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Framework for the Development and Delivery of Digital Peer Support Programs: Qualitative Study on in-Person and Digital Delivery for People With Cardiovascular Disease
Full text linkBackground: Peer support (ie, sharing experiences and providing support with others with the same condition) improves health outcomes among people with cardiovascular disease (CVD), including self-management behaviors and self-efficacy. However, current peer support interventions are diverse, and evidence is lacking on the perceptions of benefits and the elements considered priorities by peer support attenders, especially regarding digital interventions. Objective: The study aimed to (1) describe perceived benefits and recommendations for CVD peer support programs from people attending in-person peer support, (2) identify priorities for digital peer support from consumers and clinicians testing a peer support app prototype, and (3) develop a framework to inform future peer support intervention development. Methods: A qualitative study design was used across 2 components to address the objectives. In Component 1, semistructured focus groups were conducted with attenders of established in-person CVD peer support groups to explore the perceived benefits of peer support and recommendations for future programs. In Component 2, semistructured workshops with consumers with CVD and semistructured interviews with CVD clinicians/researchers were conducted to obtain feedback and recommendations for digital peer support using an exploratory digital CVD peer support application prototype. Data were digitally recorded, transcribed verbatim, and analyzed thematically. Findings from both components were iteratively synthesized to inform the development of a digital peer support framework. Results: In Component 1, a total of 22 participants (age range 29‐84 years, 45% male) took part in focus groups. The overarching theme was that peer support provides benefits through the sharing of experiences. Five themes were refined and defined: (1) peer support provides a way of coping; (2) peers learn from each other; (3) peers understand what each other is going through; (4) the peer community uplifts mood and builds confidence; and (5) awareness, flexibility, and resources are important for engagement. In Component 2, five participants (age range 55‐74 years, 60% male) attended 2 workshops, and 8 clinicians-researchers (age range 30‐65 years, 10% male) were interviewed. Three themes were refined and defined: (1) autonomy is essential to promote engagement; (2) safeguarding is important to both users and clinicians; and (3) interfaces that are simple, easy to use, and visually attractive enable use. Priorities identified from both components included greater peer support awareness and uptake, flexibility with timing and family participation, health care professional involvement, provision of resources, autonomous features enabling choice, checklists and clinician moderation for safeguarding, and simple-to-use interfaces. Conclusions: Participants in peer support programs derive benefit from sharing their experience of living with CVD, which enables coping, learning, feeling understood, and a sense of community. Priorities were synthesized to create a framework for digital peer support development, with recommendations to focus on 6 key areas: uptake, flexibility, resources, autonomy, safeguarding, and interface
Socioeconomic variation in the relationship between cardiac rehabilitation participation and clinical outcomes:a systematic review
Full text linkAIM: To systematically evaluate whether relationships between cardiac rehabilitation participation and clinical outcomes, return to work, or knowledge about cardiovascular disease vary across socioeconomic indicators.METHODS: A systematic review was conducted using CENTRAL, CINAHL, Embase and Medline up to 1 November 2024. Studies were included if they compared outcomes between participants who received cardiac rehabilitation and those who did not or received an exercise programme. Outcomes included all-cause death, all-cause and cardiovascular-related rehospitalisation, return to work and cardiovascular knowledge, stratified by socioeconomic indicators. Risk of bias was assessed using the Risk Of Bias In Non-Randomized Studies-of Interventions-I tool.RESULTS: Six studies involving 555 731 participants were included. Compared with non-participants, cardiac rehabilitation participants had lower rates of all-cause death (12.3%-16.9%) and all-cause rehospitalisation (15.2%-16.1%), with incidence rate differences in cardiovascular-related rehospitalisation reaching up to 27.8 fewer events/100 person-years. Some of the greatest differences were among participants residing in more disadvantaged areas, although this was not consistent across studies. No significant differences were observed in the combined outcome of all-cause death and cardiovascular-related rehospitalisation when stratified by educational attainment levels. Return to work and knowledge outcomes showed greater variation across education and income subgroups, with higher values consistently observed among cardiac rehabilitation participants from less disadvantaged backgrounds. All studies were observational and had moderate risk of bias.CONCLUSIONS: Cardiac rehabilitation improves clinical and functional outcomes across socioeconomic subgroups, although disparities in participation and outcomes persist. Tailoring programme delivery to be more flexible and responsive to literacy needs may help ensure its benefits are equitably achieved across patient subgroups.PROSPERO REGISTRATION NUMBER: CRD42022332355.</p
Reciprocal associations between trajectories of physical activity and physical function among older women: findings from the Australian Longitudinal Study on Women's Health
