What are the barriers to parents using child and family health nursing services during the first year of their child's life in NSW?

Adults with intellectual disabilities (IDs) have consistently poorer health outcomes than the general population. There is evidence that routine health checks in primary care may improve outcomes. We conducted a randomised controlled trial of practice nurse led health checks. Here, we report findings from the nested qualitative study. To explore practice nurse perceptions and experience of delivering an anticipatory health check for adults with IDs. Qualitative study in General Practices located in NHS Greater Glasgow and Clyde, Scotland, UK. Eleven practice nurses from 11 intervention practices participated in a semi-structured interview. Analysis was guided by a framework approach. Practice nurses reported initially feeling 'swamped' and 'baffled' by the prospect of the intervention, but early misgivings were not realised. Health checks were incorporated into daily routines with relative ease, but this was largely contingent on existing patient engagement. The intervention was thought most successful with patients already well known to the practice. Chronic disease management models are commonly used by practice nurses and participants tailored health checks to existing practice. It emerged that few of the nurses utilised the breadth of the check instead modifying the check to respond to individual patients' needs. As such, already recognised 'problems' or issues dominated the health check process. Engaging with the health checks in this way appeared to increase the acceptability and feasibility of the check for nurses. There was universal support for the health check ethos, although some questioned whether all adults with IDs would access the health checks, and as a consequence, the long-term benefits of checks. While the trial found the intervention to be dominant over standard health care, the adjustments nurses made may not have maximised potential benefits to patients. Increasing training could further improve the benefits that health checks provide for people with IDs.

Chronic kidney disease (CKD) is a prevalent disease among felids; yet its origin is still poorly understood, and the disease often remains asymptomatic for years, underscoring the need for early diagnosis. This study aimed to investigate the diagnostic value of urinalysis in accurately staging CKD, particularly as routine health checks in large felids often overlook its significance. In this research, ultrasound-guided cystocentesis (UGC) was performed on 50 captive nondomestic felids during routine veterinary health checks under general anesthesia. Urinalysis included microscopic examination of the sediment, measurement of urine specific gravity (USG) and protein to creatinine ratio (UPC). Additional serum kidney markers, such as creatinine and symmetric dimethylarginine, were compared with USG and UPC to assess their diagnostic value as urinary biomarkers. The results demonstrated proteinuria (UPC > 0.4) or borderline proteinuria (UPC 0.2-0.4) in 49% of the animals. Among these cases, 62% were of renal origin, and 38% were postrenal causes. USG was significantly higher in felids with borderline proteinuria compared to those with proteinuria. A moderate, but significant negative correlation between serum parameters and USG was observed, emphasizing the importance of assessing both diagnostic parameters during kidney evaluations. Additionally, felids with CKD have an increased risk of urinary tract infections, necessitating microscopic urinalysis and bacterial culture analysis. Abnormalities, including hematuria, pyuria, crystalluria, and bacteriuria, were found in approximately 38% of cases through microscopical examination of urine. No complications associated with UGC were observed and abnormal findings were detected in 60% of the cases. Based on these results, the authors recommend the inclusion of UGC and urinalysis as standard diagnostic tools in general health checks for nondomestic felids. This approach provides valuable insights into the early detection and staging of CKD, supporting early intervention and supportive medical care to prolong renal health in these animals.

Canine consultations can be divided into two main groups: ‘Routine’ health checks of generally healthy dogs, and consultations for dogs with injuries, illness or undergoing an important procedure such as surgery. This chapter discusses pregnancy and pre-whelping health checks, post-parturition and neonatal health checks, pre-sale examination, puppy health checks, juvenile/adolescent health checks, routine health checks for adult dogs, routine health checks for senior dogs, end-of-life examinations, general clinical examination, vaccination and common parasites. Quick Reference Guide: Head-to-tail general examination.

