Intersectionality Between Epigenetics and Cancer Health Disparities Stemming from Social Determinants of Health (SDoH) Through a Gynecologic Oncology Lens: A Narrative Review.

Racial health disparities within gynecologic cancers persist. We aim to explore the impact of epigenetics on these disparities and how social determinants of health fuel this effect. We queried PubMed with terms associated with social determinants of health and epigenetics in the scope of 3 gynecologic cancers: ovarian, endometrial, and cervical. Using the publications found, we highlight various socioeconomic and environmental factors that may influence epigenetic mechanisms and further disparities in cancer incidence, mortality, and treatment. This narrative review exposes existing gaps in evidence and provides recommendations of future preventive efforts that can target the mitigation of gynecologic cancer disparities.

Tackling Gynecologic Cancer Disparities: An Assessment of 2 Interventions for Improving Information Exchange With Racial/Ethnic Communities.

Racial health disparities continue to greatly impact the incidence and mortality rates of gynecologic cancers. Although there are many drivers for these disparities, limited inclusion of vulnerable populations in clinical research and narrowed medical knowledge of patients are large contributors that disproportionately affect racial/ethnic communities. To mitigate these disparities, we must look for avenues that connect patients from these communities to cancer researchers. In this review, we summarize 2 projects that can serve as models for future interventions that promote education and engagement in clinical research for populations most impacted by gynecologic cancer disparities.

Perinatal bereavement care during COVID-19 in Australian maternity settings.

OBJECTIVES: Perinatal bereavement care is a complex area of practice. The COVID-19 pandemic led to reconfiguration of maternity and perinatal bereavement care services. This study explores Australian health care providers' perspectives of the impact of COVID-19 on the provision of respectful and supportive care following stillbirth or neonatal death. METHODS: Members of a perinatal bereavement care network were consulted at the commencement of the pandemic in Australia using an online feedback form. Respondents provided ratings and free-text comments on the impact of COVID-19 on implementation of 49 recommendations contained in the Perinatal Society of Australia and New Zealand/Stillbirth Centre of Research Clinical Practice Guideline for Respectful and Supportive Perinatal Bereavement Care. RESULTS: Responses were received from 35 health care providers who provided perinatal bereavement care in clinical settings or through support organisations in Australia. Major impacts of COVID-19 were reported for 8 of 49 guideline recommendations. Impacts included reduced: support for mothers due to visitor restrictions; availability of cultural and spiritual support and interpreters; involvement of support people in decision-making; options for memory-making and commemorative rituals; and staff training and supervision. Adaptations to minimise impacts included virtual consultations, online staff training, use of cold cots, and increased staff support for memory-making. CONCLUSIONS: Health care providers encounter substantial challenges as they strive to implement best practice perinatal bereavement care in pandemic conditions. Some practice adaptations developed during the COVID-19 pandemic could benefit parents; however, evaluation of their effectiveness and acceptability is needed.

Toward improved public health outcomes from urban nature.

There is mounting concern for the health of urban populations as cities expand at an unprecedented rate. Urban green spaces provide settings for a remarkable range of physical and mental health benefits, and pioneering health policy is recognizing nature as a cost-effective tool for planning healthy cities. Despite this, limited information on how specific elements of nature deliver health outcomes restricts its use for enhancing population health. We articulate a framework for identifying direct and indirect causal pathways through which nature delivers health benefits, and highlight current evidence. We see a need for a bold new research agenda founded on testing causality that transcends disciplinary boundaries between ecology and health. This will lead to cost-effective and tailored solutions that could enhance population health and reduce health inequalities.

Supporting parents following pregnancy loss: a cross-sectional study of telephone peer supporters.

BACKGROUND: The death of a baby before or soon after birth can place an enormous psychological toll on parents. Parent support groups have grown in response to bereaved parents' unmet needs for support. Peer support is the hallmark of these organisations but little is known about the experiences of volunteers who provide support. This study examines the perceptions and experiences of parent support group volunteers who deliver a 24-h telephone support service for the Australian Stillbirth and Newborn Death Support (Sands) organisation in order to inform the ongoing development and sustainability of effective peer support. This parent-led organisation has delivered support to those affected by miscarriage, stillbirth and newborn death for more than 30 years. METHODS: Twenty-four Parent Supporters completed an online questionnaire. A mix of open- and closed questions asked about aspects of the Parent Supporter role. Quantitative data was summarised using descriptive statistics. Free-text responses to open-ended items were categorised and used to extend and illustrate the quantitative findings. RESULTS: Our findings reveal a group of highly dedicated and experienced volunteers who had taken 473 calls in the preceding 12 months. Calls were diverse but most were from bereaved mothers seeking 'to talk with someone who understands' in the early weeks and months after stillbirth or miscarriage. Most Parent Supporters indicated they felt well-prepared, confident, and satisfied in their role. Challenges include balancing the demands of the role and ongoing training and support. CONCLUSIONS: Peer volunteers contribute to addressing a significant need for support following pregnancy loss. Delivering and sustaining high quality parent-led support depends on volunteer recruitment and retention and this, in turn, requires organisational responses.

