Literature Collection

BACKGROUND: Effective mental health primary prevention and early detection strategies targeting perinatal mental healthcare settings are vital. Poor maternal mental health places the developing foetus at risk of lasting cognitive, developmental, behavioural, physical, and mental health problems. Indigenous women endure unacceptably poor mental health compared to all other Australians and disproportionately poorer maternal and infant health outcomes. Mounting evidence demonstrates that screening practices with Indigenous women are neither effective nor acceptable. Improved understanding of their perinatal experiences is necessary for optimizing successful screening and early intervention. Achieving this depends on adopting culturally safe research methodologies. METHODOLOGY: Decolonizing translational research methodologies are described. Perspectives of Australian Indigenous peoples were centred on leadership in decision-making throughout the study. This included designing the research structure, actively participating throughout implementation, and devising solutions. Methods included community participatory action research, codesign, and yarning with data analysis applied through the cultural lenses of Indigenous investigators to inform culturally meaningful outcomes. DISCUSSION: The Indigenous community leadership and control, maintained throughout this research, have been critical. Allowing time for extensive community collaboration, fostering mutual trust, establishing strong engagement with all stakeholders and genuine power sharing has been integral to successfully translating research outcomes into practice. The codesign process ensured that innovative strengths-based solutions addressed the identified screening barriers. This process resulted in culturally sound web-based perinatal mental health and well-being assessment with embedded potential for widespread cultural adaptability.

BACKGROUND: Deep brain stimulation (DBS) has been successfully used for the treatment of circuitopathies including movement, anxiety, and behavioral disorders. The hypothalamus is a crucial integration center for many peripheral and central pathways relating to cardiovascular, metabolic, and behavioral functions and constitutes a potential target for neuromodulation in treatment-refractory conditions. To conduct a systematic review, investigating hypothalamic targets in DBS, their indications, and the primary clinical findings. METHODS: PubMed, Scopus, and Web of Science databases were searched in accordance with the PRISMA guideline to identify papers published in English studying DBS of the hypothalamus in humans. RESULTS: After screening 3,148 papers, 34 studies consisting of 412 patients published over two decades were included in the final review. Hypothalamic DBS was indicated in refractory headaches (n = 238, 57.8%), aggressive behavior (n = 100, 24.3%), mild Alzheimer's disease (n = 58, 14.1%), trigeminal neuralgia in multiple sclerosis (n = 5, 1.2%), Prader-Willi syndrome (n = 4, 0.97%), and atypical facial pain (n = 3, 0.73%). The posterior hypothalamus was the most common DBS target site across 30 studies (88.2%). 262 (63.6%) participants were males, and 110 (26.7%) were females. 303 (73.5%) patients were adults whereas 33 (8.0%) were pediatrics. The lowest mean age of participants was 15.25 ± 4.6 years for chronic refractory aggressiveness, and the highest was 68.5 ± 7.9 years in Alzheimer's disease patients. The mean duration of the disease ranged from 2.2 ± 1.7 (mild Alzheimer's disease) to 19.8 ± 10.1 years (refractory headaches). 213 (51.7%) patients across 29 studies (85.3%) reported symptom improvements which ranged from 23.1% to 100%. 25 (73.5%) studies reported complications, most of which were associated with higher voltage stimulations. CONCLUSIONS: DBS of the hypothalamus is feasible in selected patients with various refractory conditions ranging from headaches to aggression in both pediatric and adult populations. Future large-scale studies with long-term follow-up are required to validate the safety and efficacy data and extend these findings.

