Women's empowerment and child growth faltering in Ethiopia: evidence from the Demographic and Health Survey.

BACKGROUND: Despite numerous national and international efforts to alleviate child growth faltering, it remains a global health challenge. There is a growing body of literature that recognizes the importance of women's empowerment in a wide range of public health topics, such as the utilization of maternal healthcare services, agricultural productivity, and child nutrition. However, in Ethiopia, the relationship between women's empowerment and child nutritional status is not studied at the national level. This study aimed to determine the association between women's empowerment and growth faltering in under-5 children in Ethiopia. METHODS: The data source for this analysis is the 2016 Ethiopian Demographic and Health Survey (EDHS): a nationally representative household survey on healthcare. The EDHS employed a two-stage stratified cluster sampling technique. We computed standard women's empowerment indices, following the Survey-based Women's emPowERment index approach. A multilevel logistic regression model that accounted for cluster-level random effects was used to estimate the association between women's empowerment and child growth faltering (stunting, wasting and underweight). RESULTS: Attitude to violence, social independence, and decision-making were the three domains of women's empowerment that were associated with child growth faltering. One standard deviation increase in each domain of empowerment was associated with a reduction in the odds of stunting: attitude towards violence (AOR = 0.92; 95% CI 0.88-0.96; p < 0.001), social independence (AOR = 0.95; 95% CI 0.89-0.99; p = 0.049), and decision-making (AOR = 0.93; 95% CI 0.87-0.99; p = 0.023). Similarly, each standard deviation increase in attitude towards violence (AOR = 0.93; 95% CI 0.89-0.98; p = 0.008), social independence (AOR = 0.91; 95% CI 0.86-0.97; p = 0.002), and decision-making (AOR = 0.92; 95% CI 0.86-0.99; p = 0.020) were associated with a decrease in the odds of having underweight child. CONCLUSIONS: Ensuring women's empowerment both in the household and in the community could have the potential to decrease stunting and underweight in a rapidly developing country like Ethiopia. Policymakers and health professionals need to consider women's empowerment in this unique context to improve nutritional outcomes for children and alleviate growth faltering.

Modifiable risk factors of congenital malformations in bale zone hospitals, Southeast Ethiopia: an unmatched case-control study.

BACKGROUND: Congenital malformations are structural, functional, and metabolic defects that develop during the organogenesis period and present at birth or later in life. There has been little research on congenital malformations in Ethiopia, knowledge on the incidence of birth defects at birth is unknown and the etiologies of the anomalies are limited. This study, therefore, aimed to assess the modifiable risks of congenital anomalies among women in Bale zone hospitals, Ethiopia. METHODS: An unmatched case-control study was conducted from February 2018 to January 2019 in the Bale zone; namely Goba referral hospital, Robe, Ginnir and Dolomena hospitals. A total of 409 women were selected. Mothers who gave birth with any type of congenital malformation were assigned as cases and those who gave live births without any congenital abnormalities were assigned as controls. Controls were selected by the lottery method from the labor ward. For each case, two consecutive controls were included. Data were entered into Epi-data 3.1 and exported into Statistical Package for the Social Sciences (SPSS) version 21 for analysis. Logistic regression was conducted to analyze the data. RESULTS: Alarmingly, women who had been exposed to pesticides during the current pregnancy were two times more prone to give congenital malformed infants than their counterparts (AOR = 3.19; 95% CI = 1.31, 10.96). Additionally, those women who chewed khat during the periconceptional period were two times more likely to have congenital malformed infants as compared to women who did not engage in this activity (AOR = 2.40; 95% CI = 1.11, 5.19). CONCLUSIONS: Urgent attention needs to be given by public health professionals and services to khat chewing and maternal exposure to pesticides during pregnancy to reduce the risk of congenital malformations.

New digital media interventions for sexual health promotion among young people: a systematic review.

