Achieving consensus on the essential knowledge and skills needed by nursing students to promote planetary health and sustainable healthcare: A Delphi study.

AIM: To achieve consensus on the knowledge and skills that undergraduate/pre-licensure nursing students require to steward healthcare towards a more sustainable future. DESIGN: A two-phase real-time Delphi study. METHODS: Phase 1 included the generation of Planetary Health, climate change and sustainability knowledge and skill statements based on a review of relevant literature. Phase 2 consisted of a real-time Delphi survey designed to seek consensus on the proposed statements from a panel of 42 international experts. RESULTS: Of the 49 survey statements, 44 (90%) achieved ≥75% consensus and 26 (53%) achieved ≥80% consensus. Three were removed and 32 were modified to improve clarity of language. CONCLUSION: The knowledge and skills statements that emerged through this Delphi study can serve as a guide for incorporating Planetary Health, climate change and sustainability into nursing education programs. IMPLICATIONS FOR THE PROFESSION: Incorporating Planetary Health and climate change education into nursing programs has the potential to produce more environmentally conscious and socially responsible nurses. IMPACT: The absence of consensus on the essential knowledge and skills expected of nursing students has hindered the advancement of curricula and impacted educators' confidence in teaching Planetary Health and climate change. This study has resulted in a meticulously crafted framework of knowledge and skill statements that will be beneficial to educators, the future nursing workforce, and, ultimately, the individuals and communities whom nurses serve. REPORTING METHOD: This paper adheres to the Conducting and REporting DElphi Studies (CREDES) reporting guideline. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Mental Health Literacy and Education of Complementary Medicine Practitioners: A Cross-Sectional Study.

An estimated 42% of Australians who consult complementary medicine (CM) practitioners have a mental health diagnosis. Preparedness of CM practitioners in managing such diagnoses is currently unknown. A cross-sectional survey of 257 CM practitioners who reported caring for people with a mental health diagnosis. Practitioners' mental health literacy, educational needs, and confidence in the assessment, management, and treatment of mental health-including suicide risk-were analysed. Most (59.1%) participants had no formal qualifications in mental health and 44.3% indicated they had not completed any training in psychological therapies. Only 20% were trained in mindfulness-based techniques or goal setting. Over 50% reported their undergraduate qualification contained insufficient mental health content to prepare them for clinical practice. Over one-half had attended continuing professional education on mental health. Practitioners reported greater confidence in assessing, managing, and treating mental wellbeing over complex mental health disorders and suicide risk. These findings uncovered a deficit in the CM practitioner's surveyed mental health education. As these CM practitioners are a primary point of contact for patients with mental health diagnoses, there is a critical need to expedite skills development in this workforce to support the delivery of safe and effective primary mental health care.

The prevalence of breastfeeding aversion response in Australia: A national cross-sectional survey.

Some women who breastfeed will experience complex ongoing difficulties, such as breastfeeding aversion response (BAR). This recently named breastfeeding challenge is defined as feelings of aversion while breastfeeding for the entire time that the child is latched. This study provides the first prevalence data for the experience of BAR in Australian breastfeeding women. A national online survey investigated the breastfeeding experience of Australian women including data on (1) participant demographics, (2) breastfeeding experience with up to four children, (3) breastfeeding challenges and prevalence of BAR, and (4) the value of available breastfeeding support. This study found that of the Australian breastfeeding women who participated (n = 5511), just over one in five self-identified as having experienced a BAR (n = 1227, 22.6%). Most reported experiencing some breastfeeding challenges, with only 4.5% (n = 247) having had no breastfeeding complications. Importantly, despite these difficulties, 86.9% of the total women in this study rated their overall breastfeeding experience as good (n = 2052, 37.6%), or very good (n = 2690, 49.3%), and 82.5% of those who experience BAR as good (n = 471, 38.7%) or very good (n = 533, 43.8%). BAR reporting was decreased in higher education and income groups. Women who are breastfeeding for the first time are more likely to encounter difficulties with breastfeeding such as BAR. Complications with breastfeeding are pervasive, but women who can overcome breastfeeding issues often report a positive overall breastfeeding experience.

