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AbstractThe long-term course of depression is not well-understood among minority women. We assessed depression trajectory, barriers to depression care, and life difficulties among minority women accessing health and social service programs as part of the Community Partners in Care study. Data include surveys ( N = 339) and interviews ( n = 58) administered at 3-year follow-up with African American and Latina women with improved versus persistent depression. The majority of the sample reported persistent depression (224/339, 66.1%), ≥1 barrier to mental health care (226/339, 72.4%), and multiple life difficulties (mean, 2.7; SD, 2.3). Many barriers to care ( i.e. , related to stigma and care experience, finances, and logistics) and life difficulties ( i.e. , related to finances, trauma, and relationships) were more common among individuals reporting persistent depression. Results suggest the importance of past experiences with depression treatment, ongoing barriers to care, and negative life events as contributors to inequities in depression outcomes experienced by minority women.

Although climate change poses a threat to health and well-being globally, a regional approach to addressing climate-related health equity may be more suitable, appropriate, and appealing to under-resourced communities and countries. In support of this argument, this commentary describes an approach by a network of researchers, practitioners, and policymakers dedicated to promoting climate-related health equity in Small Island Developing States and low- and middle-income countries in the Pacific. We identify three primary sets of needs related to developing a regional capacity to address physical and mental health disparities through research, training, and assistance in policy and practice implementation: (1) limited healthcare facilities and qualified medical and mental health providers; (2) addressing the social impacts related to the cooccurrence of natural hazards, disease outbreaks, and complex emergencies; and (3) building the response capacity and resilience to climate-related extreme weather events and natural hazards.

BackgroundOpen design formats for mobile apps help clinicians and stakeholders bring their needs to direct, co-creative solutions. Palliative care for patients with advanced cancers requires intensive monitoring and support and remains an area in high need for innovation.ObjectiveThis study aims to use community-partnered participatory research to co-design and pretest a mobile app that focuses on palliative care priorities of clinicians and patients with advanced cancer.MethodsIn-person and teleconference workshops were held with patient and family stakeholders, researchers, and clinicians in palliative care and oncology. Question prompts, written feedback, semistructured interviews, and facilitated group discussions identified the core palliative care needs. Using Chorus, a no-code app-building platform, a mobile app was co-designed with the stakeholders. A pretest with 11 patients was conducted, with semistructured interviews of clinician and patient users for feedback.ResultsKey themes identified from the focus groups included needs for patient advocacy and encouragement, access to vetted information, patient-clinician communication support, and symptom management. The initial prototype, My Wellness App, contained a weekly wellness journal to track patient-reported symptoms, goals, and medication use; information on self-management of symptoms; community resources; and patient and caregiver testimonial videos. Initial pretesting identified value in app-based communication for clinicians, patients, and caregivers, with suggestions for improving user interface, feedback and presentation of symptom reports, and gamification and staff coordinators to support patient app engagement.ConclusionsThe development of a mobile app using community-partnered participatory research is a low-technology and feasible intervention for palliative care. Iterative redesign and user interface expertise may improve implementation.

ImportanceIn 2016, the US Preventive Services Task Force newly recommended universal screening for depression, with the expectation that screening would be associated with appropriate treatment. Few studies have been able to assess the population-based trajectory from screening to receipt of follow-up and treatment for individuals with depression.ObjectiveTo examine adherence to guidelines for follow-up and treatment among primary care patients who newly screened positive for depression in the Veterans Health Administration (VA).Design, setting, and participantsThis retrospective cohort study used VA electronic data to identify patients who newly screened positive for depression on the 2-item Patient Health Questionnaire at 82 primary care VA clinics in California, Arizona, and New Mexico between October 1, 2015, and September 30, 2019. Data analysis was performed from December 2020 to August 2021.Main outcomes and measuresReceipt of guideline-concordant care for screen-positive patients who were determined by clinicians as having depression was assessed. Timely follow-up (within 84 days of screening) was defined as receiving 3 or more mental health specialty visits, 3 or more psychotherapy visits, or 3 or more primary care visits with a depression diagnosis according to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. Completing at least minimal treatment (within 12 months) was defined as having 60 days or more of antidepressant prescriptions filled, 4 or more mental health specialty visits, or 3 or more psychotherapy visits.ResultsThe final cohort included 607 730 veterans (mean [SD] age, 59.4 [18.2] years; 546 516 men [89.9%]; 339 811 non-Hispanic White [55.9%]); 8%, or 82 998 of 997 185 person-years, newly screened positive for depression. Clinicians identified fewer than half with depression (15 155 patients), of whom 32% (5034 of 15 650 person-years) met treatment guidelines for timely follow-up and 77% (12 026 of 15 650 person-years) completed at least minimal treatment. Younger age (odds ratio, 0.990; 95% CI, 0.986-0.993; P

