Patient experiences of information-sharing and patient-centred care across the broad landscape of primary care practice and provision: a nationally representative survey of Australian adults.

BACKGROUND: Australian government strategies and frameworks have been developed in recent years to encourage the integration and coordination of primary care delivery; including patient-centred approaches to clinical and preventative care, and health promotion. This study aims to explore patient experiences of information-sharing and patient-centred care across various primary care clinical settings, with a particular focus on clinical encounters with GPs, naturopaths, osteopaths and acupuncturists. METHODS: Data about healthcare utilisation and experiences from a 63-item cross-sectional survey obtained from a nationally representative sample of Australian adults aged ≥ 18 years were analysed. Chi-square and Kruskal-Wallis H tests were used to explore differences in the experiences of knowledge and information sharing during GP consultations among those who also consulted with a naturopath, osteopath or acupuncturist, compared those who had not. Logistic regression was used to investigate correlations between participants perceptions about GP consultation outcomes, and the GP's information-sharing behaviour or perceived experience of patient-centredness. RESULTS: Across 2354 participants, verbal explanation (76.3%) and/or individualised handouts (16.8%) were the most common type of information shared in GP consultations. Individuals who consulted with a GP and a naturopath, an osteopath, or an acupuncturist reported a lower rate of receiving a verbal explanation from their GP but higher rate of receiving other types of information sources including handouts. Over one quarter of study participants who visited a GP did not discuss any of their health information with their GP. Information sharing was lower for individuals who also visited a naturopath, osteopath or acupuncturist. Participants scored their consultations with a GP as patient-centred, but these scores were lower among participants who also consulted with at least one other primary care practitioner type included in the study. CONCLUSIONS: Public health and health services researchers, policymakers and leaders of primary care professions have a role and responsibility to ensure practitioners are confident and competent in sharing health information with their patients that considers their health literacy needs, and the importance of patient-centred care. Research focussed on a more in-depth understanding of the differences and relationships observed across the primary care landscape in this study is recommended.

What gets measured gets managed: A scoping review of musculoskeletal research conducted within practice-based research networks.

ABSTRACT: Musculoskeletal (MSK) conditions are often managed in primary care settings. To facilitate research and health care quality, practice-based research networks (PBRNs) offer sustained collaborations between clinicians and researchers. A scoping review was conducted to describe characteristics of PBRNs used for MSK research and MSK research conducted through PBRNs. PBRNs were identified from 1) MSK-studies identified In OVID Medline, CINAHL, and Embase databases from inception to 05 February 2023 and in ClinicalTrials.gov; and 2) from PBRN registries and websites. Among active MSK-focused PBRNs (i.e., currently recruiting and conducting research), an assessment of PBRN research good practices was performed. After screening 3025 records, 85 studies from 46 unique PBRNs met our eligibility criteria. Common conditions studied were low back pain (28%), MSK conditions not otherwise specified (25%), and osteoarthritis (19%). 32 PBRNs (70%) were deemed to be active. Among active MSK-focused PBRNs, best practice data management information was retrievable for most (53%). Due to the scarcity of publicly available information, a large proportion of PBRN research good practice items was not assessable. PBRNs have provided an avenue to assess clinical practice and patient outcomes related to MSK conditions. Further work to increase the transparency of MSK PBRN research practices is warranted.

Polysaccharide-fecal microbiota-based colon-targeted self-nanoemulsifying drug delivery system of curcumin for treating polycystic ovarian syndrome.

The gut microbiome is involved in the pathogenesis of many diseases including polycystic ovarian syndrome (PCOS). Modulating the gut microbiome can lead to eubiosis and treatment of various metabolic conditions. However, there is no proper study assessing the delivery of microbial technology for the treatment of such conditions. The present study involves the development of guar gum-pectin-based solid self-nanoemulsifying drug delivery system (S-SNEDDS) containing curcumin (CCM) and fecal microbiota extract (FME) for the treatment of PCOS. The optimized S-SNEDDS containing FME and CCM was prepared by dissolving CCM (25 mg) in an isotropic mixture consisting of Labrafil M 1944 CS, Transcutol P, and Tween-80 and solidified using lactose monohydrate, aerosil-200, guar gum, and pectin (colon-targeted CCM solid self-nanoemulsifying drug delivery system [CCM-CT-S-SNEDDS]). Pharmacokinetic and pharmacodynamic evaluation was carried out on letrozole-induced female Wistar rats. The results of pharmacokinetic studies indicated about 13.11 and 23.48-fold increase in AUC of CCM-loaded colon-targeted S-SNEDDS without FME (CCM-CT-S-SNEDDS (WFME)) and CCM-loaded colon-targeted S-SNEDDS with FME [(CCM-CT-S-SNEDDS (FME)) as compared to unprocessed CCM. The pharmacodynamic study indicated excellent recovery/reversal in the rats treated with CCM-CT-S-SNEDDS low and high dose containing FME (group 13 and group 14) in a dose-dependent manner. The developed formulation showcasing its improved bioavailability, targeted action, and therapeutic activity in ameliorating PCOS can be utilized as an adjuvant therapy for developing a dosage form, scale-up, and technology transfer.

