CONTEXT: The growing prevalence of pediatric mental and behavioral health disorders, coupled with scarce psychiatric resources, has resulted in a substantial increase in the number of youth waiting in emergency departments (EDs) and medical units for inpatient psychiatric care. OBJECTIVE: To characterize the prevalence of pediatric mental health boarding and identify associated patient and hospital factors. DATA SOURCES: Medline and PsycINFO. STUDY SELECTION: All studies describing frequencies, durations, processes, outcomes, and/or risk factors associated with pediatric mental health boarding in youth #21 years of age. DATA EXTRACTION: Publications meeting inclusion criteria were charted by 2 authors and critically appraised for quality. RESULTS: Eleven studies met inclusion criteria; 10 were retrospective cohort studies and 9 were conducted at single centers. All of the single-center studies were conducted at children's hospitals or pediatric EDs in urban or suburban settings. Study sample sizes ranged from 27 to 44 328. Among youth requiring inpatient psychiatric care, 23% to 58% experienced boarding and 26% to 49% boarded on inpatient medical units. Average boarding durations ranged from 5 to 41 hours in EDs and 2 to 3 days in inpatient units. Risk factors included younger age, suicidal or homicidal ideation, and presentation to a hospital during nonsummer months. Care processes and outcomes were infrequently described. When reported, provision of psychosocial services varied widely. LIMITATIONS: Boarding definitions were heterogeneous, study sample sizes were small, and rural regions and general hospitals were underrepresented. CONCLUSIONS: Pediatric mental health boarding is prevalent and understudied. Additional research representing diverse hospital types and geographic regions is needed to inform clinical interventions and health care policy.

Background Advance care planning in nursing homes is important to ensure the wishes and preferences of residents are recorded, especially during the COVID-19 pandemic. However, care staff and family members frequently report feeling unprepared for these conversations. More resources are needed to support them with these necessary discussions. This research aimed to develop, implement and evaluate a website intervention for care staff and family members to provide training and information about advance care planning during COVID-19. Methods The research was a primarily qualitative case study design, comprising multiple UK nursing home cases. Data collection included semi-structured interviews with care staff and family members which were coded and analysed thematically. A narrative synthesis was produced for each case, culminating in a thematic cross-case analysis of the total findings. Theoretical propositions were refined throughout the research. Results Eight nursing homes took part in the study, involving 35 care staff and 19 family members. Findings were reported according to the RE-AIM framework which identified the reach, effectiveness, adoption, implementation and maintenance of the intervention. Themes included: website content that was well received; suggestions for improvement; implementation barriers and facilitators; examples of organisational and personal impact. Conclusions Four theoretical propositions relating to advance care planning in nursing homes are presented, relating to: training and information needs, accessibility, context, and encouraging conversations. Implications for practice and training include an awareness of diverse learning styles, re-enforcing the right to be involved in advance care planning and encouraging opportunities for facilitated discussion. Trial registration ISRCTN registry (ID 18003630) on 19.05.21.

Although physical activity guidelines recommend muscle-strengthening activities (MSA), public health initiatives tend to focus on increasing aerobic activity and fail to mention MSA. This study sought to identify the issues influencing pre-, peri- and post-menopausal women's intentions to perform MSA with a view to informing future interventions for these populations. Mixed methods guided by the Theory of Planned Behaviour (TPB) were used to explore factors that influence women's intentions to perform MSA. In stage one, 34 women participated in either a focus group or interview. Discussions were transcribed verbatim and analysed based on menopausal status using a deductive approach. In stage two, 186 women (M = 47 years, SD = 9) completed a questionnaire to assess participant demographics, levels of MSA, affective and instrumental attitudes, injunctive and descriptive norms, self-efficacy and perceived behavioural control. Quantitative data were analysed using descriptive statistics, bivariate correlations, regression analyses and analysis of variances. Behavioural beliefs were: improved muscular health; psychological benefits; improved body shape. Normative beliefs were: health professionals; family members; work colleagues. Control beliefs were: equipment; motivation; time constraints; knowledge; physical capability; fear of judgement. However, these beliefs were not well established. Self-efficacy was the strongest predictor of intentions (spc = 0.11) followed by affective attitudes (spc = 0.09), with no significant differences on TPB variables between groups. If rising rates of musculoskeletal conditions in women are to be prevented, there is an urgent need to increase women's knowledge of recommended levels of muscle strengthening, with a view to promoting positive attitudes and enhancing women's sense of self-efficacy across all menopausal phases.

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IntroductionOver 80% of very preterm (<32 weeks) and very low birthweight (<1500 g) infants will have either typical development (TD) or mild developmental delay (MDD) in multiple domains. As differentiation between TD and MDD can be difficult, infants with MDD often miss opportunities for intervention. For many clinicians, the ongoing challenge is early detection of MDD without over servicing the population. This study aims to: (1) identify early clinical biomarkers for use in this population to predict and differentiate between TD and MDD at 24 months corrected age. (2) Determine the extent to which family and caregiver factors will contribute to neurodevelopmental and behavioural outcomes.Methods and analysisParticipants will be a prospective cohort of 90 infants (<32 weeks and/or <1500 g). Between 34 weeks gestational age and 16 weeks post-term, infants will have a series of 5 neurological, neuromotor, neurobehavioural and perceptual assessments including General Movement Assessment at preterm, writhing and fidgety age. Primary caregivers will complete questionnaires to identify social risk, maternal depression and family strain. Extensive perinatal data will be collected from the medical record. At 24 months, corrected age (c.a) infants will be assessed using standardised tools including the Bayley Scales of Infant and Toddler Development—Third Edition (Bayley III). Longitudinal trajectories of early assessment findings will be examined to determine any predictive relationship with motor and cognitive outcomes at 24 months c.a. Published data of a cohort of Australian children assessed with the Bayley III at 24 months c.a will provide a reference group of term-born controls.EthicsEthical approval has been obtained from the Queensland Children's Health Services Human Research Ethics Committee (HREC/13/QRCH/66), the University of Queensland (2013001019) and the Sunshine Coast Hospital and Health Service, SC-Research Governance (SSA/13/QNB/66). Publication of all study outcomes will be in peer-reviewed journals.Trial registration numberACTRN12614000480684; Pre-results.