disability to inhibit recent mental representations are assumed to have led to a paradoxical advantage in that the Backward Inhibition (BI) effect was recently found to be lower in adolescents with OCD as compared to healthy controls. It was hypothesized that app-based mindfulness meditation training could reduce the disability to inhibit recent mental representations and thus increase the BI-effect by adapting cognitive flexibility and inhibition abilities according to healthy controls. (2) Methods: 58 adolescents (10-19 years) with OCD were included in the final sample of this interviewer-blind, randomized controlled study. Participants were allocated to an intervention group (app-based mindfulness meditation training) or an (active) control group (app-based audiobook) for eight weeks. Symptom (CY-BOCS), behavioral (reaction times and mean accuracy), and neurophysiological changes (in EEG) of the BI-effect were analyzed in a pre-post design. (3) Results: The intervention and the control group showed an intervention effect (Reliable Change Index: 67%) with a significant symptom reduction. Contrary to the hypothesis, the BI-effect did not differ between pre vs. post app-based mindfulness meditation training. In addition, as expected the audiobook application showed no effects. Thus, we observed no intervention-specific differences with respect to behavioral (reaction times and mean accuracy) or with respect to neurophysiological (perceptual [P1], attentional [N1], conflict monitoring [N2] or updating and response selection [P3]) processes. However, in an exploratory approach, we revealed that the BI-effect decreased in participants who did not benefit from using an app, regardless of group. (4) Conclusions: Both listening to an app-based mindfulness meditation training and to an audiobook reduce symptom severity in adolescent OCD as measured by the CY-BOCS; however, they have no specific effect on BI. The extent of the baseline BI-effect might be considered as an intra-individual component to predict the benefit of both mindfulness meditation training and listening to an audiobook.

7.
J Adv Nurs ; 79(5): 1982-1993, 2023 May.
Article in English | MEDLINE | ID: mdl-36630188

ABSTRACT

AIM: To estimate the association between feeling upset by experiences of racism and self-reported depression during pregnancy among non-Hispanic Black women using a large population-based sample from the United States. DESIGN: We conducted a secondary analysis of nationally representative cross-sectional survey data with retrospective measures. METHODS: Analysis of Phase 8 (2018) data from the Pregnancy Risk Assessment Monitoring System survey included 7328 non-Hispanic Black respondents with a recent live birth from 11 states and New York City. Multivariable logistic regression models were used to estimate the association between self-report of feeling upset due to experience of racism during the year prior to delivery and self-reported depression during pregnancy, controlling for potential confounders. RESULTS: The prevalence of feeling upset due to experiences of racism was 11.4% and the prevalence of depression during pregnancy was 11.4%. Respondents who reported feeling upset due to the experience of racism had over two-fold higher odds (OR 2.37, 95% CI 1.67, 3.37) of experiencing depression during pregnancy compared to respondents who did not report feeling upset due to the experience of racism, adjusted for maternal age, educational attainment, marital status, pre-pregnancy insurance type, region, and pre-pregnancy depression. CONCLUSION: Respondents who felt upset due to the experience of racism in the year prior to delivery experienced significantly higher odds of depression during pregnancy, and thus are at an increased risk for adverse maternal outcomes. IMPACT: Stress from racism and racial discrimination during the perinatal period may contribute to maternal morbidity, including perinatal depression, among Black women. NO PATIENT OR PUBLIC CONTRIBUTION: The data in this study were collected by the Centers for Disease Control and Prevention for the Pregnancy Risk Assessment Monitoring System. To our knowledge, the conduct of the study did not include patient or public contribution. Neither did the analysis, interpretation, nor manuscript preparation include patient or public contribution because we did not have funding to support the study or their involvement.


Subject(s)
Racism , Pregnancy , Female , Humans , United States/epidemiology , Cross-Sectional Studies , Depression/epidemiology , Retrospective Studies , Population Surveillance , Risk Assessment
8.
Int J Nurs Educ Scholarsh ; 19(1)2022 Jan 01.
Article in English | MEDLINE | ID: mdl-36423354

ABSTRACT

OBJECTIVES: An international Nursing Leadership Collaborative covened in Japan to hold a patient safety and quality workshop for nursing students from six countries. The purpose was to measure students' self reported beliefs reflecting sensitivity and openness to cultural diversity before and after the international experience. METHODS: A pre-post-test design was used and the Beliefs, Events, and Values Inventory was administered to international undergraduate and graduate nursing students. RESULTS: The group aggregate data analysis indicate that prior to the start of the workshop, the group presented itself as quite introspective and after the workshop the group reported being more sophisticated in making causal explanations about why the world works in the way it does. CONCLUSIONS: Nursing students experienced an expanded awareness of their beliefs and values that reflect a greater degree of intercultural sensitivity for acceptance of inclusivity and diversity after the experience.