Microwave ablation is becoming increasingly common for the treatment of liver tumors. Despite numerous studies aimed at identifying risk factors for local recurrence after microwave ablation, a consensus on modifiable risk factors for failure remains elusive, partly because of the limited statistical power of these studies. This study investigated the incidence of technical failure after microwave ablation, encompassing both incomplete ablation and local recurrence, and aimed to identify modifiable factors that reduce technical failure. This retrospective review included patients who underwent surgical microwave ablation at a high-volume institution between October 2006 and March 2023. Univariate analysis, multivariate analysis, and propensity score matching were performed to identify risk factors for technical failure. A total of 1,613 surgical microwave ablations were performed on 3,035 tumors, with 226 instances (14% per procedure, 7.4% per tumor) of technical failure. Incomplete ablation occurred at a rate of 1.7% per tumor, whereas local recurrence was identified in 6.5% of ablations in per-tumor analysis. Body mass index >25 was significant for failure (odds ratio, 1.50; 95% confidence interval, 1.07–2.11; P <.05), suggesting that more difficult targeting may lead to increased technical failure rates. African American race (odds ratio, 1.62; 95% confidence interval, 1.16–2.27; P <.05), pre–microwave ablation transarterial chemoembolization (odds ratio, 1.54; 95% confidence interval, 1.08–2.21; P <.05), and previous ablation (odds ratio, 1.58; 95% confidence interval, 1.09–2.29; P <.05) were found to be statistically significant. On the basis of the largest microwave ablation database available to date, this study identified novel modifiable and nonmodifiable risk factors of microwave ablation failure. These results can lead to decreasing technical failure rates after microwave ablation. [Display omitted] [ABSTRACT FROM AUTHOR]

Addressing the evidence-to-practice gap in midwifery is vital for improving maternal and newborn health outcomes. Despite the potential of involving midwives in quality improvement interventions to address this gap, such interventions are understudied. In a Ugandan urban hospital, midwifery practices with a significant evidence-to-practice gap have been identified as areas for clinical improvement. The primary objective of the Quality Improvement was to increase the uptake of identified and essential midwifery practices through a quality improvement approach led by midwives. We enrolled 703 women aged 18 years and older with uncomplicated full-term pregnancies (between 37+0 and 42+0 weeks) who gave birth at the facility. The intervention focused on evidence-based practices with an identified evidence-to-practice gap: dynamic birth position, including women's involvement in birth position decision-making, perineal protection and intrapartum support. A team of midwives led a seven-month co-created quality improvement intervention. The intervention used Plan–Do–Study–Act (PDSA) cycles, following the Model for Improvement and included a train-the-trainer approach and weekly online support meetings. In this single-case prospective observational study, we compared pre-, during and post-intervention uptake of evidence-based practices. Trained research assistants collected data through interviews and observations. We observed improvements in the uptake of all clinical improvement areas. Dynamic birth positions increased from 0 % to 79 %, decision-making of birth positions from 0 % to 75 %, perineal protection measures from 62 % to 92 % and intrapartum support from 7 % to 67 %. A multifactorial midwife-led Quality Improvement resulted in significant and sustained improvements in the uptake of evidence-based practices in maternal and newborn healthcare. If given the mandate and time, midwives can successfully lead Quality Improvements, which enhance the quality of care and close the evidence-to-practice gaps in maternal and newborn health. The study's results underscore the significance of developing effective strategies to enhance care quality and promote the adoption of evidence-based midwifery practices. [ABSTRACT FROM AUTHOR]

To assess if received professional and social support are associated with father-infant bonding among primiparous (first-time) and multiparous (multi-time) fathers. Early father-infant bonding predicts several positive child outcomes. However, while received professional and social support positively impacts fathers' transition into parenthood, little research has tested if these factors are associated with a stronger father-infant bond. In total, 499 fathers (296 primiparous and 203 multiparous) of infants (aged 0–12 months) completed a cross-sectional online survey between November 2018 and March 2020. The survey included items related to socio-demographics, having a planned pregnancy, postnatal midwifery support, child health nurse support, child health center attendance, and social support. The parent-infant bonding questionnaire (PBQ) was used to assess the father-infant bond. Multiple linear regression models were estimated for the total sample and based on paternal parity. Missing data were managed through multiple imputation procedures. Fathers reported fewer bonding disturbances if they received support from their partners, postnatal midwives, child health nurses, and attended more child health visits. Primiparous fathers reported fewer bonding disturbances when receiving support from their partners, postnatal midwives, and the child health nurse. However, multiparous fathers had more bonding disturbances than primiparous fathers and received less professional and partner support. Receiving more partner and professional support is associated with less father-infant bonding disturbances. To encourage a better father-infant bond, clinicians should invite and support all fathers, regardless of parity, as they transition to parenthood. [ABSTRACT FROM AUTHOR]

