"Safe, connected, supported in a complex system." Exploring the views of women who had a First Nations baby at one of three maternity services offering culturally tailored continuity of midwife care in Victoria, Australia. A qualitative analysis of free-text survey responses

BACKGROUND

In Australia, continuity of midwife care is recommended for First Nations women to address the burden of inequitable perinatal outcomes experienced by First Nations women and newborns.

AIMS

This study aimed to explore the experiences of women having a First Nations baby who received care at one of three maternity services in Naarm (Melbourne), Victoria, where culturally tailored midwife continuity models had been implemented.

METHODS

Women having a First Nations baby who were booked for care at one of three study sites were invited to participate in an evaluation of care. Thematic analysis was used to analyse qualitative data from responses to free-text, open ended questions that were included in a follow-up questionnaire at 3-6 months after the birth.

RESULTS

In total, 213 women (of whom 186 had continuity of midwife care) participated. The global theme for what women liked about their care was 'Safe, connected, supported' including emotional and clinical safety, having a known midwife and being supported 'my way'. The global theme for what women did not like about their care was 'A complex, fragmented and unsupportive system' including not being listened to, things not being explained, and a lack of cultural safety.

CONCLUSIONS

Culturally tailored caseload midwifery models appear to make maternity care feel safer for women having a First Nations baby, however, the mainstream maternity care system remained challenging for some. These models should be implemented for First Nations women, and evidence-based frameworks, such as the RISE framework, should be used to facilitate change.

Continuity and change of genetic and environmental influences on reading and reading-related neurocognitive skills: A systematic review of longitudinal twin studies

Learning to read is a dynamic and cumulative process beginning from birth and continuing through the school years. Empirical data showed a decrease of additive genetic (A) and shared environmental (C) components and an increase of non-shared environmental (E) components from preschool to middle school. However, our understanding of the aetiology of continuity and change of reading skills across this developmental period is limited. Following the PRISMA guidelines, we reviewed the results of behavioral genetic research on reading-related neurocognitive skills of 13 longitudinal twin and adoptive sibling studies spanning from preschool/kindergarten to middle/high school. Our findings suggested that continuity was mainly explained by A components throughout the study periods, and, although to a lesser extent and less consistently, by C components during the early years; change was explained by new E components throughout the years, and also by new A components in the early years. As we are interested in models relevant to traits with early onset during development, it is crucial to deepen the investigation of how developmental time can moderate the genetic and environmental variation.

Damming exacerbates the discontinuities of phytoplankton in a subtropical river in China

Phytoplankton is sensitive to changes in river ecosystems. Increasing dams disrupt the continuity of river ecosystems. However, the spatial impacts of dams on phytoplankton have not been well documented. In this study, using multiple statistical analyses, the relationships between environmental drivers and phytoplankton community structures in natural background reaches, reservoirs, and corresponding post-dam reaches were explored in the Jiulong River with multiple cascaded dams, which encountered eutrophication and algal blooms in the past 15 years. Results illustrated that damming exacerbated longitudinal discontinuities of phytoplankton communities. The relative abundance of phytoplankton varied in three types of river sections. The average phytoplankton abundance in the reservoirs (1.62 × 105 cell·L-1) was higher than those in the natural background reaches (5.15 × 104 cell·L-1) and the corresponding downstream reaches (4.55 × 104 cell·L-1). The total β diversity ranged from 0.38 to 0.89 with an average of 0.64 and dominated by species replacement and least by species richness. The water environmental factors and hydraulic parameters rather than nutrients were more attributable to phytoplankton community variability in three river sections. These findings facilitate the management of rivers with multiple cascade dams by releasing environmental flows, jointly operating cascade hydropower stations, and developing nutrient reduction schemes to mitigate the negative impacts of damming in the river.

Deconvolution based on sparsity and continuity improves the quality of ultrasound image

The application of ultrasound (US) image has been limited by its limited resolution, inherent speckle noise, and the impact of clutter and artifacts, especially in the miniaturized devices with restricted hardware conditions. In order to solve these problems, many researchers have explored a number of hardware modifications as well as algorithmic improvements, but further improvements in resolution, signal-to-noise ratio (SNR) and contrast are still needed. In this paper, a deconvolution algorithm based on sparsity and continuity (DBSC) is proposed to obtain the higher resolution, SNR, and, contrast. The algorithm begins with a relatively bold Wiener filtering for initial enhancement of image resolution in preprocessing, but it also introduces ringing noise and compromises the SNR. In further processing, the noise is suppressed based on the characteristic that the adjacent pixels of the US image are continuous as long as Nyquist sampling criterion is met, and the extraction of high-frequency information is balanced by using relatively sparse. Subsequently, the theory and experiments demonstrate that relative sparsity and continuity are general properties of US images. DBSC is compared with other deconvolution strategies through simulations and experiments, and US imaging under different transmission channels is also investigated. The final results show that the proposed method can greatly improve the resolution, as well as provide significant advantages in terms of contrast and SNR, and is also feasible in applications to devices with limited hardware.

Expanding general practice with interprofessional teams: a mixed-methods patient perspective study

BACKGROUND

Across healthcare systems, current health policies promote interprofessional teamwork. Compared to single-profession general practitioner care, interprofessional primary healthcare teams are expected to possess added capacity to care for an increasingly complex patient population. This study aims to explore patients' experiences when their usual primary healthcare encounter with general practice shifts from single-profession general practitioner care to interprofessional team-based care.

METHODS

Qualitative and quantitative data were collected through interviews and a survey among Norwegian patients. The interviews included ten patients (five women and five men) aged between 28 and 89, and four next of kin (all women). The qualitative analysis was carried out using thematic analysis and a continuity framework. The survey included 287 respondents, comprising 58 per cent female and 42 per cent male participants, aged 18 years and above. The respondents exhibited multiple diagnoses and often a lengthy history of illness. All participants experienced the transition to interprofessional teamwork at their general practitioner surgery as part of a primary healthcare team pilot.

RESULTS

The interviewees described team-based care as more fitting and better coordinated, including more time and more learning than with single-profession general practitioner care. Most survey respondents experienced improvements in understanding and mastering their health problems. Multi-morbid elderly interviewees and interviewees with mental illness shared experiences of improved information continuity. They found that important concerns they had raised with the nurse were known to the general practitioner and vice versa. None of the interviewees expressed dissatisfaction with the inclusion of a nurse in their general practitioner relationship. Several interviewees noted improved access to care. The nurse was seen as a strengthening link to the general practitioner. The survey respondents expressed strong agreement with being followed up by a nurse. The interviewees trusted that it was their general practitioner who controlled what happened to them in the general practitioner surgery.

CONCLUSION

From the patients' perspective, interprofessional teamwork in general practice can strengthen management, informational, and relational continuity. However, a prerequisite seems to be a clear general practitioner presence in the team.

Using complaints from obstetric care for improving women's birth experiences - a cross sectional study

INTRODUCTION

Staff shortages and quality in obstetric care is a concern in most healthcare systems and a hot topic in the public debate that has centred on complaints about deficient care. However there has been a lack of empirical data to back the debate. The aim of this study was to analyse and describe complaints in obstetric care. Further, to compare the obstetric complaint pattern to complaints from women about other hospital services.

MATERIALS AND METHODS

We used the Healthcare Complaints Analysis Tool to code, analyse and extract contents of obstetric complaint cases in a region of Denmark between 2016 and 2021. We compared the obstetric complaint pattern to all other hospital complaint cases in the same period regarding female patients at a large University Hospital in a cross-sectional study.

RESULTS

Complaints regarding obstetric care differed from women's complaints regarding other healthcare services. Women from obstetric care raised more problems per complaint, and tended to complain more about relational issues indicated by odds for complaints about staff shortage four times higher in the obstetric care group. Women from obstetric care had a lower proportion of compensation claims.

CONCLUSION

Systematic complaint analysis acknowledged women's experience in obstetric care and may point to areas that potentially need further attention. Complaints from obstetric care show that women experience deficiencies related to relational problems like recognition and individualized support compared to complaints from women receiving other hospital healthcare services.

