BACKGROUND: Adherence with follow-up appointments after a pediatric intensive care unit (PICU) admission is likely a key component in managing post-PICU sequalae. However, prior work on PICU follow-up adherence is limited. The objective of this study is to identify hospitalization characteristics, discharge child health metrics, and follow-up characteristics associated with full adherence with recommended follow-up at a quaternary care center after a PICU admission due to respiratory failure.
METHODS: We conducted a retrospective cohort study of patients ≤ 18 years with respiratory failure admitted between 1/2013-12/2014 to a quaternary care PICU. Post-hospitalization full adherence with recommended follow-up in the two years post discharge (1/2013-3/2017) at the quaternary care center was quantified and compared by demographics, baseline child health metrics, hospitalization characteristics, discharge child health metrics, and follow-up characteristics in bivariate and multivariate analyses. Patients were dichotomized into being non-adherent with follow-up (patients who attended less than 100% of recommended appointments at the quaternary care center) and fully adherent (patients who attended 100% of recommended appointments at the quaternary care center).
RESULTS: Of 155 patients alive at hospital discharge, 140 (90.3%) were recommended to follow-up at the quaternary care center. Of the 140 patients with recommended follow-up at the quaternary care center, 32.1% were non-adherent with follow-up and 67.9% were fully adherent. In a multivariable logistic regression model, each additional recommended unique follow-up appointment was associated with lower odds of being fully adherent with follow-up (OR 0.74, 95% CI 0.60-0.91, p = 0.005), and each 10% increase in the proportion of appointments scheduled before discharge was associated with higher odds of being fully adherent with follow-up (OR 1.02, 95% CI 1.01-1.03, p = 0.004).
CONCLUSIONS: After admission for acute respiratory failure, only two-thirds of children were fully adherent with recommended follow-up at a quaternary care center. Our findings suggest that limiting the recommended follow-up to only key essential healthcare providers and working to schedule as many appointments as possible before discharge could improve follow-up adherence. However, a better understanding of the factors that lead to non-adherence with follow-up appointments is needed to inform broader system-level approaches could help improve PICU follow-up adherence.

BACKGROUND: Many parents report the transition from hospital to home as challenging after the birth of a preterm-born child. This study investigates parental perceptions of community-based follow-up services after hospital discharge, alterations in parental self-efficacy during the early months at home, the prevalence of depressive symptoms among parents, and the relationship between these factors and both NICU experiences and children\'s regulative behaviors.
METHODS: In this second phase of a descriptive study, 110 parents returned a digital questionnaire when their child was four months corrected for prematurity. Parents were recruited while hospitalized with their child, in one of eight Norwegian neonatal intensive care units (NICUs). Thus, the study provides insight into follow-up services across a broad geographical range. Parents\' perception of self-efficacy was reported on the Karitane Parenting Confidence Scale, and depressive symptoms were evaluated with the Edinburgh Postnatal Depression Scale (EPDS). Children\'s regulative behavior was reported on the 6-month version of the Ages and Stages Questionnaire: Social and Emotional (ASQ: SE). Using SPSS, associations between variables were investigated in multiple regression analysis in addition to descriptive analysis. Additionally, the examination of repeated measures of parental self-efficacy involved the application of linear mixed models.
RESULTS: Parents reported improved perception of self-efficacy from postdischarge to the children\'s age of four months (F (1,167) = 1233.2, p < 0.001). On average, fathers\' self-efficacy improved more than that of mothers. Parents\' perception of being well informed prior to discharge from hospital predicted improved self-efficacy (F [1, 29] = 10.4, p = 0.003). Reports of depressive symptoms were at a similar level as previously reported among new parents, as 10.4% of mothers and 6.7% of fathers reported EPDS scores ≥ 10 points. Parents\' reports on ASQ: SE show that 15% of the children scored above the recommended cutoff score for three- to nine-month-old children. The parent-reported benefit of follow-up services showed considerable variation. The importance of specific knowledge about prematurity among public health nurses and physicians was frequently mentioned, and public health nurses were perceived as coordinators and mediators of various services.
CONCLUSIONS: Parents reported improved self-efficacy, and depressive symptoms at similar levels as new parents in general, a few months after discharge from hospital. Childrens\' regulatory behavior were reported at levels comparable with term-born infants.

