Multidisciplinary Health Research Articles

Epidemiology of International Patients with Lower-Limb Deficiencies Treated at a United States–Based Pediatric Prosthesis Clinic

ABSTRACT Introduction Limited epidemiological or clinical research exists describing pediatric lower-limb deficiency (LLD) patients born outside the United States (US). Objectives The purpose of this study was to characterize a cohort of international patients treated at a single tertiary care orthopedic hospital. We set out to quantify the prevalence of international patients within a broader cohort of pediatric limb deficiency patients. In addition, we evaluated similarities and differences between adopted and nonadopted internationally born patients as well as their US-born counterparts. Study Design Retrospective chart review was performed on patients born outside the US between 1995 and 2020. Methods Patients were divided into groups based on place of birth, country of residence, and adoption status. Statistical analysis was performed using χ2 and t-test. Results A total of 111/579 (19.2%) patients seen in our limb difference clinic were born outside the US, with 39.6% adopted. Geographically, patients represented 32 countries, and 96.4% were born in low- or middle-income countries (LMICs). The most common causes of LLD were congenital malformations (72.1%), trauma (17.1%), and tumor (5.4%). Syme was the most common amputation level (26.6%), followed by knee disarticulation (23.7%) and transtibial (18.7%). Congenital diagnoses were more frequent in adoptees (93.1% vs. 58.2%), whereas nonadoptees often had trauma (25.4%) or tumor (8.9%) diagnoses leading to amputation (P = 0.0003). A total of 23/60 (38.3%) international patients with preexisting lower-limb amputations had never worn a prosthesis at the time of initial presentation. Conclusions Many pediatric patients with prosthetic needs presenting for care in the US were born in LMIC. Adopted and nonadopted internationally born patients had significant differences in clinical etiologies of their LLD. Clinical Relevance Statement Internationally born patients may constitute a substantial percentage of US-based specialty clinics treating children with lower-limb differences, particularly from low- or middle-income countries where access to orthopedic and prosthetic care may be limited. This study highlights the importance of multidisciplinary health care providers addressing these children’s distinct clinical needs for improved patient-centered care.

Sales of Veterinary Antibiotics in Serbia: Identification of Problem Areas Using Standardized Metrics

One Health, as a multi-disciplinary approach, considers animal, human, and environmental health. Serbia continuously records high rates of antimicrobial resistance, with a knowledge gap on practices regarding veterinary antibiotic use, as no standardized data regarding veterinary consumption of antibiotics that would allow for temporal or spatial comparison are available in Serbia. This study aimed to describe the sales of veterinary antibiotics in Serbia. Aggregated wholesale data on veterinary drug sales were retrieved from the annual reports available from the Medicines and Medical Devices Agency of the Republic of Serbia for a period between 2017 and 2020. Veterinary use was analyzed using standard European Medicines Agency proposed methodology and expressed in milligrams of active substance per population correction unit (mg/PCU). Overall, there has been a 13% increase in aggregated sales, in mg/PCU, of antibiotic veterinary medicinal products (VMPs) for food-producing animals in Serbia between 2017 and 2020. With sales of around 110 mg/PCU in 2020, Serbia would have ranked ninth in Europe. In 2020, the overall highest-selling antibiotic classes were penicillins (27.62 mg/PCU), tetracyclines (27.54 mg/PCU), and aminoglycosides (12.8 mg/PCU), accounting for 61.9% of the total sales of antibiotic VMPs for food-producing animals, in mg/PCU. An increase in the use of macrolides and lincosamides and a decrease in the use of penicillins and the group classified as “other antibacterials” was noted. The current study identified an increase in the sales of veterinary antibiotics in Serbia and pointed out several potential problem areas.

Building Mutually Beneficial Collaborations Between Digital Navigators, Mental Health Professionals, and Clients: Naturalistic Observational Case Study.