Autonomous Electroluminescent Textile for Visual Interaction and Environmental Warning

Visual interaction is a promising strategy for the externalized expression and transmission of information, having wide application prospects in wearable luminous textiles. Achieving an autonomous luminous display and dynamic light response to environmental stimuli is attractive but attracts little attention. Herein, we propose a liquid responsive structure based on alternating-current electroluminescent fibers and demonstrate conductive-liquid-bridging electroluminescent fabrics with high integration and personalized patterns. Impressively, our electroluminescent fibers and textiles could afford a sensitive response and high robustness to water, glycerol, ethanol, and sodium chloride solution. The final electroluminescent textiles show an excellent luminescence performance of 149.08 cd m-2. On the proof of concept, a rain-sensing umbrella, luminous sportswear, and liquid response glove are fabricated to demonstrate water detection, visual interaction, and environmental warning. The textile-type visualizing-responding strategy proposed in this work may open up new avenues for the application of ACEL devices in the field of visual interaction.

A contemporary ontology of continuity in general practice: Capturing its multiple essences in a digital age

Continuity is a long-established and fiercely-defended value in primary care. Traditional continuity, based on a one-to-one doctor-patient relationship, has declined in recent years. Contemporary general practice is organisationally and technically complex, with multiple staff roles and technologies supporting patient access (e.g. electronic and telephone triage) and clinical encounters (e.g. telephone, video and electronic consultations). Re-evaluation of continuity's relational, organisational, socio-technical and professional characteristics is therefore timely. We developed theory in parallel with collecting and analysing data from case studies of 11 UK general practices followed from 2021 to 2023 as they introduced (or chose not to introduce) remote and digital services. We used strategic, immersive ethnography, interviews, and material analysis of technologies (e.g. digital walk-throughs). Continuity was almost universally valued but differently defined across practices. It was invariably situated and effortful, influenced by the locality, organisation, technical infrastructure, wider system and the values and ways of working of participating actors, and often requiring articulation and 'tinkering' by staff. Remote and digital modalities provided opportunities for extending continuity across time and space and for achieving-to a greater or lesser extent-continuity of digital records and shared understandings of a patient and illness episode across the clinical team. Delivering continuity for the most vulnerable patients was sometimes labour-intensive and required one-off adaptations. Building on earlier work by Haggerty et al. we propose a novel ontology of four analytically distinct but empirically overlapping kinds of continuity-of the therapeutic relationship (based on psychodynamic and narrative paradigms), of the illness episode (biomedical-interpretive paradigm), of distributed work (sociotechnical paradigm), and of the practice's commitment to a community (political economy and ethics of care paradigm). This ontology allowed us to theorise and critique successes (continuity achieved) and failures (breaches of continuity and fragmentation of care) in our dataset.

Early childhood anxiety disorders: continuity and predictors in adolescence

Anxiety disorders are among the most common disorders in early childhood. Although many older children and adolescents with anxiety disorders recover and remain well, little is known about the continuity of early childhood anxiety and the factors that predict persistence/recurrence in later childhood and adolescence. We followed 129 children who met anxiety disorder criteria at age 3 and/or 6 and determined how many continued to experience an anxiety disorder between age 7 and 15, as well as the continuity of specific anxiety disorders. We explored whether biological sex, number of anxiety disorders, early childhood persistence (i.e., anxiety diagnosis at both age 3 and 6), childhood comorbidities, temperamental behavioral inhibition, a maternal history of anxiety, and authoritarian and overprotective parenting predicted persistence/recurrence of an anxiety disorder from age 7 to 15. Sixty-five (50.4%) of the adolescents with an early childhood anxiety disorder met anxiety disorder criteria during the age 7-15 interval. Homotypic continuity from early childhood to school-age/mid-adolescence was observed for social anxiety disorder, separation anxiety disorder, and generalized anxiety disorder (GAD). Early childhood agoraphobia predicted school-age/mid-adolescent GAD and early childhood GAD predicted school-age/mid-adolescent specific phobia. In bivariate analyses, number of anxiety disorders, persistence of anxiety from age 3 to 6, and having a mother with a history of anxiety predicted the persistence/recurrence of anxiety disorders from age 7 to 15. Only early childhood persistence of anxiety uniquely predicted the persistence/recurrence of an anxiety disorder over and above the other predictors. Early intervention efforts should focus on identifying and intervening with young children who demonstrate a protracted course of anxiety.

Mental disorders in former street-working boys

The continuity of mental disorders in street-working children is rarely studied. This study therefore investigated homotypic continuity, recurrence of the same disorder, and heterotypic continuity, when a new disorder follows on the previous, of mental disorders from childhood to adulthood in street-working boys from Duhok City, Kurdistan Region of Iraq. Mental disorders were assessed by structured diagnostic interviews in 40 street-working boys in 2004-2005 and again in 2021, when the participants' mean ages were 12.1 (SD 1.8) and 29.7 (SD 2.3), respectively. Mental disorders were common; 24 participants (60%) satisfied the criteria for at least one diagnosis at baseline and 28 (70%) at follow-up. Comorbidity increased from 1.2 (SD 1.4) disorders initially to 2.5 (SD 1.8) at follow-up. Only anxiety disorders showed homotypic continuity. Depressive disorders exhibited the greatest increase over time whereas externalizing disorders exhibited a decreasing tendency. The number of mental disorders in adulthood was related to the number of mental disorders in childhood but not to the number of childhood traumas experienced, having previously worked for more than two hours per day, having worked for over two years on the streets, or having at least one dead parent as a child. Parental ratings on the Child Behaviour Check List (CBCL) from childhood were also unrelated to the number of adult disorders. More longitudinal studies with bigger samples of both genders are needed to fully evaluate the continuity of mental disorders in street-working children and to determine whether the number of mental disorders in childhood is a stronger predictor of being mentally disordered in adult life than psychosocial risk factors or experiences of internalizing or externalizing symptoms in childhood.

Longitudinal Relations among Identity Distinctiveness, Continuity, and Integration among Dutch Adolescents

Identity distinctiveness, continuity, and coherence are all components of adolescents' identity development, but their longitudinal relations have rarely been examined. Data were analyzed on these three constructs collected over three years from 349 Dutch adolescents (M_age = 14.7, SD_age = 0.7, 215 [61.6%] girls and 133 [38.1%] boys). A cross-lagged panel model of the three constructs showed that stability was relatively high for distinctiveness and continuity, whereas coherence was less stable. Distinctiveness and continuity were correlated positively within time, but cross-lagged associations were mostly not significant: Only distinctiveness and coherence negatively predicted each other across waves. Results suggest that distinctiveness, continuity, and coherence may be interrelated, but may not drive the development of each other.

The approximate functional equation of some Diophantine series

We prove that a family of Diophantine series satisfies an approximate functional equation. It generalizes a result by Rivoal and Roques and proves an extended version of a conjecture posed in their paper. We also characterize the convergence points.

Continuity or team-teaching approach for midwifery education? An exploratory qualitative study of student and academic preferences

BACKGROUND

The content of midwifery courses is very similar across universities. The teaching approach is not, with universities adopting a variety of pedagogical methods.

AIM

To explore views of midwifery students, midwifery academics and senior academic managers comparing a continuity approach where one main academic provides the majority of midwifery content plus pastoral care compared with a team-teaching approach of midwifery education where lecturers change throughout the course.

METHODS

Semi-structured interviews and focus groups were used to discover thoughts, benefits and disadvantages of two teaching approaches. Data were analysed using thematic analysis.

FINDINGS

Midwifery students and academics valued relationship building, consistency of advice and assessment expectations of the continuity approach but also appreciated a variety of teaching styles and content found in the team-teaching approach. Senior academic managers favoured a team-teaching approach due to workload concerns.

DISCUSSION

Continuity and team-teaching pedagogical approaches offer different advantages. Continuity in midwifery education may provide students with a meaningful trusting relationship with their teacher and consistency of information, which could aid learning. A team-teaching approach provides students with diversity of teaching styles and midwifery 'stories'. A combination of both pedagogies offering both a mix of teachers and a named 'go-to' mentor might help meet student requirements for both continuity and variety.

CONCLUSION

Relationship building, consistency and trust, were all evident in the continuity approach whereas the team-teaching approach was considered to be a more sustainable workload model.

