Project nature: promoting outdoor physical activity in children via primary care.

BACKGROUND: Families face a range of barriers in supporting their children's active play in nature including family circumstances, environmental constraints, and behavioral factors. Evidence-based strategies to address these barriers are needed. We aimed to develop and pilot test a primary care-based family-centered behavioral intervention to promote active outdoor play in 4-10 year-old children. METHODS: Project Nature, a provider-delivered intervention that provides informational resources and an age-appropriate toy for nature play, was initially developed for children ages 0-3. With stakeholder input, we adapted existing materials for 4-10 year-olds and conducted usability testing at an urban clinic serving families from diverse backgrounds. Subsequently, we conducted a mix-methods pilot study to evaluate intervention feasibility and acceptability. Parents of 4-10 year-olds completed pre- and post-surveys (n = 22), and a purposive subset (n = 10) completed qualitative interviews. Post-intervention, pediatric providers (n = 4) were interviewed about their implementation experiences. RESULTS: The majority (82%) of parents liked the information provided and the remaining (18%) were neutral. Qualitatively, parents reported that: the toy provided a tangible element to help children and parents be active, they did not use the website, and they wished the intervention emphasized strategies for physical activity during cold and wet seasons. Providers felt the materials facilitated discussion about behavior change with families. There were no statistically significant changes in PA and outdoor time pre- and post-intervention. CONCLUSIONS: Project Nature was welcomed by providers and families and may be a practical intervention to promote outdoor active play during well-child visits. Providing an age-appropriate nature toy seemed to be a critical component of the intervention, and may be worth the additional cost, time and storage space required by clinics. Building from these results, Project Nature should be revised to better support active outdoor play during suboptimal weather and evaluated to test its efficacy in a fully-powered trial.

Patient evaluation of gynaecological information provision and preferences.

AIM: To evaluate gynaecological patients' preferences and satisfaction regarding information provision, exploring enablers and barriers to information access. DESIGN: A descriptive cross-sectional survey design was used. METHODS: A total of 293 women accessing gynaecological services responded to the survey. Quantitative analysis included descriptive and inferential statistics. Content analysis was conducted on qualitative data. RESULTS: Health professionals were the most common and preferred sources of gynaecological health information. Enablers to information provision included positive communication strategies by health professionals, participants having prior knowledge and doing their own research. Despite its widespread availability, only 24.2% of women preferred the internet as an information source. Poor communication and inadequate information provision were identified as barriers to information access. Statistically significant associations were identified between location of residence, education level, year of birth, diagnostic group and health information preferences. Recommendations from women included improved communication strategies, system changes and provision of individualized information. CONCLUSION: Health professionals are central to women accessing information about gynaecological diagnoses. Areas for improvement include communication strategies, facilitating access to internet-based resources for information and consideration of women's preferences when providing health information. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: Consumer co-design of gynaecological health information and communication training for health professionals is recommended. Improved communication and facilitated use of internet-based resources may improve women's understanding of information. IMPACT: This study explored gynaecological patients' preferences and satisfaction regarding information provision, exploring enablers and barriers to information access. It was found that gynaecological patients preferred individualized information provided to them directly by health professionals and despite its widespread availability, the internet is an underutilized health information resource. These findings are applicable to health professionals and patients utilizing tertiary gynaecological health services in Australia but may be generalized if demographic data aligns with other jurisdictions. REPORTING METHOD: The STROBE reporting method was used in the preparation of the manuscript. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Strengthening midwifery in the South-East Asian region: A scoping review of midwifery-related research.

Improving sexual, reproductive, maternal, newborn, and adolescent health outcomes necessitates greater commitment to, and investments in, midwifery. To identify future research priorities to advance and strengthen midwifery, we conducted a scoping review to synthesise and report areas of midwifery that have been explored in the previous 10 years in the 11 countries of the World Health Organization's South-East Asia region. Electronic peer-reviewed databases were searched for primary peer-reviewed research published in any language, published between January 2012 and December 2022 inclusive. A total of 7086 citations were screened against the review inclusion criteria. After screening and full text review, 195 sources were included. There were 94 quantitative (48.2%), 67 qualitative (34.4%) and 31 mixed methods (15.9%) studies. The majority were from Indonesia (n = 93, 47.7%), India (n = 41, 21.0%) and Bangladesh (n = 26, 13.3%). There were no sources identified from the Democratic People's Republic of Korea or the Maldives. We mapped the findings against six priority areas adapted from the 2021 State of the World's Midwifery Report and Regional Strategic Directions for Strengthening Midwifery in the South-East Asia region (2020-2024): practice or service delivery (n = 73, 37.4%), pre-service education (n = 60, 30.8%), in-service education or continuing professional development (n = 51, 26.2%), workforce management (n = 46, 23.6%), governance and regulation (n = 21, 10.8%) and leadership (n = 12, 6.2%). Most were published by authors with affiliations from the country where the research was conducted. The volume of published midwifery research reflects country-specific investment in developing a midwifery workforce, and the transition to midwifery-led care. There was variation between countries in how midwife was defined, education pathways, professional regulation, education accreditation, governance models and scope of practice. Further evaluation of the return on investment in midwifery education, regulation, deployment and retention to support strategic decision-making is recommended. Key elements of leadership requiring further exploration included career pathways, education and development needs and regulatory frameworks to support and embed effective midwifery leadership at all levels of health service governance.