Despite the efficacy of digital mental health technologies (DMHTs) in clinical trials, low uptake and poor engagement are common in real-world settings. Accordingly, digital technology experts or "digital navigators" are increasingly being used to enhance engagement and shared decision-making between health professionals and clients. However, this area is relatively underexplored and there is a lack of data from naturalistic settings. In this paper, we report observational findings from the implementation of a digital navigator in a multidisciplinary mental health clinic in Sydney, Australia. The digital navigator supported clients and health professionals to use a measurement-based DMHT (the Innowell platform) for improved multidimensional outcome assessment and to guide personalized decision-making. Observational data are reported from implementation logs, platform usage statistics, and response rates to digital navigator emails and phone calls. Ultimately, support from the digital navigator led to improved data collection and clearer communications about goals for using the DMHT to track client outcomes; however, this required strong partnerships between health professionals, the digital navigator, and clients. The digital navigator helped to facilitate the integration of DMHT into care, rather than providing a stand-alone service. Thus, collaborations between health professionals and digital navigators are mutually beneficial and empower clients to be more engaged in their own care.

Protocol for leading health services innovation: a hybrid type 2 mixed method implementation trial for developing and assessing a codesigned graduate certificate program in health innovation

BackgroundA significant issue with innovative problem-solving in healthcare is an existing deficiency in continuing education for many healthcare professionals, which hinders the successful implementation of inventive solutions and progress in the field. Educators play a crucial role in guiding students to cultivate the knowledge and skills necessary to confront these challenges, including problem solving, collaboration, and the use of rapidly advancing technologies. It is vital to design educational programs that empower and motivate students to develop the proficiency and knowledge they need to be effective problem solvers, collaborators, and cultivators of innovative solutions. This project aims to assess the implementation and effectiveness of a codesigned postgraduate university program for a multidisciplinary health workforce.MethodsThe Leading Health Services Innovation Project is a hybrid type 2 mixed method implementation trial of a codesigned Graduate Certificate in Health Services Innovation. In collaboration with a large tertiary and quaternary health service, we developed a codesign process to guide the project, with time quarantined to create space for two-way learning between health sector partners and healthcare academics. Qualitative interviews and quantitative surveys for primary users will evaluate the implementation strategies. The reach, effectiveness, adoption implementation, and maintenance (RE-AIM) framework will guide the evaluation and maintenance of the program.ResultsIntegrating a codesign strategy complemented by a well-structured implementation and evaluation protocol that is a combination of implementation science theoretical frameworks (Knowledge to Action, Evidence-Based Co-design, RE-AIM) may lead to translational competence as a potential outcome.Anticipated outcomesThe application, resourcing and commitment to codesigned tertiary-level learning and qualification will demonstrate the achievement of a contemporary and comprehensive postgraduate university degree program in health innovation management.

A Multidisciplinary and a Comprehensive Approach to Reducing Fragility Fractures in Preterm Infants.

With advances in neonatal care, bone fractures prior to discharge from the hospital in preterm infants receiving contemporary neonatal care, are rare. Nevertheless, such fractures do occur in very low birth weight and extremely low birth weight infants who go on to develop metabolic bone disease of prematurity (MBDP), with or without secondary hyperparathyroidism. MBDP is a multifactorial disorder arising from the disruption of bone mass accrual due to premature birth, postnatal immobilisation, and loss of placental oestrogen resulting in bone loss, inadequate provision of bone minerals from enteral and parenteral nutrition, and medications that leach out bone minerals from the skeleton. All of these factors lead to skeletal demineralisation and a decrease in bone strength and an increased risk of fractures of the long bones and ribs. Secondary hyperparathyroidism resulting from phosphate supplements, or enteral/parenteral feeds with a calcium-tophosphate ratio of < 1.3:1.0 leads to subperiosteal bone resorption, cortical thinning, and further skeletal weakening. Such fractures may occur from routine handling and procedures such as cannulation. Most fractures are asymptomatic and often come to light incidentally on radiographs performed for other indications. In 2015, we instituted a comprehensive and multidisciplinary Neonatal Bone Health Programme (NBHP), the purpose of which was to reduce fragility fractures in highrisk neonates, by optimising enteral and parenteral nutrition, including maintaining calcium-tophosphate ratio ≥1.3:1, milligram to milligram, biochemical monitoring of MBDP, safe-handling of at-risk neonates, without compromising passive physiotherapy and skin-to-skin contact with parents. The at-risk infants in the programme had radiographs of the torso and limbs at 4 weeks and after 8 weeks from enrolment into the program or before discharge. Following the introduction of the NBHP, the bone fracture incidence reduced from 12.5% to zero over an 18-month period.