Respiratory pandemics, urban planning and design: A multidisciplinary rapid review of the literature.

COVID-19 is the most recent respiratory pandemic to necessitate better knowledge about city planning and design. The complex connections between cities and pandemics, however challenge traditional approaches to reviewing literature. In this article we adopted a rapid review methodology. We review the historical literature on respiratory pandemics and their documented connections to urban planning and design (both broadly defined as being concerned with cities as complex systems). Our systematic search across multidisciplinary databases returned a total of 1323 sources, with 92 articles included in the final review. Findings showed that the literature represents the multi-scalar nature of cities and pandemics - pandemics are global phenomena spread through an interconnected world, but require regional, city, local and individual responses. We characterise the literature under ten themes: scale (global to local); built environment; governance; modelling; non-pharmaceutical interventions; socioeconomic factors; system preparedness; system responses; underserved and vulnerable populations; and future-proofing urban planning and design. We conclude that the historical literature captures how city planning and design intersects with a public health response to respiratory pandemics. Our thematic framework provides parameters for future research and policy responses to the varied connections between cities and respiratory pandemics.

The health care utilization and out-of-pocket expenditure associated with asthma amongst a sample of Australian women aged over 45 years: analysis from the '45 and up' study.

OBJECTIVE: This study aims to describe the prevalence of health care utilization (including conventional medicine, self-care and complementary medicine treatments) for the management of asthma by women aged 45 years and over and their associated out-of-pocket expenditure. METHODS: A self-reported mail survey of 375 Australian women, a cohort of the national 45 and Up Study, reporting a clinical diagnosis of asthma. The women were asked about their use of health care resources including conventional medicine, complementary medicine, and self-prescribed treatments for asthma and their associated out-of-pocket spending. Spearman's correlation coefficient, student's t-test and chi-square test were used as appropriate. Population level costs were created by extrapolating the costs reported by participants by available national prevalence data. RESULTS: Survey respondents (N = 375; response rate, 46.9%) were, on average, 67.0 years old (min 53, max 91). The majority (69.1%; n = 259) consulted at least one health care practitioner in the previous 12 months for their asthma. Most of the participants (n = 247; 65.9%) reported using at least one prescription medication for asthma in the previous 12 months. The total out-of-pocket expenditure on asthma treatment for Australian women aged 50 years and over is estimated to be AU$159 million per annum. CONCLUSIONS: The breadth of conventional and complementary medicine health care services reported in this study, as well as the range of treatments that patients self-prescribe, highlights the challenges of coordinating care for individuals living with asthma.

Conventional and complementary health care use and out-of-pocket expenses among Australians with a self-reported mental health diagnosis: a cross-sectional survey.

BACKGROUND: Mental health disorders are a global health concern. In Australia, numerous national reports have found that the current mental healthcare system does not adequately meet the needs of Australians with mental illness. Consequently, a greater understanding of how people with a mental health disorder are using the broader healthcare system is needed. The aim of this paper is to explore conventional and complementary health care use and expenditure among Australian adults reporting a mental health disorder diagnosis. METHODS: A cross-sectional online survey of 2,019 Australian adults examined socio-demographic characteristics, complementary and conventional health care use and the health status of participants. RESULTS: 32 % (n = 641) of the total sample (N = 2019) reported a mental health disorder in the previous 3 years. Of these, 96 % reported consulting a general practitioner, 90.6 % reported using prescription medicines, 42.4 % consulted a complementary medicine practitioner, 56.9 % used a complementary medicine product and 23 % used a complementary medicine practice. The estimated 12-month out-of-pocket health care expenditure among Australians with a mental health disorder was AUD$ 4,568,267,421 (US$ 3,398,293,672) for conventional health care practitioners and medicines, and AUD$ 1,183,752,486 (US$ 880,729,891) for complementary medicine practitioners, products and practices. Older people (50-59 and 60 and over) were less likely to consult a CM practitioner (OR = 0.538, 95% CI [0.373, 0.775]; OR = 0.398, 95% CI [0.273, 0.581] respectively) or a psychologist/counsellor (OR = 0.394, 95% CI [0.243, 0.639]; OR = 0.267, 95% CI [0.160, 0.447] respectively). People either looking for work or not in the workforce were less likely to visit a CM practitioner (OR = 0.298, 95% CI [0.194, 0.458]; OR = 0.476, 95% CI [0.353, 0.642], respectively). CONCLUSIONS: A substantial proportion of Australian adults living with a mental health disorder pay for both complementary and conventional health care directly out-of-pocket. This finding suggests improved coordination of healthcare services is needed for individuals living with a mental health disorder. Research examining the redesign of primary health care provision should also consider whether complementary medicine practitioners and/or integrative health care service delivery models could play a role in addressing risks associated with complementary medicine use and the unmet needs of people living with a mental health disorder.

