Do universal school‐based mental health promotion programmes improve the mental health and emotional wellbeing of young people? A literature review

Aims and objectives

To examine evidence—using a range of outcomes—for the effectiveness of school‐based mental health and emotional well‐being programmes.

Background

It is estimated that 20% of young people experience mental health difficulties every year. Schools have been identified as an appropriate setting for providing mental health and emotional well‐being promotion prompting the need to determine whether current school‐based programmes are effective in improving the mental health and emotional well‐being of young people.

Methods

A systematic search was conducted using the health and education databases, which identified 29 studies that measured the effectiveness of school‐based universal interventions. Prisma guidelines were used during the literature review process.

Results

Thematic analysis generated three key themes: (i) help seeking and coping; (ii) social and emotional well‐being; and (iii) psycho‐educational effectiveness.

Conclusion

It is concluded that whilst these studies show promising results, there is a need for further robust evaluative studies to guide future practice.

Relevance to clinical practice

All available opportunities should be taken to provide mental health promotion interventions to young people in the school environment, with a requirement for educational professionals to be provided the necessary skills and knowledge to ensure that the school setting continues to be a beneficial environment for conducting mental health promotion.

     

Risk assessment and subsequent nursing interventions in a forensic mental health inpatient setting: Associations and impact on aggressive behaviour

Aim and objectives

To examine associations between risk of aggression and nursing interventions designed to prevent aggression.

Background

There is scarce empirical research exploring the nature and effectiveness of interventions designed to prevent inpatient aggression. Some strategies may be effective when patients are escalating, whereas others may be effective when aggression is imminent. Research examining level of risk for aggression and selection and effectiveness of interventions and impact on aggression is necessary.

Design

Archival case file.

Methods

Data from clinical files of 30 male and 30 female patients across three forensic acute units for the first 60 days of hospitalisation were collected. Risk for imminent aggression as measured by the Dynamic Appraisal of Situational Aggression, documented nursing interventions following each assessment, and acts of aggression within the 24‐hours following assessment were collected. Generalised estimating equations were used to investigate whether intervention strategies were associated with reduction in aggression.

Results

When a Dynamic Appraisal of Situational Aggression assessment was completed, nurses intervened more frequently compared to days when no Dynamic Appraisal of Situational Aggression assessment was completed. Higher Dynamic Appraisal of Situational Aggression assessments were associated with a greater number of interventions. The percentage of interventions selected for males differed from females; males received more pro re nata medication and observation, and females received more limit setting, one‐to‐one nursing and reassurance. Pro re nata medication was the most commonly documented intervention (35.9%) in this study. Pro re nata medication, limit setting and reassurance were associated with an increased likelihood of aggression in some risk bands.

Conclusions

Structured risk assessment prompts intervention, and higher risk ratings result in more interventions. Patient gender influences the type of interventions. Some interventions are associated with increased aggression, although this depends upon gender and risk level.

Relevance to clinical practice

When structured risk assessments are used, there is greater likelihood of intervention. Intervention should occur early using least restrictive interventions.

     

Health promotion in specialist and community care: how a broadly applicable health promotion intervention influences patient's sense of coherence

Background

Chronic illness health interventions aim to strengthen individuals' wellness resources, in addition to their ability to handle their condition. This presupposes a partnership between patients and professionals and flexibility in care organization.

Aim

This study aims to investigate possible changes in individuals' sense of coherence while living with long‐term illness as they engage in a broadly applicable health promotion intervention developed in specialist care settings that was later implemented in the community care context.

Method

This study had a pre–postdesign. Sense of coherence was measured using the SOC ‐29 questionnaire at baseline and within 14 days of programme completion. The total baseline sample included 108 Norwegian adults (aged 21–89) with chronic illness. Data were analysed using paired samples t ‐tests.

Results

In both clinical sites, the total sample's mean SOC score changed positively from the baseline to the follow‐up 4 months later. This change was larger for the participants in the community care context. Manageability increased significantly for women. Significant positive changes in SOC score and the manageability dimension were also identified among participants who had children. Similar findings were found for those who were living with a partner, as well as for public transfer payment recipients.

