BACKGROUND: Chronic kidney disease (CKD) is a common health problem associated with increased risk of cardiovascular disease (CVD), end-stage kidney disease (ESKD), and premature death. It is estimated that one-third of people aged \u226570 years have CKD globally, many of whom are undiagnosed, but little is known about the value of screening. AIM: To compare the risk of adverse health outcomes between people with an existing diagnosis of CKD and those identified through screening, and identify factors associated with mortality in CKD. DESIGN & SETTING: Prospective cohort study of 892 primary care patients aged \u226560 years with CKD (existing and screening detected) in Oxfordshire, with data linkage to civil death registry and secondary care. METHOD: Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazard models to compare the risk of all-cause mortality, hospitalisation, CVD, ESKD separately, and as a composite between CKD groups, as well as to identify factors associated with mortality. RESULTS: After a median follow-up of 3-5 years, 49 people died, 512 were hospitalised, 78 had an incident CVD event, and none had an ESKD event. There was no difference in the composite outcome between those with existing CKD and those identified through screening (HR 0.94, 95% CI = 0.67 to 1.33). Older age (HR 1.10, 95% CI = 1.06 to 1.15), male sex (HR 2.31, 95% CI = 1.26 to 4.24), and heart failure (HR 5.18, 95% CI = 2.45 to 10.97) were associated with increased risk of death. CONCLUSION: Screening older people for CKD may be of value, as their risk of short-term mortality, hospitalisation, and CVD is comparable with people routinely diagnosed. Larger studies with longer follow-up in more diverse and representative populations of older adults are needed to corroborate these findings.
\n \n\n \n \nBACKGROUND: The impacts of parental bipolar disorder (BD) on families and children highlight the need to understand how best to talk to children about their parents' diagnosis, especially as their developmental capacity for understanding grows. This qualitative study aims to explore the strategies, challenges, and support needs of parents in relation to communicating with their children (5-12 years) about BD, in order to inform the development of further interventions and resources. METHODOLOGY: Purposive and snowball sampling strategies were used to recruit parents with BD, their partners, and stakeholders who support parents with BD. Recruitment occurred via social media, emails, and community outreach between April 2022 and April 2023. Semi-structured interviews were conducted with 11 parents with BD or non-BD partners and 12 charity workers or mental health professionals. The interview guides explored participants' lived experiences and professional insights into communicating about parental BD with children. Data were analysed using reflexive, inductive, thematic analysis. RESULT: Participants identified several benefits of sharing parental BD diagnoses with children, including fostering understanding, adaptation, compassion, and strengthening family relationships. However, they also noted challenges such as uncertainty, stigma, and potential distress for children. To make communication effective, participants emphasised the importance of age-appropriate dialogue, addressing children's concerns, providing reassurance, and preparing them for future episodes. They highlighted that transparent, interactive communication, thoughtful timing, and collaboration with family members and professionals are crucial for tailoring the process to each family's unique needs. CONCLUSION: Our findings underscore the complexities of communicating a parental BD diagnosis to children, highlighting both the potential benefits and challenges. Participants emphasised the need for developing interventions and policies specifically tailored to address the particular communication needs of families impacted by BD.
\n \n\n \n \nThe Parent Overprotection Measure (POM) is a promising scale to measure parent overprotection toward a child from the parent's perspective. However, no Japanese translation of the scale has been developed, and whether the POM can be applied to a Japanese population is unknown. This study translated the POM into Japanese and examined its psychometric properties. Parents of 380 children aged 4 to 7\u00a0years (including 190 mothers and 190 fathers) completed online questionnaires. Exploratory and confirmatory factor analyses (CFA) indicated that the Japanese translation of the POM has a bi-factor structure, including one general factor (general overprotection) and two specific factors (care/attention and control/prevention). The measurement invariance of reports from mothers' and fathers' perspectives was confirmed by multiple group CFA. The McDonald's Omega was acceptable for all factors, but the general overprotection factor explained most scale variance. Pearson's correlation coefficients were more than .20 between the control/prevention factor and child anxiety symptoms in both mother and father reports. The correlation between the control/prevention factor and parent anxiety according to fathers' reports also exceeded .20. These results provided the factor structure and supported the reliability of the POM among a Japanese population; however, further investigation of the validity of the scale is needed.
