Tertiary Prevention Interventions Research Articles

How Health Professionals Identify and Respond to Perpetrators of Domestic and Family Violence in a Hospital Setting: A Scoping Review.

There is heightened awareness that a whole-of-systems approach to perpetrator responses is key to addressing domestic and family violence (DFV). This paper reports on the findings from a scoping review which mapped the international literature on how health professionals identify and respond to perpetrators of DFV within a hospital setting. A comprehensive scoping review methodology was used. The search, spanning January 2010 to January 2022, yielded 12,380 publications from four databases. Eligibility for inclusion included peer-reviewed literature with any reference to inpatient hospital health professionals identifying or responding to perpetrators of DFV. Fourteen articles were included in the final review. The review presents the literature categorized by levels of prevention, from primary, secondary, through to tertiary preventive interventions. An additional category "other practices" is added to capture practices which did not fit into existing levels. Despite glimpses into how health professionals can identify, and respond to perpetrators of DFV, the current knowledge base is sparse. The review did not identify any mandated or formal procedures for identifying and/screening or responding to perpetration of abuse in hospitals. Rather, responses to perpetrators are inconsistent and rely on the motivation, skill, and self-efficacy of health professionals rather than an embedded practice that is driven and informed by hospital policy or procedures. The literature paints a picture of missed opportunities for meaningful work with perpetrators of DFV in a hospital setting and highlights a disjuncture between policy and practice.

Suicide prevention in India

India accounts for nearly 18 % of the global population but approximately 28 % of global suicides. Similar to many countries around the world, suicide in India is known to result from a complex interplay of social, economic, and personal factors. To address this important issue, India released its first national suicide prevention strategy in 2022. The strategy follows the WHO-recommended model of a multisectoral approach to suicide prevention, incorporating a mix of primary prevention interventions (focusing on whole populations), secondary prevention interventions (targeting 'high-risk' individuals), and tertiary prevention interventions (aimed at individuals affected by suicide). This paper delves into the details of these primary, secondary, and tertiary prevention interventions and explores how they apply to the Indian context, while arguing for the need to prioritize primary prevention interventions, at least in the short term, to reduce suicides.

Predictor of Postpartum Depression: Literature Review

The incidence of postpartum depression is quite high. The largest percentage occurs when they have their first child, and have a family history of mood disorders. The incidence of postpartum depression is 50 - 60% in mothers when they have their first child, and around 20% in mothers who give birth to subsequent children. This study aims at reviewing and synthesizing the determinants factor of depression among adolescent in rural area. This study design was a systematic review using the PICO framework. This data was carried out from various journal databases 2012-2022, including Scopus, ScienceDirect, PubMed. 16 articles meet the inclusion criteria and meet the qualifications for review. A systematic procedure is used to collect articles, as well as a critical appraisal and data synthesis with qualitative synthesis. The analysis of the literature review found that aspects of findings related to predictors of postpartum depression are as follows: socio-demographic factors (age, socio-economic status, education, risk age group), maternal factors (pregnancy spacing, parity, pregnancy condition, birth experience, postpartum complications), biological factors (hypothalamus function, prolactin, CRH, inflammatory process), psychosocial factors (negative mood, anxiety, unpreparedness, history of depression), cultural factors (children care stress, wisdom), support system (support husband, family support, decision-making patterns). Healthcare professionals should be aware of this phenomenon and strategies such as primary, secondary, and tertiary prevention interventions may be applied. Women should be screened for potential risk factors and depressive symptoms during pregnancy and postpartum periods so that appropriate interventions if needed, can be initiated in a timely fashion.

Physical Activity among Colorectal Cancer Patients and Survivors in Egypt.