Conclusion

The intervention contributed to a positive change in participants' SOC while living with illness. The findings revealed that the intervention is a flexible health promotion tool across age, diagnostic categories and clinical sites. The community participants' SOC changed the most, which indicates that the intervention is especially relevant in the follow‐up of persons living with long‐term illness within the community. The intervention contributes to a shift of perspectives in health care towards strenght‐based care and health within illness.

     

Therapeutic effect of lyophilized,Kefir‐fermented milk on constipation among persons with mental and physical disabilities

Aim

Constipation is a serious problem for persons with mental and physical disabilities in Japan. However, prophylaxis is extremely difficult because the major causes of constipation in these individuals are related to their mental and physical disabilities. Constipation can be successfully treated with glycerol enemas (GEs) and other aperients. As constipation is a lifetime issue for these persons, dietary regimens to prevent constipation can be important.

Methods

This study evaluated the probiotic effects of kefir‐fermented milk for preventing constipation in 42 persons with mental and physical disabilities. The participants were administered 2 g of lyophilized kefir with each meal for 12 weeks and their bowel movements, the administration of GE and other aperients, and stool shape were recorded.

Results

The intake of kefir significantly reduced constipation, compared with the baseline status. Some individuals showed complete relief of constipation, whereas others showed no effect.

Conclusion

Despite individual variations, consuming kefir daily could prevent constipation.

     

Dot enzyme‐linked immunosorbent assay strip as a screening tool for detection of autoantibody to interferon gamma in sera of suspected cases of adult‐onset immunodeficiency

Background

Being able to detect the presence of autoantibodies to interferon (IFN)‐γ in serum is essential for evaluating patients with suspected adult‐onset immunodeficiency (AOID) with unusual intracellular infections. Most reported patients with AOID have been Asian, although the exact prevalence of this illness is unknown. To date, no standard assay exists to detect autoantibodies to IFN‐γ. An easy‐to‐use, low‐cost assay that can be performed in any laboratory would be a valuable tool for clinical management of AOID, as well as better reveal its prevalence.

Methods

Our experimental study exploited a dot enzyme‐linked immunosorbent assay (Dot‐ELISA) strip to detect autoantibodies to IFN‐γ. Sera from 66 HIV‐negative patients having autoantibodies to IFN‐γ as determined by indirect ELISA were tested.

Results

Dot enzyme‐linked immunosorbent assay was sensitive (100%) and specific (94.5%), with a positive predictive value of 97.6% and a negative predictive value of 100%.

Conclusion

This simple method provides prompt qualitative results that can be read visually and used in facilities with limited testing capabilities.

     

Association between SMAD3 gene rs12901499 polymorphism and knee osteoarthritis in a Chinese population

Background

Many studies have revealed that transforming growth factor‐beta (TGF‐β) signals play important roles in maintaining normal status of articular cartilage in human osteoarthritis (OA). However, SMAD3 had inhibitory effect on TGF‐β‐induced chondrocyte maturation.

Method

To evaluate the association of SMAD3 genetic variants with the risk of knee OA, we conducted this hospital‐based case‐control study involving 350 knee patients with OA and 400 controls in a Chinese population. Genotyping was performed using a custom‐by‐design 48‐Plex single‐nucleotide polymorphism (SNP) Scan^™ Kit.

Results

Our results indicate that the GG genotype of rs12901499 could decrease the risk of knee OA compared to AA genotype. However, stratified analyses by sex and age did not obtain positive findings with regard to the association between rs12901499 polymorphism and knee OA risk.

Conclusion

In conclusion, SMAD3 rs12901499 polymorphism may be involved in the development of knee OA. Larger studies with more diverse ethnic populations are needed to confirm these results.

     

Mental Health–related Emergency Department Visits Associated With Cannabis in Colorado

Background

Cannabis legalization in Colorado resulted in increased cannabis‐associated health care utilization. Our objective was to examine cooccurrence of cannabis and mental health diagnostic coding in Colorado emergency department (ED) discharges and replicate the study in a subpopulation of ED visits where cannabis involvement and psychiatric diagnosis were confirmed through medical review.

Methods

We collected statewide ED International Classification of Diseases, 9th Revision, Clinical Modification diagnoses from the Colorado Hospital Association and a subpopulation of ED visits from a large, academic hospital from 2012 to 2014. Diagnosis codes identified visits associated with mental health and cannabis. Codes for mental health conditions and cannabis were confirmed by manual records review in the academic hospital subpopulation. Prevalence ratios (PRs) of mental health ED discharges were calculated to compare cannabis‐associated visits to those without cannabis. Rates of mental health and cannabis‐associated ED discharges were examined over time.

