Investigating consumer preferences and experiences of telehealth services in Australian allied health practice: a study protocol.

INTRODUCTION: Telehealth service provision and uptake has rapidly increased since the COVID-19 pandemic, allowing healthcare to be delivered safely and reducing non-essential face-to-face (F2F) contact. In Australia, the expansion of subsidisation of telehealth during COVID has led to its permanent installation within Australian primary care in 2022. However, little is known about consumer preferences and experiences with these services, particularly in relation to allied health practice (AHP). Previous studies on telehealth services have focused on general practice rather than allied health (AH) and broader primary care. Given that AH professionals make up a large proportion of the Australian healthcare workforce, the purpose of this study is to explore consumer preferences and experiences with telehealth AHP healthcare. METHODS AND ANALYSIS: This study uses a mixed methods research design that incorporates three independent but interrelated phases. Phase 2 of the study will use a focus group methodology to discuss consumer attitudes and experiences via a semistructured interview format. Phase 3 involves a discrete choice experiment (DCE) involving a large online survey conducted across the general population. The DCE will be informed by the qualitative findings from phases 1 and 2. The experiment aims to elicit consumer preferences in relation to AH services delivered through telehealth or F2F consultations, based on several hypothetical scenarios and preferences over several different dimensions. ETHICS AND DISSEMINATION: Ethics approval has been obtained from La Trobe University (approval number HEC23404). Findings will be disseminated as reports, presentations and peer-reviewed journal articles.

Implementation of DNA Methylation Array Profiling in Pediatric Central Nervous System Tumors: The AIM BRAIN Project: An Australian and New Zealand Children's Haematology/Oncology Group Study.

DNA methylation array profiling for classifying pediatric central nervous system (CNS) tumors is a valuable adjunct to histopathology. However, unbiased prospective and interlaboratory validation studies have been lacking. The AIM BRAIN diagnostic trial involving 11 pediatric cancer centers in Australia and New Zealand was designed to test the feasibility of routine clinical testing and ran in parallel with the Molecular Neuropathology 2.0 (MNP2.0) study at Deutsches Krebsforschungszentrum (German Cancer Research Center). CNS tumors from 269 pediatric patients were prospectively tested on Illumina EPIC arrays, including 104 cases co-enrolled on MNP2.0. Using MNP classifier versions 11b4 and 12.5, we report classifications with a probability score ≥0.90 in 176 of 265 (66.4%) and 213 of 269 (79.2%) cases, respectively. Significant diagnostic information was obtained in 130 of 176 (74%) for 11b4, and 12 of 174 (7%) classifications were discordant with histopathology. Cases prospectively co-enrolled on MNP2.0 gave concordant classifications (99%) and score thresholds (93%), demonstrating excellent test reproducibility and sensitivity. Overall, DNA methylation profiling is a robust single workflow technique with an acceptable diagnostic yield that is considerably enhanced by the extensive subgroup and copy number profile information generated by the platform. The platform has excellent test reproducibility and sensitivity and contributes significantly to CNS tumor diagnosis.

Non-Invasive Solutions to Identify Distinctions Between Healthy and Mild Cognitive Impairments Participants.

Mild cognitive impairment (MCI) is a condition characterized by impairment in a single cognitive domain or mild deficit in several cognitive domains. MCI patients are at increased risk of progression to dementia with almost 50% of MCI patients developing dementia within five years. Early detection can play an important role in early intervention, prevention, and appropriate treatments. In this study, we examined heart rate variability (HRV) as a novel physiological biomarker for identifying individuals at higher risk of MCI. We investigated if measuring HRV using non-invasive sensors might offer reliable, non-invasive techniques to distinguish MCI patients from healthy controls. Twenty-one MCI patients were recruited to examine this possibility. HRV was assessed using CorSense wearable device. HRV indices were analyzed and compared in rest between MCI and healthy controls. The significance of difference of numerical data between two groups was assessed using parametric unpaired t-test or non-parametric Wilcoxon rank sum test based on the fulfilment of unpaired t-test assumptions. Multiple linear regression models were performed to assess the association between individual HRV parameter with the cognitive status adjusting for gender and age. Time-domain parameters i.e., the standard deviation of NN intervals (SDNN), and the root mean square of successive differences between normal heartbeats (RMSSD) were significantly lower in MCI patients compared with healthy controls. Prediction accuracy for the logistic regression using 10-fold cross-validation was 76.5%, Specificity was 0.8571, while sensitivity was 0.8095. Our study demonstrated that healthy participants have higher HRV indices compared to older adults with MCI using non-invasive biosensors technologies. Our results are of clinical importance in terms of showing the possibility that MCI of older people can be predicted using only HRV PPG-based data.

