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Psychological Outcomes of Family Members Related to a Loved One's Resuscitation in the Emergency Department: A Cross‐Sectional Study

ABSTRACT

Aims

This study aimed to assess the psychological outcomes of family members of patients who were resuscitated in the Emergency Department (ED) and analyse factors associated with these outcomes.

Design

This study utilised a cross-sectional design

Methods

Data were collected using a self-reported questionnaire sent to family members of patients who had undergone resuscitation in the ED from February 2024 to January 2025. Instruments for data collection included The Impact of Event Scale-Revised (IES-R), the short version of The Depression, Anxiety and Stress Scale–21 items (DASS-21), the Multicultural Quality of Life Index (MQLI) and questions related to demographic variables and the resuscitation event.

Results

A total of 106 family members completed the questionnaire. Of this, 64.2% (n = 68) reported witnessing the resuscitation attempt, and 35.8% (n = 38) did not witness the event. Family members who witnessed the resuscitation displayed more symptoms of post-traumatic stress disorder (PTSD), measured by the IES-R, compared to those who did not witness the event. A statistically significant negative correlation was found between the IES-R and the MQLI scores, indicating that higher PTSD symptoms correlate with lower quality of life (QoL) ratings.

Conclusion

The findings of this study indicated that witnessing the resuscitation of a loved one in the ED is associated with increased PTSD symptoms.

Implications for Health Professionals and Patient Care

Patients' and family members' cultural and religious needs should be acknowledged by the health care providers. Study findings indicate that family members prefer to be with the patient during the patient's resuscitation. However, without adequate support from hospital staff, this experience may cause adverse psychological effects. Strategies to support family members during and after resuscitation should be developed and integrated into the management of in-hospital resuscitation.

Reporting Method

This study followed the STROBE guidelines.

Patient or Public Contribution

No patient or public contribution.

Mental health help-seeking among individuals with breast cancer: A qualitative exploration of women’s and healthcare practitioners’ perspectives

by Nurdiana Mohammad Hussin, Nik Ruzyanei Nik Jaafar, Idayu Badilla Idris, Azmawati Mohammed Nawi

Individuals with breast cancer (BC) experience significant psychological distress, yet their utilization of mental health services remains low. This study identified key factors influencing help-seeking behavior through integrated Theory of Planned Behavior (TPB) and Health Belief Model (HBM) frameworks. We conducted in-depth interviews (IDIs) with eight BC patients and nominal group technique (NGT) with six health professionals, followed by Fuzzy Delphi Method (FDM) to assess expert consensus. The IDIs revealed that the individuals with BC recognized the value of professional psychological support but were reluctant to engage with these services personally. The participants identified emotional thresholds for help-seeking, expressed preference for informal support networks, and demonstrated varied understanding of mental health professional roles. The FDM evaluation demonstrated strong expert consensus across all assessed elements, particularly those related to emotional support mechanisms. Three barrier categories emerged: individual factors (mental health literacy, autonomy preferences), social factors (family support, cultural stigma), and systemic factors (healthcare integration gaps). Expert consensus exceeded 80% agreement across all domains.This study identified a complex interplay between individual psychological barriers and systemic factors affecting mental health help-seeking among individuals with BC. Effective interventions must address psychological barriers and healthcare delivery factors while respecting individual autonomy in coping choices. A multi-level approach targeting individual education, family support systems, and healthcare integration is recommended to improve mental health service utilization among individuals with BC.

Usability evaluation of the “Teen ‘n Fit” mobile health application: A formative study among Indonesian adolescent girls

by Dwi Sisca Kumala Putri, Kencana Sari, Nur Handayani Utami, Nazarina Nazarina, Tiara Amelia, Nadira Yuthie Salwa, Ning Sulistiyowati, Adindra Vickar Ega, Muhammad Azzumar, Rika Rachmawati, Salimar, Mieska Despitasari, Donny Kristanto Mulyantoro

Background

Mobile Health (mHealth) Applications offer a promising approach to promote the adoption of healthy nutrition and behavior among adolescent girls. A tailored mobile app, Teen ‘n Fit, was developed to support adolescent girls in Indonesia to assess their nutritional status, physical activity, and eating behavior; as a nutrition education media; and as a reminder of iron folic acid consumption. However, it is essential to measure the app’s usability prior to the release.

Objective

This study aimed to measure the usability of a mobile application designed to promote nutrition and healthy behavior of adolescent girls by modifying the mHealth App Usability Questionnaire (MAUQ).

Methods

A cross-sectional usability study was conducted on 64 adolescent girls aged 15–18 from a public high school in Depok, Indonesia. Participants completed app-based tasks and filled out a post-task usability questionnaire. The usability questionnaire was adapted from a validated MAUQ for a standalone mHealth app. The exploratory factor analysis was conducted to determine the items constituting each component in the modified MAUQ. Mann-Whitney analysis was employed to analyze the difference in usability score means based on participants’ characteristics.

Results

The modified MAUQ demonstrated strong reliability (Cronbach’s alpha = 0.945). The app achieves a strong usability score, 6.0 ± 0.8 out of 7, with 79.7 percent of participants reporting no prior mHealth experience. The score among participants who occasionally used mHealth applications was higher (p = 0.046) than those who had never made prior use.

Conclusion

The findings indicate strong usability potential of Teen ‘n Fit as a digital health promotion tool for adolescent girls; however, future efforts in conducting effectiveness tests and maintaining user engagement are needed.

