e-Mental health for mood and anxiety disorders in general practice

Familiarises general practitioners (GPs) with the range of online programs in Australia that have demonstrated efficacy and are currently available for use by patients with mental health problems. Background Australia is a world leader in the development of internetdelivered programs for the prevention and management of mood and anxiety disorders. Despite a strong evidence base of time- and cost-effectiveness, as well as clinical efficacy, the uptake of these programs in general practice remains low. Objective To familiarise general practitioners (GPs) with the range of online programs in Australia that have demonstrated efficacy and are currently available for use by patients with mental health problems. Discussion E-mental health programs provide an efficacious and accessible form of mental healthcare and have the potential to fill the gap for those for whom such care is inaccessible, unaffordable or unacceptable. Clinicians can also use it in a stepped-care manner to augment existing healthcare services. There are a number of online resources currently available to Australians who have mood or anxiety disorders. These resources have strong evidence to support their effectiveness. Online portals facilitate access to these programs. Recently the Australian Federal Government has funded an education program (eMHPrac) for GPs and mental health professionals, to outline what is available, indicate situations where recommending such resources is appropriate, and suggest ways in which they can be incorporated into general practice

Using geological and geochemical information to estimate the potential distribution of trace elements in Scottish groundwater

There are currently few reliable data available for the concentrations of trace elements in Scottish groundwaters. A new project Baseline Scotland, jointly funded by the British Geological Survey (BGS) and the Scottish Environment Protection Agency (SEPA), seeks to improve the data availability and general understanding of the chemistry of Scotland’s groundwater. However, this is a major undertaking and these new data will take several years to collect and interpret across the whole of Scotland. In the interim, SEPA have asked BGS to use their existing knowledge and data to give a rough estimate of where certain elements are more likely to be elevated in groundwater. This information will be used to help focus future monitoring and give background for Baseline Scotland. Predicting trace element concentrations is difficult, in part due to lack of knowledge on the distribution of mineral phases, the reactivity of different minerals and the geochemical environment, particularly the redox status. This report scopes the potential scale of naturally elevated trace elements in Scottish groundwater, in particular those elements that are potentially harmful to health: e.g. aluminium, arsenic, barium, cadmium, chromium, lead, manganese, nickel, uranium and zinc. The problems and limitations of prediction are discussed in the report and this work does not replace a proper assessment based on actual chemical analyses of groundwater. The method uses information on the geochemistry of the Scottish environment derived from the most comprehensive geochemical data set for Scotland, the BGS Geochemical Baseline Survey of the Environment (G-BASE), combined with the limited data available on the chemistry of Scottish groundwaters. The conditions under which each of the elements can become elevated in groundwater are discussed and the geological and geochemical information interpreted to produce a series of maps highlighting areas where each trace element may be elevated in groundwater relative to the Scottish average. The maps are based primarily on the 1:625 000 scale bedrock geology map of Scotland. In order to make the scheme and the maps simple and manageable, we have used the same numbers to describe the individual rock units (1 to 114) that are usedd on the Geological map of the UK (Solid Geology): North sheet. Some rock units have been subdivided, and other small areas highlighted where additional information is known, either from G-BASE or previous studies. After assessing the results of the exercise the following conclusions can be drawn: 1. The study has provided a useful summary of geochemical information for trace elements in Scotland, and detail the conditions in which these elements may become elevated in groundwater. This provides essential background to the Baseline Scotland project, which aims to improve the availability of groundwater chemistry data and the general understanding of the chemistry of Scotland’s groundwater. 2. The predictions can be used as a first pass to help focus and prioritise additional monitoring and for helping to interpret groundwater chemistry data from different areas. The predictions are only preliminary and will be modified in the future by detailed groundwater sampling and interpretation. There are several caveats: • For all of the trace elements considered, the lack of available groundwater chemistry data with detailed analysis of trace elements, and their restricted spatial distribution, means that it is not possible to rigorously test whether the groundwater quality predictions are accurate or not. • More groundwater chemistry data are available for three elements, barium, manganese and zinc, allowing a rudimentary test of the predictive maps. For barium the prediction appears to work well, but there is poor correlation for zinc. For manganese, some correlation is evident, but the complexity and variability of local conditions are such that much variation is observed. • This approach, using broad, national scale geological and environmental data, cannot account for the complexity of the controls on groundwater chemistry: i.e. the heterogeneous nature of the Scottish environment, not least the aquifer mineralogy and glacial history, and the complex behaviour of trace elements in groundwater, determined by aspects such as flow pathways, residence times, and the geochemical environment (for example, oxidising/reducing or acidic/alkaline conditions). In summary, this approach appears to be a useful first step in trying to estimate the likely distribution of trace elements in Scottish groundwater, in the absence of much reliable groundwater quality data. However, only by systematically collecting reliable groundwater chemistry data, across different aquifers and regions and from different depths, can the variation in trace elements in groundwater across Scotland be understood. Careful modelling and interpretation of these new data in the context of the geology and environmental conditions will help make future predictions of groundwater quality more reliable and provide reference information for the Water Framework Directive