\n \n\n \n \nThe concept of 'peer support' has generated much interest in mainstream health services. In policy discourse, peer-based initiatives are often described as 'empowering' and seen as contributing to more 'democratic' and 'holistic' forms of care. Focusing on group clinics as one such example, this article challenges the assumption that peer-based initiatives represent a straightforward and unequivocal 'good' when embedded in clinical care. We draw on qualitative data from three studies (2016-2025), including 118 interviews and ethnographic observation in 59 in-person, remote, and hybrid group clinics for diabetes and menopause at 5 primary and secondary care sites in England. Adopting a sociomaterial lens, we uncover how different forms and practices of peerhood emerge (or not) in the circumstances through which these clinics are materialised. We show how biomedical artefacts (e.g. diabetes test results, menopause symptom lists) used as part of consulting play a key role in constituting forms of affiliation and differentiation between patients, in turn determining whether and what forms of peer 'support' (e.g. disciplinary, affirmative) are accomplished. We go on to explore how being presented as a peer as part of clinical consulting brings about new roles and responsibilities for patients, and introduce the term 'experiential caring' to denote a new mode of consulting that mobilises roles, practices, and subjectivities associated with peerhood.
\n \n\n \n \nOBJECTIVES: The postdischarge period is crucial for vulnerable newborns at risk of morbidity, readmission and mortality in low- and middle-income countries (LMICs). Addressing gaps in care during this period could improve outcomes. This review consolidates evidence on caregiver information needs and relevant information tools used in postdischarge care for vulnerable newborns in LMICs. DESIGN: Scoping review using the methodological framework developed by Arksey and O'Malley. DATA SOURCES: We searched six databases for relevant articles published in English between 2001 and 2021. Additional articles were identified through citation and reference checking. ELIGIBILITY CRITERIA: Articles on postdischarge care for newborns in LMICs, excluding economic and technical development studies, discharge to other healthcare facilities (rather than to home) and maternal-focused studies. DATA EXTRACTION AND SYNTHESIS: Data extraction followed Arksey and O'Malley's data charting method. Using a descriptive synthesis approach, heterogeneous data were collated in narrative format. RESULTS: From 5190 articles, 22 were included. Only a small number of articles discussed caregiver challenges, like receiving insufficient information at discharge which led to uncertainty in caring for vulnerable newborns. Caregivers had a number of needs in relation to maternal and newborn care, including in terms of coordination of follow-up care. Although a number of tools have been used to support relevant needs (for postnatal care in general rather than specifically for postdischarge care of vulnerable newborns), these have shown mixed effectiveness due to challenges with completeness, lack of training and support, supply chain issues and cultural barriers to adoption, such as preference for alternative providers. CONCLUSION: Our understanding of postdischarge information needs for those looking after vulnerable newborns in LMICs remains limited. More effective use of information tools could help address some of these needs and contribute towards reducing neonatal mortality rates.
\n \n\n \n \nChildren and adolescents exposed to traumatic events are at high risk of developing post-traumatic stress disorder (PTSD). With the rare exception of young children, their PTSD presentations at the symptom level are similar to those of trauma-exposed adults, as are their patterns of psychiatric comorbidity, particularly for adolescents. Untreated, at least a significant proportion will carry on with symptoms at or above the diagnostic threshold or at sub-threshold levels that are still clinically impairing. The presence of untreated or poorly treated PTSD symptoms leaves the young person at significantly increased risk of developing other psychiatric disorders, a worsening of any pre-existing conditions, and with greater long-term impairments in education, family, and peer functioning. Fortunately, evidence-based treatments exist with the first-line recommendation being trauma-focused cognitive behavioural therapies, with a growing body of evidence for the efficacy of eye movement desensitization and reprocessing therapy (EMDR). This chapter provides an update on the state of the literature with respect to the evidence base for trauma-focused cognitive behavioral therapy (CBT), and in particular, for an explicitly cognitive approach, originally developed for use with adults and successfully adapted for use with children and adolescents across the age range. The chapter describes the theoretical underpinning for this approach, guidance on reliving (a form of exposure to update the trauma memory) and the modification of trauma-related beliefs (two primary targets in treatment), parental involvement in treatment, dealing with comorbidity, and a case example.