Subjective wellbeing in the Indian general population: a validation study of the Personal Wellbeing Index.

PURPOSE: The Personal Wellbeing Index (PWI) is a commonly used measure of life satisfaction that reflects a person's level of subjective wellbeing (SWB). The present study aimed to establish the validity and reliability of the PWI in a large sample of Indian adults and describe their SWB. METHODS: 2004 Indian adults completed a cross-sectional online survey, which was presented in English and included the PWI and demographic questions. The sample was split to assess the psychometric properties of the 7-item (n = 981) and 8-item (n = 937) versions of the PWI. RESULTS: Both the 7- and 8-item versions of the PWI demonstrated adequate internal consistency (α = .89 and .88, respectively). The global means for both versions of the PWI (7-item = 74.43, 8-item = 73.82) were within the normative range for Western countries. Achieving in life had the lowest domain scores for both the 7-item (M = 70.51) and 8-item (M = 68.37) versions; the spirituality or religion domain had the highest domain score in the 8-item version (M = 78.84). CONCLUSION: The findings suggest that both the 7- and 8-item versions of the PWI are valid and reliable measures of life satisfaction for use in India. The global mean scores for both versions of the PWI were within the normative range for Western countries. In this study, Indians reported high levels of satisfaction with their spirituality or religion, suggesting this domain may be an important contributor of SWB; however, more research is needed to determine this.

Developing the Australian Midwifery Workplace Culture instrument.

AIM: To develop and psychometrically test the Australian Midwifery Workplace Culture instrument. BACKGROUND: Workplace culture is critical within midwifery settings. Culture determines not only the well-being and continued retention of maternity staff and managers but it also affects the quality and ultimate safety of the care they provide to women, infants and families. Several studies have identified cultural problems within maternity services. Relatively few instruments take account of the unique aspects of these workplaces and the relationship between midwives and women. DESIGN: Three-stage instrument development involved item generation (based on the Culture of Care Barometer), expert content validation and a pilot test. METHODS: During 2016, 38 midwifery experts reviewed the initial items, and 322 midwives then pilot-tested the draft instrument. We used exploratory factor analysis to identify key domains and to refine the instrument. RESULTS: The refined instrument contained 22 items in three distinct domains: relationship with managers, empowerment and collegiality. CONCLUSION: The instrument can contribute to understanding important dimensions of the culture in maternity workplaces and thus to examining problematic attitudes and practices. The instrument requires further development and testing with larger and more diverse samples of midwives and validation in specific midwifery settings and models of care.

Risk factors associated with intestinal permeability in an adult population: A systematic review.

BACKGROUND: Increased intestinal permeability (IP) involves the loss of integrity between the cells of the small intestine. IP has been suggested to contribute to the pathogenesis and exacerbation of many chronic diseases. Many potential risk factors for IP are proposed in contemporary literature. The purpose of this review is to identify the most significant risk factors for IP. METHODS: A systematic search of literature published up until September 2018 in the PubMed, EMBASE, CINAHL, and Scopus databases was conducted. RESULTS: A total of 47 articles met the inclusion criteria. Elevated levels of proinflammatory markers, dyslipidaemia, hyperglycaemia, insulin resistance, anthropometric measurements resembling obesity, advanced disease severity, comorbidity and the consumption of a Western-style diet were identified as the strongest risk factors for altered intestinal integrity. The risk of IP increases when coupled with a multiple disease state or combined with other environmental risk factors. Furthermore, many of the identified risk factors such as anthropometric measurements and biomarkers were external from intestinal health and rather resembled a metabolic-like condition. CONCLUSIONS: This review identified a number of potential risk factors for IP, ranging from biomarkers to anthropometric measurements, demographics, dietary intake and chronic diseases. These risk factors warrant the attention of clinicians and other healthcare providers to aid the identification of potential patients at risk of altered IP. Further research needs to examine whether the identified risk factors are homogeneous with the diagnosis of IP or whether the disease state influences the association.

