Refocusing on nature: the role of nature reintegration in environmental, mental, and societal wellbeing.

This perspective paper investigates the dynamic interplay between wealth, materialism, environmental degradation, and mental health amid escalating challenges of climate change. The paper critically examines how affluence, often a buffer against climate impacts, paradoxically leads to higher consumption and carbon footprints, exacerbating environmental problems. A societal emphasis on materialism contributes to an estrangement from nature, with significant implications for mental health and environmental sustainability. The paper proposes a fundamental shift in addressing these intertwined challenges through reintegration with nature. The paper recommends integrating urban planning, education, mental health, and community engagement strategies to build a sustainable, mentally resilient society more integrated with nature. This approach, supported by future research directions, aims to create a more balanced, environmentally conscious, and mentally healthy world.

Prevalence of Complementary Medicine Use in Children and Adolescents: A Systematic Review.

INTRODUCTION: The objective of this systematic review was to determine the global prevalence of complementary medicine (CM) use among children and adolescents. METHOD: Seven databases and the reference lists of included studies were searched for pertinent observational studies. Studies were limited to those published in English from July 1, 2013. Included studies were appraised using the JBI checklist for prevalence studies. RESULTS: Twenty studies were eligible for inclusion (385,527 participants). Most studies were assessed as having low risk of bias. Meta-analyses revealed a 23.0% (95% confidence interval, 0.226-0.234; 17 studies) short-term (≤ 12 month) prevalence and a 77.7% (95% confidence interval, 0.760-0.794; six studies) lifetime prevalence of CM use in children and adolescents. Differences in CM use were evident across countries and regions. DISCUSSION: The findings of this review indicate that the use of CM in children and adolescents is high and widespread and may be increasing.

IMPAACT: IMproving the PArticipAtion of older people in policy decision-making on common health CondiTions - a study protocol.

INTRODUCTION: Rapid population ageing is a demographic trend being experienced and documented worldwide. While increased health screening and assessment may help mitigate the burden of illness in older people, issues such as misdiagnosis may affect access to interventions. This study aims to elicit the values and preferences of evidence-informed older people living in the community on early screening for common health conditions (cardiovascular disease, diabetes, dementia and frailty). The study will proceed in three Phases: (1) generating recommendations of older people through a series of Citizens' Juries; (2) obtaining feedback from a diverse range of stakeholder groups on the jury findings; and (3) co-designing a set of Knowledge Translation resources to facilitate implementation into research, policy and practice. Conditions were chosen to reflect common health conditions characterised by increasing prevalence with age, but which have been underexamined through a Citizens' Jury methodology. METHODS AND ANALYSIS: This study will be conducted in three Phases-(1) Citizens' Juries, (2) Policy Roundtables and (3) Production of Knowledge Translation resources. First, older people aged 50+ (n=80), including those from traditionally hard-to-reach and diverse groups, will be purposively recruited to four Citizen Juries. Second, representatives from a range of key stakeholder groups, including consumers and carers, health and aged care policymakers, general practitioners, practice nurses, geriatricians, allied health practitioners, pharmaceutical companies, private health insurers and community and aged care providers (n=40) will be purposively recruited for two Policy Roundtables. Finally, two researchers and six purposively recruited consumers will co-design Knowledge Translation resources. Thematic analysis will be performed on documentation and transcripts. ETHICS AND DISSEMINATION: Ethical approval has been obtained through the Torrens University Human Research Ethics Committee. Participants will give written informed consent. Findings will be disseminated through development of a policy brief and lay summary, peer-reviewed publications, conference presentations and seminars.

Mental Health Literacy and Education of Complementary Medicine Practitioners: A Cross-Sectional Study.

