Exploring women's experiences of breast or trunk lymphoedema following treatment for breast cancer.

Background:The experiences of women who develop lymphoedema in the breast or trunk (BTL) after treatment for breast cancer have received little attention in either the academic or clinical setting. Consequently, women's support needs remain unrecognized.Objective and Design:As this study sought to gain an understanding of women's unheard experiences of a poorly understood condition, it was underpinned by The Silences Framework1 which facilitates research into sensitive or marginalized issues.Sample and Methods:Fourteen women with BTL participated in individual, unstructured interviews, some using photographs or drawings to reflect their experiences. The data was analyzed using the Listening Guide.2Findings:Participants revealed that they were unprepared for the development of BTL; for many, the symptoms were unfamiliar and distressing. Furthermore, their concerns were often dismissed by healthcare professionals (HCPs), leading to long delays in obtaining an accurate diagnosis and treatment. For some women, the practical and emotional impact of developing BTL was profound.Practice Implications:Increased awareness and education about the risk of BTL as a potential side-effect of treatment for breast cancer is required for HCPs and patients. This will alleviate distress, better prepare patients, and ensure timely referral for treatment to manage this chronic condition.

'Hearing silences': Exploring culturally safe transitional care: A qualitative study among Turkish-speaking migrant frail older adults.

AIMS: This study aimed to investigate the experiences and transitional care needs of Turkish frail older adults living in the UK and determine how this information can be utilized to improve the provision of culturally sensitive care during the transitional period. DESIGN: Qualitative descriptive research with semi-structured individual interviews. METHODS: "The 'Silences' Framework guided the research design, from conceptualizing the research question to structuring the report of final outputs. For this study, semi-structured, in-depth interviews were conducted with sixteen older adults living with frailty and five family caregivers between January and May of 2023 in the United Kingdom. RESULTS: Major themes that were identified included: (i) information and communication, (ii) care and support, (iii) the role of culture and (iv) trust and satisfaction. Further analysis, through discussion and immersion in the data, revealed that care transition periods were presented alongside three phases of transitional care: pre-transition (during hospitalization), early-transition (the period between discharge and the 7th day after discharge) and late transition (the period between the 8th day and 12th month after discharge). CONCLUSIONS: Our study revealed that the communication and informational needs of frail older individuals change during the transition period. While Turkish older adults and family caregivers expressed satisfaction with healthcare services in the UK, many struggled due to a lack of knowledge on how to access them. IMPACT: The support of family caregivers is a crucial component in facilitating transitional care for frail older patients, as they help in accessing healthcare services and using technological devices or platforms. It should be noted that family caregivers often hold the same level of authority as their elderly Turkish counterparts. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Transitional care of older ethnic minority patients: An integrative review.

AIMS: To critically synthesize the empirical literature on practice in transitional care and how to meet the care needs of older ethnic minority populations who discharged from hospital to community. DESIGN: An integrative literature review integrating empirical studies using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES: PubMed, Web of Science, PsycINFO, EBSCO (including CINAHL and MEDLINE) and Scopus were searched for papers published between 2012 and September 2022. REVIEW METHODS: Full-text papers were screened against inclusion and exclusion criteria subsequent to screening titles and abstracts. All included papers were evaluated for methodological quality using the Critical Appraisal Skills Programme Checklists. After extracting findings, themes were created by critically examining and synthesizing of findings. RESULTS: The search yielded a total of 1180 studies, 1153 after removing duplicates and 27 papers meeting the inclusion criteria and exclusion criteria were included in the review. The main findings were categorized into four themes: (i) intervention-related outcomes; (ii) unmet needs of older minority people; (iii) transitional care-related characteristics of older minority people and (iv) challenges for healthcare providers. Findings indicated that the transitional care experience of ethnic minority older populations differed from natives to some extent which revealed unmet needs addressing how to provide culturally appropriate transitional care for this population. CONCLUSION: This review gave insight into facilitators in the transitional care of ethnic minority older adults. Future transitional care interventions should incorporate needs of ethnic minority population. IMPACT: This review highlighted the defined gaps between existing transitional care programmes and transitional care needs of older ethnic minority. Increasing follow-up completion, evidence defining deeply of ethnic phenomenon in the transitional care process, developing interventions that meet transitional care needs and increasing healthcare providers' cultural competency were featured headlines. No Patient or Public Contribution.

