Metropolitan Setting Research Articles

P0855 Rise in admissions for Acute Severe Ulcerative Colitis at an Australian tertiary IBD centre with a culturally and linguistically diverse population: Implications for health resource planning

Abstract Background Epidemiological data suggests greater risk of inflammatory bowel disease in first- and second-generation migrants from a low to high prevalence country, with risk of ulcerative colitis (UC) preceding Crohn’s disease. Little is known about the effect of this on hospitalisations for UC, including acute severe ulcerative colitis (ASUC). This study evaluated demographic trends of ASUC admissions in a metropolitan healthcare setting with an expanding culturally and linguistically diverse (CALD) population, with admission outcomes compared. Methods Demographic and disease characteristics of patients admitted with ASUC at a single tertiary metropolitan centre from January 2016 to October 2024 were recorded. Trends in presentation and outcomes in ASUC patients of European Caucasian and non-European background were compared. Results During this 9-year period, 210 patients (88 [41.9%] female, median age 34.5 [16-90] years) had a total of 261 admissions. The ethnicity of patients for UC admissions was 50.9% European Caucasian, 16.2% South Asian, and 13.8% Middle Eastern; ethnicity information was not available for 11% of patients. Of index admissions, 150 (71.4%) met Truelove and Witts criteria for ASUC (62 [41.3%] female, median age 33.5 [16-87] years); 51.3% European Caucasian, 16% South Asian, and 12% Middle Eastern; ethnicity information was not available for 12% of patients. For patients with recorded ethnicity, when comparing all UC admissions in 2016-2019 to 2020-2024, there was a significant increase in the proportion of non-European background patients, increasing from 32.1% to 47.3% (p=0.05), and an increasing trend in ASUC admissions from 29.0% to 46.8% (p=0.08). Median length of stay was 6 days (IQR 5-11) in European Caucasian patients and 6 days (IQR 4-7) in non-European background patients (p=0.11). 12-month steroid dosage was similar in both European Caucasian (median 1685mg) and non-European (median 1612.5mg) patients (p=0.45). 12-month readmission rate was significantly less in the non-European background ASUC population (10.0%) when compared with the European Caucasian population (30.1%), p = 0.02. 7.1% patients of European Caucasian background required inpatient colectomy, compared with 7.5% of non- European background (p=0.94). Conclusion There was an increase in proportion of patients of non-European background hospitalised with UC, including ASUC. In ASUC patients, 12 month-steroid usage, colectomy rates, and length of stay of index admission were similar across ethnicities, but patients of non-European background had lower readmission rates. Further studies are required for improved planning of healthcare resources and assessment of ASUC in CALD populations.

A co-designed health education model to improve outcomes for children with emotional and behavioural difficulties: a study of acceptability, feasibility and impacts

ObjectiveTo assess the acceptability and impacts of a co-designed health education model aiming to improve outcomes for children with emotional and behavioural difficulties.DesignQualitative focus group study.SettingSix primary schools from metropolitan...

Differences in survival of patients with multiple myeloma in rural versus metropolitan regions: Analysis of population data of an Australian local health district.

The objective of this study is to determine if there are differences in outcome for patients diagnosed with multiple myeloma in a rural setting compared to a metropolitan setting and which factors influence these outcomes. Retrospective cohort study. Illawarra Shoalhaven Local Health District. A total of 391 patients diagnosed with multiple myeloma between 2000 and 2022. Treatment and survival outcomes of these patients. Patients being treated in a rural cancer care centre had lower overall survival compared to those treated at a metropolitan cancer care centre (median OS = 44.4 months vs. 80.2 months, p = 0.002), despite access to similar treatments by the same group of haematologists. There was a significantly higher rate of upfront autologous transplantation (38% vs. 20%, p = 0.001) and higher rate of inclusion in clinical trials (16% vs. 7%, p = 0.021) in patients treated at a metropolitan cancer care centre compared to the rural cancer care centre. Multiple myeloma patients treated at a rural centre had shorter survival compared to patients treated at a metropolitan centre, and this may be related to lower rates of autologous transplantation and inclusion in clinical trials.