Conditions associated with the initiation of domiciliary care following a hospital admission: a cohort study in East London, England

OBJECTIVE: Older people and people with complex needs often require both health and social care services, but there is limited insight into individual journeys across these services. To help inform joint health and social care planning, we aimed to assess the relationship between hospital admissions and domiciliary care receipt. DESIGN: Retrospective cohort study, using linked data on primary care activity, hospital admissions and social care records. SETTING: London Borough of Barking and Dagenham, England. PARTICIPANTS: Adults aged 19 and over who lived in the area on 1 April 2018 and who were registered at a general practice in East London between 1 April 2018 and 31 March 2020 (n=140 987). OUTCOME MEASURES: The outcome was initiation of domiciliary care. We estimated the rate of hospital-associated care package initiation, and of care packages unrelated to hospital admission. We also described the characteristics of hospital admissions that preceded domiciliary care, including primary diagnosis codes. RESULTS: 2041/140 987 (1.4%) participants had a domiciliary care package during a median follow-up of 1.87 years. 32.6% of packages were initiated during a hospital stay or within 7 days of discharge. The rate of new domiciliary care packages was 120 times greater (95% CI 110 to 130) during or after a hospital stay than at other times, and this association was present for all age groups. Primary admission reasons accounting for the largest number of domiciliary care packages were hip fracture, pneumonia, stroke, urinary tract infection, septicaemia and exacerbations of long-term conditions (chronic obstructive pulmonary disease and heart failure). Admission reasons with the greatest likelihood of a subsequent domiciliary care package were fractures and strokes. CONCLUSION: Hospitals are a major referral route into domiciliary care. While patients admitted due to new and acute illnesses account for many domiciliary care packages, exacerbations of long-term conditions and age-related and frailty-related conditions are also important drivers

Suicide exposure experience screener for use in therapeutic settings: A validation report

Introduction: A brief screener assessing experience of exposure to suicide for use in therapeutic settings is warranted. To examine the concurrent validity of such a screening tool, labeled as the Suicide Exposure Experience Screener (SEES), the associations of the two SEES items: (i) reported closeness with the person who died by suicide and (ii) perceived impact of suicide death with psychological distress are presented. Methods: Five separate datasets comprising surveys from Australia, Canada, and the United States (Ncombined = 7782) were used to provide evidence of concurrent validity of closeness and impact of suicide exposure. Results: Overall, closeness and impact were significantly correlated with measures of global distress across five different datasets, showing small to medium effect sizes. Closeness and impact were also intercorrelated demonstrating a large effect size across all surveys. This report used cross-sectional data and comprised varied sample sizes across different datasets that influenced statistical significance of obtained effects and did not tease apart the roles of cumulative exposure of suicide and prolonged bereavement in experiencing global distress. Conclusion: The SEES has clinical utility in determining psychological distress in bereaved individuals and is recommended for use in therapeutic settings

Cost-Effectiveness Analysis of Early Reading Programs: A Demonstration With Recommendations for Future Research

We review the value of cost-effectiveness analysis for evaluation and decision making with respect to educational programs and discuss its application to early reading interventions. We describe the conditions for a rigorous cost-effectiveness analysis and illustrate the challenges of applying the method in practice, providing examples of programs for which we have estimated costs, but find effectiveness data lacking in comparability. We provide a demonstration of how cost-effectiveness analysis can be applied to two early reading programs: the Wilson Reading System and Corrective Reading. We use existing effectiveness data from an experimental evaluation in which the programs were implemented under similar conditions and the use of common outcomes measures for both programs yielded data that are comparable. We combine these data with cost data we collected using the ingredients method to calculate cost-effectiveness ratios for the alphabetics domain. A complete picture of the relative cost-effectiveness of each program could be provided if effectiveness metrics were available for fluency, vocabulary, and comprehension. We highlight the obstacles to applying cost-effectiveness analysis more frequently and recommend strategies for improving the availability of the requisite data

Cost-effectiveness Analysis of Interventions that Improve High School Completion

This report demonstrates the methods of cost-effectiveness analysis as applied to several educational programs that have been shown to improve the rate of high school completion

Using cross-sector data linkage to track patient journeys across health and social care.