Head Injuries and Emergencies in Sports.

Head injuries are a common occurrence in sports and can involve injuries to the brain, skull, and superficial soft tissues. The most commonly discussed diagnosis is a concussion. Head and cervical spine injuries must be considered together at times, due to the overlapping nature of symptoms present during on-field evaluation. This article presents a range of head injuries, along with critical steps in evaluation and management.

Case Report: A Child With Omental Infarction.

BACKGROUND: Omental infarction (OI) is a rare cause of acute abdominal pain, which is benign and self-limited. It is diagnosed by imaging. The etiology of OI is either idiopathic or secondary and due to torsion, trauma, hypercoagulability, vasculitis, or pancreatitis. CASE REPORT: Here, we present a case of OI in a child with acute severe right upper quadrant pain. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Correct diagnosis of OI via imaging can prevent unnecessary surgery.

Accessing and navigating healthcare: A scoping review of the experiences of women of refugee background from Myanmar.

Despite well-documented health problems, healthcare access by women of refugee background in resettlement countries is typically poor. Suggested reasons include inadequate health literacy and resettlement challenges. A scoping review to explore the experiences of women of refugee background from Myanmar accessing and navigating healthcare was conducted following Arksey and O'Malley's framework, with an intersectional lens. Studies were analysed thematically following Braun and Clark's approach; four themes (eight subthemes) were constructed: Culture (Constructions of health; Navigating cultural tensions); Gender (Shifting gender roles; Sexual and reproductive health); Survivorship (Past health experiences; Strength in collectivism); and Language (The language barrier; Masked communication barriers). Intersectional factors of culture, gender, survivorship and language influenced women's experiences, shaping barriers and facilitators to healthcare. Community networks and bicultural peers are resources which may be enhanced. Research into trauma-informed cultural competency programs, community education and bicultural health navigators is recommended to support women of refugee background from Myanmar.

Seeking Health Information: A Qualitative Study of the Experiences of Women of Refugee Background from Myanmar in Perth, Western Australia.

Women of refugee background are subject to significant health inequity. Access to health information and a good level of health literacy are integral components to manage one's health needs. The aim of this study isto understand the experiences of women of refugee background from Myanmar seeking and accessing health information. Semi-structured interviews were conducted with 14 women of refugee background from Myanmar resettled in Western Australia. Interpretative phenomenological analysis underpinned the study and was conducted on the interview data. Three superordinate themes and nine subordinate themes emerged from the analysis: (1) Seeking health information (Motivation and Sources), (2) Facilitators and Barriers (Communication, Navigating the system and Community) and (3) Seeking health information in the context of past experiences (Health information as a by-product of healthcare, Health professionals' provision of health information, Accessibility of healthcare and Expectations on resettlement). These themes provide insight into the challenges of accessing understandable and actionable health information and of promoting the health literacy of women of refugee background from Myanmar. Co-designed community-based and health service interventions should be trialled, including trauma-informed training for health professionals, health information apps and community health promotion programs. Community engagement, participation and evaluation are critical for determining the effective interventions to address the inequalities experienced by this population.

E-professionalism and social media use amongst nurses and midwives: A cross-sectional study.