Formal and informal healthcare behaviours of women with chronic illness: A cross-sectional analysis of 1925 women.

AIM: To describe the healthcare behaviours of Australian women (45 years and over) diagnosed with a chronic illness. METHODS: This is a cross-sectional sub-study of the 45 and Up Study-the largest study of healthy ageing conducted in the Southern Hemisphere-including 1,932 Australian women (45 years and older) with a self-reported diagnosis of either depression, asthma, diabetes, osteoarthritis or osteoporosis. Questionnaires were posted to eligible participants between September and December 2016 and included self-reported use of formal and informal health services and healthcare behaviours, and health practitioner recommendations and monitoring of informal care. Descriptive statistics were used to describe the sample characteristics and chi-square tests assessed associations between variables. RESULTS: The average age of participants was 69. We found that 53.7% of the women used informal healthcare products or practices for their chronic illness (eg exercise, nutritional supplements). These women were significantly (P < 0.001) more likely to consult with all types of health practitioners, compared with women not using informal healthcare. Physical activity and nutritional supplements were the most commonly recommended product or practice by all healthcare practitioners. However, informal healthcare behaviours were not regularly recommended or monitored by health practitioners. CONCLUSIONS: Women use a range of informal products and practices to manage chronic illness, but many fail to communicate with their health practitioners about such use. Future research should consider how to encourage better communication between health practitioners and patients related to informal healthcare for chronic illness to help ensure safe, effective, coordinated patient management.

Predicting the intention to use herbal medicines for anxiety symptoms: a model of health behaviour.

Background: Anxiety is a prevalent mental health condition in the Western world. Adults experiencing anxiety have been found to use a range of herbal medicines to manage anxiety symptoms.Aim: This study aimed to test a theoretical model based on the theory of planned behaviour that predicted the intention to use herbal medicines for anxiety symptoms, and to identify individual predictors of intention.Methods: An online survey was conducted with Australian adults who experienced anxiety and used herbal medicines (N = 400). A two-step approach to structural equation modelling was used to test a path model predicting the intention to use herbal medicines.Results: The model was found to be well-fitting. Attitude, subjective norms, control beliefs and severity of anxiety symptoms each significantly positively predicted intention to use herbal medicines for anxiety symptoms explaining 56% of the variance.Conclusions: The results suggest that mental health practitioners and policy makers need to ensure people experiencing anxiety have access to accurate and reliable information about herbal medicines to ensure they can effectively manage anxiety symptoms and safely engage in self-care.

Naturopathy as a Model of Prevention-Oriented, Patient-Centered Primary Care: A Disruptive Innovation in Health Care.

Background and Objective: The concept of a "disruptive innovation," recently extended to health care, refers to an emerging technology that represents a new market force combined with a new value system, that eventually displaces some, or all, of the current leading "stakeholders, products and strategic alliances." Naturopathy is a distinct system of traditional and complementary medicine recognized by the World Health Organization (WHO), emerging as a model of primary care. The objective here is to describe Naturopathy in the context of the criteria for a disruptive innovation. Methods: An evidence synthesis was conducted to evaluate Naturopathy as a potentially disruptive technology according to the defining criteria established by leading economists and health technology experts: (1) The innovation must cure disease; (2) must transform the way medicine is practiced; or (3) have an impact that could be disruptive or sustaining, depending on how it is integrated into the current healthcare marketplace. Results: The fact that Naturopathy de-emphasizes prescription drug and surgical interventions in favor of nonpharmacological health promotion and self-care could disrupt the present economic model that fuels health care costs. The patient-centered orientation of Naturopathy, combined with an emphasis on preventive behaviors and popular complementary and integrative health services like natural products, mind and body therapies, and other therapies not widely represented in current primary care models increase the likelihood for disruption. Conclusions: Because of its patient-centered approach and emphasis on prevention, naturopathy may disrupt or remain a durable presence in healthcare delivery depending on policymaker decisions.

