Missing link: a qualitative analysis of community-based organisations' contributions to partnered collaborative care to treat late-life depression.

OBJECTIVE: Extending collaborative care, a model integrating mental health services into primary care, to include community-based organisations (CBOs) may improve older patient health outcomes by increasing access to care and addressing patients' social needs; however, little is known about how CBOs contribute to such partnered depression care. We explored how six primary care clinic and CBO partnerships came together to provide late-life depression care through the Care Partners funded in 2014. DESIGN: 43 key informant interviews and 15 focus groups were conducted with care managers, administrators and primary care providers partnering to provide late-life depression care. Data were coded and analysed iteratively using qualitative thematic analysis. SETTING: Six primary care clinic-CBO sites across California. PARTICIPANTS: Care managers, administrators and primary care providers participated in this study. RESULTS: Three unique contributions of CBOs to depression care in these clinic-CBO partnerships were identified: (1) CBOs added new services that focus on social needs and enhanced depression care; (2) CBOs strengthened core aspects of collaborative care for depression; (3) CBOs provided new avenues for building connections and trust with underserved patients. CONCLUSIONS: CBOs, when partnered with clinics, enhanced both medical and social aspects of depression treatment for older adults. CBOs are well positioned to assist primary care clinics in treating the complex health needs of older adults by providing new and strengthening existing aspects of partnered depression care while building patient trust among culturally diverse populations.

Micro-environmental personal radio-frequency electromagnetic field exposures in Melbourne: A longitudinal trend analysis.

BACKGROUND: A knowledge gap exists regarding longitudinal assessment of personal radio-frequency electromagnetic field (RF-EMF) exposures globally. It is unclear how the change in telecommunication technology over the years translates to change in RF-EMF exposure. This study aims to evaluate longitudinal trends of micro-environmental personal RF-EMF exposures in Australia. METHODS: The study utilised baseline (2015-16) and follow-up (2022) data on personal RF-EMF exposure (88 MHz-6 GHz) measured across 18 micro-environments in Melbourne. Simultaneous quantile regression analysis was conducted to compare exposure data distribution percentiles, particularly median (P50), upper extreme value (P99) and overall exposure trends. RF-EMF exposures were compared across six exposure source types: mobile downlink, mobile uplink, broadcast, 5G-New Radio, Others and Total (of the aforementioned sources). Frequency-specific exposures measured at baseline and follow-up were compared. Total exposure across different groups of micro-environment types were also compared. RESULTS: For all micro-environmental data, total (median and P99) exposure levels did not significantly change at follow-up. Overall exposure trend of total exposure increased at follow-up. Mobile downlink contributed the highest exposure among all sources showing an increase in median exposure and overall exposure trend. Of seven micro-environment types, five of them showed total exposure levels (median and P99) and overall exposure trend increased at follow-up.

A SURVEY OF THE RADIOFREQUENCY ELECTROMAGNETIC ENERGY ENVIRONMENT IN MELBOURNE, AUSTRALIA.

A wide variety of modern technologies make use of radiofrequency (RF) electromagnetic energy (EME) to provide convenient functions and services to users. The rise in the use of RF EME-enabled devices has led to public perception of increasing exposures and concerns about potential health effects. During March and April 2022, the Australian Radiation Protection and Nuclear Safety Agency conducted an intensive campaign to measure and characterise ambient RF EME levels within the Melbourne metropolitan area. Fifty locations across the city were visited, and a wide variety of signals in the frequency range 100 kHz to 6 GHz were detected and recorded including broadcast radio and television (TV), Wi-Fi and mobile telecommunications services. The highest measured total RF EME level was 2.85 mW/m2, which is equivalent to 0.14% of the relevant limit specified by the Australian Standard (RPS S-1). The results showed that broadcast radio signals were the largest contributor to measured RF EME levels at 30 locations across the suburbs, whereas downlink signals from mobile phone towers were the main contributor at the other 20 sites. Broadcast TV and Wi-Fi were the only other sources found to contribute more than 1% of the total RF EME exposure recorded at any site. All measured RF EME levels were well below the permitted limit for general public exposure given by RPS S-1 and therefore do not present a health hazard.

"We are the sun for our community:" Partnering with community health workers/promotores to adapt, deliver and evaluate a home-based collaborative care model to improve equity in access to quality depression care for older U.S. Latino adults who are underserved.