Subject(s)
Education, Nursing, Baccalaureate , Education, Nursing, Graduate , Students, Nursing , Humans , Learning
9.
J Perinat Neonatal Nurs ; 36(3): 233-242, 2022.
Article in English | MEDLINE | ID: mdl-35894719

ABSTRACT

Perinatal depression occurs in approximately 1 in 7 women and is considered the most common complication of pregnancy and childbearing. Management of perinatal depression may include a combination of nonpharmacological and pharmacological therapies depending on the severity of symptoms, the stage of gestation, and maternal preference. Healthcare providers are recommended to review current guidelines and provide information to women during pregnancy and postpartum regarding the risks and benefits of nonpharmacological and pharmacological treatment options for perinatal depression. In addition, healthcare providers should consider common barriers to treatment including inadequate screening and social stigma. This article reviews common treatments of perinatal depression as well as the clinical guidelines provided by the American Association of Obstetricians and Gynecologists (ACOG), the American Psychiatric Association (APA), and the US Preventive Services Task Force (USPSTF). Discussion of nonpharmacological therapies includes cognitive behavioral therapy (CBT) and interpersonal therapy (IPT). Pharmacological treatments are reviewed by drug class and include selective serotonin reuptake inhibitors (SSRIs), serotonin/norepinephrine reuptake inhibitors (SNRIs), norepinephrine/dopamine reuptake inhibitors (NDRIs), and tricyclic antidepressants (TCAs). Adjunctive treatments of severe depression, including second-generation antipsychotics (SGAs), are also discussed.


Subject(s)
Depression , Depressive Disorder , Depression/diagnosis , Depression/therapy , Depressive Disorder/drug therapy , Female , Humans , Norepinephrine/therapeutic use , Pregnancy , Selective Serotonin Reuptake Inhibitors/therapeutic use
10.
J Res Nurs ; 26(1-2): 81-94, 2021 Mar.
Article in English | MEDLINE | ID: mdl-35251228

ABSTRACT

BACKGROUND: Patient harm is a global crisis fueling negative outcomes for patients around the world. Working together in an international learning collaborative fostered learning with, from and about each other to develop evidence-based strategies for developing quality and safety competencies in nursing. AIMS: To report student outcomes from an international learning collaborative focused on patient safety using the Quality and Safety Education for Nurses competency framework. METHODS: A global consortium of nursing faculty created an international learning collaborative and designed educational strategies for an online pre-workshop and a 10-day in-person experience for 21 undergraduate and graduate nursing students from six countries. A retrospective pre-test post-test survey measured participants' confidence levels of patient safety competence using the health professional education in patient safety survey and content analysis of daily reflective writings. RESULTS: Statistical analysis revealed student confidence levels improved across all eight areas of safe practice comparing-pre and post-education (significance, alpha of P < 0.05). Two overarching themes, reactions to shared learning experiences and shared areas of learning and development, reflected Quality and Safety Education for Nurses competencies and a new cultural understanding. CONCLUSIONS: The international learning collaborative demonstrated that cross-border learning opportunities can foster global development of quality and safety outcome goals.

11.
Gerontol Geriatr Educ ; 33(4): 337-50, 2012.
Article in English | MEDLINE | ID: mdl-23095219

ABSTRACT

Engaged scholarship promotes contribution to the academic body of knowledge through equal partnership between academic scholars and community representatives in education, research, and public service or intervention. Such partnerships can expand our notions of service learning and applied research. In this article, the authors discuss the potential contribution of engaged scholarship to the relevance of gerontological education and research programs. The authors discuss the role of engaged scholarship in the philosophy of education, in the promotion of social justice, and its relevance for the civic responsibility and accountability of educational institutions. Finally, the authors describe benefits and barriers to participation in engaged scholarship and challenges in the recruitment of engaged scholars.