What preconception health services would the public find when searching the internet in Australia?: results from a simulated internet-search study.

BACKGROUND: Australian preventive health strategy outlines the importance of preconception health in improving health in the community, across multiple generations and places primary and community healthcare services as a central pillar to effective preconception care. However, there is no national implementation plan to see preconception care proactively offered in healthcare settings in Australia. Instead, there is evidence that most women search the internet for information about pregnancy planning and preparation. In response, this study explores the availability and characteristics of health services found by searching for preconception care online in Australia. METHOD: Simulated Google searches were conducted using search terms 'preconception' and the name of a city/town with a population > 50,000. Related terms, 'fertility' and 'pregnancy' were also searched. Characteristics of the health services and the information available on relevant websites were extracted and reported descriptively. RESULTS: The searches identified 831 website links, including 430 websites for health services. The health services were most often located in cities/towns with populations equal to or less than 200 000 (54.2%), and housing multiple health professionals (69.8%) including a specialist doctor (66.5%), nurse (20.9%), psychologist/counsellor (2.0%) and/or naturopath (13.0%). All the health services identified online explicitly mentioned women among their target populations, while 69.1% (n = 297) also referred to providing services for men or partners. More than one third of websites included blogs (36.9%) while external links were included in 10.8% of the online sites. CONCLUSIONS: This study provides a preliminary examination of health services that may be found through internet-based searching by Australian consumers seeking health advice or support prior to becoming pregnant. Our descriptive results suggest couples may find a variety of health professionals when seeking health services for preconception care. Future research involving co-design of search terms with consumers, ongoing monitoring of health services and ensuring access to meaningful, and accurate information found through internet-searching are all necessary to ensure people of reproductive age are able to access the preconception health information and care they need.

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.

Zerumbone liquid crystalline nanoparticles protect against oxidative stress, inflammation and senescence induced by cigarette smoke extract in vitro.

The purpose of this study was to evaluate the potential of zerumbone-loaded liquid crystalline nanoparticles (ZER-LCNs) in the protection of broncho-epithelial cells and alveolar macrophages against oxidative stress, inflammation and senescence induced by cigarette smoke extract in vitro. The effect of the treatment of ZER-LCNs on in vitro cell models of cigarette smoke extract (CSE)-treated mouse RAW264.7 and human BCi-NS1.1 basal epithelial cell lines was evaluated for their anti-inflammatory, antioxidant and anti-senescence activities using colorimetric and fluorescence-based assays, fluorescence imaging, RT-qPCR and proteome profiler kit. The ZER-LCNs successfully reduced the expression of pro-inflammatory markers including Il-6, Il-1ß and Tnf-α, as well as the production of nitric oxide in RAW 264.7 cells. Additionally, ZER-LCNs successfully inhibited oxidative stress through reduction of reactive oxygen species (ROS) levels and regulation of genes, namely GPX2 and GCLC in BCi-NS1.1 cells. Anti-senescence activity of ZER-LCNs was also observed in BCi-NS1.1 cells, with significant reductions in the expression of SIRT1, CDKN1A and CDKN2A. This study demonstrates strong in vitro anti-inflammatory, antioxidative and anti-senescence activities of ZER-LCNs paving the path for this formulation to be translated into a promising therapeutic agent for chronic respiratory inflammatory conditions including COPD and asthma.

Harnessing the neuroprotective effect of oral administration of benfotiamine in MPTP induced Parkinson's disease in rats.

