'We aren't valued for who we are': Australian nurses' and midwives' perceptions of challenges and barriers to safeguarding children.

PURPOSE: Professionals working with children, including nurses and midwives, are foundational to effectively safeguarding children from maltreatment. However, little is known about the full nature and scope of nurses' and midwives' roles in safeguarding children in Australia presenting barriers to effective workforce preparation and support. DESIGN AND METHODS: This study reports an inductive analysis of qualitative responses (n = 51 Round 1, n = 17 Round 2) from a two-round Delphi study. The Delphi study aimed to build consensus on the nature and scope of nursing and midwifery practice in safeguarding children, and this manuscript presents findings of an inductive analysis of qualitative responses beyond the scope of the Delphi study. Participants were Australian nurses and midwives (n = 51, n = 17) from diverse child-focussed settings. RESULTS: Nurses and midwives experienced many factors outside of their control that restricted their capacity to safeguard children. Influences included high workloads, burnout, lack of support, poor collaboration, structural barriers and inaccessible services for children. CONCLUSIONS: Nurses and midwives are advocates for children but experienced many factors preventing them from effectively safeguarding children. Future approaches to reducing child maltreatment must be underpinned by support for frontline professionals to promote workforce capacity and sustainability. PRACTICE IMPLICATIONS: Despite nurses' and midwives' best intentions, their attempts to prevent and respond to child maltreatment were hampered by systemic factors beyond their control. This study highlighted the need to address broader influences on nursing and midwifery practice to reduce the impacts of child maltreatment and support children to thrive.

Interprofessional Education in Child Protection for Preservice Health and Allied Health Professionals: A Scoping Review.

Health and allied health professionals are uniquely positioned to collaborate in prevention, early intervention and responses to child maltreatment. Effective collaboration requires comprehensive interprofessional education (IPE), and inadequate collaboration across sectors and professions continually contributes to poor outcomes for children. Little is known about what interprofessional preparation health and allied health professionals receive before initial qualification (preservice) that equips them for interprofessional collaboration and provision of culturally safe care in child protection. This scoping review aimed to identify what is known internationally about IPE in child protection for preservice health and allied health professionals. Thirteen manuscripts reporting 12 studies met the inclusion criteria and were included in the synthesis. Key characteristics of the educational interventions are presented, including target disciplines, core content and their learning objectives and activities. Findings demonstrated primarily low-quality methodologies and educational interventions that had not been replicated beyond their initial context. Many educational interventions did not provide comprehensive content covering the spectrum of prevention, early intervention and responses for all types of child maltreatment, and/or did not clearly indicate how IPE was achieved. Key challenges to delivering comprehensive interprofessional child protection include lack of institutional support and competing priorities across disciplines who must meet requirements of separate regulatory bodies. Consequently, there is a need for further development and robust evaluation of educational interventions to explore how interprofessional collaborative skills for child protection can be developed and delivered in preservice health and allied health professional education.

Motivational characteristics of recreational drug use among emerging adults in social settings: an integrative literature review.

Introduction: Recreational drug use by emerging adults has been identified as an increasingly normalized trend in social contexts. It has been documented that the consumption of these substances regularly occurs at music festivals, raves, nightlife and party settings. While it is known that emerging adults participate in these risk-taking behaviors, what is not known is their motivational characteristics for use. The aim of this review to identify and review literature describing the motivations for recreational drug use and drug choice (excluding alcohol, cannabis and tobacco) by emerging adults in social settings to inform selection of appropriately aligned harm reduction education and health messaging interventions. Methods: Whittemore and Knafl's (2005) integrative approach was used to conduct the review. This integrative review was based on a three-step search strategy identifying 2,772 articles published between 2000 and 2022. Eleven studies were included in the review. This review explores the following areas: drug use settings, concurrent drug use, consumer drug knowledge, motives of use including likes and dislikes and peer influence. Results: A range of factors influence motivations of emerging adults to participate in recreational drug use. Similar to the consumption of alcohol, the use of recreational drugs by emerging adults is motivated by their perceived benefits and personal motivations to achieve euphoria, emotional intimacy, social benefits, peer influence, increased confidence and to decrease inhibitions. The review findings suggest that motivational factors that reinforce recreational drug use correlate with the desire to break away from the mundane by seeking pleasure and for the opportunity to create novel experiences. Beliefs about the positive and negative impacts of drug use, together with the desire to achieve emotional satisfaction influence drug taking activity. Conclusion: Recreational drug use has become an increased societal norm amongst drug using peer groups and cannot be entirely prevented. It is to be noted that emerging adults have a basic understanding concerning recreational drugs, however, consumer drug knowledge and interventions that target illicit substances is lacking and should be addressed in future research. Festivals, raves and nightlife settings provide opportunity to implement health promotion as it reaches large number of vulnerable individuals in a short period of time.

