Stakeholder insights into implementing a systems-based suicide prevention program in regional and rural tasmanian communities.

PURPOSE: With emerging evidence indicating that systems-based approaches help optimise suicide prevention efforts, the National Suicide Prevention Trial sought to gather evidence on the appropriateness of these approaches to prevent suicide among at-risk populations, in regional and rural communities throughout Australia. The Tasmanian component of the Trial implemented the LifeSpan systems framework across three distinct rural areas with priority populations of men aged 40-64 and people 65 and over. The University of Tasmania's Centre for Rural Health undertook a local-level evaluation of the Trial. AIMS: To explore key stakeholder perceptions of implementing a systems-based suicide prevention program in regional and rural communities in Tasmania, Australia. METHOD: This study utilised qualitative methods to explore in depth, stakeholder perspectives. Focus groups and interviews were conducted with 46 participants, comprising Trial Site Working Group members (n = 25), Tasmania's Primary Health Network employees (n = 7), and other key stakeholders (n = 14). Approximately half of participants had a lived experience of suicide. Data were thematically analysed using NVivo. RESULTS: Key themes centred on factors impacting implementation of the Trial. These included how the Trial was established in Tasmania; Working Group governance structures and processes; communication and engagement processes; reaching priority population groups; the LifeSpan model and activity development; and the effectiveness, reach and sustainability of activities. DISCUSSION: Communities were acutely aware of the need to address suicide in their communities, with the Trial providing resources and coordination needed for community engagement and action. Strict adherence to the Lifespan model was challenging at the community level, with planning and time needed to focus on strategies influencing whole or multiple systems, for example health system changes, means restriction. Perceived limitations around implementation concerned varied community buy-in and stakeholder engagement and involvement, with lack of role clarity cited as a barrier to implementation within Working Groups. Barriers delivering activities to priority population groups centred around socio-cultural and technological factors, literacy, and levels of public awareness. Working Groups preferred activities which build on available capital and resources and which meet the perceived needs within the whole community. Approaches sought to increase awareness of suicide and its prevention, relationships and partnerships, and the lived experience capacity in Working Groups and communities. CONCLUSION: Stakeholder insights of implementing the National Suicide Prevention Trial in regional and rural Tasmanian from this study can help guide future community-based suicide prevention efforts, in similar geographic areas and with high-risk groups.

Prebiotic and probiotic supplementation and the tryptophan-kynurenine pathway: A systematic review and meta analysis.

This systematic review aimed to synthesise the results from studies investigating the effects of prebiotics and probiotics on kynurenine pathway metabolism. Thirteen studies were identified for inclusion, comprising 12 probiotic and two prebiotic arms. Participants included healthy individuals and individuals with various clinical conditions. Twelve metabolites were examined across the studies, using a range of biological samples. Across all interventions, 11 reported an effect on ≤ metabolite. Although limited by clinical and methodological heterogeneity, pooled analysis (n = 253) found probiotics to significantly affect serum kynurenine (g = 0.315, CI = 0.070 to 0.560, p = 0.012, 4 studies, I2 = 0%) and the kynurenine:tryptophan ratio (g = 0.442, CI = 0.074 to 0.810, p = 0.018, 4 studies, I2 = 42 %). Risk of bias across the studies was generally low. The results provide preliminary evidence that probiotics can modulate kynurenine pathway metabolism, with less evidence available regarding prebiotics. Future studies which further consider methodological confounds and sample characteristics are required, to establish intervention efficacy. PROSPERO registration #CRD42019154677.

Local evaluation of the Tasmanian component of the National Suicide Prevention Trial-Preliminary learnings.