Background: While depression is a leading cause of poor health, less than half of older adults receive adequate care. Inequities in both access and outcomes are even more pronounced for socially disadvantaged older adults. The collaborative care model (CCM) has potential to reduce this burden through community-based organizations (CBOs) who serve these populations. However, CCM has been understudied in diverse cultural and resource-constrained contexts. We evaluated the implementation and effectiveness of PEARLS, a home-based CCM adapted with and for community health workers/promotores (CHWs/Ps). Methods: We used an instrumental case study design. Our case definition is a community-academic partnership to build CHW/P capacity for evidence-based depression care for older U.S. Latino adults in the Inland Empire region of California (2017-2020). We aimed to understand adaptations to fit local context; acceptability, feasibility, and fidelity; clinical effectiveness; and contextual determinants of implementation success or failure. Data sources included quantitative and qualitative administrative and evaluation data from participants and providers. We used descriptive statistics and paired t-tests to characterize care delivery and evaluate effectiveness post-intervention, and deductive thematic analysis to answer other aims. Findings: This case study included 152 PEARLS participants and nine data sources (N = 67 documents). The CBO including their CHWs/Ps partnered with the external implementation team made adaptations to PEARLS content, context, and implementation strategies to support CHWs/Ps and older adults. PEARLS was acceptable, feasible and delivered with fidelity. Participants showed significant reductions in depression severity at 5 months (98% clinical response rate [mean (SD), 13.7 (3.9) drop in pre/post PHQ-9; p < 0.001] and received support for 2.6 social needs on average. PEARLS delivery was facilitated by its relative advantage, adaptability, and trialability; the team's collective efficacy, buy-in, alignment with organization mission, and ongoing reflection and evaluation during implementation. Delivery was challenged by weak partnerships with clinics for participant referral, engagement, reimbursement, and sustainability post-grant funding. Discussion: This case study used existing data to learn how home-based CCM was adapted by and for CHWs/Ps to reduce health inequities in late-life depression and depression care among older Latino immigrants. The CBOs and CHWs/Ps strong trust and rapport, addressing social and health needs alongside depression care, and regular internal and external coaching and consultation, appeared to drive successful implementation and effectiveness.

Tracking the British agricultural revolution through the isotopic analysis of dated parchment.

Between the sixteenth and nineteenth century, British agriculture underwent a 'revolutionary' transformation. Yet despite over a century of research and the recognised centrality of agricultural developments to industrialisation and population growth, the character or chronology of any 'revolution' during this period remains contentious. Enquiry has been hampered by the fragmented and locally specific nature of historic accounts and the broad dating of early-modern zooarchaeological assemblages. To address this, we conducted stable isotope analysis on 658 legal documents written on sheepskin parchment; a unique biological resource that records the day, month and year of use (AD 1499 to 1969). We find these provide a high temporal resolution analysis of changing agricultural practices and episodes of disease. Most significantly, they suggest that if an 'Agricultural Revolution' occurred in livestock management, it did so from the mid-nineteenth century, in the aftermath of the Napoleonic Wars.

Instruments to measure environmental and personal radiofrequency-electromagnetic field exposures: an update.

Modern human populations are exposed to anthropogenic sources of radiofrequency-electromagnetic fields (RF-EMFs), primarily to telecommunication and broadcasting technologies. As a result, ongoing concerns from some members of the public have arisen regarding potential health effects following RF-EMF exposures. In order to monitor human RF-EMF exposures and investigate potential health effects, an objective assessment of RF-EMF exposures is necessary. Accurate dosimetry is essential for any investigation of potential associations between RF-EMF exposure and health effects in human populations. This review updates state-of-the-art knowledge of currently available RF-EMF exposure assessment tools applicable in human epidemiological studies. These tools cater for assessing RF-EMF exposures in human environments; through mobile phone-based tools or other standalone tools. RF-EMF exposure assessment has been significantly improved through the application of some of these tools in recent years.

Moving beyond referrals to strengthen late-life depression care: a qualitative examination of primary care clinic and community-based organization partnerships.

BACKGROUND: National guidelines have called for greater integration of primary care and behavioral health services, with more recent attention to social care and community-based services. Under growing resource constraints healthcare organizations have tended to rely on referrals to external entities to address social care needs. Traditional referral models, however, may not be equipped to provide for the complex needs of older adults with depression. The Care Partners Project was designed to strengthen late-life depression care through integrated partnerships between primary care clinics and community-based organizations. We sought to understand how these integrated partnerships, with shared tasks and accountability across organizations, changed the nature of depression care for older adults. METHODS: We conducted 65 in-depth, semi-structured interviews and six focus groups with service providers involved in the project, including care managers, primary care providers, and psychiatric consultants, and applied inductive and deductive qualitative thematic analysis to develop themes around participants' experiences with the partnered initiative. RESULTS: We found the partnerships established by the Care Partners Project reshaped late-life depression care in two ways: (1) bidirectional communication across organizations facilitated greater recognition among providers of intersecting medical and social needs associated with late-life depression; and (2) depression care became more coordinated and effective as care teams established or strengthened relationships across organizations. CONCLUSIONS: These findings highlight the ways cross-organizational health and social care partnerships that move beyond traditional referrals can strengthen late-life depression care and enhance organizational capacities.

