Conversation Maps and Diabetes Education Groups: An Evaluation at an Australian Rural Health Service.

Objective. The rural Central Gippsland Health Service (CGHS) assists patients with diabetes through the provision of diabetes education. The purpose of this study was to compare and evaluate the CGHS 5-week didactic program and a modified group-participatory Conversation Maps diabetes education program. Method. A pre- and post-program survey was conducted of clients who attended the two different diabetes education programs. The survey consisted of a self-constructed demographic questionnaire, the Diabetes Knowledge Test, the Diabetes Empowerment Scale, and the Diabetes Self-Care Activities Measure. Results. For the CGHS program, there were no differences between pre- and post-program surveys in knowledge scores (11.05 ± 3.56 vs. 12.75 ± 4.19, P = 0.0883, n = 20), self-care activities (4.46 ± 1.11 vs. 4.83 ± 0.68, P = 0.0832, n = 12), or empowerment scores (7.16 ± 1.60 vs. 7.92 ± 1.26, P = 0.0540, n = 17). For the modified Conversation Maps program, there were significant improvements between pre- and post-program surveys in knowledge scores (12.42 ± 4.15 vs. 15.54 ± 3.79, P = 0.0004, n = 26), self-care activities (4.74 ± 1.09 vs. 5.32 ± 0.80, P = 0.0139, n = 24), and empowerment scores (6.56 ± 2.19 vs. 8.11 ± 1.46, P = 0.0016, n = 21). The greatest difference between the two programs was observed in knowledge gain (P = 0.0178). Overall, participants were satisfied with both programs, with no difference seen in satisfaction levels (P = 0.9763). A1C results improved in both programs to a mean of 6.7% (P = 0.0071 for CGHS and P = 0.0092 for Conversation Maps). Conclusion. The modified Conversation Maps program resulted in significant improvements for rural participants.

Forces of Commonly Used Chiropractic Techniques for Children: A Review of the Literature.

OBJECTIVE: The purpose of this study is to review the available literature that describes forces of the most commonly used chiropractic techniques for children. METHODS: Review of the English-language literature using search terms Chiropract* and technique, protocol, or approach in databases PubMed, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine, and Index to Chiropractic Literature and direct contact with authors of articles and book chapters. RESULTS: Eleven articles that discussed the 7 most commonly used pediatric chiropractic techniques and the forces applied were identified. Chiropractic techniques reviewed described forces that were modified based on the age of the patient. Force data for mechanically assisted devices were varied, with the minimum force settings for some devices outside the age-specific safe range recommended in the literature when not modified in some way. CONCLUSION: This review found that technique selection and application by chiropractors treating infants and young children are typically modified in force and speed to suit the age and development of the child.

Adverse Events Due to Chiropractic and Other Manual Therapies for Infants and Children: A Review of the Literature.

OBJECTIVE: The purpose of this study was to review the literature for cases of adverse events in infants and children treated by chiropractors or other manual therapists, identifying treatment type and if a preexisting pathology was present. METHOD: English language, peer-reviewed journals and non-peer-reviewed case reports discussing adverse events (ranging from minor to serious) were systematically searched from inception of the relevant searchable bibliographic databases through March 2014. Articles not referring to infants or children were excluded. RESULTS: Thirty-one articles met the selection criteria. A total of 12 articles reporting 15 serious adverse events were found. Three deaths occurred under the care of various providers (1 physical therapist, 1 unknown practitioner, and 1 craniosacral therapist) and 12 serious injuries were reported (7 chiropractors/doctors of chiropractic, 1 medical practitioner, 1 osteopath, 2 physical therapists, and 1 unknown practitioner). High-velocity, extension, and rotational spinal manipulation was reported in most cases, with 1 case involving forcibly applied craniosacral dural tension and another involving use of an adjusting instrument. Underlying preexisting pathology was identified in a majority of the cases. CONCLUSION: Published cases of serious adverse events in infants and children receiving chiropractic, osteopathic, physiotherapy, or manual medical therapy are rare. The 3 deaths that have been reported were associated with various manual therapists; however, no deaths associated with chiropractic care were found in the literature to date. Because underlying preexisting pathology was associated in a majority of reported cases, performing a thorough history and examination to exclude anatomical or neurologic anomalies before applying any manual therapy may further reduce adverse events across all manual therapy professions.