New digital media platforms (e.g. social networking sites, web pages and text messaging) have dramatically changed interpersonal communication and present novel opportunities for health interventions. Due to the high uptake and use of digital media among young people, advances in digital media provide potential new opportunities in delivering health interventions to this audience to reduce sexually transmissible infection (STI) risk. The aim of this study was to assess the effectiveness of sexual health interventions delivered via new digital media to young people (aged 13-24 years). A systematic search was conducted of seven databases for peer-reviewed literature published between January 2010 and April 2017 that evaluated a sexual health intervention delivered to young people (aged 13-24 years). Of 2017 papers reviewed, 25 met the inclusion criteria and were assessed. Sixteen studies used web-based platforms to deliver their intervention. A large proportion of studies (11/25) specifically focused on HIV prevention. Seven studies found a statistically significant effect of the intervention on knowledge levels regarding the prevention HIV and other STI, as well as general sexual health knowledge, but only one-fifth of interventions evaluating intentions to use condoms reported significant effects due to the intervention. Nine studies focused on individuals from an African American background. Although new media has the capacity to expand efficiencies and coverage, the technology itself does not guarantee success. It is essential that interventions using new digital media have high-quality, evidence-based content that engages with individual participants.

Bonding and bridging social capital in the recovery of severe mental illness: a synthesis of qualitative research.

BACKGROUND: Social networks are known to have a major influence on the recovery journey of people with severe mental illness (SMI). AIMS: To understand the role of bonding and bridging social capital in the recovery process following SMI and to identify the barriers that prevent social networks from being mobilized. METHOD: A review of major electronic databases for qualitative studies from 2006 to 2015 (41 papers) was undertaken for thematic synthesis. RESULT: The main themes for bonding social capital included: a buffer for isolation and loneliness, variations depending on illness stages, balance in relationships and connections as a source of self-management. Main themes for bridging social capital comprised: feeling powerless and excluded from community/health care, social care beyond the illness, social care barriers and social inclusion through community groups. CONCLUSION: All those involved in the management of SMI must be aware of how social support networks hinder or contribute to recovery. People with SMI need opportunities to form reciprocal relationships and sustain supportive networks that can assist them to endure the challenges presented by SMI.

Measuring the burden of treatment for chronic disease: implications of a scoping review of the literature.

BACKGROUND: Although there has been growing research on the burden of treatment, the current state of evidence on measuring this concept is unknown. This scoping review aimed to provide an overview of the current state of knowledge as well as clear recommendations for future research, within the context of chronic disease. METHODS: Four health-based databases, Scopus, CINAHL, Medline, and PsychInfo, were comprehensively searched for peer-reviewed articles published between the periods of 2000-2016. Titles and abstracts were independently read by two authors. All discrepancies between the authors were resolved by a third author. Data was extracted using a standardized proforma and a comparison analysis was used in order to explore the key treatment burden measures and categorize them into three groups. RESULTS: Database searching identified 1458 potential papers. After removal of duplications, and irrelevant articles by title, 1102 abstracts remained. An additional 22 papers were added via snowball searching. In the end, 101 full papers were included in the review. A large number of the studies involved quantitative measures and conceptualizations of treatment burden (n = 64; 63.4%), and were conducted in North America (n = 49; 48.5%). There was significant variation in how the treatment burden experienced by those with chronic disease was operationalized and measured. CONCLUSION: Despite significant work, there is still much ground to cover to comprehensively measure treatment burden for chronic disease. Greater qualitative focus, more research with cultural and minority populations, a larger emphasis on longitudinal studies and the consideration of the potential effects of "identity" on treatment burden, should be considered.

Burden of treatment for chronic illness: a concept analysis and review of the literature.

CONTEXT: Treatment burden, the burden associated with the treatment and management of chronic illness, has not yet been well articulated. OBJECTIVE: Using Rodgers' (1989, Journal of Advanced Nursing, 14, 330-335) method of concept analysis, this review describes the ways in which treatment burden has been conceptualized to define the concept and to develop a framework for understanding its attributes, antecedents and consequences. METHODS: Leading databases were searched electronically between the years 2002 and 2011. To ensure the review focused on actual observations of the concept of interest, articles that did not measure treatment burden (either qualitatively or quantitatively) were excluded. An inductive approach was used to identify themes related to the concept of treatment burden. MAIN RESULTS: Thirty articles, identified from 1557 abstracts, were included in the review. The attributes of treatment burden include burden as a dynamic process, as a multidimensional concept, and comprising of both subjective and objective elements. Prominent predisposing factors (antecedents) include the person's age and gender, their family circumstances, possible comorbidity, high use of medications, characteristics of treatment and their relationship with their health-care provider. The most dominant consequences are poor health and well-being, non-adherence to treatment, ineffective resource use and burden on significant others. Furthermore, many of these consequences can also become antecedents, reflecting the cyclic and dynamic nature of treatment burden. CONCLUSION: The findings underscore the need for researchers and health-care professionals to engage in collaborative discussions and make cooperative efforts to help alleviate treatment burden and tailor treatment regimens to the realities of people's daily lives.