Moisturizers, Emollients, or Barrier Preparations for the Prevention of Pressure Injury: A Systematic Review and Meta-Analysis.

Significance: Pressure injuries are prevalent, yet preventable global health care problem estimated to affect 14% of hospital patients and up to 46% of aged care residents. One common prevention strategy is improving skin integrity through emollient therapy to optimize hydration and avoid skin breakdown. Therefore, this study aimed to review the literature and determine effectiveness of inert emollients, moisturizers, and barrier preparations compared with standard care, to prevent pressure injury in aged care or hospital settings. Recent Advances: Search terms were derived with database searches, including ProQuest, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline, Science Direct, Scopus, and the Cochrane library. The Robins1 and Risk of Bias 2 (Rob2) quality appraisal tools were used. A meta-analysis of the effects of interventions was conducted (random effects). Four studies met the inclusion criteria, with heterogeneous quality. Pooling of nonrandomized studies found that the application of emollients, moisturizers or barrier preparations did not significantly reduce incidence of pressure injury compared with standard care (relative risk 0.50, 95% confidence interval: 0.15-1.63, Z = 1.15, p = 0.25). Critical Issues: This review suggests that the use of inert moisturizers, emollients, or barrier preparations for preventing pressure injuries was not effective to prevent pressure injury in aged care or hospital settings. However, there was a distinct lack of randomized controlled trials (RCTs), with only one meeting the inclusion criteria. Furthermore, most of the included studies did not report on the frequency of application of the product, making it difficult to determine if application was in line with current international guidelines. One included study, which utilized a combination of neutral body wash and emollient demonstrated a significant reduction in the development of stage one and two pressure injuries. This combination of care may further support skin integrity and should be further examined in future trials. Future Directions: Future studies should ideally be RCTs, which control for skin cleansing, and implement an inert moisturizer emollient or barrier preparation as part of a pressure injury reduction bundle of care. Standardization of the application of the product, the volume of product applied at each application, and the quality of the product should also be considered.

Nurses' and midwives' contributions to a public health response to keeping children safe from abuse and neglect - a Delphi study.

Nurses and midwives can be instrumental to global efforts to address child abuse and neglect through a public health approach of prevention and early intervention. However, there is limited understanding of nurses' and midwives' roles, and no international or local guidelines to inform and evaluate their safeguarding practices. The aim of this modified Delphi study was to build consensus on the nature and scope of nursing and midwifery practice in safeguarding children in Australia. Sixty-four statements located within seven clusters were developed from a literature review and nursing and midwifery practice standards. Participants (N = 102) were nurses and midwives working with children in diverse contexts. They were asked to indicate the importance of each statement to their practice setting. Consensus (80%) was achieved on all statements in Round Two. Findings highlight that participating nurses and midwives agreed safeguarding children is a core component of their practice in diverse child-focussed settings. Findings can inform ongoing discussions about development of nursing and midwifery practice standards and guide effective workforce preparation, education, support and resourcing. Further research about ongoing development of nursing and midwifery roles in safeguarding children is essential to explore how to most effectively mobilise these professions to prevent child abuse and neglect.

Promoting mental health recovery by design: Physical, procedural, and relational security in the context of the mental health built environment.

