Mindfulness-based interventions in epilepsy: a systematic review

Mindfulness based interventions (MBIs) are increasingly used to help patients cope with physical and mental long-term conditions (LTCs). Epilepsy is associated with a range of mental and physical comorbidities that have a detrimental effect on quality of life (QOL), but it is not clear whether MBIs can help. We systematically reviewed the literature to determine the effectiveness of MBIs in people with epilepsy. Medline, Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, Allied and Complimentary Medicine Database, and PsychInfo were searched in March 2016. These databases were searched using a combination of subject headings where available and keywords in the title and abstracts. We also searched the reference lists of related reviews. Study quality was assessed using the Cochrane Collaboration risk of bias tool. Three randomised controlled trials (RCTs) with a total of 231 participants were included. The interventions were tested in the USA (n = 171) and China (Hong Kong) (n = 60). Significant improvements were reported in depression symptoms, quality of life, anxiety, and depression knowledge and skills. Two of the included studies were assessed as being at unclear/high risk of bias - with randomisation and allocation procedures, as well as adverse events and reasons for drop-outs poorly reported. There was no reporting on intervention costs/benefits or how they affected health service utilisation. This systematic review found limited evidence for the effectiveness of MBIs in epilepsy, however preliminary evidence suggests it may lead to some improvement in anxiety, depression and quality of life. Further trials with larger sample sizes, active control groups and longer follow-ups are needed before the evidence for MBIs in epilepsy can be conclusively determined

The anxious wait: assessing the impact of patient accessible EHRs for breast cancer patients

<p>Abstract</p> <p>Background</p> <p>Personal health records (PHRs) provide patients with access to personal health information (PHI) and targeted education. The use of PHRs has the potential to improve a wide range of outcomes, including empowering patients to be more active participants in their care. There are a number of widespread barriers to adoption, including privacy and security considerations. In addition, there are clinical concerns that patients could become anxious or distressed when accessing complex medical information. This study assesses the implementation of a PHR, and its impact on anxiety levels and perceptions of self-efficacy in a sample of breast cancer patients.</p> <p>Methods</p> <p>A quasi-experimental pre-test/post-test design was used to collect data from participants to evaluate the use of the PHR. Study participants completed background and pre-assessment questionnaires and were then registered into the portal. By entering an activation key, participants were then able to review their lab results and diagnostic imaging reports. After six weeks, participants completed post-assessment questionnaires and usability heuristics. All data were collected using an online survey tool. Data were cleaned and analyzed using SAS v9.1.</p> <p>Results</p> <p>A total of 311 breast cancer patients completed demographic and pre-assessment questionnaires, 250 registered to use the online intervention, and 125 participants completed all required study elements. Matching the pre- and post-anxiety scores demonstrated a decrease in mean anxiety scores (-2.2, p = 0.03); the chemotherapy sub-group had a statistically insignificant mean increase (1.8, p = .14). There was no mean change in self-efficacy scores.</p> <p>Conclusions</p> <p>Participants generally found the portal easy to use; however, the perceived value of improved participation was not detected in the self-efficacy scores. Having access to personal health information did not increase anxiety levels. While these results suggest that the use of this PHR may be of benefit for informing patients, further research is required to investigate the impact on the patients experiences, their participation in their care, their relationships with the health care team, and their health outcomes.</p

E-Mental Health Service Use among Young Adults

This item is only available electronically.Background: Young adults, aged 18-24 years, often delay or avoid seeking help for their mental health concerns. The use of the internet to deliver e-mental health support offers a low cost, easy-access option, however the factors which influence online help-seeking remain unclear. Aim: To examine patterns and characteristics of e-mental health service use among young adults framed by Andersen’s Behavioral Model. Methods: One hundred and sixty-one young Australians completed an online survey, which comprised of sociodemographic questions and seven standardised measures: Attitudes Towards Services, Berkman-Syme Social Network Index, General Self-Efficacy Scale, Service Obstacles Scale, Depression, Anxiety and Stress Scales and Actual and General Help-seeking Questionnaires. Results: The majority of young people (65.8%, n = 106) reported having accessed online mental health supports. In particular, males and young adults living with family members were more like to access social media for their emotional problems. In comparison, 39.8% (n = 64) had accessed professional online services - primarily those who reported feeling socially isolated and in distress. Hierarchical logistical regression identified three predisposing factors: a positive attitude towards services facilitated online help-seeking, whereas higher education and living alone presented as significant barriers. Conclusion: E-mental health platforms can bridge the gap between technology and conventional mental health care. Whilst young adults engage in online help-seeking, more needs to be done to integrate this service model within the Australian healthcare system.Thesis (B.PsychSc(Hons)) -- University of Adelaide, School of Psychology, 201