Full text linkBackground: While physical activity (PA) is known to improve physical function (PF), and functional decline impacts the capacity to engage in PA, the reciprocal relationship between PA and PF remains unclear.Methods: Data were from participants in the 1921-26 cohort of the Australian Longitudinal Study on Women's Health (N=8,238). PA and PF were assessed at three-year intervals from 1999 (73-78y) to 2011 (85-90y). Group-based trajectory modelling was used to identify PA and PF trajectories, and associations between PA and PF were examined using mixed-effects models and restricted cubic spline modelling.Results: Three trajectories for PA and PF were identified: Low, Moderate, and High. Women in the High PA group maintained high PF and did not reach the starting PF level of the Low PA group (at age 73) until they were 87. Similarly, women in the High PF group maintained higher PA than those in the other groups. Women in the Low PF group never met PA guidelines and had PF scores below the disability threshold throughout the study. Restricted cubic splines showed that higher PA was associated with better PF three years later, and vice versa, indicating that PA and PF influence each other.Conclusion: There are reciprocal relationships between PF and PA; higher levels of PA promote better PF, and higher PF may help slow the decline in PA. While rates of decline in PF show little variation with PA in women during their eighties, habitually high PA confers considerable benefits, contributing to additional years of healthy life
Annotated Leading Cases of International Criminal Tribunals: The Special Tribunal for Lebanon, 1 January 2014 – 31 December 2018
No full textThis is the seventy-fourth volume in the series and contains the most important decisions of the Special Tribunal for Lebanon (STL) handed down in the period 1 January 2014 – 31 December 2018. It is the second volume in the series containing decisions of the STL. Given that this Tribunal has ceased its operations on 31 December 2023, volumes 78, 79 and 80 will be the last on STL case law that will be published in the series in the coming year
Lower aperiodic EEG activity is associated with reduced verbal fluency performance across adulthood
Full text linkAge-related cognitive decline associations with human electroencephalography (EEG) have previously focused on periodic activity. However, EEG primarily consists of non-oscillatory aperiodic activity, characterised with an exponent and offset value. In a secondary analysis of a cohort of 111 healthy participants aged 17 – 71 years, we examined the associations of the aperiodic exponent and offset in resting EEG with a battery of cognitive tests consisting of the Colour-Word Interference Test, Wechsler Adult Intelligence Scale IV Digit Span Test, Rey Auditory Learning Test, Delis-Kaplan Executive Function System Trail Making Test, and the Verbal Fluency Test. Using Principal Component Analysis and K-Means Clustering, we identified clusters of electrodes that exhibited similar aperiodic exponent and offset activity during resting-state eyes-closed EEG. Robust linear models were then used to model how aperiodic activity interacted with age and their associations with performance during each cognitive test. Offset by age interactions were identified for the Verbal Fluency Test, where smaller offsets were associated with poorer performance in adults as early as 33 years of age. Greater aperiodic activity is increasingly related to better verbal fluency performance with age in adulthood.</p
Exploring the barriers to mental health help-seeking among African Migrants in Australia: A qualitative study
Full text linkBackground:The health of African migrants in Australia is a largely under-researched topic despite the steadily increasing size of the population and its uniqueness. In particular, few studies have explored the mental health of African migrants in Australia or their utilization of mental health services. Aims: This study explored the barriers to mental health help-seeking among first-generation African migrants in Australia. Methods: In this qualitative study conducted using the hermeneutical phenomenological research approach, the purposive sampling method was used to recruit participants. In-depth interviews with participants were undertaken online via Zoom, Teams, and WhatsApp calls. Interviews were recorded and transcribed verbatim, utilizing a thematic analysis as the primary data analysis method. Results: African migrants were more inclined to seek support for mental health conditions from religious figures such as priests instead of seeking professional help. Religion and poor knowledge about mental illness were highlighted as barriers to mental health help-seeking. Participants also considered cultural beliefs, fear of stigma as well as the high cost of healthcare in Australia as significant barriers to mental health help-seeking among African migrants. Conclusions: Findings reinforce the critical need for culturally competent mental health services tailored to the beliefs, values, religion, and experiences of African and other migrant communities in Australia. Given the strong attachment of many African migrants in Australia to their cultural and religious beliefs, such services are essential for practical support and intervention
Built environment – the secret recipe for mental health healing and recovery: a literature review
