'We Were an Afterthought': Corona Virus Disease 2019 (COVID-19) Pandemic in Culturally and Linguistically Diverse (CALD) Communities in New South Wales, Australia.

This paper investigates the impact on Culturally and Linguistically Diverse (CALD) communities in Australia of government and community responses to the coronavirus pandemic of 2019 in the domains of education, employment, housing, social connectedness, and public health communication. Most of the examples are drawn from the state of New South Wales. In Australia, CALD refers to people from countries not classified as main English speaking. Most CALD communities reported in this article are from refugee backgrounds, are recently arrived migrants or do not use English in most of their communication. Inadequate, and in some instances, inappropriate or absent support, adversely impacts CALD communities. We used a multidisciplinary bricolage approach that draws on media, government, and community support publications and concluded that CALD communities experienced heightened pressures due to lower resource availability and poor communication. This led to disruption of support services, exposing gaps and vulnerability. The results reported here challenge Australian government, schools, community agencies, researchers to include proactively CALD community perspectives when planning and responding to such crises in future. Improving communication, pandemic response planning, addressing needs and ensuring participation are key considerations.

The Effect of a Patient Activation Tailored Intervention on Type 2 Diabetes Self-Management and Clinical Outcomes: A Study from Saudi Arabian Primary Care Settings.

Background: Type 2 diabetes mellitus (T2DM) is a global public health challenge. T2DM self-management, including diet, physical activity, blood glucose self-monitoring, foot care, and adherence to medication, is considered a primary tool for managing diabetes. Patient activation, an individual's knowledge, skill, and confidence in managing their health and healthcare, was recognized to be associated with better T2DM self-management and clinical outcomes. Patient activation intervention has been described as a potential approach for enhancing chronic disease self-management. This study is aimed at examining the effect of a patient activation-tailored intervention on T2DM self-management and clinical outcomes in primary care settings in Saudi Arabia. Method: A pre- and postintervention study was conducted among ≥18 years old T2DM patients attending primary healthcare centers in Saudi Arabia. Collected data included demographics, clinical data, the Patient Activation Measure (PAM), the Summary of Diabetes Self-Care Activities (SDSCA), the diabetes knowledge test (DKT2), the problem area in diabetes test (PAID-5), and the diabetes quality of life test (DQOL). The intervention was tailored based on the participants' patient activation level. The intervention consisted of monthly face-to-face sessions for three months and a telephone follow-up per month for three months postintervention. Descriptive statistics, a paired sample t-test for scale variables, and Wilcoxon's signed-rank test for categorical variables were used for data analysis. Results: A total of 82 patients, mostly female (61%) with a mean age of 51.3 ± 9.9 years old, completed baseline and postintervention surveys. After six months of intervention, there was a significant change in patient activation score from 54.74 to 61.58 (p < 0.001), hemoglobin A1c (HbA1c) from 8.38 to 7.55 (p < 0.001), and body mass index (BMI) from 30.90 to 29.16 (p < 0.001). Also, there was a significant change in SDSCA scores (diet from 3.12 to 3.67, exercise from 2.54 to 3.49, and blood glucose self-testing from 2.37 to 3.24) (p < 0.001) and DKT from 6.29 to 7.22 (p = 0.01). Conclusion: Our findings suggested that tailoring interventions based on patients' activation levels is more likely to yield promising T2DM self-management and clinical outcomes.

Relationship Between Patient Activation and Type 2 Diabetes Mellitus Self-management and Clinical Outcomes in Saudi Arabian Primary Care Setting.