EMPOWERCARE: EMPOWERing individuals & communities to manage their own CARE

EMPOWERing individuals and communities to manage their own CARE (EMPOWERCARE) was a 3-year social innovation project involving 13 cross border European partners. EMPOWERCARE developed a holistic community asset approach to respond to current gaps in the care of people in the target group (those aged 65+ and those aged 50+ with at least one chronic condition). It aimed to address challenges facing our societies concerning the care of our ageing populations and when older people are not being involved in decisions concerning their own health and wellbeing. The project ensured that older people are at the forefront of improved technology and better care from within their communities. This sought to improve their situation but also tackle the financial issues of an ageing population and improve social cohesion. The main key messages from the evaluation of the project initiatives were: • Self-efficacy – Across all sites, ‘inactive’ participants at baseline showed a statistically significant increase in self-efficacy at the end of the initiatives. Qualitative data confirmed end-users’ increased levels of selfconfidence and self-efficacy around taking action in relation to their own health. • Emotional and social wellbeing - When considering all project sites, there was no significant decrease of the level of reported loneliness, overall and by type (emotional and social), for participants who reported feeling lonely at the start of the initiative. For participants from philosophically focused initiatives, who reported being lonely at the start of the initiative, there was a slight decrease in emotional loneliness from baseline, although this change was not statistically significant. Overall, there was no decrease, but for initiatives that were philosophically focused there was a negative trend. Qualitative data evidenced the positive impact initiatives had in tackling end-users’ loneliness. • Digital literacy - When analysing survey responses from all sites, end-users reported internet healthseeking behaviour did change at the end of initiatives. Nonetheless, for the sites focusing more on technology, internet health-seeking behaviour increased from baseline to end of initiative, although the positive change was not statistically significant. Qualitative data from end-users confirms the survey results that those participating in the initiatives felt more digitally literate and confident in using technology for their physical and mental health needs and to keep connected with their social networks. • Internet health-seeking behaviour – There was no significant change in this area for end-users. This could be explained by them receiving help in-person and therefore they felt less need to go online for help with their health. For technology focused initiatives there was still no significant change, but there was a positive trend for technology enthusiasm. Anxiety around technology use remained and the qualitative data relating to this indicated there was room to build on technology skills. • Person centred care - Across all sites, for those that had a baseline of below average person-centredness or lower, mean scores increased from baseline to end of initiatives, and this improvement was statistically significant, indicating that the project initiatives significantly increased workforce person-centeredness. There were also similar significant improvements in the specific areas of this scale of Climate of Safety, Climate of Everydayness, Climate of community and Climate of Comprehensibility, indicating that the project initiatives significantly increased workforce feelings of whether the workplace is a place where the patients are in safe hands, staff use language that the patients can understand, it is easy for patients to talk to the staff and where the patients have someone to talk to if they so wish. Qualitative data reflected these results, talking about the transformation in people’s lives that was possible through being focused on the needs of the individuals and what matters to them. • Workforce technology uptake - Across all sites, survey results from workforce attitudes towards technology did not show any change from baseline to end of initiatives. Similarly, there was no difference between workforce participants in technology-focused and philosophical initiatives. Qualitative data from the workforce showed an understanding of the need to embrace technology in their work and that some of the drive for that need came from the implementation of COVID-19 restrictions. • Job satisfaction and workforce training embeddedness – for job satisfaction there was no significant change, although there was a positive trend for those who started below the top 15%. The context of working through COVID-19 may have had a negative impact on job satisfaction. Across all sites, there were higher average scores on certain areas of efficacy in relation to workforce training in implementing, embedding, and integrating a complex healthcare initiative, such as reflective monitoring and collective action compared to coherence, and cognitive participation findings suggest that overall workforce members showed they are willing to engage in reflexive monitoring and collective action across all sites – so they were willing to self-monitor and take time to think about their behaviour and work together to take action. The qualitative data indicated that embedding training has enabled the workforce to understand the value of taking time, reflecting and connecting, which are some of the key person-centred competencies and attributes you would want to see in a transformed workforce. The Cost Benefit Analysis showed: • Contingent Valuation Method (CVM) evaluation indicate that individuals are willing to pay (WTP) on average €10.31 per month from their own out of pocket expenses to use and obtain the health benefits and wellbeing effects of participating in the EMPOWERCARE initiatives. • WTP is positively influenced by the value individuals place on the technically focused initiatives, willingness to participate in an alternative initiative along with improvements gained in emotional and social loneliness because of the EMPOWERCARE initiatives. • The WTP estimates defined in this evaluation provide significant insights for decision makers and healthcare commissioners on the value that previous participants place on the services provided through the EMPOWERCARE initiatives in local communities. • Insights from the ‘Good Ancestor’ principles in FGD promotes the deliberation of long-term thinking which can lead to the power of change, reshaping decisions to take account of future generations, while promoting and encouraging sustainability in respect for future generations. The evaluation results provide some positive results on the success of the EMPOWERCARE initiatives across the 4 countries. More analysis has been done per site to understand the different aspects of the EMPOWERCARE Strategy, Workforce Transformation Package and Technology Blueprint that made a positive difference to end-users and members of the workforce. This further analysis will provide a more comprehensive picture of the impact of the EMPOWERCARE initiatives, as well as inform the next stages of work

