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HomeHealth is a home-based, voluntary sector service supporting older people with mild frailty to maintain independence through behaviour change. Support workers discuss the person's priorities and enable setting/achieving goals around mobility, nutrition, socialising and/or psychological well-being. We tested clinical and cost-effectiveness of HomeHealth for maintaining independence in older people with mild frailty in a randomised controlled trial. Design: Single-blind, parallel randomised controlled trial open between 18 January 2021 and 4 July 2023, with mixed-methods process evaluation. Setting: Community-dwelling older people aged 65+ years with mild frailty from 27 general practices and community settings in London, Yorkshire and Hertfordshire. Randomisation: Participants were randomised 1 : 1 to receive HomeHealth or treatment as usual. Outcomes: Primary outcome was independence in activities of daily living (modified Barthel Index), analysed using linear mixed models. Secondary outcomes included frailty phenotype score, extended activities of daily living, well-being, psychological distress, loneliness, cognition, falls and mortality. Health economic outcomes included quality of life, capability and service use, including hospital admissions. Cost-effectiveness acceptability curves and cost-effectiveness planes were used to represent the probability of cost-effectiveness compared to treatment as usual. Process evaluation: We conducted semistructured interviews with participants receiving the intervention, HomeHealth workers and other stakeholders supporting service delivery. Interviews were thematically analysed. Fidelity of audio-recorded appointments was assessed by two independent raters. We evaluated potential mechanisms of impact using data from appointments attended, types of goals set and progress towards goals. We recruited 388 participants, mean age 81.4 years (standard deviation 6.5), 64% female and 94% White British/European. HomeHealth did not improve Barthel Index scores at 12 months (0.250, 95% confidence interval -0.932 to 1.432). At 6 months, we found small significant reductions in psychological distress (-1.237, 95% confidence interval -2.127 to -0.348), and frailty phenotype score (-0.252, 95% confidence interval -0.487 to -0.017). At 12 months, we found significant improvements in well-being (1.449, 95% confidence interval 0.124 to 2.775), reduced unplanned admissions (incidence rate ratio 0.65, 95% confidence interval 0.54 to 0.92) with lower associated costs (-£586/participant, 95% confidence interval -351 to -821). There were no differences in other outcomes. HomeHealth dominates treatment as usual with a negative point estimate for incremental costs (-796, 95% confidence interval -2016 to 424), positive point estimate for incremental quality-adjusted life-years (0.009, -0.021 to 0.039) and high probability of cost-effectiveness. Process evaluation: Sixty-four semistructured interviews were completed, including 49 participants and 15 HomeHealth workers/stakeholders. The service was acceptable and safe, with good fidelity of delivery. Participants made progress on personalised goals, most working on enhancing mobility. They found the service empowering, and received emotional/practical support. Engagement was more challenging when participants identified no need for change, had significant memory impairment or new/declining illness. Flexibility around varying symptoms and incorporating behaviour change into existing routines promoted engagement. HomeHealth did not improve independent functioning for older people with mild frailty. There were small significant improvements in frailty status, psychological distress and well-being and a 35% reduction in unplanned admissions, with high probability of cost-effectiveness. We used a pragmatic design with intervention delivery in real-world settings during/after the COVID-19 pandemic, potentially with more variability in delivery. Our findings might not apply to other geographical settings/healthcare systems. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR128334. As we age, we may develop several health conditions that affect how we feel and our ability to manage without help. For some, it can mean they have less energy and muscle strength, and it is harder to do routine tasks such as shopping or cooking. Few services exist to prevent things getting worse. We designed a new service, ‘HomeHealth’, to enable older people to maintain their independence and activities they enjoy. Over six visits with a dedicated support worker, they identified concerns such as tiredness, low mood and anxiety, poor appetite, weakness and memory problems and developed goals and plans to address difficulties. Our research aimed to explore if HomeHealth helped people to stay independent for longer and provided value for money. Our study recruited 388 older people who were struggling with their everyday activities like cooking/shopping and getting out due to their health. Half were randomly allocated to the HomeHealth service, and half received usual care for 6 months. All participants were assessed by researchers at the beginning, 6 and 12 months later. We also interviewed 49 participants, and 15 people delivering the service about their experiences. We found that HomeHealth did not improve participants’ independence compared to usual care, though it showed small positive effects on mood and frailty at 6 months and well-being after 1 year. Those receiving the service were 35% less likely to be admitted to hospital for acute illness and had lower hospital care costs. The service was acceptable, safe, provided emotional and practical support and empowerment. Most older people made progress on goals to improve their health and well-being. Some found this more challenging, particularly those with worsening health or memory, or those who felt no need to change. The HomeHealth service is a promising intervention to reduce unplanned (emergency) hospital admissions.