An estimated 42% of Australians who consult complementary medicine (CM) practitioners have a mental health diagnosis. Preparedness of CM practitioners in managing such diagnoses is currently unknown. A cross-sectional survey of 257 CM practitioners who reported caring for people with a mental health diagnosis. Practitioners' mental health literacy, educational needs, and confidence in the assessment, management, and treatment of mental health-including suicide risk-were analysed. Most (59.1%) participants had no formal qualifications in mental health and 44.3% indicated they had not completed any training in psychological therapies. Only 20% were trained in mindfulness-based techniques or goal setting. Over 50% reported their undergraduate qualification contained insufficient mental health content to prepare them for clinical practice. Over one-half had attended continuing professional education on mental health. Practitioners reported greater confidence in assessing, managing, and treating mental wellbeing over complex mental health disorders and suicide risk. These findings uncovered a deficit in the CM practitioner's surveyed mental health education. As these CM practitioners are a primary point of contact for patients with mental health diagnoses, there is a critical need to expedite skills development in this workforce to support the delivery of safe and effective primary mental health care.

Evidence implementation in Australian manual therapy practice: A cross-sectional study.

BACKGROUND: Few studies have explored the determinants of evidence implementation in complementary manual therapy professions. Exploring the factors that impede or enable evidence implementation in complementary manual therapy professions is critical to determining the most appropriate strategies to optimise this practice, and enhance the quality of care. METHODS: The study used a cross-sectional study design to examine Australian complementary medicine manual therapists' attitudes, skills, training, use, barriers and enablers to evidence implementation. Eligible therapists were invited to self-administer the 84-item Evidence-Based practice Attitude and utilization Survey online. RESULTS: The survey was completed by 294 manual therapists (77% female; 65% aged ≥50 years). Participants were mostly supportive of, and reported a moderate to moderate-high level of skill in evidence implementation. However, the level of engagement in evidence implementation was low. The leading barriers to evidence implementation were lack of time, and lack of clinical evidence. While few participants reported skill-level as a barrier, most indicated a desire to develop the skills necessary to improve their engagement in evidence implementation. Participants also supported a range of other enabling strategies to foster evidence implementation in their practice, with most of these strategies targeting access to evidence. CONCLUSIONS: Although participants reported few barriers to evidence implementation, there was a low level of engagement in this activity. The barriers to evidence implementation therefore warrant further exploration. This ongoing work will help better understand how to optimise evidence implementation in complementary manual therapy practice, and help drive improvements in patient care.

Applying Learning Principles Within Parent Education: Exploring Nurses' Practice and Parents' Experiences.

Purpose: In parent-education practice nurses use Learning Principles (LPs) when helping parents to develop the knowledge and skills required to care for their children. LPs are basic precepts of learning, comprising people's beliefs, behaviors and reasoning processes. LPs underpin parents' active engagement, confidence building and decision-making, as information provided becomes usable knowledge. However, the ways nurses apply LPs in parent-education practice are poorly explained in healthcare. Likewise, descriptions of parents' learning experiences, associated with the use of LPs in nurse/parent-education interactions, are lacking. This study aimed to explore and describe nurses' perceptions and use of LPs, and parents' learning experiences in one healthcare organization. Participants and Methods: Using an action research design, 25 nurses and 18 parent participants were purposively recruited across metropolitan Adelaide, Australia. Data were collected through observations and semi-structured interviews and thematically analyzed simultaneously June-December 2017. Results: The LPs nurses used, and those important to parents' learning experiences created three overarching themes: 1) collaborative relationships, 2) deepening learning insights, 3) the learning environment. Despite their apparent use, nurses struggled to explicitly describe how they perceived LPs, believing their knowledge and use was sub-conscious - tacit. However, tacit knowledge hinders communication and explanation of LPs used within parent-education to other nurses. The member-checking of interview data helped to stimulate the nurses' metacognition (thinking about their thinking), unlocking their LPs awareness. Conclusion: Nurses used LPs in practice but their knowledge was tacit. Through metacognition, nurses started to recognize the ways LPs influenced their practice and parents' learning capabilities. Increasing healthcare constraints, including time allowed for parent-education, require nurses to optimize their use of LPs. Future research should identify ways nurses can communicate their use of LPs, potentially enhancing parents' active learning experiences and concordance with health recommendations.