BackgroundChild and Family Health Nursing (CFHN) services provide universal care to families during the first 2000 days (conception: 5 years) to support optimal health and developmental outcomes of children in New South Wales, Australia. The use of technology represents a promising means to encourage family engagement with CFHN services and enable universal access to evidenced-based age and stage information. Currently, there is little evidence exploring the acceptability of various models of technology-based support provided during the first 2000 days, as well as the maternal characteristics that may influence this.ObjectiveThis study aims to describe (1) the acceptability of technology-based models of CFHN support to families in the first 6 months, and (2) the association between the acceptability of technology-based support and maternal characteristics.MethodsA cross-sectional survey was undertaken between September and November 2021 with women who were 6-8 months post partum within the Hunter New England Local Health District of New South Wales, Australia. Survey questions collected information on maternal demographics and pregnancy characteristics, perceived stress, access to CFHN services, as well as preferences and acceptability of technology-based support. Descriptive statistics were used to describe the characteristics of the sample, the proportion of women accessing CFHN services, maternal acceptability of technology-based support from CFHN services, and the appropriateness of timing of support. Multivariable logistic regression models were conducted to assess the association between maternal characteristics and the acceptability of technology-based CFHN support.ResultsA total of 365 women participated in the study, most were 25 to 34 years old (n=242, 68%), had completed tertiary level education or higher (n=250, 71%), and were employed or on maternity leave (n=280, 78%). Almost all (n=305, 89%) women reported accessing CFHN services in the first 6 months following their child’s birth. The majority of women (n=282-315, 82%-92%) “strongly agreed or agreed” that receiving information from CFHN via technology would be acceptable, and most (n=308) women “strongly agreed or agreed” with being provided information on a variety of relevant health topics. Acceptability of receiving information via websites was significantly associated with maternal employment status (P=.01). The acceptability of receiving support via telephone and email was significantly associated with maternal education level (adjusted odds ratio 2.64, 95% CI 1.07-6.51; P=.03 and adjusted odds ratio 2.90, 95% CI 1.20-7.00; P=.02, respectively). Maternal age was also associated with the acceptability of email support (P=.04).ConclusionsTechnology-based CFHN support is generally acceptable to mothers. Maternal characteristics, including employment status, education level, and age, were found to modify the acceptability of specific technology modalities. The findings of this research should be considered when designing technology-based solutions to providing universal age and stage child health and developmental support for families during the first 2000 days.

Background Routine health checks have gained prominence as a way of detecting unmet need in primary care for adults with intellectual disabilities (ID) and general practitioners are being incentivised in the UK to carry out health checks for many conditions through an incentivisation scheme known as the Quality and Outcomes Framework (QOF). However, little is known about the data being routinely recorded in such health checks in relation to people with ID as practices are currently only incentivised to keep a register of people with ID. The aim of this study was to explore the additional value of a health check for people with ID compared with standard care provided through the current QOF structure.Methods Representative practices were recruited using a stratified sampling approach in four primary care trusts to carry out health checks over a 6‐month period. The extracted data were divided into two aggregated informational domains for the purpose of multilevel regression analysis: ‘ID‐specific’ (containing data on visual assessment, hearing assessment, behaviour assessment, bladder function, bowel function and feeding assessment) and financially incentivised QOF targets (blood pressure, smoking status, ethnicity, body mass index, urine analysis and carer details) which are incentivised processes.Results A total of 651 patients with ID were identified in 27 practices. Only nine practices undertook a health check on 92 of their patients with ID. Significant differences were found in the recorded information, between those who underwent a health check and those who did not (P < 0.001, χ2 = 56.3). In the group that had health check, recorded information was on average higher for the ‘QOF targets’ domain, compared with the ‘ID‐specific’ domain, by 58.7% (95% CI: 54.1, 63.3,P < 0.001).Conclusions If incentives are to be used as a method for improving care for people with ID through health checks a more targeted approach focused on ID‐specific health issues might be more appropriate than an extensive health check.