Over a quarter of the world's land surface is grazed by cattle and other livestock, which are replacing wild herbivores, potentially impairing ecosystem structure, and functions. Previous research suggests that cattle at moderate stocking rates can functionally replace wild herbivores in shaping understory communities. However, it is uncertain whether this is also true under high stocking rates and the effects of wild herbivore on plant communities are moderate, enhanced, or simply additive to the effects of cattle at high stocking rates. To evaluate the influence of cattle stocking rates on the ability of cattle to functionally replace wild herbivores and test for interactive effects between cattle and wild herbivores in shaping understory vegetation, we assessed herbaceous vegetation in a long‐term exclosure experiment in a semi‐arid savanna in central Kenya that selectively excludes wild mesoherbivores (50–1000 kg) and megaherbivores (elephant and giraffe). We tested the effects of cattle stocking rate (zero/moderate/high) on herbaceous vegetation (diversity, composition, leafiness). We also tested how those effects depend on the presence of wild mesoherbivores and megaherbivores. We found that herbaceous community composition (primary ordination axis) was better explained by the presence/absence of herbivore types than by total herbivory, suggesting that herbivore identity is a more important determinant of community composition than total herbivory at high cattle stocking rates. The combination of wild mesoherbivores and cattle stocked at high rates led to increased bare ground and annual grass cover, reduced perennial grass cover and understory leafiness, and enhanced understory diversity. These shifts were weaker or absent when cattle were stocked at high stocking rates in the absence of wild mesoherbivores. Megaherbivores tempered the effects of cattle stocked at high rates on herbaceous community composition but amplified the effects of high cattle stocking rate on bare ground and understory diversity. Our results show that cattle at high stocking rates do not functionally replace wild herbivores in shaping savanna herbaceous communities contrary to previous findings at moderate stocking rates. In mixed‐use rangelands, interactions between cattle stocking rate and wild herbivore presence can lead to non‐additive vegetation responses with important implications for both wildlife conservation and livestock production. [ABSTRACT FROM AUTHOR]

Editorial In this issue of I JAMA Psychiatry i , Overhage and colleagues[1] provide analyses of deidentified commercial insurance claims data from Optum Labs Data Warehouse for March 2019 to February 2022. In addition, they found a 7% reduction in the percentage of youth with outpatient MH visits before their ED visit from the prepandemic period to the second pandemic year.[1] Further, they confirmed findings reported in other studies of pandemic year 1 that the percentage of youth with any MH ED visit decreased for that year relative to the period before. Increased Emergency Department Stays for Mental Health of Insured Youth in Year 2 of the COVID-19 Pandemic - Moving Forward. [Extracted from the article]

In 2017, a new clinical visit for non-birthing parents (e.g. fathers) of three-to-five month old infants was implemented in Stockholm County. In 2018, 19 out of 134 child health centres (CHCs) saw 62% of all fathers at the father visit and these CHCs had the highest fidelity scores. The aim of the current study was to assess nurse-managers' perceptions of facilitators and barriers to implementating the father visit. Semi-structured interviews were conducted with nurse-managers from seven CHCs. Interviews were audio-recorded, transcribed and then analysed using systematic text condensation. Hasson's modified version of the Conceptual Framework for Implementation Fidelity was used to interpret the findings. Six themes emerged during the analysis, which were sorted into perceived facilitators and barriers regarding the implementation of the father visit. Facilitators included: 1) nurses are facilitators of change, 2) fathers are worthy of change, 3) a child has two parents and 4) effective cooperation. The barriers included: 5) money talks and 6) nurses under pressure. These findings provide insight into factors that moderated the implementation fidelity of the father visits at CHCs with some of the highest levels of father attendance. This provides a model of good practice that can be applied to other settings to maximise fidelity, as well as increase attendance at father visits. Findings also provide insight into the relationship between potential moderators and implementation fidelity. • Front line managers yield discretionary power to promote or inhibit a new workplace policy • A new clinical visit for non-birthing parents, e.g. fathers, is offered when the infant is three-to-five months old • 62% of all fathers visits at the child health centers were conducted in 19 out of 134 clinics • Nurse-managers at these top attending clinics qualitatively discussed how they got fathers to attend and participate • Nurse-managers discussed structural and personal barriers to implementing the new father visits [ABSTRACT FROM AUTHOR]

To explore and describe fathers' experiences of a newly implemented Swedish home-based postnatal care model. A descriptive cross-sectional qualitative study was conducted as a part of a larger study. Families who qualified to be discharged early were offered to participate in a postnatal home-based model of midwifery care by a hospital in Stockholm, Sweden. In total, 16 fathers participated in a semi-structured telephone interview, averaging 43 min. Data were analyzed using systematic text condensation. Three major themes emerged: To decide on home- or hospital-based postnatal care – a matter of safety, To be offered professional midwifery postnatal support at home, and To be at home helped fathers to navigate parenthood. Fathers appreciated the home-based postnatal care and felt safe because of the received professional support from midwives. Home-based postnatal care was valued by fathers whose partner had a non-complicated vaginal birth because they felt safe in their home environment and supported by midwives. The home environment aided fathers in supporting their partners and developing a father-infant bond. Home-based postnatal care was valued by fathers and should be considered an option for new families. To offer home-based postnatal care may result in less overcrowded postnatal wards. Midwives need to enable fathers' participation and support their parental role regardless of where the care takes place. [ABSTRACT FROM AUTHOR]