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

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

Patient-shared knowledge and information in clinical decision-making: an international survey of the perspectives and experiences of naturopathic practitioners.

INTRODUCTION: Most knowledge translation models pay relatively little attention to patient-held knowledge and are largely based on the premise that researchers and clinicians hold all valuable knowledge, and patients are passive recipients of such knowledge. Counter to this clinician- and researcher-centred lens is a growing interest and awareness of patients as experts in their health. While naturopathic medicine is described and experienced as a patient-centred system of traditional medicine, the position of patient-held knowledge is unclear particularly when considered alongside their use of other more objective forms of knowledge such as research evidence. METHODS: This international online cross-sectional survey aimed to explore naturopathic practitioners' perceptions of the value and contribution of patient-shared knowledge and information within the context of naturopathic clinical consultations. RESULTS: The survey was completed by 453 naturopathic practitioners (response rate: 74.3%). Approximately two-thirds (68.2%) of respondents reported using information shared by the patient. Most rated 'information provided by the patient' as either 'extremely important' (60.7%) or 'very important' (31.4%) to patients. Highest levels of trust were reported for information provided by the patient ('completely': 9.9%; 'a lot': 53.6%). Most practitioners indicated they trusted knowledge and information derived from the patient's personal health history 'completely' (n = 79; 21.8%) or 'a lot' (n = 226; 62.4%) from the patient's perspective of living with a health condition ('completely' [n = 63, 17.4%]; 'a lot' [n = 224, 61.9%]). Patients were the highest ranked stakeholder group (mean: 1.5) perceived to influence NP use of patient experience of living with a health condition to inform clinical decision-making. CONCLUSION: Researchers and policy makers are increasingly focused on the value of the 'expert patient' in clinical decision-making, yet health professionals' report challenges and, in some cases, resistance to meaningfully engaging with patient-shared knowledge in practice. However, our study has found patient-shared knowledge - inclusive of patient experience of their health condition - is among the knowledge used and trusted by naturopathic practitioners to inform their clinical decision-making. This study both offers insights into the knowledge translation behaviours of an under-researched health profession and provides a novel contribution to the wider aim of adopting patient-shared knowledge into clinical care more generally.

Evidence implementation in naturopathy: A cross-sectional study of Australian naturopaths.

BACKGROUND AND PURPOSE: Evidence implementation refers to the application of appropriate enabling strategies to improve clinician engagement with the best available evidence. To date, little attention has been paid to evidence implementation in disciplines such as naturopathy. This study addresses this knowledge gap by examining the determinants of evidence implementation in Australian naturopathic practice. MATERIALS AND METHODS: This cross-sectional study was open to all Australian naturopaths who had internet access and were fluent in the English language. Participants were invited to complete the 84-item Evidence-Based practice Attitude and utilization Survey (EBASE) online between March and July 2020. RESULTS: The survey was completed in full by 174 naturopaths (87.4% female; 31.6% aged 40-59 years). While participant attitudes were predominantly favourable of evidence implementation, engagement in evidence implementation activities was reported at a low to moderate level. Factors impacting participant engagement in such activities included a lack of clinical evidence in naturopathy, lack of time, and a moderate to moderately-high level of self-reported skill in evidence implementation. Enablers of evidence implementation were access to the internet, free online databases, full-text journal articles, and online education materials. CONCLUSION: This study has provided valuable insights into the level of, and factors impacting evidence implementation among Australian naturopaths. Attitude did not pose a major barrier to evidence implementation; rather, the barriers were largely structural and cognitive. This suggests that the obstacles to evidence implementation in naturopathy are most likely surmountable with the right means and concerted effort.

Development and validation of the global assessment of the evidence implementation environment [GENIE] tool.