Compelling evidence is now available that adverse childhood experiences are associated with adult pathology. However, understanding of the pathways and mechanisms underlying these associations is limited. Participants in the European Prospective Investigation into Cancer and Nutrition in Norfolk, UK (EPIC-Norfolk), aged 40 to 80 years, provided an opportunity to investigate the hypothesis that adverse experience in childhood is associated with peripheral leukocyte count in adulthood in the context of a large-scale population-based cohort study. White blood cell counts were available from 11,367 participants and, after a mean interval of 44 months, from 11,857 at a second health check. A self-completion questionnaire that included the assessment of adverse experience during childhood was administered during the interval between health checks. Associations were observed between early adverse experiences and lymphocyte counts at both health checks. Lifestyle factors accounted for about half of this association. Caution is needed in the interpretation of these findings that require replication but they may be seen to aid understanding of the mechanisms through which early environmental exposures act.

The Gloucestershire Longitudinal Study of Disability: Outcomes in Nonresponders, Responders, and Subsequent Defaulters

BackgroundThe aim of this study was to explore the experiences of healthcare interpreters working with child and family health nurses (CFHNs) in providing child and family health nursing (CFHN) services and sustained nurse home visiting (SNHV) programs to culturally and linguistically diverse (CALD) families with limited English proficiency.MethodsA mixed methods longitudinal research design was conducted to develop, implement and evaluate a training and practice support model for healthcare interpreters working with nurses and CALD families in providing CFHN services and SNHV programs in three major local health services in Sydney, Australia. One pre-training survey with 24 healthcare interpreters was conducted; field notes were recorded during training and implementation; and a post-implementation focus group with six healthcare interpreters was conducted. Quantitative survey data were analysed descriptively using Alchemer. The focus group was audio-recorded for transcription purposes, and this and the field notes were thematically analysed applying a socioecological framework.ResultsThree themes were identified from the initial, pre-training survey: facilitate communication and delivery accurately; a bridge linking the clients and the healthcare practitioners; and make everybody feel comfortable. Practice support implementation was negatively impact by system and COVID-19 related barriers. Four themes were developed from evaluative phase of the study including: system-related issues; interpreters’ challenges; working with nurses; and client session related issues.ConclusionQuality interpreting was favourably influenced by adequate time for interpreting the session including a pre- and post-briefing session with CFHNs, an appropriate mode of interpretation, allocation of female interpreters and the same interpreters with CALD mothers and clarity about interpreter role and cultural comfort. These strategies support the quality of communication and relationships in delivery of CFHN services and SNHV programs to CALD mothers with limited English proficiency.

BackgroundIn Finland, school doctors examine all children at predetermined ages in addition to annual health checks by school nurses. This study explored the association of study questionnaire-assessed need for and school doctor-evaluated benefit of routine health checks conducted by doctors.MethodsBetween August 2017 and August 2018, we recruited a random sample of 1341 children in grades 1 and 5 (aged seven and eleven years, respectively) from 21 elementary schools in four Finnish municipalities. Children mainly studying in special education groups or whose parents needed an interpreter were excluded. School nurses performed their health check as usual. Parents, nurses, and teachers then completed study questionnaires that assessed the concerns of parents, school nurses, and teachers regarding each child’s physical, mental and social health. Doctors, blinded to the responses, routinely examined all the children. The primary outcome measures were (1) the need for a health check based on the study questionnaires and (2) the benefit/harm of the appointment as estimated by the doctors according to predetermined criteria, and (3) the patient-reported experience measures (PREMs) of benefit/harm of the appointment as estimated by the parents and children. We compared the need for a health check with the doctor-evaluated benefit using multilevel logistic regression.ResultsThe participation rate was 75.5 %. According to all questionnaires, 20–25 % of the 1013 children had no need for a health check. The doctors regarded 410 (40.6 %) and the parents 812 (83.4 %) of the appointments as being beneficial. Respondents rarely reported harm. The children who were classified as needing a health check more often benefitted from the health check (assessed by the doctor) than children with no need for one (OR 3.53; 95 % CI 2.41–5.17).ConclusionsThe need for a health check is an important predictor of school-doctor evaluated benefit of the health check. This approach could allow school doctors to allocate time for the children who need them most.Trial registrationClinicalTrials.gov, Identifier NCT03178331, registration June 6th 2017.