Chronic disease management among people with serious mental illness across rural, small urban, and metropolitan settings

Chronic disease management among people with serious mental illness across rural, small urban, and metropolitan settings

Australian parents' experiences with adolescent age-based vaccinations during the COVID-19 pandemic

PurposeIn Australia, adolescents are scheduled to receive vaccinations against diphtheria, tetanus, pertussis, human papillomavirus, and meningococcal disease, delivered via school vaccination programs and general practitioners (GPs). Public health measures implemented in response to the COVID-19 pandemic impacted uptake of some adolescent age-based vaccinations. Limited information is available on parents' approaches to vaccinating their adolescent children during the pandemic. We aimed to explore parents' experiences of adolescent age-based vaccinations during the pandemic, and factors they perceived as hindering or facilitating vaccination. MethodsIn July 2022 we recruited 21 Australian parents of adolescent children eligible for age-based vaccinations in 2021. We recruited from metropolitan and regional settings, and from states where uptake was most and least affected by pandemic disruptions. We conducted 30-min virtual or phone interviews and analysed the data thematically. ResultsParents described how experiences before and during the COVID-19 pandemic influenced their perspectives on and experiences with adolescent age-based vaccinations. Motivation to vaccinate their children was informed by personal beliefs and experiences with the healthcare system. Parents described practical issues, including ease of access to the school vaccination program or a GP, and knowledge about vaccination schedules and services. Parents suggested enhancing promotion of adolescent vaccination benefits and information sharing, and recommended improving access to vaccination services outside the school program. DiscussionFindings have potential to improve delivery of adolescent age-based vaccinations, including during future pandemics. While this study was conducted in the Australian context, findings and recommendations have relevance to overseas adolescent age-based vaccination programs.

The role of socioeconomic status in resolution of type 2 diabetes mellitus following longitudinal sleeve gastrectomy.

The role socioeconomic status (SES) on outcomes following bariatric surgery has been heavily investigated in previous studies. The goal of this study is to determine the association between Area Deprivation Index (ADI), a multidimensional indicator of socioeconomic conditions, and remission of type 2 diabetes mellitus following longitudinal sleeve gastrectomy (SG). This is a retrospective analysis of 312 patients undergoing LSG at a single-center in a metropolitan hospital setting over two years. Socioeconomic disadvantage was assessed by ADI, a model that incorporates education, income, employment and housing stock to rank neighborhoods both on the state and the national level. Type 2 diabetes mellitus (T2DM) was defined as utilization of diabetes medication or HgA1C of greater than 6.5% within a 3 months period, and was assessed at three time points: pre-op, 6-month follow-up and 1-year follow-up. In this cohort of individuals presenting for LSG, 72 (23.1%) had T2DM. The mean ADI of patients with T2DM (41.1 ± 17.1) was not statistically different from the group without T2DM (45.0 ± 16.4; p = 0.08631). By one year follow-up, 39 (60.0%) of individuals with T2DM had achieved remission. The ADI for individuals that achieved T2DM resolution was not different from the ADI of the group that did not (38.1 ± 15.4 vs 45.3 ± 17.7; p = 0.0958). In individuals with T2DM at baseline, 47 (65%) had A1C pre-op and A1C at 1 year follow-up; there was a significant reduction in Hgb-A1c (-0.71; -12.3%; p < 0.01). There was no correlation between change in A1C at 1year and ADI national rank (p = 0.26). We did not find a significant association between ADI and resolution of T2DM following sleeve gastrectomy. Resolution of T2DM following SG can be achieved by individuals regardless of SES. This supports the continued use of SG for socioeconomically deprived populations. In addition, we did not find an association between resolution of T2DM and weight loss, the most commonly used outcome metric following bariatric surgery.

Investigating patient satisfaction with a hand therapy telehealth service during COVID-19.