Effectiveness, compliance and application of sunscreen for solar ultraviolet radiation protection in Australia.

Objectives and importance of study: Sunscreens are widely used, not only to prevent acute sunburn, but also for skin cancer prevention and protection against photoaging and other skin conditions related to cumulative solar ultraviolet radiation (UVR) exposure. When correctly applied, sunscreens reduce the amount of UVR reaching the skin and therefore they can reduce harmful effects of such exposures. This paper examines the benefits and risks of sunscreens, compliance requirements and how sunscreen should be used for optimal effectiveness. STUDY TYPE: Narrative review. METHODS: We reviewed evidence relating to the benefits and risks of sunscreens, sunscreen manufacturing compliance, consumer usage of sunscreen and how sunscreen should be used to be most effective. RESULTS: There is strong evidence that sunscreen is safe to use and, when applied correctly, reduces the risk of skin cancer. There is a need to address questions about the impact of sunscreen on vitamin D and its risk to the environment, as well as a need to develop sun protection factor (SPF) sunscreen testing methods that are more reproducible and ethically based. The amount of sunscreen and the way it is applied varies considerably between individuals, and this in turn markedly affects the degree and duration of protection received. Sunscreen should be used in combination with other sun protection measures that include clothing, hats, sunglasses and seeking shade. CONCLUSIONS: Regulation is essential to ensure high-quality, safe and effective sunscreen products are available to the Australian population. There is an important role for governments to put in place skin cancer prevention policies and long-term funding arrangements to build on our successful sunscreen programs so that future generations are afforded the highest level of topical protection against solar UVR.

A Nationwide Study of the Prevalence and Initial Management of Atypical Genitalia in the Newborn in Scotland.

Provision of optimum healthcare for infants with atypical genitalia requires a clear understanding of the occurrence of this condition. The objective of this study was to determine the prevalence of atypical genitalia and its initial management. A prospective, electronic survey of clinicians within managed clinical networks in Scotland was undertaken between 2013 and 2019. Notification from clinicians was sought for term neonates requiring specialist input for atypical genitalia. Additional information was also sought from the 4 regional genetics laboratories that provided details for neonates who had an urgent karyotype performed for atypical genitalia or sex determination. In total, the study identified 171 term infants who required some investigation for atypical genitalia in the neonatal period, providing a birth prevalence of 1:1,881 term births. Of the 171 infants, 97 (57%) had specialist input over the first 3 months of life, providing a birth prevalence of 1:3,318 term births that received specialist input for atypical genitalia. A total of 92 of these 97 cases had complete 3-month follow-up data, 62 (67%) presented within 24 h of birth, and age at presentation ranged from birth to 28 days. Age at sex assignment ranged from birth to 14 days, and in 63 cases (68%), sex assignment occurred at birth. Thus, the birth prevalence of a case of atypical genitalia where sex assignment was reported to be delayed beyond birth was estimated at 1:11,097 births. In 1 case sex was re-assigned at 3 months. Atypical genitalia requiring specialist input within the first month of life are rare in term newborns, and in only a third of these cases, sex assignment is delayed beyond birth. This study provides new clinical benchmarks for comparing and improving the delivery of care in centres that manage these conditions.

Disconnection in Information Exchange During Pediatric Trauma Transfers: A Qualitative Study.

Pediatric patients experiencing an emergency department (ED) visit for a traumatic injury often transfer from the referring ED to a pediatric trauma center. This qualitative study sought to evaluate the experience of information exchange during pediatric trauma visits to referring EDs from the perspectives of parents and referring and accepting clinicians through semi-structured interviews. Twenty-five interviews were conducted (10 parents and 15 clinicians) and analyzed through qualitative thematic analysis. A 4-person team collaboratively identified codes, wrote memos, developed major themes, and discussed theoretical concepts. Three interdependent themes emerged: (1) Parents' and clinicians' distinct experiences result in a disconnect of information exchange needs; (2) systems factors inhibit effective information exchange and amplify the disconnect; and (3) situational context disrupts the flow of information contributing to the disconnect. Individual-, situational-, and systems-level factors contribute to disconnects in the information exchanged between parents and clinicians. Understanding how these factors' influence information disconnect may offer avenues for improving patient-clinician communication in trauma transfers.