Subject(s)
Biomedical Research , Geriatrics/education , Humans , Knowledge , Learning , Models, Educational
12.
J Med Ethics ; 37(8): 504-9, 2011 Aug.
Article in English | MEDLINE | ID: mdl-21636608

ABSTRACT

BACKGROUND: In Canadian jurisdictions without specific legislation pertaining to research consent, the onus is placed on researchers to determine whether a child is capable of independently consenting to participate in a research study. Little, however, is known about how child health researchers are approaching consent and capacity assessment in practice. The aim of this study was to explore and describe researchers' current practices. METHODS: The study used a qualitative descriptive design consisting of 14 face-to-face interviews with child health researchers and research assistants in Southern Ontario. Transcribed interviews were analysed for common themes. RESULTS: Procedures for assessing capacity varied considerably from the use of age cutoffs to in-depth engagement with each child. Three key issues emerged from the accounts: (1) requirements that consent be provided by a single person thwarted researchers' abilities to support family decision-making; (2) little practical distinction was made between assessing if a child was capable, versus determining if study information had been adequately explained by the researcher; and (3) participants' perceived that review boards' requirements may conflict with what they considered ethical consent practices. CONCLUSION: The results suggest that researchers' consent and capacity knowledge and skills vary considerably. Perceived discrepancies between ethical practice and ethics boards' requirements suggest the need for dialogue, education and possibly ethics board reforms. Furthermore we propose, where appropriate, a 'family decision-making' model that allows parents and their children to consent together, thereby shifting the focus from separate assent and consent procedures to approaches that appropriately engage the child and family.


Subject(s)
Decision Making , Informed Consent By Minors/ethics , Child , Child Welfare , Comprehension , Harm Reduction , Humans , Information Dissemination/methods , Informed Consent By Minors/legislation & jurisprudence , Parent-Child Relations , Personal Autonomy , Qualitative Research
13.
Healthc Q ; 12(3): 60-5, 2009.
Article in English | MEDLINE | ID: mdl-19553766

ABSTRACT

Innovation is essential to ongoing improvements in quality healthcare, yet healthcare institutions continue to struggle with the challenge of how best to operationalize the multiple commitments to risk minimization, accountability, the defensible use of resources and quality innovative practices. An ideal pathway would be one that adheres to both the ethical values of the institution in which the innovation is being introduced and relevant legal standards in a way that preserves the innovators' imagination and enthusiasm while ensuring scientific rigour and accountability. An interdisciplinary team at the Hospital for Sick Children in Toronto, Ontario, developed a policy-entrenched pathway f or managing the introduction of innovative procedures in surgery. This article describes the innovation pathway and the steps; taken in its development.


Subject(s)
Diffusion of Innovation , Health Facilities , Social Responsibility , Guidelines as Topic
14.
Can J Cardiovasc Nurs ; 18(4): 40-6, 2008.
Article in English | MEDLINE | ID: mdl-19093421

ABSTRACT

Chronic heart failure (CHF) is an increasingly common condition in high-income countries that has a large and negative impact on life quality and expectancy, and is associated with high financial costs. In Canada, CHF has an especially large impact on rural settings because of the higher proportion of older adults (aged >65 years) in these settings, and because care and outcomes tend to be more adverse in rural parts of the country compared to urban settings. Much can be done to reduce these burdens in terms of pharmacological, behavioural and health service strategies. However, rural patients tend to have worse care and outcomes than urban patients. Realizing the benefits of these strategies in Canada's rural settings requires consideration of underlying reasons for poor care and outcomes. We propose the main reasons for adverse outcomes are related to the nature of CHF and the combined influence of demographics, health services and the rural context. Nurses remain under-used in CHF management in Canada and can play a vital and influential role in reducing the burden of CHF in rural settings. To increase and improve nurses' roles, we recommend that nurses should support the development and adaptation of disease management programs in rural settings and promote the centrality of nursing in these programs. Nurses in or working with rural settings should seek to support and use tele-health technologies effectively and provide better support to lay caregivers. It will also be vital to increase the nursing capacity regarding specialist roles for CHF management.


Subject(s)
Disease Management , Health Services for the Aged , Heart Failure/nursing , Rural Health Services , Aged , Canada , Chronic Disease , Cost of Illness , Health Services for the Aged/organization & administration , Health Status Disparities , Humans , Rural Health Services/organization & administration , Telenursing , Workforce
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