Trauma- and Violence-Informed Empowering Care for Sexual Assault Survivors.

BACKGROUND: Forensic nurse examiners, including sexual assault nurse examiners, provide care for survivors holistically through healthcare, emotional support, connection to follow-up care, safety planning, and, if desired, evidence collection to aid in the prosecution of sexual assault. There is increasing recognition that trauma-informed care must also include an understanding of the impacts of structural violence on minoritized patients to ensure health equity. AIM: To help address this guidance gap, we expanded Campbell and colleagues' empowering care model using a trauma- and violence-informed care (TVIC) lens. METHODS: We used an iterative discussion-based process that included five joint meetings between a seven-member transdisciplinary research team and a five-member nurse advisory board. RESULTS: In a TVIC-informed empowering care model, we propose behavioral examples for forensic nurses for each of Campbell et al.'s five key domains of empowering care for forensic nurse examinations (i.e., build rapport and establish trust, show compassion, provide patient-directed care, convey professionalism, and provide resource referral and follow-up). CONCLUSIONS: These behavioral examples for nurses can help guide forensic nurse training and practice to reduce disparities in treatment and follow-up support. Structures and systems are needed that enable forensic nurses to provide trauma- and violence-informed empowering care to survivors of sexual assault and, over time, increase the accessibility of forensic nurse examinations and improve patient outcomes.

ABHD6 suppression promotes anti-inflammatory polarization of adipose tissue macrophages via 2-monoacylglycerol/PPAR signaling in obese mice.

OBJECTIVE: Pro-inflammatory polarization of adipose tissue macrophages (ATMs) plays a critical role in the pathogenesis of obesity-associated chronic inflammation. However, little is known about the role of lipids in the regulation of ATMs polarity and inflammation in response to metabolic stress. Deletion of α/ß-hydrolase domain-containing 6 (ABHD6), a monoacylglycerol (MAG) hydrolase, has been shown to protect against diet-induced obesity and insulin resistance. METHODS: Here we investigated the immunometabolic role of macrophage ABHD6 in response to nutrient excess using whole-body ABHD6-KO mice and human and murine macrophage cell-lines treated with KT203, a selective and potent pharmacological ABHD6 inhibitor. RESULTS: KO mice on high-fat diet showed lower susceptibility to systemic diet-induced inflammation. Moreover, in the setting of overnutrition, stromal vascular cells from gonadal fat of KO vs. control mice contained lower number of M1 macrophages and exhibited enhanced levels of metabolically activated macrophages (MMe) and M2 markers, oxygen consumption, and interleukin-6 (IL-6) release. Likewise, under in vitro nutri-stress condition, inhibition of ABHD6 in MMe-polarized macrophages attenuated the expression and release of pro-inflammatory cytokines and M1 markers and induced the upregulation of lipid metabolism genes. ABHD6-inhibited MMe macrophages showed elevated levels of peroxisome proliferator-activated receptors (PPARs) and 2-MAG species. Notably, among different MAG species, only 2-MAG treatment led to increased levels of PPAR target genes in MMe macrophages. CONCLUSIONS: Collectively, our findings identify ABHD6 as a key component of pro-inflammatory macrophage activation in response to excess nutrition and implicate an endogenous macrophage lipolysis/ABHD6/2-MAG/PPARs cascade, as a lipid signaling and immunometabolic pathway, which favors the anti-inflammatory polarization of ATMs in obesity.

Campus interpersonal violence survivor advocacy services.

Objective: Although there has been increased attention to campus interpersonal violence, there is limited information on survivor advocacy services. Participants: We recruited participants from 155 U.S. institutions of higher education responsible for advocacy services on their campus. Methods: We used a community participatory action approach in partnership with the Campus Advocacy and Prevention Professionals Association to develop and disseminate a survey regarding campus advocacy services. Results: Participants shared critical insights about (a) advocacy staffing/caseload, (b) program structure, (c) advocacy practices, and (d) connection to services for people who had caused harm. We found that advocacy programs are often providing best practice services for survivors of violence but operating with few staff and unclear privacy protections. Conclusions: This study provided crucial preliminary information about how campuses provide advocacy services, but more researcher-practitioner engagement is needed to build on this study and establish clear practice guidelines.

Sexual and Relationship Violence Among LGBTQ+ College Students: A Scoping Review.