Understanding physical activity (PA) levels is important when developing tertiary cancer prevention interventions, especially in Egypt where colorectal cancer (CRC) is more often diagnosed at later stages and at a younger age of onset (≤40 years). We assessed PA levels among CRC patients and survivors in Alexandria, Egypt. All participants completed two self-reported PA assessments: Global Physical Activity Questionnaire (GPAQ) and Godin Leisure-Time Exercise Questionnaire (GLTEQ). Participants could opt to wear an accelerometer for seven days. Results were compared against WHO recommendations of ≥150 minutes or ≥600 metabolic equivalents of tasks (METs) of moderate-to-vigorous PA weekly. Of 86 participants enrolled, all completed the surveys and 29 agreed to accelerometer use. Prevalence of meeting PA recommendations was 62.8% based on the GPAQ, 14.0% based on GLTEQ, and 41% based on accelerometer. Based on the GPAQ, very few respondents reported vigorous occupational, vigorous recreational, or moderate recreational activity (median = 0 with interquartile range [IQR] of 0 - 0 weekly minutes for all three) while most activity resulted from moderate occupational and transportation (median [IQR] of 60 [0-840] and 60 [0-187.5] weekly minutes, respectively). Participants meeting PA recommendations were less likely to be married (p = 0.043) according to GPAQ and more likely to be female (p=0.047) and early cancer stage (p=0.007) by GLTEQ. Non-leisure free-living PA is a major contributor to meeting PA recommendations while leisure-time PA is a potential target for future interventions that increase PA in this population.

Homelessness Prevention Interventions for Single Adults at Risk of or Experiencing MEH: A Systematic Review on their Effectiveness

Homelessness prevention for single adults at risk of or experiencing multiple exclusion homelessness (MEH) has received limited attention in research. This systematic review focused on the effectiveness of primary, secondary, and tertiary homelessness prevention interventions and strategies for this population. We searched four databases (Embasse, PsycInfo, Medline, and Allied Social Sciences Index and Abstracts [ASSIA]) for peer-reviewed empirically completed quantitative and qualitative studies and systematic reviews between 1992 and 2021. We identified ten categories of interventions based on the kind of support they provide: accommodation, financial assistance, case management, outreach, mental health care, joint mental health and substance use care, substance use care, other social support, policies and legal assistance. We found that research has principally focused on tertiary prevention, the prevention of chronic homelessness, and there is a lack of research on the effectiveness of upstream primary prevention strategies that would intervene before someone is at imminent risk of homelessness. However, within the secondary and tertiary prevention space, the best approach was a multifaceted cross-sector collaboration of different services. Many studies concluded that those at risk of or experiencing MEH require high intensity services combining a range of housing and support service options. Housing First, Assertive Community Treatment, Critical Time Intervention were high intensity services that were consistently found to be effective in preventing homelessness. Intensive case management had mixed evidence on effectiveness. Financial assistance was identified as important for preventing first-time, recurrent, and chronic homelessness in many studies and may be essential, but unlikely to be enough on its own. Finally, the prevention of homelessness after discharge from institutional care was found to be critical with several interventions showing to be effective here.

What to remove from the work environment: the sick worker or the cause of his sickness? Workplace bullying, a form of violence that causes sickness.

Although there are many different definitions of workplace bullying in the scientific literature, it can be defined as a form of psychological and relational violence conducted systematically and continuously by one or more individuals, towards another individual, with the aim of causing him physical and mental harm and exclude him from the workplace. The elements common to all definitions are the work context, the duration for at least six months, the frequency of bullying actions, which must occur at least once a week, the evolution in phases and the power differential between aggressor and victim. The purpose of this article is not only to provide the most important definitions of workplace bullying and to identify the common elements, but also to report the most recent findings concerning gender and personality differences of both victim and aggressor, to report the most investigated professional sectors, to describe the causes and the consequences on both the worker and the organization and to present the legislative framework. Workplace bullying can be considered an emerging public health problem that requires preventive interventions. Secondary and tertiary prevention interventions are important, but the aim is to prevent the phenomenon when it has not yet developed. Primary prevention interventions promote a healthy work environment that reduces the development of work-related violence, including workplace bullying.