The ideal healthcare: priorities of people with chronic conditions and their carers.

BACKGROUND: It is well established that health consumer opinions should be considered in the design, delivery, and evaluation of health services. However, the opinions of people with chronic conditions and their carers and what they actually consider as ideal healthcare is limited. The aim of this study is to investigate the healthcare priorities of consumers with chronic conditions and their carers, if there are differences between these two groups, and if priorities differ depending on geographical location. METHODS: The nominal group technique was used as a method to identify what is currently important to, or valued by, participants. This method was also particularly suited to learning about healthcare problems and generating important solutions, thereby helping to bridge the gap between research and policy. Recruitment was carried out via purposive sampling, with the assistance of community pharmacies, general practices, various health agencies, government and non-government organisations. A total of 11 nominal groups were conducted; five groups consisted predominantly of consumers (n = 33 participants), two groups consisted predominantly of carers (n = 12 participants) and four were mixed groups, i.e. consumers, carers, and both (n = 26 participants). RESULTS: The findings suggested that to create a model of ideal healthcare for people with chronic conditions and their carers, appropriate and timely healthcare access was of paramount importance. Continuity and coordinated care, patient-centred care and affordability were equally the second most important healthcare priorities for all groups. When compared with other groups, access was discussed more frequently among participants residing in the rural area of Mount Isa. Compared to consumers, carers also discussed priorities that were more reminiscent with their caring roles, such as increased access and continuity and coordinated care. CONCLUSIONS: Access to healthcare is the most important priority for people with chronic conditions and their carers. In the event of inappropriate access for certain groups, all other efforts to increase the quality of healthcare delivery, e.g. patient-centred care, may be pointless. However, health professionals alone may be limited in their ability to address the concerns related to healthcare access; structural changes by health policy makers may be needed.

Self-management of chronic conditions in a rural and remote context.

Living in a rural or remote environment presents unique challenges for people with chronic conditions, mainly those created by limited health-care services and the physical and emotional isolation. Yet, research on how people self-manage their chronic conditions in such locations is limited. This study aims to contribute to research and clinical practice by describing the ways in which a diverse group of rural and remote people with a range of chronic conditions, and their unpaid carers, self-manage their conditions. Using semi-structured in-depth interviews, data was collected from a sample of 32 participants, residing in one of two regions of Australia: Mount Isa/North West region of Queensland and the Northern Rivers area of New South Wales. Our findings suggest that although self-managing in a rural and remote context requires many of the lifestyle changes necessary in urban areas, the uniqueness of the rural lifestyle and the limited availability of health care results in, at times, creative forms of self-management. Health-care professionals and policy makers need to be cognisant of the ways in which rural and remote residents modify self-management strategies to suit their needs, and help them develop self-management plans tailored to the realities of their rural environment.

Is the pharmacy profession innovative enough?: meeting the needs of Australian residents with chronic conditions and their carers using the nominal group technique.

BACKGROUND: Community pharmacies are ideally located as a source of support for people with chronic conditions. Yet, we have limited insight into what innovative pharmacy services would support this consumer group to manage their condition/s. The aim of this study was to identify what innovations people with chronic conditions and their carers want from their ideal community pharmacy, and compare with what pharmacists and pharmacy support staff think consumers want. METHODS: We elicited ideas using the nominal group technique. Participants included people with chronic conditions, unpaid carers, pharmacists and pharmacy support staff, in four regions of Australia. Themes were identified via thematic analysis using the constant comparison method. RESULTS: Fifteen consumer/carer, four pharmacist and two pharmacy support staff groups were conducted. Two overarching themes were identified: extended scope of practice for the pharmacist and new or improved pharmacy services. The most innovative role for Australian pharmacists was medication continuance, within a limited time-frame. Consumers and carers wanted improved access to pharmacists, but this did not necessarily align with a faster or automated dispensing service. Other ideas included streamlined access to prescriptions via medication reminders, electronic prescriptions and a chronic illness card. CONCLUSIONS: This study provides further support for extending the pharmacist's role in medication continuance, particularly as it represents the consumer's voice. How this is done, or the methods used, needs to optimise patient safety. A range of innovative strategies were proposed and Australian community pharmacies should advocate for and implement innovative approaches to improve access and ensure continuity of care.