PURPOSE: Type 2 diabetes mellitus (T2DM) self-management is a comprehensive approach that individuals with T2DM employ to manage and control their condition. Patients' activation, "an individual's knowledge, skill, and confidence for managing their health and health care", has been used as a major driver of self-management. This study aimed to assess the relationship of patient activation with T2DM self-management and clinical outcomes. DESIGN: A cross-sectional study. SUBJECTS: Patients with type T2DM who age 18-years and older. SETTING: The primary care centers in Saudi Arabia. MEASURES: Patient activation measure (PAM) and the Summary of Diabetes Self-Care Activities (SDSCA). ANALYSIS: Descriptive statistic, T-test, One-way ANOVA test, Chi-square test, and linear and logistic regressions were performed. RESULTS: A total of 398 patients, mostly male (54.9%) with a mean age of 53.2 (±10.7) years old participated in the study. The participants' mean of Hemoglobin A1c (HbA1c) was 8.4% (±1.7%) and most of them (74.5%) had an uncontrolled HbA1c level (>7% %). The mean patient activation score was 55.9 (±13.5). 24.4% were at [PA1], 26.7% at [PA2], 37.4% at [PA3], and 11.5% at [PA4]. Patient activation level was positively associated with better glycemic control and self-management behaviors including diet, physical activity, blood glucose self-testing, foot care, and smoking (P < .05) but not with adherence to medication. CONCLUSIONS: Our findings reveal a positive association between patient activation level and enhanced glycemic control and self-management behaviors and suggest that patient activation-informed self-management interventions are more likely to yield promising health outcomes.

A systematic review of the effectiveness of dust control measures adopted to reduce workplace exposure.

The recent increase in silicosis cases in several countries casts doubt on dust control practices and their effectiveness in preventing respirable crystalline silica (RCS) exposure. Apart from silicosis, RCS may lead to other illnesses, health-related quality of life losses for workers and their families, and economic losses for companies. Thus, this systematic literature review examined the effectiveness of interventions employed to prevent exposure to RCS and increase the use of dust control measures. The review used keywords related to dust control interventions to search seven databases. Search results were screened and extracted for synthesis. The narrative synthesis showed the extent of research investment in China. In several designs and combinations, the interventions utilized water, surfactant, foam, and air currents to reduce dust exposure. These interventions offer varying degrees of dust control effectiveness against RCS and respirable dust. Although evidence indicates that interventions significantly decrease dust concentration levels, the control measures in place may not effectively prevent workplace overexposure to RCS. The review found that education and training interventions are employed to improve dust controls and respiratory protective equipment (RPE) use. Also, marketing strategies promote the use of RPE. These interventions can increase the frequency of use of RPE and the adoption of best practice dust control measures. Interventions increase knowledge, awareness, and attitudes about RPE usage and generate positive perceptions while reducing misconceptions. However, the benefits obtained from an intervention may diminish after its implementation, indicating that the interventions may not continually motivate workers to adopt control measures or use RPE.

The impact of peer coach-led type 2 diabetes mellitus interventions on glycaemic control and self-management outcomes: A systematic review and meta-analysis.

Type 2 diabetes mellitus (T2DM) is a major health risk and dominant cause of global mortality and morbidity. Disease-specific support from peers with similar chronic condition has shown to improve chronic disease self-management outcomes. The purpose of this systematic review is to summarise the existing evidence on the impact of peer coach-led type 2 diabetes mellitus self-management interventions on glycaemic control and self-management outcomes. Databases including MEDLINE, PubMed, CINAHL Plus, Scopus, ProQuest Central, ScienceDirect, web of science, Wiley Online Library and UOW Library were searched for eligible papers. Thirteen randomised controlled trials (RCTs) published between 2008 and 2021 were included in this review. Random-effects meta-analyses found that there were statistically significant changes in Haemoglobin A1c HbA1c) after the interventions. However, the meta-analyses showed no significant changes in LDL (low-density lipoprotein), BMI (Body mass index), systolic BP (Blood Pressure), and HRQoL (Health-related quality of life) among intervention and control groups after the intervention. The identified studies mainly recruited patients with suboptimal glucose levels; majority of them belonging to low-income population. Our findings showed that peer coaching was helpful in improving HbA1c levels, quality of life, self-efficacy, diabetes distress and patient activation. Moreover, peer coaching associations with medication adherence, hypoglycaemic symptoms, diabetes specific social support and depression were inconclusive. This review concludes that peer-led community-based interventions with longer follow up, using a mixed method of delivery among patients with suboptimal levels of HbA1c were more efficient compared to usual care for improving T2DM self-management.

