Moderating the Morbidity of Divorce

1988 ◽  
Vol 33 (6) ◽  
pp. 443-452 ◽  
Author(s):  
Quentin Rae-Grant ◽  
Bonnie E. Robson
Keyword(s):  
Mental Health ◽  
High Risk ◽  
Developmental Stage ◽  
High Stress ◽  
High Risk Population ◽  
Physical And Mental Health ◽  
Negative Effects ◽  
Risk Population ◽  
Preventive Work ◽  
Competent Functioning

Divorce is frequent in our society. It is a “marker” of high stress periods that precede and follow it. The events surrounding it have clear negative effects on the physical and mental health of all those involved. The issues and the reactions, different for fathers and mothers and for children, are determined by the sex and developmental stage. The effects are interactive and events subsequent to the divorce influence the restoration of competent functioning. This paper examines these differential effects, methods of helping in the resolution process and opportunities of preventive work with this high risk population.

scholarly journals Population Health Management to identify and characterise ongoing health need for high-risk individuals shielded from COVID-19: a cross-sectional cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e041370
Author(s):  
Charlie Kenward ◽  
Adrian Pratt ◽  
Sam Creavin ◽  
Richard Wood ◽  
Jennifer A Cooper
Keyword(s):  
Mental Health ◽  
High Risk ◽  
Population Health ◽  
Health Management ◽  
High Risk Group ◽  
High Risk Population ◽  
Care Providers ◽  
Cross Sectional ◽  
Risk Population ◽  
Population Health Management

ObjectivesTo use Population Health Management (PHM) methods to identify and characterise individuals at high-risk of severe COVID-19 for which shielding is required, for the purposes of managing ongoing health needs and mitigating potential shielding-induced harm.DesignIndividuals at ‘high risk’ of COVID-19 were identified using the published national ‘Shielded Patient List’ criteria. Individual-level information, including current chronic conditions, historical healthcare utilisation and demographic and socioeconomic status, was used for descriptive analyses of this group using PHM methods. Segmentation used k-prototypes cluster analysis.SettingA major healthcare system in the South West of England, for which linked primary, secondary, community and mental health data are available in a system-wide dataset. The study was performed at a time considered to be relatively early in the COVID-19 pandemic in the UK.Participants1 013 940 individuals from 78 contributing general practices.ResultsCompared with the groups considered at ‘low’ and ‘moderate’ risk (ie, eligible for the annual influenza vaccination), individuals at high risk were older (median age: 68 years (IQR: 55–77 years), cf 30 years (18–44 years) and 63 years (38–73 years), respectively), with more primary care/community contacts in the previous year (median contacts: 5 (2–10), cf 0 (0–2) and 2 (0–5)) and had a higher burden of comorbidity (median Charlson Score: 4 (3–6), cf 0 (0–0) and 2 (1–4)). Geospatial analyses revealed that 3.3% of rural and semi-rural residents were in the high-risk group compared with 2.91% of urban and inner-city residents (p<0.001). Segmentation uncovered six distinct clusters comprising the high-risk population, with key differentiation based on age and the presence of cancer, respiratory, and mental health conditions.ConclusionsPHM methods are useful in characterising the needs of individuals requiring shielding. Segmentation of the high-risk population identified groups with distinct characteristics that may benefit from a more tailored response from health and care providers and policy-makers.

Mental Health Literacy and Confidence in a Sample of Student Athletic Therapists

2021 ◽  
pp. 1-10
Author(s):  
Philip Sullivan ◽  
Laura Tennant
Keyword(s):  
Mental Health ◽  
Health Literacy ◽  
High Risk ◽  
Student Athletes ◽  
Mental Health Literacy ◽  
High Risk Population ◽  
Risk Population ◽  
Student Therapists ◽  
Mental Health Referral ◽  
The Relationship