The rates of mental health hospitalisations in Australia are rising. This paper presents the findings of a study undertaken in a regional mental health unit. The aim of the study was to obtain user perspectives to inform the redesign of the unit, which provides inpatient mental health services to rural and regional adults. A qualitative descriptive study with data collected via focus groups and in-depth interviews was undertaken with 38 participants, including current inpatients, carers and 27 staff members of a single regional inpatient mental health unit. The 25-bed mental health inpatient unit accommodates adults from 18+ years of age. The mental health unit sits within a referral hospital precinct and is associated with community-based mental health services within a large regional and rural Australian public health service. The analysis of interviews and focus groups with patients, carers and mental health professionals revealed three major themes congruent with the literature These were: Firstly, Theme 1: Rooms should be designed to promote physical security. Next, Theme 2: Purposeful planning to support interactions between users and systems will promote relational security. And finally, Theme 3: Optimizing service integrity should promote procedural security. Based on the themes arising from the study, a list of recommendations was produced to inform the design of a new build for a regional mental health unit. In particular, all users of the space should expect that the built environment will promote their physical security and psychological safety and accommodate a wide range of diversity and acuity. The aesthetics should align with the promotion of recovery in the context of person-centred and trauma-informed models of care. Designers should plan to alleviate boredom and accommodate meaningful wayfinding. Mental health nurses should have spaces that support their work without compromising their relational security with consumers. Building designers should optimize therapeutic environments to facilitate dignified intensive and stabilizing treatments and eliminate vicarious stigma associated with caring for people with mental illness. This study provides valuable insights from a community of users who have experienced receiving and delivering mental health care within a regional and rural mental health unit.

Social determinants of health on human immunodeficiency virus care quality in Indonesia.

AIMS: The aim was to examine the social determinants of health on human immunodeficiency virus care quality for children in Indonesia. DESIGN: A qualitative design using constructivist grounded theory methods was utilized. METHODS: Data were collected between 2019 and 2020 using in-depth- interviews and memo writing. In total, 23 semi-structured individual interviews with healthcare professionals, 12 with children with human immunodeficiency virus, and eight family members were conducted. Data were analysed with the two-step initial coding and focused coding, along with the constant comparative method, theoretical sensitivity and memo writing. RESULTS: Five themes were constructed from participants' perspectives on human immunodeficiency virus care for children: (1) living with a low-socioeconomic status, (2) lacking instrumental support, (3) experiencing complicated procedures for public health insurance, (4) limited Human Immunodeficiency Virus care services for children and (5) lacking care coordination, policies and practices. CONCLUSION: Children living with human immunodeficiency virus had poor health outcomes, due to having a low-socioeconomic status, reduced access to healthcare, coupled with a lack of social support services. IMPACT: This study demonstrated how the social determinants of health negatively impact the quality of care for Indonesian children with human immunodeficiency virus and their families. Understanding these determinants would benefit health professionals, in particular nurses, to consider these factors in their assessment to create a holistic care plan for children living with human immunodeficiency virus and their families. Addressing the social determinants of health would beneficially enhance outcomes and well-being of children living with human immunodeficiency virus health in Indonesia.

Experiences of rural and remote nurses during and following disasters: a scoping review.

INTRODUCTION: Rural and remote nurses are often involved in disaster response. These nurses are faced with unique challenges in their daily practice due to geographical isolation and reduced resources. Nurses' roles and experiences in times of disaster have been discussed in the past; however, in the setting of rural and remote areas it remains largely underreported. The aim of this article is to provide an overview of the literature regarding the experiences of rural and remote nurses during and following disasters. Disasters affect all areas of the world. METHODS: This scoping review was guided by Arksey and O'Malley's methodological framework for scoping reviews. Electronic databases CINAHL, MEDLINE, Scopus, Cochrane, Joanna Briggs Institute and Embase were searched. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist was used to guide the reporting of this review. Key concepts and themes were identified using Braun and Clarke's six-step framework for thematic analysis. RESULTS: Eight articles met the inclusion criteria for this review. Themes that were identified included disaster roles, pre-disaster preparations, psychological and emotional states, and community involvement and relationships. CONCLUSION: Minimal literature exists that explores what rural and remote nurses experience in times of disaster. In this review, the experience of rural and remote nurses included the relationships between their personal and professional obligations and their influence on nurses' ability to respond to disasters. Further research is required in this domain to better understand the phenomena and address knowledge gaps that exist in the existing literature.