Preparing the ground for bespoke nursing training in advanced renal cell carcinoma care (RCC4Nurses): An international prospective study

ObjectivesNurses require specialist knowledge and skills to effectively support an increasing population of people affected by advanced renal cell cancer (aRCC). RCC4Nurses was a three-phase project that aimed to develop bespoke training in aRCC for nurses in Europe. Phase 1 examined pre-existing educational programs in kidney cancer, then developed a curriculum of core education topics in aRCC care to suit generalist and specialist nurses’ education needs. MethodsPhase 1 employed a prospective design that involved two parts. Part 1 was a scoping review of educational programs developed for multidisciplinary health professionals in kidney cancer/RCC. Findings of Part 1 formed the basis for Part 2, which was a three-round Delphi study that involved experts by personal experience or profession in aRCC, who rated the importance of a range of education topics and education methods for inclusion in the developing RCC4Nurses. ResultsThe scoping review identified eight education programs via two published reports and six online resources. Existing programs had limitations in accessibility, recency and target professional groups; none of them was developed specifically for nurses. Program content was primarily focused on diagnostic, treatment and management procedures in kidney cancer. Fourteen educational topics were derived from the review and evaluated during Round 1 of the Delphi by 47 experts. By Round 3, 17 topics had iteratively reached consensus for inclusion within RCC4Nurses. Experts showed preference to problem-solving and clinical-scenario learning methods, but not reflective practice learning. ConclusionsGiven the dearth of up-to-date, evidence-based training for nurses in aRCC, we have prepared the ground to develop a bespoke training course in this area of practice. Implications for Nursing PracticeThe RCC4Nurses project will offer accessible, state-of-the-art education to registered nurses in Europe to help enhance nursing competency in aRCC and enhance the standard of care provided to people affected by aRCC.

A Framework for Bariatric Surgery Patient Care: Patient and Professional Perceptions

Abstract Introduction A multidisciplinary health team for perioperative care of the bariatric patient, sustained in a viable framework to support a long-term follow-up service, may decrease rates of complications, help the recognition of the complexity of this chronic disease, and provide a comprehensive bariatric surgery process analysis. This study aimed to analyze patients’ and professionals’ experiences with the perioperative care process and identify their perceptions of the bariatric surgery process to support the long-term management of obesity surgical treatment. Methods This qualitative study was conducted in a bariatric surgery center in south Portugal. Seven health professionals participated in one focus group, and sixteen patients participated in one of the three focus groups. Patients’ focus group script had eleven open main questions with follow-up questions to probe for more information, addressing motivations, experiences with the pre-surgery and post-surgery process, and perceptions of lifestyle changes. Results Participants reported the need for a reference professional in the hospital to contact, the importance of psychological support to help patients deal with the ‘ups and downs’ of post-surgery life, and the financial support for physical activity programs. Conclusions This research helped identify a need for a framework for long-term follow-up and showed priorities to tailor health services for managing bariatric surgery patients. New bariatric surgery programs should incorporate a diverse health team, focusing on patient support in the long-term follow-up. This team should be led by a dedicated case manager and include physical activity specialists. Key messages • The positive effects of bariatric surgery go beyond weight loss, reinforcing the importance of developing a new conceptual framework based on a patient-centered care model. • A case manager specialist on the bariatric surgery process may be the key to improving the long-term benefits of bariatric surgery.