Throughout the COVID-19 pandemic, outpatient hand therapy services were restricted. The use of telehealth was adopted to continue to provide care to patients with hand injuries. This survey aims to investigate patient satisfaction with hand therapy delivered via telehealth in a NSW public tertiary referral metropolitan setting and explore whether this differs for specific hand injury/conditions and treatments offered. Patients using hand therapy services via telehealth between 28 June 2021 and 27 May 2022 responded to a bespoke electronic survey. Participants were grouped depending on their particular injury/condition and treatment received. Analysis was conducted using MS Excel, and correlations were determined by using Fisher's exact test. No consumers were involved in the study design or analysis. Sixty-eight of 262 patients responded to the survey (26% response rate). Overall results showed high patient satisfaction (n = 55, 81%) with hand therapy delivered via telehealth with most patients agreeing that telehealth should be offered going forward (n = 59, 87%). Benefits reported by patients included convenience, reduced travel time and parking issues, and time saving. Patients receiving therapy for 'finger thumb bony injury with K wires' demonstrated a statistically significant association of lower satisfaction with telehealth (n = 3, 43%, P = 0.02). Patients receiving wound care over telehealth were just as satisfied with their experience (n = 15, 82%) as overall results (n = 55, 81%). The survey suggests that patients are satisfied with their experience of telehealth for hand therapy. Patients with finger thumb bony injuries with k wires may be less suitable for telehealth. Wound care appears to be well received over telehealth in a hand therapy population. There is little evidence to guide hand therapists in which conditions or injuries patients find can be managed well with telehealth. Patients who answered a survey about their experience with telehealth for their hand therapy management overall reported satisfaction with the experience. Some patients had undergone surgery for broken fingers and thumbs using wires to hold the bone together while it healed. These patients were less likely to find telehealth satisfactory for their hand therapy care. Most patients requiring wound care over telehealth found this satisfactory.

Factors associated with caregiver burden among family members of persons with schizophrenia in urban communities of China.

Family caregivers bear a heavy burden while providing care for those with schizophrenia, and they frequently play an important role in this regard. The present study examined the degree of caregiver burden and characteristics related to it among family caregivers of persons with schizophrenia in Chinese urban settings. Between August 2023 and June 2024, a cross-sectional study was conducted of 401 family caregivers of persons with schizophrenia living in metropolitan settings. The following measures were administered: the Zarit Burden interview (ZBI), General Self-Efficacy Scale (GSES), Social Support Rating Scale (SSRS), and Simplified Coping Style Questionnaire (SCSQ). Linear regression analyses were used to identify independent correlates of caregiver burden. Family caregivers of persons with schizophrenia had an average ZBI score of 32.90(SD = 17.53) on a 0-88 scale, with the majority (80.0%) reporting moderate caregiver burden (scores of 21-39). The person with schizophrenia's marital status (not married), impulsive or aggressive conduct in the previous year, the caregiver's physical health (poor), and not having multiple caregivers were all independent correlates of caregiver burden. Family caregivers of persons with schizophrenia experience a moderate level of caregiver burden. To lessen the psychological suffering of and strain on caregivers, it is important to intervene early on impulsive and aggressive conduct of persons with schizophrenia, effectively treat physical health problems of caregivers, and strengthen the social support system or otherwise provide assistance to those caring for persons with schizophrenia.

Assessment of indoor air pollution in causing respiratory illness among women residing in rural areas of Mysuru

Introduction: The use of inefficient and harmful fuels and technology within and outside the home is the primary cause of indoor air pollution. Approximately 2.4 billion people on the planet still cook over open flames and inefficient stoves using solid fuels and kerosene. The availability of cleaner cooking options varies more in rural than in metropolitan settings. Therefore, there is a need to determine the prevalence of indoor air pollution among rural women, its association with respiratory disorders, and the frequency of respiratory illnesses among rural women residing in houses with or without indoor air pollution. Materials and methods: This analytical cross-sectional study was done for a period of six months from June to November 2020. The study conducted in 210 households living in the rural field practice areas of JSS Medical College, Mysuru. For the selection of villages, a multistage random sampling technique was used. Three villages are selected from the rural setting: Suttur, Hadinaru, and Kadakola. The households were included by probability proportionate to the size sampling technique. Pre-tested, semi-structured, phase and content validated questionnaires were used to obtain the details on socio-demographic characteristics, meter values of indoor air pollutants like Particulate Matters (PM1, PM2.5, PM10) and Volatile Organic Compounds (VOCs), respectively with the factors affecting respiratory illness and the episodes of the illness. Data was entered in Microsoft Excel and analyzed using descriptive and inferential statistics using SPSS V.26. Results: The prevalence of indoor air pollution in the present study was 13.3%. In the homes of rural women, there was a statistically significant variation in the concentration of the three particulate matter sources that cause indoor air pollution. Additionally, among the women living in rural families, there was a statistically significant difference in the concentration of PM10 that caused respiratory disease. Conclusion: The current study demonstrated the higher concentrations of pollutants such as PM10, PM2.5, and PM1.0, as well as their significant relation with indoor air pollution in rural families. To prevent indoor air pollution and its health risks, clean energy must be used for household needs.

