Conectar
by Justin Clements, Jenna E. Stanek, Kylie Gallegos, Jessica Celmer, Jesse Berryhill, Andrew Thiros, Mark A. Peyton, Shannon M. Gaukler
Polychlorinated biphenyls (PCBs) are a group of industrial chemicals that were widely used in the United States before being banned by the Toxic Substances Control Act in 1976. Concerns regarding PCBs arose in the 1960s due to their toxicity, classification as a carcinogenic compound, and longevity in the environment. Although the production of PCBs in the United States is currently banned, PCBs can still be found in legacy equipment, and the environment and PCBs are still unintentionally produced in common building materials. To document the concentration of PCBs in biota predominantly found in northern New Mexico, biota (mammalian, avian, and reptilian) were opportunistically collected from 2009 to 2025. We grouped biota species into feeding guilds (carnivore, herbivore, and omnivore) to examine whether different feeding guilds had higher or lower proportions of total PCBs, PCB homologs, dioxin-like PCB congeners, and toxic equivalents. When we examined the concentrations of PCB homologs and total PCBs, we found the highest abundance of PCBs in the carnivore feeding guild compared with both herbivores and omnivores. We also observed differences of dioxin-like PCB congeners among feeding guilds, examined in this study. Toxic equivalents were also observed at higher values in carnivores. Furthermore, we demonstrate the biomagnification of PCBs across trophic levels, with higher concentrations observed in mountain lions relative to their primary ungulate prey (mule deer and elk). A comparison of biota revealed a significant difference in concentrations of PCBs found in samples (mule deer and elk) collected in developed areas when compared with rural locations, with the developed areas having higher concentrations. Our investigation provides significant insight into the distribution, composition, and biomagnification of PCB in terrestrial animals in New Mexico, including the biomagnification of PCBs within the carnivore feeding guild, which could be at a higher risk of adverse effects from PCB exposure.by Carla Treloar, Emily Lenton, Amy Kirwan, Caitlin Douglass, Gemma Nourse, Adrian Farrugia, Kate Seear, Caroline Watts, Mark Stoove, Elena Cama
The impacts of stigma on health are well-known. Most interventions to reduce stigma focus on education or skills building of health workers and less on organisational or structural approaches. Responding to ongoing efforts to increase the quality of health care, we explore data from semi-structured interviews with 20 key stakeholders to identify and examine stigma reduction opportunities that align with existing practices, policies and structures for strengthening quality in the Australian healthcare system. Analysis focused on the “outer setting” constructs of the Consolidated Framework for Implementation Research to identify and categorise mechanisms that linked to or were determined by governing processes of the (“outer setting”). The necessity to be accredited against national standards was positioned as an over-arching driver of what health systems do and what gets the attention of leaders and executives, and can subsequently impact allocation of resources, including for stigma reduction. Participants’ accounts also raise the possibility of using other more general industrial relations laws to bring greater attention to stigma reduction. Innovative approaches to stigma reduction using macro, structural tools provide a promising opportunity to trial.by Nemanja Đorđević, Jovan Ranin, Ivana Gmizić, Biljana Ljujić, Marko Marković, Ivan Rajković, Jovana Ranin, Ivana Raković, Sofija Sekulić Marković, Biljana Popovska Jovičić
Metabolic syndrome (MS) is highly prevalent among people living with HIV (PLWH) receiving antiretroviral therapy (ART) and is driven by persistent low-grade inflammation. Hypoxia-inducible factor 1 alpha (HIF-1α) polymorphisms may influence inflammatory pathways underlying MS. This study investigated the association of the rs11549465 HIF-1α polymorphism with inflammatory markers and MS in PLWH receiving ART. We conducted a multicenter case-control study including 116 PLWH treated at two University Clinical Centers in Serbia. Participants were classified according to NCEP ATP III criteria. Genotyping was performed by Real-Time PCR using TaqMan assays. C-reactive protein (CRP) and fibrinogen levels were significantly higher in participants with MS (p < 0.05). ROC analysis demonstrated