'Diagnosis, disclosure and stigma: The perspectives of Indonesian children with HIV and their families'.

This grounded theory study aimed to explore the subjective experiences of children living with Human Immunodeficiency Virus (HIV) from the perspective of children and their families in Indonesia. Twenty participants were interviewed, consisting of 12 children aged 9-18 years and eight family members. Using grounded theory analysis, this study identified three categories: 'coping with diagnosis', 'disclosing their status' and 'living with the stigma of HIV'. Participants responded with shock, denial, sadness, secrecy and often had misconceptions about the virus to the diagnosis of themselves or their children. After diagnosis, children with HIV and their families continuously lived with stigma stemming from individual and societal beliefs about the virus. This stigma manifested in actions such as isolation, disclosure avoidance, secrecy, deception and social rejection. Because of these stigmatisations, many of the participants decided not to disclose the child's HIV status and used status strategies such as telling lies, keeping secrets and keeping their distance. The participants offered insight into the need for comprehensive programs to address care gaps. This study highlights that health professionals need to develop practical guidelines to support families during the disclosure process, provide psychosocial care for children, and create stigma reduction interventions for children with HIV.

Parents' Decision Making During Their Child's Asthma Attack: Qualitative Systematic Review.

Objective: To conduct a systematic review and synthesis of qualitative evidence exploring the factors that influence a parent's decision to seek medical assistance while their child is having an asthma attack. Methods: Studies were included if they used qualitative methodologies and explored parent or carers' experience of caring for a child (2 to 12 years) during an acute asthma attack at home or in the community. We searched MEDLINE (OVID interface, 1948 onwards), EMBASE (OVID interface, 1980 onwards) and CINAHL (EBSCO) electronic databases. Quality appraisal was assessed by the Critical Appraisal Skills Program CASP for qualitative research, and the qualitative studies in this review were analyzed by thematic synthesis. Results: From 4798 identified studies, 17 met the inclusion criteria. Synthesis revealed two distinct processes used by parents to aid their decision to seek medical intervention for their child. The first, past experiences informing future decisions and secondly facilitators that drive parents' to actively pursue medical help. Conclusion: This review highlights the importance of providing asthma education that not only focuses on the provision of information on symptoms, triggers, medication, and device use but asthma education that targets parents' unique experience. Using a family strength approach education can impact parents' future behavior when deciding to seek medical assistance for their child when experiencing an asthma attack. There was not a specific funding source, which supported this review. This review was registered with PROSPERO Identification Number CRD4201912740.

Construction of a conceptual model of comprehensive care for Indonesian children with human immunodeficiency virus.

PURPOSE: To construct a conceptual model of comprehensive care for Indonesian children with Human Immunodeficiency Virus. DESIGN AND METHODS: A qualitative constructivist grounded theory design. Purposive sampling was used to interview 12 children with Human Immunodeficiency Virus and 8 family members with the age of the children ranged from 9 to 18 years, and 23 health professionals, including general practitioners, paediatric specialists, nurses, midwife, and nutritionist from public health centres and provincial hospitals in East Java, Indonesia. Data was analysed using constant comparative coding methods, theoretical sensitivity, memo writing, and diagramming to facilitate the development of the substantive theory. RESULTS: Exploring the perspectives of the participants has revealed the need to enhance the delivery of comprehensive care across the continuum, because HIV care and services for children was sub-optimal. Understanding children's needs and preferences forms the foundation of the development of a framework for the comprehensive care of children with HIV consisting of child-centred care and social support, delivered by integration and coordination of care through a healthcare service. CONCLUSIONS: The conceptual model provides new knowledge and has the capacity to bring together optimal care across the continuum addressing the challenges of fragmentation of care for children and their families. PRACTICE IMPLICATIONS: The model informs that children with HIV not only need pharmacotherapy, but also other care interventions depending on their individual needs, preferences, and age. Implementing the model may help to resolve such problems, to improve collaborative practice and enhance children's participation, thereby promoting children's health outcomes.