Childhood cancer survivorship: barriers and preferences.

OBJECTIVE: Many survivors are disengaged from follow-up, mandating alternative models of survivorship-focused care for late effects surveillance. We explored survivors' barriers to accessing, and preferences for survivorship care. METHODS: We invited Australian and New Zealand survivors of childhood cancer from three age groups: <16 years (represented by parents), 16-25 years (adolescent and young adults (AYAs)) and >25 years ('older survivors'). Participants completed questionnaires and optional interviews. RESULTS: 633 survivors/parents completed questionnaires: 187 parents of young survivors (mean age: 12.4 years), 251 AYAs (mean age: 20.6 years) and 195 older survivors (mean age: 32.5 years). Quantitative data were complemented by 151 in-depth interviews. Most participants, across all age groups, preferred specialised follow-up (ie, involving oncologists, nurses or a multidisciplinary team; 86%-97%). Many (36%-58%) were unwilling to receive community-based follow-up. More parents (75%) than AYAs (58%) and older survivors (30%) were engaged in specialised follow-up. While follow-up engagement was significantly lower in older survivors, survivors' prevalence of late effects increased. Of those attending a follow-up clinic, 34%-56% were satisfied with their care, compared with 14%-15% of those not receiving cancer-focused care (p<0.001). Commonly reported barriers included lack of awareness about follow-up availability (67%), followed by logistical (65%), care-related beliefs (59%) and financial reasons (57%). Older survivors (p<0.001), living outside major cities (p=0.008), and who were further from diagnosis (p=0.014) reported a higher number of barriers. CONCLUSIONS: Understanding patient-reported barriers, and tailoring care to survivors' follow-up preferences, may improve engagement with care and ensure that the survivorship needs of this population are met.

Understanding Identity Changes in Psychosis: A Systematic Review and Narrative Synthesis.

BACKGROUND AND OBJECTIVE: Experiencing psychosis can be associated with changes in how people see themselves as individuals and in relation to others (ie, changes in their identity). However, identity changes receive little attention in treatment, possibly due to a lack of clarity or consensus around what identity change means in people with psychosis. We aimed to create a conceptual framework synthesizing how identity changes are understood in the psychosis literature. METHODS: Electronic databases were searched up to April 2020. Studies about identity changes among people with psychotic disorders were analyzed using narrative synthesis by a collaborative review team, including researchers from different disciplines, clinicians, and people who have experienced psychosis. RESULTS: Of 10 389 studies screened, 59 were eligible. Identity changes are understood in 5 ways as (1) characteristics of psychosis, (2) consequences of altered cognitive functioning, (3) consequences of internalized stigma, (4) consequences of lost roles and relationships, and (5) reflections of personal growth. These 5 understandings are not mutually exclusive. Across a heterogeneous literature, identity changes were mostly framed in terms of loss. CONCLUSIONS: Our conceptual framework, comprising 5 understandings, highlights the complexity of studying identity changes and suggests important implications for practice and research. For clinicians, this framework can inform new therapeutic approaches where the experience and impact of identity changes are acknowledged and addressed as part of treatment. For researchers, the conceptual framework offers a way of locating their understandings of identity changes when undertaking research in this area.

Changing from the inside out? Examining relationships between overweight identification, dieting behaviours, and body measurements over time.