Characteristics of child abuse fatalities: Insights from a statewide violent death reporting system.

BACKGROUND: Child maltreatment fatalities are a significant public health issue. Case level characteristics of abuse-related deaths can increase our understanding of maltreatment fatalities and inform region-specific prevention initiatives. OBJECTIVE: Explore child abuse fatalities in the Illinois Violent Death Reporting System (IVDRS) for commonalities and distinctive features. METHODS, PARTICIPANTS AND SETTING: A mixed methods study was conducted using IVDRS data from 2015 to 2018. All fatalities with a homicide or undetermined manner of death among decedents 10 years old or younger were included. Both discrete and narrative data were analyzed separately for victim, suspect, circumstance, and household characteristics. RESULTS: Of the 106 deaths that met inclusion criteria, 74 % of homicide deaths (64/86) and 50 % of undetermined deaths (10/20) were due to abuse. Psychosocial characteristics most often identified in abusive deaths included family relationship problems, mental illness, and history of substance abuse. Other common characteristics included use of personal weapons or blunt instruments and death due to punishment. Including narrative data rather than discrete data alone identified 148 % more deaths with three characteristics commonly found in abusive deaths: history of abuse, shaken baby syndrome, and family history of violence. CONCLUSION: This study demonstrates the capability of multi-source state-level data to enrich our understanding of child abuse fatalities. Employing the narrative review method in other states using the National Violent Death Reporting System may increase the identification of abuse fatalities. Improved recognition and characterization of abuse fatalities has the potential to help address systemic factors involved and enhance targeted prevention efforts. WHAT IS KNOWN: Child abuse fatalities represent a significant and preventable public health issue in the United States. Case-specific characteristics are limited in national data sets, and their absence curtails prevention opportunities. WHAT THIS STUDY ADDS: State-wide reporting systems of violent deaths offer rich and multisource data regarding child abuse fatalities including detailed victim, suspect, circumstance, and household characteristics. This data can be used to enhance our knowledge of maltreatment fatalities and may inform region-specific public health and prevention initiatives.

Pneumococcal Vaccination Practices in Patients With Multiple Sclerosis Receiving Anti-CD20 Monoclonal Antibodies After Pharmacy and Nursing Collaboration.

BACKGROUND: It is recommended that patients taking immunosuppressive anti-CD20 monoclonal antibodies (mAbs) receive pneumococcal vaccinations before their first dose to ensure optimal immune response. An initial medication use evaluation reviewed adherence to Centers for Disease Control and Prevention (CDC) pneumococcal immunization recommendations at the study site, and room for improvement was identified. The nursing team implemented workflow changes to increase nursing involvement in vaccination coordination, education, tracking, and administration. We sought to evaluate the impact of a nursing intervention on optimal pneumococcal vaccination administration rates in patients receiving anti-CD20 mAbs at a multiple sclerosis (MS) center. METHODS: We performed a single-center, retrospective, pre/post medication use evaluation. Inclusion criteria were older than 18 years with a diagnosis of MS and received their first anti-CD20 mAb infusion at the study site during the preintervention or postintervention time frame. RESULTS: We included 406 and 73 patients in the preintervention and postintervention studies, respectively. The nursing intervention significantly improved the percentage of patients receiving optimal pneumococcal vaccination before their first infusion from 58% to 84% and significantly reduced the number with unknown vaccination status from 17% to 3%. Patients who received optimal follow-up vaccination with 23-valent pneumococcal polysaccharide vaccine after optimal 13-valent pneumococcal conjugate vaccine administration improved from 9% to 56%. CONCLUSIONS: A nursing team intervention improved adherence to CDC pneumococcal immunization recommendations for patients receiving anti-CD20 mAb therapy. This project highlights the value of interdisciplinary team collaboration between health system specialty pharmacies and specialized nursing teams in the care of patients with MS.