Child and family health nurses' roles in the care of infants and children: A scoping review.

Child and family health nurses (CFHNs) work in a variety of settings with families to promote optimal growth and development in infants and children from birth to 5 years. Literature is available about models of care that CFHNs use in their work, but there is limited information about how CFHNs enact care specifically for infants and children. The aim of this scoping review was to identify and contextualize existing knowledge of how CFHNs, both in Australia and internationally, care for infants and children. Arksey and O'Malley's (2005) framework was used to review 27 studies from Australia, Sweden, Finland, United Kingdom (UK), United States of America (USA), Ireland, Netherlands, Denmark and Canada. It was identified that CFHNs, equipped with a range of assessment tools for early intervention and health promotion, use a partnership approach when working with parents to promote the health and well-being of infants and children. The literature revealed the complexity of the roles undertaken by CFHNs when caring for infants and children. Review findings indicated that CFHNs' work is distinctive because it is conducted in home and community settings, is relational and salutogenic in nature and is also located in the domain of preventative health and early intervention.

Novel Respiratory Viruses in the Context of Mass-Gathering Events: A Systematic Review to Inform Event Planning from a Health Perspective.

BACKGROUND: Mass-gathering events (MGEs) occur regularly throughout the world. As people congregate at MGEs, there is an increased risk of transmission of communicable diseases. Novel respiratory viruses, such as Severe Acute Respiratory Syndrome Coronavirus-1 (SARS-CoV-1), Influenza A Virus Subtype H1N1 Strain 2009 (H1N1pdm09), Middle East Respiratory Syndrome Coronavirus (MERS-CoV), and Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), or Coronavirus Disease 2019 (COVID-19), may require specific infection prevention and control strategies to minimize the risk of transmission when planning MGEs. This literature review aimed to identify and analyze papers relating to novel respiratory viruses with pandemic potential and to inform MGE planning. METHOD: This paper used a systematic literature review method. Various health care databases were searched using keywords relating to MGEs and novel respiratory viruses. Information was extracted from identified papers into various tables for analysis. The analysis identified infection prevention and control strategies used at MGEs to inform planning before, during, and following events. RESULTS: In total, 27 papers met the criteria for inclusion. No papers were identified regarding SARS-CoV-1, while the remainder reported on H1N1pdm09 (n = 9), MERS-CoV (n = 15), and SARS-CoV-2 (n = 3). Various before, during, and after event mitigation strategies were identified that can be implemented for future events. CONCLUSIONS: This literature review provided an overview of the novel respiratory virus epidemiology at MGEs alongside related public health mitigation strategies that have been implemented at these events. This paper also discusses the health security of event participants and host communities in the context of cancelling, postponing, and modifying events due to a novel respiratory virus. In particular, ways to recommence events incorporating various mitigation strategies are outlined.

Emergency healthcare workers' preparedness for disaster management: An integrative review.

BACKGROUND: Around 2 billion people globally were affected by natural disasters between 2008-2018. The World Health Organization requires countries and governments to have disaster plans and emergency health workers ready and prepared at all times. OBJECTIVES: To conduct an integrative review of literature of emergency healthcare workers' perceived preparedness for disaster management. METHODOLOGY: An integrative literature review using the PRISMA checklist guidelines was conducted to explore physicians, nurses, emergency medical services and allied medical professionals' preparedness for disasters. Literature was searched from 2005, published in the English language and from MEDLINE (PubMed), Google Scholar, EMBASE, PsycINFO, SCOPUS, ProQuest and CINAHL databases. Reviews, case reports, clinical audits, editorials and short communications were excluded. Studies were critically appraised using the Mixed Methods Appraisal Tool. RESULTS: The initial search yielded 9589 articles. Twenty-seven articles were included following application of the eligibility criteria. Included studies were geographically diverse including North America, the Middle East and the Asia Pacific. Most studies (n = 24) assessed the knowledge of healthcare workers in general disasters. Studies using the Disaster Preparedness Evaluation Tool reported moderate disaster preparedness and knowledge, while studies using other instruments largely reported inadequate disaster preparedness and knowledge. Regional variations were recorded, with high-income countries' reporting a higher perceived preparedness for disasters than low-income countries. CONCLUSION: The majority of the emergency healthcare workers appear to have inadequate disaster preparedness. Previous disaster experience and training improved disaster preparedness. Future research should focus on interventions to improve emergency healthcare workers preparedness for disasters.