OBJECTIVE: To investigate whether changes in overweight identification were associated with dieting behaviours and body measurements over time. DESIGN: Longitudinal study with assessments at three time points: before and twice during (i.e., baseline, 6 months, 12 months) a 1-year self-directed weight loss attempt. METHOD: Eighty individuals with overweight or obesity (classified by BMI ≥ 25) reported their personal (i.e., I see myself as overweight), social (i.e., I identify/feel strong ties with other overweight people), and affective (i.e., I am pleased to be overweight) overweight identification; dieting behaviours (e.g., eat less, exercise, eat more fruit and vegetables); and had their body measurements taken (i.e., weight, height, body fat, waist circumference). RESULTS: Linear mixed modelling was used to examine between-person differences and within-person changes in overweight identification on dieting behaviours and body measurements over time. Between-person differences mattered for measurements: Higher personal overweight identification was associated with higher BMI, body fat, and waist circumference over time. Higher social overweight identification was associated with higher BMI over time. Within-person changes mattered for behaviours over time: At 12 months, decreases in social overweight identification were associated with increases in a subset of 'Eat Less, Move More' dieting behaviours, but not a subset of 'Healthy' dieting behaviours. At 12 months, decreases in affective overweight identification were also associated with increases in 'Eat Less, Move More' dieting behaviours. CONCLUSION: Addressing different aspects of overweight identification and how they change over time, may harness an important psychological pathway to support behavioural change and health irrespective of weight loss. Statement of contribution What is already known on this subject? Psychological factors, such as self-concept clarity and weight stigma, are associated with dieting behaviours and body measurements. Qualitative data suggest that identity change may be tied to dieting behaviours and weight loss. What does this study add? New insights into the nature of another psychological factor, overweight identification, among individuals with overweight and obesity attempting to lose weight. The first quantitative evidence that different aspects of overweight identification, and changes in these aspects of overweight identification over time, influence body measurements and dieting behaviours.

Similarly Torn, Differentially Shorn? The Experience and Management of Conflict between Multiple Roles, Relationships, and Social Categories.

In three studies we examined the experience and management of conflict between different types of multiple identities. Participants described a conflict between pairs of role, relational, or social identities before rating the experience (i.e., magnitude, stress, and growth) and management of conflict on a newly developed scale assessing four strategies: reconciliation, where identities are integrated, realignment, where one identity is chosen over another, retreat, where both identities are avoided, and reflection, where fit (with others, situation) determines identity selection. In general, the types of identities mattered for conflict management but not its experience: Magnitude and growth did not differ, however, stress was greater for role identity conflicts (Study 3 only) and participants endorsed the use of more realignment for role conflicts (Study 2) and more retreat for relational conflicts (Study 3) relative to other types of identity conflicts. Furthermore, findings suggested that the perceived flexibility of identities, not their importance or valence, were associated with realignment and retreat for roles and with retreat for relationships. Experiencing conflicts between multiple identities leaves people similarly torn, but multiple roles and relationships may be differentially shorn to manage conflict.

Impact of Physical Activity on the Self-Perceived Quality of Life in Non-Frail Older Adults.

As the population of older adults increases, healthy aging has become a global public health issue. Physical activity can help older adults reclaim or maintain a healthy aging process. The purpose of this paper is to investigate the relationship between physical activity, physical performance, quality of life and cognition in non-frail adults aged 65 and older. English articles in peer-reviewed journals about healthy, non-frail adults aged 65 and older were included in the present review. Additionally, articles were obtained from reviewing the reference lists of the aforementioned articles. Research proves an overwhelmingly positive correlation between physical activity and the reduction of preventable chronic illnesses, lower healthcare costs, improved cognition, improved muscle function, decreased fear of falling, and thereby, inevitably, an increased self-perceived quality of life. There is research evidence on healthy aging and the effect of physical activity, which could be of importance in a public health perspective.

Having a lot of a good thing: multiple important group memberships as a source of self-esteem.

Membership in important social groups can promote a positive identity. We propose and test an identity resource model in which personal self-esteem is boosted by membership in additional important social groups. Belonging to multiple important group memberships predicts personal self-esteem in children (Study 1a), older adults (Study 1b), and former residents of a homeless shelter (Study 1c). Study 2 shows that the effects of multiple important group memberships on personal self-esteem are not reducible to number of interpersonal ties. Studies 3a and 3b provide longitudinal evidence that multiple important group memberships predict personal self-esteem over time. Studies 4 and 5 show that collective self-esteem mediates this effect, suggesting that membership in multiple important groups boosts personal self-esteem because people take pride in, and derive meaning from, important group memberships. Discussion focuses on when and why important group memberships act as a social resource that fuels personal self-esteem.

Reduction of inappropriate exit prescriptions for proton pump inhibitors: A before-after study using education paired with a web-based quality-improvement tool.