BACKGROUND: Overcoming the various barriers to evidence implementation is critical to delivering evidence-based health care. Identifying and managing these obstacles is somewhat challenging however, due to interprofessional and interjurisdictional variations in reported barriers. An efficient, systematic, comprehensive and innovative approach to isolating the barriers to evidence implementation is therefore needed. MATERIALS AND METHODS: Using a mixed methods design, the study aimed to develop, refine and validate a tool to assess the evidence implementation environment for complementary medicine (CM) professions. The tool was developed using a five-stage process, and refined and validated using a two-round e-Delphi technique. RESULTS: Informed by reviews examining the barriers and enablers to evidence implementation in CM, and shaped by the Behaviour Change Wheel Framework, a preliminary 33-item tool was created (i.e. the Global Assessment of the Evidence Implementation Environment [GENIE] tool). A two-round Delphi technique was used to refine the criteria, with a panel of 23 experts agreeing to the removal of two criteria, and the addition of two items. In the end, the Delphi panel reached consensus on 33 criteria, which were sorted into nine stakeholder groups. CONCLUSION: This study has for the first time, created an innovative tool to assess the capacity and capability of CM professions to engage in evidence-based practice at an optimal level. By assessing the evidence implementation environment of CM professions, the GENIE tool is able to determine where resources, infrastructure and personnel should be directed in order to optimise the uptake of evidence-based practices within CM professions.

Feasibility and efficacy of implementing group visits for women's health conditions: a systematic review.

BACKGROUND: Shared medical appointments, also known as group visits, are a feasible and well-accepted approach for women receiving antenatal care, yet the feasibility and efficacy of this approach for female-specific reproductive conditions is uncertain. OBJECTIVE: The aim of this systematic review was to (a) determine the feasibility of group visits in adults with any female-specific reproductive condition, and (b) identify whether delivering group care for these conditions impacts clinical outcomes. METHOD: Six databases and two clinical trials registries were searched from inception through to 26 January 2022 for original research examining group medical visits or group consultation interventions for adults with female reproductive conditions or pathologic conditions specific to the female reproductive system. RESULTS: The search yielded 2584 studies, of which four met the inclusion criteria. Included studies sampled women with breast cancer, chronic pelvic pain, polycystic ovary syndrome and gynaecological cancers. Studies reported high levels of patient satisfaction, with participants indicating their expectations had been met or exceeded. The impact of group visits on clinical outcomes was inconclusive however. DISCUSSION/CONCLUSIONS: The studies in this review indicate delivery of female-specific healthcare via a group model maybe feasible and well-accepted. The review provides a solid basis for proposing larger and longer studies on group visits for female reproductive conditions. TRIAL REGISTRATION: The review protocol was registered with PROSPERO (CRD42020196995).

Investigating attitudes, skills, and use of evidence-based practice among Norwegian chiropractors; a national cross-sectional study.

BACKGROUND: Evidence-based practice (EBP) is essential in improving the quality of healthcare and of importance for all health care personnel. No study in Norway has investigated attitudes, skills and use related to EBP among chiropractors. The aim of this study was to describe Norwegian chiropractors' attitudes, skills, and use of EBP, as well as the barriers and facilitators to their use of EBP. METHODS: A national cross-sectional survey, the online version of the Evidence Based practice Attitudes & Utilisation SurvEy (EBASE), was sent by email to 770 Norwegian practicing chiropractors, all members of the Norwegian Chiropractic Association. Three EBASE sub-scores were generated (Attitudes, Skills and Use), and the demographic characteristics of the sample were reported. Linear regression analyses were conducted to examine the association between responses of the three sub-scores and demographic characteristics. Information on main barriers and facilitators of EBP was collected and described. RESULTS: A total of 312 (41%) chiropractors responded to the survey, and 95% agreed that EBP is necessary for chiropractic practice. While overall use of EBP activities was low participants were interested in learning and improving their skills to incorporate EBP into practice. Chiropractors' attitudes, skills, and use of EBP were positively associated with being female and having spent more than one hour per week on research, but negatively associated with having practiced more than 10 years. Main barriers of EBP were lack of skills to critically evaluate, interpret, and apply research findings to practice. Main facilitators of EBP included access to the internet and free online databases in the workplace. CONCLUSION: Although chiropractors in Norway reported positive attitudes and moderate skills in EBP, their use of EBP activities was limited. The main barriers and facilitators to EBP were primarily related to perceived skills deficits, whilst enablers of EBP were mostly related to infrastructure requirements.