Connecting the health of country with the health of people: Application of "caring for country" in improving the social and emotional well-being of Indigenous people in Australia and New Zealand.

Emerging evidence from the western literature suggests an increasing focus on applying nature-based interventions for mental health improvements. However, in Indigenous communities, caring for country has always been central to the Indigenous way of life. Knowing that nature-based interventions effectively improve mental health outcomes, this review collated evidence on the application of caring for country in improving social and emotional well-being (SEWB) of Indigenous peoples in Australia and New Zealand. Three studies from Australia and one from New Zealand, explored the role of country or whenua (land) in the lives of Indigenous people. Participation in caring-for country activities was associated with lower levels of psychological distress and strengthened guardianship relationship with country, which positively affected SEWB. This systematic review offers preliminary evidence on the role of caring for country activities in improving the SEWB of Indigenous peoples and highlights the need for strengths-based approaches to improve the SEWB of Indigenous peoples. Funding: None.

Factors associated with dietary acculturation among international students at the University of Georgia.

OBJECTIVE: Western diet is associated with chronic disease risk, and degree of dietary acculturation can impact susceptibility. This study sought to understand the factors associated with changes in food consumption habits among international students at a large public university in the southern US. PARTICIPANTS: A convenience sample of 173 international students representing 41 countries at The University of Georgia participated in the survey. METHODS: This cross-sectional online survey assessed dietary habits, perception of healthy eating, and level of acculturation using previously validated measures. RESULTS: Highest number of participants were from China (19.2%), 89.0% were graduate students with an average age of 27.5 ± 4.83 years. The majority (62.0%) of participants were dietary acculturated with affordability and accessibility determining types of food consumption, as fewer whole foods and more processed foods were consumed in the U.S. CONCLUSIONS: Findings suggest dietary acculturation may be driven by economic factors, making the transition to Westernized food items a convenient and cost-effective choice among international students.

Nature-based interventions for bereavement care: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to understand the types of nature-based interventions currently used in bereavement care and to map the theories of change explaining how such interventions may support bereavement care. INTRODUCTION: Bereavement can be associated with adverse psychosocial health outcomes. Nature-based interventions have been shown to have positive health and well-being outcomes, and offer diverse and flexible design and delivery options. However, this is an emerging field, and there is a need to explore the literature on the different types of nature-based interventions used in bereavement care and to identify the underpinning theories of change. INCLUSION CRITERIA: This review will include studies or reviews of participants who have experienced bereavement following the death of a loved one, and who have taken part in a nature-based intervention (eg, animal-assisted therapy, care farming, therapeutic horticulture, community gardens). Considering all nature contexts and geographic locations, this review will include studies that explore the role of nature-based interventions in bereavement care. METHODS: Searches will be conducted in eight databases: Web of Science, Scopus, PubMed, PsycINFO, CINAHL, Social Science Database (ProQuest), PTSDpubs (ProQuest), and Research Library: Health and Medicine (ProQuest). Manual searches of reference lists of included full-text articles and keyword searches of prominent journals will be conducted. Data on the type of nature-based intervention, target sample, health outcomes, measures and methods used, and theory of change will be extracted from selected articles. The data extraction results will be presented in tabular format along with a narrative summary.

Micronutrient Profile and Carbohydrate Microstructure of Commercially Prepared and Home Prepared Infant Fruit and Vegetable Purees.

Large variability exists in ingredient selection and preparation of home prepared infant purees and there is a lack of data on nutritional quality in comparison to commercially prepared purees. This work had two aims. Study 1 compared the nutritional value of commercially prepared and home prepared infant purees. Food profiles from national food composition databases were used as a proxy for home prepared puree and served as the benchmark for the commercially prepared infant purees. Study 2 focused on a subset of produce that underwent molecular weight analysis to determine differences in carbohydrate profiles. Eighty-eight percent of the measurable micronutrients fell within or above the home prepared norm range with micronutrients falling below the range explained by differences in soil and growing conditions. Physicochemical characterization showed similar carbohydrate profiles with >90% of the carbohydrate fraction in the water extract constituted by low molecular weight sugars for purees produced with home preparation and commercial preparation. The estimated glycemic load (eGL) showed comparable potential impact on blood sugar levels with all purees having a low eGL (<10 glucose equivalent). In conclusion, these data suggest that both preparations provide similar micronutrient density and carbohydrate profiles.