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BACKGROUND: In Oman, there is a lack of data on utilisation, needs and women\'s satisfaction with care and information provided during postnatal follow-up period.
OBJECTIVE: To investigate postnatal follow-up care utilisation and women\'s needs; level of postnatal information received and satisfaction with services.
METHODS: A purposive sample of women (n = 500), recruited in the immediate postnatal period at one metropolitan and one regional birthing hospital in Oman. An electronic survey link was sent to participants at 6-8 weeks postnatally. Quantitative variables were analysed as frequencies and chi-squared test.
RESULTS: A total of 328 completed surveys were received; a response rate of 66 %. Most respondents were located in the metropolitan area (n = 250) and between 20 and 39 years (n = 308). Utilisation was low as women reported no need or no benefit in attending. Women\'s information needs were not sufficiently met by HCPs, requiring women to seek information from family and the internet to meet their needs. Satisfaction with services was mostly neither satisfied nor dissatisfied (30 %) or satisfied (30 %).
CONCLUSIONS: Postnatal follow-up care utilisation in both metropolitan and regional areas is less than optimal and not utilised as there was no advice to attend or no appointment date/time given, no benefit experienced previously, no need and information needed sourced from family or the internet. The information provided by postnatal follow-up care consumers can be used to enhance service delivery, inform future updates to the national maternity care guidelines, and provides a baseline for future evaluation and research.

BACKGROUND: In 2006, a Constitutional Court ruling partially decriminalized abortion in Colombia, allowing the procedure in cases of rape, risk to the health or life of the woman, and fetal malformations incompatible with life. Despite this less prohibitive law, some women and pregnant people preferred self-managing their abortions outside the formal healthcare system, often without accurate information. In 2018, we undertook a study to understand what motivated women to self-manage using medications that they acquired informally. Colombia has since adopted a progressive law in 2022, permitting abortion on request through the 24th week of pregnancy. However, the implementation of this law is still underway. Examining the reasons why women chose to informally self-manage an abortion after 2006 may not only highlight how barriers to legal services persisted at that time, but also could inform strategies to increase knowledge of the current abortion law and improve access to services going forward.
METHODS: In-depth interviews were conducted in 2018 with 47 women aged 18 and older who used misoprostol obtained outside of health facilities to induce an abortion, and who were receiving postabortion care in two private clinics. Interviews explored what women knew about the 2006 abortion law which was then in effect, and the reasons why they preferred informal channels for abortion care over formal healthcare services.
RESULTS: Women\'s motivations to use misoprostol obtained outside the formal healthcare system were influenced by lack of trust in the healthcare system along with incomplete and inaccurate knowledge of the abortion law. Conversely, women considered misoprostol obtained outside the healthcare system to be effective, affordable, and easier to access.
CONCLUSIONS: Obtaining misoprostol outside the formal healthcare system offered a more accessible and appealing prospect for some women given fears of legal repercussion and stigma toward abortion. Though this preference will likely continue despite the more liberal abortion law, strategies should be implemented to broaden knowledge of the recent change in law and to combat misinformation and stigma. This would support knowledge of and access to legal abortion for those who wish to avail themselves of these services.
UNASSIGNED: En el 2006 la Corte Constitucional de Colombia despenalizó el aborto en casos de violación, riesgo para la salud o vida de la mujer y malformaciones fetales. A pesar de ello, algunas mujeres y personas con capacidad de gestar continuaron obteniendo abortos fuera del sistema de salud. En el año 2018, realizamos un estudio para comprender qué las motivaba a hacerlo. Desde entonces Colombia ha adoptado un marco legal más progresista, permitiendo en el año 2022 el aborto a solicitud hasta la semana 24 de embarazo. Sin embargo, la implementación de este marco legal aún está en curso. Examinar las razones por las que las mujeres recurrieron a auto inducirse un aborto de manera informal después del 2006 no solo informa sobre las barreras a los servicios legales en ese periodo, sino también ayuda a desarrollar estrategias para aumentar el conocimiento del marco legal actual y mejorar el acceso a los servicios MéTODOS: Durante el 2018 entrevistamos a 47 mujeres mayores de 18 años que compraron misoprostol fuera del sistema de salud para inducirse un aborto, y que recibieron atención postaborto. En las entrevistas exploramos lo que sabían sobre el marco legal de ese momento –el del 2006–, y las razones por las cuales recurrieron a fuentes informales para abortar.
RESULTS: Las motivaciones de las mujeres para usar misoprostol obtenido de fuentes informales resultan de la desconfianza hacia el sistema de salud y un conocimiento incompleto del marco legal. En contraste, las mujeres consideran que el misoprostol obtenido por fuentes alternativas ofrece eficacia y asequibilidad, y es más fácil de obtener.
CONCLUSIONS: Obtener misoprostol fuera del sistema de salud formal es una alternativa más llamativa para algunas mujeres dadas las preocupaciones sobre las repercusiones legales y el estigma asociado al aborto. Aunque esta preferencia persista a pesar del cambio del marco legal, se deben implementar estrategias para ampliar el conocimiento sobre la despenalización y combatir la desinformación y el estigma. Esto garantizaría que las mujeres estén informadas y puedan acceder a servicios legales de aborto de calidad si así lo desean.
Despite the availability of legal services, pregnant individuals in Colombia have continued to seek abortion outside of the formal healthcare system. Understanding their knowledge of the abortion law and their perceptions of legal abortion services may provide insight into what motivates them to seek alternative routes of abortion.Women who obtained misoprostol outside of the formal healthcare system were interviewed in 2018, twelve years after abortion was partially decriminalized in Colombia (and prior to the full decriminalization of abortions up to 24 weeks in 2022). A combination of factors led women to seek misoprostol in this manner: incomplete knowledge of the abortion law, fear of legal consequences, fear of social stigma, and a desire for a faster and private process.Self-management with informally obtained medication can offer pregnant individuals the opportunity to have an abortion on their own terms, especially when abortion in the formal healthcare system appears to be unavailable, proves difficult to access, or is accompanied by social and legal risks. While increasing awareness that abortion is legal in Colombia might empower pregnant people to seek formal care, judgment from their community, healthcare providers, and law enforcement may still serve as powerful hindrances to obtaining these services unless there are efforts made to combat abortion stigma as well.