British Columbia's Mental Health Act permits the involuntarily detention and treatment of individuals who meet specific criteria. Over the past 15 years, British Columbia has seen an increasing trend in the number of involuntary psychiatric admissions. This qualitative study explores the experiences of people receiving and providing involuntary psychiatric treatment within two health organizations in British Columbia, Canada. Five focus groups were conducted with 23 individuals who had previously received involuntary psychiatric treatment at a facility operated by one of the two health organizations. All sessions were facilitated by individuals with lived experience of involuntary psychiatric treatment. Additionally, semi-structured interviews were conducted with 11 clinical staff and 10 non-clinical support personnel involved in delivering involuntary psychiatric treatment or associated services. Data were analyzed using reflexive thematic analysis, guided by an equity-oriented care framework. Seven themes were generated, including the limited availability of voluntary care options, the compounding role of social determinants of health in mental health crises, the lack of conclusive evidence supporting involuntary psychiatric treatment, the negative impacts on both patients and providers, and the importance of peer support. Across themes, participants described involuntary psychiatric care as shaped by systemic constraints with limited access to upstream, voluntary and community-based alternatives. These findings highlight the need for system-level reform to reduce reliance on coercive practices and to expand access to voluntary, community-based mental health supports that address underlying social and structural factors contributing to mental health crises.

High-quality dementia care is underpinned by interprofessional collaborative practise, and healthcare training is a critical opportunity to develop these skills. This review aims to examine the evidence for whether interprofessional dementia education for undergraduate healthcare students positively impacts outcomes related to collaborative practise. Inclusion criteria consisted of papers investigating dementia interprofessional education interventions delivered within undergraduate education and that assessed outcomes relating to interprofessional collaboration. Searches were limited to papers published after 2014 and were conducted in eight databases: PubMed/MEDLINE, EMBASE, Web of Science, ERIC, The Cochrane Library, PsycINFO, CINAHL, Applied Social Sciences Index and Abstracts (ASSIA), British Education Index (BEI). A narrative synthesis was conducted and data quality was assessed. 11 papers, evaluating 11 different interventions, were included in the narrative synthesis. Four studies demonstrated positive changes in student attitudes or perceptions of interprofessional education or collaboration. Seven studies had evidence that students' knowledge or perceived skills about interprofessional collaboration increased. No evidence was presented for change in student behaviour, or impact on patients or organisational practise. Three studies presented findings on outcomes specifically relating to interprofessional dementia care. The findings suggest that dementia interprofessional education may contribute to interprofessional competencies. Therefore, interprofessional education could provide added value to dementia education, both of which are high priorities in the undergraduate curriculum. However, the strength of the evidence was weak as the methodological quality of the papers was low. Additionally, interventions were varied and therefore, optimal components of dementia interprofessional education were not identified. More rigorous investigation is needed on the impact of dementia interprofessional education with a focus on the longer-term impact on student practise and service delivery.

The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.

BackgroundFamily members of people with Parkinson's disease (PwP) often experience significant burden and poor quality of life (QoL). However, existing research predominantly centres on caregiver burden, with limited exploration of the broader impact of Parkinson's disease (PD) on family QoL.AimTo measure the impact of a person's PD on the QoL of their family members and partners using the validated generic Family Reported Outcome Measure-16 (FROM-16).MethodsA cross-sectional study recruited online UK family members/partners of PwP through patient support groups to complete the FROM-16.Results152 family members/partners (mean age=67 years, median=70, SD = 10.9; females=106) of patients (mean age=72.3, median=74, SD = 8.5; females=55) with PD completed the FROM-16. The FROM-16 mean total score was 15.3 (SD = 7.9), with 45% of family members/partners having a score ≥17, meaning "a very large effect" on QoL of family members. A significant predictor of family impact was if the patient was male. The most impacted areas were feeling worried, sad, and frustrated, and the impact on holiday, family activities, sleep and sex life.ConclusionsA person's PD greatly impacts the QoL of their family members/partners. Their well-being has important implications for supporting PwP and nursing home placement, hence the need to measure this impact to provide tailored support to these family members/partners. FROM-16 could be used to measure the family impact of PD in the routine practice of different settings. The impact of Parkinson's on the quality of life of family members and partnersThis study looked at how a person's Parkinson's affects the quality of life of family members and partners. The researchers used a questionnaire called the Family Reported Outcome Measure (FROM-16) to measure the impact on people's lives. The study showed that 76% of family members and partners of people with Parkinson's disease experienced moderate to extremely high negative effects on their quality of life. Family members were most affected emotionally—they often felt worried, sad, and frustrated. The caregiving also affected their other activities, such as going on holidays, spending time with family, getting good sleep, and enjoying intimacy. These results suggest that there is a need for this impact to be measured routinely by healthcare professionals, so that the right kind of support can be provided to partners and families, to improve their quality of life and to prevent family carers' exhaustion.