their potential as biomarkers of MS with cut-off values of 1.85 mg/L for CRP and 2.49 g/L for fibrinogen. Age significantly correlated with CRP and Neutrophil/Lymphocyte ratio (p < 0.05). Elevated CRP and fibrinogen levels were associated with hypertension, hypertriglyceridemia, and other MS-abnormalities (p < 0.05). The HIF-1α rs11549465 CT + TT genotype was associated with higher IL-6 levels among participants with MS (p = 0.026). CRP and fibrinogen may complement existing MS criteria in identifying PLWH at increased risk of cardiovascular disease and diabetes. These findings highlight the role of chronic inflammation and genetic variability in metabolic complications of HIV.Psychosocial interventions are essential to support people living with dementia and their carers. A consensus on what is most important for research on psychosocial intervention in dementia and how intervention studies should best be conducted is currently lacking. This protocol describes the research plan aimed at achieving consensus on (i) the relevance of core elements (CEs) for the development, feasibility testing/piloting, evaluation and/or implementation phases of psychosocial interventions in dementia and (ii) methodologies (eg, design) and methods most suitable to address CEs per phase.
This study was co-designed with a multi-stakeholder advisory group and a multi-disciplinary INTERDEM (psychosocial INTERventions in DEMentia) Methodology Taskforce steering committee. It will involve a multi-phase modified Delphi design, including surveys and group discussions with stakeholders, namely people living with dementia, (informal/unpaid/family) carers, health and social care professionals, policy makers, representatives from insurance companies and psychosocial researchers. A series of iterative ‘rounds’ will be conducted. In round 1 (Phase 1: ‘identification’), stakeholders will be asked to complete an online survey rating the importance of CEs from the UK Medical Research Council (MRC) Framework, namely (i) consider context; (ii) develop, refine and (retest) programme theory; (iii) engage stakeholders; (iv) identify key uncertainties; (v) refine interventions and (vi) economic considerations per phase; propose relevant additional CEs and list methodologies/methods that most suitably address CEs. These ratings will be further explored through online discussion rounds (Phase 2: ‘elaboration’). In round 2 (Phase 3: ‘consensus’), participants will be asked to rate the importance of CEs again (ie, new CEs and where no consensus was reached in Phase 1) and the usefulness of methodologies/methods to address CEs. Outcomes will be discussed with the advisory group and steering committee (Phase 4: ‘validation’). This process (Phases 3 and 4) will be repeated until a consensus on CEs and methodologies/methods is achieved.
Ethical approval was received at Maastricht University (FHML-REC/2025/078) and the University of West London (UWL/REC/SBS-01195). Participants will sign informed consent prior to study participation. Results will be disseminated through a peer-reviewed publication, seminars, webinars, conferences, postgraduate dementia programmes, blogs, commissioner briefings and social media.
Open Science Framework (https://doi.org/10.17605/OSF.IO/DQRFA).
Adherence to compression stocking wear is essential for reducing venous leg ulcer recurrence, yet adherence rates remain low. This study examined the relationship between a novel digital clinical decision-aid (the Personalized and Multidimensional Compression Assessment and Intervention [PAMCAI]), clinician practice, and patient adherence with compression stocking use, by embedding a prospective comparative cohort study within a pilot randomized controlled trial. The clinical notes of occupational therapists using PAMCAI were compared with those not using PAMCAI on their documentation of adherence and frequency of wear, identification of patient-specific barriers and attempts to address barriers. The relationship between higher documentation scores and patient adherence was also explored. Thirty-six medical records from 18 patients demonstrated significantly higher documentation scores when PAMCAI was used for all three categories (p < 0.001). Improvements in adherence were positively associated with documentation quality in the targeted categories (p < 0.001). These findings indicate that PAMCAI supports practice changes that translate to improved patient adherence, highlighting the potential value of clinician-focused decision-aids in venous leg ulcer care.
