Interventions to reduce stress, anxiety and depression symptoms in teenagers – a systematic review

Introduction

Stress, anxiety and depression symptoms are frequent in teenagers. Objectives: To identify the interventions effectively able to prevent or reduce anxiety, depression and psychological stress in adolescents; to assess the effectiveness, feasibility and transferability of the interventions.

Methods

Comprehensive systematic review was performed. Three steps searching strategy using the databases: PsycINFO, PubMed, SCOPUS, Cochrane Library, and Google Scholar identified 679 studies and reviews. Critical appraisal was performed by 2 reviewers, data extraction performed on finally selected 59 reviews, RCT, cohort studies focused on sample size, geographical context, setting, description of intervention, measures of primary and secondary outcomes.

Results

The considered interventions are: Internet-based multifaceted cognitive bias modification training (CBM), Internet (iCBT) or school-based cognitive behavioral group training (CBT), Social skills training (SST), Metacognitive therapy, Psychosocial Support Intervention, organized sports participation and voluntary outdoor play, school-based resilience-focused intervention, assertiveness group training, short-term psychoanalytic psychotherapy (STPP), brief psychosocial intervention (BPI), Guided Parent-Delivered Cognitive Behaviour Therapy (GPD-CBT), Internet-based self-support method.

Conclusions

Interventions for promoting mental health in adolescents have to combine parenting programs with leisure activities and balanced curriculum; various approaches (physical activity, music, sports participation) should be tailored into the national, community and school contexts. Resilience factors (relationship with parents, communications with peers), development of help-seeking behaviours and available self-help programs could support early detection and assistance. Most interventions showed positive effects on short and medium term and potential transferability.

Key messages

Regular screening for childhood adversities and traumas and screening of symptoms as feeling sad, hopeless, worried should be performed in adolescents as they get older. Besides mental health risk factors, interventions should target developmental risk factors in transitional stages from childhood to adolescence and from adolescence to young adulthood.

Appropriate approaches for improving health promotion literacy in adolescents – a systematic review

Background

Adolescents are exposed to various risks for their health: substance use, Internet overuse, video game addiction, unhealthy diet (reduced intake of fruits and vegetables, fast food culture), low physical activity, overweight, stress, violence, unsafe sexual behaviours, self-medication. Health literacy is defined as the knowledge, motivation and competence to access, understand, appraise and apply right information to make decisions in terms of healthcare, disease prevention and health promotion. Despite the advancement of theoretical models, many national and international health promotion programs, the percentage of unhealthy behaviours still persist in young age. Objective: Current review proposes to assess the implementation and effectiveness of various interventions in order to identify possible success or failure factors.

Methods

Comprehensive Systematic review was performed. After three steps data searching (in PubMed, SCOPUS, Cochrane, PsycINFO, Google Scholar) and critical appraisal, 63 studies out of 739 were fully retrieved.

Results

Implementation aspects as intervention types (single or combined targeted risk factors), type of audience (students, parents, school staff, communities), settings (home, school or outdoor), type of organization (face to face, groups, online), professional or peer-led, communication type (written materials as brochures, posters or videoconferencing) or effectiveness measures were extracted and synthesized. Important features of context such as funding, European or government programs were used for clustering the studies.

Conclusions

Health literacy interventions in adolescents need the involvement of education staff and parents participation. Health literacy for adolescents has to take into account cultural context, language, psychological features of each age; either digital or non-digital interventions cannot elude face to face communication between adolescents and their parents, academics or peers.

Key messages

Health literacy school-based interventions are effective but the content for adolescents audience should rely on guidelines provided by interdisciplinary teams of experts. Health Literacy interventions in adolescents should be age-appropriate and do-not-harm precautions must always be taken in order to avoid prejudices, body-image or self-esteem concerns.

INCIDENCE AND TIME TREND OF HIP FRACTURES IN ROMANIA: A NATIONWIDE STUDY FROM 2008 TO 2018

Background

Hip fractures are a major issue of public health as they are responsible for high morbidity, excess mortality and costs. There are differences in Europe and worldwide in the incidence rates of hip fractures and time trends, in the context of the population aging. Ten years ago, we characterized the incidence of hip fracture in Romania using data from the national hospital discharge register.

Objective

This is the first Romanian study to assess the hip fracture incidence rates over a period of 11 years, between 2008 and 2018.

Subjects and Methods

This analysis is a nationwide retrospective study on hospitals reporting primary DRG data on hip fracture, using a rigorous definition with both diagnostic and surgical procedure codes. The population aged 40+ was stratified in 5-year intervals and both the crude incidence rates and the adjusted incidence rates of hip fracture using standardization on age for the 2018 reference population were calculated in women and men.

Results

From 2008 to 2018, the number of hip fractures rose by 53 % in women (from 7513 to 11512) and 22.4 % in men (from 4266 to 5220). Meanwhile, the Romanian population over 40 years increased by 12.5% in women and 14.2% in men. The crude incidence rate rose by 36.2% in women and 7.2% in men and the age-standardized incidence rates by 27.4% in women and 6% in men. These increases are mostly based on 85+ age populations' changes.