The study was performed to evaluate the neuroprotective effects of Benfotiamine (BFT) in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced Parkinson's disease (PD) in rats. The rats were given daily doses of BFT (100 mg/kg, 200 mg/kg) through oral administration for 42 days. The rats were given a single bilateral dosage of MPTP (0.1 mg/nostril) intranasally once before the drug treatment to induce PD. On day 42, the animals were subjected to various behavioral paradigms. Post-treatment with BFT for 42 days significantly improved the motor and nonmotor fluctuations of MPTP. The results demonstrated that treatment with BFT ameliorated MPTP-induced disorders in behavior, body balance, and dopamine levels in the mid-brain. Among the post-treated groups, a high dose of BFT was the most effective treatment. Mean values are indicated in ±SEM, n = 5***(p < 0.001) when compared with the vehicle control, n = 5 ### (p < 0.001) when compared with the disease control; (p < 0.001) when compared with the BFT per se; (p < 0.001) when compared with the low dose of BFT; (p < 0.001) when compared with the high dose of BFT. Our finding suggests that BFT contributed to superior antioxidant, and anti-inflammatory and could be a novel therapeutic method for PD management. In conclusion, BFT could be a potential drug candidate for curbing and preventing PD.

Profile of Australian Yoga Providers: Results from the Practitioner Research and Collaboration Initiative (PRACI) Workforce Survey.

Yoga is becoming increasingly popular in Western countries, particularly for maintaining health and managing chronic noncommunicable diseases. Yoga providers, including yoga teachers, yoga therapists, and healthcare workers using yoga in clinical practice, are vital in facilitating group and personalized yoga sessions. This article aims to meet an unmet need to profile the sociodemographic and practice characteristics of yoga providers in Australia. A workforce survey was distributed electronically to yoga providers throughout Australia via the Practitioner Research and Collaboration Initiative (PRACI). The yoga providers' sociodemographic and practice characteristics, professional qualifications, and practice interests reported in the survey were analyzed. The study reveals a predominantly female, middle-aged, and tertiary-educated workforce. The yoga providers considered themselves group educators offering complementary and integrative health services. Typically, they had worked part-time as a solo provider for more than 10 years since acquiring their first yoga qualification. This study represents the first exploration of the Australian yoga provider workforce on a national level. It suggests that some Australian yoga providers are highly qualified professionals integrating with healthcare modalities in education and practice. The landscape of yoga providers in Australia needs further investigation.

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.

Agarwood oil nanoemulsion counteracts LPS-induced inflammation and oxidative stress in RAW264.7 mouse macrophages.

PURPOSE: Oxidative stress and inflammation are key pathophysiological features of chronic respiratory diseases, including asthma and chronic obstructive pulmonary disease (COPD). Agarwood oil obtained from Aquilaria trees has promising antioxidant and anti-inflammatory activities. However, its clinical application is hampered by poor solubility. A viable approach to overcome this involves formulation of oily constituents into emulsions. Here, we have investigated the antioxidant and anti-inflammatory potential of an agarwood oil-based nanoemulsion (DE'RAAQSIN) against lipopolysaccharide (LPS)-induced RAW264.7 mouse macrophages in vitro. METHODS: The antioxidant and anti-inflammatory activity of DE'RAAQSIN was assessed by measuring the levels of ROS and nitric oxide (NO) produced, using the DCF-DA assay and the Griess reagent assay, respectively. The molecular pathways activated by DE'RAAQSIN were investigated via qPCR. RESULTS: LPS stimulation of RAW264.7 cells increased the production of nitric oxide (NO) and ROS and resulted in the overexpression of the inducible nitric oxide synthase (iNOS) gene. Furthermore, LPS induced the upregulation of the expression of key proinflammatory genes (IL-6, TNF-α, IL-1ß, and CXCL1) and of the antioxidant gene heme oxygenase-1 (HO-1). DE'RAAQSIN demonstrated potent antioxidant and anti-inflammatory activity by significantly reducing the levels of ROS and of secreted NO, simultaneously counteracting the LPS-induced overexpression of iNOS, IL-6, TNF-α, IL-1ß, and HO-1. These findings were corroborated by in silico activity prediction and physicochemical analysis of the main agarwood oil components. CONCLUSIONS: We propose DE'RAAQSIN as a promising alternative managing inflammatory disorders, opening the platform for further studies aimed at understanding the effectiveness of DE'RAAQSIN.

'I live in extremes': A qualitative investigation of Autistic adults' experiences of inertial rest and motion.