by Jasmine S. Turner, Victo Kyobutungi, Hellen Ayozu, Nikhit D’Sa, Mark J. D. Jordans
This study aimed to develop an intervention to improve consistent school attendance in participation with caregivers, teachers, and other stakeholders, in refugee settings in Uganda. In Phase 1, we organized four group model building workshops with caregivers and teachers in four refugee settlements to identify factors influencing attendance and caregiver engagement in education, and generate proposed actions to address them. We synthesized the outputs into a causal map and set of intervention strategies. These were reviewed through four respondent validation workshops with caregivers, teachers, school management, and representatives from refugee settlement authorities, international organisations, and local government. The resultant intervention – SchoolLinks – was field tested in one school with students and teachers of Primary 3 and Accelerated Education Programme 1 (government-run non-formal education supporting refugee and out-of-school children to complete primary school). Feedback was systematically collected from school staff, caregivers, children and community members to inform adaptations to improve the SchoolLinks design. Group model building revealed that attendance and retention were influenced by caregivers’ attitudes toward education and encouragement towards their children, which affected children’s motivation to attend school. Relationships between caregivers and teachers, mediated by their communication, mutual knowledge, and constrained by language barriers, influenced caregivers’ attitudes and levels of encouragement. Broader contextual factors, including poverty and lack of safety, undermined attendance and retention. SchoolLinks comprises six complementary strategies: (1) caregiver–teacher meetings, (2) meeting translation, (3) enrolment week with digital data capture, (4) attendance monitoring and incentives, (5) homework clubs, and (6) children walking in groups to school. Field testing supported the intervention’s acceptability, appropriateness, and feasibility. This multi-phase participatory approach provides insights into intervention development in refugee contexts. Future research should aim to identify the intervention’s mechanism(s) of action, analyse cost-effectiveness and cost-efficiency, engage children in further development, and assess the transferability of SchoolLinks to other settings.by Jasper Mol, Rob van Dalen, Yvonne Pannekoek, Malgorzata E. Mnich, Marcel R. de Zoete, Mark Davids, Hilde Herrema, Nina M. van Sorge
Bacterial glycans are key components in immune interactions. We lack insight into the diverse glycan landscape present in complex microbial communities since current -omics techniques do not capture this post-translational information. Here we employed C-type lectin receptors (CLRs), which are dedicated innate glycan-sensing receptors, as probes for bacterial cell sorting in combination with 16S rRNA gene sequencing to identify microbiota species with a specific CLR-reactive glycan profile. We established our experimental CLR-sequencing (CLR-seq) pipeline using soluble fluorescently-labeled human macrophage galactose C-type lectin (MGL, CD301) and langerin (CD207). Both receptors identified known langerin- or MGL-interacting Staphylococcus aureus strains in a synthetic microbial community even when present at low abundance. Subsequent application of CLR-seq on fecal microbiota samples from healthy donors identified specific langerin- and MGL-interacting bacterial species that were subsequently validated as monocultures. In summary, CLR-seq is a modular platform that allows identification of human microbiota species based on CLR-interacting glycans with easy expansion to other CLRs or microbiota samples from patients. Given that CLRs are densely expressed on dendrites of antigen-presenting cells, this pathway may play a role in cross-barrier recognition and sampling of the environment during homeostasis.Very preterm infants (
Australasian multicentre, two-arm, parallel-group, prospective, randomised, open, blinded-endpoint superiority trial in 868 infants born less than 32 weeks’ gestation. Infants are randomised to cycled environmental light and noise or routine care in a non-cycled hospital environment from soon after birth until discharge home. The intervention comprises wearing eye-masks and ear plugs from 20:00 to 6:00, followed by removal of these devices and exposure to normal environmental noise and 300-600 lux light from 6:00 to 20:00. The primary outcome is composite cognitive score on Bayley-4 developmental assessment at 2 years corrected postnatal age.