\n \n\n \n \nBACKGROUND: Hypertension is an important risk factor for subsequent cardiovascular events, including ischaemic and haemorrhagic stroke, myocardial infarction, and heart failure, as well as chronic kidney disease, cognitive decline, and premature death. Overall, the use of antihypertensive medications has led to a reduction in cardiovascular disease, morbidity rates, and mortality rates. However, the use of antihypertensive medications is also associated with harms, especially in older people, including the development of adverse drug reactions and drug-drug interactions, and can contribute to increasing medication-related burden. As such, discontinuation of antihypertensives may be considered appropriate in some older people. OBJECTIVES: To evaluate the effects of withdrawal of antihypertensive medications used for hypertension or primary prevention of cardiovascular disease in older adults. SEARCH METHODS: For this update, we searched the Cochrane Hypertension Specialised Register, CENTRAL (2022, Issue 9), Ovid MEDLINE, Ovid Embase, the WHO ICTRP, and ClinicalTrials.gov up to October 2022. We also conducted reference checking and citation searches, and contacted study authors to identify any additional studies when appropriate. There were no language restrictions on the searches. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of withdrawal versus continuation of antihypertensive medications used for hypertension or primary prevention of cardiovascular disease in older adults (defined as 50 years of age and over). Eligible participants were living in the community, residential aged care facilities, or based in hospital settings. We included trials evaluating the complete withdrawal of all antihypertensive medication, as well as those focusing on a dose reduction of antihypertensive medication. DATA COLLECTION AND ANALYSIS: We compared the intervention of discontinuing or reducing the dose of antihypertensive medication to continuing antihypertensive medication using mean differences (MD) and 95% confidence intervals (95% CIs) for continuous variables, and Peto odds ratios (ORs) and 95% CI for binary variables. Our primary outcomes were mortality, myocardial infarction, and the development of adverse drug reactions or adverse drug withdrawal reactions. Secondary outcomes included hospitalisation, stroke, blood pressure (systolic and diastolic), falls, quality of life, and success in withdrawing from antihypertensives. Two review authors independently, and in duplicate, conducted all stages of study selection, data extraction, and quality assessment. MAIN RESULTS: We identified no new studies in this update. Six RCTs from the original review met the inclusion criteria and were included in the review (1073 participants). Study duration and follow-up ranged from 4 weeks to 56 weeks. Meta-analysis of studies showed that discontinuing antihypertensives, compared to continuing, may result in little to no difference in all-cause mortality (OR 2.08, 95% CI 0.79 to 5.46; P = 0.14, I2 = 0%; 4 studies, 630 participants; low certainty of evidence), and that the evidence is very uncertain about the effect on myocardial infarction (OR 1.86, 95% CI 0.19 to 17.98; P = 0.59, I2 = 0%; 2 studies, 447 participants; very low certainty of evidence). Meta-analysis was not possible for the development of adverse drug reactions and withdrawal reactions; the evidence is very uncertain about the effect of antihypertensive discontinuation on the risk of adverse drug reactions (very low certainty of evidence), and the included studies did not assess adverse drug withdrawal reactions specifically. One study reported on hospitalisations; discontinuing antihypertensives may result in little to no difference in hospitalisation (OR 0.83, 95% CI 0.33 to 2.10; P = 0.70; 1 study, 385 participants; low certainty of evidence). Meta-analysis showed that discontinuing antihypertensives may result in little to no difference in stroke (OR 1.44, 95% CI 0.25 to 8.35; P = 0.68, I2 = 6%; 3 studies, 524 participants; low certainty of evidence). Blood pressure may be higher in the discontinuation group than the continuation group (systolic blood pressure: MD 9.75 mmHg, 95% CI 7.33 to 12.18; P < 0.001, I2 = 67%; 5 studies, 767 participants; low certainty of evidence; and diastolic blood pressure: MD 3.5 mmHg, 95% CI 1.82 to 5.18; P < 0.001, I2 = 47%; 5 studies, 768 participants; low certainty of evidence). No studies reported falls. The sources of bias included selective reporting (reporting bias), lack of blinding of outcome assessment (detection bias), incomplete outcome data (attrition bias), and lack of blinding of participants and personnel (performance bias). AUTHORS' CONCLUSIONS: The main conclusions from the 2020 review still apply. Discontinuing antihypertensives may result in little to no difference in mortality, hospitalisation, and stroke. The evidence is very uncertain about the effect of discontinuing antihypertensives on myocardial infarction and adverse drug reactions and adverse drug withdrawal reactions. Discontinuing antihypertensives may result in an increase in blood pressure. There was no information about the effect on falls. The evidence was of low to very low certainty, mainly due to small studies and low event rates. These limitations mean that we cannot draw any firm conclusions about the effect of deprescribing antihypertensives on these outcomes. Future research should focus on populations with the greatest uncertainty of the benefit:risk ratio for the use of antihypertensive medications, such as those with frailty, older age groups, and those taking polypharmacy, and measure clinically important outcomes such as adverse drug events, falls, and quality of life.
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