A survey of availability and affordability of polypills for primary and secondary prevention of cardiovascular diseases in selected countries

Abstract Background/Introduction The recent inclusion of polypills—fixed-dose combinations of two or more antihypertensive drugs and statin with or without aspirin—in the World Health Organization’s Essential Medicines List (EML) reiterates the potential of this approach to improve global treatment coverage for primary or secondary prevention of cardiovascular diseases (CVDs). Although there exists extensive evidence on efficacy, safety, and acceptability of polypills, there is no research to-date assessing the "real world" availability and affordability of polypills globally. Purpose We conducted a cross-sectional survey of public and private sector facilities in 13 countries from around the world to evaluate the availability and affordability of polypills. Methods In the surveyed countries, we first ascertained whether any polypill was authorized for marketing and/or included in the national EMLs and clinical guidelines. The facility survey employed a modified WHO/Health Action International methodology. In each country, we collected retail and price data for polypills from at least one public sector facility and three private pharmacies using convenience sampling. Polypills were considered unaffordable in a given country if the lowest paid worker spends more than a days’ wage to purchase monthly supply. Results Polypills were approved for marketing in four of the 13 surveyed countries: Spain, India, Mauritius, and Argentina. None of these countries included polypills in national guidelines, formularies, or EMLs. Further, none of the surveyed public pharmacies in any of the four countries stocked any polypills. Among the surveyed private sector facilities, availability ranged from 0% in India (out-of-stock on the survey day but listed for sale) to 100% in Argentina and Spain. In the private sector, we identified seven unique polypill combinations, marketed by eight different companies. Although not in stock, India had a wider range of various combinations (n=5). Many combinations (63%) found in this survey were affordable in the local context, but these were limited to India and Spain. A lowest paid government worker would spend between 0.2 (India)–2.8 (Mauritius) days’ wages to pay the price for one month’s supply of the polypills. Polypills were likely to be affordable in countries that locally manufactured them. Further, two-pill combinations (one antihypertensive and a statin) were stocked by private pharmacies in Argentina, Bangladesh, Cameroon, India, Nepal, and Spain, with affordability ranging from 0.2 (India)–7.1 (Cameroon) days’ wages. Conclusion Low availability and affordability of polypills in both public and private sectors suggest that the implementation and overall uptake of polypills remains poor globally. Context-specific multi-disciplinary health system research is required to understand factors affecting polypill implementation and to design and evaluate appropriate implementation strategies.

18 Past and current care practices for neonates with complex medical needs: A scoping review to support clinical program evaluation

Abstract Background Neonates with complex medical needs (NCMN) are a rapidly growing patient population internationally. Although NCMN are a relatively small proportion of all Neonatal Intensive Care Unit (NICU) admissions, they are high healthcare utilizers. Since 2018, a dedicated Neonatal Complex Care Team (NCCT) has cared for NCMN at a large quaternary care center. The NCCT cares for NCMN in a dedicated, single-family room, patient area within the NICU. This model of care has yet to be evaluated for its potential impact on healthcare outcomes. Objectives The objective of the scoping review is to determine the breadth of available literature on the care practices for the management of NCMN and to collate the available evidence to define outcome measures to be used in a formal program evaluation. Design/Methods The review followed the PRISMA extension for scoping reviews and utilized resources from the Joanna Briggs Institute. The two databases that were utilized include Medline via OVID and CINAHL. The dates for included publications are January 1st 1993, until July 15th 2023. Only studies published in English and primary research were included. Two independent reviewers performed the initial title and abstract screening, and the full text review. The data extraction was completed by one independent reviewer. Results 102 articles were included in the title and abstract screen, and 12 were considered for full text review. Four articles were included. Interventions discussed in the included articles ranged from discharge conferences with patient’s caregivers, to the implementation of an entirely new model of care. Multidisciplinary health care teams appear to be integral to the in-hospital care and smooth discharge of NCMN. We identified that caregiver involvement and satisfaction are important to the discharge process as they are primarily responsible for their infant’s care after discharge, and so it is important that the specifics of care are communicated and taught effectively. The outcomes of interest identified as most useful for clinical program evaluation were length of stay and readmission rate. Additionally there was limited data reported on long-term health outcomes of this patient population. Conclusion This scoping review identified few articles that reported new models of care, a lack of consistent outcomes used in evaluating existing care models and overall a gap in research in this rapidly growing patient population. There is more work to be done to improve care of NCMN and our findings will be used in designing future studies that evaluate care models.