Polyunsaturated fatty acids (PUFA) for attention deficit hyperactivity disorder (ADHD) in children and adolescents.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is a major problem in children and adolescents, characterised by age-inappropriate levels of inattention, hyperactivity, and impulsivity, and is associated with long-term social, academic, and mental health problems. The stimulant medications methylphenidate and amphetamine are the most frequently used treatments for ADHD, but these are not always effective and can be associated with side effects. Clinical and biochemical evidence suggests that deficiencies of polyunsaturated fatty acids (PUFA) could be related to ADHD. Research has shown that children and adolescents with ADHD have significantly lower plasma and blood concentrations of PUFA and, in particular, lower levels of omega-3 PUFA. These findings suggest that PUFA supplementation may reduce the attention and behaviour problems associated with ADHD. This review is an update of a previously published Cochrane Review. Overall, there was little evidence that PUFA supplementation improved symptoms of ADHD in children and adolescents. OBJECTIVES: To compare the efficacy of PUFA to other forms of treatment or placebo in treating the symptoms of ADHD in children and adolescents. SEARCH METHODS: We searched 13 databases and two trials registers up to October 2021. We also checked the reference lists of relevant studies and reviews for additional references. SELECTION CRITERIA: We included randomised and quasi-randomised controlled trials that compared PUFA with placebo or PUFA plus alternative therapy (medication, behavioural therapy, or psychotherapy) with the same alternative therapy alone in children and adolescents (aged 18 years and under) diagnosed with ADHD. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcome was severity or improvement of ADHD symptoms. Our secondary outcomes were severity or incidence of behavioural problems; quality of life; severity or incidence of depressive symptoms; severity or incidence of anxiety symptoms; side effects; loss to follow-up; and cost. We used GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS: We included 37 trials with more than 2374 participants, of which 24 trials were new to this update. Five trials (seven reports) used a cross-over design, while the remaining 32 trials (52 reports) used a parallel design. Seven trials were conducted in Iran, four each in the USA and Israel, and two each in Australia, Canada, New Zealand, Sweden, and the UK. Single studies were conducted in Brazil, France, Germany, India, Italy, Japan, Mexico, the Netherlands, Singapore, Spain, Sri Lanka, and Taiwan. Of the 36 trials that compared a PUFA to placebo, 19 used an omega-3 PUFA, six used a combined omega-3/omega-6 supplement, and two used an omega-6 PUFA. The nine remaining trials were included in the comparison of PUFA to placebo, but also had the same co-intervention in the PUFA and placebo groups. Of these, four trials compared a combination of omega-3 PUFA plus methylphenidate to methylphenidate. One trial each compared omega-3 PUFA plus atomoxetine to atomoxetine; omega-3 PUFA plus physical training to physical training; and an omega-3 or omega-6 supplement plus methylphenidate to methylphenidate; and two trials compared omega-3 PUFA plus dietary supplement to dietary supplement. Supplements were given for a period of between two weeks and six months. Although we found low-certainty evidence that PUFA compared to placebo may improve ADHD symptoms in the medium term (risk ratio (RR) 1.95, 95% confidence interval (CI) 1.47 to 2.60; 3 studies, 191 participants), there was high-certainty evidence that PUFA had no effect on parent-rated total ADHD symptoms compared to placebo in the medium term (standardised mean difference (SMD) -0.08, 95% CI -0.24 to 0.07; 16 studies, 1166 participants). There was also high-certainty evidence that parent-rated inattention (medium-term: SMD -0.01, 95% CI -0.20 to 0.17; 12 studies, 960 participants) and hyperactivity/impulsivity (medium-term: SMD 0.09, 95% CI -0.04 to 0.23; 10 studies, 869 participants) scores were no different compared to placebo. There was moderate-certainty evidence that overall side effects likely did not differ between PUFA and placebo groups (RR 1.02, 95% CI 0.69 to 1.52; 8 studies, 591 participants). There was also moderate-certainty evidence that medium-term loss to follow-up was likely similar between groups (RR 1.03, 95% CI 0.77 to 1.37; 13 studies, 1121 participants). AUTHORS' CONCLUSIONS: Although we found low-certainty evidence that children and adolescents receiving PUFA may be more likely to improve compared to those receiving placebo, there was high-certainty evidence that PUFA had no effect on total parent-rated ADHD symptoms. There was also high-certainty evidence that inattention and hyperactivity/impulsivity did not differ between PUFA and placebo groups. We found moderate-certainty evidence that overall side effects likely did not differ between PUFA and placebo groups. There was also moderate-certainty evidence that follow-up was similar between groups. It is important that future research addresses the current weaknesses in this area, which include small sample sizes, variability of selection criteria, variability of the type and dosage of supplementation, and short follow-up times.