Medical Treatment for Rheumatic Heart Disease: A Narrative Review.

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are rare in high-income countries; however, in Aotearoa New Zealand ARF and RHD disproportionately affect Indigenous Māori and Pacific Peoples. This narrative review explores the evidence regarding non-surgical management of patients with clinically significant valve disease or heart failure due to RHD. Medline, EMBASE and Scopus databases were searched, and additional publications were identified through cross-referencing. Included were 28 publications from 1980 onwards. Of the available interventions, improved anticoagulation management and a national RHD register could improve RHD outcomes in New Zealand. Where community pharmacy anticoagulant management services (CPAMS) are available good anticoagulation control can be achieved with a time in the therapeutic range (TTR) of more than 70%, which is above the internationally recommended level of 60%. The use of pharmacists in anticoagulation control is cost-effective, acceptable to patients, pharmacists, and primary care practitioners. There is a lack of local data available to fully assess other interventions; including optimal therapy for heart failure, equitable access to specialist RHD care, prevention, and management of endocarditis. As RHD continues to disproportionately affect Indigenous and minority groups, pro-equity tertiary prevention interventions should be fully evaluated to ensure they are reducing disease burden and improving outcomes in patients with RHD.

Association between childhood maltreatment and atopy in the UK: A population based retrospective cohort study.

Childhood maltreatment affects over one in three children worldwide and is associated with a substantial disease burden. This study explores the association between childhood maltreatment and the development of atopic disease. We did a population-based retrospective matched open cohort study using participating general practices between 1st January 1995 and 30th September 2019. Read codes were utilised to identify patients exposed to childhood maltreatment (either suspected or confirmed) who were matched to up to four unexposed patients by age, sex, general practice, and Townsend deprivation quintile. Cox regression analysis was used to calculate adjusted (age, sex, Townsend deprivation quintile) hazard ratios (aHR) for development of atopy (asthma, atopic dermatitis, or allergic rhino conjunctivitis) during follow up in those without atopy at study entry. 183,897 exposed patients were matched to 621,699 unexposed patients. During the follow up period, 18,555 patients (incidence rate (IR) 28.18 per 1000 person-years) in the exposed group developed atopic disease compared to the 68,368 (IR 23.58 per 1000 person-years) in the unexposed group, translating to an adjusted HR of 1.14 (95% CI 1.12-1.15). Notably, the risk of developing asthma was aHR 1.42 (95% CI 1.37-1.46). Associations were more pronounced in analyses restricted to females and confirmed cases of childhood maltreatment only. Considering the substantial health burden associated with childhood maltreatment, it is important to implement public health policies aimed at enhancing: 1) detection and primary prevention of childhood maltreatment, 2) secondary and tertiary prevention interventions to reduce the burden of ill health associated with exposure to maltreatment and 3) clinical awareness of such associations and subsequent knowledge of management. None.

Using a Public Health Approach to Prevent Child Sexual Abuse by Targeting Those at Risk of Harming Children

The evidence is clear that child sexual abuse is a public health concern internationally. Prevention of child sexual abuse requires a variety of interventions including those that stop individuals from either sexually assaulting a child or viewing sexually abusive online images. In contrast, most current approaches internationally focus on criminal justice strategies aimed at preventing reoffending rather than stopping the first offence. Additionally, and albeit there is a general paucity of relevant scholarship, there are few signs of countries adopting coherent, unified and evidence-based strategies to prevent individuals at risk of harming a child becoming actual or repeat offenders. The focus of interventions to date is largely on prevention at the tertiary end. Understanding and adopting an integrated public health approach represents an opportunity to incorporate a range of primary, secondary and tertiary prevention interventions and develop comprehensive prevention strategies at local, national, or international levels. A comprehensive approach to prevention targeted at stopping offending in the first place is required, and it needs to be able to recognise the complex nature of offending and the diversity therein. Research shows that those who harm children are diverse in their age and gender, the children they sexually abuse—intra-familial/extra-familial, prepubescent/pubescent, peer/younger children, male or female—and the type of abuse—contact, non-contact, or online. Preventing child sexual abuse is complex and requires more than an ad hoc collection of unrelated programs, if it is to succeed. This paper synthesises and integrates the disparate scholarly literature on the potential and actual perpetrators of child sexual abuse and responses to and prevention of such abuse. It recommends an increased focus on primary prevention within a comprehensive public health approach as a conceptual framework to prevent the occurrence of child sexual abuse. A systems approach is taken to develop the proposed conceptual framework.

