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Mapping the prevalence of soil-transmitted helminth infections in the Western Pacific Region:a spatial modelling study
No full textBackground: Soil-Transmitted Helminth (STH) infections are a significant health issue in the Western Pacific Region (WPR). This study aims to produce high-resolution spatial prediction STH prevalence maps for the WPR. Methods: Bayesian model-based geostatistical frameworks were developed for each STH species (Ascaris lumbricoides, Trichuris trichiura, Strongyloides stercoralis, and hookworm) to estimate infection prevalence at a spatial resolution of 1 km2. A systematic review created a comprehensive database of STH prevalence surveys, which informed the geostatistical frameworks. Logistic regression models incorporating both fixed covariate effects and spatial random effects were applied to identify drivers of spatial distribution for each species. Findings: We analysed 227 surveys from 3122 locations across 15 countries in the WPR. Between 1998–2011 and 2012–2021 substantial reductions in the pooled prevalence of hookworm (21.3%–3.7%), A. lumbricoides (21.7%–6.5%) and T. trichiura (22.5%–9.7%) were observed, while S. stercoralis prevalence increased (13.3%–18.4%). High-resolution spatial prediction maps revealed notable geographical variations in STH prevalence, with persistent hotspots identified in China, Cambodia, Malaysia, and Vietnam. Altitude and distance to health facilities were positively associated with the prevalence of hookworm and A. lumbricoides, while sand content in soil was positively associated with all STH species. In contrast, coarse soil fragments and organic carbon content were negatively associated with the prevalence of T. trichiura and A. lumbricoides. Interpretation: The high-resolution spatial prediction maps produced in this study can inform resource prioritization to accelerate STH elimination efforts. Funding: National Health and Medical Research Council (1153727 ACE-NTD).</p
Is There an Association Between Symptoms of Pelvic Floor Dysfunction, Running Kinetics, and Pelvic Acceleration in Postpartum Women?
No full textThe aim of this study was to explore the association between pelvic floor dysfunction and running kinetics and pelvic acceleration in a cohort of postpartum women. The Australian Pelvic Floor Questionnaire was used to quantify symptom severity (mean [SD]: 6 [ 4] out of 40; range: 1–14) in 25 postpartum women. Participants completed a pelvic floor muscle assessment to measure pelvic muscle strength and endurance, then completed a 7-minute treadmill running protocol at a speed of 10 km·h−1 to evaluate their running kinetics and pelvic acceleration. After the run, participants responded to a modified version of the symptom’s component of the PFD-SENTINEL screening tool. Mean pelvic muscle strength and endurance were 3 (1) and 9 (2), respectively. We found no significant association between PFD symptom severity and running kinetic (P = .209–.410) or pelvic acceleration (P = .081–.947) outcome measures. Fifteen participants experienced at least one symptom during the treadmill protocol. Running kinetics and pelvic acceleration may not affect or be affected by symptoms of PFD. Given the relatively low symptom expression among study participants, further research in a cohort of women with higher levels of PFD is recommended.</p
Barriers to Self-Care and Seeking Help Among Mental Health Professionals and Trainees:A Systematic Review
No full textThe aim of this systematic review was to synthesize evidence identifying the barriers mental health professionals and clinicians in training face in both engaging in self-care and seeking help when in need. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PsycINFO, Web of Science, Scopus, MEDLINE, and Cumulative Index of Nursing and Allied Health Literature databases were searched for articles published between 1990 and June 2024. Inclusion criteria reflected peer-reviewed articles published in English, report of original data where the participant sample targeted mental health professionals or trainees, and examination of barriers to self-care or help seeking. An adapted critical appraisal tool to assess the quality of cross-sectional studies (AXIS) and the Critical Appraisal Skills Programme checklist for qualitative research were used to assess the quality of included studies. The review identified 14 studies (n = 5,422 participants) that examined barriers to seeking help or self-care. Mental health concerns appeared common among mental health professionals. Reported barriers reflected stigma, concern for confidentiality and career implications, and practical challenges associated with time, the competing demands of the profession, and cost. Barriers and concerns were shared across career stage and profession. The studies reviewed were limited by sampling and methodological issues that may underestimate the problem and miss important barriers or contextual factors associated with help-seeking and self-care behaviors. Improved understanding of the barriers mental health professionals and trainees face in seeking help and engaging in self-care is needed to inform improvements to workplace initiatives and training programs and the promotion of better health and well-being across the workforce.Public Health Significance StatementUnderstanding the barriers mental health professionals face in seeking help is important for safeguarding the workforce. Employers and educators play an important role in building a work culture where mental health professionals feel supported in seeking help and returning to work following periods of distress
