‘Talkin’ ‘bout my generation’: using a mixed-methods approach to explore changes in adolescent well-being across several European countries

The promotion of positive mental health is a becoming priority worldwide. Despite all the efforts invested in preventive and curative work, it is estimated that one in four persons will experience a mental health condition at some point in their lives. Even more worrying is the fact that up to a half of all mental health problems have their onset before the age of 14. Recent statistics(national & international surveys, meta-analyses, international reports) point out to the fact that child and adolescent mental health problems are on the rise. The present study will try to corroborate these results and further explore their meaning, by employing a sequential mixed methods research design (quantitative-qualitative). The quantitative part will analyse time trends using Health Behaviours in School-aged Children (HBSC) data (four survey cycles: 2002, 2006, 2010, 2014) on mental well-being from four European countries (the Czech Republic, Germany, Italy, and the United Kingdom). The qualitative part will rely on focus groups to explore the perspectives of 13- and 15-year-old boys and girls on gender differences and on the changes in adolescent mental well-being over time, as well as measures through which these issues could be addressed. Thematic analysis will be employed to analyse qualitative data. The results of this study could make a major contribution to our understanding of the current trends in adolescent mental well-being, as well as the ways in which existing data could be linked to international and national health policies.Publisher PDFPeer reviewe

Using a Mixed-Methods Approach to Explore Changes in Adolescent Well-Being across Several European Countries

The promotion of positive mental health is a becoming priority worldwide. Despite all the efforts invested in preventive and curative work, it is estimated that one in four persons will experience a mental health condition at some point in their lives. Even more worrying is the fact that up to a half of all mental health problems have their onset before the age of 14. Recent statistics (national and international surveys, meta-analyses, international reports) point out to the fact that child and adolescent mental health problems are on the rise. The present study will try to corroborate these results and further explore their meaning, by employing a sequential mixed methods research design (quantitative–qualitative). The quantitative part will analyze time trends using Health Behaviors in School-aged Children data (four survey cycles: 2002, 2006, 2010, 2014) on mental well-being from four European countries (the Czechia, Germany, Italy, and United Kingdom). The qualitative part will rely on focus groups to explore the perspectives of 13- and 15-year- old boys and girls on gender differences and on the changes in adolescent mental well-being over time, as well as measures through which these issues could be addressed. Thematic analysis will be employed to analyze qualitative data. The results of this study could make a major contribution to our understanding of the current trends in adolescent mental well-being, as well as the ways in which existing data could be linked to international and national health policies

Karakteristik Mutu Hedonik Dan Proksimat Nugget Ikan Lele Dumbo (Clarias gariepinus) Menggunakan Tepung Biji Durian (Durio Zibethinus murr)

Penelitian ini bertujuan untuk menganalisis karakteristik organoleptik dan kimia nugget ikan lele dumbo (Clarias gariepinus) menggunakan tepung biji durian (Durio zibethinus murr). Perlakuan pada penelitian ini adalah penggunaan konsentrasi tepung biji durian yang berbeda yaitu 10 g, 20 g dan 30 g. Parameter yang diuji adalah karakteristik organoleptik hedonik yang meliputi tekstur, kenampakan, warna, aroma dan rasa yang menggunakan uji Kruskal Wallis, parameter kimia meliputi kadar air, abu, lemak, protein dan karbohidrat yang menggunakan RAL (Rancangan Acak Lengkap). Hasil uji Kruskal Walllis menunjukan penambahan tepung biji durian tidak berpengaruh nyata terhadap kenampakan, warna, aroma, dan tekstur, tetapi berpengaruh nyata terhadap rasa. Hasil uji RAL (Rancangan Acak Lengkap) menunjukan penambahan tepung biji durian tidak berpengaruh nyata terhadap parameter kimia (kadar air, kadar protein, abu), tetapi berpengaruh nyata terhadap kadar lemak dan karbohidrat

“Who blends in and why (not)?” A qualitative study on psychotherapists' patient inclusion in blended care

Introduction Psychotherapists may act as bottlenecks in the integration of digital interventions into psychotherapy, known as blended care (BC). In the literature, various factors are discussed as potential inclusion, exclusion, or limiting criteria in BC. Method Our aim for this interview study was to gain a deeper understanding of the factors psychotherapists consider when inviting patients to participate in BC. For this purpose, we interviewed seven psychotherapists with a psychodynamic and seven psychotherapists with a cognitive behavioral background who participated in a naturalistic trial on BC in routine outpatient psychotherapy. Results Psychotherapists considered few fixed inclusion or exclusion criteria when considering which patients to introduce BC to. The basic technical requirements had to be met and the patients had to be “fit for outpatient therapy”. Psychotherapists found patients' response to BC, like their motivation, to be a decisive factor when considering BC. Discussion Psychotherapists emphasized patient motivation for BC as a potential bottleneck in its implementation. Therefore, a successful implementation strategy should focus on strengthening both psychotherapists' and patients' motivation to engage with BC. The openness of psychotherapists towards patient characteristics suggests that BC in outpatient care may target a broad patient population