Continuity of illicit drug use among Malay patients attending methadone clinics in Kelantan, Malaysia

The study aimed to determine the prevalence of continuity of illicit drug use and its associated factors among Malay opioid users receiving methadone treatment in Kelantan, Malaysia. This cross-sectional study involved a total of 150 respondents. Sociodemographic characteristic of participants, level of religiosity, and quality of life were collected using the self-administered questionnaires. The prevalence of continuity illicit drug use was 38.7% (n = 58) by self-report and 40.7% (n = 61) by positive urine test result for drugs. Positive hepatitis C status and high quality of life in the psychological health domain were associated with low continuity of illicit drug use by self-reported data and urine drug test results. In conclusion, the continuity of illicit drug use among methadone program users is still high, especially among those on methadone therapy for less than 2 years.

An algorithm to predict data completeness in oncology electronic medical records for comparative effectiveness research

INTRODUCTION

Electronic health record (EHR) discontinuity (missing out-of-network encounters) can lead to information bias. We sought to construct an algorithm that identifies high EHR-continuity among oncology patients.

METHODS

Using a linked Medicare-EHR database and regression, we sought to 1) measure how often Medicare claims for outpatient encounters were substantiated by visits recorded in the EHR, and 2) predict continuity ratio, defined as the yearly proportion of outpatient encounters reported to Medicare that were captured by EHR data. The prediction model...s performance was evaluated with the coefficient of determination and Spearman...s correlation. We quantified variable misclassification by decile of continuity ratio using standardized difference and sensitivity.

RESULTS

A total of 79,678 subjects met all eligibility criteria. Predicted and observed continuity was highly correlated (σ_Spearman=0.86). On average across all variables measured, MSD was reduced by a factor of 1/7^th and sensitivity was improved 35-fold comparing subjects in the highest vs. lowest decile of CR.

CONCLUSION

In the oncology population, restricting EHR-based study cohorts to subjects with high continuity may reduce misclassification without greatly impacting representativeness. Further work is needed to elucidate the best manner of implementing continuity prediction rules in cohort studies.

Implementation barriers and enablers of midwifery group practice for vulnerable women: a qualitative study in a tertiary urban Australian health service

Background

Maternity services have limited formalised guidance on planning new services such as midwifery group practice for vulnerable women, for example women with a history of substance abuse (alcohol, tobacco and other drugs), mental health challenges, complex social issues or other vulnerability. Continuity of care through midwifery group practice is mostly restricted to women with low-risk pregnancies and is not universally available to vulnerable women, despite evidence supporting benefits of this model of care for all women. The perception that midwifery group practice for vulnerable women is a high-risk model of care lacking in evidence may have in the past, thwarted implementation planning studies that seek to improve care for these women. We therefore aimed to identify the barriers and enablers that might impact the implementation of a midwifery group practice for vulnerable women.

Methods

A qualitative context analysis using the Consolidated Framework for Implementation Research was conducted at a single-site tertiary health facility in Queensland, Australia. An interdisciplinary group of stakeholders from a purposeful sample of 31 people participated in semi-structured interviews. Data were analysed using manual and then Leximancer computer assisted methods. Themes were compared and mapped to the Framework.

Results

Themes identified were the woman’s experience, midwifery workforce capabilities, identifying “gold standard care”, the interdisciplinary team and costs. Potential enablers of implementation included perceptions that the model facilitates a relationship of trust with vulnerable women, that clinical benefit outweighs cost and universal stakeholder acceptance. Potential barriers were: potential isolation of the interdisciplinary team, costs and the potential for vicarious trauma for midwives.

Conclusion

There was recognition that the proposed model of care is supported by research and a view that clinical benefits will outweigh costs, however supervision and support is required for midwives to manage and limit vicarious trauma. An interdisciplinary team structure is also an essential component of the service design. Attention to these key themes, barriers and enablers will assist with identification of strategies to aid successful implementation. Australian maternity services can use our results to compare how the perceptions of local stakeholders might be similar or different to the results presented in this paper.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08633-8.

A pilot study: Transitioning into a new graduate midwife - perspectives about a unique student-led practice

OBJECTIVE

To explore midwifery students' (and as new graduates') experiences and level of satisfaction about a student-led midwifery model of care.

METHODS

This was a qualitative study to elicit rich descriptive data from the participants. Thematic analysis was used. The students were interviewed at the end of their final year of study and they were subsequently interviewed at the end of their graduate year.

RESULTS

Two overarching themes were identified from the qualitative findings from the first and second interviews including the students building and sustaining important relationships and transitioning from a student to new graduate.

CONCLUSIONS

The midwifery students valued the opportunity to spend one year in a student-led model of care so that they could build and sustain important relationships with women and their team including the mentor midwife as new graduates. The students developed confidence by being respected by midwives and enabled them to advocate for women.

Effects of spatiotemporal (dis)continuity on working memory for human movements

Human movements are dynamic and continuous in nature. However, how the spatiotemporal continuity influences working memory for movements is still unclear. Specifically, spatiotemporal continuity of movements may facilitate integrative processing ("integration") and enhance memory performance by optimizing the encoding process, but it may also diminish memory benefits from distinctive processing ("separation"). In this study, we manipulated the continuity state (continuous/discontinuous) (Experiment 1) and its predictability (Experiment 2) of whole-body movement sequences and tested participants' working memory for observed movements with a single-probe recognition task. We formulated potential influence from spatiotemporal (dis)continuity by two opposite forces - integration vs. separation, and demonstrated a conflict between these two processes across space and time. Moreover, we found that the seemingly stimulus-driven perceptual effects from spatiotemporal (dis)continuity might be supported by a prediction-based mechanism, which guided the selection of an optimal processing strategy. Overall, our finding illustrates an interweaving relationship between spatial and temporal processing during action observation and highlights the importance of considering the dynamic and continuous nature of human movements in visual perception and working memory research.

Fulfilment of expectations on birth and the postpartum period - A Swedish cohort study

BACKGROUND

The fulfilment of birth expectations is important to women and strongly related to birth satisfaction.

OBJECTIVE

The aim of this study was to investigate women's expectations and experiences of birth and the postnatal period and associated factors. An additional aim was to explore if women's expectations were fulfilled.

METHODS

A longitudinal cohort study of 280 women where 226 were followed up two months after birth. Data were collected using questionnaires. Odds ratios with a 95% confidence interval were calculated between the explanatory background variables and expectations/experiences.

RESULTS

The majority (79%) rated continuity as important, but few (32%) actually had a known midwife assisting during birth. Positive birth expectations were found in 37% and a positive birth experience in 66%. Many women (56%) preferred a short postnatal stay, and 63% went home within 24 h. Thirty-six percent preferred postnatal home visits, but only eight women (3.5%) received this. Breastfeeding expectations were high with 86% rating it as important but after birth 63% reported exclusively breastfeeding. Only a few background factors were associated with women's expectations and experiences. Most likely to be fulfilled were women's expectations for a vaginal birth (83%), a positive birth experience (71%) and short length of postnatal stay (67%). Postnatal home visits (96%) and continuity of care (73%) were not fulfilled.

CONCLUSIONS

Pregnant women's expectations about continuity are fulfilled only to a minor degree. The fulfilment of postnatal expectations varied and the preference for a short postnatal stay was fulfilled whereas home visits were not.

Progression of externalizing disorders into anxiety disorders: Longitudinal transitions in the first three decades of life

BACKGROUND

There is a notable comorbidity between externalizing disorders and anxiety disorders, which may be explained by the co-occurrence of two prevalent early-onset disorders, by shared vulnerability and risk factors, or as evidence that one disorder group might be causally related to the other.

AIM

To investigate the longitudinal trajectories of externalizing disorders, their interplay with anxiety disorders, and putative predictors for symptom progression in youth.

METHODS

1053 adolescents (14-17 years) from the general population were assessed at baseline and prospectively at 2, 4, and 10-year follow-up using a standardized interview of mental disorders (DIA-X/M-CIDI) to assess "early" (oppositional-defiant disorder, conduct disorder, ADHD) and "late" (antisocial behavior, substance use disorders) externalizing disorders as well as anxiety disorders. Longitudinal associations and predictors for symptom progression were examined using Kaplan-Meier-analyses.