Scratching the surface: the use of sheepskin parchment to deter textual erasure in early modern legal deeds.

Historic legal deeds are one of the most abundant resources in British archives, but also one of the most neglected. Despite the millions that survive, we know remarkably little about their manufacture, including the species of animal on which they were written. Here we present the species identification of 645 sixteenth-twentieth century skins via peptide mass fingerprinting (ZooMS), demonstrating the preferential use of sheepskin parchment. We argue that alongside their abundance and low cost, the use of sheepskins over those of other species was motivated by the increased visibility of fraudulent text erasure and modification afforded by the unique structure of their skin. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40494-021-00503-6.

Meaningful Engagement of Patient Advisors in Research: Towards Mutually Beneficial Relationships.

Patient engagement in research improves trustworthiness of the research findings, increases relevance, and ensures designs include the most meaningful outcomes for patients living with targeted health conditions. The Patient Centered Outcomes Research Institute (PCORI) requires engagement of patient stakeholders. There is limited description of both the context and the processes used to engage patients effectively. This paper discusses engagement activities, roles and responsibilities, value of a Patient Advisory Board (PAB), and lessons learned. Data include program notes, research team reflections, PCORI reporting, and an advisor survey.Facilitators of meaningful engagement included creating a learning community, co-defining clear roles, reimbursing advisors, establishing clear avenues for communication, and welcoming unique contributions. Lessons learned were the value of time, the importance of building trust, and the benefits of diverse perspectives. The approach to meaningful engagement of patient advisors in research has the potential to enhance the relevance and usefulness of research for improving lives.

Understanding adherence to the CardioMEMS pulmonary artery pressure monitoring system for heart failure: A qualitative study.

BACKGROUND: The CardioMEMS HF system is a remote monitoring device that allows patients to transmit pulmonary artery pressure readings to providers, who are alerted when pressures increase above the patient's normal threshold. OBJECTIVES: The purpose of this study was to gain a better understanding of patient adherence to the CardioMEMS system and to compare patients' self-reported use of the system with actual adherence. METHODS: We conducted semi-structured interviews with patients who had a CardioMEMS device. Transcripts were analyzed using a combination of structural and process coding. RESULTS: Patients engaged with the CardioMEMS system in a reciprocal manner, continually learning from the feedback provided by the system. Self-concept influenced the way that patients adhere. CONCLUSIONS: Patients experience many benefits of the CardioMEMS system; however, it is not clear that these perceived or real benefits affect how a person adheres. Rather, our findings suggest that a person's self-concept may be a better predictor of adherence to telemonitoring systems.

Complexity in partnerships: A qualitative examination of collaborative depression care in primary care clinics and community-based organisations in California, United States.

Partnering across health clinics and community organisations, while worthwhile for improving health and well-being, is challenging and time consuming. Even partnerships that have essential elements for success in place face inevitable challenges. To better understand how cross-organisational partnerships work in practice, this paper examines collaborations between six primary care clinics and community-based organisations in the United States that were part of an initiative to address late-life depression using an enhanced collaborative care model (Archstone Foundation Care Partners Project). As part of an evaluation of the Care Partners Project, 54 key informant interviews and 10 focus groups were conducted from 2015 to 2017. Additionally, more than 80 project-related documents were reviewed. Qualitative thematic analysis was used to code the transcripts and identify prominent themes in the data. Examining clinic and community organisation partnerships in practice highlighted their inherent complexity. The partnerships were fluid and constantly evolving, shaped by a multiplicity of perspectives and values, and vulnerable to unpredictability. Care Partners sites negotiated the complexity of their partnerships drawing upon three main strategies: adaptation (allowing for flexibility and rapid change); integration (providing opportunities for multi-level partnerships within and across organisations) and cultivation (fostering a commitment to the partnership and its value). These strategies provided opportunities for Care Partners collaborators to work with the inherent complexity of partnering. Intentionally acknowledging and embracing such complexity rather than trying to reduce or avoid it, may allow clinic and community collaborators to strengthen and sustain their partnerships.

Empowering Diabetes Self-Management Through Technology and Nurse Health Coaching.

PURPOSE: This research explores the impact of mobile health (mHealth) technology and nurse health coaching on views of diabetes self-management (DSM) for persons living with diabetes. METHODS: Three focus groups (N = 24) were conducted with individuals living with type 2 diabetes who participated in a nurse health coaching and mHealth technology intervention study. Qualitative thematic analysis was used to identify overarching themes in each group. RESULTS: Major themes identified following intervention participation included enhanced perspectives about living with diabetes, increased awareness of how health behaviors influence DSM, improved support, and increased ownership of DSM. CONCLUSIONS: The themes identified suggest that the mHealth technology and health coaching intervention together may have had an empowering effect on participants' DSM. These results suggest that providing nurse health coaching with mHealth technology may help individuals ameliorate some of the challenges of living with and managing diabetes.

