Evaluating complex interventions in real context: Logic analysis of a case management program for frequent users of healthcare services

Case management programs for frequent users of healthcare services are complex interventions which implementation and application are challenging to evaluate. The aim of this article was to conduct a logic analysis to evaluate a case management program for frequent users of healthcare services. The study proceeded in three phases: 1) establishing causal links between the program’s components by the construction of a logic model, 2) developing an integrated framework from a realistic synthesis, and 3) making a new reading of the case management program in regard of the integrated framework. The study demonstrated, on one hand, strengths and weaknesses of the actual case management program, and, on the other hand, how logic analysis can create a constructive dialogue between theory and practice. The evaluative process with decision-makers, clinicians and patients has helped to make connexions between theory, practice, experience and services organization

Exploring the Perceived Impact of Parental PTSD on Parents and Parenting Behaviours—A Qualitative Study

A considerable number of adults who are currently living with posttraumatic stress disorder (PTSD) are also parents caring for at least one biological child. Evidence suggests that parental PTSD can be associated with impairments to certain parenting behaviours, particularly increasing the use of more negative practices. However, most of the evidence to date has been collected using quantitative methodology, which gives limited insight into why such effects might occur. The current study qualitatively explored study the lived experiences of parents currently living with PTSD, within the United Kingdom. Interviews were conducted with 30 parents (16 mothers, 14 fathers) who were recruited via a PTSD research registry, and who had children living at home under the age of 18 years at the time they experienced their trauma. Three main themes were identified: key impacts of the trauma to the parent personally; negative changes to specific parenting outcomes; impact of these parenting changes on the parent’s sense of parental efficacy; and recovery and coping. These findings provide novel insight into the experiences of both mothers and fathers with PTSD, and highlight the multiple challenges faced by parents living with PTSD that extend beyond impairments to themselves as individuals. Potential implications for the implementation of effective support for parents and their families following trauma exposure are considered

Generic self-reported questionnaires measuring self-management: a scoping review

This study aimed to (1) identify generic questionnaires that measure self-management in people with chronic conditions, (2) describe their characteristics, (3) describe their development and theoretical foundations, and (4) identify categories of self-management strategies they assessed. This scoping review was based on the methodological framework developed by Arksey and O’Malley and completed by Levac et al. A thematic analysis was used to examine self-management strategies assessed by the questionnaires published between 1976 and 2019. A total of 21 articles on 10 generic, self-reported questionnaires were identified. The questionnaires were developed using various theoretical foundations. The Patient Assessment of Self-Management Tasks and Partners in Health scale questionnaires possessed characteristics that made them suitable for use in clinical and research settings and for evaluating all categories of self-management strategies. This study provides clinicians and researchers with an overview of generic, self-reported questionnaires and highlights some of their practical characteristics

Exploring the Perceived Impact of Parental PTSD on Parents and Parenting Behaviours – A Qualitative Study

A considerable number of adults who are currently living with posttraumatic stress disorder (PTSD) are also parents caring for at least one biological child. Evidence suggests that parental PTSD can be associated with impairments to certain parenting behaviours, particularly increasing the use of more negative practices. However, most of the evidence to date has been collected using quantitative methodology, which gives limited insight into why such effects might occur. The current study qualitatively explored study the lived experiences of parents currently living with PTSD, within the United Kingdom. Interviews were conducted with 30 parents (16 mothers, 14 fathers) who were recruited via a PTSD research registry, and who had children living at home under the age of 18 years at the time they experienced their trauma. Three main themes were identified: key impacts of the trauma to the parent personally; negative changes to specific parenting outcomes; impact of these parenting changes on the parent’s sense of parental efficacy; and recovery and coping. These findings provide novel insight into the experiences of both mothers and fathers with PTSD, and highlight the multiple challenges faced by parents living with PTSD that extend beyond impairments to themselves as individuals. Potential implications for the implementation of effective support for parents and their families following trauma exposure are considered

The effect of the COVID-19 pandemic on mental health in individuals with pre-existing mental illness

BACKGROUND: There is evidence that the COVID-19 pandemic has negatively affected mental health, but most studies have been conducted in the general population. AIMS: To identify factors associated with mental health during the COVID-19 pandemic in individuals with pre-existing mental illness. METHOD: Participants (N = 2869, 78% women, ages 18–94 years) from a UK cohort (the National Centre for Mental Health) with a history of mental illness completed a cross-sectional online survey in June to August 2020. Mental health assessments were the GAD-7 (anxiety), PHQ-9 (depression) and WHO-5 (well-being) questionnaires, and a self-report question on whether their mental health had changed during the pandemic. Regressions examined associations between mental health outcomes and hypothesised risk factors. Secondary analyses examined associations between specific mental health diagnoses and mental health. RESULTS: A total of 60% of participants reported that mental health had worsened during the pandemic. Younger age, difficulty accessing mental health services, low income, income affected by COVID-19, worry about COVID-19, reduced sleep and increased alcohol/drug use were associated with increased depression and anxiety symptoms and reduced well-being. Feeling socially supported by friends/family/services was associated with better mental health and well-being. Participants with a history of anxiety, depression, post-traumatic stress disorder or eating disorder were more likely to report that mental health had worsened during the pandemic than individuals without a history of these diagnoses. CONCLUSIONS: We identified factors associated with worse mental health during the COVID-19 pandemic in individuals with pre-existing mental illness, in addition to specific groups potentially at elevated risk of poor mental health during the pandemic