Results

Statewide data demonstrated a fivefold higher prevalence of mental health diagnoses in cannabis‐associated ED visits (PR = 5.35, 95% confidence interval [CI], 5.27–5.43) compared to visits without cannabis. The hospital subpopulation supported this finding with a fourfold higher prevalence of psychiatric complaints in cannabis attributable ED visits (PR = 4.87, 95% CI = 4.36–5.44) compared to visits not attributable to cannabis. Statewide rates of ED visits associated with both cannabis and mental health significantly increased from 2012 to 2014 from 224.5 to 268.4 per 100,000 (p < 0.0001).

Conclusions

In Colorado, the prevalence of mental health conditions in ED visits with cannabis‐associated diagnostic codes is higher than in those without cannabis. There is a need for further research determining if these findings are truly attributed to cannabis or merely coincident with concurrent increased use and availability.

     

Rare LPL gene missense mutation in an infant with hypertriglyceridemia

Background

Severe hypertriglyceridemia usually results from a combination of genetic and environmental factors and is most often attributable to mutations in the lipoprotein lipase (LPL) gene.

Objectives

The aim of this study was to identify rare mutations in the LPL gene causing severe hypertriglyceridemia.

Methods

A Chinese infant who presented classical features of severe hypertriglyceridemia recruited for DNA sequencing of the LPL gene. The pathogenicity grade of the variants was defined based on the prediction of pathogenicity using in silico prediction tools. Review some studies to understand the molecular mechanisms underlying the severe hypertriglyceridemia.

Results

We identified a rare mutation in the LPL gene causing severe hypertriglyceridemia: a nucleotide substitution (c.836T>G) resulting in a leucine to arginine substitution at position 279 of the protein (p.Leu279Arg).The pathogenicity of the variant was predicted by in silico analysis using PolyPhen2 and SIFT prediction programs, which indicated that mutation p.Leu279Arg is probably harmful. We have also reviewed published studies concerning the molecular mechanisms underlying severe hypertriglyceridemia. A missense mutation in the 6 exon of the LPL gene is reportedly associated with LPL deficiency.

Conclusions

We have here identified a rare pathogenic mutation in the LPL gene in a Chinese infant with severe hypertriglyceridemia.

     

Modified Carba NP Test: Simple and rapid method to differentiate KPC‐ and MBL‐producing Klebsiella species

Background

The aim of this study was to evaluate the modified Carba NP test to differentiate KPC (Klebsiella pneumoniae carbapenemase)‐ and MBL (metallo‐β‐lactamase)‐producing Klebsiella species.

Methods

A total of 508 non‐duplicate clinical isolates of Klebsiella spp. were processed by modified Carba NP and combined disc tests which were further confirmed by conventional polymerase chain reaction (PCR), a gold standard method for statistical analysis.

Results

Modified Carba NP test demonstrated 91.7% sensitivity, 100% specificity, 100% positive predictive value (PPV) and 99.8% negative predictive value (NPV) for KPC and 96.7%, 100%, 100%, and 99.5% for MBL detection, respectively.

Conclusion

The performance of modified Carba NP test was significantly better than combined disc test, fulfilling the requirement of simple and rapid test for clinical applications.

     

Between hope and hopelessness: COPD patients' and their family members' experiences of interacting with healthcare providers – a qualitative longitudinal study

Background

Patient–family–healthcare provider interaction seems important for patients with chronic obstructive pulmonary disease (COPD ) and their family members' self‐management practices. Because the need for support might be enhanced after a hospitalisation, it might be beneficial to explore this interaction further in follow‐up health care.

Aim

To explore the meaning of patients' and their family members' experiences of interacting with healthcare providers to their daily self‐management over time.

Methods

Participant observations and in‐depth interviews were conducted repeatedly with 10 patients and seven family members during follow‐up visits at hospital and at the participants' homes between 2014 and 2016. A phenomenological–hermeneutical approach was used to interpret the data.