Unequally distributed education impacts of ecosystem degradation: Evidence from an invasive species

Ecosystem degradation can have substantial social and economic costs, which may vary across groups in society. In this paper, we leverage variation from the introduction of the emerald ash borer beetle to explore how invasive species-induced declines in environmental quality impact education outcomes in a metropolitan setting. Exploiting the idiosyncratic and staggered spread of the ash borer throughout the Chicago Metropolitan Region from 2006 to 2014, we show that infestation led to declines in tree cover and subsequently, education outcomes. Our findings indicate that ash borer infestation reduced canopy cover in affected areas, stemming from both increased tree cover loss and declines in tree cover gain. Further, the ash borer reduced standardized test performance at exposed schools. Infestation exposure led to an average of 1 percentage point (1.22%) fewer students that met or exceeded the state’s testing benchmark at the typical school. While exposure to ash borer infestation was lower around low-income schools, education impacts were concentrated almost entirely among low-income students. This work adds to our understanding of the environmental drivers of education outcomes and the unequally distributed impacts of human-induced environmental change.

Integration of a facilitated access pathway for contraception into alcohol and other drug treatment services: A cohort study comparing metropolitan and regional settings.

Women who attend alcohol and other drug (AOD) services experience higher rates of unintended pregnancy, and access less contraception, than the general population. This study aims to observe contraceptive initiation and use after contraception services were offered at metropolitan and regional AOD services. Clinical staff were provided contraception education. One hundred women aged 16-49 were recruited from two services between 2017 and 2021. Women completed a questionnaire on their obstetrics and gynaecological history, pregnancy plans and contraception use. Women were provided education on contraception options and offered referral to a contraception pathway. The primary outcome was initiation of highly reliable contraception; secondary outcomes were the types of contraception initiated, and contraception use and pregnancy at 12 months. We compared the initiation of contraception across the two study sites. At baseline, 91% of women were not planning a pregnancy within 12 months, with 21% of these using highly reliable contraception. Of all women not planning a pregnancy, 28% initiated highly reliable contraception via the pathway (2% metropolitan, 51% regional, p < 0.001), with intrauterine devices being the most frequent method initiated (15%). At 12 months, 44% were using highly reliable contraception and 15% had recorded pregnancies. Contraception pathways for women in AOD treatment can improve initiation of highly reliable methods of contraception, although pregnancy rates were still high and there were large differences between the study sites. Care navigation and clinical champions are some potential facilitators to contraception access, and understanding additional barriers to access may be useful.

SDG’S and Emerging Synergy: Green Healthcare System for Sustainable Healthcare Delivery in Metropolitan Cities in India

Objectives: This research paper explores the intricate landscape of healthcare delivery in metropolitan cities, focusing on addressing challenges such as environmental impact, resource management, and patient accessibility. Theoretical Framework: This paper investigates the integration of Green Healthcare System principles with Healthcare 4.0 technologies in metropolitan cities The study applies concepts of sustainability from Green Healthcare Systems and technological advancements from Healthcare 4.0 to explore their synergy in enhancing urban healthcare delivery. Method: Using NVivo Pro 12, the research employs qualitative analysis of interviews and field observations to identify key factors, challenges, and opportunities associated with implementing these systems in metropolitan settings. Findings reveal that leadership commitment, stakeholder collaboration, financial resources, and regulatory frameworks are crucial for successful integration. Results and Discussion: The findings reveal the transformative potential of combining green healthcare practices with digital technologies, underscoring the importance of stakeholder collaboration, leadership, and supportive policies in realizing sustainable healthcare delivery. The integration offers a comprehensive approach to meeting Sustainable Development Goals (SDGs) and advancing urban healthcare systems. Research Implications: The research contributes to understanding sustainable healthcare practices in urban environments and provides a roadmap for integrating green initiatives with advanced technologies to enhance healthcare accessibility and quality. Originality/Value: This study enriches the literature on sustainable healthcare by exploring synergies between Green Healthcare System and Healthcare 4.0, offering valuable insights for researchers and practitioners in metropolitan settings.

