Parents bereaved by offspring suicide: a population-based longitudinal case-control study

CONTEXT Suicide bereavement remains understudied and poorly understood. OBJECTIVES To examine outcomes of parents bereaved by the suicide death of their offspring and to compare these with both nonbereaved parent controls and parents who had offspring die in a motor vehicle crash (MVC). DESIGN Population-based case-control study. Suicide-bereaved parents were compared with nonbereaved matched control parents in the general population (n = 1415) and with MVC-bereaved parents (n = 1132) on the rates of physician-diagnosed mental and physical disorders, social factors, and treatment use in the 2 years after death of the offspring. Adjusted relative rates (ARRs) were generated by generalized estimating equation models and adjusted for confounding factors. SETTING Manitoba, Canada. PARTICIPANTS All identifiable parents who had an offspring die by suicide between 1996 and 2007 (n = 1415). MAIN OUTCOME MEASURES Mental and physical disorders, social factors, and treatment use. RESULTS Suicide bereavement was associated with an increased rate of depression (ARR, 2.14; 95% CI, 1.88-2.43), anxiety disorders (ARR, 1.41; 95% CI, 1.24-1.60), and marital breakup (ARR, 1.18; 95% CI, 1.13-1.23) in the 2 years after the suicide of an offspring, as compared with the 2 years prior to the death. Suicide-bereaved and MVC-bereaved parents had very few differences on predeath to postdeath outcomes. Depression rate increases were greater for MVC-bereaved parents (19.9%) compared with suicide-bereaved parents (15.9%; P = .005), whereas suicide-bereaved parents had higher rate increases of hospitalization for mental illness (P = .049). Suicide-bereaved parents were more likely than their MVC-bereaved counterparts to have depression (ARR, 1.30; 95% CI, 1.06-1.61), physical disorders (ARR, 1.32; 95% CI, 1.19-1.45), and low income (ARR, 1.34; 95% CI, 1.18-1.51) before their offspring's death. CONCLUSIONS Suicide bereavement is associated with adverse mental health and social outcomes. These consequences appear similar to those associated with MVC bereavement. Parents who lose offspring to suicide appear to be a vulnerable group even prior to their offspring's death.

Predictors of persistent nicotine dependence among adults in the United States

BACKGROUND

Evidence suggests that nicotine dependence is the key barrier to successful smoking cessation. No previous study has documented predictors of persistent nicotine dependence among adults in the community. The goal of this study is to prospectively identify predictors of continued nicotine dependence over a 3-year period among adults.

METHODS

Data were drawn from Waves I and II of the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC), a nationally representative sample of 34,653 adults in the United States. Logistic regression analyses were used to estimate the odds of persistent nicotine dependence at Wave 2 given the presence of various sociodemographic and psychiatric predictors at Wave 1.

RESULTS

Mood, anxiety, personality and illicit substance use disorders were associated with significantly increased risk of persistent nicotine dependence. The strength of these relationships was attenuated slightly after adjusting for demographic differences, but remained statistically significant. Persistent nicotine dependence was more common among unmarried, younger females with lower income levels and lower educational attainment.

CONCLUSIONS

To our knowledge, this study is the first to prospectively identify predictors of persistent nicotine dependence among adults. Our results suggest that the incorporation of mental health treatment into alternative smoking cessation approaches may help to increase the effectiveness of these programs and that a greater focus of these services on vulnerable segments of the population is needed in order to reduce continued disparities in smoking in the general population.

Predicting suicide attempts with the SAD PERSONS scale: a longitudinal analysis

OBJECTIVE

The SAD PERSONS scale is a widely used risk assessment tool for suicidal behavior despite a paucity of supporting data. The objective of this study was to examine the ability of the scale in predicting suicide attempts.

METHOD

Participants consisted of consecutive referrals (N=4,019) over 2 years (January 1, 2009 to December 31, 2010) to psychiatric services in the emergency departments of the 2 largest tertiary care hospitals in the province of Manitoba, Canada. SAD PERSONS and Modified SAD PERSONS (MSPS) scale scores were recorded for individuals at their index and all subsequent presentations. The 2 main outcome measures in the study included current suicide attempts (at index presentation) and future suicide attempts (within the next 6 months). The ability of the scales to predict suicide attempts was evaluated with logistic regression, sensitivity and specificity analyses, and receiver operating characteristic curves.