RESULTS

Lifetime prevalence of early externalizing disorders were 9.1% and 6.4% among those with and without any anxiety disorder. A late externalizing disorder was reported by 50.3% of those with an early externalizing disorder and in 26.6% of those with any anxiety disorder. Both early (HR: 1.5, 95%CI: 1.0-2.3) and late externalizing disorders (HR: 2.1, 95%CI: 1.7-2.6) were associated with incident anxiety disorders. Higher parental rejection, lower volitional inhibition, and higher volitional avoidance predicted incident anxiety disorders among those with early externalizing disorders.

DISCUSSION

Early externalizing disorders likely follow a homotypic continuity (to late externalizing disorders) and/or a heterotypic continuity to anxiety disorders, and thus appear as a useful target for prevention and early intervention.

Associations of continuity and coordination of care with outcomes and costs after discharge among patients with heart failure: A nationwide population-based study

BACKGROUND

Although continuity and coordination of care have received increased attention as important ways to improve outcomes and decrease costs, limited information is available concerning the effects of "care continuity" and "care coordination" on mortality and costs. We used nationwide population-based data from Taiwan to explore the effects of care continuity and coordination on mortality and costs for heart failure.

METHODS

We analyzed all 18,991 heart failure patients 18 years of age or older and discharged from hospitals in 2016 using Taiwan's National Health Insurance claims data. Cox proportional hazard and multiple linear regression models were used, after adjustment for patient characteristics, to explore the relative impacts of the continuity of care (COC) index and care density on 1-year mortality and costs.

RESULTS

Higher COC index was associated with lower mortality (low vs. medium: hazard ratio [HR], 1.59; 95% confidence interval [CI], 1.47-1.71; high vs. medium: HR, 0.66; 95% CI, 0.61-0.72) and costs (low vs. medium: cost ratio [CR], 1.11; 95% CI, 1.07-1.16; high vs. medium: CR, 0.84; 95% CI, 0.81-0.88). Low care density was associated with higher mortality (low vs. medium: HR, 1.12; 95% CI, 1.04-1.20). Higher care density was associated with lower costs (low vs. medium: CR, 1.14; 95% CI, 1.10-1.18; high vs. medium: CR, 0.76; 95% CI, 0.73-0.79).

CONCLUSIONS

Low care continuity and coordination are associated with higher 1-year post-discharge mortality and costs. Facilitating care continuity and coordination may be an important strategy for improving value-based care for heart failure.

Temporal stability and change in manifest intelligence scores: Four complementary analytic approaches

The temporal stability of psychological test scores is one prerequisite for their practical usability. This is especially true for intelligence test scores. In educational contexts, high stakes decisions with long-term consequences, such as placement in special education programs, are often based on intelligence test results. There are four different types of temporal stability: mean-level change, individual-level change, differential continuity, and ipsative continuity. We present statistical methods for investigating each type of stability. Where necessary, the methods were adapted for the specific challenges posed by intelligence research (e.g., controlling for general intelligence in lower order test scores). We provide step-by-step guidance for the application of the statistical methods and apply them to a real data set of 114 gifted students tested twice with a test-retest interval of 6 months.

• Four different types of stability need to be investigated for a full picture of temporal stability in psychological research

• Selection and adaption of the methods for the use in intelligence research

• Complete protocol of the implementation

Spatial transition management for improving outdoor cinematic augmented reality experience of the TV show

There have been attempts to provide new cinematic experiences by connecting TV or movie content to suitable locations through augmented reality (AR). However, few studies have suggested a method to manage breakdowns in continuity due to spatial transitions. Thus, we propose a method to manage the spatial transition that occurs when we create a TV show trajectory by mapping TV show scenes with spatiotemporal information to the real world. Our approach involved two steps. The first step is to reduce the spatial transition considering the sequence, location, and importance of TV show scenes when creating the TV show trajectory in the authoring tool. The second is to fill the spatial transition with additional TV show scenes considering sequence, importance, and user interest when providing the TV show trajectory in the mobile application. The user study results showed that reducing spatial transition increases narrative engagement by allowing participants to see important content within the trajectory. The additional content in spatial transition decreased the physical demand and effort in terms of the perceived workload, although it increased the task completion time. Integrated spatial transition management improved the overall cinematic augmented reality (CAR) experience of the TV show. Furthermore, we suggest design implications for realizing the CAR of TV shows based on our findings.

The Arcuate Fasciculus and language origins: Disentangling existing conceptions that influence evolutionary accounts

The Arcuate Fasciculus (AF) is of considerable interdisciplinary interest, because of its major implication in language processing. Theories about language brain evolution are based on anatomical differences in the AF across primates. However, changing methodologies and nomenclatures have resulted in conflicting findings regarding interspecies AF differences: Historical knowledge about the AF originated from human blunt dissections and later from monkey tract-tracing studies. Contemporary tractography studies reinvestigate the fasciculus' morphology, but remain heavily bound to unclear anatomical priors and methodological limitations. First, we aim to disentangle the influences of these three epistemological steps on existing AF conceptions, and to propose a contemporary model to guide future work. Second, considering the influence of various AF conceptions, we discuss four key evolutionary changes that propagated current views about language evolution: 1) frontal terminations, 2) temporal terminations, 3) greater Dorsal- versus Ventral Pathway expansion, 4) lateralisation. We conclude that new data point towards a more shared AF anatomy across primates than previously described. Language evolution theories should incorporate this continuous AF evolution across primates.

Determinants of the continuous operations of micro and small enterprises during COVID-19 pandemic in Ethiopia

The main objective of this study is to assess determinant factors for the continuous operations of micro and small enterprises during COVID-19 pandemic. The study adopted a cross-sectional  design, with both descriptive and explanatory research design. To achieve the objectives of the study, 276 respondents were selected from 890 micro and small enterprise owners. The sample of the study was selected through proportional stratified random sampling technique from the business types (manufacturing, construction, urban agriculture, service and trade). To collect the primary data, questionnaires were dispatched to owners/operators of micro and small enterprises. The collected data were analyzed through descriptive, correlation and regression analysis techniques. The finding of the study revealed that people and administrative factors, regulatory factors, economic factors, partnerships, leadership of owner have a positive relationship to micro-small enterprise continuous operations during COVID-19 pandemic with the value of r = 0.457, 0.558, 0.572, 0.519 and 0.654, respectively. The study regression analysis result assured that partnership, economic factors, and leadership of the owner has a positive statistical significant effect on the continuous operations of the micro and small enterprise during COVID-19 pandemic with the value of (p < 0.05). The researcher recommended that strenghtening partnership with stakeloders and excersing best leadership practices are essential to ensure the continuous operations of the micro and small enterpreses.

Familiar in the Unfamiliar - Children's, Parents', and Healthcare Professionals' Experiences of Procedure-Related Anesthesia in the Pediatric Oncological Ward

PURPOSE

To explore children's, parents', and healthcare professionals', experiences of anesthesia related to pediatric oncological treatment performed at the pediatric oncology ward.

DESIGN AND METHODS

The study was a qualitative study. 11 children and 12 parents were recruited for individual or dyadic interviews and two focus groups with a total of 12 healthcare professionals were recruited through purposeful and convenience sampling procedures.

RESULTS

Thematic analysis generated one main theme, the familiar in the unfamiliar, and two subthemes, the room creates an atmosphere and relational continuity.

CONCLUSIONS

Changing the physical environment and composition of the team positively influenced the experience of anesthesia in pediatric cancer treatment for both children, parents, and healthcare professionals. Familiarity was important for all involved and familiarity was associated with continuity related to the physical environment, as well as the relational and procedural professional continuity. Parents expressed that they never felt good about anesthesia as there were feelings of leaving your child's life into the hands of others. However, familiarity in trusting relationships with healthcare professionals helped to moderate these aspects.

PRACTICE IMPLICATIONS

Familiarity should be considered important with continuity in trusting relations and collaborations between nurses and families, as well as between healthcare staff. Pediatric oncology ward is a preferred safe familiar setting for procedure-related anesthesia. Parents and children value individualized flexible nursing care, that takes the child's and parents habits and preferences into account during procedure-related anesthesia in pediatric oncological treatment.