Systematic review of electronically delivered behavioral obesity prevention interventions targeting men.

Globally, obesity persists at epidemic rates. Men are underrepresented within behavior-based obesity prevention research. As men prefer individualized, self-guided interventions, electronic delivery of treatment modalities has potential to reach this population. The purpose of this study was to systematically review primary, secondary, or tertiary behavioral obesity prevention interventions that used controlled designs; targeted men; and incorporated at least one electronically delivered treatment modality explicitly designed to elicit an intervention effect. Literature searches were delimited to peer-reviewed articles; published between 2000 and 2021; in the English language; and indexed in PsycINFO, CINHAL, MEDLINE, CENTRAL, and WOS electronic databases. Interventions satisfying inclusion criteria were critiqued for methodological quality using the Jadad Scale (0 = lowest quality; 10 = highest quality). Eleven studies satisfied the inclusion criteria (n = 1748; total participants) with five reporting group-by-time intervention effects on the primary variable targeted. Jadad scale quality assessment scores ranged from 5.00 to 9.00 with a mean of 7.72. Majority of the interventions applied a randomized control trial design (n = 10). Most interventions were theory based, with eight rooted in social cognitive theory. Behavior change strategies included self-monitoring (n = 10), personalized feedback (n = 8), health counseling (n = 8), and goal setting (n = 9). Community-level theories have the potential to guide future obesity prevention interventions targeting men.

Strengthening Primary Healthcare in Kosovo Requires Tailoring Primary, Secondary and Tertiary Prevention Interventions and Consideration of Mental Health.

ObjectivesKosovo has the lowest life expectancy in the Balkans. Primary healthcare (PHC) plays an essential role in non-communicable disease (NCD) prevention. We described primary, secondary and tertiary prevention indicators in Kosovo and assessed their association with depressive symptoms.MethodsPHC users (n = 977) from the Kosovo NCD cohort baseline study were included. Depressive symptoms were assessed using the Depressive Anxiety Stress Scale-21. Cross-sectional associations between depressive symptoms and prevention indicators were quantified with mixed logistic regression models.ResultsPoor nutrition (85%), physical inactivity (70%), obesity (53%), and smoking (21%) were common NCD risk factors. Many cases of hypertension (19%), diabetes (16%) and Chronic Obstructive Pulmonary Disease (COPD) (45%) remained undetected by a PHC professional. Uncontrolled hypertension (28%), diabetes (79%), and COPD (76%) were also common. Depressive symptoms were positively associated with physical inactivity (OR 1.02; 95% CI 1.00–1.05 per 1-point increase in DASS-21) and undetected COPD (OR 1.07; 95% CI 1.00–1.15), but inversely with undetected diabetes (OR 0.95; 95% CI 0.91–1.00).ConclusionsContinued attention and tailored modifications to primary, secondary and tertiary prevention in Kosovo are needed to narrow the Balkan health gap.

Communication-based suicide prevention after the first attempt. A systematic review.