RESULTS

566 people presented with suicide attempts (14.1% of the sample). Both SAD PERSONS and MSPS showed poor predictive ability for future suicide attempts. Compared to low risk scores, high risk baseline scores had low sensitivity (19.6% and 40.0%, respectively) and low positive predictive value (5.3% and 7.4%, respectively). SAD PERSONS did not predict suicide attempts better than chance (area under the curve =0.572; 95% confidence interval [CI], 0.51-0.64; P value nonsignificant). Stepwise regression identified 5 original scale items that accounted for the greatest proportion of future suicide attempt variance. High risk scores using this model had high sensitivity (93.5%) and were associated with a 5-fold higher likelihood of future suicide attempt presentation (odds ratio =5.58; 95% CI, 2.24-13.86; P<.001).

CONCLUSION

In their current form, SAD PERSONS and MSPS do not accurately predict future suicide attempts.

Psychotropic Medication Use Before and During COVID-19: A Population-Wide Study

Background: The coronavirus disease 2019 (COVID-19) pandemic and public health measures that took place have led to concerns regarding mental health and receipt of psychotropic medications. We aimed to study the changes in psychotropic medication dispensation rates before and during the COVID-19 pandemic in the general population.

Methods: Administrative health data from the Canadian province of Manitoba was used to describe the quarterly incidence and prevalence of antipsychotics, antidepressants, and anxiolytic/sedative-hypnotics from January 1, 2015 to December 31, 2020. Individuals who received at least one prescription within each quarter were considered exposed to the medication. The denominator was the total population within each quarter. Incidence was defined as no receipt of medication in the 3 years prior to the quarter of interest. Autoregression models for time series data plus indicator variables were used to compare each quarter of 2020 after public health measures were implemented in March 2020 in relation to the expected trend. Analyses were stratified by age and sex.

Results: There were 1,394,885 individuals in the first quarter of 2020, with a mean (SD) age of 38.9 (23.4) years, 50.3% were female, and 36.1% had a psychiatric diagnosis in the previous 5 years. A significant decrease was observed for incident antidepressant use (p < 0.05 for both sexes and all age groups except for those 65 years and older) and anxiolytic use (p < 0.05 for both sexes and all age groups except 80 years and older) in the second quarter (April-June) of 2020 compared to the expected trend. Females and those aged 40 years and older had a significantly higher incidence of antidepressant and antipsychotic use in the final quarter of 2020 compared to the expected trend (p < 0.05).

Conclusion: Our findings indicate a decrease in new prescriptions for antidepressants and anxiolytics in the 3 months after COVID-19 in-person restrictions were first implemented. We then observed an increase in the new use of antidepressants and antipsychotics at the end of 2020, in females and people aged 40 years and older, with the highest rates of use in the population 80 years and older.

Carnitine for fatigue in multiple sclerosis

BACKGROUND

Fatigue is reported to occur in up to 92% of patients with multiple sclerosis (MS) and has been described as the most debilitating of all MS symptoms by 28% to 40% of MS patients.

OBJECTIVES

To assess whether carnitine (enteral or intravenous) supplementation can improve the quality of life and reduce the symptoms of fatigue in patients with MS-related fatigue and to identify any adverse effects of carnitine when used for this purpose.

SEARCH METHODS

A literature search was performed using Cochrane MS Group Trials Register (09 September 2011), Cochrane Central Register of Controlled Trials (CENTRAL) "The Cochrane Library 2011, issue 3", MEDLINE (PubMed) (1966-09 September 2011), EMBASE (1974-09 September 2011), and www.clinicaltrials.gov for ongoing trials retrieval. Reference lists of review articles and primary studies were also screened. A hand search of the abstract book of recent relevant conference symposia was also conducted. Personal contact with MS experts and a manufacturer (Source Naturals, United States) of carnitine formulation was contacted to determine if they knew of other clinical trials. No language restrictions were applied.

SELECTION CRITERIA

Full reports of published and unpublished randomized controlled trials and quasi-randomized trials of any carnitine intervention in adults affected by multiple sclerosis with a clinical diagnosis of fatigue associated with multiple sclerosis were included.

DATA COLLECTION AND ANALYSIS

Data from the eligible trials was extracted and coded using a standardized data extraction form and entered into RevMan 5. Discrepancies were to be resolved by discussion with a third reviewer, however this was not necessary.The quality items to be assessed were method of randomization, allocation concealment, blinding (participants, investigators, outcome assessors and data analysis), intention-to-treat analysis and completeness of follow up.