BACKGROUND: The Department of Veterans Affairs (VA) is the largest integrated healthcare system in the United States and serves a rapidly aging patient population. The VA's Home-Based Primary Care (HBPC) program is a home care model for older, complex, high-risk Veterans that provides comprehensive, longitudinal primary care delivered by an interdisciplinary team of VA staff, with plans for expansion by 2027. HBPC program implementation varies considerably across local sites and contexts. Accordingly, these characteristics offer a unique opportunity to investigate real-world, cross-case heterogeneity and identify crucial factors that may lead to improved patient outcomes. METHODS: Patient home time in the last 180 days of life will serve as the primary outcome measure, calculated at the patient-level as the total days not in an acute care (e.g., emergency department [ED], hospital), post-acute care (e.g., skilled nursing facility), or institutional long-term care setting (e.g., nursing home) in the 180 days prior to death. Secondary outcomes include patient satisfaction and other utilization outcomes: ED visits, hospitalizations, days in long term care, care transitions, hospice use prior to death, and site of death. Multiple datasets will be combined to obtain a comprehensive view of HBPC site characteristics. This study will use an exploratory sequential mixed methods design to describe the heterogeneity in HBPC program implementation and evaluate how contextual factors and program delivery patterns influence home time and other patient outcomes. Analyses will identify difference-making configurations of contextual, operational, cultural, and care delivery factors that distinguish high- versus low-home time sites. Analytic methods include quantitative descriptive analyses, regression analyses, in-depth qualitative case studies at 10 high and 10 low home time sites, qualitative cross-case analysis, and the application of Coincidence Analysis to identify successful HBPC program configurations. DISCUSSION: Health care systems can take advantage of real-world heterogeneity in program implementation across sites that vary in context and setting to identify the key difference-makers and use these findings to inform future program expansion. By understanding which HBPC program features lead to improved outcomes for older adults in specific contexts, the VA can learn where site variation is a positive sign of adaptation versus a sign of inefficiency and an opportunity for improvement. CLINICAL TRIAL NUMBER: Not applicable.

BACKGROUND: Like many other nations, the rates of mental illness among children and youth have risen. Youth and emerging adults (YEA) between the ages of 16 and 25, in particular, have the highest rate of mental health disorders of any age group leading clinicians and researchers to ponder new and innovative ways to treat mental ill health (1-2). Youth centred practices (YCP) have emerged as possible new approaches in youth mental health care to better treat YEA living with mental illness, but also to empower this population to take control of their wellbeing. Despite the growing use of the term 'youth-centred,' there is little consensus on what this looks like in mental health care for youth. Using research coming out of MINDS of London-Middlesex, we explore how mental health professionals, including clinicians, researchers, administrative staff, and trainees, understand the term YCP and how they implement youth-centredness in practice. METHODS: Using a Youth Participatory Action Research framework as a guide, MINDS' researchers worked alongside YEA research assistants in all phases of research. Participants were selected from a pool of known practitioners and mental health programs utilizing YCP, as identified by YEA research assistants. Qualitative focus group and interviews, developed using an appreciative inquiry approach, were conducted with 13 mental health care professionals, staff, and trainees to ascertain how they understand and practice YCP. Researchers conducted a codebook thematic analysis of the data: five themes and fourteen subthemes were identified. RESULTS: Our analysis identified five main themes: (1) Acknowledging YCP's Role in Supporting YEA Mental Health; (2) Developing Authentic and Meaningful Relationships Between YEA and Care Providers; (3) Collaboration in Care: Engaging YEA as Active Agents in their Treatment; (4) Creation and Maintenance of Accessible Service to Facilitate YEA Engagement; and (5) Moving Beyond Tacit Knowledge to YCP as a Trainable Construct. Underlying each of these key components of YCP was a thread of recognition that systems of care for YEA must be responsive to the unique needs of those the system intends to serve. This process is seen as dynamic and fluid; often representative of societal change and growth, the specific needs of YEA will remain in flux and YCP approaches require continued reflexivity. CONCLUSIONS: When YCPs are used in mental health care, YEA and their lived experiences are respected by trusted adults on their care team. At the core, YCPs are collaborative. There is a shift from the dynamic of "practitioner as expert" to one that provides YEA a sense of agency and autonomy to make informed decisions regarding their care.