Animal-assisted interventions in adult hospital rehabilitation settings: A scoping review.

Animal-assisted interventions (AAIs) have the potential to enhance people's well-being and function and are increasingly being implemented across a range of settings. This scoping review explored how AAIs have been used in adult hospital rehabilitative care. Using JBI and PRISMA-ScR guidelines, a systematic search of four databases was undertaken. Inclusion criteria involved adults, aged >18 years, who had received AAIs in the hospital rehabilitation setting. Twenty-two articles met the inclusion criteria. Results identified two intervention types: visitation activities (n = 8 studies) and structured therapeutic interventions (n = 14 studies). Dogs were the most common animal species. Improvements in social and emotional well-being were reported across both types of interventions, with improvements in ambulation, motor skills, and verbal communication reported by those engaged in structured therapeutic interventions. Implementation challenges included a dependency on volunteer dog-handlers; the need for better recording of interventions in medical records to enable evaluation; and cost, safety, infection control, and animal welfare considerations. Strengthening the planning of AAIs is fundamental for the realization of potential outcomes from human-animal interactions in hospital rehabilitative care.

Women's experiences of accessing a medical termination of pregnancy through a Queensland regional sexual health service: a qualitative study.

Background An estimated 25% of Australian women will undergo induced abortion. Few studies have explored Australian women's experiences of accessing medical termination of pregnancy (MToP). This study explored the experiences of women accessing MToP through a regional sexual health service in North Queensland. It aimed to determine the aspects of the process from seeking information about abortion to completion that worked well and to identify areas for improvement. METHODS: Semi-structured telephone interviews with 11 women who accessed MTOP at Cairns Sexual Health Service (CSHS) were conducted. Interviews were recorded and transcribed verbatim. A deductive analysis approach was used to analyse the data. RESULTS: Most women had little prior knowledge of MToP or access options and used the Internet to source information. Accessing MToP through a sexual health service was considered positive, non-judgemental, discrete and low-cost despite challenges of fitting in with appointment times and obtaining off-site ultrasound. GPs did not always provide referral; some women described experiences of stigma, discrimination and judgemental care during consultation and when obtaining ultrasounds. Concern for women living in more rural/remote areas was raised. Potential solutions including increased provision through rural general practitioners (GPs) and telehealth. CONCLUSION: Our study highlights the need for greater awareness of abortion options and access points among the community and healthcare providers. Access through sexual health clinics in regional settings is accepted; however, other options such as increased provision through rural GPs, primary health clinics, telehealth and nurse-led models of care could help overcome some of the barriers faced by rural and remote women.

Australian interdisciplinary healthcare providers' perspectives on the effects of broader pre-exposure prophylaxis (PrEP) access on uptake and service delivery: a qualitative study.

Background The addition of pre-exposure prophylaxis (PrEP) for HIV prevention to the Australian Government-subsidised Pharmaceutical Benefits Scheme (PBS) enables any doctor or nurse practitioner to prescribe it and has increased accessibility options. However, understanding of Australian healthcare providers' (HCP) knowledge and preparedness to prescribe PrEP remains limited. METHODS: Semistructured interviews, conducted before PBS listing (October 2016-April 2017), explored PrEP knowledge and prescription experiences of 51 multidisciplinary HCPs involved with the Queensland Pre-Exposure Prophylaxis Demonstration study. RESULTS: Thematic analysis revealed that participants viewed PrEP as a necessary HIV prevention option, but there was concern about confusing prevention messages and potential risk compensation. Clinical capacity, stigma, cultural norms, rural access and PrEP-associated costs were identified as barriers to access and uptake. Some of these barriers may be addressed by the PBS listing; nonetheless, there was strong specialist concern about the preparedness of general practitioners without sexual health experience to prescribe PrEP. Participants identified a need to educate all HCPs, implement multidisciplinary supply models and provide timely access to PrEP for vulnerable populations and those ineligible for Medicare (Australia's universal healthcare insurance system). CONCLUSIONS: Although PrEP listing on the PBS addressed structural barriers to access, this study highlights the role of nurses and other interdisciplinary healthcare workers in the provision of PrEP in addressing the sociocultural barriers that still affect the access of certain populations to HIV prevention measures. These findings will inform further professional training as PrEP is more widely accessed and requested outside specialist sexual health services. Future work is needed to ensure that the primary healthcare workforce is prepared to provide competent and safe access to PrEP across diverse locations and population groups.