Cancer inequities among vulnerable populations in rural areas remain a public health challenge in Canada. Rural populations are defined as vulnerable due to geographic isolation, limited access to specialized oncology care, and socioeconomic barriers such as transportation and financial toxicity. Professional navigation offers a potential solution to bridge these gaps, yet there is a lack of evidence on the barriers to and facilitators of its adoption in breast cancer survivorship. The objective of this study is to evaluate the effectiveness of a cancer navigation intervention using professional navigators compared to the standard of care (medical care) in improving the quality of life and functional outcomes of newly diagnosed survivors of breast cancer in interior British Columbia. A single-center, parallel-group, open-cohort randomized controlled trial is being conducted over 3 years. Ethics approval was obtained for the study. Participants who provide informed consent are randomized into 2 groups: the intervention group receives the cancer navigation intervention and the control group receives the standard of care (the usual medical care offered by health care practitioners). The baseline study time point spanned January to March 2025, the first follow-up spanned April to June 2025 at 3 months after enrollment, and the second follow-up spanned July to September 2025 at the end of 6 months after enrollment. The cancer navigation intervention comprises direct psychosocial and educational webinars, coordinated telephone support services, and community-based cancer care resources. Professional navigators are qualified registered nurses who facilitate information and connect participants with available supportive resources, services, and programs. The main outcomes are financial distress, quality of life, and satisfaction with navigation and interpersonal relationships. The Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy, Functional Assessment of Cancer Therapy-Breast, Breast Cancer Navigation Survey, Participant Satisfaction With Navigation Scale, Satisfaction With Interpersonal Relationships Survey, and Breast Cancer Navigation Interview are used in the study. Steps are being taken to ensure the trustworthiness of the qualitative data. With a 5% level of significance (2 tailed) and 90% power, the sample size was calculated as 108. Data collection took place from January 2 to September 30, 2025. A total of 164 participants were recruited. This study aims to demonstrate effectiveness and satisfaction with professional navigation and knowledge translation for future implementation of a cancer navigation intervention in British Columbia.

Incarcerated populations face greater health challenges, including higher rates of communicable and mental diseases. However, traditional health measures like disease prevalence and life expectancy do not capture their physical, mental, emotional, and social well-being. This scoping review will summarize the health-related quality of life (HRQoL) outcomes in incarcerated populations using preference-based HRQoL instruments (and measures that can be used to derive utility scores), providing insights for health policies and economic evaluations. A scoping review was conducted following PRISMA-ScR guidelines. Six electronic databases and three health technology assessment agencies were searched for peer-reviewed studies reporting preference-based HRQoL or HRQoL scores that can be used to generate health state utility values in incarcerated populations. Eligibility and data extraction were performed by two independent researchers.Findings were synthesized to identify knowledge gaps. Twenty-two articles met the inclusion criteria, primarily focusing on male and white populations. Ten studies targeted disease-specific populations, with mental health disorders (n = 7) being the most prevalent. Across studies, inmates generally reported lower HRQoL scores than the general population, especially those with mental health issues. Female and Indigenous inmates had lower HRQoL scores than male and non-Indigenous inmates. The variety in HRQoL instruments used, with each assessing different domains, hinders direct comparisons between studies. Validating instruments specific to incarcerated populations may be needed for future research. Overall, incarcerated populations, especially women and Indigenous inmates, demonstrate poorer HRQoL than the general population. There is a need for more diverse, inclusive studies to address these gaps. Incarcerated populations face greater health issues that are not fully captured by traditional health measures. Health-related quality of life (HRQoL) provides a more comprehensive view of their physical, mental, emotional and social well-being. This study summarizes HRQoL research in incarcerated populations using standardized tools. The purpose of this study is to provide a scoping review of the HRQoL outcomes of incarcerated populations, summarizing existing research and identifying gaps in the literature. Our findings reveal that inmates generally have lower HRQoL scores compared to the general population, and those with mental health issues reporting the lowest scores. Additionally, female and Indigenous inmates tend to have poorer HRQoL than male and non-Indigenous inmates. The findings highlight the need for HRQoL tools specifically tailored to incarcerated populations and call for more diverse studies, particularly for underrepresented groups.