UNASSIGNED: High rates of youth re-offending indicate that young custody-leavers face challenges when reintegrating into their communities. Aftercare and resettlement programs can occur pre-, during, and post-release and generally provide multiple forms of support services to address youths\' transitional needs.
UNASSIGNED: The present review examines (1) the impact of youth aftercare/resettlement programs on crime-related outcomes, (2) how treatment effect is moderated by participant, program, and study characteristics, (3) whether some types of interventions are more effective than others, (4) barriers/facilitators to effective program implementation, (5) the theory of change underlying resettlement interventions, and (6) available research on intervention cost.
UNASSIGNED: A comprehensive set of keywords and synonyms was combined in a Boolean search across 26 electronic databases. Multiple gray literature sources were also searched, including 23 journals, 4 meeting archives, 11 organization websites, 3 open access journal websites, and the CVs of 8 well-known researchers in the field. The search was completed in January 2023.
UNASSIGNED: For objectives 1-3, studies were included if they utilized a randomized controlled design or quasi-experimental comparison group design in which participants were matched on at least some baseline variables and included at least one quantitative individual-measure of crime. For objective 4, included studies presented process evaluations of aftercare/reentry programs, clearly stated their research goals, and used qualitative methods in an appropriate way to answer the stated research question. For objectives 5 and 6, no specific methods were required; any study meeting the criteria for objectives 1-4 which presented findings on theory of change or cost data were included. For all outcomes, only studies conducted in a westernized country, and published after 1991 in English, French, or German were considered.
UNASSIGNED: Two coders conducted primary data extraction for the included studies. Data were entered into a Microsoft Excel database. After data extraction, the two coders validated the coding by cross-checking the database with each research report. Discrepancies between coders were discussed until consensus was reached. Where consensus could not be reached, a third coder was consulted. Study risk of bias was addressed using the ROBINS-I (Sterne et al., 2016), ROB-2 (Higgins et al., 2019), and the critical appraisal skills programme (CASP, 2018). Objectives 1-3 were addressed by synthesizing quantitative outcomes from rigorous impact evaluations of aftercare interventions using random effects models and meta-regression. Thematic and narrative analysis was conducted to address objectives 4-6.
UNASSIGNED: The search resulted in 15 impact studies, representing 4,718 participants across 21 program sites, and 35 effect sizes. The 21 impact evaluations were rated as having either low/moderate bias (k = 11) or serious bias (k = 10). The synthesis of 15 impact studies found no significant effects for arrest (k = 14; OR = 1.044, 95% prediction interval [0.527, 2.075], t = 0.335) or incarceration (k = 8, OR = 0.806, 95% prediction interval [2.203, 1.433], t = -1.674). A significant pooled effect was found for conviction (k = 13, OR = 1.209, 95% prediction interval [1.000, 1.462], t = 2.256), but results were highly sensitive to the inclusion of specific studies. No meaningful pattern of results emerged in moderator analyses with respect to study, sample, program component, or program delivery characteristics. The 19 process studies were rated as either high quality (k = 12) or moderate quality (k = 7). Thematic synthesis of the process evaluations revealed 15 themes related to the strengths/challenges of program implementation. The assessment of program cost (k = 7) determined a lack of data within the literature, preventing any summative analysis.
UNASSIGNED: Current evidence is promising with respect to conviction outcomes but overall does not find that aftercare/resettlement interventions have a reliably positive impact on crime-related outcomes for young people who have offended. High variability across outcomes and reported data resulted in small sample sizes per outcome and limited moderator analyses. Multiple challenges for program implementation exist; additional rigorous research is sorely needed to further investigate the nuances of the program effects.