Chronic conditions, financial burden and pharmaceutical pricing: insights from Australian consumers.

OBJECTIVE: To explore the perceptions of Australian consumers and carers about the financial burden associated with medicines used for the treatment of chronic conditions. METHOD: Semi-structured interviews were undertaken with individuals (n=97) who identified as having a chronic condition(s) (n=70), cared for someone with a chronic condition(s) (n=8), or both (n=19). Participants included individuals identifying with an Aboriginal or Torres Strait Islander (n=23) or Culturally and Linguistically Diverse (n=19) background. Data were analysed using the constant comparison method and reported thematically. RESULTS: Participants described substantial costs associated with medicines use, along with aggravating factors, including the duration and number of medicines used, loss of employment, lack of pricing consistency between pharmacies and the cost of dose administration aids. Consequences included impacts on medicine adherence, displacement of luxury items and potentially a reduced financial incentive to work. Understanding and beliefs related to pharmaceutical pricing policy varied and a range of proactive strategies to manage financial burden were described by some participants. CONCLUSIONS: The financial burden associated with medicines used for the management of chronic conditions by Australian consumers is substantial. It is compounded by the ongoing need for multiple medicines and indirect effects associated with chronic conditions, such as the impact on employment. WHAT IS KNOWN ABOUT THE TOPIC?: Medicines are a common form of treatment in chronic conditions. The financial burden related to medicines use, including co-payments, is associated with reduced adherence and other cost-coping strategies. Out of pocket costs for prescription medicines are relatively high in Australia compared with some other countries, including New Zealand and the United Kingdom. Australian consumers with chronic illness are likely to be at particular risk of financial burden associated with medicines use. WHAT DOES THIS PAPER ADD?: This paper explores the perceptions of consumers and carers around the financial burden associated with the use of medicines for the treatment of chronic conditions in Australia. It draws on the experiences and perceptions of a diverse group of consumers in Australia who identify as having, or caring for someone with, a chronic condition(s). WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS?: Health professionals who assist consumers to manage their medicines need to be aware of the potential for financial burden associated with medicines use and its potential impact on adherence. There is a need for health professionals to educate and assist consumers with chronic conditions to ensure they can navigate the health system to maximum benefit and receive financial entitlements for which they are eligible.

Medicinal Cannabis and Implications for Workplace Health and Safety: Scoping Review of Systematic Reviews.

PURPOSE: Although medicinal cannabis is prescribed for conditions such as pain, epilepsy, nausea and vomiting during cancer treatment, evidence about associated adverse side effects is still evolving. Because adverse events (AEs) might impact the performance of workers, it is important to consider their implications on workplace health and safety (WHS). This study aimed to map the types and prevalence of the AEs associated with medical cannabis and articulate how those events could impact WHS. METHODS: A scoping review of systematic reviews and/or meta-analyses published between 2015 and March 2021 was performed to identify the AEs of medicinal cannabis in adults. Publications in English and full text available online were collected from Embase, MEDLINE, PsychINFO, PubMed, Scopus, and Web of Science. RESULTS: Of 1,326 papers identified from the initial search, 31 met the inclusion criteria and were analyzed. The studies reported various AEs with the most predominant being sedation, nausea/vomiting, dizziness, and euphoria. Acute and chronic pain was the most prevalent disorder under review. CONCLUSIONS: Adverse events associated with the use of medicinal cannabis could increase workplace risks, including decreased alertness and reaction times, increased absenteeism, reduced ability to safely drive or operate machinery and an increased probability of falling. Focused research into the risk to workers and workplaces from the use of medical cannabis and related human performance impairment is urgently warranted.

Alignment of Doctors' Understanding of Treatment Burden Priorities and Chronic Heart Failure Patients' Experiences: A Nominal Group Technique Consultation.