Identifying the need for a nurse-driven palliative care intervention for American Indian and rural family caregivers.

The purpose of this qualitative study was to understand the needs of family caregivers (FCGs) from the perspectives of health care professionals delivering cancer care to American Indian and rural populations. A descriptive content analysis of 18 interviews with multidisciplinary health care professionals delivering cancer care at a rural cancer institute in the Great Plains region was conducted. We identified three themes: access, support, and awareness with six subthemes. Consideration of these core needs, coupled with the individual cultural circumstance, is critical in addressing disparities faced by American Indian/Alaska Native and rural FCGs. The availability of specialized health care services, like palliative care, can positively impact the experience of FCGs providing care. However, access is limited. The needs and challenges faced by American Indian/Alaska Native and rural FCGs described in this study can inform the development of a culturally responsive palliative care intervention. Nurses are well positioned to develop and lead this intervention, which will be the first of its kind. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Pediatrics ACES and related life event screener (PEARLS): translation, transcultural adaptation, and validation to Brazilian Portuguese

ObjectiveAdverse Childhood Experiences (ACEs) have been associated with negative health outcomes. Screening for ACEs is crucial for improving health results, however, there is a shortage of standardized tools designed for children in Brazilian Portuguese. This study aimed to translate, culturally adapt, and validate the Pediatrics ACES and Related Life Event Screener (PEARLS) for use in Brazil. MethodThe study followed a methodological design for cross-cultural adaptation and psychometric evaluation. The PEARLS was translated and culturally adapted following a methodology that includes translation, synthesis, expert committee evaluation, target audience evaluation, and back-translation. After adaptation, a pilot cross-sectional study was conducted at a Multidisciplinary Health Care Clinical Center and a General Hospital-Reference Center for Child and Adolescent Care to assess the instrument's internal consistency, convergent validity, content validity and test-retest reliability. ResultsThe PEARLS-Br versions for Children, Teens, and Teen Self-Report were developed and subjected to pilot testing with 202 subjects. Participants demonstrated excellent comprehension, with Verbal Rating Scale median scores of 4 (IQR 4–5). Internal consistency was high, with Cronbach's alpha coefficients ranging from 0.78 to 0.81. Content validity, assessed by Kappa, indicated slight to almost perfect agreement across constructs. Test-retest reliability, assessed by Spearman's correlation coefficient, ranged from 0.89 to 0.94. ConclusionsPEARLS-BR (Child, teen, and teen self-report versions) were successfully translated, culturally adapted, and validated for assessing ACEs in Brazilian children and adolescents. This tool fills a crucial gap in ACE assessment in the Brazilian context, aligning with global recommendations for screening ACEs to improve overall health outcomes.