Sharing knowledge on implementing mental health and wellbeing projects for veterans and first responders
No full textPurpose: The aim of this study was to describe the knowledge to action and knowledge transfer approaches used in an international mental health research funding program and its outcomes. A key goal of the evaluation was to maximise organisational learning and knowledge sharing to inform future implementation projects. Methods: A series of interactive knowledge sharing workshops focused on five key themes: peer support; psychoeducation; the involvement of family, friends, and significant others; retreat, residential, or group-based programs; and organisational change. Qualitative descriptive analysis was used to code, summarise and describe themes. Findings: Key learnings that influenced the success of mental health initiatives include building relationships across all organisational levels, involving Veterans and First Responders with lived experience in the design and implementation process, and understanding the unique workplace culture and operations. Conclusion: Our findings highlight the need for collaborative, informed approaches tailored to the culture, organisation and mental health support needs of Veteran and First Responder. These insights enhance understanding of the factors that impact the successful implementation of mental health prevention and support programs for those exposed to work-related trauma.</p
Global, regional, and national prevalence of child and adolescent overweight and obesity, 1990–2021, with forecasts to 2050:a forecasting study for the Global Burden of Disease Study 2021
Get PDFBackground: Despite the well documented consequences of obesity during childhood and adolescence and future risks of excess body mass on non-communicable diseases in adulthood, coordinated global action on excess body mass in early life is still insufficient. Inconsistent measurement and reporting are a barrier to specific targets, resource allocation, and interventions. In this Article we report current estimates of overweight and obesity across childhood and adolescence, progress over time, and forecasts to inform specific actions. Methods: Using established methodology from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021, we modelled overweight and obesity across childhood and adolescence from 1990 to 2021, and then forecasted to 2050. Primary data for our models included 1321 unique measured and self-reported anthropometric data sources from 180 countries and territories from survey microdata, reports, and published literature. These data were used to estimate age-standardised global, regional, and national overweight prevalence and obesity prevalence (separately) for children and young adolescents (aged 5–14 years, typically in school and cared for by child health services) and older adolescents (aged 15–24 years, increasingly out of school and cared for by adult services) by sex for 204 countries and territories from 1990 to 2021. Prevalence estimates from 1990 to 2021 were generated using spatiotemporal Gaussian process regression models, which leveraged temporal and spatial correlation in epidemiological trends to ensure comparability of results across time and geography. Prevalence forecasts from 2022 to 2050 were generated using a generalised ensemble modelling approach assuming continuation of current trends. For every age-sex-location population across time (1990–2050), we estimated obesity (vs overweight) predominance using the log ratio of obesity percentage to overweight percentage. Findings: Between 1990 and 2021, the combined prevalence of overweight and obesity in children and adolescents doubled, and that of obesity alone tripled. By 2021, 93·1 million (95% uncertainty interval 89·6–96·6) individuals aged 5–14 years and 80·6 million (78·2–83·3) aged 15–24 years had obesity. At the super-region level in 2021, the prevalence of overweight and of obesity was highest in north Africa and the Middle East (eg, United Arab Emirates and Kuwait), and the greatest increase from 1990 to 2021 was seen in southeast Asia, east Asia, and Oceania (eg, Taiwan [province of China], Maldives, and China). By 2021, for females in both age groups, many countries in Australasia (eg, Australia) and in high-income North America (eg, Canada) had already transitioned to obesity predominance, as had males and females in a number of countries in north Africa and the Middle East (eg, United Arab Emirates and Qatar) and Oceania (eg, Cook Islands and American Samoa). From 2022 to 2050, global increases in overweight (not obesity) prevalence are forecasted to stabilise, yet the increase in the absolute proportion of the global population with obesity is forecasted to be greater than between 1990 and 2021, with substantial increases forecast between 2022 and 2030, which continue between 2031 and 2050. By 