Improving the continuity and coordination of ambulatory care through feedback and facilitated dialogue-a study protocol for a cluster-randomised trial to evaluate the ACD study (Accountable Care in Germany)

Background

Patients in Germany are free to seek care from any office-based physician and can always ask for multiple opinions on a diagnosis or treatment. The high density of physicians and the freedom to choose among them without referrals have led to a need for better coordination between the multiple health professionals treating any given patient. The objectives of this study are to (1) identify informal networks of physicians who treat the same patient population, (2) provide these physicians with feedback on their network and patients, using routine data and (3) give the physicians the opportunity to meet one another in facilitated network meetings.

Methods

The Accountable Care Deutschland (ACD) study is a prospective, non-blinded, cluster-randomised trial comprising a process and economic evaluation of informal networks among 12,525 GPs and office-based specialists and their 1.9 million patients. The units of allocation are the informal networks, which will be randomised either to the intervention (feedback and facilitated meetings) or control group (usual care). The informal networks will be generated by identifying connections between office-based physicians using complete datasets from the Regional Associations of Statutory Health Insurance (SHI) Physicians in Hamburg, Schleswig Holstein, North Rhine and Westphalia Lip, as well as data from three large statutory health insurers in Germany. The physicians will (a) receive feedback on selected indicators of their own treatment activity and that of the colleagues in their network and (b) will be invited to voluntary, facilitated network meetings by their Regional Association of SHI physicians. The primary outcome will be ambulatory-care-sensitive hospitalisations at baseline, at the end of the 2-year intervention period, and at six months and at 12 months after the end of the intervention period. Data will be analysed using the intention-to-treat principle. A pilot study preceded the ACD study.

Discussion

Cochrane reviews show that feedback can improve everyday medical practice by shedding light on previously unknown relationships. Providing physicians with information on how they are connected with their colleagues and what the outcomes are of care delivered within their informal networks can help them make these improvements, as well as strengthen their awareness of possible discontinuities in the care they provide.

Trial registration

German Clinical Trials Register DRKS00020884. Registered on 25 March 2020—retrospectively registered.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05584-z.

Transitioning From Hospital to Palliative Care at Home: Patient and Caregiver Perceptions of Continuity of Care

CONTEXT

Continuity of care is important at improving the patient experience and reducing unnecessary hospitalizations when transitioning across care settings, especially at the end of life.

OBJECTIVE

To explore patient and caregiver understanding and valuation of "continuity of care" while transitioning from an in-hospital to a home-based palliative care team.

METHODS

Longitudinal qualitative design using semistructured interviews conducted with patients and their caregivers before and after transitioning from hospital to palliative care at home. Interviews were audio-recorded and transcribed verbatim. Data were analyzed using thematic analysis within a postpositivist framework. Thirty-nine participants (18 patients, seven caregivers, and seven patient-caregiver dyads) were recruited from two acute care hospitals, wherein they received care from an inpatient palliative care consultation team and transitioned to home-based palliative care.

RESULTS

Patients had a mean age of 68 years, 60% were female and 60% had a diagnosis of cancer. Caregivers had a mean age of 62 years and 50% were female. Participants perceived continuity of care to occur in three ways, depending on which stage they were at in their hospital-to-home transition. In hospital, continuity of care was experienced, as consistency of information exchanged between providers. During the transition from hospital to home, continuity of care was experienced as consistency of treatments. When receiving home-based palliative care, continuity of care was experienced as having consistent providers.

CONCLUSION

Patients' and their caregivers' valuation of continuity of care was dependent on their stage of the hospital-to-home transition. Optimizing continuity of care requires an integrated network of providers with reliable information transfer and communication.

Patient-Reported Continuity of Care and Functional Safety Concerns After Inpatient Cancer Rehabilitation

BACKGROUND

Patients with cancer have been noted to have inadequate continuity of care after discharge from hospital. We sought to assess patient-reported continuity of care and functional safety concerns after acute inpatient rehabilitation.

METHODS

This was a prospective study that used cross-sectional surveys at a National Cancer Institute Comprehensive Cancer Center. All patients who were admitted to acute inpatient rehabilitation from September 5, 2018, to February 7, 2020, met the inclusion criteria, and completed two surveys (assessing continuity of care and functional safety concerns) upon discharge and 1 month after discharge were included in the study.

RESULTS

A total of 198 patients completed the study, and no major concerns were reported by the patients. The greatest concern was a lack of adequate communication management among different providers, reported by only 10 (5.0%) patients. The combined fall and near-fall rate within 1 month after discharge was (25/198) 13%. Brain metastasis, a comorbidity of depression, and a history of falls were significantly associated with a higher risk of falls or near falls within 1 month after discharge.

CONCLUSION

Although overall patients with cancer reported adequate continuity of care and feeling safe to function at home after acute inpatient rehabilitation, it is important to be aware that fall or near-fall events within 1 month after acute inpatient rehabilitation are associated with brain metastasis, comorbidity of depression, and a history of falls. Thus, patients with these risk factors may benefit from including more focused fall prevention education and interventions.

IMPLICATIONS FOR PRACTICE

Patients with cancer often have extensive problems that require care from multiple health care providers simultaneously, and a high level of coordination is needed for adequate transition of care from the inpatient to the outpatient setting. This transition of care period is prone to inadequate continuity of care and, for older adults, a particular risk for falls. Assessment for risk of fall is also an important factor to consider when evaluating patients to continue oncology treatments. There is a gap in knowledge regarding patient-reported continuity of care and functional safety concerns after acute inpatient cancer rehabilitation.

Patterns of clinic switching and continuity of medication for opioid use disorder in a Medicaid-enrolled population

BACKGROUND

Many persons with opioid use disorder (OUD) initiate medication for opioid use disorder (MOUD) with one clinic and switch to another clinic during their course of treatment. These switches may occur for referrals or for unplanned reasons. It is unknown, however, what effect switching MOUD clinics has on continuity of MOUD treatment or on overdoses.

OBJECTIVE

To examine patterns of switching MOUD clinics and its association with the proportion of days covered (PDC) by MOUD, and opioid-related overdose.

DESIGN

Cross-sectional retrospective analysis of Pennsylvania Medicaid claims data.

MAIN MEASURES

MOUD clinic switches (i.e., filling a MOUD prescription from a prescriber located in a different clinic than the previous prescriber), PDC, and opioid-related overdose.

RESULTS

Among 14,107 enrollees, 43.2 % switched clinics for MOUD at least once during the 270 day period. In multivariate regression results, enrollees who were Non-Hispanic black (IRR = 1.43; 95 % CI = 1.24-1.65; p < 0.001), had previous methadone use (IRR = 1.32; 95 % CI = 1.13-1.55; p < 0.001), and a higher total number of office visits (IRR = 1.01; CI = 1.01-1.01; p < 0.001) had more switches. The number of clinic switches was positively associated with PDC (OR = 1.12; 95 % CI = 1.10-1.13). In secondary analyses, we found that switches for only one MOUD fill were associated with lower PDC (OR = 0.97; 95 % CI = 0.95-0.99), while switches for more than one MOUD fill were associated with higher PDC (OR = 1.40; 95 % CI = 1.36-1.44). We did not observe a relationship between opioid-related overdose and clinic switches.

CONCLUSIONS

Lack of prescriber continuity for receiving MOUD may not be problematic as it is for other conditions, insofar as it is related to overdose and PDC.

Patient perceptions of students in a longitudinal integrated clerkship in Taiwan: a qualitative study

BACKGROUND

Longitudinal integrated clerkships (LICs) are a model of clinical education growing rapidly in Western contexts. LICs use educational continuity to benefits students' clinical learning and professional identity formation. Patient-centered care is a core component of medical professionalism in the West. To support patient-centered care, education leaders in Taiwan restructured clinical education and implemented the first longitudinal integrated clerkship in East Asia. We aimed to investigate patients' perceptions of longitudinal relationships with the LIC students within Taiwan's Confucian cultural and social context.

METHODS

We invited patients or their family members who were cared for longitudinally by a LIC student to participate in the study. Participating patients or their family members undertook semi-structured interviews. We analyzed data qualitatively using a general inductive approach to identify themes in the patients' descriptions of their experiences interacting with the LIC students.