Living with Loss: study protocol for a randomized controlled trial evaluating an internet-based perinatal bereavement program for parents following stillbirth and neonatal death.

BACKGROUND: Stillbirth and neonatal death are devastating pregnancy outcomes with long-lasting psychosocial consequences for parents and families, and wide-ranging economic impacts on health systems and society. It is essential that parents and families have access to appropriate support, yet services are often limited. Internet-based programs may provide another option of psychosocial support for parents following the death of a baby. We aim to evaluate the efficacy and acceptability of a self-guided internet-based perinatal bereavement support program "Living with Loss" (LWL) in reducing psychological distress and improving the wellbeing of parents following stillbirth or neonatal death. METHODS: This trial is a two-arm parallel group randomized controlled trial comparing the intervention arm (LWL) with a care as usual control arm (CAU). We anticipate recruiting 150 women and men across Australia who have experienced a stillbirth or neonatal death in the past 2 years. Participants randomized to the LWL group will receive the six-module internet-based program over 8 weeks including automated email notifications and reminders. Baseline, post-intervention, and 3-month follow-up assessments will be conducted to assess primary and secondary outcomes for both arms. The primary outcome will be the change in Kessler Psychological Distress Scale (K10) scores from baseline to 3-month follow-up. Secondary outcomes include perinatal grief, anxiety, depression, quality of life, program satisfaction and acceptability, and cost-effectiveness. Analysis will use intention-to-treat linear mixed models to examine psychological distress symptom scores at 3-month follow-up. Subgroup analyses by severity of symptoms at baseline will be undertaken. DISCUSSION: The LWL program aims to provide an evidence-based accessible and flexible support option for bereaved parents following stillbirth or neonatal death. This may be particularly useful for parents and healthcare professionals residing in rural regions where services and supports are limited. This RCT seeks to provide evidence of the efficacy, acceptability, and cost-effectiveness of the LWL program and contribute to our understanding of the role digital services may play in addressing the gap in the availability of specific bereavement support resources for parents following the death of a baby, particularly for men. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12621000631808 . Registered prospectively on 27 May 2021.

Investigating referral pathways from primary care to consumer health organisations.

While chronic disease places an increasing burden on Australia's primary care system it is unrealistic to expect GPs to meet the range of support needs experienced by patients managing chronic conditions. Consumer health organisations (CHO) have the potential to augment clinical care by providing a variety of supportive services; however, they are underutilised by patients and GPs. This qualitative study investigates GPs' knowledge and perceptions of CHO and their contributions to chronic disease care. The study involved semi-structured interviews with 10 GPs. Overall, participants demonstrated clear understanding of the role of CHO in chronic disease management, but a critical finding was the way GPs' view of their own chronic care role appears to influence referral practices. GPs operating in a traditional role were less likely to refer to CHO than those who had adopted a chronic care approach. A second key finding related to GPs' views of Diabetes Australia. All GPs identified this organisation as an important referral point, providing some reassurance that CHO can be integrated into the primary care sector. Further research is needed to determine how the 'definite advantages' associated with Diabetes Australia can be used to extend GP referral and enhance the health system's integration of other CHO.

Stillbirth in Australia 5: Making respectful care after stillbirth a reality: The quest for parent-centred care.

Stillbirth is a tragedy that can leave parents feeling powerless and vulnerable. Respectful and supportive bereavement care is essential to reducing adverse psychosocial impact. Initiatives of the Australian Centre of Research Excellence in Stillbirth are designed to improve care after stillbirth. At their heart are the voices of perinatally bereaved parents and support organisations and shared decision making between parents and health care providers. Priorities in future perinatal bereavement care research include ensuring appropriate care for population groups who experience higher rates of stillbirth and addressing implementation challenges to best practice in respectful and supportive bereavement care within our health systems.

Nature-Based Interventions for Improving Health and Wellbeing: The Purpose, the People and the Outcomes.

Engagement with nature is an important part of many people's lives, and the health and wellbeing benefits of nature-based activities are becoming increasingly recognised across disciplines from city planning to medicine. Despite this, urbanisation, challenges of modern life and environmental degradation are leading to a reduction in both the quantity and the quality of nature experiences. Nature-based health interventions (NBIs) can facilitate behavioural change through a somewhat structured promotion of nature-based experiences and, in doing so, promote improved physical, mental and social health and wellbeing. We conducted a Delphi expert elicitation process with 19 experts from seven countries (all named authors on this paper) to identify the different forms that such interventions take, the potential health outcomes and the target beneficiaries. In total, 27 NBIs were identified, aiming to prevent illness, promote wellbeing and treat specific physical, mental or social health and wellbeing conditions. These interventions were broadly categorized into those that change the environment in which people live, work, learn, recreate or heal (for example, the provision of gardens in hospitals or parks in cities) and those that change behaviour (for example, engaging people through organized programmes or other activities). We also noted the range of factors (such as socioeconomic variation) that will inevitably influence the extent to which these interventions succeed. We conclude with a call for research to identify the drivers influencing the effectiveness of NBIs in enhancing health and wellbeing.