Depression is one of the leading causes of disability and is a highly recurrent condition. Recurrent depression has been associated with risk of suicide and greater morbidity. British South Asians are at greater risk of developing depression and face greater barriers to help-seeking and treatment uptake. To better support this population and reduce the risk of relapse it is important to explore treatment experiences and preferences. This study explored the treatment experiences and preferences of 12 British South Asians living with recurrent depression. We conducted semi-structured interviews and analysed the data using thematic analysis. Pharmacological treatments were accompanied by a continuous lay evaluation process of the pros and cons. A preference for non-pharmacological interventions was found, particularly art-based, creative approaches. Interventions that were culturally adapted, with incorporation of religion were preferred. Barriers to recovery included inexperienced therapists and lack of support post-intervention to maintain durable effects of therapy. Health professionals, such as general practitioners and therapists, play a key role in shared decision making, to ensure people with recurrent depression feel supported and culturally appropriate treatment is offered. Managing recurrent depression, including reducing the risk of relapse can improve quality of life, wellbeing and reduce the risk of co-morbid conditions.

This study examines the association between divorce conflict and medicine prescriptions, primary care visits and hospitalisations, over a 10-year period around juridical divorce. A longitudinal observational study was conducted using a cohort of 1784 Danes who divorced between 2015 and 2017. Conflict was measured with the validated Divorce Conflict Scale, and health outcomes were obtained from national registers. Negative binomial and logistic regression models examined the relationship between divorce conflict and health outcomes, controlling for prior health status, demographic factors and socioeconomic variables. Analyses included sensitivity tests to explore pre- and post-divorce health patterns, and an exploratory analysis of health trajectories based on conflict levels. A one-standard deviation increase in divorce conflict was associated with a significant 28% increase in medicine prescriptions, a 5% increase in primary care visits, and 13% higher odds of hospitalisation in the 5 years following juridical divorce. Sensitivity analyses showed that these associations were robust but also varied depending on the pre-divorce health period, highlighting the importance of pre-divorce health in explaining outcomes. Exploratory analyses indicated that high-conflict divorcees had consistently elevated health trajectories across all outcomes, with a significantly steeper increase in primary care visits before divorce compared to those with average or low conflict. High-conflict divorcees experienced consistently worse health outcomes, including more medicine prescriptions, primary care visits and hospitalisations, both before and after divorce. These findings stress the importance of conceptualising divorce as a process and addressing conflict during the divorce process to mitigate long-term health consequences.