Purpose: To identify and rank areas of treatment burden in chronic heart failure (CHF), including solutions, that should be discussed during the clinical encounter from a patient, and doctors' perspective. Patients and Methods: Patients with CHF and clinicians managing heart failure were invited. Nominal group technique sessions held either face to face or online in 2021-2022, with individual identification of priorities and voting on ranking. Results: Four patient groups (N=22) and one doctor group (N=5) were held. For patients with heart failure, in descending order of priority Doctor-patient communication, Inefficiencies of the healthcare system, Healthcare access issues, Cost implications of treatment, Psychosocial impacts on patients and their families, and Impact of treatment work were the most important treatment burdens. Priorities independently identified by the doctors aligned with the patients' but ranking differed. Patient solutions ranged from involvement of nurses or pharmacists to enhance understanding of discharge planning, through to linkage between health information systems, and maintaining strong family or social support networks. Doctors' solutions covered timing medicines with activities of daily living, patient education on the importance of compliance, medication reviews to overcome clinical inertia, and routine clinical audits. Conclusion: The top treatment burden priorities for CHF patients were related to interaction with clinicians and health system inefficiencies, whereas doctors were generally aware of patients' treatment burden but tended to focus on the complexity of the direct treatment work. Addressing the priority issues identified here can commence with clinicians becoming aware of the issues that matter to patients and proactively discussing feasible immediate and longer-term solutions during clinical encounters.

Occupational Factors Affecting Women Workers' Sexual and Reproductive Health Outcomes in Oil, Gas, and Mining Industry: A Scoping Review.

Objectives: Globally, female workers workforce in Oil, Gas, and Mining (OGM) industry have increased significantly. The complexities of the OGM operations and the extensive exposure to workplace hazards potentially affect the health status of workers, including sexual and reproductive health (SRH) outcomes of female workers. Yet, the current state of knowledge on SRH issues in OGM contexts seems to be limited and fragmented. This scoping review aims to identify the occupational factors that influence women's SRH outcomes in OGM industry. Methods: This scoping review followed the Joanna Briggs Institute's guidelines (PRISMA) and was conducted in five databases, including the citation chaining via Google Scholar and manual search through relevant organisations and Government websites. Sixteen articles met the inclusion criteria and were analysed. Results: Despite the scarcity of evidence, chemical and physical are found to be the predominant factors greatly influencing women workers' SRH outcomes in OGM. Most studies showed menstrual and cycle disorders, and risky pregnancy as key SRH issues. However, menstruation disorder was considerably linked with psychological and organisational factors. Conclusion: This review suggests further empirical research on the relationship between OGM occupational hazards and women workers' SRH. This will contribute to improvements in workplace safety legislations, measures, policies, and management systems taking into account women's needs.

Treatment Burden Discussion in Clinical Encounters: Priorities of COPD Patients, Carers and Physicians.

Purpose: Many people with chronic obstructive pulmonary disease (COPD) feel overburdened with the treatment and management of their illness. Although research has begun to shed light on how COPD patients experience treatment burden, most of what we know is limited to personal experiences of patients. The aim of this study is to identify and prioritise areas of treatment burden that should be discussed during the clinical encounter from the perspectives of COPD patients, carers, and respiratory physicians. Patients and Methods: Data were collected from participants using the nominal group technique. Five nominal group sessions were conducted in total (n = 31); three sessions with patients (n = 18), one with carers (n = 7) and another with respiratory physicians (pulmonologists or chest physicians) (n = 6). Each session was recorded and analyzed using thematic analysis. Results: Going beyond understanding patients' and carers' experiences of treatment burden, this study offers a practical viewpoint of what should be discussed in a clinical encounter. Each group of participants contextualized treatment burden issues for discussion from their own perspectives. There was strong agreement, however, across the groups that difficulties accessing healthcare, lack of education and information, and worry about COPD treatment and prognosis were the most important treatment burden priorities for discussion. Conclusion: Understanding and creating opportunities to discuss these issues in a clinical encounter is important in not only reducing treatment burden but also improving health outcomes and quality of life for COPD patients and their carers.

Patient and physician perspectives on treatment burden in end-stage kidney disease: a nominal group technique study.