MAIN RESULTS

The search identified one ongoing randomized, placebo-controlled, cross-over trial (expected completion 2013) and one completed randomized, active-comparator, cross-over trial. In the completed study, adult patients with relapsing-remitting and secondary progressive MS were exposed to both acetyl L-carnitine 2 grams daily and amantadine 200 mg daily The effects of carnitine on fatigue are unclear. There was no difference between carnitine and amantadine for the number of patients withdrawing from the study due to an adverse event (relative risk ratio 0.20; 95% confidence interval 0.03 to 1.55) and no patients experienced a serious adverse event in either treatment group. Mortality and quality of life were not reported.

AUTHORS' CONCLUSIONS

There is insufficient evidence that carnitine for the treatment of MS-related fatigue offers a therapeutic advantage over placebo or active comparators. Results of the ongoing trial are eagerly anticipated in order to provide clarity.

The SAD PERSONS scale for suicide risk assessment: a systematic review

The SAD PERSONS scale (SPS) is widely used for suicide risk assessment in clinical and educational settings. The study objective was to systematically review the SPS performance in clinical situations. A systematic search of electronic databases was conducted. Relevant descriptive, quality, and outcome data were reviewed. In the search, 149 studies were identified and 9 met inclusion criteria. Included studies were highly variable across outcome measures, populations, and assessment methods. Only 3 studies examined SPS performance in predicting suicide outcomes; none showed the scale accurately predicted suicidal behavior. Available literature is of limited quality and quantity. Insufficient evidence exists to support SPS use in assessment or prediction of suicidal behavior. Well-designed studies that address the observed limitations are required.

The relationship between physical intimate partner violence and sexually transmitted infection among women in India and the United States

To investigate the association between physical intimate partner violence (IPV) and sexually transmitted infection (STI) in two national samples. Data came from the National Epidemiologic Survey on Alcohol and Related Conditions Wave 2 (n=34,653) and the National Family Health Survey-3 (n=124 385). Ever-married women between the ages of 20 and 49 were asked if they had experienced physical violence by their partner in the past year. Outcomes were presence of doctor confirmed HIV and self-reported STI. Age at first intercourse was examined as a mediator of the relationship between IPV and STI. Logistic regression examined associations between IPV, age at first intercourse and STI. Compared to individuals with no physical IPV, risk for STI was higher for individuals who experienced past year IPV living in the United States and India, however once controlling for age at first intercourse, age, education, household wealth/income and past year sexual violence, the relationship between IPV, and STI was significant in the American sample [(AOR)=1.65, 95% (CI)=1.21-2.26], however not for individuals living in India [(AOR)=1.75, 95% (CI)=0.84-3.65]. Individuals with exposure to physical IPV are at increased odds for STI. Age at first intercourse although a marker of risk, may not be an accurate marker of risky sexual behavior in both samples.

The impact of eHealth group interventions on the mental, behavioral, and physical health of adults: a systematic review protocol

BACKGROUND

COVID-19 has resulted in an increased demand for eHealth services globally. There is emerging evidence for the efficacy for group eHealth interventions that support population-based mental health and wellbeing, but a systematic review is lacking. The primary objective of this systematic review is to summarize the evidence for eHealth group counseling and coaching programs for adults. A second objective is to assess, within studies selected for our primary objective, the impact of programs that encourage PA on outcomes compared to those that do not.

METHODS

Randomized controlled trials that assess the impact of eHealth group counseling or coaching programs on mental health, health behavior, or physical health activity among community-dwelling adults will be included. We will search the following electronic databases (from January 2005 onwards): MEDLINE, PsycINFO, CINHAL, and the Central Register of Controlled Trials. The primary outcomes will be changes in mental health conditions (e.g., depression, anxiety, stress, quality of life), behavioral health conditions (e.g., substance use, smoking, sexual behavior, eating behavior, medication adherence), and physical health conditions (e.g., coping with cancer, menopausal symptoms, arthritis pain). Secondary outcomes will be changes in physical activity. Two reviewers will independently screen all citations, full-text articles, and abstract data. Potential conflicts will be resolved through discussion with a third reviewer. A narrative synthesis without meta-analysis will be conducted. The strength of the body of evidence will be assessed using GRADE. The risk of bias in individual studies will be appraised using the Cochrane Risk of Bias 2.0 tool. Potential sources of gender bias in included studies will be considered at all stages of the planned review.

DISCUSSION

This review will contribute to the literature by providing evidence on the effectiveness of eHealth counseling and coaching programs delivered to adults in a group format.

SYSTEMATIC REVIEW REGISTRATION

The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO: CRD42020187551 ).

Carnitine for fatigue in multiple sclerosis

BACKGROUND

Fatigue is reported to occur in up to 92% of patients with multiple sclerosis (MS) and has been described as the most debilitating of all MS symptoms by 28% to 40% of MS patients.