RESULTS

Twenty-five patients and family members participated in interviews: 16 patients and 9 family members. Qualitative analysis of interview transcripts identified three themes from patients' experience receiving care from their LIC students: care facilitation, companionship, and empathy. To provide care facilitation, LIC students served as a bridge between the physicians and patients. Students served patients by reminding, consulting, tracking disease progression, and researching solutions for problems. To provide companionship, students accompanied patients interpersonally like a friend or confidant who listens and provides a presence for patients. To provide empathy, patients reported that students showed sincere concern for patients' experience, feelings, and mood.

CONCLUSION

In our study, Taiwanese patients' perspectives of LIC students suggested the value of care facilitation, companionship, and empathy. We discuss these themes within the context of Confucian culture and the Taiwanese context of care.

Continuity and Stability of Parenting of Infants by Women at Risk for Perinatal Depression

OBJECTIVE

The present study aimed to enhance understanding of continuity and stability of positive parenting of infants, across age and different settings in women with a history of depression who are at elevated risk for postpartum depression.

DESIGN

Mothers (N = 103) with a history of major depression and their infants were observed during 5-min play and feeding interactions when their infants were 3, 6, and 12 months of age. Summary scores representing mothers' positive parenting were computed separately for each age and context based on ratings of five parenting behaviors. Mothers' depressive symptom levels were assessed at each infant age.

RESULTS

Continuity (consistency of level) and stability (consistency of rank order) were assessed across age and context at both the group and individual level. Across-age analyses revealed continuity in the play context and discontinuity in the feeding context, albeit only at the group level, as well as weak to moderate stability. Across-context analyses revealed higher positive parenting scores in play than feeding at all time points as well as weak to moderate stability. Variations in positive parenting across age and context were independent of mothers' postpartum depressive symptom levels.

CONCLUSIONS

Findings based on normative samples may not generalize to women with a history of depression, who may benefit from interventions aimed at enhancing their positive parenting over the course of infancy, regardless of postpartum depressive symptom level. Results also underscore the importance of assessing parenting at multiple age points and across varying contexts.

The effect of perceptual-motor continuity compatibility on the temporal control of continuous and discontinuous self-paced rhythmic movements

One of the questions yet to be fully understood is to what extent the properties of the sensory and the movement information interact to facilitate sensorimotor integration. In this study, we examined the relative contribution of the continuity compatibility between motor goals and their sensory outcomes in timing variability. The variability of inter-response intervals was measured in a synchronization-continuation paradigm. Participants performed two repetitive movement tasks whereby they drew circles either using continuous or discontinuous self-paced movements while receiving discrete or continuous auditory feedback. The results demonstrated that the effect of perceptual-motor continuity compatibility may be limited in self-paced auditory-motor synchronization as timing variability was not significantly influenced by the continuity of the feedback or the continuity compatibility between feedback and the movement produced. In addition, results suggested that the presence of salient perceptual events marking the completion of the time intervals elicited a common timing process in both continuous and discontinuous circle drawing, regardless of the continuity of the auditory feedback. These findings open a new line of investigation into the role of the discriminability and reliability of the event-based information in determining the nature of the timing mechanisms engaged in continuous and discontinuous self-paced rhythmic movements.

A continuity of care project with two on-call schedules: Findings from a rural area in Sweden

BACKGROUND

In many countries, various continuity models of midwifery care arrangements have been developed to benefit women and babies. In Sweden, such models are rare.

AIM

To evaluate two on-call schedules for enabling continuity of midwifery care during labour and birth, in a rural area of Sweden.

METHOD

A participatory action research project where the project was discussed, planned and implemented in collaboration between researchers, midwives and the project leader, and refined during the project period. Questionnaires were collected from participating women, in mid pregnancy and two months after birth.

RESULT

One of the models resulted in a higher degree of continuity, especially for women with fear of birth. Having a known midwife was associated with higher satisfaction in the medical (aOR 2.02 (95% CI 1.14-4.22) and the emotional (aOR 2.05; 1.09-3.86) aspects of intrapartum care, regardless of the model.

CONCLUSION

This study presented and evaluated two models of continuity with different on-call schedules and different possibilities for women to have access to a known midwife during labour and birth. Women were satisfied with the intrapartum care, and those who had had a known midwife were the most satisfied. Introducing a new model of care in a rural area where the labour ward recently closed challenged both the midwives' working conditions and women's access to evidence-based care.

Childbirth experience in women participating in a continuity of midwifery care project

BACKGROUND

Continuity models of care are rare in Sweden, despite the evidence of their benefit to women and babies. Previous studies have shown certain factors are associated with a positive birth experience, including continuity of midwifery care.

AIM

The aim was to investigate women's childbirth experiences in relation to background data, birth outcome and continuity with a known midwife, in a rural area of Sweden.

METHODS

An experimental cohort study. Participating women were offered continuity of midwifery care in pregnancy and birth, during selected time periods. Data were collected in mid-pregnancy and two months after birth. The Childbirth Experience Questionnaire was used to determine women's birth experiences.

RESULT

A total of 226 women responded to the follow-up questionnaire. Not living with a partner, fear of giving birth, and a birth preference other than vaginal were associated with a less positive birth experience. Having had a vaginal birth with no epidural, no augmentation and no birth complication all yield a better birth experience. Women who had had a known midwife were more likely to have had a positive birth experience overall, predominantly in the domain Professional support.

CONCLUSIONS

The results of this study showed that women who received care from a known midwife in labour were more likely to have a positive birth experience. The results also pointed out the benefits of a less medicalized birth as important for a good birth experience, and that some women may need extra support to avoid a less positive birth experience.

Assessing mental health during pregnancy: An exploratory qualitative study of midwives' perceptions

BACKGROUND

Mental health disorders are estimated to affect between 10% and 20% of women who access maternity services and can be defined as a public health issue due to the potential consequences for women, children and families. Detecting problems early in pregnancy can significantly improve outcomes for women and their families. However, mental health problems are not being consistently identified in routine midwifery practice and little is known from current literature about midwives' practice in relation to current national guidelines or the impact models of care have on assessing maternal mental health.

OBJECTIVE

To identify midwives' views about barriers and facilitators to screening for mental health in pregnancy using current UK guidelines.

DESIGN

Nine community midwives from a single district general hospital in the south of England were recruited to take part in focus groups. Thematic analysis was used to extract key themes from the data.

FINDINGS

Three key themes were identified from the focus groups and included system factors, social factors and trust. Barriers and facilitators to screening maternal mental health were associated with the initial 'booking' appointment' and differences in models of care. Barriers to screening were defined as high workload, poor continuity, and a lack of trust between women and midwives.

CONCLUSIONS

This study highlights key barriers and facilitators associated with mental health screening during pregnancy, including issues of trust and uncertainty about women's willingness to disclose mental health conditions. Further research is required to evaluate the relationship between women and midwives in contemporary practice and the influence this may have on maternal mental health.

Evaluation of a student-led midwifery group practice: A woman's perspective

BACKGROUND

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OBJECTIVE

To evaluate women's experiences of a student-led midwifery group practice.

DESIGN

A mixed methods design was used to examine women's experiences and level of satisfaction about a student-led midwifery model of care. An on-line survey elucidated women's levels of satisfaction and experiences with the student-led midwifery group practice. The online survey was sent to all women (n = 25) who were receiving care from third year Bachelor of Midwifery students in 2018 via email up to 6 weeks postnatally. The online survey was distributed in the first instance to obtain baseline information about the importance of this student-led midwifery group practice and so the survey information was linked to the in-depth interview in the analysis for the purpose of identifying if the women were primiparous or multiparous. Women (n = 9) were invited to participate in an in-depth interview by self-opting on the survey and this extra data provided a richer understanding about the level of satisfaction about woman-centred care led by midwifery students. Retrospective data were also collected from the Maternity database - E-Maternity about birth outcomes.

SETTING

A tertiary teaching public hospital in New South Wales (NSW).

PARTICIPANTS

Fifteen women participated in an online survey. Five primiparous and four multiparous women opted to be involved in the in-depth interviews on the online survey.