TONI - One for all? Participatory development of a transtheoretic and transdiagnostic online intervention for blended care

Background Internet-based interventions offer a way to meet the high demand for psychological support. However, this setting also has disadvantages, such as the lack of personal contact and the limited ability to respond to crises. Blended care combines Internet-based interventions with face-to-face psychotherapy and merges the benefits of both settings. To ensure the uptake of blended care in routine care, Internet-based interventions need to be suitable for different therapeutic approaches and mental disorders. Objective This paper describes the participatory development process of the Internet-based intervention “TONI” using a common therapeutic language and content on various transdiagnostic topics to be integrated into routine outpatient psychotherapy. Methods To develop this intervention in a participatory manner, we followed the Integrate, Design, Assess, and Share (IDEAS) framework. In a multilevel development process, we used a combination of interviews, focus groups, and proofreading to optimally tailor online modules to routine outpatient psychotherapy. Building on well-established cognitive-behavioral online content, we included expert interviews with psychodynamic (n = 20) and systemic psychotherapists (n = 9) as well as focus groups with psychotherapists of different approaches (n = 10) and persons with lived experience of mental illness (PWLE; n = 10). Results We describe the development process of TONI step-by-step, outlining the specific requirements that therapists from different therapeutic approaches as well as PWLE have and how we implemented them in our intervention. This includes the content and specific exercises in the online modules, aspects of data protection, language, design, and usability. Conclusion Internet-based interventions that use a common therapeutic language and address therapeutic principles across different approaches have the potential to advance digitalization in psychotherapy. Involving psychotherapists and PWLE in intervention development may positively impact acceptance and usage in practice. This study shows how participatory intervention development involving both psychotherapists and PWLE can be carried out

Increasing the effectiveness of psychotherapy in routine care through blended therapy with transdiagnostic online modules (PsyTOM): study protocol for a randomized controlled trial

Background In blended therapy, face-to-face psychotherapy and Internet-based interventions are combined. Blended therapy may be advantageous for patients and psychotherapists. However, most blended interventions focus on cognitive behavioral therapy or single disorders, making them less suitable for routine care settings. Methods In a randomized controlled trial, we will compare blended therapy and face-to-face therapy in routine care. We intend to randomize 1152 patients nested in 231 psychotherapists in a 1:1 ratio. Patients in the blended therapy group will receive access to a therapeutic online intervention (TONI). TONI contains 12 transdiagnostic online modules suited for psychodynamic, cognitive behavioral, and systemic therapy. Psychotherapists decide which modules to assign and how to integrate TONI components into the psychotherapeutic process to tailor treatment to their patients’ specific needs. We will assess patients at baseline, 6 weeks, 12 weeks, and 6 months. Patients enrolled early in the trial will also complete assessments at 12 months. The primary outcomes are depression and anxiety at 6-month post-randomization, as measured by PHQ-8 and GAD-7. The secondary outcomes include satisfaction with life, level of functioning, personality traits and functioning, eating pathology, sexual problems, alcohol/drug use, satisfaction with treatment, negative effects, and mental health care utilization. In addition, we will collect several potential moderators and mediators, including therapeutic alliance, agency, and self-efficacy. Psychotherapists will also report on changes in symptom severity and therapeutic alliance. Qualitative interviews with psychotherapists and patients will shed light on the barriers and benefits of the blended intervention. Furthermore, we will assess significant others of enrolled patients in a sub-study. Discussion The integration of online modules which use a common therapeutic language and address therapeutic principles shared across therapeutic approaches into regular psychotherapy has the potential to improve the effectiveness of psychotherapy and transfer it into everyday life as well help save therapists’ resources and close treatment gaps. A modular and transdiagnostic setup of the blended intervention also enables psychotherapists to tailor their treatment optimally to the needs of their patients

Isotropic 3D compressed sensing (CS) based sequence is comparable to 2D-LGE in left ventricular scar quantification in different disease entities

The goal of this study was to evaluate a three-dimensional compressed sensing (3D-CS) LGE prototype sequence for the detection and quantification of myocardial fibrosis in patients with chronic myocardial infarction (CMI) and myocarditis (MYC) compared with a 2D-LGE standard. Patients with left-ventricular LGE due to CMI (n = 33) or MYC (n = 20) were prospectively recruited. 2D-LGE and 3D-CS images were acquired in random order at 1.5 Tesla. 3D-CS short axis (SAX) images were reconstructed corresponding to 2D SAX images. LGE was quantitatively assessed on patient and segment level using semi-automated threshold methods. Image quality (4-point scoring system), Contrast-ratio (CR) and acquisition times were compared. There was no significant difference between 2D and 3D sequences regarding global LGE (%) (CMI [2D-LGE: 11.4 ± 7.5; 3D-LGE: 11.5 ± 8.5; p = 0.99]; MYC [2D-LGE: 27.0 ± 15.7; 3D-LGE: 26.2 ± 13.1; p = 0.70]) and segmental LGE-extent (p = 0.63). 3D-CS identified papillary infarction in 5 cases which was not present in 2D images. 2D-LGE acquisition time was shorter (2D: median: 06:59 min [IQR: 05:51-08:18]; 3D: 14:48 min [12:45-16:57]). 3D-CS obtained better quality scores (2D: 2.06 ± 0.56 vs. 3D: 2.29 ± 0.61). CR did not differ (p = 0.63) between basal and apical regions in 3D-CS images but decreased significantly in 2D apical images (CR basal: 2D: 0.77 ± 0.11, 3D: 0.59 ± 0.10; CR apical: 2D: 0.64 ± 0.17, 3D: 0.53 ± 0.11). 3D-LGE shows high congruency with standard LGE and allows better identification of small lesions. However, the current 3D-CS LGE sequence did not provide PSIR reconstruction and acquisition time was longer