Co-Design of an Evidence-Based Practice Continuing Education Course for Canadian Naturopathic Doctors.

Objectives: Evidence-based practice (EBP) is a clinical decision-making process combining the best available scientific evidence with clinician expertise and patient preference. While EBP has been associated with a range of benefits, it is recognized that EBP is used suboptimally by a range of health professionals, including naturopathic doctors (NDs). Canadian NDs have expressed a high level of interest in opportunities to improve their EBP skills; however, barriers exist, including those that apply broadly to health professionals, and those that are unique to the naturopathic profession. The objective of the present project was to co-design an EBP continuing education (CE) course tailored to the needs and preferences of Canadian NDs. Design: These needs were solicited through the use of focus groups. Groups were stratified based on participants' use of evidence at baseline. The focus groups asked NDs about their definition of EBP, and their interest in an EBP course, including preferred content, and method of delivery. The focus group discussions were transcribed, and thematic analysis was completed. Subjects: Twenty-two Canadian NDs participated. Results: Participants reported a high level of understanding of EBP, a high level of interest in participating in an EBP course and provided actionable recommendations about course content and delivery. Some of the themes that emerged were consistent across the groups while others differed by stratification. Conclusions: The findings of this project will inform the development and evaluation of a future CE course.

Deep learning pose estimation for multi-cattle lameness detection.

The objective of this study was to develop a fully automated multiple-cow real-time lameness detection system using a deep learning approach for cattle detection and pose estimation that could be deployed across dairy farms. Utilising computer vision and deep learning, the system can analyse simultaneously both the posture and gait of each cow within a camera field of view to a very high degree of accuracy (94-100%). Twenty-five video sequences containing 250 cows in varying degrees of lameness were recorded and independently scored by three accredited Agriculture and Horticulture Development Board (AHDB) mobility scorers using the AHDB dairy mobility scoring system to provide ground truth lameness data. These observers showed significant inter-observer reliability. Video sequences were broken down into their constituent frames and with a further 500 images downloaded from google, annotated with 15 anatomical points for each animal. A modified Mask-RCNN estimated the pose of each cow to output 5 key-points to determine back arching and 2 key-points to determine head position. Using the SORT (simple, online, and real-time tracking) algorithm, cows were tracked as they move through frames of the video sequence (i.e., in moving animals). All the features were combined using the CatBoost gradient boosting algorithm with accuracy being determined using threefold cross-validation including recursive feature elimination. Precision was assessed using Cohen's kappa coefficient and assessments of precision and recall. This methodology was applied to cows with varying degrees of lameness (according to accredited scoring, n = 3) and demonstrated that some characteristics directly associated with lameness could be monitored simultaneously. By combining the algorithm results over time, more robust evaluation of individual cow lameness was obtained. The model showed high performance for predicting and matching the ground truth lameness data with the outputs of the algorithm. Overall, threefold lameness detection accuracy of 100% and a lameness severity classification accuracy of 94% respectively was achieved with a high degree of precision (Cohen's kappa = 0.8782, precision = 0.8650 and recall = 0.9209).