OBJECTIVES: The treatment workload associated with end-stage kidney disease (ESKD) is high. The treatment burdens experienced by patients with ESKD are not well understood. In this study, we aimed to elucidate the most important areas of treatment burden for discussion in a clinical encounter from the perspectives of patients with ESKD and nephrologists. We sought to explore possible solutions to these high priority treatment burden challenges. DESIGN: Nominal group technique (NGT) sessions. SETTING AND PARTICIPANTS: Three in-person NGT sessions were conducted with 19 patients with dialysis-dependent ESKD from one tertiary treatment centre (mean age 64 years; range 47-82). All patients were either retired or on a disability pension; 74% perceived moderate or severe treatment burden; and 90% spent more than 11 hours on treatment-related activities per week (range 11-30). One online NGT session was conducted with six nephrologists from two Australian states. MAIN OUTCOME MEASURES: The primary outcome was a ranked list of treatment burden priorities. The secondary outcome was potential solutions to these treatment burden challenges. RESULTS: Every patient group ranked health system issues as the most important treatment burden priority. This encompassed lack of continuity and coordination of care, dissatisfaction with frequent healthcare encounters and challenges around healthcare access. Psychosocial burdens on patients and families were perceived to be the most important area of treatment burden by physicians, and were ranked the second highest priority by patients. CONCLUSIONS: Discussing treatment burden in a clinical encounter may lead to a better understanding of patients' capacity to cope with their treatment workload. This could facilitate tailored care, improve health outcomes, treatment sustainability and patients' overall quality of life.

Burden of Treatment among Elderly Patients with Cancer: A Scoping Review.

BACKGROUND: The objective of this scoping review is to understand how treatment burden is experienced in elderly patients with cancer and what the most prevalent dimensions of treatment burden are among this population. According to one conceptual model, there are six dimensions of treatment burden, including financial, medication, administrative, time/travel, lifestyle, and healthcare. METHODS: A scoping review methodology framework was used to collected data from EMBASE CINAHL (Cumulative Index to Nursing and Allied Health Literature), Medline/PubMed, Scopus, Web of Science, Embase, and Cochrane from 2000 to March 2020. Studies which focused on treatment burden among elderly patients with cancer (+65 years) were selected. Data were extracted using a standardized proforma. RESULTS: The results identified 3319 total papers. Of these, 24 met the inclusion criteria and were included in the scoping review. A significant proportion of these studies was conducted in the United States (n = 10) using self-reported, cross-sectional data. Financial burden was the most prevalent dimension of treatment burden, with 11 studies focusing on the direct and indirect costs associated with cancer treatment. Other but less obvious aspects of treatment burden elderly patients experienced included the length of time taken to access and administer treatment and medication-related burdens. CONCLUSIONS: Emerging findings suggest that the financial aspects of cancer treatment are a significant burden for most elderly cancer patients. Personalized healthcare interventions targeting ways to reduce and screen for treatment burden, particularly those related to cost, are urgently needed.

Does Flourishing Reduce Engagement in Unhealthy and Risky Lifestyle Behaviours in Emerging Adults?

Emerging adulthood is a transitional life stage with increased probability of risky and unhealthy lifestyle behaviours that are known to have strong links with premature mortality and morbidity. Wellbeing, as a positive subjective experience, is identified as a factor that encourages self-care and may steer individuals away from risky lifestyle behaviours. Investigating wellbeing-behaviour links in the emerging adult population may increase understanding of the factors that lead to, and ways to prevent, engagement in risky behaviours. This study examines the association between flourishing, that is, the experience of both high hedonic and eudaimonic wellbeing, and a broad range of risky and unhealthy lifestyle behaviours among emerging adults in Australia. A cross-sectional survey of 1155 emerging adults aged 18-25 years measured wellbeing, socio-demographics, and six groups of lifestyle behaviours surrounding substance use, physical activity, diet, sex, sun protection, and driving. Bivariate and multivariate statistics were used to analyse the data. The findings revealed that flourishing was negatively associated with more dangerous types of risk behaviours, such as driving under the influence of drugs, and positively associated with self-care behaviours, such as healthier dietary behaviour and sun protection. If enabling emerging adults to flourish can contribute to reduced engagement in risky/unhealthy lifestyle behaviours, then promoting it is an important goal for health promotion efforts not only because flourishing is desirable in its own right, but also to bring about sustainable change in behaviour. Further research is needed to inform the designs of such interventions.

Support for Australian carers from community pharmacy: Insight into carer perspectives of a novel service.