The trial is approved by the Child and Adolescent Health Service Human Research Ethics Committee under the National Mutual Acceptance Scheme in Australia. Infants are randomised to intervention or control group after informed parental consent is obtained. Results of the CIRCA DIEM Study will be disseminated widely via presentations at local, national and international conferences, publication in international peer-reviewed journals and inclusion on the study website. Information about trial findings will also be communicated directly to the parents/guardians of trial participants through the regular study newsletter. The trial investigators will seek opportunities to communicate study results to the lay public through media and social media avenues.
ANZCTRN12618000371291.
Long COVID is a debilitating condition consisting of prolonged neurological symptoms such as cognitive impairment (‘brain fog’) and sleep disturbance. Symptoms may be associated with ongoing neuroinflammation from the persistence of a viral reservoir, activation of other viruses, protracted macrophagic inflammatory memory or enduring viral Spike protein that stimulates proinflammatory cytokines via toll-like receptor (TLR) signalling. Bezisterim (NE3107) is an oral, blood–brain barrier-permeable, anti-inflammatory, insulin-sensitising dehydroepiandrosterone derivative that inhibits TLR-driven neuroinflammation and is being developed for neurodegenerative diseases in which TLR-driven inflammation contributes to cognitive decline.
ADDRESS-LC (NCT06847191) is a phase 2, triple-blind, placebo-controlled, randomised proof-of-concept study to evaluate the efficacy and safety of bezisterim in adults with long COVID. This multicentre study will recruit 208 adults (aged 18–69 years) with symptoms of fatigue and neurocognitive impairment for at least 3 months following an index SARS-CoV-2 infection. Individuals who meet all eligibility criteria will be randomised 1:1 to receive bezisterim 20 mg or placebo two times per day for 12 weeks. Cognition, fatigue, sleep, post-exertional malaise, quality of life and burdensome symptoms will be evaluated via several assessments, including a bespoke Cogstate Cognition Battery, Patient-Reported Outcomes Measurement Information System (PROMIS) Cognitive Function Short Form (SF)-8a, PROMIS Fatigue SF-13a and Patient’s Global Impression of Severity, among others.
The protocol has been approved by an institutional review board prior to study initiation. The study is being conducted at multiple clinical research sites across the USA. A current list of participating study sites is publicly available through the ClinicalTrials.gov registration record (NCT06847191). The study protocol has received central institutional review board approval (Advarra #Pro00081088), and participating sites obtained the necessary approvals and agreements required for study conduct and data access in accordance with applicable regulations and Good Clinical Practice guidelines. Authorised representatives of the sponsor, regulatory authorities and ethics committees may access study-related records for monitoring, auditing and regulatory purposes consistent with participant informed consent. The study will disseminate results through academic publication and conference presentations.
Blood pressure treatment response is variable in individual patients, and the choice of medical therapy is often dependent on clinician experience. Treatment choices could be personalised by patient empowerment and metabolomic profiles, and augmented by machine learning, but robust evaluation is lacking on how these can be combined to enhance clinical effectiveness. The HYPERMARKER trial will evaluate how an individualised choice of medication class can address the avoidable global health and economic burdens of hypertension.
The HYPERMARKER trial is a proof-of-concept, pragmatic, multicentre, adaptive, open-label strategy trial embedded into routine clinical practice with stratified individual patient randomisation. The trial was co-designed with a patient and public involvement team. The intervention is a digital portal that supports shared decision-making on hypertension therapy class using clinical features plus metabolomic profiles determined with liquid chromatography-mass spectrometry.
Eligible patients are aged≥18 years with a systolic blood pressure≥140 mm Hg and a clinical indication for antihypertensive therapy. 400 participants will be randomised to the usual standard of care for treatment selection or to the intervention group. Remote follow-up will occur through a patient smartphone application and linked blood pressure monitor to assess the primary outcome of change in home systolic blood pressure during a 4-week period after medication changes. Secondary outcomes will include patient-reported adverse effects and quality of life, treatment withdrawal, healthcare utilisation and a health economic analysis. In the second phase of the trial, all participants will receive an updated version of the intervention regardless of the original randomised group.