Conclusions

In Romania, the hip fractures incidence continues to grow throughout an 11-year-period, especially in women, representing an increasing burden for our society.

Overview of post-discharge predictors for psychiatric re-hospitalisations: a systematic review of the literature

BACKGROUND

High levels of hospital readmission (rehospitalisation rates) is widely used as indicator of a poor quality of care. This is sometimes also referred to as recidivism or heavy utilization. Previous studies have examined a number of factors likely to influence readmission, although a systematic review of research on post-discharge factors and readmissions has not been conducted so far. The main objective of this review was to identify frequently reported post-discharge factors and their effects on readmission rates.

METHODS

Studies on the association between post-discharge variables and readmission after an index discharge with a main psychiatric diagnosis were searched in the bibliographic databases Ovid Medline, PsycINFO, ProQuest Health Management, OpenGrey and Google Scholar. Relevant articles published between January 1990 and June 2014 were included. A systematic approach was used to extract and organize in categories the information about post-discharge factors associated with readmission rates.

RESULTS

Of the 760 articles identified by the initial search, 80 were selected for this review which included a total number of 59 different predictors of psychiatric readmission. Subsequently these were grouped into four categories: 1) individual vulnerability factors, 2) aftercare related factors, 3) community care and service responsiveness, and 4) contextual factors and social support. Individual factors were addressed in 58 papers and were found to be significant in 37 of these, aftercare factors were significant in 30 out of the 45 papers, community care and social support factors were significant in 21 out of 31 papers addressing these while contextual factors and social support were significant in all seven papers which studied them.

CONCLUSIONS

This review represents a first attempt at providing an overview of post-discharge factors previously studied in association with readmission. Hence, by mapping out the current research in the area, it highlights the gaps in research and it provides guidance future studies in the area.

Epidemiologic and Bacteriologic Study of the Burned Patients from the Plastic Surgery Department of the County Emergency Hospital of Ploieşti, over a 4 Years Period (2010-2013)

This study analyses the epidemiologic data and the bacteriologic results of a total number of 759 burned patients, which were treated and discharged from the Plastic Surgery Department of the County Emergency Hospital of Ploiesti, between 01 01 2010 and 31 12 2013. The investigated parameter shave been: age and gender distribution, rural or urban population, burn etiology, total burn surface area (TBSA),TBSA, location and depth of lesions, therapeutic management,length of hospital stay, types of bacteria isolated from the infected wounds and their sensitivity to antibiotics, patients' mortality. The statistical analysis revealed the following results: mean age 51.33 ± 18.44 years, male/female ratio 1.35/1, rural/urban ratio 1.34/1, most common etiologies were scalds (44.8%) and flames (37.6%), mean TBSA 7.7 ± 8.4%, main locations were the extremities, splitthickness skin grafting in 15% of the patients, hospital stay 15.57 ± 13.84 days, main bacteria isolated were Pseudomonas aeruginosa (26.3%) and Staphylococcus aureus (22.9%), mortality rate 0.13%. The best methods to decrease the burn morbidity are the burn and infection prevention, for which several measures are discussed.

Biophysical radiosensitization

Experimental studies on normal and tumor-bearing rats revealed that chronic treatment with hydroquinone (5 mg/kg/day) inhibited catalase activity in liver, spleen, blood, and H 18R tumor. 3H-hydroquinone (1.5 microCi/g body weight) showed tumor specificity, with maximum radioactivity in the tumor at 1 h after administration. The biological half-time of 3H-hydroquinone in the tumor was 2 h, but there seems to exist a longer component, since 24 h after administration, some 30% of the maximum radioactivity could be detected in the tumor. Hydroquinone treatment produces a specific inhibition of catalase in the tumor and a higher degree of oxygenation at this level. These findings support the assumption that the mechanism of action of hydroquinone as an anticancer agent is achieved mainly via peroxide production. The oxygenation of the hypoxic tumoral tissue is done at non-toxic levels of hydroquinone, through a natural and specific biophysical pathway, recommending hydroquinone for combined anticancer treatment (radiotherapy and chemotherapy).

[Research on hepatic and overall collagen metabolism in irradiated rats (author's transl)]

The authors studied the effect of ionising radiation on hepatic and overall collagen metabolism in rats. Doses of 100 and 250 rads produced a reduction in urinary hydroxyproline while doses of 500 and 700 rads produced an increase. These results may be interpreted in favour of an increase in reticulation in the first case and in the second case, destruction of inter-molecular bonds. The quantity of total and insoluble collagen increases proportionally to the dose 40 days after the radiation. This proportional relationship is not observed during the first few days after radiation. Prolonged radiation with 700 rads produces a marked reduction in all collagen fractions, compared with 4 days after acute radiation. Among the substances studied, "folcisteine" had the best radio-protective effect when administered before radiation with 700 rads.