To explore the experience, knowledge and confidence of orthodontic practitioners in the United Kingdom in managing patients with learning disability or autism. National online survey. British Orthodontic Society membership. A novel questionnaire was developed and distributed online to orthodontic practitioners within the British Orthodontic Society. It included questions on the participants' prior training, experience in treating patients with learning disability or autism, knowledge levels using the Learning Disability Knowledge Questionnaire and Autism Knowledge Survey, and self-efficacy in managing these patients. A total of 171 responses were received with participation from various practitioner groups: orthodontic consultants, specialists, postgraduates, therapists and dentists with special interest. The median score for the Learning Disability Knowledge Questionnaire was 73% (interquartile range [IQR] = 20). The median score for the Autism Knowledge Survey was 93% (IQR = 6.7). The percentage of respondents who reported feeling confident in patient management varied across the self-efficacy domains: (1) treating patients with learning disability (51%) and autism (64%); (2) making reasonable adjustments for patients with learning disability (54%) and autism (61%); (3) recognising the signs of learning disability (38%) and autism (48%); and (4) signposting patients with learning disability (27%) and autism (30%) to the relevant local care pathways or services. The participants employed a range of techniques and resources when managing these patients. These included tailoring communication to individuals, adapting to sensory needs, involving parents/carers in treatment planning, adjusting the pace of care, and building trust through behavioural and acclimatisation strategies. Having a good knowledge of learning disability or autism does not always translate to greater confidence in patient management. Improving access to orthodontic-specific learning disability and autism training, national guidance and communication aids could enhance the confidence of orthodontic practitioners in managing these patient groups. A national survey of the experience and understanding of learning disability and autism of orthodontic practitioners in the United KingdomWhy was the study done? People with learning disabilities or autism can find it harder to access orthodontic care. This may be due to behaviour, other health needs or how confident the orthodontic clinician feels about caring for these patients. This study looked at how much the clinicians in the UK knew about learning disabilities and autism. They also asked about the clinicians’ experiences of and confidence in treating such patients. What did the researchers do? They sent an online survey to members of the British Orthodontic Society. It asked about their training, experience, knowledge and confidence in treating patients with learning disabilities or autism. A total of 171 clinicians replied. They were from orthodontic consultants, specialists, postgraduate trainees, therapists and dentists with a special interest in orthodontics.What did the researchers find? The clinicians had a good knowledge of autism and moderate knowledge of learning disabilities. Many clinicians said they did not feel confident in managing both groups. This was mainly when spotting these conditions or knowing where to refer patients for extra support. Even so, they reported using a mix of methods that were helpful. These included using clear language, supporting sensory needs and involving families. Taking treatment in smaller steps and using methods to modify behaviour also helped.What do the findings mean? The findings suggest that knowledge alone is not enough to make clinicians feel confident. More orthodontic-specific training, clear national guidance and easy-to-use communication tools could help clinicians feel more confident. These may make treatment better for people with learning disabilities or autism.

Acute respiratory infections (ARIs) remain a significant global health challenge and are the second leading cause of disease burden and mortality. Early warning systems (EWS) play a key role in detecting clinical deterioration, alerting health care providers (HCPs), and supporting pandemic surveillance. While existing literature highlights HCPs' positive experiences with EWS in confirming clinical assessments and guiding escalation, perspectives on how these systems can be optimized for ARI management remain underexplored. As Canada continues to develop and operationalize EWS for outbreak and pandemic preparedness, this study aims to explore the experiences and insights of primary care providers, emergency department (ED) physicians, and researchers regarding the use of EWS for ARI management in Canada. Eleven participants, including primary care providers, ED physicians, and researchers from urban and rural settings across 5 Canadian provinces (Ontario, Newfoundland and Labrador, Quebec, British Columbia, and Manitoba), were recruited in 2024. All participants regularly managed patients with ARIs or played key roles in pandemic response. A codebook thematic analysis was conducted to identify patterns and themes, with subthemes organized under broader thematic categories. Data saturation was assessed during the analysis phase. The study adhered to the COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines. Among the 11 participants, there was approximately equal representation across gender and age groups, and more than 90% had over ten years of experience in ARI management. Three overarching themes emerged. First, participants demonstrated general awareness of the use of EWS in ARI management, including outbreak detection, screening and triage support, and informing clinical decision-making. Technologies and surveillance tools used during the COVID-19 pandemic were frequently referenced; however, understanding of specific EWS and their application to ARI management was often limited. Second, participants identified key attributes of an effective EWS as accuracy, timeliness, integration, and equity, emphasizing the need for seamless integration into existing Canadian health care workflows without increasing administrative burden. Third, anticipated challenges were described across 4 stages of EWS development, including initiation (funding and privacy concerns), implementation (outdated data systems and limited legislation), use (staff shortages and capacity constraints), and evaluation (lack of standardized and innovative evaluation approaches). This study engaged 11 experienced HCPs and researchers who were directly involved in patient care and public health response to ARI outbreaks and qualitatively explored their perspectives on EWS for ARI management and pandemic preparedness. The findings identified 3 overarching themes regarding the general knowledge, desired attributes, and anticipated challenges of EWS in ARI management, highlighting the importance of co-designing EWS with clinicians, researchers, and other key stakeholders to improve their effectiveness and integration into clinical practice and pandemic preparedness across Canada.