Prioritizing food systems interventions to reduce adolescents nutrition insecurity and malnutrition in low-income settings: protocol for the Dishi Fiti Ishi Fiti (Eat Well Live Well) mixed-methods study

Por: Lee · G. O. · McCormick · B. J. · Staromiejska · W. · Mutuku · V. · Fox · E. L. · Kimenju · S. · Mawa · P. A. · Asiki · G. · Downs · S.
Introduction

Adolescents in informal urban communities, defined as settlements that fall outside of formal governmental planning and regulatory frameworks, are at increasing risk of poor-quality diets and malnutrition in all its forms. The food environment is the interface of adolescent food choice and the broader food system, and food environment interventions have the potential to improve adolescent diets and nutritional outcomes.

Methods and analysis

We will conduct a mixed-methods study, integrating methods from participatory systems science and nutritional epidemiology to characterise linkages among adolescents’ neighbourhood and home food environments, and their food choices, diets and nutritional outcomes. We will recruit adolescents, caregivers, school staff and food system actors from five communities along a gradient of urban informality in Nairobi, Kenya, to participate in cognitive mapping, group-based modelling and a cohort study over one academic year to evaluate dietary choices and nutritional outcomes.

Ethics and dissemination

The study has been approved by the Research Ethics Committee of Rutgers University (Pro2024001981) and Amref Health Africa (P1831-2025). Adult participants will provide written informed consent, and adolescents will provide written informed assent to participate in the study. Findings will be disseminated through peer-reviewed journals, conference presentations and to participants through planned participatory interaction throughout the study.

Assessing the quality of amoxicillin in the private market in Indonesia: a cross-sectional survey exploring product variety, market volume and price factors

Por: Hasnida · A. · Rahmi · M. · Rahmawati · A. · Anggriani · Y. · van Leth · F. C. M. · Kok · M. O.
Objectives

To assess the quality of amoxicillin products in Indonesia’s private market by surveying the range of products available across different areas, followed by product sampling and laboratory testing.

Design

A cross-sectional survey employing mystery shoppers to purposively sample the widest possible range of amoxicillin products available to patients across different areas in Indonesia.

Setting

Licensed and unlicensed medicine outlets in remote, rural and urban areas and online.

Participants

Amoxicillin products that are sold to patients as oral solid and dry liquid formulations.

Main outcome measures

Quality of amoxicillin products, assessed using compendial testing of active pharmaceutical ingredient content and dissolution. Samples that failed any quality test were classified as substandard or out-of-specification (OOS). The raw prevalence of substandard amoxicillin was adjusted based on the national market volume of each product variant.

Results

We surveyed 476 outlets, mostly pharmacies (68.5%), websites (19.7%) and drug stores (10.9%). Among the 120 collected samples, there were 59 distinct products, collectively representing 95% of the estimated market volume for oral solid products and 65% for dry syrups. 12 out of 110 oral solid samples tested OOS (10.9%), as did 3 out of 10 dry syrups (30%). The samples that failed originated from various areas and types of outlets. We found no relation between the price and quality of amoxicillin.

Conclusions

The oral solid amoxicillin products that tested OOS represent an estimated 12.7% of the national market volume. We found no relation between the price and quality of amoxicillin. Combining product-variety sampling with data on market volume presents a promising approach to gain insight into the prevalence of poor-quality medical products using a relatively small sample size.

Assessing delays in primary percutaneous coronary intervention for ST-segment elevation myocardial infarction patients at a tertiary care hospital in Sri Lanka: a retrospective cohort study

Por: Ranasinghe · G. · Riyal · H. · Perera · K. · Pathirana · A. · Premawansha · T. · Ananthamoorthy · D. · Gunarathne · S. D.
Objectives

To analyse patient profiles, transportation patterns and time delays in ischaemic time and door-to-balloon (DTB) time and evaluate the effect of these delays on in-hospital mortality among patients undergoing primary percutaneous coronary intervention (P-PCI) for ST-segment elevation myocardial infarction (STEMI) at a tertiary care hospital in Colombo.

Design

Retrospective observational study.

Setting

Tertiary care hospital specialising in STEMI treatment, located in Sri Lanka.

Participants

The study included adults aged 16–87 years admitted for P-PCI between January 2018 and September 2023, presenting with STEMI and undergoing emergency P-PCI. Patients with incomplete records or unrealistic values on ischaemic time or DTB time were excluded.

Outcome measures

Outcome measures include ischaemic time, DTB time and in-hospital mortality. The associations of demographic factors, transfer methods and DTB time with survival rates were analysed.

Results

A total of 1758 patients underwent P-PCI (mean age, 53.0±11.64), with 85.2% being male. The male risk group was 46–60 years (OR, 1.22), whereas the female risk group was predominantly older than 60 years (OR, 1.87). The median ischaemic time was 4 hours and 36 min, and the median DTB time was 110 min. The in-hospital mortality rate was 3.8% (63/1,664). Prolonged DTB times exceeding 120 min were significantly associated with increased mortality (p=0.046), although alternative thresholds (45, 60 or 90 min) were not significant (p>0.05). Binary logistic regression with multiple variables identified female sex (OR, 2.52; 95% CI, 1.168 to 5.435, p=0.018), increasing age (OR 1.05; 95% CI, 1.016 to 1.085, p=0.004) and DTB times (OR, 1.001; 95% CI, 1.000 to 1.002, p=0.027) as independent predictors of mortality.

Conclusions

Despite improvements in DTB times, this study indicates that prolonged delays exceeding 120 min remain associated with increased mortality. Older age and female sex were identified as independent predictors of higher mortality. These findings underscore the need for efficient patient transfer methods and prompt decision-making at the primary healthcare level to minimise delays and disparities in P-PCI outcomes.

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