Previous suicide attempts are the strongest risk factor for a new suicide attempt, suicide death, the development of recurrent suicide behavior and even the development of suicidal ideation in the general population. Primary prevention aims to reduce new suicide attempts in the general population, while secondary prevention tries to reduce the chance of suicide attempts in patients with high risk. Tertiary interventions are targeted at individuals who have already made one or more suicide attempts and aim to prevent second or repetitive attempts and to suppress suicidal behavior. Communication with patients and family is a very effective way of preventing a second suicide attempt. The aim of this paper is to present an overview of tertiary suicide prevention interventions focusing on communication with the patient and their family and study their effectiveness. This systematic review was based on the PRISMA checklist and was conducted using the databases Pubmed, Scopus and Google Scholar for articles published between 2000 and 2020 focus in go communication with family and patient. All studies concerning at least one previous suicide attempt were included. The interventions described in the studies concerned: [1] face-to-face and telephone contacts, [2] communication with greeting cards and letters, [3]telephone contact with the patient and record keeping to facilitate the implementation of the action plan, [4] telephone contacts only, and [5] technology-based communication. Our investigation brought up9 studies on interventions focusing on communication with the patient and their family. Family and patient communication interventions, with a particular emphasis on telephone and written communication, have shown a good level of effectiveness in the prevention of a new suicide attempt, especially if the intervention has been completed according to the schedule and the patient has not abandoned the treatment early. The generalization of the results is limited due to the inclusion of other types of studies jointly with randomized controlled trials and the variability among the samples of the studies. In conclusion, family and patient communication interventions have shown a positive effect on preventing a second suicide attempt. More studies are needed to investigate the effectiveness of different prevention approaches at hand and clarify in which patient populations each intervention could be more effective.Previous suicide attempts are the strongest risk factor for a new suicide attempt, suicide death, the development of recurrent suicide behavior and even the development of suicidal ideation in the general population. Primary prevention aims to reduce new suicide attempts in the general population, while secondary prevention tries to reduce the chance of suicide attempts in patients with high risk. Tertiary interventions are targeted at individuals who have already made one or more suicide attempts and aim to prevent second or repetitive attempts and to suppress suicidal behavior. Communication with patients and family is a very effective way of preventing a second suicide attempt. The aim of this paper is to present an overview of tertiary suicide prevention interventions focusing on communication with the patient and their family and study their effectiveness. This systematic review was based on the PRISMA checklist and was conducted using the databases Pubmed, Scopus and Google Scholar for articles published between 2000 and 2020 focus in go communication with family and patient. All studies concerning at least one previous suicide attempt were included. The interventions described in the studies concerned: [1] face-to-face and telephone contacts, [2] communication with greeting cards and letters, [3]telephone contact with the patient and record keeping to facilitate the implementation of the action plan, [4] telephone contacts only, and [5] technology-based communication. Our investigation brought up9 studies on interventions focusing on communication with the patient and their family. Family and patient communication interventions, with a particular emphasis on telephone and written communication, have shown a good level of effectiveness in the prevention of a new suicide attempt, especially if the intervention has been completed according to the schedule and the patient has not abandoned the treatment early. The generalization of the results is limited due to the inclusion of other types of studies jointly with randomized controlled trials and the variability among the samples of the studies. In conclusion, family and patient communication interventions have shown a positive effect on preventing a second suicide attempt. More studies are needed to investigate the effectiveness of different prevention approaches at hand and clarify in which patient populations each intervention could be more effective.

Adaption and implementation of the Housing Outreach Program Collaborative (HOP-C) North for Indigenous youth.