Health knowledge and iodine intake in pregnancy.

BACKGROUND: Pregnant women have much higher iodine requirements as compared to all other population groups. The National Health and Medical Research Council (NHMRC) recommends pregnant women take a daily iodine supplement of 150 µg to meet their high iodine requirements. AIM: To investigate iodine supplement use and health knowledge among pregnant women. METHOD: A cross-sectional sample of 200 pregnant women aged 18 years or older, in their third trimester based in Gippsland (Victoria, Australia) undertook a self-administered questionnaire from August 2011-May 2012. The women were recruited from antenatal classes and clinics from all birthing hospitals across Gippsland. Data were analysed using descriptive statistics and logistic regression. RESULTS: A total of 46% of participants did not follow the NHMRC recommendation of 150 µg/day iodine supplement. The participants lacked knowledge about iodine and the need for supplementation. Only 18.5% of pregnant women believed they needed an iodine supplement. The majority of participants (83.5%) indicated their medical practitioners were the main source of health information, yet only 34.5% indicated being made aware of the importance of increasing iodine intake during pregnancy by their medical practitioner. The predictors of iodine supplementation are general supplementation use and knowledge of the importance of iodine. CONCLUSIONS: Despite NHMRC guidelines for iodine supplementation during pregnancy, many women were not taking a sufficient iodine supplement. Pregnant women may be inclined to take an iodine supplement if they had greater knowledge of their increased iodine needs during pregnancy. Medical practitioners are best placed to provide this information to pregnant women.

Mental health integrated care models in primary care and factors that contribute to their effective implementation: a scoping review.

BACKGROUND: In the state of Victoria, Australia, the 111-day lockdown due to the COVID-19 pandemic exacerbated the population's prevailing state of poor mental health. Of the 87% of Australians who visit their GP annually, 71% of health problems they discussed related to psychological issues. This review had two objectives: (1) To describe models of mental health integrated care within primary care settings that demonstrated improved mental health outcomes that were transferable to Australian settings, and (2) To outline the factors that contributed to the effective implementation of these models into routine practice. METHODS: A scoping review was undertaken to synthesise the evidence in order to inform practice, policymaking, and research. Data were obtained from PubMed, CINAHL and APA PsycINFO. RESULTS: Key elements of effective mental health integrated care models in primary care are: Co-location of mental health and substance abuse services in the primary care setting, presence of licensed mental health clinicians, a case management approach to patient care, ongoing depression monitoring for up to 24 months and other miscellaneous elements. Key factors that contributed to the effective implementation of mental health integrated care in routine practice are the willingness to accept and promote system change, integrated physical and mental clinical records, the presence of a care manager, adequate staff training, a healthy organisational culture, regular supervision and support, a standardised workflow plan and care pathways that included clear role boundaries and the use of outcome measures. The need to develop sustainable funding mechanisms has also been emphasized. CONCLUSION: Integrated mental health care models typically have a co-located mental health clinician who works closely with the GP and the rest of the primary care team. Implementing mental health integrated care models in Australia requires a 'whole of system' change. Lessons learned from the Mental Health Nurse Incentive Program could form the foundation on which this model is implemented in Australia.

Clinicians' and Users' Views and Experiences of a Tele-Mental Health Service Implemented Alongside the Public Mental Health System during the COVID-19 Pandemic.

A tele-mental health model called Head to Health was implemented in the state of Victoria, Australia to address the crisis caused by the COVID-19 pandemic. It was a free centralized intake service that adopted a targeted approach with several novel elements, such as stepped care and telehealth. This study examines the views and experiences of clinicians and service users of the tele-mental health service in the Gippsland region of Victoria during the COVID-19 pandemic. Data from clinicians were obtained via an online 10-item open-ended survey instrument and from service users through semi-structured interviews. Data were obtained from 66 participants, including 47 clinician surveys and 19 service user interviews. Six categories emerged from the data. They were: 'Conditions where use of tele-mental health is appropriate', 'Conditions where tele-mental health may not be useful', 'Advantages of tele-mental health', 'Challenges in using tele-mental health', 'Client outcomes with tele-mental health', and 'Recommendations for future use'. This is one of a few studies where clinicians' and service users' views and experiences have been explored together to provide a nuanced understanding of perspectives on the efficacy of tele-mental health when it was implemented alongside public mental health services.