Is Nature Relatedness Associated with Better Mental and Physical Health?

Nature relatedness is a psychological characteristic with the potential to drive interaction with nature and influence well-being. We surveyed 1538 people in Brisbane, Australia to investigate how nature relatedness varies among socio-demographic groups. We determined whether people with higher nature relatedness reported fewer symptoms of depression, anxiety, stress and better overall health, controlling for potentially confounding socio-demographic and health-related variables. Overall nature relatedness was higher in older people, females, those without children living at home, not working, and people speaking English at home. Aspects of nature relatedness reflecting enjoyment of nature were consistently associated with reduced ill health, consistent with widespread evidence of the health and well-being benefits of experiencing nature. In contrast, aspects of nature relatedness reflecting self-identification with nature, and a conservation worldview, were associated with increased depression, anxiety or stress, after accounting for potential confounding factors. Detailed investigation of causal pathways among nature relatedness, socio-demographic factors and health is warranted, with particular focus on the relationship between stress and nature orientation.

Mental health promotion and non-profit health organisations.

Health related non-profit organisations (NPOs) provide a potentially important but largely untapped role in mental health promotion in communities. This paper reports on a study investigating the activities and contributions made by NPOs to mental health and well-being. One hundred and eight NPOs based in the metropolitan area of Brisbane, Queensland, Australia, participated in a survey exploring agency activities that contribute to promoting mental well-being; factors that helped or hindered the organisation in engaging in mental health promotion activities and evaluation methods and processes. An index of key themes was developed and frequencies derived from categorical data. NPOs undertook five key types of activities to promote mental health and well-being: support provision (81%); service provision (59%); information sharing (52%); activities to promote well-being (24%); and advocacy (6%). Systematic evaluation of longer-term outcomes was rare, with most NPOs (72%) relying on informal feedback from clients. Human resources in the form of paid or volunteer workers were most frequently (58%) identified as contributing to the capacity of agencies to carry out mental health promotion activities. Training and education emerged as a substantive need (34%). NPOs are well placed to enhance resiliency in the context of ongoing health problems, disability or other adverse psychosocial circumstances that place people at risk of mental health problems. As such they constitute a significant resource for advancing mental health promotion goals. What is needed to extend the practice and evidence base in this area is training and skill development for NPO workers, along with larger-scale research conducted in collaboration with NPOs to assess the contributions and cost-effectiveness of the sector.

Why do people with chronic disease not contact consumer health organisations? A survey of general practice patients.

UNLABELLED: Aim Consumer health organisations (CHOs) are non-profit or voluntary sector organisations that promote and represent the interests of patients and carers affected by particular conditions. The purpose of this study was to examine, among patients with chronic disease, what differentiates those who contact CHOs from those who do not and what stops people from making contact. BACKGROUND: CHOs can enhance people's capacity to manage chronic disease by providing information, education and psychosocial support, but are under-utilised. Little is known about barriers to access. METHODS: Data were from a baseline telephone survey conducted as part of a randomised trial of an intervention to improve access to CHOs. Participants constituted a consecutive sample of 276 adults with diagnosed chronic disease recruited via 18 general practitioners in Brisbane, Australia. Quantitative survey items examined participants' use and perceptions of CHOs and a single open-ended question explored barriers to CHO use. Multiple logistic regression and thematic analysis were used. Findings Overall, 39% of participants had ever contacted a CHO for their health and 28% had contacted a CHO specifically focussed on their diagnosed chronic condition. Diabetes, poorer self-reported physical health and greater health system contact were significantly associated with CHO contact. The view that 'my doctor does it all' was prevalent and, together with a belief that their health problems were 'not serious enough', was the primary reason patients did not make contact. CONCLUSION: Attitudinal and system-related barriers limit use of CHOs by those for whom they are designed. Developing referral pathways to CHOs and promoting awareness about what they offer is needed to improve access.