There is a high prevalence of Indigenous youth experiencing either precarious housing or homelessness in northwestern Ontario. Given that Indigenous pathways to homelessness can differ from non-Indigenous youth, interventions that address homelessness must also adapt to meet diverse needs. The Housing Outreach Program Collaborative (HOP-C) is a tertiary prevention intervention designed to provide congruent housing and peer and mental health supports for youth experiencing homelessness in Toronto, Ontario. Less is known regarding its adaptability to adequately serve Indigenous youth in northwestern Ontario. This study assessed the preliminary effectiveness and feasibility of an adaptation of the HOP-C North program for transitional aged Indigenous youth exiting homelessness in Thunder Bay, Ontario. Participants completed premeasures (n = 15) and postmeasures (n = 8) as well as qualitative interviews regarding their experiences in the program. Qualitative interviews were also conducted with staff (n = 14) engaged in implementing the program. After completing the HOP-C North program, participants reported improvements in a number of outcomes, including increased educational enrollment, attainment of employment, reduced hospitalizations, and increased engagement in clinical mental health services. Specific program aspects that participants found helpful included increased program flexibility, accessibility, emphasis on relationships, relevance of programming, fostering participant autonomy, and an adaptive approach to program implementation. These findings suggest that the HOP-C North model, when adapted, is a helpful program for Indigenous youth. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Protocol for a systematic review on tertiary prevention interventions for patients with stroke in African countries.

IntroductionStroke is one of the common causes of mortality, morbidity and years of life lost worldwide. Baseline research on stroke epidemiology, prevention, acute and rehabilitative interventions in Africa is necessary to approach specific contexts and regional circumstances. Most studies on stroke have been conducted in high-income countries. This protocol describes the methodology to summarise the best available evidence on tertiary preventive strategies like rehabilitation interventions for patients with stroke in African contexts.Methods and analysisWe will include experimental studies and prospective cohort studies conducted in African countries. A protocol has been registered in PROSPERO. Systematic search will include eight electronic databases (MEDLINE, Embase, the Cochrane Library, CINAHL, Cab-Direct, Physiotherapy Evidence Database (PEDro), African Journals Online and African Index Medicus) and the International Clinical Trials Register Platform and base on predefined search terms. We will search from inception of each database and repeat this strategy 3 months prior to review submission. Details of all eligible studies will be extracted and risk of bias for outcomes on global disability or dependence in daily living will be assessed. Main aim of this systematic review is to provide a narrative description of evidence on tertiary prevention strategies (including rehabilitation) for stroke. This description will be visualised in structured tables to aid interpretation of study characteristics, intervention effects and certainty of the evidence.Ethics and disseminationNo ethical approval is necessary. Results will be presented in national and international conferences and published in a peer-reviewed journal.PROSPERO registration numberCRD42020159125.

4508 Contextual Predictors of Hospitalization and Quality of Life Among Patients on Hemodialysis

OBJECTIVES/GOALS: People engaging in high-risk substance use or experiencing food insecurity or housing instability are at increased risk to develop end-stage kidney disease. This study will examine associations between these risk factors, patient indicators of socioeconomic position, and hospitalization rates and quality of life after initiation of hemodialysis. METHODS/STUDY POPULATION: The proposed study will leverage a prospective cohort design. We will enroll a convenience sample of 330 participants from the same large dialysis organization. Participants will complete measures of socioeconomic position (age, gender, race, ethnicity, education, income, occupation and community poverty); substance use; food insecurity; housing instability; and quality of life at baseline. We will follow participants for 6 months and extract hospitalization counts from the dialysis facility medical record. RESULTS/ANTICIPATED RESULTS: We will generate risk scores (low, medium, high) from measures of substance use, food insecurity and housing instability. We will conduct multiple logistic regression to generate odds ratios comparing risk group membership by indicators of socioeconomic position. We anticipate that low or medium-risk groups will differ from high risk groups by indicators of socioeconomic position. We will conduct Poisson regression to generate incidence rate ratios for 6-month hospitalization rates comparing low or medium-risk and high-risk groups. Lastly, we will conduct multiple linear regression to generate beta coefficients for changes in quality of life scores comparing low or medium-risk and high-risk groups. We anticipate that high-risk groups will have higher hospitalization rates and lower quality of life scores. DISCUSSION/SIGNIFICANCE OF IMPACT: As the prevalence of end-stage kidney disease continues to increase, there is a need for tertiary prevention interventions that reduce costly inpatient utilization and improve health-related quality of life. The proposed study will lay groundwork for the development of interventions to improve patient outcomes and reduce Medicare spending.