Ethical approval will be obtained for all sites. Approval in England: North West – Greater Manchester West Research Ethics Committee (REC) (25/NW/0296). Trial results will be disseminated via peer-reviewed publications and plain-language patient summaries.
by Petr Bahenský, Tomáš Mrkvička, David Marko, Renata Malátová, Miroslav Krajcigr, Eric Harbour
Respiratory protective equipment, particularly filtering facepiece respirators (FFRs), are increasingly used during physical activity, yet their influence on breathing mechanics remains unclear. This randomized, crossover trial investigated the impact of N95 FFRs on thoracoabdominal breathing patterns during graded treadmill exercise. Twenty competitive runners (10 male, 10 female; 18.9 ± 2.3 years) performed Bruce protocol tests with and without FFRs, while optoelectronic plethysmography quantified the contributions of pulmonary ribcage (RCp), abdominal ribcage (RCa), and abdomen (Ab) to tidal volume. Global ventilatory parameters (tidal volume, breathing frequency, minute ventilation) were unaffected by FFR use. However, compartmental analysis revealed significant alterations in breathing patterns at higher intensities. At 12 and 15 minutes, FFRs reduced RCp contribution (−7.85 ± 2.49%, P = 0.002; −8.41 ± 3.35%, P = 0.012) and increased Ab contribution (+5.97 ± 2.08%, P = 0.004; + 6.51 ± 2.80%, P = 0.020). Across all phases, females demonstrated moderate, but variable RCp dominance (P = 0.052). These findings indicate that while FFRs do not impair overall ventilation in trained runners, they substantially modify the biomechanics of breathing under load, reflecting compensatory adjustments that likely help preserve ventilatory efficiency. The results suggest that well-trained athletes may tolerate acute respiratory stress more effectively than the general population, which has implications for athletic training, rehabilitation, and occupational health where respirator use is required.
Trial registrationClinicalTrials.gov NCT07032740
This clinical investigation was undertaken to confirm the safety and performance of a canister-based single-use negative pressure wound therapy system when used as intended in the management of low-to-moderately exuding chronic wounds, including diabetes-related foot ulcers (n = 34), venous leg ulcers (n = 34), and pressure ulcers (n = 36) for up to 28 days. Using a prospective non-comparative, multi-centre design, device performance was evaluated at 14 sites in seven European countries. The study covered a broad spectrum of wounds, reflecting the inclusion of both inpatients (67.7%) and outpatients (32.3%). The primary outcome measure was wound progress. Overall, wounds were deemed improved since the previous clinic visit in 76.3% of visits and reductions in both absolute and relative wound size were noted over the study period. The device was considered effective and easy to apply by investigators, with no unexpected safety concerns noted.
Commentary on: Monari E, Younas A, Salimi S. (2025). Barriers and Facilitators to Self-Management of Multimorbidity Among Culturally and Linguistically Diverse Immigrants: A Qualitative Descriptive Study. Journal of Advanced Nursing, (online ahead of print) 11 April. Available at: https://doi.org/10.1111/jan.16971
Implications for practice and research Healthcare professionals must adopt culturally responsive strategies for nurturing self-management capabilities for culturally and linguistically diverse patients living with multimorbidity. Targeted culturally responsive health literacy interventions are paramount, ensuring cultural values, health beliefs and communication preferences are reflected in both health information content and delivery. Further research is needed to examine the implementation, effectiveness and long-term impact of culturally responsive approaches to preparing individuals to self-manage multimorbidity.