Intercollegiate student-athletes appear to be a high-risk population with respect to mental health. Student athletic therapists are one of the groups with whom these athletes may be comfortable disclosing concerns. The current study investigated the relationship between mental health literacy and mental health referral efficacy in a sample of intercollegiate student therapists. One hundred and eleven student athletic therapists (81 female, 29 male, 1 nondiscloure) competed a revised version of the multicomponent mental health literacy measure and a four-item measure of mental health referral efficacy. T tests revealed statistically significant differences in mental health literacy by gender and personal history, and a multiple linear regression revealed a significant model predicting referral efficacy from mental health literacy. There are several implications of these results, particularly when working with a high-risk population of student-athletes.

scholarly journals Discrimination and Health: The Mediating Effect of Acculturative Stress

2021 ◽  
Vol 18 (10) ◽  
pp. 5312
Author(s):  
Alfonso Urzúa ◽  
Alejandra Caqueo-Urízar ◽  
Diego Henríquez ◽  
David R. Williams
Keyword(s):  
Mental Health ◽  
Racial Discrimination ◽  
Acculturative Stress ◽  
Short Form ◽  
Cross Sectional Study ◽  
Ethnic Discrimination ◽  
Mediating Effect ◽  
Physical And Mental Health ◽  
Negative Effects ◽  
Cross Sectional

There is not much evidence on the effects of south–south migration and its consequences on physical and mental health. Our objective was to examine the mediating role of Acculturative Stress in the association between ethnic discrimination and racial discrimination with physical and mental health. This research is a non-experimental, analytical, cross-sectional study. A total of 976 adult Colombian migrants living in Chile were interviewed. We used the Everyday Discrimination Scale, the acculturative stress scale, and the Medical Outcomes Study Short Form (SF-12) for health status; we found that racial and ethnic discrimination had a negative effect on physical and mental health. In the simultaneous presence of both types of discrimination, racial discrimination was completely absorbed by ethnic discrimination, the latter becoming a total mediator of the effect of racial discrimination on mental and physical health. Our findings are consistent with the literature, which suggests that there are various types of discrimination which, individually or in their intersectionality, can have negative effects on health.

scholarly journals Cisplatin +/− rucaparib after preoperative chemotherapy in patients with triple-negative or BRCA mutated breast cancer

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Maitri Kalra ◽  
Yan Tong ◽  
David R. Jones ◽  
Tom Walsh ◽  
Michael A. Danso ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Neoadjuvant Therapy ◽  
Triple Negative ◽  
Residual Disease ◽  
Disease Free Survival ◽  
Parp Inhibition ◽  
High Risk Population ◽  
Risk Population ◽  
The Impact

AbstractPatients with triple-negative breast cancer (TNBC) who have residual disease after neoadjuvant therapy have a high risk of recurrence. We tested the impact of DNA-damaging chemotherapy alone or with PARP inhibition in this high-risk population. Patients with TNBC or deleterious BRCA mutation (TNBC/BRCAmut) who had >2 cm of invasive disease in the breast or persistent lymph node (LN) involvement after neoadjuvant therapy were assigned 1:1 to cisplatin alone or with rucaparib. Germline mutations were identified with BROCA analysis. The primary endpoint was 2-year disease-free survival (DFS) with 80% power to detect an HR 0.5. From Feb 2010 to May 2013, 128 patients were enrolled. Median tumor size at surgery was 1.9 cm (0–11.5 cm) with 1 (0–38) involved LN; median Residual Cancer Burden (RCB) score was 2.6. Six patients had known deleterious BRCA1 or BRCA2 mutations at study entry, but BROCA identified deleterious mutations in 22% of patients with available samples. Toxicity was similar in both arms. Despite frequent dose reductions (21% of patients) and delays (43.8% of patients), 73% of patients completed planned cisplatin. Rucaparib exposure was limited with median concentration 275 (82–4694) ng/mL post-infusion on day 3. The addition of rucaparib to cisplatin did not increase 2-year DFS (54.2% cisplatin vs. 64.1% cisplatin + rucaparib; P = 0.29). In the high-risk post preoperative TNBC/BRCAmut setting, the addition of low-dose rucaparib did not improve 2-year DFS or increase the toxicity of cisplatin. Genetic testing was underutilized in this high-risk population.