Preventing suicide by young people

Introduction In 2013, 2,522 people died by suicide in Australia. Twenty-two of these were children aged 5- 14 years, 148 were adolescents aged 15-19 years, and a further 200 were young people aged 20-24 years. Although the suicide rate for children and adolescents is lower than that for some older age groups, suicide is the leading cause of death in children and young people. Suicide has immense effects on the families, friends, and communities of people who die by suicide, causing long lasting grief and guilt. Arguably, these effects are even greater when the person who died by suicide is young. It is estimated that suicide costs the Australian economy more than $17 billion per year. Researchers and policy makers recognise that suicide is preventable, yet suicide rates have changed little in the past 10 years. This discussion paper aims to focus a spotlight on the unique experience of young people. It does this by providing a critical analysis of existing policy and evidence based responses relevant to young people

The Impacts of Advancements in Digital Technologies on Students’ Self-Regulated Learning

This study examined student digital technology usage and student self-regulated learning in 2012 and 2020. Digital technologies have become a staple in both our learning environment, as well as our personal environment. In order to promote and enhance student self-regulated learning, two domains were examined in this study: the student’s personal environment and the educational provider’s learning environment. This holistic examination led to the development a Dual Model of Self-Regulated Learning for supporting student learning

Rhetorical relationships with students: A higher education case study of perceptions of online assessment in mathematics

Some students perceive that online assessment does not provide for a true reflection of their work effort. This article reports on a collaborative international project between two higher education institutions with the aim of researching issues relating to engineering student perceptions with respect to online assessment of mathematics. It provides a comparison between students of similar educational standing in Finland and Ireland. The students undertook to complete questionnaires and a sample of students was selected to participate in several group discussion interviews. Evidence from the data suggests that many of the students demonstrate low levels of confidence, do not display knowledge of continuous assessment processes and perceive many barriers when confronted with online assessment in their first semester. Alternative perspectives were sought from lecturers by means of individual interviews. The research indicates that perceptions of effort and reward as seen by students are at variance with those held by lecturers. The study offers a brief insight into the thinking of students in the first year of their engineering mathematics course. It may be suggested that alternative approaches to curriculum and pedagogical design are necessary to alleviate student concerns

Citizens’ Perception About M-Government Services: Results from an Exploratory Survey

The development of mobile technology is facilitating the transformation in a way that governments deliver their services. Mobile government is one area that has received very little research, but it can have a tremendous impact on the way citizens engage with their government. This research analyses the data gathered from 81 respondents through online survey on the various aspects of mobile government and collects their views on some of the key questions related to the use of mobile government. The findings showed that although citizens are aware of the possibilities they hardly used mobile devices as a direct communication channel with government. Most users tend to use social media platforms and social media is used as an intermediary between government and citizens. The findings of this research also indicated that although the users are well aware of m-government services and own smartphones, only a handful of them use their mobiles for accessing government services

“I’m just a long history of people rejecting referrals” experiences of young people who fell through the gap between child and adult mental health services

The paediatric-adult split in mental health care necessitates young people to make a transition between services when they reach the upper end of child and adolescent mental health services (CAMHS). However, we know that this transition is often poor, and not all young people who require ongoing support are able to continue care in adult mental health services (AMHS). These young people are said to have fallen through the gap between services. This research aimed to explore the reasons why young people fall through the gap between CAMHS and AMHS, and what effect his has had on them and their families. Narrative interviews were conducted with 15 young people and 15 parents, representing 19 unique transition stories. Themes were identified collaboatively using thematic analysis. Reasons for falling through the gap were grouped into systemic problems and problems with the quality of care received. Effects of alling through the gap were grouped into separate themes for young people (feeling abandoned; struggling to manage without continued care; problems with medication) and parents (emotional impact of care ending; parents taking an active role in the young person’s care). To our knowledge, this is the firt qualitative study that has focused only on the experiences of young people who have fallen through the gap between services. This research adds novel findings o existing literature regarding barriers to transition and the effectsof discontinuity of care