OBJECTIVES

To assess whether carnitine (enteral or intravenous) supplementation can improve the quality of life and reduce the symptoms of fatigue in patients with MS-related fatigue and to identify any adverse effects of carnitine when used for this purpose.

SEARCH STRATEGY

A literature search was performed using Cochrane MS Group Trials Register (21 May 2009), Cochrane Central Register of Controlled Trials (CENTRAL) "The Cochrane Library 2009, issue 2, MEDLINE (PubMed) (1966-21 May 2009), EMBASE (1974-21 May 2009). Reference lists of review articles and primary studies were also screened. A hand search of the abstract book of recent relevant conference symposia was also conducted. Personal contact with MS experts and a manufacturer (Source Naturals, United States) of carnitine formulation was contacted to determine if they knew of other clinical trials. No language restrictions were applied.

SELECTION CRITERIA

Full reports of published and unpublished randomized controlled trials and quasi-randomized trials of any carnitine intervention in adults with a clinical diagnosis of fatigue associated with multiple sclerosis were included.

DATA COLLECTION AND ANALYSIS

Data from the eligible trials was extracted and coded using a standardized data extraction form and entered into RevMan 5. Discrepancies were to be resolved by discussion with a third reviewer however this was not necessary. The quality items to be assessed were method of randomization, allocation concealment, blinding (participants, investigators, outcome assessors and data analysis), intention-to-treat analysis and completeness of follow up.

MAIN RESULTS

The search identified one randomized cross-over trial. In this study patients were exposed to both acetyl L-carnitine (ALCAR(tm)) 2 grams daily and amantadine 200 mg daily in adult patients with relapsing-remitting and secondary progressive MS. The effects of carnitine on fatigue are not clear based on the one included crossover RCT. There was no difference between carnitine and amantadine for the number of patients withdrawing from the study due to an adverse event (relative risk ratio 0.20; 95% confidence interval 0.03 to 1.55. Mortality, serious adverse events, total adverse events, and quality of life were not reported.

AUTHORS' CONCLUSIONS

There is insufficient evidence that carnitine for the treatment of MS-related fatigue offers a therapeutic advantage over placebo or active comparators.

Medical students' and postgraduate residents' observations of professionalism

BACKGROUND

There is increasing interest in teaching professionalism to medical learners. The purpose of this study was to explore professionalism observed among medical learners and faculty in a Canadian academic institution.

METHODS

A total of 253 medical learners (30% response rate) completed an online survey measuring medical professionalism. The survey used a validated professionalism scale "Climate of Professionalism", which queries subjects' observations of professional and unprofessional behavior in clinical teaching environments.

RESULTS

Overall, 73.3% of medical learners felt prepared in the area of medical professionalism. Differences existed in observed professionalism by level of training. By respondents' reports, both medical students and residents viewed their peer groups as more professional than the other. Both groups also rated faculty as the poorest in terms of observed professional behaviors but the best in observed unprofessional behavior.

DISCUSSION

Most learners in this Canadian medical school felt well prepared in the area of professionalism, and each training level viewed their peer group as the most professional. Peer groups may rate themselves more favorably due to increased interaction with their group, and active recall of professional communications. This study found differences in observations of professionalism by training level, therefore provides support for specialized professionalism education tailored to the learners level of medical training.

Childhood exposure to caregiver suicidal behavior and risk for adult suicide attempts: findings from a national survey

The objective of this study was to investigate the association between exposure to caregiver suicidality and subsequent adult suicide attempt (SA). Data came from the National Epidemiologic Survey on Alcohol and Related Conditions Wave 2 (n = 34,653). Respondents were asked if they had a caregiver attempt or complete suicide during childhood. Logistic regression examined associations between SA and caregiver suicidality. Compared to individuals with no suicidality, risk for lifetime SA was higher for individuals that were exposed to a SA (15.6%, [OR] = 5.86, 95% [CI] = 4.57-7.51) and for those who experienced a death by suicide (6.1%, [OR] = 2.08, CI = 1.32-3.26]. Associations remained significant after controlling for demographics, Axis I and II disorders and childhood adversity. Individuals with exposure to suicidality are at increased odds for SA.

Effectiveness of live health professional-led group eHealth interventions for adult mental health: A systematic review of randomized controlled trials

Background

The COVID-19 pandemic has had adverse impacts on mental health and substance use worldwide. Systematic reviews suggest eHealth interventions can be effective at addressing these problems. However, strong positive eHealth outcomes are often tied to the intensity of web-based therapist guidance, which has time and cost implications that can make the population scale-up of more effective interventions difficult. A way to offset cost while maintaining the intensity of therapist guidance is to offer eHealth programs to groups rather than more standard one-on-one formats.