Multimorbidity is the presence of two or more chronic health conditions within an individual. Delivering programmes that enhance health literacy and support self-management is recognised for improving patient...
by Ben Langford, Johanna Brans, Claire Broadbent, Tim Gibson, Mark Hanlon, Marie Haskell, Laura Nicoll, Neil J. Mullinger, Carol-Anne Duthie
Breath analysis offers a promising, non-invasive approach for early disease detection in livestock, particularly for bovine respiratory disease (BRD). However, the widespread use of antibiotics in veterinary practice raises concerns about their potential to confound breath-based diagnostics. In this study, we analysed breath samples from 65 calves to evaluate the diagnostic performance of volatile organic compounds (VOCs) as biomarkers of BRD. We identified several candidate ions, including formaldehyde and acetone/propanal, that showed significant elevation at the onset of disease and a modest detection capability (AUC = 0.53-0.77). However, the strongest discrimination between diseased and controls occurred after antibiotic administration, suggesting a confounding pharmacological influence. To isolate this effect, a secondary trial was conducted in which healthy calves were treated with oxytetracycline dihydrate (Alamycin® LA 300). This revealed rapid and transient changes in the breath volatilome, with significant increases in dimethyl sulphide and (C₅H₁₀O)H+ within 1 hour, and other VOCs, including formaldehyde and acetone/propanal within 24 hours of treatment. These findings demonstrate that antibiotics can substantially alter breath VOC profiles, potentially mimicking or masking disease signals. We conclude that breath-based diagnosis of BRD holds promise but must account for treatment history to avoid misclassification. Moreover, the reproducible and time-resolved nature of the VOC response suggests that breath analysis could also be developed as a tool for monitoring antimicrobial exposure and optimising therapeutic dosing in livestock.In current practice, fluid volumes administered to children following kidney transplant vary widely. Up to 52% of children experience fluid overload-related complications. Current fluid guidelines are not evidence-based and the optimal amount of fluid for children after transplant is not known. The aim of Randomised multiple centre trial of conservative versus LIberal fluid adMInisTration for children receiving a kidney tranSplant (LIMITS) is to determine whether relative limitation of fluid volume administered to children receiving kidney transplants is superior to liberal fluid volume administration.
LIMITS is a pragmatic, open-label, UK-based, multicentre randomised controlled trial, with an internal pilot phase and integrated economic evaluation. A total of 140 children receiving kidney transplants will be randomised to receive either conservative postoperative fluid administration (maximum of 150 mL/m2/hour for no longer than 18 hours, followed by a fixed daily target of maximum 1.5 L/m2/day thereafter) versus the comparator of liberal postoperative fluid administration (fluid volume administered to replace urine output and insensible losses for at least 48 hours with target urine output >2 mL/kg/hour). The primary outcome is mean days at home in the first 30 days after kidney transplant. The primary outcome will be analysed using a mixed linear regression model adjusted for donor type (living vs deceased donor) and participant weight (
The trial received Health Research Authority approval on 20 August 2025 (REC reference: 25/EE/0161, IRAS project ID: 354370). Findings will be presented to academic groups via national and international conferences and peer-reviewed journals. The patient and public involvement group will play an important part in disseminating the study findings to the public domain.
by Wasim Labban, Juan Forero, Lindsey Westover, Mark Sommerfeldt, Stephanie Nathanail, Lauren Beaupre
ObjectivesTo compare dynamic postural stability, measured by time to stabilization (TTS) and postural stability indices (PSI), after double-leg counter-movement jump (CMJ) landing in individuals 9–24 months following anterior cruciate ligament reconstruction (ACLR) and healthy controls. Additionally, to explore the effect of sex and ACLR status on postural stability.
MethodsThis cross-sectional laboratory-based study included 41 participants: 21 individuals (10 females) 9–24 months post-ACLR and 20 healthy controls (10 females). Participants performed double-leg countermovement jumps (CMJs) on force plates, landed, and maintained the landing position for 10 seconds. Time to stabilization (TTS), defined as the time (s) required for the ground reaction force to reach and maintain a stable state following landing, and postural stability index (PSI), a composite measure of the ability to maintain equilibrium during the transition from dynamic to static conditions, were calculated and compared between groups.