AIM: To describe nurses' and midwives' social media use, knowledge, attitudes and information needs, in the context of e-professionalism. A secondary aim was to identify any relationship between these variables and age, or professional role. BACKGROUND: Midwives and nurses are viewed by the public as trusted professionals. On social media, the boundary between professional and personal identities can be blurred. Previous research has explored how student nurses navigate professional behaviour online, or e-professionalism. However, confusion persists amongst established nurses and midwives, despite the policies which guide and regulate their online conduct. DESIGN: A cross-sectional designwas applied. The STROBE guideline informed reporting of the findings. METHODS: A validated survey tool was modified to the study setting. Responses to 17 survey items were analysed using Chi-square and Fisher's exact tests. Qualitative content analysis was conducted on responses to two open-ended questions. RESULTS: In total, 311 nurses and midwives from one Western Australian tertiary hospital participated between August 2019 and February 2020. Social media use was widespread (97.4%, n = 299). Associations were identified between age group and eight survey items assessing social media use, knowledge and attitudes. No associations were identified between professional role and social media use, knowledge and attitudes. Content analysis revealed five themes: Maintaining professional boundaries; Avoidance; Protecting self; Responsibilities and consequences; and Social media as a tool. CONCLUSIONS: Midwives and nurses in this study approached social media with caution yet many were curious about its potential. If midwives and nurses are to be held accountable to social media policies and use the benefits social media affords, they must be supported to evolve into proficient users by educators and policy makers. TWEETABLE ABSTRACT: Nurses and midwives must be supported through policy and education to embrace social media as a tool of the future.

Establishing an occupational therapy assessment clinic in a public mental health service: A pragmatic mixed methods evaluation of feasibility, utilisation, and impact.

INTRODUCTION: Employment of occupational therapists in generic roles in public mental health services (PMHSs) constrains capacity to undertake discipline-specific activity meaning consumers may be unable to access valuable occupational therapy assessments and interventions that could promote recovery. Establishing a dedicated occupational therapy clinic has been identified as one way of improving care provided and outcomes for organisations, therapists, and consumers. To inform such developments, this paper reports evaluation of feasibility, acceptability, and sustainability of a pilot clinic established within a PMHS. METHODS: An observational evaluation was used combining quantitative and qualitative data collected from service documents, clinic records, and in semi-structured interviews with 42 stakeholders. Quantitative data were used to describe referrals and flow through the clinic. Framework analysis of qualitative data examined the process and outcomes of referrals and enabled understanding of acceptability, perceived impact and areas for improvement. RESULTS: Substantial ground work, particularly stakeholder engagement, and redistribution of resources enabled establishment and successful operation of an assessment clinic for 12 months. Assessments were completed for 68% of the 100 accepted referrals, with the remainder in process or unable to be completed. Stakeholders agreed that the clinic enabled clinicians' timely access to specialist assessment, improving care for consumers. Occupational therapists valued the opportunity to deploy and develop discipline-specific skills and when there was some impact on work flow of occupational therapists' 'home teams', team managers judged the investment worthwhile. Strong leadership by the discipline lead and support from team managers who enabled allocation of occupational therapists to the clinic were critical to success. CONCLUSION: An occupational therapy assessment clinic can be established and operate successfully within a public mental health setting. Redistribution of resources supported increased efficiency and consumer access to specialist interventions that support their recovery.

Hemophagocytic lymphohistiocytosis: An update on pathogenesis, diagnosis, and therapy.

Hemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening state of immune hyperactivation that arises in the setting of genetic mutations and infectious, inflammatory, or neoplastic triggers. Sustained, aberrant activation of cytotoxic CD8+ T cells and resultant inflammatory cytokine release are core pathogenic mechanisms. Key clinical features include high persistent fever, hepatosplenomegaly, blood cytopenia, elevated aminotransferase and ferritin levels, and coagulopathy. HLH is likely under-recognized, and mortality remains high, especially in adults; thus, prompt diagnosis and treatment are essential. Familial forms of HLH are currently treated with chemotherapy as a bridge to hematopoietic stem cell transplantation. HLH occurring in rheumatic disease (macrophage activation syndrome) is treated with glucocorticoids, IL-1 blockade, or cyclosporine A. In other forms of HLH, addressing the underlying trigger is essential. There remains a pressing need for more sensitive, context-specific diagnostic tools. Safer, more effective therapies will arise with improved understanding of the cellular and molecular mechanisms of HLH.

Gaining insight into the supportive care needs of women experiencing gynaecological cancer: A qualitative study.

AIM AND OBJECTIVES: To gain insight into the supportive care needs of Western Australian women experiencing gynaecological cancer. BACKGROUND: Meeting the supportive care needs of people living with cancer is becoming increasingly important as advances in cancer treatment contribute to growing numbers of survivors. International evidence suggests between 24%-56% of women with gynaecological cancer have unmet supportive care needs and that psychological challenges, information provision and holistic care are priorities. No qualitative investigation has previously explored women's journey of gynaecological cancer within the Australian setting. DESIGN: A qualitative descriptive design was used. METHODS: Women treated for gynaecological cancer were recruited from a tertiary public women's hospital in Western Australia. Thematic analysis was conducted on qualitative data collected from 190 women over 12 months through written open-ended survey responses and telephone interviews. The COnsolidated criteria for REporting Qualitative research (COREQ) guided presentation of results. RESULTS: Analysis yielded five themes and four subthemes: (a) Communication style directs the experience (subthemes: feeling supported; absence of empathy); (b) It's not just about the disease (subthemes: life has changed; holistic care); (c) A desire for information; (d) Drawing upon resilience; and (e) Navigating the system. DISCUSSION: Exploration of the women's needs leads to the discussion of three concepts. Communication styles, harnessing women's resilience and alternative models of care are evaluated for their capacity to improve care and women's quality of life into survivorship. Recommendations are made for further research and possible interventions that can be translated into the clinical setting. CONCLUSION: Women with gynaecological cancer described complex often unmet supportive care needs and interactions with the healthcare system. Insight gained directs suggestions for improved service provision. RELEVANCE TO CLINICAL PRACTICE: Improved patient-centred communication, harnessing resilience as a resource and alternative models of care for follow-up are encouraged as areas of improvement for clinicians and care services.

