An Interdisciplinary Collaboration for Environmental Education

Climate change education in advanced practice registered nursing curricula prepares nurse practitioners to respond to the health effects of climate change. Knowledge of the relationship between human and environmental health is essential for nurse practitioners to identify, teach, and respond to the health effects of climate change in clinical and community settings. This article describes a webinar hosted by the Sarah P. Duke Gardens in partnership with the Duke University School of Nursing. Our webinar provided an opportunity for attendees to understand how gardening can mitigate climate change, the important relationship between human and environmental health, and nurses’ role in climate crisis.     

芦山地震5年后雅安市高血压患者心理卫生问题检出率及其影响因素

目的 了解芦山地震5年后雅安市高血压患者心理卫生问题检出率及其影响因素，为促进地震灾区高血压患者心理健康提供参考。方法 采用分层整群随机抽样方法，于2018年12月选取雅安市高血压患者800例作为研究对象。采用自编居民基本信息调查表收集患者的基本资料，采用12项一般健康问卷（GHQ-12）评定患者近期是否存在心理卫生问题，采用Logistic回归分析其影响因素。结果 回收有效问卷744份（93.00%），检出存在心理卫生问题者79例（10.62%）。单因素分析结果显示，不同婚姻状况（P?0.01）、家庭人均月收入（P=0.012）、是否接受社会救助（χ²=25.194，P?0.01）的高血压患者心理卫生问题检出率差异均有统计学意义。Logistic回归分析显示，未婚/分居/离异/丧偶（OR=3.879，P=0.015）以及接受社会救助（OR=4.705，P?0.01）是高血压患者存在心理卫生问题的危险因素。结论 雅安市高血压患者心理卫生问题检出率较低，未婚/分居/离异/丧偶者以及接受社会救助的高血压患者心理卫生问题可能更突出。     

Designing and Implementing Deliberative Processes for Health Technology Assessment: A Good Practices Report of a Joint HTAi/ISPOR Task Force

ObjectivesDeliberative processes for health technology assessment (HTA) are intended to facilitate participatory decision making, using discussion and open dialogue between stakeholders. Increasing attention is being given to deliberative processes, but guidance is lacking for those who wish to design or use them. Health Technology Assessment International (HTAi) and ISPOR—The Professional Society for Health Economics and Outcomes Research initiated a joint Task Force to address this gap.MethodsThe joint Task Force consisted of 15 members with different backgrounds, perspectives, and expertise relevant to the field. It developed guidance and a checklist for deliberative processes for HTA. The guidance builds upon the few, existing initiatives in the field, as well as input from the HTA community following an established consultation plan. In addition, the guidance was subject to 2 rounds of peer review.ResultsA deliberative process for HTA consists of procedures, activities, and events that support the informed and critical examination of an issue and the weighing of arguments and evidence to guide a subsequent decision. Guidance and an accompanying checklist are provided for (i) developing the governance and structure of an HTA program and (ii) informing how the various stages of an HTA process might be managed using deliberation.ConclusionsThe guidance and the checklist contain a series of questions, grouped by 6 phases of a model deliberative process. They are offered as practical tools for those wishing to establish or improve deliberative processes for HTA that are fit for local contexts. The tools can also be used for independent scrutiny of deliberative processes.     

Economic Evaluation of Prenatal and Postpartum Care in Women With Gestational Diabetes and Hypertensive Disorders of Pregnancy: A Systematic Review

ObjectivesThis study aimed to summarize evidence on the economic outcomes of prenatal and postpartum interventions for the management of gestational diabetes mellitus and hypertensive disorders of pregnancy (HDP), assess the quality of each study, and identify research gaps that may inform future research.MethodsElectronic databases including PubMed/MEDLINE, Embase, the Cochrane Library, and Cochrane Central Register of Controlled Trials were searched from January 1, 2000, to October 1, 2021. Selected studies were included in narrative synthesis and extracted data were presented in narrative and tabular forms. The quality of each study was assessed using the Consolidated Health Economic Evaluation Reporting Standards and Consensus on Health Economic Criteria list.ResultsAmong the 22 studies identified through the systematic review, 19 reported favorable cost-effectiveness of the intervention. For prenatal management of HDP, home blood pressure monitoring was found to be cost-effective compared with in-person visits in improving maternal and neonatal outcomes. For postpartum care, regular screening for hypertension or metabolic syndrome followed by subsequent treatment was found to be cost-effective compared with no screening in women with a history of gestational diabetes mellitus or HDP.ConclusionsExisting economic evaluation studies showed that prenatal home blood pressure monitoring and postpartum screening for hypertension or metabolic syndrome were cost-effective. Nevertheless, limitations in the approach of the current economic evaluations may dampen the quality of the evidence and warrant further investigation.     