The perspectives of UK personnel towards current killing practices for laboratory rodents.

Rodents are the predominant species used for scientific research and must be humanely killed upon completion of the work. In the UK this is regulated by Schedule 1 of the Animals Scientific Procedures Act 1986, which lists permitted methodologies considered capable of humane killing, including overdose of an anaesthetic, exposure to carbon dioxide (CO2) gas, dislocation of the neck and concussion of the brain by striking the cranium. Although all are permitted, operator motivations behind method selection and individual operator preference remain unknown. The views of 219 laboratory animal personnel on institutional availability and use of Schedule 1 killing methods for laboratory rodents were obtained. Only 10% of participants reported that all four methods were available at their institution with 57.5% of respondents preferring cervical dislocation. For CO2, only 18.6% of participants reported using the recommended flow rate, while 45.5% did not know the flow rate employed. We highlight the urgent requirement for the development of quality-controlled training programmes, to improve knowledge and confidence in the selection and application of killing methods. We advocate for continuous review of killing practices to ensure best practice is reflected in legislation and achieve optimal protection of the welfare of laboratory rodents during killing.

Mindfulness and Chronic Musculoskeletal Pain: An Umbrella Review.

Background: Chronic musculoskeletal pain (CMSP) disorders are a leading cause of disability globally, affecting up to one in three people. Mindfulness-based interventions (MBI) have become a popular treatment for CMSP. The aim of this umbrella review was to synthesise the best available research evidence for the effectiveness of MBI for adults with CMSP. Methods: Eight databases were searched from inception to 30th June 2021 for systematic reviews that examined the use of MBI in CMSP (pain experienced >3 months) in adult populations. Two reviewers independently conducted screening and selection, data extraction, and assessment of methodological quality using The Assessing the Methodological Quality of Systematic Reviews tool (AMSTAR 2). Outcomes examined were pain, sleep quality, depression, quality of life, physical functioning, and mindfulness. Furthermore, definitions of mindfulness, and intervention parameters (mindfulness practices used, length, frequency of sessions, duration) were also reported. Results: Nineteen systematic reviews (n = 1 rated high quality, n = 1 moderate quality, n = 2 low quality and n = 15 critically low quality) examining 194 primary studies met the review criteria. Although some promising evidence was identified for the use of MBI in CMSP, the general low quality and widespread heterogeneity of included SRs and made it difficult to reach a definitive conclusion. Differences in results and outcomes amongst systematic reviews that, in many cases, had a high overlap of included RCTs, suggests fundamental differences in critical design elements that make data difficult to compare. Conclusion: This umbrella review found mixed results on the effectiveness of MBI for the management of CMSP across a range of outcomes (pain, sleep quality, depression, quality of life, physical functioning, mindfulness). Definitions of MBI varied as did parameters, which may have contributed to these mixed results. More rigorous research with stringent MBI protocols is required.

Providing naturopathic care in the community: Perspectives of recent naturopathy graduates in Australia.

BACKGROUND AND PURPOSE: Naturopathy is a traditional medicine system originating from Europe and naturopathic practitioners provide care to 6.2% of Australians in a 12-month period. Australian naturopathic programs have undertaken a slow transition over the last 20 years from Advanced diploma to Bachelor degree as the minimum level of qualification for entry into the profession. This study aimed to understand and describe the experience of naturopathic graduates completing Bachelor degree and transitioning to provide naturopathic care in the community. MATERIALS AND METHODS: Qualitative semi-structured phone interviews were conducted with graduates of Bachelor's degree naturopathy programs, within five years of completing their studies. The data were analysed using Framework analysis methods. RESULTS: The analysis identified three related themes: (1) Love for looking after patients, but clinical practice is not easy, (2) Finding a place in the naturopathic profession and in the health system; and (3) Protecting the future of the profession and practice through registration. CONCLUSION: Graduates of Australian Bachelor's degree naturopathic programs face challenges as they attempt to find a place within their professional community. By identifying these challenges the profession's leaders may be able to develop initiatives to better support graduates and increase the success of new naturopaths.