Use of fetal fibronectin testing in women transferred for threatened preterm labour in remote far north Queensland.

BACKGROUND: Threatened preterm labour is a common reason for medical transfer from remote communities; however, many transferred women do not deliver preterm. A tool for prediction of preterm birth such as fetal fibronectin may reduce transfers and related social and economic costs. AIM: To review the use of fetal fibronectin testing in women transferred for threatened preterm labour from Cape York to Cairns Hospital between 2011 and 2015 and determine the role testing could play in reducing transfers and associated costs. MATERIALS/METHODS: Records from the Royal Flying Doctor Service and Cairns Hospital were accessed. Women transferred solely for threatened preterm labour were included in the study. Fetal fibronectin testing, hospital admission, outpatient stays and birth outcome data were collated and analysed. Costs were assigned using the National Hospital Cost Data Collection, round 19. RESULTS: Forty-seven women were included in the study; however, only 20 underwent fetal fibronectin testing. Transfer of 30 women who had either a negative test or were not tested but delivered at term resulted in 41 inpatient nights and 443 excess outpatient nights, costing an estimated AU$57 408. Aeromedical transfers were estimated to cost a further $151 500. CONCLUSION: Adherence to clinical guidelines and greater availability and use of fetal fibronectin testing in Cape York have the potential to reduce aeromedical transfers for threatened preterm labour. Substantial inpatient and excess outpatient stays could be avoided with associated reduction in health system and social costs. Strategies to improve adherence to guidelines and increase access to testing are required.

Ten years on: a review of medical terminations of pregnancy performed in a sexual health clinic.

Background Access to medical termination of pregnancy (MToP) services in regional Queensland remains inadequate and it is still possible for women and providers to be criminally prosecuted for accessing or providing abortion. Cairns Sexual Health Service (CSHS) has been providing medical terminations of pregnancy for 10 years, demonstrating that this service can be safely and successfully integrated into a primary healthcare setting. METHODS: A retrospective audit of MToPs performed between 2011 and 2015 was conducted to follow on from our previously reported audit covering 2006-09. RESULTS: In total, 1859 MToPs have been performed by CHSH since 2006, with 1712 within the 5-year period of 2011-15. Changes in clinical practice over this time have streamlined the service and reduced unsuccessful outcomes from 12.2% between 2006 and 2009 to 0.9% between 2011 and 2015. CONCLUSION: The initial provision of MToP through CSHS was anticipated to be a short-term arrangement; however, 10 years on, this service continues with strong community demand. Provision of MToP services through primary healthcare settings can help improve access for women living outside of major metropolitan areas. If moves to decriminalise abortion in Queensland are successful, there is potential for even greater access.

Diagnosis of latent tuberculosis infection among HIV-infected clients in Far North Queensland: use of an interferon-gamma release assay.

Latent Mycobacterium tuberculosis infection is a significant risk for those infected with HIV. We examined the use of an interferon-gamma release assay for the diagnosis of latent tuberculosis among HIV-infected clients attending two sexual health services in Far North Queensland. Of 240 clients tested, 19 returned a positive result (7.9%, 95% confidence interval (CI): 4.5-11.3%) and three were indeterminate (1.3%, 95% CI: -0.2%-2.7%). Low CD4 count was found to be significantly associated with an indeterminate test result (P=0.004). However, we found no significant association between test results and client demographics, self-reported prior tuberculosis infection, Bacille Calmette-Guérin vaccine status or selected tuberculosis risk factors (P-values=0.2-0.9).

Increasing chlamydia test of re-infection rates using SMS reminders and incentives.