Background The rapid increase in demand for primary healthcare (PHC) services after the pandemic requires reconsidering nursing staff planning and availability. The objectives of the study were to i) identify knowledge, attitudes, practices and work expectations of future nurses in primary care; ii) estimate the prevalence of nursing students who desire to be employed in PHC and Family and Community Health Nursing (FCHN) services after graduation. Methods A cross-sectional study is being conducted on a sample of nursing students enrolled in universities in the Lazio Region. A structured instrument was built based on the literature and national regulations and validated (Cronbach’s alpha=0.81). Results In this first phase, 163 nursing students were enrolled. The majority of the sample was female (N = 125, 76.7%), with a mean age of 22 (SD ± 5) years and were enrolled in the last year of degree program (N = 85, 52.1%). A total of 49 students (30%) reported adequate knowledge of PHC service reorganization policies and nursing practice in this setting. While 74% (N = 122) of the sample intended to undertake a PHC curricular internship during their degree program, only seven students (4%) participated in one. 52 individuals (30%) expressed their intention to be employed in PHCs after graduation, and 29 (17.8%) indicated their desire to work as FCHN practitioners. The main factors contributing to the undesirability of employment in PHC reported by students were: i) preferring the hospital settings (N = 53, 48%); ii) not having adequate skills to be employed in the PHC (N = 21, 19%); and iii) believing that the PHC does not offer attractive services for nursing practice (N = 14, 13%). Conclusions A multivariable analysis will be conducted to identify predictors of nursing students’ desire to work in PHCs after graduation. Preliminary results of the study showed that only one-third of nursing students indicated a desire to work in PHCs. Key messages • Only one-third of nursing students express a desire to work in PHC and in Family and Community Health Nursing (FCHN) services post-graduation. • Collaboration between the PHC workforce, academics, stakeholders, and policymakers is needed to create tailored initiatives that increase the attractiveness of PHC.

Simple SummaryThe health of zoo-housed animals is of critical importance for their welfare and conservation. Since many wild species often do not show signs of illness, zoo veterinarians routinely carry out health checks in seemingly healthy individuals to identify issues requiring treatment. The benefits of these “elective” health checks must be balanced against the risk of injury or stress, and their financial cost. This study involved the analysis of data gathered from 74 examinations carried out at one UK zoological collection, on 33 gibbons between 2011 and 2018. More than half (n = 38) of these health checks resulted in veterinary intervention and/or a management change to the gibbon’s care (referred to as an actionable outcome). Age was found to be an important and reliable determinant of health check outcome, with health checks in elderly gibbons being 13.64 times more likely to have an actionable outcome than those in non-elderly gibbons. X-ray abnormalities, such as osteoarthritis, were also 34 times more likely in this group. Zoo managers and veterinarians can use the methods and findings outlined in this paper to quantify the benefits of elective health checks in their own collections, and to inform evidence-based decision making about the frequency and intensity with which they are implemented. Elective health checks form an important part of the preventative healthcare of many zoo-housed animals. These procedures are not without risk or financial expenditure, meaning careful cost–benefit analysis is required when determining the frequency and intensity with which they are implemented. This study evaluated the value of elective health checks (n = 74) carried out on 33 gibbons at a single UK zoological collection from 2011 to 2018. Data were categorised by health check type, animal age, clinical findings and outcome. Univariable binary logistic regression and multivariable modelling were used to identify factors associated with the likelihood of actionable (clinically significant) outcomes. In total, 51.35% of all elective health checks resulted in an actionable outcome. Elderly heath checks had 13.64 times greater odds of an actionable outcome and 34 times greater odds of a significant radiographic finding, when compared to routine (non-elderly) health checks. Our findings suggest that 75% wild longevity is a suitable threshold for identifying elderly captive gibbons and increasing health check frequency. Whilst further work is needed to ascertain whether these findings can be extrapolated to other collections and/or species, this study demonstrates how the analysis of clinical data can aid in the implementation of an effective and evidence-based preventative healthcare plan.