Does the Presence of On-Site Medical Services at Outdoor Music Festivals Affect Attendees' Planned Alcohol and Recreational Drug Use?

BACKGROUND: Dedicated on-site medical services have long been recommended to improve health outcomes at mass-gathering events (MGEs). In many countries, they are being reviewed as a mandatory requirement. While it is known that perceptions of risk shape substance use plans amongst outdoor music festival (OMF) attendees, it is unclear if attendees perceive the presence of on-site medical services as a part of the safety net. The aim of this paper is to better understand whether attendees' perceptions of on-site medical services influence high-risk behaviors like alcohol and recreational drug use at OMFs. METHOD: A questionnaire was distributed to a random sample of attendees entering and attending two separate 20,000-person OMFs; one in Canada (Festival A) and one in New Zealand (Festival B). Responses focused on demographics, planned alcohol and recreational drug use, perceptions of medical services, and whether the absence of medical services would impact attendees' planned substance use. RESULTS: A total of 851 (587 and 264 attendees for Festival A and Festival B, respectively) attendees consented and participated. Gender distribution was equal and average ages were 23 to 25. At Festival A, 48% and 89% planned to use alcohol and recreational drugs, respectively, whereas at Festival B, it was 92% and 44%. A great majority were aware and supportive of the presence of medical services at both festivals, and a moderate number considered them a factor in attendance and something they would not attend without. There was significant (>10%) agreement (range 11%-46%; or 2,200-9,200 attendees for a 20,000-person festival) at both festivals that the absence of medical services would affect attendees' planned use of alcohol and recreational drugs. CONCLUSIONS: This study found that attendees surveyed at two geographically and musically distinct OMFs had high but differing rates of planned alcohol and recreational drug use, and that the presence of on-site medical services may impact attendees' perceptions of substance use risk. Future research will aim to address the limitations of this study to clarify these findings and their implications.

Comfort Equals Nurturing: Young People Talk About Mental Health Ward Design.

AIM: The aim of this research was to obtain user perspectives of adolescent patients to inform the redesign of an adolescent mental health inpatient facility ward unit in regional Australia. BACKGROUND: It is well established that the consumer will use and understand unit space differently than the health professional, because of their unique positioning and depth of experience. The participation of young people in the design of ward environments and programs is essential. METHODS: A combination of focus groups and interviews was undertaken with eight participants. RESULTS: This study found that, in its current form, the unit revolves around routines, tasks, and patient safety, which in turn are driven by secure spaces and surveillance of the patients. Due to these routines and tasks, the aspects of individualized patient care and personal impetus and comfort are lost. Adolescent patients are able to identify solutions to enhance their hospital stay in the mental health context without being excessive and unrealistic in their suggestions. CONCLUSIONS: When designing an adolescent unit, there needs to be some consideration as to how the group using the unit understands space. Through their role and depth of hospital experience, the adolescent patient will use and understand unit space differently from that of the health professional whose role is a worker. Therefore, it is necessary to gain the perspectives of adolescent patients for efficient and effective functioning of such an environment and to suit the needs of those it is "built for," the adolescent patient.

Measuring the Masses: Mass-Gathering Medical Case Reporting, Conceptual Modeling - The DREAM Model (Paper 5).