In recent decades, there has been a noteworthy increase in the efficacy of oncological treatments for a variety of neoplasms, which has improved the overall results and survival rates in cancer therapy [...].

OBJECTIVE: To improve the understanding of adherence as one major factor of disease control in acromegaly patients, we systematically assessed patients\' motivations to adhere to advised follow-up schedules and recommended medication for acromegaly.
METHODS: Cross-sectional, postal questionnaire study on adult patients with acromegaly, operated upon a growth hormone producing pituitary adenoma more than 1 year ago in two tertiary treatment centers. We assessed demographic and clinical characteristics, disease status, adherence to acromegaly medication and/or aftercare, and the five dimensions defined by the World Health Organization influencing adherence. Wherever applicable, we included validated short scales. The answers of 63 patients (33 f, 30 m; mean age 56.1 y) were analyzed.
RESULTS: Patients with problems in adherence to aftercare had a significantly lower subjective symptomload than those adherent to aftercare (p = 0.026) and a lower perceived need for treatment (p = 0.045). Patients with adherence problems to medication had a higher subjective symptomload than those without (p = 0.056). They also tended to have shorter consultations, were significantly more often dissatisfied with the duration of their medical consultations (42% vs 4.8%, p = 0.019) and tended to find that their physician explained potential difficulties with adherence less well than patients without adherence problems (p = 0.089).
CONCLUSIONS: To our knowledge, this is the first study which explored adherence to medication and aftercare in patients with acromegaly, taking into account potential influencing factors from all areas defined by the WHO model of adherence. Of the modifiable factors of adherence, patient-doctor relationship seemed to play a crucial role and could be one leverage point to improve adherence.

OBJECTIVE: In Germany, children diagnosed with cancer survive their initial disease in more than 80%, and the majority will become long-term survivors. Around the age of 18, survivors are transferred to adult healthcare. The transition can be a critical period in the process of care at which many childhood cancer survivors discontinue to participate in regular follow-up care. Hence, the objective of the paper was to explore (a) survivors\' attitudes towards pediatric follow-up care and (b) their concerns regarding the transition process to draw conclusions for optimizing pediatric care and transition processes.
METHODS: We conducted semi-structured interviews with 21 adolescent childhood cancer survivors between the ages of 14 and 20. The survivors were recruited via a pediatric oncology department of a university hospital in Germany. Based on the principles of qualitative content analysis, a deductive-inductive method according to Kuckartz was applied.
RESULTS: Based on the interview guide and derived from the exploratory research questions, two key categories were generated: (a) Survivors\' attitudes towards pediatric follow-up care, which encompasses all formal and emotional aspects of survivors regarding follow-up care, and (b) their concerns regarding transition from pediatric to adult healthcare, where hindering and facilitating factors for a successful transition occur. Our results show high satisfaction among survivors with follow-up care. Nevertheless, they wish to be more integrated into processes and the organization of their follow-up care. Most adolescent survivors do not feel ready for transition.
CONCLUSIONS: The integration of survivors into the organization processes and routines, and the promotion of emotional detachment from pediatric health care professionals (HCPs) are important to reduce concerns and uncertainties of adolescent survivors regarding the transition process and to promote subjective readiness for transition. To gain confidence in the adult healthcare, it is crucial to provide tailored education depending on individual requirements and needs and to build trusting relationships between survivors and adult HCPs.