Supportive Care Needs of Young Adults With Endometriosis: An Open-Ended Online Survey and Exploration of Unmet Needs.

The aim of this study is to identify and explore the unmet needs of adolescents and young adults living with endometriosis. An open-ended online survey was conducted, with questions derived from prior research looking at areas of unmet need in healthcare, career and work, financial, information, psychological, social and cultural domains. Self-selecting 18-25 year olds with surgically diagnosed endometriosis (self-reported) currently living in Australia were included as participants. Invitation to participate in an open-ended online survey was shared through the social media of Australian endometriosis organisations and the Royal Women's Hospital, Melbourne. Surveys were analysed qualitatively through template analysis. Recording of the unmet supportive care needs of this population was carried out. One hundred and thirty-one respondents fit the eligibility criteria of being aged 18-25 years (median age 23 years). Most were born in Australia (94%), university-educated (54%) and lived in a metropolitan setting (69%). There was a range of unmet needs that were presented across education, work, healthcare and relationships. Group-specific challenges were identified: doctors either over- or underemphasising future fertility; disrupted sexual and romantic life due to painful sex; managing pain in the classroom and workplace where periods are taboo; and being gender-queer in gynaecological medical spaces. The increasingly young age at which patients are receiving an endometriosis diagnosis precipitates a shift in patient care. The treatment decisions that are being made must be reflective of the unique needs of the adolescents who carry the burden of the disease. Clinicians are advised to be aware of and discuss needs with their patients. The nine open-ended questions in this survey were developed from data from a preliminary series of interviews with endometriosis patients in a tertiary women's healthcare centre. In asking these data-informed questions to the online endometriosis community, patients across broader sociocultural demographics and disease states (including less symptomatic endometriosis) have provided a broader understanding of their supportive care needs.

Characterizing pulmonary rehabilitation referrals from primary care

BackgroundSupporting referral to pulmonary rehabilitation (PR) from primary care for people with chronic lung disease could improve equity of access. Understanding who is referred to PR from primary care, and by whom, could inform development of strategies to increase awareness of and referral to PR for people with chronic respiratory disease. We aimed to quantify the proportion of patients referred to PR from primary care in an Australian metropolitan setting; and to identify characteristic features of patients and referrers. MethodsA retrospective, single-site, audit of referrals was undertaken. Corresponding patient medical records were reviewed for referral details, patient demographics and baseline PR assessment measures. ResultsBetween January 2020 and December 2023 658 referrals to PR were received of which 6.2 % (n = 41) originated from a primary care source (98 % general practice; 2 % allied health). People referred to PR from primary care were typically diagnosed with COPD (71 %), were female (59 %), had moderate disease severity (mean(SD) forced expiratory volume in 1 s 70(26) %predicted) and had mild symptoms (53 % modified Medical Research Council dyspnoea score 0 or 1) and modest functional impairment (6-min walk distance 410(121) meters). Just 4 of 36 primary care practitioners referred more than one patient. ConclusionIn this audit the proportion of people referred to PR from primary care was very low. Processes to support the referral of more patients from primary care to PR, across the spectrum of chronic respiratory disease, remain a priority for improving access to this well-established treatment.