Although there has been increased attention to campus sexual and relationship violence (SRV) because of Title IX and the #MeToo movement, much of that attention has focused on victimization of cisgender heterosexual women. This scoping review uncovers information from empirical studies on what is known about LGBTQ+ (e.g., lesbian, gay, bisexual, transgender, queer, and nonbinary) students' experiences of campus SRV. Using rigorous scoping review methods (i.e., searches of 15 databases, searches of expert websites, hand searching, reference harvesting, and forward citation chaining), we identified 60 documents published since 2000 that contained findings from empirical studies related to LGBTQ+ students and SRV on U.S. college and university campuses. Through content analysis, we summarized findings around five key themes: (1) extent and types of victimization, (2) negative outcomes, (3) knowledge of and attitudes about SRV, (4) perspectives on SRV services and prevention education programs, and (5) recommendations from study authors based on their findings. Implications for research, practice, and policy based on these findings are discussed.

A Scoping Review of Human Trafficking Screening and Response.

Service providers are increasingly asked to identify individuals who are experiencing trafficking and to connect them with resources and support. Nonetheless, identification is complicated by the reality that those who are experiencing trafficking may rarely self-identify, and providers may fail to identify individuals who are experiencing trafficking due to lack of guidance on how to screen for trafficking capably and sensitively. With the aim of guiding practice, we undertook a scoping review to search for and synthesize trafficking screening tools and response protocols. Following the PRISMA extension for Scoping Reviews (PRISMA-ScR), we located 22 screening tools contained in 26 sources. We included any documents that described or tested human trafficking screening tools, screening or identification protocols, response protocols, or guidelines that were published in any year. All documents were abstracted using a standardized form. Key findings showed that most tools were developed by practice-based and non-governmental organizations located in the U.S. and were administered in the U.S. Few screening tools have been rigorously evaluated. The common types of screening questions and prompts included (a) work conditions; (b) living conditions; (c) physical health; (d) travel, immigration, and movement; (e) appearance and presentation; (f) mental health, trauma, and substance abuse; (g) associations and possessions; and (h) arrests and prior involvement with law enforcement. We were not able to locate specific response protocols that provided step-by-step guidance. Nonetheless, the review revealed available practice-based and research-based evidence to help inform guidance concerning how screening and identification of human trafficking may be administered.

LGBTQ+-Affirming Campus Sexual and Relationship Violence Prevention: A Qualitative Study.

LGBTQ+ (e.g., lesbian, gay, bisexual, transgender, nonbinary, queer) people are often left out of campus sexual and relationship violence (SRV) prevention efforts despite experiencing higher rates of SRV. To inform LGBTQ+-affirming prevention efforts, we use a practice-to-research approach to aggregate wisdom from 32 LGBTQ+ professionals working to address campus SRV among LGBTQ+ college students garnered through semi-structured interviews. Participants shared four approaches to including or excluding LGBTQ+ students in campus SRV prevention programs as well as recommendations to cultivate more LGBTQ+-affirming campus SRV prevention efforts. We summarize recommendations for possible action steps at individual, relationship, community, and policy levels of the social ecological model for LGBTQ+-affirming campus SRV prevention.

Alcohol's Role in Campus Sexual Assault Bystander Behavior: A Systematic Review.

Between 50% and 70% of campus sexual assaults (SA) involve alcohol and campuses frequently promote bystander intervention strategies to prevent SA in student party contexts. This systematic review evaluates the measurement and outcomes of quantitative studies on how alcohol affects campus SA bystander outcomes. Using four search strategies and rigorous systematic review methods, we conducted a review of 36 studies. We included studies published after 2,000 conducted with college students in the United States, its territories, and Canada which contained information on alcohol use and SA bystander outcomes (behaviors and upstream proxies). Only a third of included studies measured bystander behavior directly, the majority measured upstream proxies (e.g., intentions, self-efficacy). Most studies considered the influence of victim intoxication on bystander outcomes. No studies assessed the pharmacological or physiological effects of alcohol on bystander outcomes. A single study examined hypothetical bystander responses when intoxicated, one-third examined bystander's typical alcohol use in relation to bystander outcomes. Many findings are contradictory, including fundamental details such as how often students encounter SA involving alcohol or whether bystanders' alcohol use predicts outcomes. Findings suggest that students are less likely help intoxicated victims compared to sober victims, but there are clear moderating factors. Perpetrator intoxication was not studied in relation to bystander behavior and did not influence any upstream proxies. Evaluations of interventions on alcohol and bystander topics are promising yet more research is required. This review illuminates key gaps in the literature, including the need for validated measures and scenarios, event-level studies, and alcohol administration trials.