Are routine general health checks in healthy adults effective in preventing morbidity and mortality due to cardiovascular diseases and cancer? Summary of the evidence and implications for public health programmes

The background to this community service activity is the low understanding and skills of the people of Triwidadi Village, Pajangan, Bantul in utilizing digital technology for product marketing and the lack of access to adequate health services. The majority of people in this area are micro, small and medium enterprises (MSMEs) who have not yet optimally utilized digital technology to develop their businesses. Apart from that, access to basic health services such as routine health checks is still limited, which has an impact on people's quality of life. The formulation of the problem raised in this research is: (1) How to increase people's understanding and skills in digital marketing to increase the competitiveness of MSMEs in Triwidadi Village? (2) How to provide health check services that are easily accessible to the local community? The aim of this community service is to: (1) Increase community knowledge and skills about digital marketing through structured counseling and training activities; (2) Providing routine health check services to increase awareness and preventive action on health in the Triwidadi Village community. The results of this service activity show a significant increase in the community's understanding and skills regarding digital marketing. This is proven by the increase in the number of MSMEs that are starting to utilize digital platforms to market their products. Apart from that, the health check service provided during the activity has been well utilized by the community, as can be seen from the quite high number of participants and the results of the health check which helps the community to care more about their health condition. This activity also has a positive impact on improving people's quality of life through better access to information and health services.

BackgroundThe global prevalence of social-emotional problems in children and adolescents is nearly double in First Nations populations compared to non-First Nations populations, highlighting health inequities due to the impact of colonisation. Addressing this requires culturally responsive social-emotional screening in primary healthcare, enhanced by a simple, psychometrically sound tool. The Rapid Neurodevelopmental Assessment (RNDA) is user-friendly, incorporates child observations and parental input, and can be used by primary healthcare providers. This study evaluated the RNDA’s performance in screening social-emotional problems during routine health checks with First Nations children.MethodsWorking with an Aboriginal Community Controlled Health Organisation in Australia, children (60% male, 92% identifying as First Nations) aged 3 to 16 years (M = 8.40, SD = 3.33) and a caregiver participated in this study as part of a health check. The convergence with, and accuracy of, children’s scores derived from single-item measures of seven social-emotional problems on the RNDA was compared to their corresponding multi-item scores from the parent-report Behavior Assessment System for Children 3rd Edition (BASC-3).ResultsEach of the single-item measures on the RNDA were significantly correlated with the corresponding multi-item construct on the BASC-3, except for anxiety. The total accuracy of the RNDA relative to the BASC-3 was 58 to 81%, with high sensitivity for four of the seven items: hyperactivity (90%), attention problems (87%), externalising problems (82%) and behaviour symptoms index (88%). Sensitivity of the remaining items ranged from 14 to 71% and specificity ranged from 29 to 88%. The measure showed an average positive predictive value of 50% and negative predictive value of 75%.ConclusionsThe single-item measures within the RNDA’s behaviour domain showed good convergent validity relative to the BASC-3. Most items had acceptable accuracy, comparable with similar screening measures. These findings further support the RNDA’s integration into First Nations child health checks, allowing for a rapid, holistic assessment of child development to improve health equity.

The elderly group in Bantul Regency is about 8.4% of the total population. This number is quite significant and needs attention from the government because these elders are vulnerable. Physical weakness makes the elderly group experience vulnerability in terms of health. This situation was worsened by the low public awareness about health. The same condition also occurred in Sawahan Hamlet, Pendowoharjo, Sewon, Bantul. Accordingly, to overcome this condition, routine checks should be carried out. The government has provided adequate public health centers to maintain the health of the elderly in each sub-district. However, the patient load of each puskesmas and the distance to the puskesmas become undeniable obstacles, especially in the elderly group with decreased motor skills. For this reason, efforts were made to bring health checks closer to the community, especially the elderly, by encouraging people who have the ability to carry out routine health checks. The purpose of this community service program was to increase public awareness and knowledge, especially the elderly, of the importance of regular health checks. The methods applied in program implementation were tutorials as a medium of education and mentoring. The results showed that the elderly are more aware and willing to carry out regular and continuous examinations.