LAY ABSTRACT: 'Autistic inertia' is a term used by Autistic people to refer to difficulties with starting and stopping tasks. However, there has not been much research on Autistic inertia. The research that is available on Autistic inertia has mostly focused on the negative aspects of inertia, rather than on the possible benefits of needing to continue tasks. In this research, we wanted to understand more about Autistic people's experiences of inertia and to work out what things might influence these experiences. Autistic and non-Autistic researchers spoke in-depth to 24 Autistic adults. We identified four key ideas from people's responses. Autistic people spoke about their inertial 'difficulties moving from one state to another' and described how these challenges affected them 'every single day'. While they experienced inertia as 'the single most disabling part of being Autistic', people also described the positive aspects of inertia, including the joy they felt when completely immersed in a task. Our Autistic participants emphasised that inertial difficulties are experienced by everyone, the intensity of these task-switching difficulties might be especially challenging for Autistic people. Our findings also reveal how Autistic inertia can be seen both as a disabling and as an enabling condition.

Do yoga and meditation moderate the relationship between negative life events and depressive symptoms? Analysis of a national cross-sectional survey of Australian women.

Objectives: This study aims to examine the role of yoga/meditation in the relationship between negative life events, stress and depression. Methods: The Australian Longitudinal Study on Women's Health (ALSWH) surveyed 7,186 women aged 36-43 years (mean age 39.2 years; 57.2% university degree) in 2015. Mediation and moderation analyses were conducted to examine whether yoga/meditation practice moderated those relationships. Results: Yoga/meditation was practiced by 27.5% of participants, 33.2% reported negative life events in the past 12 months, and 24% had clinical depression. Perceived stress partially mediated the association between negative life events and depressive symptoms (B = 6.28; 95%CI 5.65; 6.92). Social support (B = -0.38; 95%CI -0.54; -0.23) and optimism (B = -0.25;95%CI -0.31; -0.18) moderated the association between stress and depressive symptoms. Yoga/meditation practice moderated the direct association between negative life events and depressive symptoms (B = -0.92; 95%CI -1.67; -0.18). Conclusion: Yoga/meditation use was a significant moderator of the relationship between negative life events and depression. Yoga/mediation use did not act via reducing perceived stress, but instead was found to dampen the influence of negative life events on depression directly. More research on how yoga has an impact on depression is warranted.

Criteria for the selection, evaluation and application of traditional knowledge in contemporary health practice, education, research and policy: A systematic review.

BACKGROUND: Traditional and complementary medicine (T&CM) is highly utilised and draws on traditional knowledge (TK) as evidence, raising a need to explore how TK is currently used. OBJECTIVES: Examine criteria used to select, evaluate and apply TK in contemporary health contexts. METHODS: Systematic search utilising academic databases (AMED, CINAHL, MEDLINE, EMBASE, SSCI, ProQuest Dissertations Theses Global), Trip clinical database and Google search engine. Citations and reference lists of included articles were searched. Reported use of TK in contemporary settings was mapped against a modified 'Exploration-Preparation-Implementation-Sustainment' (EPIS) implementation framework. RESULTS: From the 54 included articles, EPIS mapping found TK is primarily used in the Exploration phase of implementation (n = 54), with little reporting on Preparation (n = 16), Implementation process (n = 6) or Sustainment (n = 4) of TK implementation. Criteria used in selection, evaluation and application of TK commonly involved validation with other scientific/traditional evidence sources, or assessment of factors influencing knowledge translation. DISCUSSION: One of the difficulties in validation of TK (as a co-opted treatment) against other evidence sources is comparing like with like as TK often takes a holistic approach. This complicates further planning and evaluation of implementation. CONCLUSION: This review identifies important criteria for evaluating current and potential contemporary use of TK, identifying gaps in research and practice for finding, appraising and applying relevant TK studies for clinical care.

Berberine-loaded engineered nanoparticles attenuate TGF-ß-induced remodelling in human bronchial epithelial cells.

Airway remodelling occurs in chronic respiratory diseases (CRDs) such as asthma and chronic obstructive pulmonary disease (COPD). It is characterized by aberrant activation of epithelial reparation, excessive extracellular matrix (ECM) deposition, epithelial-to-mesenchymal transition (EMT), and airway obstruction. The master regulator is Transforming Growth Factor-ß (TGF-ß), which activates tissue repair, release of growth factors, EMT, increased cell proliferation, and reduced nitric oxide (NO) secretion. Due to its fundamental role in remodelling, TGF-ß is an emerging target in the treatment of CRDs. Berberine is a benzylisoquinoline alkaloid with antioxidant, anti-inflammatory, and anti-fibrotic activities whose clinical application is hampered by poor permeability. To overcome these limitations, in this study, berberine was encapsulated in monoolein-based liquid crystalline nanoparticles (BM-LCNs). The potential of BM-LCNs in inhibiting TGF-ß-induced remodelling features in human bronchial epithelial cells (BEAS-2B) was tested. BM-LCNs significantly inhibited TGF-ß-induced migration, reducing the levels of proteins upregulated by TGF-ß including endoglin, thrombospondin-1, basic fibroblast growth factor, vascular-endothelial growth factor, and myeloperoxidase, and increasing the levels of cystatin C, a protein whose expression was downregulated by TGF-ß. Furthermore, BM-LCNs restored baseline NO levels downregulated by TGF-ß. The results prove the in vitro therapeutic efficacy of BM-LCNs in counteracting TGF-ß-induced remodelling features. This study supports the suitability of berberine-loaded drug delivery systems to counteract airway remodelling, with potential application as a treatment strategy against CRDs.