Smoking cessation in pregnant women using financial incentives: a feasibility study.

BACKGROUND: The high prevalence of smoking pregnant women in Dutch areas with lower socioeconomic status and the consecutively harmful exposure to tobacco to both mother and child, depicted a high need for a novel intervention. According to other studies, the utilisation of financial incentives appeared to be a promising method for smoking cessation in pregnant women. Therefore, the aim of this study was to investigate the feasibility of implementing contingent financial incentives as smoking cessation support for pregnant women in the Netherlands. METHODS: Feasibility study consisting of four developmental phases: (1) acceptability of Dutch population regarding financial-incentive-intervention by conducting an online questionnaire, (2) composing a pilot study utilising the financial-incentive-intervention in clinical practice, (3) execution of the composed pilot study and (4) evaluation of the executed pilot study utilising a mixed-methods approach. A financial-incentive-intervention, given in a contingent financial scheme (during five consequential appointments, respectively €25/€50/€100/€150/€250), if smoking abstinence was proven by the amount of cotinine in the urine of the pregnant women measured utilising a urine dipstick test. The public acceptability for the financial-incentive-intervention was assessed using 5-Likert scales. The number of pregnant women able to abstain from smoking during the pilot study and utilising the financial-incentive-intervention in clinical practice were used to assess the prosperity and practicality of the pilot study respectively. The pilot study was evaluated using a mixed-methods approach. RESULTS: In total, 55.1% of the Dutch population sample (n = 328) found a financial incentive inappropriate for smoking cessation in pregnant women, while the healthcare professionals and pilot study participants thought the financial-incentive-intervention to be a helpful approach. Eleven vouchers were given during the pilot study, and one woman completed all test points and tested negative for cotinine at the end of the pilot study. CONCLUSION: Although the financial-incentive-intervention appeared to be a promising approach for smoking cessation in pregnant women, the acceptability of the Dutch population and the number of pregnant women able to abstain smoking during this pilot study was low. Despite the limited study population, this study proved the concept of this financial-incentive-intervention to be feasible for implementation in the Netherlands. TRIAL REGISTRATION: Not applicable since this is a feasibility study prior to a trial.

Introduction to the Special Issue on Common Goals, Different Needs: Improving Communication and Collaboration Between Researchers and Practitioners to End Interpersonal Violence.

Rates of interpersonal violence have largely remained stagnant over the past three decades, despite the magnitude of prevention and response efforts to address this issue. Although interpersonal violence researchers have stressed the importance of partnerships between researchers and campus and community-based practitioners, there is still a disconnect between the work done by researchers and those engaged in direct practice in the field. This special issue brings together researchers and practitioners to explore a variety of challenges and successes in identifying common goals, building relationships, and improving strategies for addressing interpersonal violence using researcher-practitioner models.

Unilateral transfemoral amputees exhibit altered strength and dynamics of muscular co-activation modulated by visual feedback.

Objective.Somatosensory perception is disrupted in patients with a lower limb amputation. This increases the difficulty to maintain balance and leads to the development of neuromuscular adjustments. We investigated how these adjustments are reflected in the co-activation of lower body muscles and are modulated by visual feedback.Approach.We measured electromyography (EMG) signals of muscles from the trunk (erector spinae and obliquus external), and the lower intact/dominant leg (tibialis anterior and medial gastrocnemius) in 11 unilateral transfemoral amputees and 11 age-matched able-bodied controls during 30 s of upright standing with and without visual feedback. Muscle synergies involved in balance control were investigated using wavelet coherence analysis. We focused on seven frequencies grouped in three frequency bands, a low-frequency band (7.56 and 19.86 Hz) representing more sub-cortical and spinal inputs to the muscles, a mid-frequency band (38.26 and 62.63 Hz) representing more cortical inputs, and a high-frequency band (92.90, 129 and 170.90 Hz) associated with synchronizing motor unit action potentials. Further, the dynamics of changes in intermuscular coupling over time were quantified using the Entropic Half-Life.Main results.Amputees exhibited lower coherency values when vision was removed at 7.56 Hz for the muscle pair of the lower leg. At this frequency, the coherency values of the amputee group also differed from controls for the eyes closed condition. Controls and amputees exhibited opposite coherent behaviors with visual feedback at 7.56 Hz. For the eyes open condition at 129 Hz, the coherency values of amputees and controls differed for the muscle pair of the trunk, and at 170.90 Hz for the muscle pair of the lower leg. Amputees exhibited different dynamics of muscle co-activation at the low frequency band when vision was available.Significance.Altogether, these findings point to the development of neuromuscular adaptations reflected in the strength and dynamics of muscular co-activation.

