Exploring adolescents' perspectives on and experiences with post-primary school-based suicide prevention: a meta-ethnography protocol

Bring dying at home: What facilitates and hinders home-based end-of-life care for people living with dementia?-A systematic review and meta-ethnography protocol

BACKGROUND

Although home-based end-of-life care is more in line with the preferences of people living with dementia, operationalizing this ideal remains challenging. Many people living with dementia are still unable to die at home or receive end-of-life care at home. This review aims to apply meta-ethnography to synthesize existing qualitative studies, to identify the facilitators and barriers of home-based end-of-life care for people living with dementia.

METHODS

This review will use the meta-ethnography method to systematically synthesize and analyze qualitative studies. The seven stages described by Noblit and Hare (1988) will serve as the framework for this review. The systematic literature search will comprehensively cover the following databases: PubMed, MEDLINE, EMBASE, Cochrane Library, PsycINFO, CINAHL, and Web of Science. Inclusion criteria are: (A) qualitative research design; (B) participants are people living with dementia, family caregivers, or healthcare providers; (C) discussion of barriers and facilitators affecting home end-of-life care for people living with dementia; (D) original peer-reviewed studies in English. The included studies will be quality assessed using the CASP quality assessment form. The entire research process will refer to the meta-ethnography reporting guidelines (eMERGe) and the PRISMA statement to ensure the scientific and systematic nature of the results.

DISCUSSION

This review will synthesize and analyze the results of different qualitative studies, transforming different perspectives through an iterative process of comparison, translation, and synthesis to generate new insights, and will form a comprehensive and insightful interpretive framework. This will promote a more comprehensive and in-depth understanding of the facilitators and barriers to the implementation of home-based end-of-life care for people living with dementia. In addition, the results of this review will guide the development and improvement of home-based end-of-life care interventions for people living with dementia, and guide policymakers and practitioners to optimize relevant policies and services.

Recent anti-infective exposure as a risk factor for first episode of suicidal thoughts and/or behaviors in pediatric patients

Objectives

We conducted a retrospective cohort study of medical records from a large, Maryland, U.S.-based cohort of pediatric primary care patients for potential associations between antibacterial, antifungal and antiviral prescriptions and subsequent suicidal thoughts and/or behaviors.

Methods

Using first suicide-related diagnosis as the outcome and prior prescription of antibacterial, antifungal, and/or antiviral use as the exposure, we employed a series of multivariate Cox proportional hazards models. These models examined the hazard of developing newly recognized suicidal thoughts and/or behaviors, controlling for age, sex, race, insurance, number of encounters during the study period, prior mood disorder diagnosis and number of chronic health conditions. We constructed the same series of models stratified by the groups with and without a prior recorded mental or behavioral health diagnosis (MBHD).

Results

Suicidal thoughts and/or behaviors were associated with the previous prescription of an antibacterial, antifungal and/or antiviral medication (HR 1.31, 95 %-CI 1.05-1.64) as well as the total number of such medications prescribed (HR 1.04, 95 %-CI 1.01-1.08), with the strongest relationship among patients with three or more medications (HR 1.44, 95 %-CI 1.06-1.96). Among individual medications, the strongest association was with antibacterial medication (HR 1.28, 95 %-CI 1.03-1.60). Correlations were strongest among the subgroup of patients with no previous (MBHD).

Interpretation

Infections treated with antimicrobial medications were associated with increased risks of a suicide-related diagnosis among patients who had not had a previous mental or behavioral health diagnosis. This group should be considered for increased levels of vigilance as well as interventions directed at suicide screening and prevention.

Funding

National Institutes of Health, Stanley Medical Research Institute.