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 direct and mediating effect of social support on health-related quality of life during pregnancy among Australian women.

BACKGROUND: Prenatal stress can have a negative effect on the quality of life (QoL) of pregnant women. Social support plays a vital role in improving the psychological well-being of pregnant women by enhancing their stress-coping ability. The current study assessed the association between social support and health-related quality of life (HRQoL) as well as the mediating role of social support in the linkage between perceived stress and HRQoL among pregnant Australian women. METHODS: Secondary data was obtained from 493 women who reported being pregnant in survey six of the 1973-78 cohort of the Australian Longitudinal Study on Women's Health (ALSWH). Social support and perceived stress were assessed using the Medical Outcomes Study Social Support Index (MOS-SSS-19) and the Perceived Stress Scale, respectively. The Mental Component Scale (MCS) and Physical Component Scale (PCS) of the SF-36 were used to examine the mental and physical HRQoL. A mediation model was used to examine the mediating effect of social support in the relationship between perceived stress and HRQoL. A multivariate quantile regression (QR) model was used to assess the association between social support and HRQoL after adjusting for potential confounders. RESULT: The mean age of the pregnant women was 35.8 years. The mediational analysis revealed that emotional/informational support (ß= -1.53; 95% CI: -2.36, -0.78), tangible support (ß= -0.64; 95% CI: -1.29, -0.09), and affectionate support/positive social interaction (ß= -1.33; 95% CI: -2.25, -0.48), played a significant mediating role in the relationship between perceived stress and mental health-related QoL. In addition, perceived stress had a significant indirect effect on mental health-related QoL through overall social support (ß = -1.38; 95% CI: -2.28, -0.56), and the mediator accounted for approximately 14.3% of the total effect. The multivariate QR analysis indicated that all the domains of social support and overall social support scores were positively associated with higher MCS scores (p < 0.05). However, social support was found to have no significant association with PCS (p > 0.05). CONCLUSION: Social support plays a direct and mediating role in improving the HRQoL of pregnant Australian women. Maternal health professionals need to consider social support as an essential tool to improve the HRQoL of pregnant women. Further, as part of routine antenatal care activity, assessing pregnant women's level of social support is beneficial.

Exploring Criteria for the Translation of Traditional Knowledge Within Contemporary Clinical Practice, Research, Policy, and Education: A Stakeholder Forum.

Background: The 2018 Declaration of Astana identifies traditional knowledge (TK) as one of the drivers for strengthening primary health care systems through the use of technology (traditional medicines) and knowledge and capacity building (traditional practitioners). While TK underpins both traditional practice and the use of traditional medicines, facilitating the use of TK in contemporary health care systems has been difficult to achieve. The aim of this study was to identify key factors related to the translation of TK into contemporary settings to help establish tools to support the knowledge translation process. Methods: This study used World Café methodology to collect the observations, ideas, and perspectives of experts who use TK in their practice. These experts (n = 9) were from a variety of contexts, including clinical practice, research, education, policy, and consumer advocacy, participated in the 1-day event. Data were collected into NVivo 12 software and analyzed using inductive-deductive thematic analysis. Results: Thematic analysis identified five themes: the need to define the elements required for critical evaluation of sources of TK as evidence, the importance of applying a tradition-centric lens when translating TK for contemporary use, the need to bridge gaps between TK and its contemporary applications, the value of critically evaluating the TK translation process itself, and the recognition of traditions as living systems. Taken together, the themes showed holistic interpretation of the translation process that incorporates critical analysis of the TK itself and accountable, transparent, and ethical processes of translation that consider safety, socioeconomical and intellectual property impacts of TK in contemporary use. Conclusions: Stakeholders identified TK as a valid and important source of evidence that should guide practice in a range of contemporary settings (e.g., policy and clinical practice), and outlined important consideration for critiquing, evaluating, communicating, and using TK within these settings.