Improving public knowledge and awareness of cancer aids prevention and early detection, yet limited data exist on this subject in low- and middle-income African countries. This study aimed to assess knowledge and awareness of colorectal cancer (CRC) in the general population of central Uganda. A community-based, cross-sectional survey was conducted among a random sample of 428 individuals from the general population in 2 districts of central Uganda. Data were collected using a semi-structured questionnaire and a modified version of the validated bowel cancer awareness measure. Multiple linear regression analysis was performed to identify factors associated with CRC awareness. Just over half of respondents had good awareness of CRC warning signs (57.9%, ≥ 6/9 correct responses), and risk factors (55.8%, ≥ 7/10 correct responses). Participants scored higher for awareness (responses to prompted questions), than knowledge (responses to unprompted questions) in relation to CRC warning signs (mean: 5.60 vs 0.46, out of 9) and risk factors (mean: 6.46 vs 0.22, out of 10). Residing in an urban area, lacking awareness of screenable cancers and not having private health insurance were associated with lower awareness of CRC warning signs. Being female and having non-degree tertiary education were associated with lower awareness of CRC risk factors. This study found very low CRC knowledge in central Uganda, despite good recognition of warning signs and risk factors, with notable rural-urban disparities. These findings highlight the need of reinforcing CRC prevention messages within ongoing cancer sensitization efforts to improve public understanding of CRC.

To evaluate the contribution of health anxiety, mental defeat and fear of recurrence and progression (FRP) as variables in the adjustment process following cardiac events and subsequent wellbeing, adjustment and rehabilitation. A two-part study was conducted: cross-sectionally examining psychological factors shortly following a cardiac event and longitudinally examining how these variables were associated with adherence and physical/psychological outcomes of cardiac rehabilitation. A UK-based sample of post-cardiac event patients (N = 176, Mage = 66.1, SD = 10.0) was categorized as high health anxiety with depression and/or anxiety, depression or anxiety only, or neither health anxiety nor depression/anxiety. Mental defeat and FRP were compared across groups pre-rehabilitation and examined in relation to adherence to, and outcomes of, an 8-session cardiac rehabilitation programme. Analyses indicated significantly higher mental defeat and FRP in those with health anxiety than in the other groups. However, regression analyses showed that neither health anxiety, mental defeat, nor FRP was significantly associated with rehabilitation adherence or outcomes. This study identified mental defeat and FRP as important factors in health-anxious cardiac patients, with implications for the coping and adjustment process and rehabilitative efforts. No linear association between these variables and rehabilitation adherence and outcomes was found, suggesting that more nuanced approaches to identifying their impact on rehabilitation may require development.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that affects physical, social and emotional aspects of life for people living with HS (plwHS). Although many plwHS consider pain the most bothersome symptom, fatigue and sleep disturbance are underexplored in research and rarely discussed in clinical practice. This article shares perspectives from plwHS and people working with patients, including healthcare professionals (HCPs), from Europe and North America, on the impact of HS-related fatigue and sleep disturbance on quality of life (QoL). Fatigue was described as a debilitating symptom affecting QoL, with HCPs often noting that plwHS were unaware of the full impact of fatigue until treatment improved their HS symptoms. Sleep disturbance was mainly attributed to HS-related pain, pruritus and lesion drainage, with sleep deficits accumulating over time. The strain of HS impacted personal relationships, with plwHS expressing less interest in social interactions or intimate relationships, leading to feelings of guilt, failure, isolation and reduced self-esteem. Fatigue and sleep disturbance also affected work productivity, and consequently, career progression and financial stability. Recognizing the multifaceted HS symptoms, providing reasonable adjustments in the workplace, encouraging open dialogue with HCPs and measuring fatigue with a validated instrument could help improve QoL of plwHS.

Elexacaftor/tezacaftor/ivacaftor (ETI) has demonstrated significant improvements in lung function, body mass index (BMI), symptom control, and health-related quality of life (HRQoL) in individuals with cystic fibrosis (CF). However, real-world evidence regarding its long-term impact on HRQoL, particularly in people without significant lung function improvement, remains limited. This study aimed to (1) assess HRQoL changes across multiple domains in individuals initiating ETI and (2) explore the relationship between clinical outcomes and HRQoL, particularly in those who do not experience a significant improvement in lung function. We conducted a prospective cohort study of adults initiating ETI at CF clinics across Canada. HRQoL was assessed using the Cystic Fibrosis Questionnaire-Revised (CFQ-R), Cystic Fibrosis Quality-of-Life Evaluative Self-Administered Test (CF-QUEST), and Sino-Nasal Outcome Test (SNOT-22) at baseline and at 3, 6, 9, and 12 months post-initiation. Lung function (percent predicted forced expiratory volume in 1&#x202f;s [ppFEV1]) and BMI were also monitored. Individuals were classified as lung function responders (&#x2265;5% increase in ppFEV1) or non-responders (<5% increase). Among 353 individuals, significant improvements in CFQ-R, CF-QUEST, and SNOT-22 scores were observed within one month of ETI initiation and sustained over 12 months. Notably, both lung function responders and non-responders experienced significant HRQoL improvements, with no evidence of a difference between groups in terms of mean changes in CFQ-R respiratory scores (28.8 vs. 24.2, p&#x202f;=&#x202f;0.2), CF-QUEST global scores (14.8 vs. 13.0, p&#x202f;=&#x202f;0.48), or SNOT-22 scores (-13.8 vs. -13.7, p&#x202f;=&#x202f;0.97). Our real-world data involving a large cohort of PwCF demonstrate that HRQoL improvements are sustained across multiple domains regardless of lung function response. These findings underscore the importance of using a multimodal approach to evaluate the effectiveness of modulator therapy in people with CF.