An international exploration of blended learning use in pre-registration nursing and midwifery education.

AIM: To explore international experiences of using blended learning in preparing nursing and midwifery students for initial professional registration to inform future education policy. BACKGROUND: The global nursing and midwifery skills shortage and need for an expanded nursing workforce that is fit for contemporary care delivery is widely acknowledged. The immense pressure the profession was already under because of austerity, staff shortages and increasingly complex healthcare needs has been worsened by the Covid-19 pandemic. The UK is extending and evaluating the use of blended learning programmes for pre-registration nursing and midwifery students to help address these issues. This study sought to explore relevant nursing and midwifery experiences from outside the UK to help inform future health professional education policy here and elsewhere. DESIGN: Cross-sectional, sequential, mixed methods study PARTICIPANTS/SETTINGS: Nursing/nurse education leaders from across International Council of Nurses regions METHODS: Exploratory online survey (n = 32) and three follow-up case studies (March-May 2021). Participants' knowledge and experiences of blended learning were examined along with any perceived benefits for workforce development and successful strategies for addressing the challenges blended learning presents in this context. Case studies were developed inductively from survey responses and follow up telephone calls to provide more detailed information about reported successes. RESULTS: Participants reported flexibility, cost effectiveness, increased student/tutor and student/student communication and interaction as benefits of blended learning. Challenges included the design and use of interactive learning resources, appropriate preparation and support for staff and students, the potential of blended learning to exacerbate otherwise hidden disadvantage and the need for multi-stakeholder cost/benefit evaluation. CONCLUSIONS: Blended learning is used globally in the pre-registration education of nurses, midwives and other healthcare professionals. These results broadly mirror the literature regarding the benefits blended learning offers healthcare students, staff and organisations and the strategies employed to mitigate risk. As the deployment of blended learning nursing and midwifery programmes expands, further work is needed to address gaps in the current evidence base regarding the practice and impact of this approach. These concern adequate preparation and support of students and staff, ensuring access to appropriate equipment and connectivity, exploration of student perceptions that online learning is of lesser value and comprehensive multi-stakeholder, exploratory evaluation to uncover any hidden factors and impact. TWEETABLE ABSTRACT: Blended learning plays an effective part in the education of pre-registration nursing and midwifery students to help tackle global workforce shortages, but further work is needed to address gaps in the current evidence base regarding the practice and impact of this approach.

The role of distance and transportation in decision making to seek emergency obstetric care among women of reproductive age in south-South Nigeria: A mixed methods study.

OBJECTIVE: To explore the role of transportation in seeking emergency obstetric care among women with obstetric complications. METHODS: A mixed-methods design. The study population comprised women aged 15-49 years who had experience direct obstetric complications and were attending the health facility for care at the time of this study. A total of 318 women completed the questionnaires, and in-depth interviews were held for six women who were purposively selected from the 318 respondents. Both questionnaire and semi-structured interviews were used in collecting data for this study. Quantitative data were analyzed using SPSS using both inferential and bivariate analysis, and a qualitative content analysis was carried out on the qualitative data. RESULTS: Of the 318 respondents, 290 (91.2%) accessed health facilities by motorized transport with 28 (8.8%) on foot. Mode of transportation was related to regularity at prenatal care (P = 0.003), with those who came on foot being regular attenders compared with those that came on motorized transport. CONCLUSION: An efficient and suitable transport system as well as distance are key factors influencing women's role in decision making to seek care.

Optimising service users and carers involvement in nursing and social work pre-registration degrees.