Naturopathic Management of Acute Pediatric Respiratory Infections: A Modified Delphi Study.

Objective: Both the United Nations and the World Health Organization have identified antimicrobial resistance as a significant threat to global health. The Centers for Disease Control and Prevention identified five pediatric respiratory conditions as requiring particular scrutiny in terms of antibiotic stewardship. This study sought to identify strategies used by experienced naturopathic practitioners to treat acute respiratory infections in children. The authors theorize that naturopathic strategies safely fill the gap between watchful waiting and antibiotic prescription, thus reducing the use of antibiotics. Methods: Naturopathic practitioners in Canada, the United States, and Australia with a minimum of 5 years of experience in clinical naturopathic care of children were recruited for a modified Delphi study. A 14-person panel of practitioners was selected to complete a series of four iterative surveys assessing agreement to statements in five domains of knowledge/attitudes, assessment/diagnosis, management, monitoring, and education. Items were deemed to have reached consensus if they reached a predetermined threshold of 70% agreement, or failed to reach a threshold of 40% agreement. Items between these boundaries were modified and retested until either consensus was reached or the four surveys had been completed. Results: Results yielded a large degree of agreement on core naturopathic approaches to the management of acute pediatric respiratory infections, especially lifestyle strategies, including adequate rest and dietary recommendations. The use of vitamins C and D was strongly supported, as were herbs, particularly echinacea and elderberry. Some hydrotherapy and topical applications specific to the individual focus on infection also reached consensus. Results suggested that most respondents, even if they have the authority to prescribe antibiotics, rarely deem it necessary to do so. Conclusion: Findings of this study provide (1) clarity on the role of naturopathic doctors in the management of pediatric health concerns and the stewardship of antibiotics; and (2) initial guidance to less experienced naturopathic practitioners. The findings also identify key priorities for research into the safety and effectiveness of naturopathic interventions to reduce the unnecessary prescribing of antibiotics.

Effects of Human Observer Presence on Pain Assessment Using Facial Expressions in Rabbits.

The goal of this study was to evaluate the effect of a human observer on Rabbit Grimace Scale (RbtGS) scores. The study scored video footage taken of 28 rabbits before and after orthopedic surgery, as follows: 24 h before surgery ( baseline), 1 h after surgery ( pain), 3 h after analgesia administration ( analgesia), and 24 h after surgery ( 24h) in the presence and absence of an observer. Videos were assessed twice in random order by 3 evaluators who were blind to the collection time and the presence or absence of an observer. Responses to pain and analgesia were evaluated by comparing the 4 time points using the Friedman test, followed by the Dunn test. The influence of the presence or absence of the observer at each time point was evaluated using the Wilcoxon test. Intra- and interrater reliabilities were estimated using the intraclass correlation coefficient. The scale was responsive to pain, as the scores increased after surgery and had decreased by 24 h after surgery. The presence of the observer reduced significantly the RbtGS scores (median and range) at pain (present, 0.75, 0 to 1.75; absent, 1, 0 to 2) and increased the scores at baseline (present, 0.2, 0 to 2; absent, 0, 0 to 2) and 24h after surgery (present, 0.33, 0 to 1.75; absent, 0.2, 0 to 1.5). The intrarater reliability was good (0.69) to very good (0.82) and interrater reliability was moderate (0.49) to good (0.67). Thus, the RbtGS appeared to detect pain when scored from video footage of rabbits before and after orthopedic surgery. In the presence of the observer, the pain scores were underestimated at the time considered to be associated with the greatest pain and overestimated at the times of little or no pain.