Compulsory medical rural placements: senior student opinions of early-year experiential learning.

OBJECTIVE: The aim of this study was to determine senior medical student (year 3-5) opinions of their early-year (year 1-2) rural placement. DESIGN: We assessed the impact of MBBS early-year rural placements through a follow up of this cohort in their later years using a cross-sectional questionnaire. SETTING: The questionnaire was administered to year 3-5 medical students at their clinical school. PARTICIPANTS: There were 97 participants (49% response rate) in the study. Twenty-nine per cent were male and 71% were female; 44% were from a rural background and 56% were from a metropolitan background; 48% were year 3 students, 32% were year 4 students and 20% were year 5 students; and 59% of the students were, at the time, situated at a rural clinical school and 41% were at a metropolitan clinical school. MAIN OUTCOME MEASURE: Closed-ended questions were quantified and statistically analysed. Open-ended responses were thematically analysed to determine what their experience of early-year rural placements were like. RESULTS: Seventy-nine per cent of students considered the year 1 placement length as 'about right'. Overall, most students found year 1 rural placements positive and grasped the placement aims and objectives. Most students were also pleased with year 2 rural placements, mainly due to the clinical aspects. CONCLUSIONS: Medical students appear to prefer shorter early-year rural placements and understand the benefits and importance of such placements. They also have a desire for greater clinical exposure during these early-year placements.

Recent trends in health assessments for older Australians.

Non-Indigenous older Australians (aged 75+ years) are encouraged to undertake an annual health assessment (75+HA) to identify overlooked medical conditions, holistically assess the management of current chronic conditions and highlight potential risk factors for poor health. Uptake in the 2000s has been previously reported to be slowly increasing, but still very low. This study aimed to identify the uptake of 75+HA between 2011 and 2019, comparing State and National trends over a 9-year period. The uptake of Medicare Items 701, 703, 705 and 707 between 2011 and 2019 was analysed. These results were incorporated with Australian Demographics data to present rate ratios by State and age groups. An increasing number of 75+HAs were performed between 2011 and 2019, and the 75+HAs performed were increasing in duration. Overall, the 75+HA uptake was still generally low, at approximately one-third of the eligible population; however, despite the low uptake, age-standardised figures showed upward trends. The 75+HA rate in the 85+ year group has now overtaken their younger (aged 75-84 years) counterparts. There were also clear variations between States. Given the low rates, strategies to improve uptake should be targeted so all eligible Australians receive an annual Medicare Benefits Schedule (MBS)-funded 75+HA.

Experienced general practitioners.

ObjectiveHealth assessments (HAs) are available annually for community-dwelling older people: the 75+HA for non-Indigenous Australians aged ≥75 years and the 55+IHA for Indigenous Australians aged ≥55 years. Medicare requires general practitioners (GPs) to cover the items within the relevant HA form. This study explored the views of experienced GPs and practice nurses (PNs) towards the older-person HA forms.MethodsThirty-nine experienced GPs and PNs responded to an online questionnaire.ResultsIn this study, experienced GPs and PNs suggested that current items within the 75+HA Medicare-provided guideline form need reviewing, such as those relating to psychological function, medication and exercise and falls. There were also recommendations to consider including items consistently across both the 55+IHA and 75+HA and to include new items, such as personal alarms, loneliness, support networks, spiritual health, musculoskeletal diseases, whether other screening is up to date and future planning. Many parts of the HA were deemed irrelevant or condescending to 'well' older Australians, so should be optional. Healthcare professionals also requested reintroducing conducting the HA at the community-dwelling patient's home. User-friendly integrated forms would improve healthcare professionals' time management and provide better communication with patients and carers, and create greater opportunities for multidisciplinary referral processes, as well as provide linkages to MyAgedCare and myHealthRecord.ConclusionCapturing the views of healthcare professionals towards older-person HA forms generated suggested improvements. The adoption of these suggestions would elicit more holistic health information for older Australians.What is known about the topic?Annual HAs are available for older Australians (75+HAs and 55+IHAs). Medicare requires GPs cover items within their prescribed HA form. The 75+HAs and 55+IHAs allow for the monitoring of health problems specific to community-dwelling older people, which may be difficult to address in the time frames of a standard GP consultation; however, there is very little research on the experiences of health professionals regarding the conditions required to be assessed within the HAs.What does this paper add?This study examined the views of experienced GPs and PNs to identify potential changes to the current procedures. Capturing the views of healthcare professionals towards older-person HA forms generated important suggested improvements, such as reviewing psychological function, medication, exercise and falls items. There were recommendations to include items across both the 55+IHA and 75+HA and new items, such as personal alarms, loneliness, support networks, spiritual health, musculoskeletal diseases assessments, future planning and whether the patient's screening is up to date.What are the implications for practitioners?The experienced GPs and PNs in this study suggested significant additions and revisions to the current HA forms. The incorporation of these suggestions should lead to permanent modifications of the current forms to make them more relevant and appropriate for older Australians, but the challenge for implementation is how these additional items would be funded.