The awareness of the contribution of service users and carers' involvement in nursing and social work pre-registration degree education continues to grow. This study explored ways of optimising its beneficial outcomes to students, service users/carers and academic staff. A phenomenology qualitative approach was employed. The study sample was drawn from service users/carers involved in students' education, and adult nursing and social work degree students and academic staff. A total of 38 participants took part. Semi-structured interviews were used to gather views, which was then thematically analysed. This study identified factors that can optimise the beneficial outcomes of service users and carers' involvement to students, service users/carers and academic staff in Adult nursing and Social work pre-registration degree. The findings of this study support the value of service users' and carers' involvement in undergraduate nursing and social work education and offer strategies which support best practice, and optimise and sustain the efficacy and benefits of this approach in a higher education setting. An understanding of issues related to optimising service user and carer involvement may assist in the development of strategies that continue to make service users and carers' involvement in nursing and social work pre-registration degree effective and meaningful to students, service users/carers and academic staff.

Do Black, Asian and Minority Ethnic nurses and midwives experience a career delay? A cross-sectional survey investigating career progression barriers.

BACKGROUND: Black, Asian and Minority Ethnic nurses and midwives are under-represented in higher and managerial roles. AIMS: This study explored the presence and nature of career progression delays for Black, Asian and Minority Ethnic nurses and midwives and investigated where the barriers to progression were. DESIGN: A secondary analysis of data from a wider cross-sectional survey investigating workplace experiences, burnout and patient safety in nurses and midwives. METHODS: 538 nurses and midwives were recruited from four UK hospitals between February and March 2017. A career progression delay was viewed as being present if Black, Asian and Minority Ethnic nurses and midwives had spent longer on the entry level nursing grade and less time on higher grades in the previous 10 years. The analysis included items pertaining to: receipt of professional training, perceived managerial support for progression, likelihood of submitting applications and application success rates. Data were analysed using linear regression, odds ratios and t-tests. Results were reported using the STROBE Checklist. RESULTS: Black, Asian and Minority Ethnic nurses and midwives (n = 104; 19.4%) had spent more months working at the entry-level grade (M = 75.75, SD = 44.90) than White nurses and midwives (n = 428; 79.7%; M = 41.85, SD = 44.02, p < 0.001) and fewer months at higher grades (M = 15.29, SD = 30.94 v 29.33, SD = 39.78, p = 0.006 at Band 6; M = 6.54, SD = 22.59 v M = 19.68, SD = 37.83, p = 0.001 at Band 7) over the previous 10 years. Black, Asian and Minority Ethnic nurses and midwives were less likely to have received professional training in the previous year (N = 53; 53.0% v N = 274; 66.0%, p = 0.015) and had to apply for significantly more posts than White nurses and midwives before gaining their first post on their current band (M = 1.22, SD = 1.51 v M = 0.81, SD = 1.55, p = 0.026). CONCLUSIONS: Interventions are needed to improve racial equality regarding career progression in nurses and midwives. Increasing access to professional training and reducing discriminatory practice in job recruitment procedures may be beneficial. IMPACT STATEMENT: Black, Asian and Minority Ethnic nurses and midwives experience career progression inequalities. Interventions should improve transparency in recruitment procedures and enhance training opportunities.

A nurse-led conceptual model to inform patient-centred, type 2 diabetes mellitus management in public clinical settings.

BACKGROUND: Globally, there is an increased need to provide patient-centred care for people diagnosed with type 2 diabetes mellitus. In Nigeria, a poorly financed health system has worsened the difficulties associated with managing type 2 diabetes mellitus in clinical settings, causing a detrimental effect on patient-centred care. AIMS: We aimed to develop a conceptual model to promote patient-centred type 2 diabetes mellitus care in clinical settings. We explored nurses' contextual perceptions of clinical practices and operations in light of type 2 diabetes mellitus management across public hospitals in Lagos, Nigeria. Identifying a nurse-led intervention is critical to care optimisation for people diagnosed with type 2 diabetes mellitus. METHODS: We adopted a qualitative approach. Using the constant comparison method and semi-structured questions and interviewed practice nurses, with over one year's experience and who were working in public hospitals across Lagos, Nigeria. The framework method was used to analyse the data obtained. RESULTS: Nurses provided insight into four areas of patient-centred type 2 diabetes mellitus management in clinical settings: empowering collaboration; empowering flexibility; empowering approach; and empowering practice. Nurses discussed an empowering pathway through which health settings could provide patient-centred care to individuals diagnosed with type 2 diabetes mellitus. The pathway entailed the integration of macro, meso and micro levels for patient management. Nurses' accounts have informed the development of a conceptual model for the optimisation of patient care. CONCLUSIONS: The model developed from this research sits within the patient-centred care model of healthcare delivery. The research sits within the patient-centred care model of healthcare delivery. inform patient-centred care, not only in countries with poorly financed healthcare systems, but in developed countries with comparatively better healthcare.