MEASUREMENTS AND FINDINGS

Analysis in SPSS provided descriptive statistics including frequencies and percentages of data including birth outcomes. Simple correlations enabled associations to be established between levels of satisfaction, individualised care, quality of care, benefits and anxiety during pregnancy. The overarching themes from the qualitative findings identified the students' presence for the women as the most important component of the women's journey. The four main themes that emerged from the study included: familiarity of the caregiver, staying informed on the journey, feeling supported and reassured by their expertise, and control and decisions over birth events.

KEY CONCLUSIONS

For a variety of reasons, women valued the presence of the students throughout their childbearing journey, including valuing the woman's private space during labour and her time with her partner. This combination of pedagogical approaches provides an alternative to the current placement approach, which includes working shifts in all areas of maternity. This approach will better support midwifery students to achieve the skills necessary to provide a continuity of care experience (CoCE) amongst a small team by a student-led midwifery group practice that is supported by a registered midwife in the antenatal clinic. The midwifery student is able to develop a relationship with the woman as a component of the CoCE under the guidance of a registered midwife and this is an important underpinning of the philosophy of woman-centred care.

IMPLICATIONS FOR PRACTICE

This model of care provides evidence that women do value the students' support and presence throughout their experience and that the benefits of this model should be offered to all women as a normal component of their midwifery care.

Strategies to improve continuity maintenance for people with dementia: a rapid realist review

OBJECTIVES

People with life-limiting diseases such as dementia are living longer. How to improve the quality of life of those living with dementia is an important challenge for society. Continuity maintenance in older adulthood is a psychosocial adaptation strategy by searching for preference and familiarity, making a sense of connection, and creating coherence. Continuity maintenance is a useful concept for effective dementia care, which could bring psychosocial benefits. This review investigates effective ways of continuity maintenance for people with dementia (PWD).

STUDY DESIGN

A rapid realist review (RRR) of a comprehensive range of databases was conducted.

METHODS

Realist review methodology provides an explanatory analysis of what works for whom, in what circumstances, and is characterized by its focus on strategies/interventions, contexts, mechanisms, and outcomes. A literature search was conducted using four databases, and articles discussing potential interventions to maintain continuity in PWD were included. Data were extracted on key variables related to contextual factors, mechanisms, and outcomes.

RESULTS

Four key themes emerged: (1) maintaining personal identity, (2) maintaining social identity, (3) keeping a familiar environment, and (4) sustaining daily activities. It is hypothesized that these four factors combine and interact to maintain continuity and ultimately lead to psychosocial benefits.

CONCLUSIONS

Maintenance of identity, environment, and activities is central to continuity for PWD. The resulting model and program theories respond to the need for a coherent approach to continuity maintenance. Using the foundations created by this RRR, nursing homes may psychosocially improve PWD through maintaining continuity.

A systematic survey of regional multi-taxon biodiversity: evaluating strategies and coverage

Background

In light of the biodiversity crisis and our limited ability to explain variation in biodiversity, tools to quantify spatial and temporal variation in biodiversity and its underlying drivers are critically needed. Inspired by the recently published ecospace framework, we developed and tested a sampling design for environmental and biotic mapping. We selected 130 study sites (40 × 40 m) across Denmark using stratified random sampling along the major environmental gradients underlying biotic variation. Using standardized methods, we collected site species data on vascular plants, bryophytes, macrofungi, lichens, gastropods and arthropods. To evaluate sampling efficiency, we calculated regional coverage (relative to the known species number per taxonomic group), and site scale coverage (i.e., sample completeness per taxonomic group at each site). To extend taxonomic coverage to organisms that are difficult to sample by classical inventories (e.g., nematodes and non-fruiting fungi), we collected soil for metabarcoding. Finally, to assess site conditions, we mapped abiotic conditions, biotic resources and habitat continuity.

Results

Despite the 130 study sites only covering a minute fraction (0.0005%) of the total Danish terrestrial area, we found 1774 species of macrofungi (54% of the Danish fungal species pool), 663 vascular plant species (42%), 254 bryophyte species (41%) and 200 lichen species (19%). For arthropods, we observed 330 spider species (58%), 123 carabid beetle species (37%) and 99 hoverfly species (33%). Overall, sample coverage was remarkably high across taxonomic groups and sufficient to capture substantial spatial variation in biodiversity across Denmark. This inventory is nationally unprecedented in detail and resulted in the discovery of 143 species with no previous record for Denmark. Comparison between plant OTUs detected in soil DNA and observed plant species confirmed the usefulness of carefully curated environmental DNA-data. Correlations among species richness for taxonomic groups were predominantly positive, but did not correlate well among all taxa suggesting differential and complex biotic responses to environmental variation.

Conclusions

We successfully and adequately sampled a wide range of diverse taxa along key environmental gradients across Denmark using an approach that includes multi-taxon biodiversity assessment and ecospace mapping. Our approach is applicable to assessments of biodiversity in other regions and biomes where species are structured along environmental gradient.

Continuity in the neural system supporting children's theory of mind development: Longitudinal links between task-independent EEG and task-dependent fMRI

Children's explicit theory of mind (ToM) understandings change over early childhood. We examined whether there is longitudinal stability in the neurobiological bases of ToM across this time period. A previous study found that source-localized resting EEG alpha attributable to the dorsal medial prefrontal cortex (DMPFC) and right temporoparietal junction (RTPJ) was associated with children's performance on a battery of theory of mind tasks. Here, we investigated a small subset of children (N = 12) in that original study as a preliminary investigation of whether behavioral measures of ToM performance, and/or EEG localized to the DMPFC or RTPJ predicted ToM-specific fMRI responses 3.5 years later. Results showed that preschoolers' behavioral ToM-performance positively predicted later ToM-specific fMRI responses in the DMPFC. Preschoolers' resting EEG attributable to the DMPFC also predicted later ToM-specific fMRI responses in the DMPFC. Given the small sample, results represent a first exploration and require replication. Intriguingly, they suggest that early maturation of the area of the DMPFC related to ToM reasoning is positively linked with its specific recruitment for ToM reasoning later in development, affording implications for characterizing conceptual ToM development, and its underlying neural supports.

Sequences in popular cinema generate inconsistent event segmentation

Popular movies have an event structure that includes scenes and sequences. Scenes are fashioned to be perceived as smoothly flowing, a feature called continuity. Discontinuity is said to occur when scene (event) boundaries are crossed. This article focuses on the structure and perception of sequences that have subscenes (i.e., scene-like components) but whose boundaries, unlike those of scenes, tend to demonstrate some perceived continuity. Although the structure of sequences has been addressed by film theory, this topic has not received psychological attention. Here, data are used from viewer judgments and physical measurements of 24 popular movies, released from 1940 to 2010. Each film was inspected for narrative shift patterns-that is, changes in location, character, or time-across shots. Sequences were determined by repeated shift types, common sound coverage, and the shorter durations of subscenes than of scenes. By these criteria, sequences have increased in movies over time. The results also show that viewer judgments of event boundaries diminish in the presence of music and of shorter and less modulated shot durations. These results fit snugly within event segmentation theory, and this categorization of movie sequences by narrative shifts can accommodate previous accounts of sequence structure.

Continuity and Change in Psychopathic Traits Among School-Aged Children with Conduct Problems

The three dimensions of psychopathic traits in childhood have been consistently associated with high levels of conduct problems among children. However, little is known about the continuity and change in psychopathic traits among children with conduct problems. This study aimed to examine the homotypic continuity and change of the three dimensions of psychopathic traits from 8 to 14 years old among 370 children (40.3% girls) who were identified at school as having conduct problems at study inception. Results supported the structural continuity of the tridimensional model of psychopathic traits and revealed that the callous-unemotional dimension is more stable than the two other dimensions. However, the levels of the three dimensions of psychopathic traits remained high over time among a substantial number of children with conduct problems. This study has implications regarding the longitudinal assessment of psychopathic traits within this specific population.

Process evaluation of a cluster randomised intervention in Swedish primary care: using care managers in collaborative care to improve care quality for patients with depression

Background

The collaborative care model with a care manager has previously generated beneficial results for patients with depression in terms of decreased burden of depression symptoms. A care manager function has been tested in Sweden in the PRIM-CARE RCT with successful results. The aim of the present study was to evaluate the process of implementing care managers in collaborative care for patients with depression in Swedish primary health care in the PRIM-CARE RCT.

Methods

The study followed UK Medical Research Council guidance for process evaluation.