INTRODUCTION: Without a robust evidence base to support recommendations for first aid, health, and medical services at mass gatherings (MGs), levels of care will continue to vary. Streamlining and standardizing post-event reporting for MG medical services could improve inter-event comparability, and prospectively influence event safety and planning through the application of a research template, thereby supporting and promoting growth of the evidence base and the operational safety of this discipline. Understanding the relationships between categories of variables is key. The present paper is focused on theory building, providing an evolving conceptual model, laying the groundwork for exploring the relationships between categories of variables pertaining the health outcomes of MGs. METHODS: A content analysis of 54 published post-event medical case reports, including a comparison of the features of published data models for MG health outcomes. FINDINGS: A layered model of essential conceptual components for post-event medical reporting is presented as the Data Reporting, Evaluation, & Analysis for Mass-Gathering Medicine (DREAM) model. This model is relational and embeds data domains, organized operationally, into "inputs," "modifiers," "actuals," and "outputs" and organized temporally into pre-, during, post-event, and reporting phases. DISCUSSION: Situating the DREAM model in relation to existing models for data collection vis a vis health outcomes, the authors provide a detailed discussion on similarities and points of difference. CONCLUSION: Currently, data collection and analysis related to understanding health outcomes arising from MGs is not informed by robust conceptual models. This paper is part of a series of nested papers focused on the future state of post-event medical reporting.

Measuring the Masses: A Proposed Template for Post-Event Medical Reporting (Paper 4).

BACKGROUND: Standardizing and systematizing the reporting of health outcomes from mass gatherings (MGs) will improve the quality of data being reported. Setting minimum standards for case reporting is an important strategy for improving data quality. This paper is one of a series of papers focused on understanding the current state, and shaping the future state, of post-event case reporting. METHODS: Multiple data sources were used in creating a lean, yet comprehensive list of essential reporting fields, including a: (1) literature synthesis drawn from analysis of 54 post-event case reports; (2) comparison of existing data models for MGs; (3) qualitative analysis of gaps in current case reports; and (4) set of data domains developed based on the preceding sources. FINDINGS: Existing literature fails to consistently report variables that may be essential for not only describing the health outcomes of a given event, but also for explaining those outcomes. In the context of current and future state reporting, 25 essential variables were identified. The essential variables were organized according to four domains, including: (i) Event Domain; (ii) Hazard and Risk Domain; (iii) Capacity Domain; and (iv) Clinical Domain. DISCUSSION: The authors propose a first-generation template for post-event medical reporting. This template standardizes the reporting of 25 essential variables. An accompanying data dictionary provides background and standardization for each of the essential variables. Of note, this template is lean and will develop over time, with input from the international MG community. In the future, additional groups of variables may be helpful as "overlays," depending on the event category and type. CONCLUSIONS: This paper presents a template for post-event medical reporting. It is hoped that consistent reporting of essential variables will improve both data collection and the ability to make comparisons between events so that the science underpinning MG health can continue to advance.

Measuring the Masses: Domains Driving Data Collection and Analysis for the Health Outcomes of Mass Gatherings (Paper 3).

INTRODUCTION: Without a robust evidence base to support recommendations for medical services at mass gatherings (MGs), levels of care will continue to vary and preventable morbidity and mortality will exist. Accordingly, researchers and clinicians publish case reports and case series to capture and explain some of the health interventions, health outcomes, and host community impacts of MGs. Streamlining and standardizing post-event reporting for MG medical services and associated health outcomes could improve inter-event comparability, thereby supporting and promoting growth of the evidence base for this discipline. The present paper is focused on theory building, proposing a set of domains for data that may support increasingly comprehensive, yet lean, reporting on the health outcomes of MGs. This paper is paired with another presenting a proposal for a post-event reporting template. METHODS: The conceptual categories of data presented are based on a textual analysis of 54 published post-event medical case reports and a comparison of the features of published data models for MG health outcomes. FINDINGS: A comparison of existing data models illustrates that none of the models are explicitly informed by a conceptual lens. Based on an analysis of the literature reviewed, four data domains emerged. These included: (i) the Event Domain, (ii) the Hazard and Risk Domain, (iii) the Capacity Domain, and (iv) the Clinical Domain. These domains mapped to 16 sub-domains. DISCUSSION: Data modelling for the health outcomes related to MGs is currently in its infancy. The proposed illustration is a set of operationally relevant data domains that apply equally to small, medium, and large-sized events. Further development of these domains could move the MG community forward and shift post-event health outcomes reporting in the direction of increasing consistency and comprehensiveness. CONCLUSION: Currently, data collection and analysis related to understanding health outcomes arising from MGs is not informed by robust conceptual models. This paper is part of a series of nested papers focused on the future state of post-event medical reporting.