Exploring the perceptions of dignity among patients and nurses in hospital and community settings: an integrative review.

Background: Patients have a right to be treated with dignity. However, reports have continually identified concerns regarding the quality of care and dignity in hospitals. Undignified care can have unfavourable impact on the patient's recovery such as leading to depression and loss of will to live. The aim of this study was to explore dignity as perceived by patients and nurses within hospital and community environments. Methods: An integrative review methodological approach was adopted. Nine databases including Medline, CINAHL plus with full text, Web of Science, Embase, Pubmed, Psycinfo, Scopus, Nursing and Allied Health Source, and Science Direct were systematically searched for relevant articles using a predetermined set of inclusion criteria. Articles were included if they were primary empirical studies, peer reviewed, published between 2008-2019, assessing patients' or nurses' perception of dignity outside the end-of-life context, conducted in one of the European countries and written in English. Included papers were analysed using constant comparative analysis. The preferred reporting system for systematic review and meta-analysis (Prisma) flow diagram was used for quality appraisal and review. Results: Fourteen relevant articles were included in this review. Four overarching themes and 10 subthemes were identified as impacting on patient dignity. Overarching themes include autonomy, healthcare delivery factors, organisational factors and the meaning of dignity, whilst subthemes include dependence/independence, choice, staff attitudes, communication, privacy, structure of services, staff shortages, physical environment, respect and person-centred care. Conclusion: There are a wide range of factors impacting on patient dignity. Adopting evidence-based interventions supported by adequate theoretical backing can help to enhance patient dignity in hospital and community settings.

People with aphasia's perspectives of the therapeutic alliance during speech-language intervention: A Q methodological approach.

Purpose: To identify which elements of the therapeutic alliance are important to people with aphasia (PWA) attending speech-language pathology post-stroke.Method: A Q methodology design was adopted to explore which elements of the therapeutic alliance were valued by PWA. Statements (n = 453) relevant to the research question were extrapolated from the literature and qualitative interviews. A representative sample of statements (n = 38) was identified from the expansive data set. PWA (n = 23) sorted statements hierarchically according to whether they thought the statement was important or unimportant. Completed Q sorts were analysed using a by-person factor analysis.Result: Analysis yielded a five-factor solution, representing five distinct viewpoints: (1) acknowledge me, help me to understand; (2) respect me, listen to me; (3) challenge me, direct me; (4) understand me, laugh with me; and (5) hear me, encourage me.Conclusion: The findings highlight the need for clinicians to adopt a flexible and idiosyncratic approach to therapeutic alliance construction in order to meet the relational needs of a heterogeneous population. This is the first study to use Q methodology with PWA, demonstrating that Q methodology is an effective and viable method for investigating subjectivity in this population.

Silenced Knowing: An Intersectional Framework for Exploring Black Women's Health and Diasporic Identities.

Understanding the needs of Black women within a cultural and medical framework which recognizes the impact on health and well-being on the spaces where culture, health, and expectation intersect remains a challenge. In the UK, Black women are often more likely to have poor prognosis, worse outcomes and greater morbidity from treatable and preventable health conditions than their white peers. UK researchers have struggled to find a culturally appropriate safe methodological framework to help explore the challenges faced by Black women and their families in safeguarding their health, particularly around sensitive issues such as sexual and reproductive health. This article presents a relatively new intersectional framework which has been use for conducting health research on culturally sensitive health issues. The Silences Framework introduces the notion of "Screaming Silences." Screaming Silences (or Silences) reflect the unsaid or unshared aspects of how beliefs, values and experiences of (or about) some groups affect their health and life chances. The article will explore how, the framework aligns with existing Intersectional approaches and how it could be used to expose intersectional nature of issues which influence and inform both individual and group understandings Black Women's health using examples relating to sexual health and life chances for Black women in the Diaspora.

