In this Perspective, Mark Tomlinson and Marguerite Marlow argue that equitable improvements in mental health outcomes cannot be achieved without first dismantling colonial and paternalistic ...approaches to global mental health.
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This multicenter study compared a prenatal assay of cell-free DNA with a standard method of screening for trisomies among women at average risk. The positive predictive values of cfDNA testing and ...standard screening for trisomy 21 were 80.9% and 3.4%, respectively.
Screening for fetal aneuploidy with the use of cell-free DNA (cfDNA) obtained from maternal plasma was introduced in 2011. Such screening has been reported to have a detection rate for trisomy 21 (Down's syndrome) of more than 99%, with a false positive rate as low as 0.1%.
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Thus, cfDNA testing appears to represent a substantial improvement over traditional multiple-marker screening. In practice, the use of this test could result in a significant reduction in diagnostic procedures.
Although several large proof-of-principle studies have confirmed the high sensitivity and specificity of cfDNA testing for the detection of trisomy 21, most of these . . .
Objective We sought to evaluate performance of a noninvasive prenatal test for fetal trisomy 21 (T21) and trisomy 18 (T18). Study Design A multicenter cohort study was performed whereby cell-free DNA ...from maternal plasma was analyzed. Chromosome-selective sequencing on chromosomes 21 and 18 was performed with reporting of an aneuploidy risk (High Risk or Low Risk) for each subject. Results Of the 81 T21 cases, all were classified as High Risk for T21 and there was 1 false-positive result among the 2888 normal cases, for a sensitivity of 100% (95% confidence interval CI, 95.5–100%) and a false-positive rate of 0.03% (95% CI, 0.002–0.20%). Of the 38 T18 cases, 37 were classified as High Risk and there were 2 false-positive results among the 2888 normal cases, for a sensitivity of 97.4% (95% CI, 86.5–99.9%) and a false-positive rate of 0.07% (95% CI, 0.02–0.25%). Conclusion Chromosome-selective sequencing of cell-free DNA and application of an individualized risk algorithm is effective in the detection of fetal T21 and T18.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Youth suicide prevention in high-schools and universities is a public health priority. Our aim was to propose a research agenda to advance evidence-based suicide prevention in high-schools and ...universities by synthesizing and critically reviewing the research focus and methodologies used in existing intervention studies.
Fourteen databases were systematically searched to identify studies which evaluate suicide prevention interventions delivered on high-school or university campuses, with before and after measures. Data from included studies (n = 43) were extracted to identify what, where, how and for whom interventions have been tested. Narrative synthesis was used to critically evaluate research focus and methodology. Study quality was assessed.
Research has focused primarily on selective interventions, with less attention on indicated and universal interventions. Most evidence comes from North America and high-income countries. The target of interventions has been: non-fatal suicidal behaviour; confidence and ability of staff/students to intervene in a suicidal crisis; suicide-related knowledge and attitudes; and suicide-related stigma. No studies included suicide deaths as an outcome, evaluated eco-systemic interventions, explored how context influences implementation, used multisite study designs, or focused explicitly on LGBTQ+ youth. Two studies evaluated digital interventions. Quality of the majority of studies was compromised by lack of methodological rigour, small samples, and moderate/high risk of bias. Interventions often assume the existence of an external well-functioning referral pathway, which may not be true in low-resource settings.
To advance evidence-based suicide prevention in educational settings we need to: conduct more high-quality clinical and pragmatic trials; promote research in low- and middle-income countries; test targeted interventions for vulnerable populations (like LGBTQ+ youth), evaluate interventions where death by suicide is the primary outcome; include translational studies and use implementation science to promote intervention uptake; evaluate the potential use of digital and eco-systemic interventions; and conduct multisite studies in diverse cultural settings.
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Mark Tomlinson and Crick Lund analyze why mental health does not garner the international attention, political priority, or funding that it deserves, and offer suggestions to improve the visibility ...of global mental health.
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Summary Points * Despite hundreds of mHealth pilot studies, there has been insufficient programmatic evidence to inform implementation and scale-up of mHealth. * We discuss what constitutes ...appropriate research evidence to inform scale up. * Potential innovative research designs such as multi-factorial strategies, randomized controlled trials, and data farming may provide this evidence base. * We make a number of recommendations about evidence, interoperability, and the role of governments, private enterprise, and researchers in relation to the scale up of mHealth. Interventions categorized under the rubric "mobile health" or "mHealth"--broadly defined as medical and public health practice supported by mobile devices 2--span a variety of applications ranging from the use of mobile phones to improve point of service data collection 3, care delivery 4, and patient communication 5 to the use of alternative wireless devices for real-time medication monitoring and adherence support 6.
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Mobile health, also known as m-health,1 has been defined by the Global Observatoy for e-health of the World Health Organization as "medical and public health practice supported by mobile devices, ...such as mobile phones, patient monitoring devices, personal digital assistants and other wireless devices". To lay the groundwork for establishing an evidence base for the cost-effectiveness and programme utility of m-health innovations, the authors outline seven key recommendations aimed at reducing resource wastage and programme duplication: 1. M-health needs to develop an evidence base. 2. M-health systems should be interoperable with existing e-health initiatives. 3. M-health should adopt and implement the same standards already present in e-health. 4. M-health should take a participatory approach. 5. M-health should promote equity in health. 6. M-health programmes need to move towards sustainability. 7. M-health needs to focus on health, not on the technology.
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CEKLJ, DOBA, IZUM, KILJ, NUK, ODKLJ, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Improved technology and advances in clinical testing have resulted in increased detection rates of congenital anomalies during pregnancy, resulting in more parents being confronted with the ...possibility of terminating a pregnancy for this reason. There is a large body of research on the psychological experience and impact of terminating a pregnancy for fetal anomaly. However, there remains a lack of evidence on the holistic healthcare experience of parents in this situation. To develop a comprehensive understanding of the healthcare experiences and needs of parents, this systematic review sought to summarise and appraise the literature on parents' experiences following a termination of pregnancy for fetal anomaly.
What are the healthcare experiences and needs of parents who undergo a termination of pregnancy following an antenatal diagnosis of a fetal anomaly?
A systematic review was undertaken with searches completed across six multi-disciplinary electronic databases (Medline, Embase, PsycINFO, CINAHL, Web of Science, and Cochrane). Eligible articles were qualitative, quantitative or mixed methods studies, published between January 2010 and August 2021, reporting the results of primary data on the healthcare experiences or healthcare needs in relation to termination of pregnancy for fetal anomaly for either, or both parents. Findings were synthesised using Thematic Analysis.
A total of 30 articles were selected for inclusion in this review of which 24 were qualitative, five quantitative and one mixed-methods. Five overarching themes emerged from the synthesis of findings: (1) Contextual impact on access to and perception of care, (2) Organisation of care, (3) Information to inform decision making, (4) Compassionate care, and (5) Partner experience.
Compassionate healthcare professionals who provide non-judgemental and sensitive care can impact positively on parents' satisfaction with the care they receive. A well organised and co-ordinated healthcare system is needed to provide an effective and high-quality service.
PROSPERO registration number: CRD42020175970 .
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