2050, super-region obesity prevalence is forecasted to remain highest in north Africa and the Middle East (eg, United Arab Emirates and Kuwait), and forecasted increases in obesity are still expected to be largest across southeast Asia, east Asia, and Oceania (eg, Timor-Leste and North Korea), but also in south Asia (eg, Nepal and Bangladesh). Compared with those aged 15–24 years, in most super-regions (except Latin America and the Caribbean and the high-income super-region) a greater proportion of those aged 5–14 years are forecasted to have obesity than overweight by 2050. Globally, 15·6% (12·7–17·2) of those aged 5–14 years are forecasted to have obesity by 2050 (186 million [141–221]), compared with 14·2% (11·4–15·7) of those aged 15–24 years (175 million [136–203]). We forecasted that by 2050, there will be more young males (aged 5–14 years) living with obesity (16·5% [13·3–18·3]) than overweight (12·9% [12·2–13·6]); while for females (aged 5–24 years) and older males (aged 15–24 years), overweight will remain more prevalent than obesity. At a regional level, the following populations are forecast to have transitioned to obesity (vs overweight) predominance before 2041–50: children and adolescents (males and females aged 5–24 years) in north Africa and the Middle East and Tropical Latin America; males aged 5–14 years in east Asia, central and southern sub-Saharan Africa, and central Latin America; females aged 5–14 years in Australasia; females aged 15–24 years in Australasia, high-income North America, and southern sub-Saharan Africa; and males aged 15–24 years in high-income North America. Interpretation: Both overweight and obesity increased substantially in every world region between 1990 and 2021, suggesting that current approaches to curbing increases in overweight and obesity have failed a generation of children and adolescents. Beyond 2021, overweight during childhood and adolescence is forecast to stabilise due to further increases in the population who have obesity. Increases in obesity are expected to continue for all populations in all world regions. Because substantial change is forecasted to occur between 2022 and 2030, immediate actions are needed to address this public health crisis. Funding: Bill & Melinda Gates Foundation and Australian National Health and Medical Research Council.</p
‘I tried to get into their shoes and their culture’. Care worker experiences in cultural end-of-life care:Interpretative phenomenological analysis
No full textAim: What are care workers' lived experiences caring for people of culturally and linguistically diverse backgrounds during end-of-life care?. Design: Interpretative phenomenological analysis. Methods: The lived experiences of 11 care workers within the Australian Capital Territory and region who have cared for someone of a culturally and linguistically diverse background during end-of-life care were captured. Each care worker was interviewed individually and answered a series of semi-structured open-ended questions. Results: Using interpretative phenomenological analysis, three group experiential themes were derived: (i) navigating cultural shock and death, (ii) the hard work of communication and (iii) searching for deeper connections with client and self. Within these were key elements: Care workers worked hard to embrace cultural diversity, but struggled to meet cultural needs, particularly in relation to the unpredictable timeline of dying. Care workers relied on themselves and their improvisation, but experienced self-blame for inadequate care and unexpected challenges in communication. Blurred boundaries in relation to therapeutic relationships were apparent, and care workers felt alone with emotional burden, but also found belonging and joy in their work. Conclusion: Care workers' experiences are vital to understanding the barriers and challenges in providing culturally appropriate end-of-life care. Care workers repeatedly experienced an emotional burden and vicarious trauma throughout their work in this field. Care workers were self-reliant in all aspects of care including communication and consistently desired education, training, resources and support. There remains inadequate research on care workers and their role within the Australian healthcare context. Implications for the Profession and/or Patient Care: Care workers need access to support and resources including professional translators to provide culturally appropriate end-of-life care. Workplaces and registered nurses should facilitate training and provide guidance to care workers. A person-centred approach is required during all client encounters while maintaining appropriate therapeutic relationships including therapeutic use of self and professional boundaries. Reporting Method: COREQ Checklist. Patient or Public Contribution: During this study, care workers were interviewed on their experiences caring for people of culturally and linguistically diverse backgrounds during end-of-life care. Patients were not directly involved within this study, but their views may have been expressed through the care workers' experience.</p
Classification systems for chronic pelvic pain in males: a systematic review