Objective

This systematic review aims to assess experimental evidence for the effectiveness of live health professional–led group eHealth interventions on mental health, substance use, or bereavement among community-dwelling adults. Within the articles selected for our primary aim, we also seek to examine the impact of interventions that encourage physical activity compared with those that do not.

Methods

Overall, 4 databases (MEDLINE, CINAHL, PsycINFO, and the Cochrane Library) were searched in July 2020. Eligible studies were randomized controlled trials (RCTs) of eHealth interventions led by health professionals and delivered entirely to adult groups by videoconference, teleconference, or webchat. Eligible studies reported mental health, substance use, or bereavement as primary outcomes. The results were examined by outcome, eHealth platform, and intervention length. Postintervention data were used to calculate effect size by study. The findings were summarized using the Synthesis Without Meta-Analysis guidelines. Risk of bias was assessed using the Cochrane Collaboration Tool.

Results

Of the 4099 identified studies, 21 (0.51%) RCTs representing 20 interventions met the inclusion criteria. These studies examined mental health outcomes among 2438 participants (sample size range: 47-361 participants per study) across 7 countries. When effect sizes were pooled, live health professional–led group eHealth interventions had a medium effect on reducing anxiety compared with inactive (Cohen d=0.57) or active control (Cohen d=0.48), a medium to small effect on reducing depression compared with inactive (Cohen d=0.61) or active control (Cohen d=0.21), and mixed effects on mental distress and coping. Interventions led by videoconference, and those that provided 8-12 hours of live health professional–led group contact had more robust effects on adult mental health. Risk of bias was high in 91% (19/21) of the studies. Heterogeneity across interventions was significant, resulting in low to very low quality of evidence. No eligible RCT was found that examined substance use, bereavement, or physical activity.

Conclusions

Live eHealth group interventions led by health professionals can foster moderate improvements in anxiety and moderate to small improvements in depression among community-based adults, particularly those delivered by videoconference and those providing 8-12 hours of synchronous engagement.

Trial Registration

PROSPERO CRD42020187551; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=187551

International Registered Report Identifier (IRRID)

RR2-10.1186/s13643-020-01479-3

Narrative discourse of burn injury and recovery on peer support websites: A qualitative analysis

Although advances have been made in burn care and recovery, less is known about the experience of living with severe burn injury. Like other patient groups, burn survivors are now turning to social media and shared web-based peer support resources during recovery and continuing long after discharge. Ongoing peer support is often part of the reclamation process after-burn injury. Peer support and event sharing helps foster hope, motivation and reassurance.

OBJECTIVES

To: 1) Examine and further understand the narrative discourse of burn survivorship in peer support social media content, 2) establish commonalities in the sharing community and key themes related to recovery and adaptation.

METHODS

This qualitative enquiry began with a comprehensive overview of burn narratives on survivor peer generated websites. We conducted a purposeful sampling of 21 biographies posted on burn survivor peer and patient support websites. Participants with greater than 30% burn injury were included that provided narrative and discourse regarding burn recovery and survivorship. Underlying story arcs, meaning behind sentences and shared language of the experience were investigated using thematic analysis.

RESULTS

Four themes were identified: retelling of the traumatic event; social support; body image, the new normal; and rebirth and transformation. Accounts reflected the traumatic nature of the event with slowed downtime, attention to details and heightened recall. The value of peer and family support was a common theme. There was attention to the challenges related to changed body image and regaining confidence in body appearance. Most stories also documented transitioning and rebirth and other more positive aspects of trauma recovery.

CONCLUSIONS

Accounting the burn experience and recovery is part of the reclamation process. Biographies document the trauma recovery process. Storying the event is an integral component of burn survivor community content. These online communities have become a mainstream resource and part of the reclamation process.

Spouses bereaved by suicide: A population-based longitudinal cohort comparison of physician-diagnosed mental disorders and hospitalized suicide attempts

BACKGROUND

This study compares a longitudinal population-based sample of spouses bereaved by suicide and those bereaved by other sudden deaths to determine if suicide-bereaved spouses (SBS) experience greater rates of physician-diagnosed mental disorders.

METHODS

First, married individuals whose spouse died by suicide, sudden natural death (SND) and unintentional injury (UI) were compared to non-bereaved matched cohorts to determine if there were differences in mental disorder rates between bereavement groups and non-bereaved matches. Second, SBS (n = 365), spouses bereaved by SND (n = 1000), and spouses bereaved by UI (n = 270), were compared using inverse probability treatment weighting and generalized estimating equations to calculate relative rates of mental disorders 5 years before/after death.