Herbal medicine use behaviour in Australian adults who experience anxiety: a descriptive study.

BACKGROUND: Anxiety disorders are the most prevalent mental health condition in Australia. In addition, there are many people who experience problematic anxiety symptoms who do not receive an anxiety disorder diagnosis but require treatment. As herbal medicine use is popular in Australia, and little is known about how adults experiencing anxiety are using these medicines, this study aimed to identify how Australian adults who experience anxiety are using herbal medicines. METHODS: An online cross-sectional descriptive study was conducted using purposive convenience sampling to recruit Australian adults who have experienced anxiety symptoms and have used herbal medicines (N = 400). Descriptive statistics, chi-square test of contingency, analysis of variance, and simple logistic regression was used to analyse the data. RESULTS: Eighty two percent of participants experienced anxiety symptoms in the previous 12 months, with 47% reporting having previously been diagnosed with an anxiety disorder. In addition, 72.8% had used herbal medicines specifically for anxiety symptoms in their lifetime, while 55.3% had used prescribed pharmaceuticals, with 27.5% having used herbal medicines concurrently with prescribed pharmaceuticals. The Internet and family and friends were the most frequently used sources of information about herbal medicines. Forty eight percent of participants did not disclose their herbal medicine use to their doctor. CONCLUSIONS: Herbal medicines are being used by adults with anxiety and are commonly self-prescribed for anxiety symptoms. Health practitioners who are experts in herbal medicine prescribing are consulted infrequently. In addition, herbal medicine use is often not disclosed to health practitioners. These behaviours are concerning as people may not be receiving the most suitable treatments, and their use of herbal medicines may even be dangerous. It is critical we develop a better understanding of why people are using these medicines, and how we can develop improved health literacy to help with treatment decision making to ensure people receive optimal care.

Practice recommendations and referrals, perceptions of efficacy and risk, and self-rated knowledge regarding complementary medicine: a survey of Australian psychologists.

BACKGROUND: Many people with mental health problems use a range of complementary medicine (CM), including over the counter products, practices, and utilise the services of CM practitioners. Psychologists are likely to consult with clients using CM, in some form, as part of their broader mental health care. The aim of this research was to determine the number of types of CM products, practices, and practitioners are recommended and/or referred by Australian psychologists as part of their clinical practice, as well as explore the relationship between psychologists' perspectives on the risk and relevance of engaging with CM in psychology. METHODS: Survey data was collected from psychologists in clinical practice who self-selected to participate in the study via an online 79-item questionnaire exploring core aspects of CM engagement in psychology clinical practice. RESULTS: Amongst the 201 psychologists, 5% reported not recommending any type of CM, with 63% recommending four or more types of CM. Further, 25% had not referred to a CM practitioner, while 33% had referred to four or more types of CM practitioner. Psychologists are recommending and referring to CM even when they perceive their knowledge of CM to be poor, and that engaging with CM was a risk. CONCLUSION: This study provides insights into psychologist perceptions of CM within psychology practice and how these perceptions are associated with rates of recommending and referring to CM as part of their clinical practice. These findings may inform the development of CM relevant education and guidelines for psychologists.

A participatory system map of the adverse influence of urban environments on population health: integrating urban development and preventive health expertise.