The feasibility of an individualised carer support service delivered in community pharmacies was assessed from the perspective of carer participants using a pre-post questionnaire and semistructured interviews. Eligible pharmacies were required to offer a medication management service relevant to carers and have a semiprivate space for conversations. Carers were required to self-identify as an unpaid support person for someone with a chronic condition or disability. Between September 2016 and March 2017, staff from 11 community pharmacies in South-East Queensland, Australia were trained, and provided with ongoing mentoring from a pharmacist and carer to support service implementation. Identification of carers and support to achieve a personal and care-giving goal were key features of the service. Questionnaires included the EQ-5D-3L, the Bakas Caregiving Outcomes Scale, and questions relating to goal achievement, carer roles, and responsibilities. Seven follow-up carer interviews were undertaken between March and May 2017 and analysed thematically. Pre-post questionnaires were available for 17 carers (one withdrew, two incomplete). Of the 29 goals set, 10 were achieved and 14 partially achieved. EQ-5D-3L scores were unchanged, while 7 of the 15 items comprising the Bakas score improved (p < 0.05). Carer service evaluation was generally favourable, and these two main interview themes were the impact of caring and pharmacy experience. The impact of caring, while variable, was significant. Pharmacy experiences were mostly positive and the opportunity for carers to further engage with pharmacy staff was appreciated. The service was feasible and initial reported benefits to carers may support further research potentially in terms of a larger controlled trial.

A pharmacy carer support service: obtaining new insight into carers in the community.

OBJECTIVES: Unpaid carers have many and varied responsibilities in society, which can include medication management for the person they support. However, the potential for Australian community pharmacies to better assist carers is relatively unexplored. This mixed-methods study investigated the acceptability of a local carer support service by trained community pharmacy staff, including issues regarding the implementation and impact of this service. METHODS: Staff from 11 community pharmacies in South East Queensland, Australia, were trained to deliver a six-step carer support service between September 2016 and March 2017. Pharmacies were supported by a carer and pharmacist mentor pair and asked to recruit up to six carers each. Evaluations of staff training were descriptively analysed. Semi-structured interviews were undertaken with pharmacy staff, and interview transcripts were analysed thematically. KEY FINDINGS: Staff training evaluations were positive; participants acquired new information about carers and rated the service highly in terms of its importance within the pharmacy setting. Feedback was obtained on how to improve the training, such as further opportunities for role-play. Seven staff members were interviewed, and data analysis revealed two main themes: (1) implementation of the carer support service and (2) perceived impact on pharmacy staff. Positive attitudes towards recognising and supporting carers, and training and mentoring were identified with community pharmacies viewed as a suitable place for delivering this new service. New insights into the impact of caring were widely reported, which staff had not appreciated from previous carer interactions. Structural issues, including space and time pressures, and a lack of awareness about the types of support currently available to carers were emphasised. CONCLUSION: Pharmacy staff are well positioned to support carers. Engaging carers in conversation to better understand their needs is a small step with potential for big gains, including a more empathetic understanding of their individual circumstances and overall well-being.

Interventions for acute stroke management in Africa: a systematic review of the evidence.

BACKGROUND: The past decades have witnessed a rapid evolution of research on evidence-based acute stroke care interventions worldwide. Nonetheless, the evidence-to-practice gap in acute stroke care remains variable with slow and inconsistent uptake in low-middle income countries (LMICs). This review aims to identify and compare evidence-based acute stroke management interventions with alternative care on overall patient mortality and morbidity outcomes, functional independence, and length of hospital stay across Africa. METHODS: This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. An electronic search was conducted in six databases comprising MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, Academic Search Complete and Cochrane Library for experimental and non-experimental studies. Eligible studies were abstracted into evidence tables and their methodological quality appraised using the Joanna Briggs Institute checklist. Data were analysed and presented narratively with reference to observed differences in patient outcomes, reporting p values and confidence intervals for any possible relationship. RESULTS: Initially, 1896 articles were identified and 37 fully screened. Four non-experimental studies (three cohort and one case series studies) were included in the final review. One study focused on the clinical efficacy of a stroke unit whilst the remaining three reported on thrombolytic therapy. The results demonstrated a reduction in patient deaths attributed to stroke unit care and thrombolytic therapy. Thrombolytic therapy was also associated with reductions in symptomatic intracerebral haemorrhage (SICH). However, the limited eligible studies and methodological limitations compromised definitive conclusions on the extent of and level of efficacy of evidence-based acute stroke care interventions across Africa. CONCLUSION: Evidence from this review confirms the widespread assertion of low applicability and uptake of evidence-based acute stroke care in LMICs. Despite the limited eligible studies, the overall positive patient outcomes following such interventions demonstrate the applicability and value of evidence-based acute stroke care interventions in Africa. Health policy attention is thus required to ensure widespread applicability of such interventions for improved patients' outcomes. The review findings also emphasises the need for further research to unravel the reasons for low uptake. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016051566.