Students' perceptions of self-direction in pre-registration nurse education.

This study explored to understand the lived experiences of a group of pre-registration nursing students' in a United Kingdom Higher Education setting, in the context of increasing responsibility for self-direction throughout the learning process. Care is underpinned by evidence, knowledge and problem solving skills, predicated on enhanced student capability to ensure self-direction in learning. A hermeneutic phenomenological approach framed within an interpretative paradigm enabled exploration to seek out individual and collective perceptions of the learning process. Four over-arching themes were identified: Divergent perceptions of self-directed learning, Adult learning needs and transition, Motivation and Understanding responsibility. Students appeared very dependent and, paradoxically, demanded both variety and consistency from educators in assisting them to develop as they progressed through the course. Within these themes, anxiety and vulnerability were shared motifs in students' experiences. Clear expectations of responsibilities and roles in learning is key to supporting students from the beginning of the undergraduate programme. Teacher and student interaction is important in developing and enabling critical engagement in learning with clear directions and guidelines.

Tuberculosis/HIV/AIDS coinfection in Porto Alegre, RS/Brazil - invisibility and silencing of the most affected groups. / Coinfecção tuberculose/HIV/aids em Porto Alegre, RS - invisibilidade e silenciamento dos grupos mais afetados.

OBJECTIVE: To analyze how belonging to certain social groups contributes to constituting the vulnerabilities associated with illnesses due to tuberculosis/HIV/AIDS coinfection. METHODOLOGYThis is a qualitative study carried out in the city of Porto Alegre, state of Rio Grande do Sul, in regions of high social vulnerability. Twenty coinfected people were interviewed in specialized health services between August and December 2016. The analysis was based on the frameworks The Sound of Silence and Vulnerability and Human Rights. RESULTS: Socioeconomic conditions were decisive for the constitution of the vulnerability conditions. Processes of people invisibilization, and the silencing of their voices, in a scenario marked by economic, racial and gender inequalities, contributed for their health needs not to be understood and effectively taken into account in the services actions. FINAL CONSIDERATIONS: The more effective strategies are to legitimize voices and to understand the needs of those affected by coinfection, the greater the chances that programmatic responses to the problem will be successful.

Factors associated with hospitalization and death among TB/HIV co-infected persons in Porto Alegre, Brazil.

In locations with a high rate of tuberculosis (TB) and HIV infection, there are a number of strategies to prevent negative outcomes such as opportunistic infections, hospitalizations and death, and this article investigates risk factors for the occurrence of hospitalization and death in cases of TB/HIV co-infection in the south of Brazil. The data are taken from a population-based retrospective cohort study on cases of TB/HIV co-infection from 2009 to 2013 in Porto Alegre, Brazil. Sociodemographic, epidemiological and clinical variables were analyzed. Relative risk (RR) estimates for hospitalization and death were determined by regression models. There were 2,419 co-infection cases, of which 1,527 (63.1%) corresponded to hospitalizations, and 662 (27.4%) to death. The occurrence of hospitalization was associated with ≤ 7 years of schooling (RR = 3.47, 95%CI: 1.97-6.29), 8-11 years of schooling (RR = 2.56, 95%CI: 1.44-4.69), place of origin-district health authorities Northwest/Humaitá/Navegantes/Ilhas (RR = 2.01, 95%CI: 1.44-2.82), type of entry into the surveillance system as in cases of reentry after withdrawal (RR = 1,35, 95%CI: 1.07-1.70), closure in surveillance as in withdrawal of treatment (RR = 1.47, 95%CI: 1.18-1.83) and multidrug-resistant tuberculosis (RR = 3.94, 95%CI: 1.97-8.81). The occurrence of death was associated with age (RR = 1.07, 95%CI: 1,01-1,14), ≤ 7 years of schooling (RR = 3.94, 95%CI: 2.26-7.09), 8-11 years of schooling (RR = 2.84, 95%CI: 1.61-5.16), place of origin-district health authorities Baltazar (RR = 2.05, 95%CI: 1.48-2.86), type of entry in the surveillance system as cases of re-entry after withdrawal (RR = 1.53, 95%CI: 1.22-1.91), relapse (RR = 1.33, 95%CI: 1.03-1.73). The occurrence of hospitalizations and deaths is high among co-infected patients. Our estimation approach is important in order to identify, from the surveillance data, the risk factors for hospitalization and death in co-infected patients, so that they may receive more attention from the Brazilian national healthcare system.