OBJECTIVES: A growing number of urban development and public health professionals are developing expertise in how urban environments influence population health to support preventive health (PH) planning, implementation and outcomes. This study aimed to address the growing interest among these experts in Sydney, Australia, to move beyond silo-based approaches to PH planning and urban development by developing a preliminary mapping of the complex adaptive system. This is a network of agents and parts that collectively relate and interact, where they seek to intervene by meshing the disparate knowledge of their multidisciplinary expertise. This mapping will help experts to better integrate PH approaches by linking primordial and primary prevention within urban environments, collectively prioritising areas for intervention within the complex adaptive system, and developing a better understanding of relations between multiple factors at play within it. METHODS: The system map was developed using a unique participatory system-mapping (PSM) process involving a modified Delphi technique consisting of three rounds between October 2019 and August 2020 and 15 urban development and public health experts engaged in PH in Sydney's urban environment. RESULTS: The final system map encompassed features of the local environment, determinants of health and wellbeing in urban environments, pre-clinical health and wellbeing impacts, and clinical health outcomes, providing a comprehensive map of the adverse effects of urban environments on population health. There was a high level of agreement among experts on the final system map. While experts from different disciplines generally agreed on priority areas for intervention, consensus was higher among those from similar disciplinary backgrounds. CONCLUSIONS: The study highlights how the collective intelligence of experts from diverse disciplines can generate PSM. Furthermore, it illustrates how using systems mapping can help experts interested in complex public health problems to take a broader view of the complex adaptive system for PH planning, support collaborative prioritisation, and offer valuable insights for targeted interventions.

The relationship between psychology practice and complementary medicine in Australia: Psychologists' demographics and practice characteristics regarding type of engagement across a range of complementary medicine modalities.

INTRODUCTION: Many people with mental health problems utilise a range of complementary medicine (CM) practitioners, products, and practices. Psychologists are likely to consult with clients who are seeking and using CM, in some form, as part of their wider mental health treatment. The aim of this research is to determine how much, and in what ways, Australian psychologists recommend CM products and/or practices, and/or initiate referrals to CM practitioners as part of their clinical practice and to explore if these behaviours have any association with the characteristics of the psychologist or their wider practice. METHODS: Survey data was collected from psychologists in clinical practice who self-selected to participate between February and April 2021. Participation in the study was via an online 79-item questionnaire exploring core aspects of CM engagement in psychology clinical practice. RESULTS: Amongst the 202 psychologists who completed the survey, mind/body approaches (90.5%) were the most recommended CM and cultural/spiritual approaches the least recommended CM (7.5%). Participants also reported referring to CM practitioners with naturopaths the most common focus of their referrals (57.9%) and cultural and spiritual practitioners the least common focus of their referrals (6.69%). Our analysis shows the demographic and practice characteristics of a psychologist are generally not predictors of a psychologist's engagement with CM in their clinical practice. CONCLUSIONS: Substantial numbers of psychologists recommend CM products and practices and/or refer clients to CM practitioners. Alongside subjecting CM interventions for mental health to an evidence-base assessment, the broader discipline of psychology needs to also consider psychologist engagement with CM in clinical practice in order to help ensure cultural-sensitivity, client safety and client choice.

The engagement of psychology with complementary medicine: A critical integrative review.

Amidst the global rise in complementary medicine (CM) use for mental health, a substantial number of clients consulting a psychologist also utilise at least one form of CM. Yet, how psychologists should engage with CM in their clinical practice (e.g., how to respond to a client disclosing CM use or enquiries regarding CM products or services for mental health) remains contested and unclear. In response, a systematic integrative review was conducted to examine empirical literature reporting on one or more aspects of the relationship between psychology (incorporating clinical practice, professional associations and academia) and CM, and how that relationship may relate to or inform psychologists' engagement with CM in their clinical practice. Twenty-seven peer-reviewed articles met the specific inclusion criteria and quality appraisal was employed. Analysis shows a substantial number of psychologists are engaging with, or are interested in engaging with, CM in their clinical practice. Analysis identified a dissonance between psychologists' engagement with CM in clinical practice and the limited engagement of the broader discipline of psychology with CM. Further research is required to understand these differing types of engagement with a view to helping inform relevant policy and practice guidelines, and ultimately assist psychologists in navigating CM in their clinical practice.

Breastfeeding Aversion Response (BAR): A Descriptive Study.