BACKGROUND: Proton pump inhibitors (PPIs) are overprescribed despite concerns regarding associated adverse drug events. OBJECTIVE: To reduce inappropriate PPI prescriptions using hospitalization as the point of contact to effect meaningful change. DESIGN: Before-after study design. SETTING: Forty-six-bed medical clinical teaching unit in a 417-bed university teaching hospital in Montreal, Canada. PATIENTS: Four hundred sixty-four consecutively admitted patients in the preintervention control group, and 640 consecutively admitted patients in the intervention group. INTERVENTION: A monthly educational intervention paired with a Web-based quality improvement tool. MEASUREMENTS: We determined the proportion of patients admitted on PPIs, their indications, and appropriateness of use. We then compared the proportion of patients whose PPIs were discontinued at discharge before and after our intervention. RESULTS: Forty-four percent of patients were already using a PPI prior to their hospitalization. In evaluated patients, only 54% of these patients had an evidence-based indication for ongoing use. The proportion of PPIs discontinued at hospital discharge increased from 7.7% per month in the 6 months prior to intervention, to 18.5% per month postintervention (P = 0.03). CONCLUSIONS: Strategies to combat PPI overuse are needed to improve the overall quality of patient care. We significantly reduced discharge prescriptions for PPIs through the implementation of an educational initiative paired with a Web-based quality improvement tool. An active interventional strategy is likely required considering the increasingly recognized and preventable adverse events associated with PPI misuse.

Perceived control qualifies the effects of threat on prejudice.

People sometimes show a tendency to lash out in a prejudiced manner when they feel threatened. This research shows that the relationship between threat and prejudice is moderated by people's levels of perceived control: Threat leads to prejudice only when people feel concurrently low in control. In two studies, terrorist threat was associated with heightened prejudice among people who were low in perceived control over the threat (Study 1; N = 87) or over their lives in general (Study 2; N = 2,394), but was not associated with prejudice among people who were high in perceived control. Study 3 (N = 139) replicated this finding experimentally in the context of the Global Financial Crisis. The research identifies control as an important ingredient in threatening contexts that, if bolstered, can reduce general tendencies to lash out under threat.

Neurogenic and psychogenic acute postconcussion symptoms can be identified after mild traumatic brain injury.

OBJECTIVES: As provenance of postconcussion symptoms after mild traumatic brain injury (mTBI) is controversial, with similar rates found in other populations, we aimed to identify postconcussion symptoms specific to mTBI compared with controls. We also compared differences between complicated and uncomplicated mTBIs. SETTING: Hospital emergency department. PARTICIPANTS: Adult individuals (34 individuals with complicated mTBI, 76 individuals with uncomplicated mTBI, and 47 orthopedic controls) who sought care in the emergency department and were consecutively recruited by post at 2 weeks postinjury. MAIN MEASURES: Rivermead Postconcussion Symptom Questionnaire. Preinjury factors were used as covariates. RESULTS: Compared with orthopedic controls, complicated mTBI group reported greater severity of headaches, dizziness, and nausea, as well as concentration difficulties, suggesting that these are neurogenic. Severity of other symptoms measured on the Rivermead Postconcussion Symptom Questionnaire was not significantly different between these groups, suggesting that these are psychogenic. Differences were evident between the 2 mTBI samples on the items of dizziness, nausea, fatigue, sleep disturbance, and concentration difficulties. CONCLUSIONS: Neurogenic and psychogenic postconcussion symptoms were identified at the acute-phase postinjury. Findings suggest that treating persons with mTBI as a homogenous sample is not prudent. This should inform prognostic models and follow-up support offered after leaving the emergency department.

The role of psychological symptoms and social group memberships in the development of post-traumatic stress after traumatic injury.

OBJECTIVES: The costs associated with traumatic injury are often exacerbated by the development of post-traumatic stress symptoms. However, it is unclear what decreases the development of post-traumatic symptoms over time. The aim of the present research was to examine the role of psychological symptoms and social group memberships in reducing the development of post-traumatic stress symptoms after orthopaedic injuries (OIs) and acquired brain injuries (ABIs). DESIGN AND METHODS: A longitudinal prospective study assessed self-reported general health symptoms, social group memberships, and post-traumatic stress symptoms among participants with mild or moderate ABI (n= 62) or upper limb OI (n= 31) at 2 weeks (T1) and 3 months (T2) after injury. RESULTS: Hierarchical regressions revealed that having fewer T1 general health symptoms predicted lower levels of T2 post-traumatic stress symptoms after OI but forming more new group memberships at T1 predicted lower levels of T2 post-traumatic stress symptoms after ABI. CONCLUSION: A focus on acquiring group memberships may be particularly important in reducing the development of post-traumatic stress symptoms after injuries, such as ABI, which result in long-term life changes.

Water clubs in residential care: is it the water or the club that enhances health and well-being?