No full textObjective To systematically review the classification systems for male chronic pelvic pain (CPP). Methods The Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE), and Web of Science were searched. Any publication, with no restriction to publication date, was eligible. Publications had to propose a classification system for CPP in males or provide additional information of a system that had been identified. Systems were assessed with an adapted Critical Appraisal of Classification Systems tool. Results A total of 33 relevant publications were identified, with 22 proposing an original classification system. Systems aimed to: (i) diagnose CPP and/or differentially diagnose CPP from other conditions, (ii) differentially diagnose subtypes within CPP, or (iii) identify features that could inform underlying mechanisms and/or treatment selection. Conditions referred to as chronic prostatitis/chronic pelvic pain syndrome and interstitial cystitis/bladder pain syndrome were most represented. Clinical signs/symptoms, pathoanatomical investigations, and presumed pain mechanisms were used for classification. Quality of systems was low to moderate, implying limitations to consider for their interpretation. Conclusions Many classification systems for CPP in males exist. Careful consideration of their intended purpose is required. Future work should examine whether outcomes for patients are improved when decisions are guided by their use
Implementing a gerontological nursing competencies programme in aged care:Participant experiences
No full textAims: To explore the experience of registered nurses and their mentors in the implementation of the Gerontological Nursing Competencies in long-term aged care and the perceived effectiveness and suitability of the programme to support nurse development. Background: The global population is ageing and needs a reliable aged-care nursing workforce. Introduction: Opportunities for education and mentorship for newly qualified and experienced aged-care nurses warrant investigation. Methods: Qualitative evaluation using semi-structured focus groups was conducted following the implementation of the programme into five not-for-profit long-term aged-care organisations and analysed by a reflexive qualitative thematic approach and reported according to COREQ criteria. Results: A total of 21 nurses (7 mentors and 14 mentees) participated in six focus groups. Five themes were generated: (1) nurses gained confidence and competence through the programme; (2) the facilitation of suitable mentoring activities and approaches was crucial to success; (3) the programme helps nurses recognise gerontology as a specialty; (4) the programme contributes to building a strategy of recruitment/retention/quality improvement in the sector; (5) barriers, challenges, changes and recommendations were identified. Discussion: The Gerontological Nursing Competency model, which combined adaptive mentoring supported by reflective practice embedded in a gerontological nursing competencies framework, was perceived to improve nurse confidence and competence to lead and improve nursing standards of care. Conclusion and implications for nursing and health policy: The evidence-based competencies are an acceptable and effective method for supporting gerontological nurse development. Expansion of, and accessibility to, the programme may aid global responses to aged-care reform, by building the recognition of gerontological nursing as a specialty and contributing towards recruitment, retention and quality care improvements.</p
A proposal to recognize investment in breastfeeding as a carbon offset
No full textPolicy-makers need to rethink the connections between the economy and health. The World Health Organization Council on the Economics of Health for All has called for human and planetary health and well-being to be moved to the core of decision-making to build economies for health. Doing so involves valuing and measuring what matters, more and better health financing, innovation for the common good and rebuilding public sector capacity. We build on this thinking to argue that breastfeeding should be recognized in food and well-being statistics, while investments in breastfeeding should be considered a carbon offset in global financing arrangements for sustainable food, health and economic systems. Breastfeeding women nourish half the world’s infants and young children with immense quantities of a highly valuable milk. This care work is not counted in gross domestic product or national food balance sheets, and yet everincreasing commercial milk formula sales are counted. Achieving global nutrition targets for breastfeeding would realize far greater reductions in greenhouse gas emissions than decarbonizing commercial milk formula manufacturing. New metrics and financing mechanisms are needed to achieve the health, sustainability and equity gains from more optimal infant and young child feeding. Properly valuing crucial care and environmental resources in global and national measurement systems would redirect international financial resources away from expanding carbon-emitting activities, and towards what really matters, that is, health for all. Doing so should start with considering breastfeeding as the highest quality, local, sustainable first-food system for generations to come.</p