OUTCOMES

All bereaved cohorts had higher rates of mental disorders compared to non-bereaved cohorts. SBS had the greatest rate of depression post-bereavement (50·96%), followed by UI (38·52%) and SND (33·70%) spouses. When comparing bereavement cohorts, a significant group-by-time interaction (P = 0·047) revealed the rate change for depression was significantly different between suicide and UI-bereaved spouses, with SBS having higher rates of depression before bereavement. SBS had increased rates of any mental disorder both pre (ARR = 1·35, 95% CI = 1·03-1·18, P<·05) and post spousal death (ARR = 1·24, 95% CI = 1·03-1·45, P<·05) when compared to UI spouses signifying pre-existing mental disorders. Post-bereavement, SBS had greater rates of depression only when compared to SND-bereaved spouses (ARR = 1·31, 95% CI = 1·10-1·55, P<·01).

INTERPRETATION

SBS have the greatest rates of depression and any mental disorder before the death of their spouse, suggesting suicide bereavement may be unique. Sudden spousal bereavement is a vulnerable time for mental disorders.

Suicide policy in Canada: lessons from history

In Canada, suicide has transitioned from being a criminal activity with much associated stigma, to being a public health concern that needs to be managed by governments and clinicians in a culturally sensitive manner. In Canada and worldwide, the social attitudes toward and legal interpretation of suicide have been dynamic. Much has been proposed in the development of suicide policy in Canada, however Canada is unique in that it remains one of the only industrialized countries without a national suicide prevention strategy. The current article provides a critical review of the history of suicide in Canada, as well as an appraisal of Canadian suicide prevention policies and key government and political milestones that have impacted suicide policy. Current activity regarding a national suicide prevention strategy in Canada is discussed, as well as potential options for clinician involvement.

Complicated grief in Aboriginal populations

To date there have been no studies examining complicated grief (CG) in Aboriginal populations. Although this research gap exists, it can be hypothesized that Aboriginal populations may be at increased risk for CG, given a variety of factors, including increased rates of all-cause mortality and death by suicide. Aboriginal people also have a past history of multiple stressors resulting from the effects of colonization and forced assimilation, a significant example being residential school placement. This loss of culture and high rates of traumatic events may place Aboriginal individuals at increased risk for suicide, as well as CG resulting from traumatic loss and suicide bereavement. Studies are needed to examine CG in Aboriginal populations. These studies must include cooperation with Aboriginal communities to help identify risk factors for CG, understand the role of culture among these communities, and identify interventions to reduce poor health outcomes such as suicidal behavior.

Examining perception and actual knowledge change among learners in a standardized burn course

Background

Essential Burn Management (EBM) is a burn training program created for East Africa and aims to meet the needs of low- and middle-income countries. The authors present a report on objective testing of change in knowledge, with pre and post tests, and comparison of this testing with the self perception of knowledge gained to explore course utility.

Objective

To evaluate the ability of EBM to improve knowledge in burn care among course participants; and to explore whether participants' self-perception of knowledge gained is comparable with their actual change in knowledge.

Methods

Twenty health care providers from a variety of disciplines participated in EBM and completed the pre and post course burn care knowledge test. Participants also self-rated knowledge in burn care both pre and post course. All tests and self-rated assessments were anonymous and consent was obtained. Paired t tests were conducted on pre and post test scores. Improvements in pre-post scores according to module or topic area were examined to determine the proportion correct, and then analyzed using Wilcoxon signed-rank tests. Module scores pre-post course were compared with individuals' self-rating of knowledge both before and after the course for that particular module.

Results

Pre-post course tests reflected an increase in knowledge. An increase in self-rated knowledge was matched with a significant increase in module test scores for primary survey, burn resuscitation, wound management, infection control and electrical injury, but not inhalation injury and compartment syndrome modules.

Conclusion

Findings support a combination of self-report and objective pre-post testing to evaluate courses designed to teach burn management.

Techniques to Assess Long-Term Outcomes after Burn Injuries

Burn injuries have a tremendous impact on not only the physical health of the burn survivor, but also mental health and social outcomes of the individual and their support systems. While much effect occurs at the point of injury, post-injury pain, infection, scarring, inflammatory response and metabolic changes all impact the long-term health of the burn survivor. The goal of the following article is to explore how to examine long term outcomes associated with burn injury, including mental disorders, suicide, loss of work and quality of life in the context of risk factors for burn injury, including social determinants of health. We then discuss ways to examine post-burn outcomes, including the important role of administrative data, the advantages of mixed methodology research studies including qualitative research, and the importance of considering sex, gender and vulnerable populations, not only in study design, but in prevention and intervention programs.