Beyond breast cancer: An exploration of the experiences of middle-aged female breast cancer survivors in Australia

ObjectivesMiddle-aged women (i.e., aged 40–65 years) who live with, through and beyond breast cancer (survivors) are an under-researched population, particularly within an Australian context. The unmet needs reported within this population include fatigue, psychological distress, body image concerns, early-onset menopause, and a lack of information on these issues. This study explores how the experiences of breast cancer survivorship impact the lives of Australian middle-aged women. Study designQualitative analysis of written comments in an open text field of a survey completed by 644 women reporting breast cancer in the middle-aged cohort of the Australian Longitudinal Study of Women's Health gathered between 1996 and 2013. Data was collected from any participants who reported breast cancer in any survey. Researchers conducted a thematic analysis using consensus coding on data and identified key themes. Main outcome measuresAny data where participants described their experiences of breast cancer survivorship. ResultsThis cohort reported a unique experience of breast cancer survivorship due to their age group. Analysis developed the following themes: the middle-aged context of breast cancer; care and support, body changes, overcoming fears and maintaining balance; and finding a ‘new normal’. ConclusionsBreast cancer survivorship is a diverse experience. For many it involves chronic limitations and challenges. Investigation and application of survivorship care plans in Australia could benefit breast cancer survivors by including multidisciplinary health professionals in their care. Unmet needs and psychological distress were described by participants rather than biomedical concerns. Further recommendations include development of online support groups providing access to rehabilitation professionals, especially for otherwise isolated rural women.

Challenges and Alternatives to Evaluation Methods and Regulation Approaches for Medical Apps as Mobile Medical Devices: International and Multidisciplinary Focus Group Discussion.

The rapid proliferation of medical apps has transformed the health care landscape by giving patients and health care providers unprecedented access to personalized health information and services. However, concerns regarding the effectiveness and safety of medical apps have raised questions regarding the efficacy of randomized controlled trials (RCTs) in the evaluation of such apps and as a requirement for their regulation as mobile medical devices. This study aims to address this issue by investigating alternative methods, apart from RCTs, for evaluating and regulating medical apps. Using a qualitative approach, a focus group study with 46 international and multidisciplinary public health experts was conducted at the 17th World Congress on Public Health in May 2023 in Rome, Italy. The group was split into 3 subgroups to gather in-depth insights into alternative approaches for evaluating and regulating medical apps. We conducted a policy analysis on the current regulation of medical apps as mobile medical devices for the 4 most represented countries in the workshop: Italy, Germany, Canada, and Australia. We developed a logic model that combines the evaluation and regulation domains on the basis of these findings. The focus group discussions explored the strengths and limitations of the current evaluation and regulation methods and identified potential alternatives that could enhance the quality and safety of medical apps. Although RCTs were only explicitly mentioned in the German regulatory system as one of many options, an analysis of chosen evaluation methods for German apps on prescription pointed toward a "scientific reflex" where RCTs are always the chosen evaluation method. However, this method has substantial limitations when used to evaluate digital interventions such as medical apps. Comparable results were observed during the focus group discussions, where participants expressed similar experiences with their own evaluation approaches. In addition, the participants highlighted numerous alternatives to RCTs. These alternatives can be used at different points during the life cycle of a digital intervention to assess its efficacy and potential harm to users. It is crucial to recognize that unlike analog tools, digital interventions constantly evolve, posing challenges to inflexible evaluation methods such as RCTs. Potential risks include high dropout rates, decreased adherence, and nonsignificant results. However, existing regulations do not explicitly advocate for other evaluation methodologies. Our research highlighted the necessity of overcoming the gap between regulatory demands to demonstrate safety and efficacy of medical apps and evolving scientific practices, ensuring that digital health innovation is evaluated and regulated in a way that considers the unique characteristics of mobile medical devices.

What can the psychoneuroimmunology of yoga teach us about depression's psychopathology?