Assessing Mental Health Concerns of Spanish-Speaking Dairy Farm Workers.

Background: Hispanic dairy farm workers have risk factors for mental health concerns. There is insufficient study of their mental health needs.Methods: We conducted focus groups at five farms. We quantified the burden of depressive symptoms with Patient Health Questionnaires (PHQ-2 and PHQ-9) during three seasons of mobile clinics on farm sites.Results: Focus groups revealed that sources of stress included working conditions, language barriers, fear of deportation, and distance from family. Depression screening found that the rate of mild depressive symptoms ranged from 0% to 3.2%. No individual scored higher than mild depression.Discussion: Rates of depressive symptoms were substantially lower than in the general US population, which may be explained by a population that self-selects for resilience. Our mixed qualitative and quantitative data acquisition provided us a more robust and comprehensive understanding of our population's mental health concerns than using one method alone.

The supportive care needs of women experiencing gynaecological cancer: a Western Australian cross-sectional study.

BACKGROUND: Women diagnosed with gynaecological cancer experience supportive care needs that require care provision to reduce the impact on their lives. International evidence suggests supportive care needs of women with gynaecological cancer are not being met and provision of holistic care is a priority area for action. Knowledge on gynaecological cancer supportive care needs is limited, specifically comparison of needs and cancer gynaecological subtype. Our aim was to identify supportive care needs of Western Australian women experiencing gynaecological cancer, their satisfaction with help and explore associations between participant's demographic characteristics and identified needs. METHODS: A cross-sectional design incorporating a modified version of the Supportive Care Needs Survey - short form (SCNS-SF34) assessed 37 supportive care needs under five domains in conjunction with demographic data. Three hundred and forty three women with gynaecological cancer attending a tertiary public referral hospital completed the survey over 12 months. Statistical analysis was performed using the R environment for statistical computing. A linear regression model was fitted with factor scores for each domain and demographic characteristics as explanatory variables. RESULTS: Three hundred and three women (83%) identified at least one moderate or high level supportive care need. The five highest ranked needs were, 'being informed about your test results as soon as feasible' (54.8%), 'fears about cancer spreading' (53.7%), 'being treated like a person not just another case' (51.9%), 'being informed about cancer which is under control or diminishing (that is, remission)' (50.7%), and 'being adequately informed about the benefits and side-effects of treatments before you choose to have them' (49.9%). Eight of the top ten needs were from the 'health system and information' domain. Associations between supportive care items and demographic variables revealed 'cancer type', and 'time since completion of treatment' had no impact on level of perceived need for any domain. CONCLUSIONS: Western Australian women with gynaecological cancer identified a high level of supportive care needs. The implementation of a supportive care screening tool is recommended to ensure needs are identified and care is patient-centred. Early identification and management of needs may help to reduce the burden on health system resources for managing ongoing needs.

"It's not like judgment day": public understanding of and reactions to personalized genomic risk information.

The value of genomic risk assessment depends upon patients making appropriate behavioral changes in response to increased risk leading to disease prevention and early detection. To date, few studies have investigated consumers' response to personalized genomic disease risk information. To address this gap, we conducted semi-structured interviews with 60 adults participating in the Coriell Personalized Medicine Collaborative. The interviews took place after receiving results providing genomic and other risk information for up to eight common complex diseases. We found that participants were most likely to recall results which conferred an increased risk or those of particular personal interest. Participants understood the multi-factorial nature of common complex disease, and generally did not have negative emotional responses or overly deterministic perceptions of their results. Although most participants expressed a desire to use results to improve their health, a minority had actually taken action (behavior change or shared results with their doctor) at the time of the interview. These results suggest that participants have a reasonable understanding of genomic risk information and that provision of genomic risk information may motivate behavior change in some individuals; however additional work is needed to better understand the lack of change seen in the majority of participants.