DEM-based pluvial flood inundation modeling at a metropolitan scale

The global increase in urban flooding presents a substantial challenge that affects communities across the globe. This study introduces a post-flood inundation modeling framework tailored to pluvial floods on a metropolitan scale. We employ a dual drainage modeling approach for enhanced accuracy. The framework comprises two primary components: a Storm Water Management Model (SWMM) for simulating water movement within the storm drain system, and an advanced DEM-based flood inundation module that leverages SWMM results to predict flood inundation areas. Compared to the conventional flood spreading models commonly used in dual drainage modeling, this module incorporates high-resolution DEM cells into the surface flow routing processes, allowing to capture intricate surface terrain complexities. Additionally, the proposed module considers direct rainfall impacts on pluvial flood inundation mapping, resulting in enhanced accuracy. To evaluate the proposed model's accuracy, a two-step validation approach has been implemented. This includes comparing the proposed model results with both the high water marks measured in the aftermath of Hurricane Harvey and the flood depth map generated by a hydrodynamic model. The findings affirm the effectiveness of our proposed framework for post-flood inundation mapping within metropolitan settings. This method provides a dependable approach to urban flood modeling and represents an advancement in addressing the challenges associated with urban flooding.

Secondary prophylaxis and specialist review compliance in paediatric patients with acute rheumatic fever and rheumatic heart disease in a Western Australian metropolitan setting.

Rheumatic heart disease (RHD), a consequence of acute rheumatic fever (ARF), continues to cause significant morbidity and mortality in susceptible young people. Secondary antibiotic prophylaxis is an effective strategy to prevent ARF recurrence and RHD progression. However, the proportion of patients receiving the recommended minimum benzathine penicillin injections (>80%) remains low. This retrospective cohort study reviews the utility of the Hospital in the Home nursing service in providing secondary prophylaxis for outpatients in a metropolitan state capital. Fifty-eight patients with ARF/RHD receiving secondary prophylaxis through the Hospital in the Home service between 1 July 2012 and 30 June 2020 were included. Compliance of secondary prophylaxis, specialist review and echocardiogram frequency were compared against the recommendations from the Australian RHD guidelines. Forty-six (79%) patients received >80% of recommended doses, with 36% (n = 21) receiving 100% and a further 29% (n = 17) achieving compliance of 90%-99%. We found that 35% of patients attended all specialist reviews (including echocardiography) at the recommended frequency, with 75% of those not attending all reviews, missing only one or two appointments. Compliance was greater in those with more severe disease. In the 12 (21%) patients who did not meet the >80% target, compliance ranged between 33% and 79% (mean 64.5%) and all had priority 3 disease. Community-based administration of secondary prophylaxis through a registry-based system is an effective strategy of improving compliance within a metropolitan area and should be utilised in a culturally safe and collaborative manner to increase uptake.

Impact of Demographics on Early-Stage vs. Stage IV Diagnosis in Amelanotic Melanoma: An Analysis of the National Cancer Database.

Introduction Amelanotic melanoma (AM) is a rare form of melanoma that lacks pigment. Although curable when diagnosed early, it is often missed or mistaken for other benign conditions. There has not been a study investigating the impact of demographic features on the diagnosis of stage 0-I (early-stage) versus stage IV AM. Objective This study addresses a gap in knowledge regarding demographic factors that influence the odds of early-stage vs. stage IV diagnosis of AM. Methods This study identified 684 patients from the National Cancer Database who were diagnosed with early-stage AM or stage IV AM from 2004 to 2020 and compared them based on age, sex, race, insurance, income, education, insurance status, rurality, facility type, geographic region, and Charleson-Deyo score. Socioeconomic and demographic features of patients with early-stage and stage IV were compared using the chi-squared test, the independent t-test, and multivariate logistic regression. Statistical significance was set at α = 0.05. Results Most cases analyzed were White (98.5%), male (57.7%), and lived in a metropolitan setting (86.7%). Males made up most of the early-stage and stage IV groups (55.0% vs. 45% and 66.5% vs. 33.5%, respectively, p < 0.05). Younger age is associated with decreased odds of stage IV disease (OR = 0.973, 95% CI = 0.952-0.993, p < 0.05). In addition, the female sex is associated with decreased odds of stage IV disease (OR = 0.584, 95% CI = 0.381-0.897, p < 0.05). Conclusions Age and sex are two variables that influence the odds of stage IV diagnosis in patients with AM, which is strongly associated with worse survival outcomes.

