A systematic review of the views of healthcare professionals on the provision of long-acting reversible contraception.

RESEARCH QUESTION: What are the views of healthcare professionals outside of the general practice setting on long-acting reversible contraception? BACKGROUND: Despite global sexual health organisations advocating for widespread prescription of long-acting reversible contraception, uptake in developed countries remains relatively low. The role of healthcare professionals outside of the general practice setting in long-acting reversible contraception provision requires further attention. DESIGN: Systematic review. METHODS: Five electronic databases were searched for existing qualitative findings using terms related to long-acting reversible contraception and healthcare professional views for the period 2013-2018. A rigorous protocol was applied following the Preferred Reporting Items for Systematic Meta-Analyses checklist and flow diagram. The Critical Appraisal Skills Programme tool was used to assess the quality of studies. A total of six studies were included for thematic analysis. RESULTS: Three key themes emerged through analysis that had significant impact on healthcare professional views of long-acting reversible contraception: (a) contraceptive counselling practices and constraints; (b) knowledge and training about long-acting reversible contraception; and (c) concerns and personal beliefs about long-acting reversible contraception. CONCLUSIONS: Healthcare professional views on long-acting reversible contraception are shaped by practical time constraints, levels of knowledge and training, and personal beliefs and concerns. Further research is required to address these issues in order to improve clinical training and guidelines for all settings, not just general practice. RELEVANCE TO CLINICAL PRACTICE: Settings outside of general practice need to be included within the scope of initiatives that aim to improve clinical practice around access to new and emerging contraceptive methods. Further research could inform models of clinical practice that enable healthcare professionals to take enough time to talk through all contraceptive options with patients in a way that both focuses on their individual needs and is fully informed by up-to-date evidence and training.

Mange Caused by a Novel Micnemidocoptes Mite in a Golden Eagle ( Aquila chrysaetos ).

A second-year, female golden eagle ( Aquila chrysaetos ) was live trapped in northern California because of severe feather loss and crusting of the skin on the head and legs. On physical examination, the bird was lethargic, dehydrated, and thin, with severe feather loss and diffuse hyperemia and crusting on the head, ventral wings, ventrum, dorsum, and pelvic limbs. Mites morphologically similar to Micnemidocoptes derooi were identified with scanning electron microscopy. The eagle was treated with ivermectin (0.4 mg/kg) once weekly for 7 weeks, as well as pyrethrin, meloxicam, ceftiofur crystalline free acid, and voriconazole. Although the eagle's condition improved, and live mites or eggs were not evident on skin scrapings at the time of completion of ivermectin treatment, evidence of dead mites and mite feces were present after the last dose of ivermectin. Two additional doses of ivermectin and 2 doses of topical selamectin (23 mg/kg) were administered 2 and 4 weeks apart, respectively. No mite eggs, feces, or adults were evident after treatment was completed. A second golden eagle found in the same region was also affected with this mite but died soon after presentation. This is the first report, to our knowledge, of successful treatment, as well as treatment with selamectin, of mites consistent with Micnemidocoptes species in any raptorial species.

Knemidocoptic mange in wild golden eagles, California, USA.

During 2012-2013 in California, USA, 3 wild golden eagles were found with severe skin disease; 2 died. The cause was a rare mite, most closely related to Knemidocoptes derooi mites. Cautionary monitoring of eagle populations, habitats, and diseases is warranted.

"You got an instant conversation": Goal progress and perceptions following an e-mentoring social media intervention for young people who use augmentative and alternative communication.

INTRODUCTION: Persons with communication disability are at increased risk of social isolation due to multiple societal barriers. Young people with communication disability are not using social media to the same extent as the general population, limiting their access to social networks. The aim of this research was to investigate an e-mentoring intervention to progress the goal attainment of online conversation for young people who use augmentative and alternative communication (AAC). METHODS: Using a mixed-methods design, four participants between 13 and 18 years of age who used AAC participated in a 4-month cross-age peer e-mentoring intervention. Mentoring was provided by adults who were considered cross-age peers as they also used AAC. The Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS) tools were used to measure progress in individually developed goals for online conversation. Interviews with participants, their parents, and their mentors were conducted to describe their experiences of the intervention. RESULTS: Changes in participants' COPM ratings of performance and satisfaction with performance following intervention were statistically significant (p = 0.001, p = 0.032 respectively) and on average participant goals were attained at the expected level on the goal attainment scale (T = 63.97). However, goal attainment varied when considering specific goals. Variability in goal progress was described by participants alongside a range of barriers and facilitators. Mentees, their parents, and their mentors perceived that the intervention enabled goal progress and described improvements in social media use that extended beyond the targeted goals. CONCLUSIONS: Outcomes from the COPM and GAS demonstrate the value of cross-age peer e-mentoring to support young people who use AAC to participate in online conversation. Benefits of the intervention were commonly perceived by mentees, their parents, and mentors to extend beyond the specific goal attainments.

Perceptions of barriers to addressing pharmaceutical stockout in timor-leste.

Background: Since 2005, stockout of pharmaceuticals has been a constant issue at all health services in Timor-Leste (TL). Aim: This study identifies factors that contribute to the ongoing pharmaceutical stockout as perceived by various stakeholders. Methods: A mixed-method approach was implemented, including face-to-face interviews with 46 Timorese health professionals involved in the pharmaceutical supply chain, along with documentational review and analysis. The field study was conducted in four locations (Dili, Liquiça, Aileu, and Ermera) from July to October 2018. This paper draws on qualitative accounts of participants' perceptions, which were investigated through an interview schedule in the Tetum language, with transcripts translated into English for analysis. Results: The responses gathered were consistent among various groups of employees. Perceptions of stakeholder views on factors contributing to pharmaceutical stockout were identified. These included issues such as poor coordination, failure to adhere to policy guidelines, significant difficulties, and lack of knowledge with inventory management, quantification, forecasting, and budgetary constraints. A weak logistic management information system and a lack of capacity in inventory management resulted in a lack of reliable data. Other factors, such as political intervention, work ethics and lack of basic infrastructure, such as internet connectivity, were also reported by participants. Conclusion: The findings highlighted that there are multiple factors contributing to the ongoing pharmaceutical stockout. This may be addressed by implementing more culturally appropriate education and training on forecasting methods.

How Do Disadvantaged Children Perceive, Understand and Experience Household Food Insecurity?

Food insecurity is associated with reduced physical, social, and psychological functioning in children. There has been sparse research into child food insecurity that incorporates children's own perspectives, as adults are often interviewed as child proxies. While a nuanced, child-centred understanding of food insecurity is needed to inform effective policy and program responses, little is known about Australian children's firsthand understanding or experience of household food insecurity. This study aimed to fill this gap by inviting preadolescent children's perspectives. Eleven participants aged 10-13 years (seven girls and four boys) took part in the study and were recruited from an Australian charity school holiday camp that targets severely disadvantaged youth. Children took part in individual semi-structured interviews that incorporated drawings and emoji scales. Qualitative interviews were audio recorded, transcribed, and analysed using thematic techniques. Four themes emerged from the data analysis, children had: (i) financial understanding; (ii) awareness of food insecurity and coping mechanisms; (iii) sharing, empathy, and compassion for food insecure families; and (iv) described the nature of 'food' preparation. This study provides a child-centric analysis, demonstrating how children's agency is enacted and constrained in food insecure contexts. This child-derived understanding of food insecurity provides a critical basis from which to build effective approaches to assess and respond to this significant social issue.