Intimate Partner Violence Survivors' Housing Needs and Preferences: A Brief Report.

Intimate partner violence (IPV) victimization contributes to homelessness and housing insecurity for survivors and their children. Despite growing interest in expanding strategies for addressing the housing needs of survivors, there is a dearth of knowledge regarding survivors' preferences and recommendations. To begin to address knowledge gaps, this article reports findings from a qualitative study examining the housing needs of IPV survivors and survivors' preferences and recommendations for addressing their housing needs. In-depth interviews with 19 adult IPV survivors in a southeastern community determined three key themes: (a) IPV housing needs and challenges, (b) domestic violence shelter strengths and concerns, and (c) recommendations for addressing survivors' housing needs. The findings highlight the need for flexibility and variability in housing services as opposed to a one-size-fits-all strategy, and stress the importance of centering the voices of survivors as the field explores new housing directions.

Metas internacionais de segurança do paciente na atenção primária à saúde: uma revisão integrativa / International patient safety goals in the Primary Health Care: an integrative review

A atenção primária em saúde (APS) representa o primeiro contato dos indivíduos com a porta de entrada dos sistemas de saúde. A implementação de estratégias como as Metas Internacionais de Segurança do Paciente (MISP) neste nível de atenção em saúde surge como alternativa para qualificação do cuidado. O presente estudo tem como objetivo investigar na literatura, estudos relacionados às MISP no âmbito da APS. Trata-se de uma revisão de literatura integrativa com busca nas bases de dados Scopus, MEDLINE/Pubmed, LILACS e Scielo, de 2012 a 2019. Dos 43 artigos selecionados, 20,9% apresentaram origem na Espanha, seguidos de Brasil e Reino Unido com sete (16,3%) estudos cada. A MISP 3, sobre o uso seguro de medicamentos, foi a mais prevalente, 65,4% dos estudos, e envolveu estudos com as temáticas de polifarmácia, medicamentos potencialmente inapropriados, revisão de medicamentos e conciliação medicamentosa. A presente revisão integrativa contribuiu para ampliar o conhecimento sobre a segurança do paciente no âmbito da APS e para ressaltar a necessidade da realização de mais estudos referentes às seis MISP, muitas delas, já bem descritas e debatidas no ambiente hospitalar, mas com discreta abordagem mesmo com igual relevância, no âmbito da APS. (AU)

The Primary Health Care (PHC) characterizes the first contact of citizens with the health systems. The implementation of strategies such as the International Patient Safety Goals (IPSG) in this level of healthy attention appears as an alternative to qualify care. The study aims to investigate, thought science literature, studies related to IGPS in the field of PHC. It is an integrative review based on data from Scopus, MEDLINE/Pubmed, LILACS and Scielo, from 2012 to 2019. Out of 43 selected studies, the majority has analyzed data from the Spain (20.9%), followed by Brazil and United Kingdom, seven (16.4%) studies each. The MISP 3, regarding the improve the safety of medications was the most prevalent, 65.4% of the studies, sustaining themes as polypharmacy, potentially inappropriate medication, medication review and medication reconciliation. This integrative review contributes to increase the knowledge about the patient’s safety in the field of PHC and emphasizes the need for further studies related to the six IGPS. Although most of them has already been described and debated in the hospital environment, the PHC remains an overlooked field of study. (AU)

[Diagnosis and management of liver cysts]. / Diagnostic et traitement des kystes hépatiques.

Cystic hepatic lesions are frequent and sometimes large. They are generally asymptomatic and discovered by chance. The differential diagnosis of these lesions includes congenital, post-traumatic, benign or malignant tumors, as well as infectious pathologies. Conventional or contrast ultrasonography, abdominal computed tomography and magnetic resonance imaging can be used to characterize them. Therapeutic abstention with or without iconographic monitoring constitutes the optimal management of many benign liver cysts without clinical repercussions. Treatments for symptomatic or potentially aggressive lesions may include fenestration, puncture with sclerotherapy, or surgical resection. In this article, the authors discuss how to diagnose and treat the various hepatic cystic lesions.