Climate change mitigation and women’s economic empowerment

In Pakistan, a country acutely vulnerable to climate change, this study delved into the gendered dynamics of climate sensitivity. It analyzed the correlation between gender and climate vulnerability, with a particular focus on the disproportionate influences on women and the efficacy of adaptation policies. The results showed stark gender disparities in health outcomes, with women more susceptible to the harmful effects of extreme weather events. Women in rural areas struggle to maintain their livelihoods due to water and pasture scarcity, affecting the cattle industry. Additionally, women in agriculture face economic hardships, resource constraints, and societal barriers that compound the adverse effects of climate change on their livelihoods. The paucity of food and water presents significant concerns, resulting in malnutrition and health hazards for women. Women in rural locations are compelled to depend on detrimental fuel sources due to energy shortages, which adversely affect their respiratory health. Conversely, in metropolitan settings, women have limitations in accessing vital services. The study highlights the importance of implementing policies that are sensitive to gender issues and include women in the decision-making processes related to climate change in order to establish communities that are able to withstand and recover from adverse conditions. The policy implications encompass several measures such as adapting to climate change, ensuring women's participation, investing in assistance for rural livelihoods, managing disasters, and promoting gender equality in climate governance. It is crucial to raise awareness and educate people about the gender-specific impacts of climate change in order to strengthen resilience.

Persisting gaps in dementia carer wellbeing and education: A qualitative exploration of dementia carer experiences.

To explore the emotional wellbeing of dementia carers in the lead up to and during transition of a person living with dementia to a residential aged care facility. An interpretative qualitative study. Semi-structured interviews were conducted with informal carers of person living with dementia between February and June 2023. Data were analysed using an inductive thematic approach and resulted in three themes. The majority of carers were adult children (n = 19) and six were wives. Carers lived across metropolitan (n = 20) and regional settings (n = 5) in the most populous state of Australia. Three themes were identified which were attributed to different aspects of the carer role: (1) Carer emotional journey as dementia progresses - impacted by knowledge and lack of support; (2) Questioning decision making-underpinned by knowledge and confidence; and (3) Challenges in re-establishing identity - impacted by ongoing concerns. As dementia progresses carers of person living with dementia consistently reported gaps in knowledge including how to access support. Specifically, this study identified the need for more to be done to help carers to develop the skills needed for their role, including participation in care planning and identifying care preferences for the future. Nurses can play a key role in promoting referral to services that support carers. Findings offer practical solutions to ameliorate carer stress and promote shared decision making. This research was guided by the Consolidated Criteria for Reporting Qualitative Research.

General practitioner and practice nurses perspectives on implementation of the 75+ health assessment: Implications for dementia care and well-being.

The uptake of the health assessment for persons aged 75 years and older (75 + HA) remains low. Repeat assessments provide an opportunity to identify areas of change in cognitive function which may mark the onset of dementia. We aimed to explore general practitioner (GP) and practice nurse experiences of implementing the 75 + HA with a focus on clinical considerations for dementia care. An interpretative qualitative study involving interviews with 15 GPs (female = 11, male = 4) and 5 practice nurses (all female). Data were analysed using an inductive thematic approach. The majority of GPs (n = 11) worked in metropolitan settings and four GPs worked in regional settings across NSW. All participants worked in separate clinics, except for two GPs and one practice nurse who worked within the same metropolitan clinic. Distinct themes emerged regarding participants experiences of implementing the 75 + HA for patients with dementia: (1) negotiating aged care is complex and facilitated by a comprehensive assessment; (2) implementing work practices that support the 75 + HA in patients with cognitive decline; and (3) variations in follow up of findings and implications for care. The 75 + HA provides an opportunity for monitoring and acting on emergent physical and cognitive health changes. Increased engagement and support towards implementing the 75 + HA, particularly in the context of dementia, may facilitate the instigation of interventions. While some participants in this study were confident with identifying and managing cognitive decline, the majority relied on geriatricians to confirm dementia diagnosis and refer to community support services. We suggest the need for greater initiatives and clinical guidelines to assist GPs in the identification and management of cognitive decline. From a nursing perspective, this study highlights the valuable role of nurses towards assessment and management of issues raised in the health assessment for persons aged 75 years and older. However, more resources are needed to enable nurse time for adequate follow-up care.