COVID-19 related posttraumatic stress disorder in adults with lived experience of psychiatric disorder

Background Prevalence estimates of COVID-19-related posttraumatic stress disorder (PTSD) have ranged from 1% to over 60% in the general population. Individuals with lived experience of a psychiatric disorder may be particularly vulnerable to COVID-19-related PTSD but this has received inadequate attention. Methods Participants were 1571 adults with lived experience of psychiatric disorder who took part in a longitudinal study of mental health during the COVID-19 pandemic. PTSD was assessed by the International Trauma Questionnaire (ITQ) anchored to the participant's most troubling COVID-19-related experiencevent. Factors hypothesised to be associated with traumatic stress symptoms were investigated by linear regression. Results 40.10% of participants perceived some aspect of the pandemic as traumatic. 5.28% reported an ICD-11 PTSD qualifying COVID-19 related traumatic exposure and 0.83% met criteria for probable ICD-11 COVID-19-related PTSD. Traumatic stress symptoms were associated with younger age, lower income, lower social support, and financial worries, and lived experience of PTSD/complex PTSD. Depression and anxiety measured in June 2020 predicted traumatic stress symptoms at follow-up approximately 20 weeks later in November 2020. Conclusions We did not find evidence of widespread COVID-19-related PTSD among individuals with lived experience of a psychiatric disorder. There is a need for future research to derive valid prevalence estimates of COVID-19-related PTSD

Treatment Interruption and Variation in Tablet Taking Behaviour Result in Viral Failure: A Case-Control Study from Cape Town, South Africa

BACKGROUND: Understanding of the impact of non-structured treatment interruption (TI) and variation in tablet-taking on failure of first-line antiretroviral therapy (ART) is limited in a resource-poor setting. METHODS: A retrospective matched case-control analysis. Individuals failing ART were matched by time on ART with 4 controls. Viral load (VL) and CD4 count were completed 4-monthly. Adherence percentages, from tablet returns, were calculated 4-monthly (interval) and from ART start (cumulative). Variation between intervals and TI (>27 days off ART) were recorded. Conditional multivariate logistic regression analysis was performed to estimate the effect of cumulative adherence 10% and TI on virological failure. Age, gender, baseline log VL and CD4 were included as possible confounders in the multivariate model. RESULTS: 244 patients (44 cases, 200 controls) were included. Median age was 32 years (IQR28-37), baseline CD4 108 cells/mm3 (IQR56-151), VL 4.82 log (IQR4.48-5.23). 94% (96% controls, 86% failures) had cumulative adherence >90%. The odds of failure increased 3 times (aOR 3.01, 95%CI 0.81-11.21) in individuals with cumulative adherence 10% and 4.01 times (aOR 4.01, 95%CI 1.45-11.10) in individuals with TIs. For individuals with TI and cumulative adherence >95%, the odds of failing were 5.65 (CI 1.40-22.85). CONCLUSION: It is well known that poor cumulative adherence increases risk of virological failure, but less well understood that TI and variations in tablet-taking also play a key role, despite otherwise excellent adherence

Mortality of HIV-Infected Patients Starting Antiretroviral Therapy in Sub-Saharan Africa: Comparison with HIV-Unrelated Mortality

Comparing mortality rates between patients starting HIV treatment and the general population in four African countries, Matthias Egger and colleagues find the gap decreases over time, especially with early treatment

Desulfovibrio spp. dans la maladie parodontale : Interactions avec les cellules épithéliales KB et activité de l'amoxicilline libre ou complexée sur ces formes extracellulaires et intracellulaires