全国2015-2020年精神科医师转岗培训状况

目的:调查全国精神科医师转岗培训情况,为优化精神科医师转岗培训和制定精神卫生人才培养体系建设提供参考。方法:设计精神科医师转岗培训调查问卷,调查全国31个省(自治区、直辖市)和新疆生产建设兵团2015-2020年转岗培训情况。采用描述性分析方法,对全国精神科医师转岗培训和培训区县覆盖等情况进行分析;采用χ~2检验比较东中西部地区转岗医师中已提供精神科诊疗服务情况。结果:全国共13 388人完成精神科医师转岗培训,9923人变更或加注了精神科执业资质,6538人已提供精神科诊疗服务,无精神卫生资源空白区县数减少85.1%。结论:转岗培训短期内缓解了精神卫生人才紧缺现状,提高了精神卫生服务可及性。     

Spinal Cord Injury–Functional Index/Capacity: Responsiveness to Change Over Time

ObjectiveTo establish responsiveness of 3 Spinal Cord Injury–Functional Index/Capacity (SCI-FI/C) item banks in the first year after spinal cord injury (SCI).DesignLongitudinal patient-reported outcomes assessment replicated through secondary analysis of an independent data set.SettingA total of 8 SCI Model Systems rehabilitation hospitals in the United States.ParticipantsStudy 1 participants included 184 adults with recent (≤4 months) traumatic SCI and 221 community-dwelling adults (>1 year post injury) (N=405). Study 2 participants were 418 individuals with recent SCI (≤4 months) (N=418).InterventionsIn study 1, SCI-FI/C computer adaptive tests were presented in a standardized interview format either in person or by phone call at baseline and 6-month follow-up. Responsiveness was examined by comparing 6-month changes in SCI-FI scores within and across samples (recently injured vs community-dwelling) because only the recent injury sample was expected to exhibit change over time. Effect sizes were also computed. In study 2, the study 1 results were cross-validated in a second sample with recent SCI 1 year after baseline measurement. Study 2 also compared the SCI-FI/C measures’ responsiveness to that of the Self-reported Functional Measure (SRFM) and stratified results by injury diagnosis and completeness.Main Outcome MeasuresThe SCI-FI Basic Mobility/C, Self-care/C and Fine Motor/C item banks (study 1 and study 2); Self-reported Functional Measure SRFM (study 2 only).ResultsIn study 1, changes in SCI-FI/C scores between baseline and 6-month follow-up were statistically significant (P<.01) for recently injured individuals. SCI-FI Basic Mobility/C, Self-care/C, and Fine Motor/C item banks demonstrated small to medium effect sizes in the recently injured sample. In the community-dwelling sample, all SCI-FI/C effects were negligible (ie, effect size<0.08). Study 2 results were similar to study 1. As expected, SCI-FI Basic Mobility/C and Self-care/C were responsive to change for all individuals in study 2, whereas the SCI-FI Fine Motor/C was responsive only for individuals with tetraplegia and incomplete paraplegia. The SRFM demonstrated a medium effect size for responsiveness (effect size=0.65).ConclusionsThe SCI-FI Basic Mobility/C and Self-care/C banks demonstrate adequate sensitivity to change at 6 months and 1 year for all individuals with SCI, while the SCI-FI/C Fine Motor item bank is sensitive to change in individuals with tetraplegia or incomplete paraplegia. All SCI-FI/C banks demonstrate stability in a sample not expected to change. Results provide support for the use of these measures for research or clinical use.