Objectives Older people and people with complex needs often require both health and social care services, but there is limited insight into individual journeys across these services. To help inform joint health and social care planning, we aimed to assess the relationship between hospital admissions and domiciliary care receipt. Approach We used an individually linked dataset of primary care activity, hospital admissions and local authority-held social care records for adults living in Barking and Dagenham, a borough in London, England, on 1 April 2018, and followed them up until 31 March 2020. The outcome was initiation of a new domiciliary care package. We estimated the rate of hospital-associated care package initiation, and of care packages unrelated to hospital admissions. We also described the characteristics of hospital admissions that preceded domiciliary care and examined which primary diagnoses codes were associated with receiving domiciliary care after discharge. Results In our cohort, 1.4 of participants had a domiciliary care package during a median follow-up of 1.87 years. One in three domiciliary care packages were initiated during a hospital stay or within 7 days of discharge. The rate of new domiciliary care packages was 120 times greater (95% CI 110-130) during or after a hospital stay than at other times, and this association was present for all age groups. Primary admission reasons accounting for the largest number of domiciliary care packages were hip fracture, pneumonia, urinary tract infection, septicaemia, and exacerbations of long-term conditions (COPD and heart failure). Admission reasons with the greatest likelihood of a subsequent domiciliary care package were fractures and strokes. Conclusion Hospitals are a major referral route into domiciliary care. While new and acute illnesses account for many domiciliary care packages, exacerbations of long-term conditions and age- and frailty-related conditions are also an important driver. National-level linked datasets are needed for a better understanding of the relationship between health and social care receipt

Exploring sociodemographic correlates of suicide stigma in Australia: Baseline cross-sectional survey findings from the life-span suicide prevention trial studies

The risk of suicidal behaviour in Australia varies by age, sex, sexual preference and Indigenous status. Suicide stigma is known to affect suicide rates and help-seeking for suicidal crises. The aim of this study was to investigate the sociodemographic correlates of suicide stigma to assist in prevention efforts. We surveyed community members and individuals who had attended specific emergency departments for suicidal crisis. The respondents were part of a large-scale suicide prevention trial in New South Wales, Australia. The data collected included demographic characteristics, measures of help-seeking and suicide stigma. The linear regression analyses conducted sought to identify the factors associated with suicide stigma. The 5426 participants were predominantly female (71.4 %) with a mean (SD) age of 41.7 (14.8) years, and 3.9 % were Indigenous. Around one-third of participants reported a previous suicide attempt (n = 1690, 31.5 %) with two-thirds (n = 3545, 65.3 %) seeking help for suicidal crisis in the past year. Higher stigma scores were associated with Indigenous status (β 0.123, 95 % CI 0.074 – 0.172), male sex (β 0.527, 95 % CI 0.375 – 0.626) and regional residence (β 0.079, 95 % CI 0.015 – 0.143). Lower stigma scores were associated with younger age (β − 0.002, 95 % CI − 0.004 – − 0.001), mental illness (β − 0.095, 95 % CI − 0.139 to − 0.050), male bisexuality (β − 0.202, 95 % CI − 0.351 to − 0.052) and males who glorified suicide (β − 0.075, 95 % CI − 0.119 to − 0.031). These results suggested that suicide stigma differed across the community, varying significantly by sex, sexual orientation and Indigenous status. Targeted educational programs to address suicide stigma could assist in suicide prevention efforts

Improving Early Literacy: Cost-Effectiveness Analysis of Effective Reading Programs

This study is a cost-effectiveness analysis of seven early literacy programs that have all been previously identified as effective at improving reading outcomes for students in Grades K-3. We use the ingredients method to collect cost data for each program and compare the cost-effectiveness of programs serving students in the same grade level