BACKGROUND: Clients diagnosed and treated for Chlamydia trachomatis are a recognised high-risk group for subsequent infection. An estimated 8% of clients treated for chlamydia at Cairns Sexual Health Service return for re-testing within the recommended 3-4-month period. There is no recall or reminder system in place. This study assesses the effectiveness of using short messaging service (SMS) reminders with and without incentive payments to increase re-testing rates. METHODS: Eligible consenting clients were randomly allocated to one of three groups. Group 1 (controls) received the standard advice from the clinician to return for re-testing in 3-4 months. Group 2 received the standard advice and an SMS reminder at 10-12 weeks post-treatment. Group 3 received the standard advice and the SMS reminder, which also offered an incentive payment on clinic attendance. RESULTS: 32 participants were recruited to groups 1 and 2 and 30 participants to group 3. 62 SMS reminders were sent with 13 (21.0%) reported as undelivered. Re-testing rates were 6.3%, 28.1% and 26.7% for groups 1, 2 and 3, respectively. CONCLUSION: SMS reminders with or without an incentive payment increased re-testing rates in our clients who were diagnosed and treated for chlamydia. However, re-testing remained less than ideal, and the high rate of undelivered SMS reminders suggest that this intervention alone will not achieve desired re-testing rates and that a range of strategies will be required to increase re-testing in this population.

Enhanced surveillance for gonorrhoea in two diverse settings in Queensland in the 2000s: comparative epidemiology and selected management outcomes.

Gonorrhoea is an important sexually transmitted notifiable condition. This paper describes findings from two gonorrhoea enhanced surveillance programs operating during the 2000s in Queensland: one in the remote Torres and Northern Peninsula Area (T&NPA); the other in an urban region. The overall response rate in the T&NPA (2006-2011) was 82% (723 of 879), and in Brisbane Southside and West Moreton (BSWM) (2003-2011), it was 62% (1,494 of 2,401 notifications). In the T&NPA, cases were young (80% <25 years), Indigenous (97%) and 44% were male. In the BSWM, cases were predominantly male (76%), non-Indigenous (92%) and 42% were aged less than 25 years. Co-infection with chlamydia was found in 54% of males and 60% of females in the Torres, and in 18% of males and 35% of females in the BSWM. In the BSWM 35% of the men without a syphilis test recorded had reported sexual contact with men; similarly 34% of the men without an HIV test recorded had reported sexual contact with men. Compliance with recommended treatment (ceftriaxone) was greater than 90% in all years except 2008 (84%) in the T&NPA. Treatment compliance increased significantly, from 40% in 2003 to 84.4% in 2011 (P<0.0001) in the BSWM cohort. The proportion of contacts with a documented treatment date increased significantly in the T&NPA from 56% in 2009 to 76% in 2011 (P=0.019), after a system for follow-up with the clinician became routine. Gonorrhoea epidemiology and management challenges vary across Queensland populations. Enhanced surveillance allows public health authorities to monitor epidemiology and reminds clinicians to prioritise effective sexually transmitted infection treatment for their clients.

Emergency contraception over-the-counter: practices and attitudes of pharmacists and pharmacy assistants in far North Queensland.

BACKGROUND: Emergency contraception (EC) has been available as a Schedule 3 (over-the-counter, OTC) medication through Australian pharmacies since 2004. This study aimed to describe OTC EC dispensing services in pharmacies in the Cairns and Hinterland Health Service District and to explore the knowledge and attitudes of pharmacy staff. The study findings will assist in developing resources to support pharmacy staff in their OTC EC provision role. STUDY DESIGN: We conducted semi-structured interviews with pharmacy managers and pharmacists to determine the availability, cost, dispensing processes and distribution estimates of EC and anonymous surveys of pharmacy staff to examine their knowledge and attitudes. RESULTS: Forty-six (88%) of the 52 local pharmacies participated; 43 (93%) provide OTC EC at an average cost of $28.95. One hundred and forty-five staff surveys were completed. Few pharmacists identified Family Planning Queensland (FPQ) or the Cairns Sexual Health Service (CSHS) as referral options for women not meeting the dispensing criteria. A range of written information is provided to EC customers by 23 (53%) of pharmacies. CONCLUSIONS: This study has documented OTC EC dispensing services in the District and identified areas for improvement. A working group has been established to oversee the development and distribution of customer information packs and information for pharmacists on referral options.

Tuberculosis trends in the Pacific: 2000-2006.