Examining perception and actual knowledge change among learners in a standardized burn course

BACKGROUND

Essential Burn Management (EBM) is a burn training program created for East Africa and aims to meet the needs of low- and middle-income countries. The authors present a report on objective testing of change in knowledge, with pre and post tests, and comparison of this testing with the self perception of knowledge gained to explore course utility.

OBJECTIVE

To evaluate the ability of EBM to improve knowledge in burn care among course participants; and to explore whether participants' self-perception of knowledge gained is comparable with their actual change in knowledge.

METHODS

Twenty health care providers from a variety of disciplines participated in EBM and completed the pre and post course burn care knowledge test. Participants also self-rated knowledge in burn care both pre and post course. All tests and self-rated assessments were anonymous and consent was obtained. Paired t tests were conducted on pre and post test scores. Improvements in pre-post scores according to module or topic area were examined to determine the proportion correct, and then analyzed using Wilcoxon signed-rank tests. Module scores pre-post course were compared with individuals' self-rating of knowledge both before and after the course for that particular module.

RESULTS

Pre-post course tests reflected an increase in knowledge. An increase in self-rated knowledge was matched with a significant increase in module test scores for primary survey, burn resuscitation, wound management, infection control and electrical injury, but not inhalation injury and compartment syndrome modules.

CONCLUSION

Findings support a combination of self-report and objective pre-post testing to evaluate courses designed to teach burn management.

Identifying people with post-COVID condition using linked, population-based administrative health data from Manitoba, Canada: prevalence and predictors in a cohort of COVID-positive individuals

OBJECTIVE

Many individuals exposed to SARS-CoV-2 experience long-term symptoms as part of a syndrome called post-COVID condition (PCC). Research on PCC is still emerging but is urgently needed to support diagnosis, clinical treatment guidelines and health system resource allocation. In this study, we developed a method to identify PCC cases using administrative health data and report PCC prevalence and predictive factors in Manitoba, Canada.

DESIGN

Cohort study.

SETTING

Manitoba, Canada.

PARTICIPANTS

All Manitobans who tested positive for SARS-CoV-2 during population-wide PCR testing from March 2020 to December 2021 (n=66 365) and were subsequently deemed to have PCC based on International Classification of Disease-9/10 diagnostic codes and prescription drug codes (n=11 316). Additional PCC cases were identified using predictive modelling to assess patterns of health service use, including physician visits, emergency department visits and hospitalisation for any reason (n=4155).

OUTCOMES

We measured PCC prevalence as % PCC cases among Manitobans with positive tests and identified predictive factors associated with PCC by calculating odds ratios with 95% confidence intervals, adjusted for sociodemographic and clinical characteristics (aOR).

RESULTS

Among 66 365 Manitobans with positive tests, we identified 15 471 (23%) as having PCC. Being female (aOR 1.64, 95% CI 1.58 to 1.71), being age 60-79 (aOR 1.33, 95% CI 1.25 to 1.41) or age 80+ (aOR 1.62, 95% CI 1.46 to 1.80), being hospitalised within 14 days of COVID-19 infection (aOR 1.95, 95% CI 1.80 to 2.10) and having a Charlson Comorbidity Index of 1+ (aOR 1.95, 95% CI 1.78 to 2.14) were predictive of PCC. Receiving 1+ doses of the COVID-19 vaccine (one dose, aOR 0.80, 95% CI 0.74 to 0.86; two doses, aOR 0.29, 95% CI 0.22 to 0.31) decreased the odds of PCC.

CONCLUSIONS

This data-driven approach expands our understanding of the prevalence and epidemiology of PCC and may be applied in other jurisdictions with population-based data. The study provides additional insights into risk and protective factors for PCC to inform health system planning and service delivery.

Mental and physical health disorders following paediatric traumatic injury: a population-based longitudinal study in Manitoba, Canada

IMPORTANCE

Paediatric traumatic injury (PTI) is a leading cause of hospitalisation among children. Little is known about subsequent mental and physical health disorders while accounting for pre-injury health.

OBJECTIVE

To compare pre-injury and post-injury mental and physical disorders in survivors of PTI with an uninjured matched cohort from the general population. This study hypothesised injured youth will have increased rates of mental and physical disorders relative to matched uninjured youth in the post-injury period.

DESIGN

Retrospective longitudinal cohort study using linked administrative health data to examine paediatric patients hospitalised for injury between 1 January 2004 and 31 December 2016, measured 2 years pre-injury and 2 years post-injury.