Recent research suggests that establishing water clubs in care homes can counteract the dangers of dehydration and enhance residents' health and well-being. This study provided an experimental test of this idea, and also explored the possibility that it is the social interaction that clubs provide which delivers health-related benefits. Consistent with this hypothesis, the study found no evidence that, on its own, increased focus on water consumption enhanced residents' health or well-being. However, residents who took part in water clubs showed improved levels of perceived social support, and those who participated in water and control clubs showed beneficial outcomes in terms of the number of General Practitioner calls they required. Consistent with a social identity approach to health and well-being, a mediation analysis also indicated that clubs achieve these positive outcomes by providing social support that helps to build a shared sense of social identity among residents.

Stigma and depression during pregnancy: does race matter?

Rates of depression treatment are low in pregnant women, particularly Black women. Stigma is an important barrier to treatment, but little research has examined how depression stigma differs in Blacks and Whites; a key purpose of this study. Participants were 532 pregnant women recruited in obstetrics settings, who responded to measures of stigma and mood. Black women reported more depression stigma than White women, regardless of their depression status, and were more likely to endorse the view that depression should be kept secret, than White women. In White women, stigma increased as a function of depression status (current, past, never). White women's perceptions of depression stigma were positively correlated with their beliefs about keeping depression secret. Secrecy and depression stigma were uncorrelated in Black women. There are important racial differences in the way depression stigma functions in pregnant women. Implications for engaging women in mental health treatment are discussed.

No country for old men? The role of a 'Gentlemen's Club' in promoting social engagement and psychological well-being in residential care.

OBJECTIVE: Social isolation is a common problem in older people who move into care that has negative consequences for well-being. This is of particular concern for men, who are marginalised in long-term care settings as a result of their reduced numbers and greater difficulty in accessing effective social support, relative to women. However, researchers in the social identity tradition argue that developing social group memberships can counteract the effects of isolation. We test this account in this study by examining whether increased socialisation with others of the same gender enhances social identification, well-being (e.g. life satisfaction, mood), and cognitive ability. METHOD: Care home residents were invited to join gender-based groups (i.e. Ladies and Gentlemen's Clubs). Nine groups were examined (five male groups, four female groups) comprising 26 participants (12 male, 14 female), who took part in fortnightly social activities. Social identification, personal identity strength, cognitive ability and well-being were measured at the commencement of the intervention and 12 weeks later. RESULTS: A clear gender effect was found. For women, there was evidence of maintained well-being and identification over time. For men, there was a significant reduction in depression and anxiety, and an increased sense of social identification with others. CONCLUSION: While decreasing well-being tends to be the norm in long-term residential care, building new social group memberships in the form of gender clubs can counteract this decline, particularly among men.

That which doesn't kill us can make us stronger (and more satisfied with life): the contribution of personal and social changes to well-being after acquired brain injury.

This study examined the roles of personal and social changes on the relationship between injury severity and life satisfaction among individuals with acquired brain injury (ABI). Personal change (i.e. having developed a survivor identity, identity strength), social changes (i.e. improved social relationships, support from services), injury severity (i.e. length of time in coma) and well-being (i.e. life satisfaction) were assessed in a sample of 630 individuals with ABIs. A counterintuitive positive relationship was found between injury severity and life satisfaction. Bootstrapping analyses indicated that this relationship was mediated by personal and social changes. Although identity strength was the strongest individual mediator, both personal and social changes each explained unique variance in this relationship. These findings suggest that strategies that strengthen personal identity and social relationships may be beneficial for individuals recovering from ABIs.

Differences in self-report measures by adolescent sex offender risk group.

Differences in self-reports among three groups of juvenile sex offenders (N = 162) were examined. Risk was defined as the sum of the following static variables based on interviews with juveniles and others and from written records: type of offense (violent or predatory = 1, not = 0), prior sex offense (any = 1, none = 0), history of sexual abuse (self or family = 1, none = 0), history of substance abuse (self or family = 1, none = 0), history of behavior problems (yes = 1, no = 0), and unstable home life (yes = 1, stable = 0). Low-risk (0 to 2 risk factors), medium-risk (3 factors), and high-risk (4 to 6 factors) groups of offenders were formed. Univariate ANCOVAs indicated that the high-risk group reported less family cohesion, more aggression, lower self-esteem, more social discomfort, and more frequent and extreme sexual fantasies. The implications of these findings for differential identification of and interventions with adolescent sex offenders are discussed.