End-of-Shift Monitoring of Respirable Crystalline Silica: A Critical Review of Measurement Techniques and Factors Influencing Accurate Measurements.

This article presents the findings of a systematic literature review focusing on the impact of interferences in host materials on Respirable Crystalline Silica (RCS) measurement, and the development of a validated method of calibration for RCS instrumentation for in-field use. The impact of interferences in host materials on RCS measurement has been shown to be critical information required for in-field use of portable RCS devices. Portable RCS instruments such as FTIR and XRD have been established to have good sensitivity for measurement but relatively low specificity due to interference in host materials. It has been shown that correction factors are needed to be applied to account for known interferences, especially when calibrating portable RCS instrumentation in-field. The potential to obtain reliable and repeatable results from RCS analysis instrumentation has also been demonstrated. There was significant evidence that interference materials could be present in host materials, and they influence RCS measurement. There is the potential and possibility of using portable RCS instrument for in-field measurement however the challenge is the calibration of such instrumentation in the field to account for changing host materials and thus potential interferences.

Quantitative skin exposure assessment of metals: A case study.

This article provides guidance into the quantitative risk assessment of skin exposures to metals. The use of wipe sampling methodologies has been shown to be standardised and effective for skin exposure assessment to metals. However, there is a lack of guidance documents and frameworks available to evaluate the level of health risk to workers from skin exposures to metals. Adverse health effects from exposures to metals have been described in the literature (Fernández-Nieto et al. 2006; Herman et al. 2006; Kreiss et al. 1996). Monitoring of workplace exposures typically focuses on the assessment of respiratory exposures. To provide a safe workplace there is a need to ensure all routes of exposure are risk assessed and controlled. The goal of this article was to develop skin (surface) exposure limits to metals, using the construction industry as a test environment, to quantitatively assess worker health risk of skin exposures to metals. This research concluded it was not feasible to establish single quantitative skin exposure limits to metals due to the many assumptions surrounding dermal exposures. A range of acceptable exposure limits are presented.

Impact of Public Seating Design on Mobility and Independence of Older Adults.

Background:Mobility and independence of older adults are influenced by age-related capabilities and limitations, as well as environmental factors such as non-optimum design of public seating (e.g., inappropriate seat height, angle, and compressibility as well as armrests). This study was the first part of a multi-stage investigation of the impact of public seating on older adults. Method:One hundred and six older adults (aged 65 and over) completed an online survey regarding difficulties experienced with standing up from public seating (e.g. frequency; location; type of seating; effects). Results:A majority (59.4%) reported experiencing problems, with seat height the most common issue. Shopping malls, cafes and restaurants, doctor's offices, outdoor locations, and public toilets were the most common locations. Effects included inconvenience, embarrassment, discomfort, pain, and needing help from another person to stand. Discussion:Further research is needed to explore the locations and features of seating that can contribute to this problem.

Patient activation and Type 2 diabetes mellitus self-management: a systematic review and meta-analysis.

Patient activation has been recognised as a reliable driver of self-management decision-making. This systematic review and meta-analysis examines existing evidence on whether embedding patient activation within Type 2 diabetes mellitus (T2DM) self-management programs can improve patient outcomes. This review has included 10 randomised controlled trials (RCTs) conducted between 2004 and 2019 retrieved from well-known databases such as MEDLINE, PubMed, CINAHL Plus, Scopus, ProQuest and ScienceDirect. The eligible RCTs were excluded if they scored low according to Cochrane Collaboration's 'risk of bias' criteria. Random-effects meta-analyses showed that there were no significance changes in haemoglobin A1C (HbA1c), body mass index (BMI) and patient activation measure (PAM) between intervention and control groups after the intervention; however, the systematic review findings indicated that an improved patient activation level led to significant improvements in T2DM self-management and clinical outcomes including HbA1c level. Studies with a longer follow-up period conducted in community settings and delivered by peer coaches were more likely to lead to significant improvement in both patient activation levels and T2DM self-management and clinical outcomes. This review concludes that patient activation can be used as a reliable tool for improving T2DM self-management and clinical outcomes.