INTRODUCTION: For many women, breastfeeding their infant is an enjoyable experience. Some, however, have reported negative sensations such as an overwhelming need to unlatch while breastfeeding. This phenomenon is known as breastfeeding aversion response (BAR). The incidence of BAR is unknown and literature on this experience is limited. This study therefore aimed to expand the understanding of BAR using an online survey targeting those who have experienced feelings of aversion while breastfeeding. METHODS: An online survey was distributed within Australia using purposive sampling to those who self-identified as experiencing BAR. This survey contained 5 sections: (1) demographics and health-related characteristics, (2) breastfeeding difficulties and onset of BAR, (3) the experience of BAR, (4) birth and breastfeeding experience, and (5) coping with BAR and support. Questions were included to test the generalizability of previous qualitative findings on BAR. RESULTS: Participants (N = 210) predominantly were aged between 25 and 35 years (69.2%), were in a relationship (96.2%), and had one child (80%). BAR was more commonly experienced when feeding the first-born child (44.8%), breastfeeding while pregnant (31%), or tandem feeding (10%). The feelings of aversion were experienced by most respondents throughout the feed while the child was latched (76.7%). More than half (52.4%) of participants reported that BAR had caused them to end breastfeeding sessions before their child was ready to stop feeding. Almost half of the participants (48.6%) reported receiving no support from a health care provider for BAR. DISCUSSION: This study contributes new information about the experience of BAR, including when it commonly happens and who may be at greater risk. More support is needed for women who want to breastfeed while experiencing BAR. New public health policies which promote breastfeeding are needed to help women achieve satisfying breastfeeding experiences and meet their own breastfeeding goals.

Assessing tenant health amid social housing redevelopment: lessons from a pilot project.

OBJECTIVES: To trial methods for a future longitudinal study to: a) assess how the redevelopment of a large social housing estate affects the health of tenants; and b) act on health needs identified throughout the redevelopment. Type of program or service: Self-reported health assessment with referral to community-based link worker. METHODS: Participants recruited from the tenant population completed (online or face-to-face) a health questionnaire covering self-reported health status and behaviours, housing conditions, sense of community, and demographics. Those identified as being at moderate/high risk of psychological distress and/or alcohol use disorder were contacted by a community-based link worker, who connected them with health/human services as appropriate. RESULTS: A total of 24 tenants were recruited for the pilot study against a target sample size of 50. The health questionnaire and referral process worked as expected, with no issues reported. LESSONS LEARNT: This pilot study successfully trialled methods for: a) assessing tenants' health; and b) referring those identified as being likely to have unmet health service needs to a community-based link worker, leveraging existing collaborations between academics, the local health district and community groups. Fewer tenants than expected, and none aged younger than 35 years, participated in the survey. Furthermore, the substantial number of suspicious/fraudulent responses was not anticipated. Recruitment and data collection approaches must be reviewed to address these issues if this study is to be scaled up. Although only a pilot project, we connected several tenants who had unmet health needs with a health service. While it is impossible to generalise from our small sample, the number of referrals (one-quarter of participants) indicates a potentially large unmet need for health services in the community. It highlights the importance of link workers or other person-centred integrated care interventions in social housing populations.

Prevalence and Characteristics of Australians Complementary Medicine Product Use, and Concurrent Use with Prescription and Over-the-Counter Medications-A Cross Sectional Study.

Data about the characteristics and prevalence of complementary medicine (CM) product use by Australians, including concurrent use with prescription and over-the-counter medications, have not been collected in the last five years. A cross-sectional online survey involving a representative sample of the Australian population was administered in 2021-2022. Of the 2351 survey responses included in this study, 49.4% reported use of a CM product over the previous 12-month period. Of these, 50% reported they always or often used CM products on the same day as a prescription medicine. Participants aged 65 and over were five times more likely to use CMs and other medications on the same day compared to 18-24-year-olds. Lower levels of education and having a chronic illness were also predictors of same-day use. The prevalence and characteristics of CM use by participants was similar to data collected five years ago. The study shows that concurrent use of CM products with prescription medications among older and more vulnerable populations is prevalent and this area requires further research to help ensure appropriate and safe use of CM products.