To identify the strategies and contextual factors that enable optimal engagement of patients in the design, delivery, and evaluation of health services.
We searched MEDLINE, EMBASE, CINAHL, Cochrane, ...Scopus, PsychINFO, Social Science Abstracts, EBSCO, and ISI Web of Science from 1990 to 2016 for empirical studies addressing the active participation of patients, caregivers, or families in the design, delivery and evaluation of health services to improve quality of care. Thematic analysis was used to identify (1) strategies and contextual factors that enable optimal engagement of patients, (2) outcomes of patient engagement, and (3) patients' experiences of being engaged.
Forty-eight studies were included. Strategies and contextual factors that enable patient engagement were thematically grouped and related to techniques to enhance design, recruitment, involvement and leadership action, and those aimed to creating a receptive context. Reported outcomes ranged from educational or tool development and informed policy or planning documents (discrete products) to enhanced care processes or service delivery and governance (care process or structural outcomes). The level of engagement appears to influence the outcomes of service redesign-discrete products largely derived from low-level engagement (consultative unidirectional feedback)-whereas care process or structural outcomes mainly derived from high-level engagement (co-design or partnership strategies). A minority of studies formally evaluated patients' experiences of the engagement process (n = 12; 25%). While most experiences were positive-increased self-esteem, feeling empowered, or independent-some patients sought greater involvement and felt that their involvement was important but tokenistic, especially when their requests were denied or decisions had already been made.
Patient engagement can inform patient and provider education and policies, as well as enhance service delivery and governance. Additional evidence is needed to understand patients' experiences of the engagement process and whether these outcomes translate into improved quality of care.
N/A (data extraction completed prior to registration on PROSPERO).
Phenylpropenes such as eugenol, chavicol, estragole, and anethole contribute to the flavor and aroma of a number of important herbs and spices. They have been shown to function as floral attractants ...for pollinators and to have antifungal and antimicrobial activities. Phenylpropenes are also detected as free volatiles and sequestered glycosides in a range of economically important fresh fruit species including apple, strawberry, tomato, and grape. Although they contribute a relatively small percentage of total volatiles compared with esters, aldehydes, and alcohols, phenylpropenes have been shown to contribute spicy anise- and clove-like notes to fruit. Phenylpropenes are typically found in fruit throughout development and to reach maximum concentrations in ripe fruit. Genes involved in the biosynthesis of phenylpropenes have been characterized and manipulated in strawberry and apple, which has validated the importance of these compounds to fruit aroma and may help elucidate other functions for phenylpropenes in fruit.
There is growing evidence for the relationship between working memory and academic attainment. The aim of the current study was to investigate whether working memory is simply a proxy for IQ or ...whether there is a unique contribution to learning outcomes. The findings indicate that children’s working memory skills at 5
years of age were the best predictor of literacy and numeracy 6
years later. IQ, in contrast, accounted for a smaller portion of unique variance to these learning outcomes. The results demonstrate that working memory is not a proxy for IQ but rather represents a dissociable cognitive skill with unique links to academic attainment. Critically, we find that working memory at the start of formal education is a more powerful predictor of subsequent academic success than IQ. This result has important implications for education, particularly with respect to intervention.
A
bstract
We consider the possibility that the neutral-current
B
anomalies are due to radiative corrections generated by Yukawa interactions of quarks and leptons with new vector-like quark and ...lepton electroweak doublets and new Standard Model singlet scalars. We show that the restricted interactions needed can result from an underlying Abelian family symmetry and that the same symmetry can give rise to an acceptable pattern of quark and charged lepton masses and mixings, providing a bridge between the non-universality observed in the
B
-sector and that of the fermion mass matrices. We construct two simple models, one with a single singlet scalar in which the flavour changing comes from quark and lepton mixing and one with an additional scalar in which the flavour changing can come from both fermion and scalar mixing. We show that for the case the new quarks are much heavier than the new leptons and scalars the B anomalies can be due to box diagrams with couplings in the perturbative regime consistent with the bounds coming from
B
s
−
B
¯
s
,
K
−
K
¯
and
D
−
D
¯
mixing as well as other lepton family number violating processes. The new states can be dark matter candidates and, in the two scalar model with a light scalar of
O
(60) GeV and vector-like lepton of
O
(100) GeV, there can be a simultaneous explanation of the
B
-anomalies, the muon anomalous magnetic moment and the dark matter abundance.
The impact of the COVID-19 pandemic on mental health and well-being were assessed in a convenience sample of 600 UK adults, using a cross-sectional design. Recruited over 2 weeks during the initial ...phase of lockdown, participants completed an online survey that included COVID-19-related questions, the Hospital Anxiety and Depression Scale, the World Health Organization (Five) Well-Being Index and the Oxford Capabilities Questionnaire for Mental Health. Self-isolating before lockdown, increased feelings of isolation since lockdown and having COVID-19-related livelihood concerns were associated with poorer mental health, well-being and quality of life. Perceiving increased kindness, community connectedness and being an essential worker were associated with better mental health and well-being outcomes.