Depression, the most prevailing mental health condition, remains untreated in over 30% of patients. This cluster presents with sub-clinical inflammation. Investigations trialling anti-inflammatory medications had mixed results. The lack of results may result from inflammation's complexity and targeting only a few of depression's abnormal pathways. Mind-body therapies' biological and neuro-imaging studies offer valuable insights into depression psychopathology. Interestingly, mind-body therapies, like yoga, reverse the aberrant pathways in depression. These aberrant pathways include decreased cognitive function, interoception, neuroplasticity, salience and default mode networks connectivity, parasympathetic tone, increased hypothalamic-pituitary-adrenal (HPA) axis activity, and metabolic hyper/hypofunction. Abundant evidence found yogic techniques improving self-reported depressive symptoms across various populations. Yoga may be more effective in treating depression in conjunction with pharmacological and cognitive therapies. Yoga's psychoneuroimmunology teaches us that reducing allostatic load is crucial in improving depressive symptoms. Mind-body therapies promote parasympathetic tone, downregulate the HPA axis, reduce inflammation and boost immunity. The reduced inflammation promotes neuroplasticity and, subsequently, neurogenesis. Improving interoception resolves the metabolic needs prediction error and restores homeostasis. Additionally, by improving functional connectivity within the salience network, they restore the dynamic switching between the default mode and central executive networks, reducing rumination and mind-wandering. Future investigations should engineer therapies targeting the mechanisms mentioned above. The creation of multi-disciplinary health teams offering a combination of pharmacological, gene, neurofeedback, behavioural, mind-body and psychological therapies may treat treatment-resistant depression.

The Mental Health Clinical Liaison Programme for Schools: developing a new approach in Child and Adolescent Mental Healthcare in Spain

Mental health issues among children and adolescents have increased, especially after the COVID-19 pandemic. Despite awareness, less than half get needed care, leading to long-term consequences. The World Health Organization calls for integrated, preventive community interventions. In this paper, we present The Mental Health Clinical Liaison Programme for Schools in the Community of Madrid, Spain, which features school-based activities delivered by multidisciplinary mental health teams, offering early detection, intervention, and prevention strategies for children and adolescents. We describe the activities implemented, present the evidence supporting them, provide preliminary data, and discuss the scope and challenges of the programme. In 2023–2024, the programme intervened in 53 primary and secondary schools, helping identify in 876 cases, evaluating 356, and referring 122 to other services. It supported interventions for 179 patients already in mental healthcare and 34 reintegrations after psychiatric hospitalization. Anti-stigma workshops have been conducted, involving approximately 1620 students. Ongoing research aims to evaluate the effectiveness and cost-effectiveness of these interventions to ensure continuous improvement in mental health services for young people.

A Qualitative Exploration of Refugee Experiences of Access to a Dedicated Multi-Disciplinary Refugee Health Team in an Australian Context: Implication for Future Care

Aims Refugees experience physical and mental health issues that need attention following settlement in a new community. However, access to and utilisation of healthcare services is challenging. We aimed to explore the experience of refugee access to a dedicated multi-disciplinary refugee health team. Methods An interpretative qualitative study. 17 qualitative interviews were conducted with Ezidi refugees who attended a newly established multi-disciplinary refugee health program in a regional town in NSW, Australia. Data were analysed using an inductive thematic approach. Results Participants ( n = 17) identified as Ezidi and were from Iraq. Parents were between 23 and 57 years of age and had 1–12 children per family. Most had been in Australia between 2 and 5 years. Four key themes were identified: (1) Identifying the extent of health needs following a long wait to migrate; (2) Health support across the life span: the benefit of access to a multi-disciplinary team; (3) Gaps in cultural competence – impacted by understanding and interpreter access; and (4) Ongoing health and lifestyle concerns – influenced by understanding and education. Conclusions We identified the benefit of access to allied health for prompt diagnosis, treatment and management of conditions including congenital and developmental conditions, mental health and chronic diseases. Access to a dedicated team ensured early intervention for a broad range of health and social issues including early referral to services, close coordination and help to complete supporting paperwork and applications. Ongoing investments are needed to maintain this comprehensive and coordinated approach to care that is underpinned by a family centric approach.

Association between body mass index and physical activity among prostate cancer survivors.