Results

‘Between hope and hopelessness’ involved frustrations, concerns and doubts, all of which could relate to the interaction with healthcare providers. ‘Seeking support from healthcare services’, ‘navigating between healthcare providers’ and ‘collaborating with healthcare providers at home’ could entail opportunities to strengthen self‐management and hope; however, it could also entail reduced faith in getting the right help and hopelessness.

Conclusion

During a period of transition after hospitalisation, available and well‐coordinated healthcare services, and alliances with healthcare professionals are crucial to COPD patients and their family members in terms of their self‐management, hope and well‐being.

     

Is modified brief assertiveness training for nurses effective? A single‐group study with long‐term follow‐up

Aim

To evaluate the long‐term effectiveness of modified brief assertiveness training (with cognitive techniques) for nurses.

Background

Most assertiveness training takes a long time to conduct; thus, briefer training is required for universal on‐the‐job training in the workplace.

Methods

In this single‐group study, nurses received two 90‐min training sessions with a 1‐month interval between sessions. The degree of assertiveness was assessed by using the Rathus Assertiveness Schedule as the primary outcome, at four time points: pre‐ and post‐training, 3‐month follow‐up and 6‐month follow‐up.

Results

A total of 33 nurses received the training, and the mean Rathus Assertiveness Schedule score improved from ?14.2 (SD  = 16.5) pre‐training to ?10.5 (SD  = 18.0) post‐training (p  <  .05). These improvements were maintained until the 6‐month follow‐up. The pre–post effect size of 0.22 (indicating small effect) was larger than the effect sizes ranging from ?0.56 to 0.17 (no effect) reported in previous studies that used brief training.

Conclusions

Modified brief assertiveness training seems feasible and may achieve long‐term favourable outcomes in improving assertiveness among nurses.

Implications for Nursing Management

The ease of implementation of assertiveness training is important because creating an open environment for communication leads to improved job satisfaction, improved nursing care and increased patient safety.

     

Assessing the Effect of a Medical Toxicologist in the Care of Rattlesnake‐envenomated Patients

Background

Rattlesnake envenomation is an important problem in the United States, and the management of these envenomations can be complex. Despite these complexities, however, the majority of such cases are managed without the involvement of a medical toxicologist. The primary objective of this study was to evaluate the impact of a medical toxicology service (MTS) on the length of stay (LOS) of such patients.

Methods

The authors conducted a retrospective study at six centers in California. Patients were included if they were admitted in the 2 years before the establishment of a MTS (pre‐MTS) or in the 2 years after the creation of a MTS (post‐MTS).

Results

A total of 300 subjects were included (169 pre‐MTS, 131 post MTS). Baseline characteristics between the pre‐MTS and post‐MTS groups were very similar. The creation of a MTS was associated with a significant reduction in the mean (95% confidence interval) LOS (69.5 [59.1–79.9] hours vs. 48.1 [41.4–54.8] hours). This reduced LOS was not associated with any statistically significant change in readmission rates.

Conclusion

Rattlesnake bite patients treated by a medical toxicologist have a significantly reduced LOS compared to those without direct involvement of a medical toxicologist.

     

Ward nurses' experiences of the discharge process between intensive care unit and general ward

Background

Intensive care unit (ICU) discharges are challenging practices that carry risks for patients. Despite the existing body of knowledge, there are still difficulties in clinical practice concerning unplanned ICU discharges, specifically where there is no step‐down unit.

Aims and objectives

The aim of this study was to explore general ward nurses' experiences of caring for patients being discharged from an ICU.

Design and methods

Data were collected from focus groups and in‐depth interviews with a total of 16 nurses from three different hospitals in Sweden. An inductive qualitative design was chosen.

Findings

The analysis revealed three themes that reflect the challenges in nursing former ICU patients: a vulnerable patient, nurses' powerlessness and organizational structure. The nurses described the challenge of nursing a fragile patient based on several aspects. They expressed feeling unrealistic demands when caring for a fragile former ICU patient. The demands were related to their own profession and knowledge regarding how to care for this group of patients. The organizational structure had an impact on how the nurses' caring practice could be realized. This evoked ethical concerns that the nurses had to cope with as the organization's care guidelines did not always favour the patients.

Conclusions

The structure of the organization and its leadership appear to have a significant impact on the nurses' ability to offer patients the care they need.

Relevance to clinical practice

This study sheds light on the need for extended outreach services and intermediate care in order to meet the needs of patients after the intensive care period.