Occurrence of metachronous second primary cancer in head and neck cancer survivors: A systematic review and meta-analysis of the literature.

Head and neck cancer (HNC) is the sixth leading cancer worldwide with approximately 600,000 new cases per year. Several studies suggest that HNC survivors may have an increased risk of developing second primary cancers (SPCs). A systematic review and meta-analysis was performed aiming to quantify the overall and site-specific risk of metachronous SPCs in HNC survivors. PubMed, Web of Science and Scopus were searched to identify studies published until October 2019. Studies investigating the standardised incidence ratio (SIR) of metachronous SPC were included. A random-effects meta-analysis was performed to calculate the overall and site-specific SIRs. Newcastle-Ottawa Scale was used to assess the study's quality. Heterogeneity was quantified using the I2 statistics and explored using meta-regression. Twenty-six studies were included in the systematic review. Studies differed by the definition of metachronous SPC used. For the meta-analyses, the studies were grouped according to these definitions. In the three groups, the overall risk of metachronous SPC was increased. The highest SPC risk was for oropharynx, oesophagus and lung. Head and neck cancer survivors are at increased overall risk of metachronous SPCs. The canonical upper aerodigestive sites, HNLE (head and neck, oesophagus and lung), were the SPC sites with the highest risk. Our results emphasise the importance of targeted surveillance strategies aimed at early detection and tertiary preventive interventions.

Impact evaluation of a four-year academic-community partnership in provision of medication management and tertiary prevention services for rural patients with diabetes and/or hypertension.

Medication therapy management (MTM) services, including targeted, pharmacist-delivered, tertiary prevention interventions, were provided to rural patients with chronic diseases via an academic-community partnership. The purpose of this investigation was to evaluate the overall program and pre/post patient outcomes from this four-year, multi-site collaboration. Five community health sites collaborated with a university-based MTM provider to deliver services in Arizona (2012–16). Eligible patients: were 18 or older (median 65 years); had a diagnosis of diabetes and/or hypertension; and resided in a rural community. Participants received an initial telephone consultation with the MTM pharmacist; follow-up consultations were conducted after 30 or 90 days for high- and low-risk patients, respectively. Community partner staff collected clinical data and addressed pharmacists’ recommendations. Descriptive analysis and bivariate analyses of pre- and post-intervention results were conducted. Most (n = 410, 70%) of the 577 participants receiving an initial and follow-up consultation with the MTM pharmacist had both diabetes and hypertension. These individuals showed statistically significant improvements in fasting blood glucose (p < 0.0001), hemoglobin A1C (p = 0.0082) and systolic blood pressure (p = 0.009) while those with only one condition did not demonstrate significant changes. While the pre/post changes in chronic disease control indicators were statistically significant, the clinical significance was low to moderate. Patients with both comorbid diabetes and hypertension experienced benefit from collaborative, targeted MTM pharmacist-delivered, tertiary prevention interventions in tandem with community-based pharmacy resources. This multi-site MTM program showed promise in increasing patients’ use of these services, yet effective strategies are needed to expand recruitment of eligible patients in the future.

A public health approach to serious youth violence for policy making in the London Borough of Lambeth: an evidence review