OBJECTIVE: Tasmania is one of the 12 Australian sites chosen to participate in the National Suicide Prevention Trial. The Centre for Rural Health, University of Tasmania, was contracted to conduct a local-level, process evaluation of this initiative using a Participatory Action Research approach, with the objective of this article to summarise progress and key learnings from the local evaluation to date. DESIGN: Empowerment and Utilisation-Focus Evaluation theoretical approaches informed the conduct of process evaluation activities, within an overarching participatory action research approach. SETTING: Three participating regions in Tasmania were included as follows: Launceston, the North-West and Break O'Day. PARTICIPANTS: Working group members, service providers and other relevant stakeholders. INTERVENTIONS: Mixed-methods surveys, field observations and content analysis were conducted. RESULTS: Survey results indicated that most working group members understood the concept of a "systems-based" approach to suicide prevention. Most participants believed that working group structures/functions engaged community members with lived experience, while around half believed that these structures/functions facilitated relationships with local services and that working group action plans adequately addressed issues of capacity building and sustainability. Preliminary field data suggested that awareness raising, engagement and face-to-face capacity-building activities focused on the wider community were preferred to activities targeting specific populations. CONCLUSION: These preliminary findings suggest ambivalence among key stakeholders concerning the application of a systems-based approach to suicide prevention in regional areas of Tasmania. Consistent with a participatory action research approach, the findings will inform the evolution of trial site activity for the remainder of the trial and, in due course, the implementation of future such initiatives.

Body dissatisfaction, internalized weight bias and quality of life in young men and women.

PURPOSE: We examined the relative importance of body dissatisfaction (BD) and internalized weight bias (IWB) in accounting for variance in quality of life (QoL) impairment in an ethnically diverse sample of college students (n = 630) and potential moderation of these associations by sex. METHODS: Participants completed an online survey that included established measures of BD, IWB and QoL. Regression models were used to examine the relative contributions of BD and IWB in accounting for variance in physical and mental QoL impairment. RESULTS: BD and IWB were highly correlated with bivariate analysis in both women (r = .76) and men (r = .60). In multivariable analysis, IWB was found to be associated with both physical (b = - 1.33, 95% CI - 1.93, - 0.72) and mental (b = - 2.58, 95% CI - 3.45, - 1.72) QoL impairment, whilst BD was not associated with impairment in either physical (b = - 0.29, 95% CI - 0.68, 0.09) or mental (b = - 0.48, 95% CI - 1.03, 0.07) QoL. While levels of both BD and IWB were higher for women than for men, sex did not moderate the association between either BD or IWB and either physical or mental QoL. CONCLUSIONS: The findings support the view that IWB warrants greater attention in interventions seeking to reduce the adverse impact of BD in both women and men and both normal-weight and overweight individuals.

Gambling Behaviour, Problem Gambling and Reasons for Gambling Among International Students in Tasmania, Australia.

Individuals who undertake tertiary study outside their home countries ("international students") may be at increased risk of problem gambling behaviour. To inform this issue, we examined gambling behaviour, problem gambling behaviour and reasons for gambling among international students, primarily from Asian countries, attending university in Tasmania, Australia. Online surveys that included established measures of each outcome were completed by these students (n = 382) along with a comparison group of domestic students (n = 1013). While most forms of gambling assessed were less common among international students than among domestic students, rates of problem gambling were higher among international students (2.6%) than among domestic (1.4%) students. Further, whereas rates of problem gambling did not differ by sex among domestic students, problem gambling among international students was confined to males. Hence, rates of problem gambling were markedly elevated in this subgroup (5% of all male international students, 15% of male international students who reported any form of gambling in the past 12 months). International students were more likely than domestic students to report engaging in gambling as a means of regulating their internal states and for a challenge and these and other reasons for gambling were positively correlated with problem gambling behaviour. The findings support the need for population- and campus-based health promotion and early intervention programs targeting international students, male students in particular. Information concerning individuals' reasons for gambling might usefully be included in these programs.

Health and Well-Being of International University Students, and Comparison with Domestic Students, in Tasmania, Australia.

International students comprise an increasingly larger proportion of higher education students globally. Empirical evidence about the health and well-being of these students is, however, limited. We sought to examine the health and well-being of international students, primarily from Asian countries, attending the University of Tasmania, Australia, using domestic students as a comparison group. Ethics approval was given to invite (via email) all currently enrolled students to participate in the study by completing a pilot-tested, online survey. The survey was completed by 382 international students (response rate = 8.9%) and 1013 domestic students (9.2%). Independent samples t-tests, analysis of variance (ANOVA) and chi-square tests were used for bivariate comparisons between international and domestic students, and between subgroups of international students. Regression models were used to examine the associations between student status (international vs. domestic) and health outcomes, controlling for demographic and enrolment variables. International students, particularly male students, were found to be at increased risk of several adverse health outcomes while also being less likely to seek help for mental health and related problems. The findings indicate the need for accessible, targeted, culturally-sensitive health promotion and early intervention programs.