Les lésions kystiques hépatiques sont fréquentes et parfois volumineuses. Elles sont généralement asymptomatiques et de découverte fortuite. Le diagnostic différentiel de ces lésions inclut des pathologies congénitales, post-traumatiques, tumorales bénignes ou malignes ainsi qu'infectieuses. L'échographie conventionnelle ou avec contraste, le scanner abdominal et la résonance magnétique nucléaire peuvent être utilisés pour les caractériser. L'abstention thérapeutique, avec ou sans surveillance iconographique, constitue la prise en charge optimale de nombreux kystes bénins sans répercussion clinique. Les traitements des lésions symptomatiques ou potentiellement agressives peuvent inclure la fenestration, la ponction avec sclérothérapie ou la résection chirurgicale. Dans cet article, les auteurs discutent des modalités de diagnostic et de traitement des diverses lésions kystiques hépatiques.

Threshold-dependent iodine imaging and spectral separation in a whole-body photon-counting CT system.

OBJECTIVE: To evaluate the dual-energy (DE) performance and spectral separation with respect to iodine imaging in a photon-counting CT (PCCT) and compare it to dual-source CT (DSCT) DE imaging. METHODS: A semi-anthropomorphic phantom extendable with fat rings equipped with iodine vials is measured in an experimental PCCT. The system comprises a PC detector with two energy bins (20 keV, T) and (T, eU) with threshold T and tube voltage U. Measurements using the PCCT are performed at all available tube voltages (80 to 140 kV) and threshold settings (50-90 keV). Further measurements are performed using a conventional energy-integrating DSCT. Spectral separation is quantified as the relative contrast media ratio R between the energy bins and low/high images. Image noise and dose-normalized contrast-to-noise ratio (CNRD) are evaluated in resulting iodine images. All results are validated in a post-mortem angiography study. RESULTS: R of the PC detector varies between 1.2 and 2.6 and increases with higher thresholds and higher tube voltage. Reference R of the EI DSCT is found as 2.20 on average overall phantoms. Maximum CNRD in iodine images is found for T = 60/65/70/70 keV for 80/100/120/140 kV. The highest CNRD of the PCCT is obtained using 140 kV and is decreasing with decreasing tube voltage. All results could be confirmed in the post-mortem angiography study. CONCLUSION: Intrinsically acquired DE data are able to provide iodine images similar to conventional DSCT. However, PCCT thresholds should be chosen with respect to tube voltage to maximize image quality in retrospectively derived image sets. KEY POINTS: • Photon-counting CT allows for the computation of iodine images with similar quality compared to conventional dual-source dual-energy CT. • Thresholds should be chosen as a function of the tube voltage to maximize iodine contrast-to-noise ratio in derived image sets. • Image quality of retrospectively computed image sets can be maximized using optimized threshold settings.

Photon-counting detectors in computed tomography: from quantum physics to clinical practice.

Over the last decade, a fundamentally new type of computed tomography (CT) detectors has proved its superior capabilities in both physical and preclinical evaluations and is now approaching the stage of clinical practice. These detectors are able to discriminate single photons and quantify their energy and are hence called photon-counting detectors. Among the promising benefits of this technology are improved radiation dose efficiency, increased contrast-to-noise ratio, reduced metal artifacts, improved spatial resolution, simultaneous multi-energy acquisitions, and the prospect of multi-phase imaging within a single acquisition using multiple contrast agents. Taking the conventional energy-integrating detectors as a reference, the authors demonstrate the technical principles of this new technology and provide phantom and patient images acquired by a whole-body photon-counting CT. These images serve as a basis for discussing the potential future of clinical CT.

Potential of ultra-high-resolution photon-counting CT of bone metastases: initial experiences in breast cancer patients.