Season, Terrestrial Ultraviolet Radiation, and Markers of Glucose Metabolism in Children Living in Perth, Western Australia.

Seasonality in glucose metabolism has been observed in adult populations; however, little is known of the associations between season and glucose metabolism in children. In this study, we examined whether markers of glucose metabolism (fasting glucose, insulin and HbA1c) varied by season in a paediatric population (6-13 years of age) located in Perth (Western Australia, n = 262) with data categorised by weight. Linear regression was used to analyse the nature of the relationships between mean daily levels of terrestrial ultraviolet radiation (UVR) (prior to the day of the blood test) and measures of glucose metabolism. Fasting blood glucose was significantly lower in autumn compared to spring, for children in combined, normal and obese weight categories. Fasting insulin was significantly lower in autumn and summer compared to winter for individuals of normal weight. HbA1c was significantly higher in summer (compared with winter and spring) in overweight children, which was in the opposite direction to other published findings in adults. In children with obesity, a strong inverse relationship (r = -0.67, p = 0.002) was observed for fasting glucose, and daily terrestrial UVR levels measured in the previous 6 months. Increased safe sun exposure in winter therefore represents a plausible means of reducing fasting blood sugar in children with obesity. However, further studies, using larger paediatric cohorts are required to confirm these relationships.

More than A1C: Types of success among adults with type-2 diabetes participating in a technology-enabled nurse coaching intervention.

OBJECTIVE: Success in diabetes research and self-management is often defined as a significant decrease in glycated hemoglobin (A1C). The aim of this article is to explore different types of successes experienced by adults with type-2 diabetes participating in a health technology and nurse coaching clinical trial. METHODS: A qualitative analysis was conducted using surveys and documentation from motivational interview-based coaching sessions between study nurses and intervention participants. RESULTS: Of the 132 cases reviewed, types of success predominantly fell into five categories: 1) change in health behaviors; 2) change in mindset or awareness; 3) change in engagement with healthcare resources; 4) change in physical or emotional health; and 5) change in health indicators. CONCLUSION: Experiences of success in diabetes are more varied than traditional A1C-based outcome models. Our findings suggest coaching and technology can assist patients to achieve a range of successes in diabetes management through goal setting, health tracking, resolving barriers, and aligning goals with factors that impact change. PRACTICE IMPLICATIONS: While A1C reduction is a critical factor in decreasing risk of diabetes-related complications, when healthcare professionals focus on A1C as the main indicator of diabetes management success, important changes in individuals' health and well-being may be overlooked or undervalued.

Exposure to Radiofrequency Electromagnetic Fields From Wi-Fi in Australian Schools.

The increasing use of Wi-Fi in schools and other places has given rise to public concern that the radiofrequency (RF) electromagnetic fields from Wi-Fi have the potential to adversely affect children. The current study measured typical and peak RF levels from Wi-Fi and other sources in 23 schools in Australia. All of the RF measurements were much lower than the reference levels recommended by international guidelines for protection against established health effects. The typical and peak RF levels from Wi-Fi in locations occupied by children in the classroom were of the order of 10-4 and 10-2% of the exposure guidelines, respectively. Typical RF levels in the classroom were similar between Wi-Fi and radio but higher than other sources. In the schoolyard typical RF levels were higher for radio, TV and mobile phone base stations compared to Wi-Fi. The results of this study showed that the typical RF exposure of children from Wi-Fi at school is very low and comparable or lower to other sources in the environment.

Training Medical Students for Rural, Underserved Areas: A Rural Medical Education Program in California.

The Association of American Medical Colleges projects an increasing shortage of physicians in rural areas. Medical schools have developed specialty track programs to improve the recruitment and retention of physicians who can serve rural populations. One such program in California includes a variety of unique elements including outreach, admissions, rural clinical experiences, focused mentorship, scholarly and leadership opportunities, and engagement with rural communities. Preliminary outcomes demonstrate that this rural track program has achieved some success in the recruitment, retention, and training of students interested in future rural practice and in the placement of students in primary care residencies. Long-term outcomes, such as graduates entering rural practice, are still unknown, but will be monitored to assess the impact and sustainability of the rural program. This article illustrates the opportunities and challenges of training medical students for rural practice and provides lessons learned to inform newly-established and long standing rural medical education programs.