ResultsThe ACLR group exhibited significantly higher TTS values than healthy controls, indicating a longer duration to achieve stability. Specifically, the resultant vector TTS when combined from both force plates (RVTTS-C), and the vertical TTS in the operated leg (VTTS-op) was higher in the ACLR than the healthy controls (p = 0.03, p = 0.02, respectively). Furthermore, males with ACLR demonstrated higher VTTS combined (VTTS-C) and VTTS-op than females post-ACLR (p = 0.03, p Conclusion
Our study revealed significant deficits in dynamic postural stability in individuals post ACLR, with notable sex differences. The findings suggest a need for targeted neuromuscular rehabilitation to improve landing stability post ACLR and reduce the risk of secondary injury. Further research is needed to understand sex-specific postural stability mechanisms for tailored rehabilitation.
To understand healthcare professionals' perspectives of what works well and what can be improved in the supply and administration of anticipatory medications at the end of life in the community.
Qualitative interpretive study using focus groups.
Semi-structured focus groups included healthcare professionals with experience of using anticipatory medications, and public contributors with lived experiences of relatives' end-of-life care. Participants' demographic information was elicited in a brief questionnaire. Transcripts were analysed inductively using thematic analysis. Data were collected in September 2022.
Eight focus groups involved 58 UK-based participants. Each group included people with a variety of professional roles from diverse geographical areas, and public contributors with relevant lived experiences.
The administration of anticipatory prescriptions was widely perceived to be a valuable intervention, but extensive operational challenges were identified, with three interconnected themes arising from the data: (a) Communication between healthcare teams; (b) Intuitive documentation; (c) Accessibility of medications. Addressing these challenges was perceived to be onerous, particularly for nurses and families.
Operational barriers to the timely and appropriate administration of anticipatory medications risk were perceived as adversely affecting patient care and patients' and families' experiences.
System-level improvements are needed to streamline care processes and ensure equitable, appropriate, and timely access to end-of-life symptom control medications in the community.
This study adheres to relevant EQUATOR guidelines and follows the appropriate Standards for Reporting Qualitative Research (SRQR).
Our Public and Clinician Advisory Group helped shape questions and commented on findings. Focus groups included public participants with lived experience of end-of-life care in the community.
Paediatric anxiety disorders are among the most common psychiatric disorders of childhood and adolescence, affecting between 15% and 30% of youth. Rates rose sharply during the COVID-19 pandemic, and untreated anxiety is associated with impaired functioning and increased risk of depression, suicidality and substance use in adulthood. Evidence-based treatments such as cognitive-behavioural therapy and selective serotonin reuptake inhibitors are highly effective yet remain underused, while non-recommended treatments, including benzodiazepines, are often prescribed. Despite the public health burden, there are currently no endorsed outcome-focused quality measures for paediatric anxiety. Developing such measures would allow health systems and providers to track outcomes, reduce disparities and drive quality improvement.
This study will develop and test two complementary outcome-focused paediatric anxiety quality measures based on the seven-item Generalised Anxiety Disorder scale: (1) remission (clinically significant reduction in anxiety symptoms to below threshold) and (2) response (clinically significant improvement, even if remission is not achieved). Using electronic health record and claims data from Kaiser Permanente Northwest and Kaiser Permanente Southern California from 2017 to 2024, we will establish measure inclusion and exclusion criteria, evaluate the application of symptom weighting, test measure reliability and validity and implement casemix adjustment models. Analyses will examine disparities by race, ethnicity and social risk factors through linkage indices capturing local social determinants of health. Qualitative interviews with providers and electronic medical record vendors will be conducted to assess feasibility and usability. Measures will be prepared and submitted for endorsement by a national quality measurement body.
This study has been reviewed and approved by the institutional review boards at RTI International and Kaiser Permanente. Findings will be disseminated through peer-reviewed publications, scientific conferences, stakeholder workshops and submissions to a national quality endorsement body.
FreshRSS 