Screaming silences: lessons from the application of a new research framework.

BACKGROUND: The Silences Framework ( Serrant-Green 2011 ) originated from research exploring ethnicity, gender and sexual health decision-making, and provides a useful tool for researching underrepresented groups and topics. AIM: To present the lessons learned from the application of the Silences Framework in the context of a qualitative study exploring the experiences of people under the age of 60 recovering from a fragility hip fracture. DISCUSSION: The authors explore current conceptions of marginalisation in healthcare with reference to nursing research and provide practical tips for others interested in applying and further testing the framework. CONCLUSION: The framework is likely to be attractive to nurses as it is underpinned by core nursing values, such as advocacy-based action. It places participant and public voices at the centre of the research and resembles the familiar nursing process. The structure and flexibility it offers also makes it relevant for new and experienced researchers in a variety of contexts. IMPLICATIONS FOR PRACTICE: Critical analysis of the initial application of the Silences Framework in a different setting to the one in which it was developed indicates it offers a beneficial addition to the research toolkit. Its limited use to date means its relevance for nursing and potential for further development have not yet been fully established. It should be tested more widely and in other contexts.

Coinfecção tuberculose/HIV/aids em Porto Alegre, RS - invisibilidade e silenciamento dos grupos mais afetados / Coinfección tuberculosis/VIH/SIDA en Porto Alegre, RS/Brasil - invisibilidad y silenciamiento de los grupos más afectados / Tuberculosis/HIV/AIDS coinfection in Porto Alegre, RS/Brazil - invisibility and silencing of the most affected groups

Resumo OBJETIVO Analisar como o pertencimento a certos grupos sociais contribui para a constituição das vulnerabilidades associadas ao adoecimento pela coinfecção tuberculose/HIV/aids. METODOLOGIA Pesquisa qualitativa realizada em Porto Alegre-RS, em regiões de alta vulnerabilidade social. Foram entrevistadas 20 pessoas coinfectadas em serviços especializados de saúde, entre agosto e dezembro de 2016. A análise teve como aporte os referenciais The Sound of Silence e Vulnerabilidade e Direitos Humanos. RESULTADOS Condições socioeconômicas foram decisivas para constituição das condições de vulnerabilidade. Processos de invisibilização das pessoas e silenciamento de suas vozes, em um cenário marcado por desigualdades econômicas, raciais e de gênero contribuíam para que suas necessidades de saúde não fossem compreendidas e efetivamente levadas em consideração nas ações dos serviços. CONSIDERAÇÕES FINAIS Quanto mais efetivas forem as estratégias para legitimar as vozes e compreender as necessidades das pessoas afetadas pela coinfecção, maiores serão as chances de que as respostas programáticas para o problema sejam exitosas.