The objective in this manuscript is to describe the epidemiology of tuberculosis in 19 Pacific Island countries and territories by analysing routine surveillance data from 2000 to 2006. In addition, progress against World Health Organization targets is described. The setting is National Tuberculosis Programmes in 19 Pacific Island countries and territories served by the Secretariat of the Pacific Community. The study is a descriptive study of routinely collected surveillance data from 19 Pacific Island countries and territories. In 2006 there were 1585 cases of TB notified in the Pacific region. The case notification rate in the Pacific was 54/100,000 population. Almost half (49%) of all TB notifications were in the subregion of Micronesia, with 42% in Melanesia and 9% in Polynesia. Micronesia had the highest rate of TB in the region with a case notification rate of 145/100,000 population. The TB case notification rate in the Pacific increased by 10% between 2000 and 2006, from 49/100,000 to 54/100,000 population. The highest increase in rates has been in Micronesia, where the TB case notification rate rose by 39% between 2000 and 2006. In the Pacific in 2006, 71% of all TB notifications were pulmonary, and just over one third (36%) of all TB notifications were sputum smear positive. One quarter (25%) of sputum smear positive cases were in people aged 15-24 years and slightly more than half of all sputum smear positive cases were in males (52%). In Micronesia this pattern was different; 61% of all sputum smear positive cases were in males. In 2005, the treatment success rate of new sputum smear positive cases in the Pacific was 85%, equivalent to the WHO target. The treatment success rate of sputum smear positive cases rose from 78% in 2000 to 85% in 2005, an increase of 7%. In 2005, 4% of all people with TB died, and of those with sputum smear positive TB, 8% died. In 2005 in Polynesia, 13% of all people with sputum smear positive TB died. Since the year 2000, the rates of TB have increased in the Pacific region, with a relatively large increase in the subregion of Micronesia. Treatment success rates in the same time period have improved and are now at the WHO target of 85%. The conclusion is that to continue to make progress toward TB control in the region, intensified efforts may be needed in the sub-region of Micronesia while support is also maintained at current or increased levels in Melanesia and Polynesia.

Three years on: a review of medical terminations of pregnancy performed in a sexual health service.

Access to abortion services is often limited in parts of regional Australia, including north Queensland. Since March 2006, the Cairns Sexual Health Service (CSHS) has provided medical termination of pregnancy (MToP) services for women up to 9 weeks gestation, using a regimen of methotrexate and misoprostol. We conducted a retrospective chart audit of all women undergoing an MToP at the CSHS between 1 March 2006 and 31 March 2009. In total, 147 medical terminations in 136 women were performed during this 3-year period. At the time of first presentation, the mean age was 27 years, 77 (57%) of the 136 women were of less than 7 weeks gestation and 86 (63%) had not had a previous termination. A successful medical termination of pregnancy was achieved in 69 of 85 (81%, 95% confidence interval (CI): 72, 88) women at less than 7 weeks gestation and in 43 of 62 (69%, 95% CI: 57, 80) women with gestation between 7 and 9 weeks. Provision of medical termination of pregnancy through sexual health services is one strategy to address access inequity in regional areas. Demand for this service in Cairns continues to rise; however, since late August 2009 MToP in Queensland is no longer available pending legal reform.

Effect of inflammatory mediators on the physiology of the human Fallopian tube.

The physiological basis for the use of non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of acute pelvic pain in women was examined in terms of: (i) the electrophysiological responses of epithelial cells in the human Fallopian tube; and (ii) the longitudinal and circular contractions of the myosalpinx. Epithelial cells were grown as a polarized layer in primary culture, and transepithelial potential difference (p.d.) and short-circuit current (I(scc)) were recorded using a modified Ussing chamber. The inflammatory mediators histamine (0.1-100.0 micromol l(-1)) and platelet activating factor (PAF) (1.9-1900.0 nmol l(-1)) increased p.d. and I(scc) in a dose-dependent manner. Pre-incubation with the NSAID diclofenac sodium (100 micromol l(-1)) inhibited the histamine- and PAF-induced stimulation of p.d. and I(scc). Aspirin (100 micromol l(-1)), ibuprofen (100 micromol l(-1)), indomethacin (100 micromol l(-1)) or naproxen (100 micromol l(-1)) were only partially effective. Histamine (0.1-1000.0 micromol l(-1)) increased the frequency of contractions of longitudinal and circular smooth muscle in segments of Fallopian tube in vitro, in a dose-dependent manner. Pre-incubation with diclofenac significantly reduced the histamine-induced stimulation of tubal smooth muscle contraction at the higher doses of histamine. The other NSAIDs had no effect. These data provide evidence that diclofenac downregulates acute inflammation in the human Fallopian tube and may be of use as an anti-inflammatory agent in the treatment of pelvic inflammatory disease.