Characteristics of Marginalized Populations Seeking Acupuncture: Findings from an Observational Study of an Inner-City Community Health Service.

Introduction: Marginalized populations experience health inequities and are often underserved within existing health systems. Australian marginalized populations and their use of complementary medicine, including acupuncture, lack investigation. We have collected information on the health-seeking behaviors of marginalized individuals who utilize an acupuncture service within a community-based integrative health setting. Methods: A secondary analysis of pre-existing data involving the linking of three datasets. Information was collected across four domains: health characteristics, socio-demographics, health services utilization, and vulnerability markers. Bivariate analysis using Fisher's exact and chi-square tests additional to logistic regression analysis were conducted to determine the characteristics of the study population. All data once analyzed were then presented as a cumulative statistic. Results: Study participants (n = 42) included 28% of individuals with reported histories of homelessness (n = 12) and 32% with a history of psychological trauma (n = 13). Eighty-three percent (n = 31) of the population sought acupuncture to manage pain and 91% (n = 36) for musculoskeletal conditions. Sixty-three percent (n = 24) reported a mental health diagnosis, most commonly depression (n = 18). Participants were most likely to engage with three other health services within the study setting, in addition to acupuncture. Participants with an illicit substance abuse problem were 12 times more likely to seek a greater number of acupuncture treatments, and individuals with trauma histories were twice as likely to attend the acupuncture clinic eight or more times. Discussion: Our study findings suggest a robust level of engagement with acupuncture treatment among the target population and a willingness to engage with integrative health services when barriers to uptake such as accessibility and affordability are removed. Findings support current evidence pertaining to acupuncture's use as an adjunct to managing pain in marginalized populations as well as a perceived acceptability and feasibility of the integration of acupuncture within conventional health settings. There is the further observation that acupuncture in a group setting is suitable for a marginalized population and an interest in commitment to treatment among individuals with substance abuse problems.

The Significance of Traditional and Complementary Medicine to Self-Care and Addressing Global Health Challenges: Advancing the Commitments of the Declaration of Astana Through a Strong Research Program.

The Declaration of Astana (DoA) developed at the Global Conference on Primary Health Care (PHC) in 2018 outlined a number of core commitments and aspirations that fall in line with the broader vision for advancing global health, addressing a number of health-related sustainable development goals and ultimately ensuring health for all. Two specific goals of the DoA that are of particular interest and concern to the argument posited here are as follows: "to build sustainable primary health care" and "to empower individuals and communities." Moreover, these specific goals and the broader declaration all point to and "highlight the importance of empowering individuals as self-carers." However, it would appear that the conception of PHC, the related health workforce and the types of self-care activities, practices and initiatives envisioned within the DoA fail to explicitly accommodate or fully acknowledge the importance of both traditional and complementary medicine (T&CM) and more specifically "T&CM self-care" in strengthening the health of all communities. The aim of this editorial is to help articulate the significance of T&CM to self-care and as a consequence to the success of the DoA and wider desired advances in global health.

The role of anxiety and depression in suicidal thoughts for autistic and non-autistic people: A theory-driven network analysis.

BACKGROUND: Autistic adults experience more frequent suicidal thoughts and mental health difficulties than non-autistic adults, but research has yet to explain how these experiences are connected. This study explored how anxiety and depression contribute to suicidal thoughts according to the Interpersonal Theory of Suicide for autistic and non-autistic adults. METHODS: Participants (autistic adults n = 463, 61% female; non-autistic n = 342, 64% female) completed online measures of anxiety, depression, thwarted belonging, and perceived burdensomeness. Network analysis explored whether: (i) being autistic is a risk marker for suicide; and (ii) pathways to suicidal thoughts are consistent for autistic and non-autistic adults. RESULTS: Being autistic connected closely with feeling like an outsider, anxiety, and movement, which connected to suicidal thoughts through somatic experiences, low mood, and burdensomeness. Networks were largely consistent for autistic and non-autistic people, but connections from mood symptoms to somatic and thwarted belonging experiences were absent for autistic adults. CONCLUSION: Autistic people experience more life stressors than non-autistic people leading to reduced coping, low mood, and suicidal thoughts. Promoting belonging, reducing anxiety, and understanding the role of movement could inform suicide prevention for autistic people. Research should accurately capture autistic lived experience when modeling suicide to ensure suicide prevention meets autistic needs.