Resumen OBJETIVO Analizar cómo la pertenencia a ciertos grupos sociales contribuye a la constitución de las vulnerabilidades asociadas al padecimiento de coinfección tuberculosis/VIH/SIDA. METODOLOGÍA Investigación cualitativa realizada en Porto Alegre-RS/Brasil, en zonas de alta vulnerabilidad social. Fueron entrevistadas 20 personas coinfectadas en servicios especializados de salud, entre agosto y diciembre de 2016. Análisis con aporte de referenciales The Sound of Silence y Vulnerabilidad y Derechos Humanos. RESULTADOS Las condiciones socioeconómicas resultaron decisivas para constituir las condiciones de vulnerabilidad. Los procesos de invisibilización de las personas y el silenciamiento de sus voces contribuían a que sus necesidades de salud no fuesen comprendidas y efectivamente consideradas en las acciones de los servicios. CONSIDERACIONES FINALES Cuanto más efectivas sean las estrategias para legitimar las voces y comprender las necesidades de los afectados por la coinfección, mayores serán las posibilidades para que las respuestas programáticas al problema resulten exitosas.

Abstract OBJECTIVE To analyze how belonging to certain social groups contributes to constituting the vulnerabilities associated with illnesses due to tuberculosis/HIV/AIDS coinfection. METHODOLOGYThis is a qualitative study carried out in the city of Porto Alegre, state of Rio Grande do Sul, in regions of high social vulnerability. Twenty coinfected people were interviewed in specialized health services between August and December 2016. The analysis was based on the frameworks The Sound of Silence and Vulnerability and Human Rights. RESULTS Socioeconomic conditions were decisive for the constitution of the vulnerability conditions. Processes of people invisibilization, and the silencing of their voices, in a scenario marked by economic, racial and gender inequalities, contributed for their health needs not to be understood and effectively taken into account in the services actions. FINAL CONSIDERATIONS The more effective strategies are to legitimize voices and to understand the needs of those affected by coinfection, the greater the chances that programmatic responses to the problem will be successful.

Men, Mental Health and Elite Sport: a Narrative Review.

Mental health in elite sport is receiving more publicity due to an increase in male athletes sharing their personal experiences. Sports injury is recognised as the major risk factor for psychological distress amongst male athletes, although anecdotally this may be that athletes are more likely to discuss their emotional wellbeing when related to the injury they are experiencing. Stress can be amplified within elite sport and the pressure they experience in relation to competition and performance can be exacerbated by adverse life events. This ongoing stress does not end when their sporting career does, it can follow them into retirement. The physical and psychological demands placed upon them by the sporting environment may predispose athletes to developing depression. As an athlete's symptoms of mental illness intensify, their performance can be negatively affected leaving them vulnerable and exposed to further symptoms of common mental disorders. The pressure of performance can also expose male athletes to overtraining syndrome which can be difficult to distinguish from depression. Male athletes are more vulnerable to eating disorders compared with males in the general population and they do have anxieties, particularly around their bodies, but find it difficult to disclose their concerns. In addition to this, male athletes are more likely to use substances, including opioids to improve both sport and non-sport performance.Despite the prevalence of common mental disorders in male athletes, stigma still exists, and although some athletes discuss their issues publicly after their career has ended, the majority of athletes prefer to remain silent. There remains a view that athletes who seek help for psychological problems may be seen as weak. Although there is an improvement in help-seeking attitudes within elite sport, further research and education is needed to encourage men to talk about their mental health, share their experiences and to enjoy a greater sense of emotional wellbeing.

Silent slips, trips and broken hips in the under 60s: A review of the literature.

This critical review of the literature regarding the recovery experiences and healthcare needs of people under 60 following a fragility hip fracture seeks to identify the associated implications for nursing practice and inform care delivery. Forty papers were included following a structured database, citation and grey literature search and filtering of results in line with specified inclusion criteria. Hip fracture is a common, serious and complex injury and an important cause of morbidity, mortality and rising healthcare costs worldwide. This review indicates that although commonly associated with the elderly, incidence and impact in the under 60s has been under-explored. Current health policy, professional and social norms almost exclusively focus on the elderly, surgical interventions and short-term outcomes, rendering the under 60s an inadvertently marginalised, relatively 'silent' sub-set of the hip fracture population. Nurses must be aware, however, of the different recovery needs of this younger group. The limited evidence available indicates these include work related needs and long term physical and psychosocial limitations in this socially and economically active group. Priorities are identified for research to inform policy and practice. Meanwhile, nurses can address the needs of this group by listening to and involving them and their families as healthcare partners.