Small steps: barriers and facilitators to physical health self-management by people living with mental illness

It has been established that people with mental illness experience mortality and morbidity from all the major health conditions at 2–3 times the rate of those without mental illness. One way to overcome this problem is to encourage consumers of mental health services to self-manage their physical health. The purpose of the study was to investigate the facilitators and barriers to physical health self-management by people living with a mental illness. The study was underpinned by a hermeneutic phenomenological framework and utilised focus groups for data collection. A total of 27 participants, who lived in the community, had a diagnosed mental illness and who also had a co-morbid chronic physical health condition were included in one of three focus groups. The collected data were thematically analysed to identify common experiences and difficulties. It was found that participants were well aware of the need to attend to physical health issues. However, a number of factors at the individual, social and system levels impeded their ability to do so. Barriers to self-management included the debilitating nature of mental illness, poor physical health literacy, stigma from medical staff and social isolation, which resulted in a lack of support. Whereas informal peer networks, group participation and where it was offered, the support and encouragement from healthcare professionals facilitated health self-management.     

Small steps: physical health promotion for people living with mental illness

Physical health promotion for people with mental illness is vital if the life expectancy of this population group is to be improved. While there is promising evidence of physical health promotion initiatives in the literature in this population group, it is unclear whether these have resulted in long-term gains and actually reduced morbidity and mortality. We aimed to identify which physical health promotion strategies and resources were most likely to resonate with people who have long-term mental health problems and live in the community. We facilitated three focus groups in metropolitan Perth with 27 participants who experienced long-term serious mental health problems for this qualitative study. Participants were clear about which health promotion resources and approaches they did or did not consider would engage them. Participants wanted health messages that were positive, clear and not too wordy. They tended to dislike pamphlets and preferred DVDs. They also preferred to participate in health promotion activities in groups. Participants were aware of the need to engage in health protective behaviours but were often overwhelmed by their mental health problems. Health promotion for this population group ought to capitalise on therapeutic alliances with staff and informal peer networks already established in drop-in centres and clubhouses.     

Cross-cultural invariance of the Academic Expectations Stress Inventory: Adolescent samples from Canada and Singapore

We provide further evidence for the two-factor structure of the 9-item Academic Expectations Stress Inventory (AESI) using confirmatory factor analysis on a sample of 289 Canadian adolescents and 310 Singaporean adolescents. Examination of measurement invariance tests the assumption that the model underlying a set of scores is directly comparable across groups. This study also examined the cross-cultural validity of the AESI using multigroup confirmatory factor analysis across both the Canadian and Singaporean adolescent samples. The results suggested cross-cultural invariance of form, factor loadings, and factor variances and covariances of the AESI across both samples. Evidence of AESI's convergent and discriminant validity was also reported. Findings from t-tests revealed that Singaporean adolescents reported a significantly higher level of academic stress arising from self expectations, other expectations, and overall academic stress, compared to Canadian adolescents. Also, a larger cross-cultural effect was associated with academic stress arising from other expectations compared with academic stress arising from self expectations.     

Risk Stratification for the In-Hospital Mortality in Subarachnoid Hemorrhage: The HAIR Score

Background

The intracerebral hemorrhage (ICH) score is a simple grading scale that can be used to stratify risk of 30 day mortality in ICH patients. A similar risk stratification scale for subarachnoid hemorrhage (SAH) is lacking. We sought to develop a risk stratification mortality score for SAH.

Methods

With approval from the Institutional Review Board, we retrospectively reviewed 400 consecutive SAH patients admitted to our institution from August 1, 2006 to March 1, 2011. The SAH score was developed from a multivariable logistic regression model which was validated with bootstrap method. A separate cohort of 302 SAH patients was used for evaluation of the score.

Results

Among 400 patients with SAH, the mean age was 56.9 ± 13.9 years (range, 21.5–96.2). Among the 366 patients with known causes of SAH, 292 (79.8 %) of patients had aneurysmal SAH, 65 (17.8 %) were angiogram negative, and 9 (2 %) were other vascular causes. The overall in-hospital mortality rate was 20 %. In multivariable analysis, the variables independently associated with the in-hospital mortality were Hunt and Hess score (HH) (p < 0.0001), age (p < 0.0001), intraventricular hemorrhage (IVH) (p = 0.049), and re-bleed (p = 0.01). The SAH score (0–8) was made by adding the following points: HH (HH1-3 = 0, HH4 = 1, HH5 = 4), age (<60 = 0, 60–80 = 1, ≥80 = 2), IVH (no = 0, yes = 1), and re-bleed within 24 h (no = 0, yes = 1). Using our model, the in-hospital mortality rates for patients with score of 0, 1, 2, 3, 4, 5, 6, and 7 were 0.9, 4.5, 9.1, 34.5, 52.9, 60, 82.1, and 83.3 % respectively. Validation analysis indicates good predictive performance of this model.

Conclusion

The SAH score allows a practical method of risk stratification of the in-hospital mortality. The in-hospital mortality increases with increasing SAH mortality score. Further investigation is warranted to validate these findings.     

Psychosocial factors influencing teenage sexual activity, use of contraception and unplanned pregnancy

Objective: to compare teenagers who become unintentionally pregnant and teenagers who have never been pregnant but are using contraception on matters related to family/partner stability, and communication with a parent or stable sexual partner about sexual matters.Design: survey utilising self-completed questionnaire.Setting: a hospital antenatal clinic and community-based family planning clinic.Participants: 30 teenagers with an unplanned pregnancy and 31 ‘never-pregnant’ teenagers using contraception.Findings: the two groups were similar on demographic factors, mean age at which sexual intercourse was first experienced, total number of sexual partnerships, the number of teenagers having a current, regular boyfriend and mean length of the interval between when the teenagers first started going out with their boyfriend and when first sexual intercourse took place. Teenagers in the family planning clinic group were more likely to be living with both natural parents and to be still at school or in higher education. The mean length of time pregnant teenagers had been going out with their boyfriend was longer, they were more likely to be cohabiting with him and to be unemployed. Participants from the antenatal clinic group communicated more with their mothers about sexual matters than those in the family planning clinic group, who were more likely to seek this information from books. The family planning clinic participants were more likely to discuss personal rules and values with friends than those in the antenatal clinic group.Implications for practice: to develop understanding of factors predisposing to unplanned pregnancy during adolescence and to implement measures to counter them, further studies to examine the influence of teenagers' perceptions of family relationships and future life prospects on contraception use and unplanned pregnancy were identified.