Dementia screening in elderly high-risk patients following heart failure decompensation may predict unfavorable long-term clinical outcomes

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Stepien ◽  
P Furczynska ◽  
M Zalewska ◽  
K Nowak ◽  
A Wlodarczyk ◽  
...  
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Clinical Outcomes ◽  
Mmse Score ◽  
Coronary Revascularization ◽  
High Risk Population ◽  
Risk Population ◽  
History Of

Abstract Background Recently heart failure (HF) has been found to be a new dementia risk factor, nevertheless their relations in patients following HF decompensation remain unknown. Purpose We sought to investigate whether a screening diagnosis for dementia (SDD) in this high-risk population may predict unfavorable long-term clinical outcomes. Methods 142 patients following HF decompensation requiring hospitalization were enrolled. Within a median time of 55 months all patients were screened for dementia with ALFI-MMSE scale whereas their compliance was assessed with the Morisky Medication Adherence Scale. Any incidents of myocardial infarction, coronary revascularization, stroke or transient ischemic attack (TIA), revascularization, HF hospitalization and bleedings during follow-up were collected. Results SDD was established in 37 patients (26%) based on the result of an ALFI-MMSE score of &lt;17 points. By multivariate analysis the lower results of the ALFI-MMSE score were associated with a history of stroke/TIA (β=−0.29, P&lt;0.001), peripheral arterial disease (PAD) (β=−0.20, P=0.011) and lower glomerular filtration rate (β=0.24, P=0.009). During the follow-up, patients with SDD were more often rehospitalized following HF decompensation (48.7% vs 28.6%, P=0.014) than patients without SDD, despite a similar level of compliance (P=0.25). Irrespective of stroke/TIA history, SDD independently increased the risk of rehospitalization due to HF decompensation (HR 2.22, 95% CI 1.23–4.01, P=0.007). Conclusions As shown for the first time in literature patients following decompensated HF, a history of stroke/TIA, PAD and impaired renal function independently influenced SDD. In this high-risk population, SDD was not associated with patients' compliance but irrespective of the stroke/TIA history it increased the risk of recurrent HF hospitalization. The survival free of rehospitalization Funding Acknowledgement Type of funding source: None

scholarly journals Impact of national influenza vaccination strategy in severe influenza outcomes among the high-risk Portuguese population

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Ausenda Machado ◽  
Irina Kislaya ◽  
Amparo Larrauri ◽  
Carlos Matias Dias ◽  
Baltazar Nunes
Keyword(s):  
High Risk ◽  
Influenza Vaccination ◽  
Seasonal Influenza ◽  
Vaccine Coverage ◽  
Vaccination Strategy ◽  
High Risk Population ◽  
Risk Population ◽  
Seasonal Influenza Vaccination ◽  
Severe Influenza ◽  
The Impact

Abstract Background All aged individuals with a chronic condition and those with 65 and more years are at increased risk of severe influenza post-infection complications. There is limited research on cases averted by the yearly vaccination programs in high-risk individuals. The objective was to estimate the impact of trivalent seasonal influenza vaccination on averted hospitalizations and death among the high-risk population in Portugal. Methods The impact of trivalent seasonal influenza vaccination was estimated using vaccine coverage, vaccine effectiveness and the number of influenza-related hospitalizations and deaths. The number of averted events (NAE), prevented fraction (PF) and number needed to vaccinate (NVN) were estimated for seasons 2014/15 to 2016/17. Results The vaccination strategy averted on average approximately 1833 hospitalizations and 383 deaths per season. Highest NAE was observed in the ≥65 years population (85% of hospitalizations and 95% deaths) and in the 2016/17 season (1957 hospitalizations and 439 deaths). On average, seasonal vaccination prevented 21% of hospitalizations in the population aged 65 and more, and 18.5% in the population with chronic conditions. The vaccination also prevented 29% and 19.5% of deaths in each group of the high-risk population. It would be needed to vaccinate 3360 high-risk individuals, to prevent one hospitalization and 60,471 high-risk individuals to prevent one death. Conclusion The yearly influenza vaccination campaigns had a sustained positive benefit for the high-risk population, reducing hospitalizations and deaths. These results can support public health plans toward increased vaccine coverage in high-risk groups.

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