It has been suggested that Desulfovibrio, which are sulfate-reducing anaerobic bacteria, may be involved in periodontitis. We investigated the capacity of Desulfovibrio to invade epithelial cells and induce cytokine secretion from these cells. We showed that Desulfovibrio desulfuricans and Desulfovibrio fairfieldensis were able to invade and to multiply within oral epithelial cells (KB cells). Intracytoplasmic location of both bacteria was confirmed by confocal laser scanning and transmission microscopy. Invasion of these strains involved microtubule but not microfilament polymerization. Infection by Desulfovibrio resulted in an increase of the production of IL-6 and IL-8 by KB cells. The ability of D. desulfuricans and D. fairfieldensis to survive within oral epithelial cells and to modulate the epithelial immune response may contribute to the initiation and progression of periodontal diseases. Desulfovibrio as well as other periodontopathogens may produce [bêta]-lactamases and have the capacity to invade epithelial cells. It has been suggested that the hydrolysis of amoxicillin might be prevented by using an amoxicillin-[bêta]-cyclodextrin ([bêta]CD) complex and that intracellular diffusion of antimicrobial agents might be enhanced after complexation with [bêta]CDs. A stable [1:1] amoxicillin-[bêta]CD complex, characterized by spectroscopic and thermal analysis, did neither improve the activity of amoxicillin against [bêta]-lactamase producing strains nor enhance the intracellular diffusion of this compound.Il a été suggéré que les Desulfovibrio, qui sont des bactéries anaérobies sulfato-réductrices, pourraient être impliqués dans les parodontites. Nous avons évalué le pouvoir invasif de Desulfovibrio vis-à-vis de cellules épithéliales et leur capacité à induire la production de cytokines par ces cellules. Nous avons montré que Desulfovibrio desulfuricans et Desulfovibrio fairfieldensis sont capables d'envahir et de se multiplier dans les cellules épithéliales buccales (cellules KB). La localisation intracytoplasmique de ces deux bactéries a été confirmée par microscopie confocale et électronique à transmission. L'internalisation de ces souches était dépendante de la polymérisation des microtubules mais pas de celle de l'actine. L'infection avec Desulfovibrio était responsable d'une augmentation de la production d'IL-6 et d'IL-8 par les cellules KB. La capacité de D. desulfuricans et de D. fairfieldensis à survivre dans les cellules épithéliales et à moduler leur réponse immunitaire pourrait contribuer au développement des maladies parodontales. Desulfovibrio ainsi que d'autres parodontopathogènes peuvent produire des [bêta]-lactamases et sont capables d'envahir les cellules épithéliales. Il a été suggéré que l'hydrolyse de l'amoxicilline pourrait être évitée grâce à l'utilisation d'un complexe amoxicilline-[bêta]-cyclodextrine ([bêta]CD) et que la diffusion intracellulaire d'agents antimicrobiens pourrait être améliorée après complexation avec des [bêta]CD. Un complexe stable amoxicilline-[bêta]CD, caractérisé après analyse spectrale et thermique, n'a ni amélioré l'activité de l'amoxicilline vis-à-vis de souches produisant des [bêta]-lactamases ni augmenté la diffusion intracellulaire de ce composé

Desulfovibrio spp. in peridontal disease : interactions with KB epithelial cells and activity of free and complexed amoxillin on its extracellular forms

Il a été suggéré que les Desulfovibrio, qui sont des bactéries anaérobies sulfato-réductrices, pourraient être impliqués dans les parodontites. Nous avons évalué le pouvoir invasif de Desulfovibrio vis-à-vis de cellules épithéliales et leur capacité à induire la production de cytokines par ces cellules. Nous avons montré que Desulfovibrio desulfuricans et Desulfovibrio fairfieldensis sont capables d'envahir et de se multiplier dans les cellules épithéliales buccales (cellules KB). La localisation intracytoplasmique de ces deux bactéries a été confirmée par microscopie confocale et électronique à transmission. L'internalisation de ces souches était dépendante de la polymérisation des microtubules mais pas de celle de l'actine. L'infection avec Desulfovibrio était responsable d'une augmentation de la production d'IL-6 et d'IL-8 par les cellules KB. La capacité de D. desulfuricans et de D. fairfieldensis à survivre dans les cellules épithéliales et à moduler leur réponse immunitaire pourrait contribuer au développement des maladies parodontales. Desulfovibrio ainsi que d'autres parodontopathogènes peuvent produire des ß-lactamases et sont capables d'envahir les cellules épithéliales. Il a été suggéré que l'hydrolyse de l'amoxicilline pourrait être évitée grâce à l'utilisation d'un complexe amoxicilline-ß-cyclodextrine (ßCD) et que la diffusion intracellulaire d'agents antimicrobiens pourrait être améliorée après complexation avec des ßCD. Un complexe stable amoxicilline-ßCD, caractérisé après analyse spectrale et thermique, n'a ni amélioré l'activité de l'amoxicilline vis-à-vis de souches produisant des ß-lactamases ni augmenté la diffusion intracellulaire de ce composé.It has been suggested that Desulfovibrio, which are sulfate-reducing anaerobic bacteria, may be involved in periodontitis. We investigated the capacity of Desulfovibrio to invade epithelial cells and induce cytokine secretion from these cells. We showed that Desulfovibrio desulfuricans and Desulfovibrio fairfieldensis were able to invade and to multiply within oral epithelial cells (KB cells). Intracytoplasmic location of both bacteria was confirmed by confocal laser scanning and transmission microscopy. Invasion of these strains involved microtubule but not microfilament polymerization. Infection by Desulfovibrio resulted in an increase of the production of IL-6 and IL-8 by KB cells. The ability of D. desulfuricans and D. fairfieldensis to survive within oral epithelial cells and to modulate the epithelial immune response may contribute to the initiation and progression of periodontal diseases. Desulfovibrio as well as other periodontopathogens may produce ß-lactamases and have the capacity to invade epithelial cells. It has been suggested that the hydrolysis of amoxicillin might be prevented by using an amoxicillin-ß-cyclodextrin (ßCD) complex and that intracellular diffusion of antimicrobial agents might be enhanced after complexation with ßCDs. A stable [1:1] amoxicillin-ßCD complex, characterized by spectroscopic and thermal analysis, did neither improve the activity of amoxicillin against ß-lactamase producing strains nor enhance the intracellular diffusion of this compound