Musculoskeletal disorders in aged care workers: a systematic review of contributing factors and interventions.

BACKGROUND: There is limited evidence on contributing factors and effective interventions for musculoskeletal injuries in aged care workers. PURPOSE: To systematically review the factors that contribute to musculoskeletal disorder risk amongst workers in the aged care industry, and to undertake a qualitative comparison of the interventions designed and implemented to prevent injury within this workforce. METHODS: A systematic review of the literature was conducted in Web of Science, Scopus, ProQuest, Medline, and PubMed. Relevant grey literature was also examined. Articles that reported factors that contribute to musculoskeletal injuries, or interventions to prevent and manage musculoskeletal injuries in residential aged care workers were included. FINDINGS: Of the 864 articles and 35 grey literature publications found, 63 and 29 were included in the review respectively. Results indicate that physical factors such as manual handling of people, use of assistive devices, and physical work environment are most commonly associated with musculoskeletal disorders in this population. Limited evidence of organisational and psychosocial factors considered staffing issues, work schedules, and violence. The heavy emphasis on physical factors is echoed in the grey literature in relevant guidance material and codes of practice focused on assessment and control of risks. There was limited evidence for interventions specific to aged care; existing evidence focused on equipment, training and education, policy and procedure. Interventions incorporating a combination of approaches, such as equipment and training, showed promise while preliminary evidence of the effectiveness of participatory approaches are positive. DISCUSSION: Interventions which address multiple types of contributing factors are needed to adequately prevent musculoskeletal injuries in aged care workers. Tweetable abstract: Review of contributing factors, interventions, and application of knowledge for work-related musculoskeletal injuries in aged care.

Quantitative skin exposure assessment of metals: a systematic literature review of current approaches for risk assessment using the construction industry as an exposure scenario.

PURPOSE: This article summarises a systematic literature review of skin exposure assessment methods and concepts for deriving skin (dermal) exposure limits for metals, using the construction industry, where there is a high prevalence of occupational skin exposures as a test environment. METHODS: A systematic literature review was undertaken across ten databases key to Occupational Health and Safety. Articles were considered for inclusion if they evaluated skin or surface exposure to metals or discussed the feasibility of establishing skin or surface exposure limits in an occupational setting. Only full text, peer-reviewed articles were retrieved. All publications up to 30/06/2019 were considered. The quality of evidence was evaluated based on methodology. RESULTS: A total of 71 studies were selected for inclusion in the review with 49 on skin exposure assessment methods for metals and 22 relating to the derivation of skin exposure limits. The use of wipe sampling methodologies was shown to be standardised and effective for sampling skin exposures to metals. In contrast, there was no scientific consensus on the concept of quantitative skin exposure limits. CONCLUSION: There was greater strength of evidence that wipe methods for the measurement of metals would work well. A research gap with respect to the development of health-based skin exposure limits for metals was identified. Frameworks currently proposed for devising quantitative skin exposure limits are provided. These approaches could be adapted to improve the risk assessment of skin exposures to surface metal contaminants.

The effectiveness of patient activation intervention on type 2 diabetes mellitus glycemic control and self-management behaviors: A systematic review of RCTs.