Attitudes of general practitioners and practice nurses regarding older person health assessments.

Health assessments (HAs) are available for community-dwelling older people to receive annually from general practitioners (GPs), but have low uptake. Little is known regarding the views of GPs and practice nurses (PNs) towards older person HAs and whether this might contribute to the low uptake. The objective of this study was to explore the attitudes of GPs and PNs towards older person HAs. Fifty-eight participant responses to an online questionnaire were analysed through descriptive statistics and content analysis. Most participants (77%) found older person HAs to be useful. Participants felt HAs identified health problems that may otherwise be missed (n=21). The main barriers to delivery of HAs were patient refusal (n=25) and insufficient practitioner time (n=19). The most requested change to HAs was increased patient education and public awareness regarding older person HAs (n=10). Health professionals felt increased patient education and public awareness, particularly to address patient misconceptions regarding older person HAs, may improve HA uptake.

A prospective survey of chiropractic student experiences with pediatric care and variability of case mix while on clinical placement in Rarotonga.

OBJECTIVE: To compare chiropractic students' perceptions of preparedness for practice before and after a clinical placement in Rarotonga and to report demographics from these experiences. METHODS: The students completed deidentified pre- and postplacement surveys assessing pediatric practice preparedness. Students tallied the patient numbers, age, and chiropractic techniques used per visit for each day of clinic placement. On completion of the program, participating students (27/34, or 79% of the student cohort) did a postplacement survey on their perception of practice preparedness. Data were analyzed with the Spearman rho correlation, the Mann-Whitney U test, and regression analysis. RESULTS: There was an increase in perceived preparedness for pediatric practice, ranging from 24.1% of the student cohort at the start of the study to 82.1% following clinical placement in Rarotonga. The change in student preparedness to practice with children was positively correlated with the total number of children managed (rs = .05, p = .01) and the number of children managed who were under 10 years of age (rs = .60, p = .001). Multiple regression analysis demonstrated a medium positive effect for postprogram preparedness (F [4, 20] = 3.567, p = .024). CONCLUSION: Clinical outreach to Rarotonga provided a broad case mix of patients and a change in student perceptions of preparedness to practice with children, which was positively affected by the total number of children managed and the number of children managed who were under 10 years of age.

Differential gene expression in the developing mouse ureter.

In many instances, kidney dysgenesis results as a secondary consequence to defects in the development of the ureter. Through the use of mouse genetics a number of genes associated with such malformations have been identified, however, the cause of many other abnormalities remain unknown. In order to identify novel genes involved in ureter development we compared gene expression in embryonic day (E) 12.5, E15.5 and postnatal day (P) 75 ureters using the Compugen mouse long oligo microarrays. A total of 248 genes were dynamically upregulated and 208 downregulated between E12.5 and P75. At E12.5, when the mouse ureter is comprised of a simple cuboidal epithelium surrounded by ureteric mesenchyme, genes previously reported to be expressed in the ureteric mesenchyme, foxC1 and foxC2 were upregulated. By E15.5 the epithelial layer develops into urothelium, impermeable to urine, and smooth muscle develops for the peristaltic movement of urine towards the bladder. The development of these two cell types coincided with the upregulation of UPIIIa, RAB27b and PPARgamma reported to be expressed in the urothelium, and several muscle genes, Acta1, Tnnt2, Myocd, and Tpm2. In situ hybridization identified several novel genes with spatial expression within the smooth muscle, Acta1; ureteric mesenchyme and smooth muscle, Thbs2 and Col5a2; and urothelium, Kcnj8 and Adh1. This study marks the first known report defining global gene expression of the developing mouse ureter and will provide insight into the molecular mechanisms underlying kidney and lower urinary tract malformations.