Bipolar disorder (BD) affects approximately 40 million people worldwide and is a chronic, potentially disabling mood disorder. Although effective treatments exist, access to evidence-informed psychosocial care remains limited, particularly for culturally and linguistically diverse populations, contributing to persistent global treatment gaps. Digital mental health interventions (DMHIs), such as smartphone apps, offer a promising means to improve access to self-management support and quality of life (QoL), an outcome prioritized by people with BD and in clinical guidelines. However, most apps for BD lack quality and are not culturally adapted or co-designed with people with BD, limiting relevance and engagement. PolarUs (mobile app) is an evidence-informed DMHI developed using co-design with people with BD. The app is structured on the core 14 domains from the Quality of Life in BD scale, the only BD-tailored scale, combined with psychoeducation on self-management strategies and QoL. A recent pilot study demonstrated promising QoL, clinical, and feasibility outcomes. This study aims to culturally and linguistically adapt the PolarUs app into French, Chinese, and Spanish for the North American context using qualitative and co-design methods. Guided by community-based participatory research principles, whereby end users are engaged throughout the research process, and the Ecological Validity Framework of Bernal et al, we will engage advisory groups of people with lived experience from each linguistic community throughout the cultural adaptation process. Semimonthly virtual meetings will support systematic cultural adaptation of the self-management strategies, affirmations, and resources while maintaining fidelity to core evidence-based components. This will include cultural tailoring of app content and the identification of culturally appropriate resources. Advisory groups will also contribute to the cointerpretation of findings and the co-design of culturally appropriate recruitment and implementation strategies of PolarUs for a future clinical trial. Meetings will be recorded and coanalyzed as research data with advisory groups using qualitative reflexive thematic analysis to capture advisory group perspectives and experiences. This study was funded in October 2024. As of January 31, 2026, we enrolled 7 participants, and the results are expected to be published in the fall of 2026. The findings will support the development of a culturally appropriate DMHI for BD for additional linguistic communities, advance cultural adaptation methodologies, and inform preparation for a future clinical trial. This study will produce the first culturally adapted, BD-specific DMHI developed through co-design using a community-based participatory research approach with multilingual end users from traditionally underserved communities, advancing equitable access, engagement, and scalability of DMHIs for BD and digital health care more broadly.

Insomnia is highly prevalent in Armed Forces (AF) and veteran populations and undermines readiness and quality of life. While Cognitive Behavioural Therapy for Insomnia (CBT-I) is first-line, access is limited in military settings, and although digital CBT-I offers a scalable alternative, evidence in this population remains limited and not systematically synthesised. The aim of this systematic review and meta-analysis is to evaluate the efficacy of digital CBT-I on insomnia severity in AF personnel. Four electronic databases (PubMed, CENTRAL, Ovid MEDLINE, Ovid PsycINFO, Ovid Embase, Web of Science) were searched between July 12th 2025 to 30th August 2025, supplemented by grey literature searching. Randomised controlled trials (RCT) of AF personnel with insomnia diagnosed via DSM-5 criteria (n&#xa0;=&#xa0;5) or Insomnia Severity Index (ISI)&#xa0;&#x2265;&#xa0;14 (n&#xa0;=&#xa0;1) were included. Digital CBT-I interventions were compared with minimum contact controls. Participants were included regardless of age, duty status, comorbidities, intervention modality, or setting. Change in ISI scores at post-treatment were meta-analysed using random-effects models, with follow-up assessed descriptively. Risk of bias was assessed using RoB 2, and certainty of evidence was evaluated using GRADE. Five RCTs (n&#xa0;=&#xa0;309 intervention; n&#xa0;=&#xa0;249 control) met inclusion criteria. Pooled post-treatment effects showed a statistically significant moderate-to-large reduction in insomnia severity favouring digital CBT-I, with substantial heterogeneity (I2&#xa0;=&#xa0;74%). Leave-one-out sensitivity analyses indicated that this heterogeneity was largely driven by Chao et al.; removal of this study resulted in a considerable reduction in heterogeneity while the overall effect remained robust. Available follow-up ISI scores indicated maintenance of treatment gains up to 12 months. Three studies reported clinically meaningful ISI reductions (&#x2265;6 points). Overall risk of bias was unclear or high, primarily due to limited reporting and attrition. Certainty of evidence was rated moderate. Despite limited study numbers, digital CBT-I was shown to be effective in reducing insomnia severity in AF personnel with complex health needs. Future research should address engagement and attrition within digital therapeutics to optimise implementation and treatment efficacy in military settings.