Different impacts on the heart after COVID-19 infection and vaccination: insights from cardiovascular magnetic resonance

INTRODUCTION: Myocarditis-like findings after COVID-19 (coronavirus disease 2019) infection and vaccination were reported by applying cardiovascular magnetic resonance (CMR). These results are very heterogenous and dependent on several factors such as hospital admission or outpatient treatment, timing of CMR, and symptomatic load. This retrospective study aimed to identify differences in myocardial damage in patients with persistent symptoms both after COVID-19 infection and vaccine by applying CMR. MATERIALS AND METHODS: This study entails a retrospective analysis of consecutive patients referred for CMR between August 2020 and November 2021 with persistent symptoms after COVID-19 infection or vaccination. Patients were compared to healthy controls (HC). All patients underwent a CMR examination in a 1.5-T scanner with a scan protocol including: cine imaging for biventricular function and strain assessment using feature tracking, T2 mapping for the quantification of edema, and T1 mapping for diffuse fibrosis and late gadolinium enhancement (LGE) for the detection and quantification of focal fibrosis. Patients were divided into a subacute COVID-19 (sCov) group with symptoms lasting 12 weeks, and patients after COVID-19 vaccination (CovVac). RESULTS: A total of 162 patients were recruited of whom 141 were included for analysis. The median age in years (interquartile range (IQR)) of the entire cohort was 45 (37–56) which included 83 women and 58 men. Subgroups were as follows (total patients per subgroup, median age in years (IQR), main gender): 34 sCov, 43 (37–52), 19 women; 63 pCov, 52 (39–58), 43 women; 44 CovVac, 43 (32–56), 23 men; 44 HC (41 (28–52), 24 women). The biventricular function was preserved and revealed no differences between the groups. No active inflammation was detected by T2 mapping. Global T1 values were higher in pCov in comparison with HC (median (IQR) in ms: pCov 1002ms (981–1023) vs. HC 987ms (963–1009; p = 0.005) with other parings revealing no differences. In 49/141 (34.6%) of patients, focal fibrosis was detectable with the majority having a non-ischemic pattern (43/141; 30.4%; patients) with the subgroups after infection having more often a subepicardial pattern compared with CovVac (total (% of group): sCov: 7/34(21%); pCov 13/63(21%); CovVac 2/44(5%); p = 0.04). CONCLUSION: Patients after COVID-19 infection showed more focal fibrosis in comparison with patients after COVID-19 vaccination without alterations in the biventricular function

Evaluating the effect of heart rate on T2 balanced steady-state free precession cardiac MRI mapping

PURPOSE: To evaluate heart rate as a patient-related confounder in a commonly applied T2 balanced steady-state free precession (bSSFP) mapping sequence used for myocardial tissue characterization. MATERIALS AND METHODS: This retrospective analysis included prospectively (from December 2013 to November 2021) acquired cardiac MRI (1.5 T) datasets with T2 bSSFP mapping from 69 healthy volunteers. Phantom studies and Bloch simulations were performed with heart rates of 60–130 beats per minute and different resting periods (three, six, or nine R-R intervals). Sequence parameters (repetition time, echo time, flip angle, echo train length) were matched across volunteer, phantom, and simulation measurements. Reference values covered clinically relevant T1 and T2 properties found in native myocardium (short, 1041 and 44 msec; medium, 1293 and 43 msec; long, 1534 and 40 msec). A mixed linear model assessed the effect of heart rate on T2 values in volunteer measurements. RESULTS: The study included 69 healthy volunteers (median age, 34 years; 44 female and 25 male). Heart rate influenced T2 values acquired with three R-R resting periods (r = −0.38, P = .002; linear regression slope, −0.7 msec/10 beats per minute [95% CI: −1.2, −0.1]). In simulation and phantom measurements, T2 values acquired with three R-R resting periods strongly correlated with heart rate, irrespective of myocardial T1 and T2 properties (r ≤ −0.88; P < .01 for all measurements). Heart rate dependency was reduced with increased resting periods in simulations and phantom measurements. Short myocardial T1 and T2 values derived from T2 bSSFP with nine R-R resting periods were not dependent on heart rate (r = −0.41; P = .33). CONCLUSION: T2 bSSFP with three R-R resting periods underestimates T2 values with increasing heart rates. Use of longer resting periods with T2 bSSFP mapping sequences reduced heart rate dependency