Death anxiety is considered to be a basic fear underlying the development and maintenance of numerous psychological conditions. Treatment of transdiagnostic constructs, such as death anxiety, may ...increase treatment efficacy across a range of disorders. Therefore, the purpose of the present review is to: (1) examine the role of Terror Management Theory (TMT) and Experimental Existential Psychology in understanding death anxiety as a transdiagnostic construct, (2) outline inventories used to evaluate the presence and severity of death anxiety, (3) review research evidence pertaining to the assessment and treatment of death anxiety in both non-clinical and clinical populations, and (4) discuss clinical implications and future research directions. Numerous inventories have been developed to evaluate the presence and severity of death anxiety, and research has provided compelling evidence that death anxiety is a significant issue, both theoretically and clinically. In particular, death anxiety appears to be a basic fear at the core of a range of mental disorders, including hypochondriasis, panic disorder, and anxiety and depressive disorders. Large-scale, controlled studies to determine the efficacy of well-established psychological therapies in the treatment of death anxiety as a transdiagnostic construct are warranted.
•Death anxiety is a normal human experience, yet it can engender paralyzing fear.•Terror Management Theory has generated extensive research into death anxiety.•Death anxiety is a transdiagnostic construct involved in numerous disorders.•Existential and Cognitive–Behavior therapies can successfully treat death anxiety.•More research into the clinical aspects of death anxiety across disorders is needed.
Impacts of the Covid-19 pandemic and its public health measures go beyond physical and mental health and incorporate wider well-being impacts in terms of what people are free to do or be. We explored ...the impacts of the Covid-19 lockdown and relevant vulnerabilities on capability well-being, mental health and social support in Austria.
Adult Austrian residents (n = 560) provided responses to a cross-sectional online survey about their experiences during Covid-19 lockdown (15 March-15 April 2020). Instruments measuring capabilities (OxCAP-MH), depression and anxiety (HADS), social support (MSPSS) and mental well-being (WHO-5) were used in association with six pre-defined vulnerabilities using multivariable linear regression.
31% of the participants reported low mental well-being and only 30% of those with a history of mental health treatment received treatment during lockdown. Past mental health treatment had a significant negative effect across all outcome measures with an associated capability well-being score reduction of - 6.54 (95%CI, - 9.26, - 3.82). Direct Covid-19 experience and being 'at risk' due to age and/or physical health conditions were also associated with significant capability deprivations. When adjusted for vulnerabilities, significant capability reductions were observed in association with increased levels of depression (- 1.77) and anxiety (- 1.50), and significantly higher capability levels (+ 3.75) were associated with higher levels of social support. Compared to the cohort average, individual capability impacts varied between - 9% for those reporting past mental health treatment and + 5% for those reporting one score higher on the social support scale.
Our study is the first to assess the capability limiting aspects of lockdown and relevant vulnerabilities alongside their impacts on mental health and social support. The negative capability well-being, mental health and social support impacts of the Covid-19 lockdown were strongest for people with a history of mental health treatment. Future public health policies concerning lockdowns should pay special attention to improve social support levels in order to increase public resilience.
Policy Points
Considerable investments have been made to build high‐performing primary care systems in Canada. However, little is known about the extent to which change has occurred over the last ...decade with implementing programs and policies across all 13 provincial and territorial jurisdictions.
There is significant variation in the degree of implementation of structural features of high‐performing primary care systems across Canada. This study provides evidence on the state of primary care reform in Canada and offers insights into the opportunities based on changes that governments elsewhere have made to advance primary care transformation.
Context
Despite significant investments to transform primary care, Canada lags behind its peers in providing timely access to regular doctors or places of care, timely access to care, developing interprofessional teams, and communication across health care settings. This study examines changes over the last decade (2012 to 2021) in policies across 13 provincial and territorial jurisdictions that address the structural features of high‐performing primary care systems.
Methods
A multiple comparative case study approach was used to explore changes in primary care delivery across 13 Canadian jurisdictions. Each case consisted of (1) qualitative interviews with academics, provincial health care leaders, and health care professionals and (2) a literature review of policies and innovations. Data for each case were thematically analyzed within and across cases, using 12 structural features of high‐performing primary care systems to describe each case and assess changes over time.
Findings
The most significant changes include adopting electronic medical records, investments in quality improvement training and support, and developing interprofessional teams. Progress was more limited in implementing primary care governance mechanisms, system coordination, patient enrollment, and payment models. The rate of change was slowest for patient engagement, leadership development, performance measurement, research capacity, and systematic evaluation of innovation.
Conclusions
Progress toward building high‐performing primary care systems in Canada has been slow and variable, with limited change in the organization and delivery of primary care. Canada's experience can inform innovation internationally by demonstrating how preexisting policy legacies constrain the possibilities for widespread primary care reform, with progress less pronounced in the attributes that impact physician autonomy. To accelerate primary care transformation in Canada and abroad, a national strategy and performance measurement framework is needed based on meaningful engagement of patients and other stakeholders. This must be accompanied by targeted funding investments and building strong data infrastructure for performance measurement to support rigorous research.
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