BackgroundDespite an overall national decline in violent crime, weapon carrying and serious violence among youth appears to be rising. Following the example of successful programmes taking a public health approach to violence, such as that in Glasgow (UK), we aimed to review the global evidence base to inform the development of the serious youth violence strategy for the London Borough of Lambeth (UK). MethodsThis narrative review examined evidence for key factors involved in youth violence, effective preventative interventions (using a thematic approach), shared characteristics of effective interventions, and key principles used by successful interventions or programmes in order to inform Lambeth's approach. Evidence was found through programme websites, clearing houses, and databases (National Health Service Healthcare Databases Advanced Search, Trip, and Social Survey Research Intervention using variations on “youth”, “violence”, and “prevention”, for evidence published between 2013 and 2018 in English). FindingsMore than 30 different risk and protective factors were found to be strongly associated with youth violence. Factors are often age-specific: family factors including adverse childhood events are crucial in early childhood, whereas individual factors (eg, conduct disorders or substance misuse) have a greater role in adolescence. 28 effective and ten promising intervention themes were found: most focused on effective parenting or childhood skills development, constituting primary prevention. Despite evidence suggesting greater cost effectiveness, fewer secondary and tertiary prevention intervention types were found. There was a substantial gap in the evidence for interventions targeting gang-related violence. Key characteristics, such as enhancing protective factors, mitigating risk factors, working in the natural environments of youth, and use of trained facilitators, are shared by effective interventions. Many successful programmes have demonstrated that strong community partnerships, targeting of multiple risk and protective factors, and robust monitoring and evaluation mechanisms might be important determinants of success. InterpretationA comprehensive programme for preventing youth violence, across different levels of prevention and tackling multiple areas of need, should be designed in partnership with the local community. There are many effective interventions that could be implemented in Lambeth, ensuring fidelity to the original specification; promising interventions could be implemented if they match specific local needs. When it is not possible to match an evidence-based intervention to an area of need, the substantial evidence on key characteristics of successful interventions should be used to innovate at a local level, with robust mechanisms for monitoring and evaluation. FundingNone.

Respecting Sexual Safety: A Program to Prevent Sexual Exploitation and Harmful Sexual Behaviour in Out-of-Home Care

ABSTRACT For children and young people living in residential care, recent Victorian and national inquiries have found that harmful sexual behaviour carried out by children and young people, and child sexual exploitation perpetrated by adults, are significant problems. Efforts to address harmful sexual behaviour and child sexual exploitation in Victoria include the establishment of sexually abusive behaviour treatment services and the Sexual Exploitation Protocol. Applying the public health model of prevention, these programs of work are tertiary prevention interventions that respond after the abuse has occurred. A gap exists in secondary prevention efforts for children and young people living in residential care that target this vulnerable group and intervene early when warning signs emerge. This paper describes a secondary prevention program, Respecting Sexual Safety, that may provide an early intervention response to harmful sexual behaviour and child sexual exploitation for children and young people living in residential care. The program has been designed, and is being trialled and evaluated, through an action research collaboration. IMPLICATIONS Multi-agency collaboration to intervene earlier to address harmful sexual behaviour and child sexual exploitation for children and young people living in residential care requires strengthening. Residential carers require upskilling and support to respond to children and young people going missing from the home to keep them at home. Residential carers require upskilling and support to identify problematic sexual behaviour and ensure appropriate intervention.

Development of a complex tertiary prevention intervention for the transition out of youth homelessness

This paper describes the process of design, development, and implementation of a complex, multi-component, tertiary prevention intervention aimed at stabilizing pathways out of homelessness, the Housing Outreach Project-Collaborative (HOP-C). HOP-C is a multi-organizational, cross-sector, inter-professional collaboration. This process-oriented paper aims to elucidate the rationale for and experience of implementing the three main components of HOP-C: case management, mental health treatment and peer support, as well as the processes that support this wrap-around intervention as a whole. This paper draws on qualitative process-oriented data (i.e. field notes and interviews with staff) collected over the course of the intervention, and integrates perspectives from multiple practitioners involved in this endeavour. Practitioners reported the diversity in the type and intensity of services offered to clients, the building of a close and communicative interprofessional and inter-agency team, as well as the development of broader connectivity between organizations and practitioners as significant strengths of this approach. Challenges and successes in implementation are explored with the intention of providing insight into ways in which other collaborative complex interventions might be approached in the youth homelessness sector.