Atrial fibrillation (AF) is the most common sustained heart rhythm disorder and is a challenging chronic disease to manage. Patients' daily self-care decisions are associated with improved AF outcomes, quality of life, and decreased hospital use and cost. However, many patients find these real-world or naturalistic decisions difficult, often because of their inherent complexity and ambiguity, coupled with the uncertainty of AF. Intervention research using technology to support AF self-care has largely emphasized making decisions with clinicians. Patients with AF are increasingly using consumer technology; yet, little is known about the use of technology by patients with AF in independent self-care decision-making. Addressing this gap will facilitate developing interventions that better leverage technology to enhance patients' naturalistic decision-making. This study aimed to explore the experiences of older adult patients in using technology to support self-care decision-making. Following an interpretive descriptive qualitative approach, older adult patients with AF were recruited from 3 specialty heart function clinics in a Western Canadian province to participate in 1 of 6 facilitated virtual focus groups for 1.5 hours. Patients were asked about their self-care decision-making since AF diagnosis, their AF-specific technology use and its use in making self-care decisions, their technology motivations, benefits, constraints, and other possibilities for use. Inductive thematic analysis was used to code the transcribed data, moving from open coding to clustering of common codes into categories, looking for patterns of meaning between and across categories to iteratively arrive at main themes and subthemes. Thirty patients (n=15, 50% women) with AF (mean age, 73, SD 5.7 years; range 63-85 years) participated in the focus groups. Participants' experiences of using technology to make daily self-care decisions were highly variable but centered on its personalized use to meet their individualized needs, preferences, and life context. The personalizing process of technology use in decision-making was characterized by three themes: (1) beginning technology use in their own times and ways, during their AF trajectory-pre-, at the time, at some point AF post diagnosis, and could be either self-initiated and/or provider recommended or influenced; (2) developing patterns of AF self-care decision-making using technology, including establishing their personal baseline, keeping out of the danger zone, watchful waiting, and seeking decision-making support; and (3) finding the place for technology in normalizing daily life, either settling on or limiting its use to normalize life. Findings expand understandings of naturalistic decision-making by elucidating the personalized process of technology use in AF self-care.

This scoping review explores the school and school-related experiences of children and adolescents with Inflammatory Bowel Disease (IBD), drawing on 10 studies identified from an initial pool of 2676 records published between 2014 and 2022 across eight countries. The review identifies the following four key themes: school attendance/absenteeism; educational outcomes; general school experience; and school functioning and school-related quality of life outcomes. This scoping review included studies that were predominantly quantitative in design, with findings synthesised thematically across study types, alongside a narrative summary of quantitative indicators such as absenteeism, school functioning, and school-related quality of life. The findings reveal that, while educational outcomes for children with IBD were generally not significantly different from their peers (although some studies noted lower academic performance in children with IBD), children with IBD often felt that teachers and peers lacked understanding of their condition, which led to increased stress and sometimes bullying. Furthermore, children with IBD had lower quality-of-life scores related to school functioning compared with healthy peers. Despite these challenges, participation in school activities varied, with some children missing out on physical education and extracurricular activities. Overall, the review highlights the need for more research directly exploring children's perspectives on the emotional and embodied impact of IBD on their everyday lived school experiences. Furthermore, it emphasises the importance of improving school accommodations and understanding for children with IBD among peers, teachers and wider school staff. Future studies should consider qualitative approaches, including use of creative methods, to deepen the understanding of the complex lived experiences of schoolchildren with IBD.