Do social support and community engagement act as mechanisms in the association between neighbourhood income inequality and the mental health of mothers in Calgary,Canada? A mediation analysis

PurposeAccording to the social determinants of health framework, income inequality is a potential risk factor for adverse mental health. However, few studies have explored the mechanisms suspected to mediate this relationship. The current study addresses this gap through a mediation analysis to determine if social support and community engagement act as mediators linking neighbourhood income inequality to maternal anxiety and depressive symptoms within a cohort of new mothers living in the City of Calgary, Canada.MethodsData collected at three years postpartum from mothers belonging to the All Our Families (AOF) cohort were used in the current study. Maternal data were collected between 2012 and 2015 and linked to neighbourhood socioeconomic data from the 2006 Canadian Census. Income inequality was measured using Gini coefficients derived from 2006 after-tax census data. Generalized structural equation models were used to quantify the associations between income inequality and mental health symptoms, and to assess the potential direct and indirect mediating effects of maternal social support and community engagement.ResultsIncome inequality was not significantly associated with higher depressive symptoms (β = 0.32, 95%CI = −0.067, 0.70), anxiety symptoms (β = 0.11, 95%CI = −0.39, 0.60), or lower social support. Income inequality was not associated with community engagement. For the depression models, higher social support was significantly associated with lower depressive symptoms (β = −0.13, 95%CI = −0.15, −0.097), while community engagement was not significantly associated with depressive symptoms (β = 0.059, 95%CI = −0.15, 0.27). Similarly, for the anxiety models, lower anxiety symptoms were significantly associated with higher levels of social support (β = −0.17, 95%CI = −0.20, −0.13) but not with higher levels of community engagement (β = 0.14, 95%CI = −0.14, 0.41).ConclusionThe current study did not find clear evidence for social support or community engagement mediating the relationship between neighbourhood income inequality and maternal mental health. Future investigations should employ a broader longitudinal approach to capture changes in income inequality, potential mediators, and mental health symptomatology over time.     

宫颈癌幸存者社会疏离感现状及影响因素研究

目的 探讨宫颈癌幸存者社会疏离现状及其影响因素，为实施针对性干预提供参考。方法选取395例宫颈癌幸存者作为研究对象，采用一般情况调查表、一般疏离感量表、社会影响量表、社会支持评定量表进行调查。结果宫颈癌幸存者一般疏离感量表得分（41.98±6.81）分；家庭人均月收入、治疗后时间、病耻感总分、社会支持总分是社会疏离的主要影响因素(均P＜0.05），可以解释46.1%的变异量。结论宫颈癌幸存者社会疏离总体水平呈中等偏高。医护人员应关注宫颈癌幸存者的社会疏离水平，尤其是低收入、治疗后时间短的患者，可通过降低患者病耻感和提高患者社会支持水平，降低其社会疏离水平。     

乳腺癌术后上肢淋巴水肿患者自我管理体验的质性研究

目的 了解乳腺癌术后上肢淋巴水肿患者自我管理中的体验和感受，为临床制订解决方案提供参考。 方法 采用质性研究方法对15例乳腺癌术后上肢淋巴水肿患者进行半结构式访谈，采用Colaizzi7步分析法分析资料。 结果 提炼出6个主题，包括缺乏自我管理知识、思想上未引起足够重视、管理方式的差异化、自我管理过程中存在诸多障碍、自我管理中的情绪问题和社会支持不足。 结论 乳腺癌术后上肢淋巴水肿患者在自我管理过程中存在较多问题，医护人员应帮助患者纠正对疾病的错误认知及处理方式，树立良好的自我管理行为与习惯，重视患者由自我管理产生的心理问题，联合家庭和社会共同提高患者的自我管理能力。     

Effect of peer support on adults with diabetes-related peripheral neuropathy

ObjectiveTo explore the effect of peer support on exercise self-efficacy, physical activity level, and neuropathic symptoms in patients with diabetes-related peripheral neuropathy (DPN).MethodsA total of 60 adults with DPN were assigned to groups. Patients in the control group received routine education (RE), while patients in the intervention group received peer support (PS) combined with routine diabetes education. Data were collected at baseline and after intervention (12 weeks).ResultsAt 12 weeks, better outcomes were found in the PS group compared to the RE group for the following aspects: exercise self-efficacy, steps, total physical activity, fasting blood glucose and 2-hour postprandial blood glucose. Decreases in scores on Toronto Clinical Scoring System occurred between baseline and post-intervention in both groups.ConclusionPeer support is an effective way to improve exercise self-efficacy, number of steps, and general physical activity and to reduce blood glucose for patients with DPN. But the effects of peer support on neuropathic symptoms is are obvious. Further research is needed.Practice implicationsAs a low-cost, effective education approach, peer support strategies should be integrated into our healthcare system to meet the minimum needs of patients with DPN.     

Innovating medication reviews through a technology-enabled process

Medication reviews are effective in improving the quality of medication use among older people. However, they are conducted to various standards resulting in a wide range of outcomes which limit generalisability of findings arising from research studies. There also appear to be funding and time constraints, lack of data storage for quality improvement purposes, and non-standardised reporting of outcomes, especially clinically relevant outcomes. Furthermore, the coronavirus disease-19 (COVID-19) pandemic has restricted many face-to-face activities, including medication reviews. This article introduces a technology-enabled approach to medication reviews that may overcome some limitations with current medication review processes, and also make it possible to conduct medication reviews during the COVID-19 pandemic by providing an alternate platform. The possible advantages of this technology-enabled approach, legislative considerations and possible implementation in practice are discussed.