We assessed the associations between (1) body mass index (BMI) and participating in any physical activities (PAs) in past 30days and (2) cancer and behavioral-related variables and participating in any PAs in past 30days among prostate cancer (PCa) survivors. We conducted a cross-sectional analysis of data from the 2018-2022 Behavioral Risk Factor Surveillance System. Multivariable weighted logistic regression was used to examine the associations. Of the 4944 PCa respondents, 22.9% were classified as obese class I and 10.6% as obese class II or III. Obese class I and obese class II or III respondents were significantly less likely to participate in any PAs in past 30days (odds ratio (OR) = 0.48; 95% confidence interval (CI): 0.28-0.84 and OR = 0.37; 95% CI: 0.20-0.67, respectively). Men who received a summary of their cancer treatment were significantly more likely to participate in any PAs in past 30days (OR = 1.53; 95% CI: 1.03-2.28). Men who received instructions from a doctor for routine check-ups after completing treatment for cancer were not significantly more likely to participate in any PAs in past 30days (OR = 1.36; 95% CI: 0.87-2.12). Current smokers were less likely to participate in any PAs in past 30 days (OR = 0.50; 95% CI: 0.26-0.96). Obese men and current smokers were less likely to participate in any PAs in past 30days. Men who received a summary of their cancer treatment were more likely to participate in any PAs in past 30days. Health care providers should talk to their patients about the benefits of participating in PA and refer PCa patients to available exercise programs. PA was lowest among obese class II or III PCa survivors. These men could benefit from a coordinated multidisciplinary health care team effort to improve PCa prognosis and QoL.

Trauma-Informed Care in Nursing Curricula: Development of a Simulation-Based Educational Framework to Guide Health Professions.

This research aimed to uncover elements of a comprehensive, trauma-informed (TI) multidisciplinary health professions simulation framework to improve the delivery of care to traumatized patients. Trauma is a pervasive public health problem requiring a TI approach. Simulation is an evidence-based teaching strategy that advances knowledge and clinical reasoning. There is a lack of scientifically based simulation education models addressing the delivery of TI care for the health professions. A Delphi study utilizing a panel of experts was conducted to identify the most critical elements of a simulation framework. Phase one identified 10 content areas and 111 subcontent areas. Phase two analysis revealed 99 percent of the 111 subcontent areas achieved expert consensus. This Delphi study provides the first scientifically based framework to guide the development of a comprehensive, TI, multidisciplinary simulation framework to recognize trauma survivors and subsequently display concern and respect.

"What will the caregiver do?" at home for stroke exercise using a wheelchair: qualitative research in multidisciplinary health professionals perspective

"What will the caregiver do?" at home for stroke exercise using a wheelchair: qualitative research in multidisciplinary health professionals perspective

Evidence-based general practice: Selected abstracts from the 98th EGPRN Meeting, Porto, Portugal, 9–12 May 2024

With its strong commitment to Primary Care, Portugal’s healthcare landscape has witnessed significant strides in recent years. The 98th EGPRN meeting in Porto was a testament to the dedication and progress of primary care research and education in the country.The theme of the 98th EGPRN meeting, ‘Evidence-Based General Practice’, aligned seamlessly with the evolving healthcare landscape in Portugal. This paradigm shift aims to foster better interdisciplinary collaboration and establish a framework for connecting welfare and healthcare on a local community level. Over the past few decades, primary health care and general practitioners in Portugal have gained prominence, following the guidelines set forth by the World Health Organisation (WHO). With a focus on prevention and wellbeing, practices have transitioned into multidisciplinary health centres. Considering this evolving healthcare context, the need for innovative and multidisciplinary research designs becomes imperative for translating evidence into practice. Moreover, this gathering provided an opportunity to discuss the challenges and opportunities associated with population-based studies. Understanding the collective health needs of communities and implementing data-driven strategies will shape the future of evidence-based general practice in Europe.In conclusion, the 98th EGPRN meeting in Porto, Portugal, was a dynamic platform for exchange, learning, and innovation, as we collectively strive to enhance evidence-based general practice. As an academic community, we aim to chart a course towards a healthier and more interconnected future for primary care, leaving a positive impact on the wellbeing of communities and patients alike.