Conventional CT scanners use energy-integrating detectors (EIDs). Photon-counting detector (PCD) computed tomography (CT) utilizes a CT detector technology based on smaller detector pixels capable of counting single photons and in addition discriminating their energy. Goal of this study was to explore the potential of higher spatial resolution for imaging of bone metastases. Four female patients with histologically confirmed breast cancer and bone metastases were included between July and October 2019. All patients underwent conventional EID CT scans followed by a high resolution non-contrast experimental PCD CT scan. Ultra-high resolution (UHR) reconstruction kernels were used to reconstruct axial slices with voxel sizes of 0.3 mm × 0.3 mm (inplane) × 1 mm (z-direction). Four radiologists blinded for patient identity assessed the images and compared the quality to conventional CT using a qualitative Likert scale. In this case series, we present images of bone metastases in breast cancer patients using an experimental PCD CT scanner and ultra-high-resolution kernels. A tendency to both a smaller inter-reader variability in the structural assessment of lesion sizes and in the readers' opinion to an improved visualization of lesion margins and content was observed. In conclusion, while further studies are warranted, PCD CT has a high potential for therapy monitoring in breast cancer.

Sexual Harassment of College and University Students: A Systematic Review.

Increased attention to Title IX and the #MeToo movement has led to more interest in developing strategies to prevent forms of gender-based violence beyond acquaintance rape, including sexual harassment (SH). This study reviewed the extant literature published since 2000 on SH of college/university students (n = 24) to determine (a) study methods, (b) sample sociodemographic characteristics, (c) prevalence, (d) risk and protective factors, and (e) consequences of campus SH. These studies shared the view that overall SH rates are high, but their findings were difficult to cross-evaluate due to variations in their study designs. Generally, unwanted sexual attention and gender harassment were more commonly experienced in campus SH occurrences than sexual coercion. Findings indicated that being White, a woman, or a sexual minority increased a student's likelihood of experiencing SH while at a college/university. Student SH survivors rarely filed official reports but often faced a variety of mental and physical health consequences. Women of color experienced lower rates of SH but more severe consequences in the aftermath. This review concludes by detailing several implications for future research, as well as possible campus SH prevention, intervention, and policy protocols.

Housing Interventions for Intimate Partner Violence Survivors: A Systematic Review.

Intimate partner violence (IPV) survivors are much more likely to experience housing insecurity or homelessness than those who have not experienced IPV. However, little comprehensive research has evaluated the effectiveness of interventions used to address IPV survivors' housing insecurity. To address this knowledge gap, our team conducted a systematic review guided by three questions: (a) What are current interventions for addressing IPV survivors' housing needs? (b) What are the methodological strengths and limitations of the research evaluating those interventions? (c) How effective are the identified interventions? We identified potentially relevant peer-reviewed and gray literature using variations of predetermined search terms and four search methods. Twelve articles met inclusion criteria. Accordingly, this study showed that there is an overall dearth of research concerning interventions that address IPV survivors' housing insecurity and needs. Shelter is the most commonly assessed and available housing intervention for IPV survivors, but only limited empirical evaluation is available of shelter effectiveness. In addition, findings indicate both traditional shelter services and innovative interventions (e.g., rapid rehousing, flexible funding) would benefit from rigorous evaluation including examining survivor and situation characteristics contributing to housing strategy effectiveness.

Role legitimacy, comfort and confidence providing tobacco, alcohol and other drug care: a cross-sectional study of Australian early-career general practitioners.

Australian general practitioners (GPs) see most Australians each year and, as tobacco, alcohol and other drug use (substance use) are common, GPs often see problematic, risky or dependent substance use. This study aimed to explore early-career GPs' role legitimacy, comfort and confidence managing patients with problematic use of tobacco, alcohol, psychoactive pharmaceutical or illicit substances.Using the '5A's framework: Ask, Assess, Advise, Assist and Arrange, we surveyed 251 early-career GPs (GP registrars) on role legitimacy, confidence managing patient substance use, and sources of clinical information, advice and support.There was strong agreement that managing substance use is a GP's role, with high levels of confidence 'Asking' (screening) about tobacco and alcohol use, which decreased across other substance classes. Early-career GPs reported lower levels of confidence 'Assessing' and 'Advising' (brief interventions); and much lower levels of confidence 'Assisting' (treating) and 'Arranging' (follow up and/or referral) for patients with substance issues across all substances, including tobacco. Participants were most likely to seek advice from senior colleagues in their practice.Early-career GPs reported lower than optimal levels of confidence for all substances. Our findings have important implications for educators globally. Education that improves confidence across all 5As for high-prevalence substances (tobacco and alcohol) while focusing on increasing comfort screening and improving understanding of referral pathway options for low-prevalence substances may improve early-career GPs' confidence. This could increase engagement in managing substance use issues potentially leading to better health and wellbeing outcomes for patients.