Field notes from the implementation of the PRIM - CARE RCT were used, as well as data collected from five focus group discussions with General Practitioners (n = 29) and three focus group discussions with care managers (n = 11). Data were analysed with content analysis.

Results

Training sessions, careful preparation and extensive initial support to the care manager and staff at the Primary Care Centres were important ingredients in the implementation. The close access to facilitators, the recurrent peer support meetings, and the weekly newsletter strengthened the care manager function.

Conclusions

A complex intervention adapted to the Swedish primary care context focusing on a care manager function for patients with depression could be performed through a stepwise implementation process. Financial support from the health care regions included in the study helped to reduce the impact of identified barriers. This process evaluation has revealed new and important knowledge for primary care development concerning infrastructure and organization building, knowledge sharing, and facilitating factors and barriers.

Trial registration

NCT02378272 Care Manager – Coordinating Care for Person Centered Management of Depression in Primary Care (PRIM – CARE). Registered March 4 2015. Retrospectively registered.

Electronic supplementary material

The online version of this article (10.1186/s12875-019-0998-4) contains supplementary material, which is available to authorized users.

External support programs to improve rural drinking water service sustainability: A systematic review

Achieving sufficient, safe, continuously-available drinking water services in rural areas is a challenge, in high- and especially low-and middle-income countries. External support programs (ESPs) - which may include administrative, financial, and technical assistance - have been hypothesized to contribute to sustainable rural water services. While there are many descriptions of ESPs, a standard terminology and typology of ESP activities does not exist and the effect of ESP activities on system sustainability remains inadequately characterized. We conducted a systematic review of ESPs for rural drinking water systems to identify ESP terminology and describe ESP activities. Findings from 218 publications from low-, middle-, and high-income countries were analyzed. ESP terms were used inconsistently between regions and income classifications. There were few studies describing ESP activities related to mechanized piped water systems. Few studies quantitatively assess the effect of ESPs. Those that did found positive associations with functionality, household satisfaction, household participation, and financial stability. This review is the first comprehensive evaluation of the ESP literature and we derive a definition of external support programs and typology of ESP activities from the descriptions of ESPs. A common understanding of ESPs facilitates discussion and knowledge transfer between stakeholders. Consistent terminology creates a foundation for adapting ESPs to water services in community institutions and for mechanized piped water systems.

Change and Consistency of Self-Esteem in Early and Middle Adolescence in the Context of School Transition

Self-esteem is continuous and has stable characteristics, but it may also change, e.g., during transitions from one educational level to the next. In a prospective cross-sectional study over a year and a half, 250 Polish early adolescents (N = 109, 54 girls; mean age at T1 = 12.68 years, SD = 0.49) and middle adolescents (N = 141, 107 girls; mean age at T1 = 15.80, SD = 0.44) were tested three times using Harter’s Self-Perception Profile for Adolescents, assessing both global self-esteem and self-evaluation in eight domains. The change and consistency of self-esteem were analyzed, at both group and individual levels. At the group level, the following results were found: (1) continuity of self-esteem in five domains (scholastic competence, athletic competence, physical appearance, close friendship, and romantic appeal) and in global self-esteem and discontinuity in only three domains (social acceptance, job competence, and behavioral conduct); (2) significant inter-individual variation in the change not explained by age; and (3) higher self-esteem (in five domains) in early adolescents. At the individual level, the stability in most domains was weak, but was restored over the second year at the new school. The complexity of the developmental change and consistency in self-esteem in adolescence was highlighted, emphasizing the need for analyzing both group and individual change.

Body weight loss after surgery affects the continuity of adjuvant chemotherapy for pancreatic cancer

BACKGROUND

Postoperative chemotherapy is beneficial for many pancreatic cancer patients. However, some patients require dose reduction or the discontinuation of adjuvant chemotherapy because of adverse treatment-related effects. In this study, we aimed to evaluate two main outcomes. First, we evaluated the clinicopathological factors affecting patient disease-free survival (DFS) and overall survival (OS) following upfront surgery. Second, we evaluated the factors that influence the continuity of adjuvant chemotherapy.

METHODS

Fifty-four patients with resected pancreatic cancer were enrolled. First, we evaluated the clinicopathological factors affecting postoperative survival using the Kaplan-Meier method and Cox regression method. Next, factors affecting the continuity of adjuvant chemotherapy were analyzed using multiple logistic regression analysis.

RESULTS

Univariate and multivariate analyses revealed that positive LN metastasis (HR (95% CI) 6.329 (2.381-16.95); p < 0.001) and relative dose intensity (RDI) < 80% for adjuvant chemotherapy (HR (95% CI) 5.154 (1.761-15.15); p = 0.003) were independent predictive factors for DFS. Regarding OS, extended dissection of the nerve plexus around the superior mesenteric artery (SMA) (HR (95% CI) 4.504 (1.721-11.76); p = 0.002), positive microscopic surgical margin (HR (95% CI) 5.565 (1.724-17.96); p = 0.004), and adjuvant chemotherapy of RDI < 80% (HR (95% CI) 3.534 (1.135-2.667); p = 0.029) were also independent predictive factors. Moreover, the level of RDI significantly correlated with DFS and OS. Multiple logistic regression analysis revealed that low RDI was significantly associated with postoperative body weight loss (BWL) ≥ 10%.

CONCLUSIONS

The following factors were significantly associated with poor survival: extended dissection of the nerve plexus around the SMA, lymph node metastasis, residual tumor, and RDI of the adjuvant chemotherapy. Patient's prognosis with adjuvant chemotherapy of RDI < 80% was worse. BWL ≥10% was the most important factor affecting the continuity of adjuvant chemotherapy. Perioperative nutritional intervention is necessary for patients who receive adjuvant chemotherapy for advanced pancreatic cancer.

Policy, evidence and practice for post-birth care plans: a scoping review

BACKGROUND

Postnatal care continually attracts less attention than other parts of the childbirth year. Many regions consistently report poor maternal satisfaction with care in the post-birth period. Despite policy recommending post-birth planning be part of maternity services there remains a paucity of empirical evidence and reported experience using post-birth care plans. There is a need to report on post-birth care plans, identify policy and guideline recommendations and gaps in the current empirical research, as well as experiences creating and using post-birth care plans.

METHODS

This scoping review accessed empirical literature and government and professional documents from 2005 to present day to build a picture of current understanding of policy imperatives and existent published empirical evidence. The review was informed by the Arksey and O'Malley approach employing five stages.

RESULTS

The review revealed that post-birth care planning is promoted extensively in health policy and there is emergent evidence for its implementation. Yet there is a paucity of practice examples and only one evaluation in the UK. The review identified four overarching themes: 'Positioning of post-birth care planning in policy; 'Content and approach'; 'Personalised care and relational continuity'; Feasibility and acceptability in practice'.

CONCLUSIONS

Empirical evidence supports post-birth care planning, but evidence is limited leaving many unanswered questions. Health care policy reflects evidence and recommends implementation of post-birth care plans, however, there remains a paucity of information in relation to post-birth care planning experience and implementation in practice. Women need consistent information and advice and value personalised care. Models of care that facilitate these needs are focused on relational continuity and lead to greater satisfaction. It remains unclear if a combination of post-birth care planning and continuity of carer interventions would improve post-birth outcomes and satisfaction. Gaps in research knowledge and practice experience are identified and implications for practice and further research suggested.

Stereotypes About Enterotype: the Old and New Ideas

In 2011, the term “enterotype” first appeared to the general public in Nature, which refers to stratification of human gut microbiota. However, with more studies on enterotypes conducted nowadays, doubts about the existence and robustness of enterotypes have also emerged. Here we reviewed current opinions about enterotypes from both conceptual and analytical points of view. We firstly illustrated the definition of the enterotype and various factors influencing enterotypes, such as diet, administration of antibiotics, and age. Then we summarized lines of evidence that pose the concept against the enterotype, and described the current methods for enterotype analysis. Finally, we showed that the concept of enterotype has been extended to other ecological niches. Based on current studies on enterotypes, it has been clear that more studies with larger sample sizes are needed to characterize the enterotypes. Improved computational methods are also required to build sophisticated models, reflecting the dynamics and resilience of enterotypes.