SETTING

Population-based study in Manitoba, Canada.

PARTICIPANTS

Youth<18 years old who survived to discharge after an injury requiring hospitalisation in the study period (n=9551) were matched 1:5 (age, sex and region) to youth from the general uninjured population (n=47 755).

EXPOSURES

PTI that required hospitalisation.

MAIN OUTCOMES AND MEASURES

Mental disorders (anxiety, depression and substance use) and physical disorders (arthritis, cancer, diabetes, gastrointestinal, hypertension and total respiratory morbidity) were measured at physician visits and hospitalisations 2 years pre-injury and post-injury. Generalised estimating equations were used to estimate adjusted rate ratios (ARR).

RESULTS

This study examined 9551 in the injured cohort and 47 755 matches in the uninjured cohort. Injured individuals had increased ARRs for all mental disorders (p<0.0006) pre-injury (anxiety=1.30 (95% CI, 1.16 to 1.47); depression=2.00 (95% CI, 1.73 to 2.32); substance use=4.99 (95% CI, 3.08 to 5.20); any mental disorder=1.50 (95% CI, 1.37 to 1.66)) and post-injury (anxiety=1.66 (95% CI, 1.51 to 1.82); depression=2.87 (95% CI, 2.57 to 3.21); substance use=3.25 (95% CI, 2.64 to 3.99); any mental disorder=1.90 (95% CI, 1.76 to 2.04)). For physical disorders, injured individuals had increased ARRs (p<0.0006) pre-injury for arthritis (1.50 (95% CI, 1.39 to 1.60)), cancer (1.97 (95% CI, 1.35 to 2.88)), gastrointestinal (1.12 (95% CI, 1.06 to 1.18)) and any physical disorder (1.14 (95% CI, 1.11 to 1.18)). Post-injury, the injured had higher ARRs (p<0.0006) for arthritis (2.02 (95% CI, 1.91 to 2.15)), cancer (1.97 (95% CI, 1.35 to 2.88)), diabetes (1.76 (95% CI, 1.33 to 2.32)), gastrointestinal (1.19 (95% CI, 1.12 to 1.27)), hypertension (2.36 (95% CI, 1.83 to 3.06)) and any physical disorder (1.33 (95% CI, 1.29 to 1.37)). Comparing the pre-injury and post-injury periods, ARRs for injured showed a difference over time for all mental disorders except substance use and all physical disorders except gastrointestinal and total respiratory morbidity compared with matched uninjured. Greater injury severity was associated with two times greater ARR for developing any mental health disorder, and the injured had three times the ARR for dying by suicide (p<0.0006).

CONCLUSIONS AND RELEVANCE

Child survivors of traumatic injury had increased relative rates of mental and physical disorders compared with a matched uninjured cohort. These findings support targeted intervention strategies for this population at the time of hospitalisation.

Investigating social determinants of child health and their implications in reducing pediatric traumatic injury: A framework and 17-year retrospective case-control study protocol

INTRODUCTION

Traumatic physical injuries are the number one cause of hospitalization and death among children in Canada. The majority of these injuries are preventable. The burden from injury can be reduced through prevention programs tailored to at-risk groups, however, existing research does not provide a strong explanation of how social factors influence a child's risk of injury. We propose a theoretical framework to better understand social factors and injury in children and will examine the association between these social factors and physical traumatic injury in children using large population-wide data.

METHODS AND ANALYSIS

We will examine data from 11,000 children hospitalized for traumatic physical injury and 55,000 matched uninjured children by linking longitudinal administrative and clinical data contained at the Manitoba Centre for Health Policy. We will examine 14 social determinants of child health measures from our theoretical framework, including receipt of income assistance, rural/urban status, socioeconomic status, children in care, child mental disorder, and parental factors (involvement with criminal justice system, education, social housing, immigration status, high residential mobility, mother's age at first birth, maternal Axis I mental disorder, maternal Axis II mental disorder and maternal physical disorder) to identify groups and periods of time when children are at greatest risk for traumatic physical injury. A conditional multivariable logistic regression model will be calculated (including all social determinant measures) to determine odds ratios and adjusted odds ratios (95% confidence interval) for cases (injured) and controls (non-injured).

ETHICS AND DISSEMINATION

Health Information Privacy Committee (HIPC No. 2017/2018-75) and local ethics approval (H2018-123) were obtained. Once social measures have been identified through statistical modelling, we will determine how they fit into a Haddon matrix to identify appropriate areas for intervention. Knowing these risk factors will guide decision-makers and health policy.