BACKGROUND: Type 2 diabetes mellitus T2DM is a major health challenge and associated with several complications and mortality. Self-management behaviors SMBs such as healthy diet, physical activity, blood glucose self-monitoring, foot care and medication adherence are critical part of diabetic care. Empowered or activated patients, are more likely to practice better SMBs. However, the effectiveness of patient activation intervention on T2DM glycemic control and SMBs is not totally well understood. AIM: To assess the effectiveness of patient activation intervention on T2DM glycemic control and SMBs. METHOD: A systematic search was undertaken through five databases to find relevant studies published between 2004 and 2018. We included randomized controlled trials with sample size ≥120 and follow up period of ≥12 months and assess the effectiveness of patient activation intervention on T2DM glycemic control and SMBs. RESULTS: 10 RCTs were identified for analysis. The total sample size is 3728 and the combined mean age is 57.3 years. The combined mean BMI is 31.2kg/m2 (obese). Seven intervention demonstrated a significant reduction in HbA1c, ranged from 0.36 to 0.80%. All interventions presented an improvement in at least one self-management behavior. DISCUSSION AND CONCLUSION: Patient activation intervention showed a significant positive effect on T2DM glycemic control and SMBs, particularly physical activity, healthy diet, foot care and blood glucose self-monitoring. The effectiveness on SMBs was seen across different intervention strategies, modes of delivery, length of intervention, and number of providers. Better effectiveness on HbA1c was associated with poorly controlled participants, culturally tailored-intervention, and in-person sessions intervention combined with telephone calls follow up.

The Physical Work Environment and Sleep: A Latent Class Analysis.

OBJECTIVE: To investigate the relationships between the physical work environment and sleep using a person-centered approach. METHODS: A total of 542 Australian employees aged 18 to 60 years completed a survey assessing exposure to physical work environment stressors (eg, noise, poor air quality, and hazardous manual tasks), sleep timing and sleep quality, and relevant covariates. RESULTS: Latent class analysis (LCA) revealed three physical work environment classes: Infrequent exposure (51%); Occasional Exposure (31%); and Regular Exposure (18%). LCA also identified four sleep classes: Larks (24%); Typical sleep (43%); Insufficient sleep (20%); and Owls (13%). The Regular Exposure class was significantly associated with the Insufficient Sleep (odds ratio [OR] = 3.15, [1.29, 7.66]) and Owls (OR = 3.47 [1.24, 9.71]) classes. CONCLUSIONS: The person-centered approach provides important insights into how unique physical work environment experiences are linked with sleep.

Normal Q-angle in an adult Nigerian population.

The Q-angle has been studied among the adult Caucasian population with the establishment of reference values. Scientists are beginning to accept the concept of different human races. Physical variability exists between various African ethnic groups and Caucasians as exemplified by differences in anatomic features such as a flat nose compared with a pointed nose, wide rather than narrow faces, and straight rather than curly hair. Therefore, we cannot assume the same Q-angle values will be applicable to Africans and Caucasians. We established a baseline reference value for normal Q-angles among asymptomatic Nigerian adults. The Q-angles of the left and right knees were measured using a goniometer in 477 Nigerian adults (354 males; 123 females) in the supine and standing positions. The mean Q-angles for men were 10.7 degrees +/- 2.2 degrees in the supine position and 12.3 degrees +/- 2.2 degrees in the standing position in the right knee. The left knee Q-angles in men were 10.5 degrees +/- 2.6 degrees in the supine position and 11.7 degrees +/- 2.8 degrees in the standing position. In women, the mean Q-angles for the right knee were 21 degrees +/- 4.8 degrees in the supine position and 22.8 degrees +/- 4.7 degrees in the standing position. The mean Q-angles for the left knee in women were 20.9 degrees +/- 4.6 degrees in the supine position and 22.7 degrees +/- 4.6 degrees in the standing position. We observed a difference in Q-angles in the supine and standing positions for all participants. The Q-angle in adult Nigerian men is comparable to that of adult Caucasian men, but the Q-angle of Nigerian women is greater than that of their Caucasian counterparts.