Feeling supported and abandoned: mixed messages from attendance at a rural community cardiac rehabilitation program in Australia.

PURPOSE: In 2010, the Healthy Heart (HH) community-based cardiac rehabilitation program was offered at Latrobe Community Health Service in rural Victoria, Australia. The 8-week program, based on National Heart Foundation guidelines, consisted of exercise sessions; health education on diet, stress, and smoking cessation; and behavioral change strategies. Participants were also informed about local community exercise opportunities. A program evaluation was conducted in 2011 to assess whether the content of the program was meeting the needs of participants and to identify what suggestions they had for improvement. METHODS: Eighteen patients had completed the HH program in 2010. Eight of these participants, 7 men and 1 woman, volunteered to take part in a focus group. Conventional content analysis was used to identify and group the common themes that emerged from the focus group discussions. RESULTS: Three themes were identified that reflected the participant experiences of attending the HH program. The first, "recovering confidence," described participant responses to the content of the sessions. The second, "putting it into practice," referred to their comments about taking responsibility for making lifestyle changes. The third, "feeling abandoned," emerged from the reported difficulty participants expressed about maintaining motivation for change after program completion. CONCLUSION: Participants rated the HH program as very successful by objective measures. However, they reported struggling to maintain self-management strategies postprogram. There is clearly a need to develop strategies that support cardiac rehabilitation participants over the longer-term.

Learning styles of first-year undergraduate nursing and midwifery students: a cross-sectional survey utilising the Kolb Learning Style Inventory.

It is important that educators understand their students' learning styles. In this study we investigate the learning styles of first-year undergraduate nursing and midwifery university students and whether these learning styles are influenced by student demographic characteristics. A cross-sectional survey including demographic questions and the Kolb Learning Style Inventory was utilised. There was a 78% response rate (n=345). The majority of first-year students investigated in this study were divergers (29.5%), followed by assimilators (28.8%), accommodators (23.9%) and convergers (17.9%). Female students had a higher reflective observation (RO) score than male students (p=0.0078). Those with English as first language showed a higher active experimentation score (p=0.0543) and a lower concrete experience (CE) score (p=0.0038). Australian citizens and permanent residents had a higher RO score (p=0.0560) and a lower CE score (p=0.0100) than migrants and international students. Nursing/arts students had a higher abstract conceptualisation (AC) score than nursing students (p=0.0013). Students enrolled in 4-5 subject units had a higher AC score than those enrolled in 1-2 units (p=0.0244). Nursing and midwifery students are mainly of the diverger and assimilating learning styles. Some student demographic characteristics show a significant influence on learning styles. This study has teaching and research implications.

Nephron endowment and filtration surface area in the kidney after growth restriction of fetal sheep.

Low birth weight is associated with adult-onset diseases including hypertension and renal disease; altered renal development after intrauterine growth restriction (IUGR) may underlie such prenatal programming. Our aim was to investigate nephron endowment and renal filtration surface area in fetal sheep in which IUGR resulted from late gestational umbilico-placental embolization (UPE) or natural twinning. UPE was performed between 120 and 140 d of gestation (term approximately 147 d). At autopsy (140 d), body weights of UPE and twin fetuses were, respectively, 34% and 28% lower than controls. Kidneys were sampled using a smooth fractionator approach and glomerular number was estimated using a physical disector/fractionator technique. Glomerular capillary length and filtration surface area were estimated using unbiased stereological techniques. Although relative kidney weights (grams per kilogram body weight) were not different between groups, nephron endowment was 40% lower in twin fetuses compared with controls (34.3 +/- 10.6 x 10(4) and 55.9 +/- 19.8 x 10(4), respectively; p < 0.05); UPE did not alter nephron number (50.7 +/- 13.2 x 10(4)). There was no difference in the glomerular capillary length or surface area between the UPE and control fetuses. IUGR due to twinning leads to reduced nephron endowment whereas late gestational IUGR does not, suggesting that reduced nephron endowment is dependent on the timing of the growth restriction. Our findings demonstrate that reduced birth weight per se does not necessarily imply reduced nephron endowment.