No full textPurpose: In the context of urbanization, mental health disorders are becoming an increasing presence that cannot be ignored. It has been discovered that the built environment can influence mental health; however, the relationship between the two is complex, and previous studies lack a general overview of the two. Consequently, this study examines built environment and mental health through a literature review to provide a comprehensive overview and recommendations for psychological health planning in relation to the built environment. Design/methodology/approach: This literature review includes bibliometric analysis and narrative synthesis. Additionally, meta-analysis has been employed to scrutinize the relationship between built environment elements and mental health effects. Findings: The bibliometric analysis reveals that “health equity” and “healthy aging” have prompted a new wave of research in this field, with the meso- and micro-environment becoming the main focus. Based on the keywords, a narrative synthesis is conducted to identify the influence mechanism, the spatial definition of built environment provides the foundation for the identification of impact elements, the influence of built environment on mental health is realized both directly and indirectly, and diverse methods of data acquisition and analysis offer the basis for exploration and research. Originality/value: Ultimately, six optimization strategies and four modular planning recommendations are proposed to improve built environment practices to mitigate mental health problems, strengthen public psychological resilience and help achieve the sustainable development goal of health and well-being
The effectiveness of educational interventions in enhancing health professionals' and students' pain assessment for people living with dementia: A systematic review
Full text linkObjectives: To evaluate the effectiveness of educational interventions in improving the knowledge, attitudes, beliefs, self-efficacy, and confidence of health professionals' and students' pain assessment in dementia. Design: A systematic review was conducted and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data sources: Eight English databases were searched: Medline, Psychological Information Database, Cochrane Library, PubMed, Cumulative Index of Nursing and Allied Health Literature, ProQuest, Scopus, and Web of Science. Review methods:Databases were searched without any time limit using synonyms for “health personnel”, “health students”, “pain assessment”, “dementia”, “educational intervention”, “knowledge”, “attitude”, “beliefs”, “self-efficacy”, and “confidence”. The review included studies published up to 26 March 2024. Reference lists and review papers were screened to identify additional papers. Data was synthesised according to the intervention designs and outcome measures and presented narratively. Results: The seven studies retained involved 517 registered nurses, 17 physical therapists, eight occupational therapists, 17 physicians, 99 nursing students, and 161 medical students. All seven studies evaluated the effectiveness of educational interventions on knowledge, three on attitudes, two on confidence, one on self-efficacy, and none on beliefs of pain assessment in dementia. Health professionals' and students' knowledge scores improved irrespective of the training delivery mode and duration. Their confidence scores improved irrespective of training duration. Health professionals' self-efficacy scores improved upon completion of online training. Overall attitude scores for most health professionals and students did not increase upon educational intervention completion, irrespective of the training delivery mode and duration. Educational interventions mainly focused on methods that assess pain in both communicative and non-communicative people with dementia. Conclusions: Educational interventions enhance health professionals' and students' knowledge, self-efficacy, and confidence in pain assessment in dementia. Studies showed mixed findings related to attitudes, and there is a limited understanding of interventions' effectiveness in correcting erroneous beliefs
Predictive Factors for Patient Recovery Following Triangular Fibrocartilage Foveal Repair Surgery: A Retrospective Case-Series
Full text linkBackground:There are many factors that may influence patient recovery following triangular fibrocartilage complex (TFCC) foveal repair surgery. This study aimed to retrospectively analyze patient records following TFCC foveal repair surgery to identify characteristics that predict patient outcomes.Methods: A multicenter, retrospective case-series was conducted. Informed written consent was obtained from participating hand therapy clinics, who provided deidentified patient records for adult patients following TFCC foveal repair surgery between January 1 2015 and December 31 2020. Predictors of outcomes were identified using Linear Mixed Effects Regression and Logistic Regression models.Results: A total of 210 patients were included. The most notable improvements in range of motion (ROM) and grip strength, and pain reduction, were observed in the first 10 weeks postsurgery. Longer forearm immobilization duration predicted poorer ROM for pronation, flexion, and extension. Workcover (compensable) patients demonstrated poorer ROM progression compared with private patients. Forty-two patients (20%) required further surgery, of which was due to postoperative TFCC rupture for 22 patients (10%). Patients who received a shorter wrist immobilization period were more likely to experience TFCC rupture. The duration of time between injury and operative treatment did not predict ROM, grip strength, or pain progression.Conclusions: Longer forearm immobilization predicted poorer ROM and grip strength progression, whereas shorter wrist immobilization predicted an increased risk of TFCC rupture. These findings support a staggered commencement of wrist and forearm ROM exercises, whereby forearm rotation exercises could commence earlier than wrist exercises. The duration of time between injury and operative treatment did not predict ROM, grip strength, or pain progression