Primary care interventions and current service innovations in modifying long-term outcomes after stroke: a protocol for a scoping review.

INTRODUCTION: Interventions delivered by primary and/or community care have the potential to reach the majority of stroke survivors and carers and offer ongoing support. However, an integrative account emerging from the reviews of interventions addressing specific long-term outcomes after stroke is lacking. The aims of the proposed scoping review are to provide an overview of: (1) primary care and community healthcare interventions by generalist healthcare professionals to stroke survivors and/or their informal carers to address long-term outcomes after stroke, (2) the scope and characteristics of interventions which were successful in addressing long-term outcomes, and (3) developments in current clinical practice. METHODS AND ANALYSIS: Studies that focused on adult community dwelling stroke survivors and informal carers were included. Academic electronic databases will be searched to identify reviews of randomised controlled trials (RCTs) and controlled trials, trials from the past 5 years; reviews of observational studies. Practice exemplars from grey literature will be identified through advanced Google search. Reports, guidelines and other documents of major health organisations, clinical professional bodies, and stroke charities in the UK and internationally will be included. Two reviewers will independently screen titles, abstracts and full texts for inclusion of published literature. One reviewer will screen search results from the grey literature and identify relevant documents for inclusion. Data synthesis will include analysis of the number, type of studies, year and country of publication, a summary of intervention components/service or practice, outcomes addressed, main results (an indicator of effectiveness) and a description of included interventions. ETHICS AND DISSEMINATION: The review will help identify components of care and care pathways for primary care services for stroke. By comparing the results with stroke survivors' and carers' needs identified in the literature, the review will highlight potential gaps in research and practice relevant to long-term care after stroke.The work on the protocol is the part of the programme of research ‘Developing primary care services for stroke survivors’ funded by the National Institute for Health Research (NIHR)'s Programme Grants for Applied Research Programme (grant reference number PTC-RP-PG-0213-20001).This is the final version of the article. It first appeared from BMJ Publishing Group via https://doi.org/10.1136/bmjopen-2016-01284

Understanding stroke survivors' and informal carers' experiences of and need for primary care and community health services--a systematic review of the qualitative literature: protocol.

INTRODUCTION: Despite the rising prevalence of stroke, no comprehensive model of postacute stroke care exists. Research on stroke has focused on acute care and early supported discharge, with less attention dedicated to longer term support in the community. Likewise, relatively little research has focused on long-term support for informal carers. This review aims to synthesise and appraise extant qualitative evidence on: (1) long-term healthcare needs of stroke survivors and informal carers, and (2) their experiences of primary care and community health services. The review will inform the development of a primary care model for stroke survivors and informal carers. METHODS AND ANALYSIS: We will systematically search 4 databases: MEDLINE, EMBASE, PsycINFO and CINAHL for published qualitative evidence on the needs and experiences of stroke survivors and informal carers of postacute care delivered by primary care and community health services. Additional searches of reference lists and citation indices will be conducted. The quality of articles will be assessed by 2 independent reviewers using a Critical Appraisal Skills Programme (CASP) checklist. Disagreements will be resolved through discussion or third party adjudication. Meta-ethnography will be used to synthesise the literature based on first-order, second-order and third-order constructs. We will construct a theoretical model of stroke survivors' and informal carers' experiences of primary care and community health services. ETHICS AND DISSEMINATION: The results of the systematic review will be disseminated via publication in a peer-reviewed journal and presented at a relevant conference. The study does not require ethical approval as no patient identifiable data will be used.National Institute for Health Research (PTC-RP-PG-0213-20001)

Factors that influence help-seeking behaviours in young men aged 25 to 30 years

Using Heidegger\u27s (1962) hermeneutic phenomenology informed by van Manen (1984) and Gadamer (1975), this qualitative inquiry has been an exploration, analysis and interpretation of the lived experiences of the help-seeking phenomenon in young men aged 25 to 30 years. A purposive sample of thirteen young men, 25 to 30 years of age, living in urban areas of Perth, were interviewed using in-depth, semi-structured interviews. The ultimate aim of this study was to discover meaning and enhance the understanding of the essential experiences that influence help-seeking behaviours of these young men. The findings of this inquiry indicate a sophisticated emotional discourse around help-seeking and mental health issues. It also exposes the tensions and complex interplay between the masculinity stereotype, problem type and available sources of help, stigma, and the strong societal expectations of competency that these young men experience. In many areas of help-seeking behaviours, there was a structural division that separated this group of young men into those willing to engage in early professional support, the early seekers , and those who would delay formal help until crisis point, the delayed seekers . Contrary to the literature, these factors were independent of the young men\u27s emotional competence and literacy. Overall, the study findings showed that there were significant, complex and unique factors influencing their help-seeking experiences. Future research could explore and seek to confirm the results of this study for delayed seekers in a broader age bracket

The effect of N-acetylcysteine supplementation on recovery of strength following eccentric muscle injury

This study determined the effect of N-acetylcysteine (NAC) supplementation on recovery of strength following eccentric muscle injury. Female subjects (n = 21, age = 20.7 ± .10 yr, weight = 68.05 ± 10.3 kg, height = 1.69 ± .07 m) performed one bout of eccentric exercise involving the forearm flexor muscles. Subjects were given a placebo (food-grade cellulose; n = 10) or NAC supplement (10 mg·kg-1 bw·d-1; n = 11) for 7D prior to and 14D following the exercise bout. Maximal Voluntary Contraction (MVC) torque, muscle soreness, range of motion (ROM), and arm circumference were measured at pre-exercise, immediately post-exercise, and at 1D, 3D, 7D and 10D post-exercise. In addition, serum interleukin-6 (IL-6), serum creatine kinase (CK), and serum glutathione were measured. Subjects also completed a food frequency questionnaire to determine the antioxidant content of their diet. There was no difference in the loss and subsequent recovery of muscular strength between the placebo and NAC group immediately post-exercise (26.93 ± 6.4 vs. 24.95 ±9.4 Nm), 1D (27.83 ± 5.7 vs. 26.9 ± 8.5 Nm), 3D (38.35 ± 6.7 vs. 34.69 ± 10.2 Nm), 7D (46.9 ± 8.8 vs. 42.5 ± 11.8 Nm), or 10D (57.83 ± 11.7 vs. 52.92 ± 14.3 Nm) post-exercise (p = .274). In addition, there was no difference in muscle soreness (p = .752), arm circumference (p = .535), ROM (p = .539), serum CK (p = .449), serum glutathione (p = .967), or serum IL-6 (p = .360) at any time point. Scores on the food frequency questionnaire demonstrated that dietary antioxidant intake was not different between groups (41.04 ± 8.04 vs. 33.01 ± 12.6; p = .054). In conclusion, a bout of eccentric forearm flexor exercise resulted in muscle injury and a significant decrease in subjects’ ability to produce force. Supplementation with NAC had no effect on recovery of strength, arm circumference, ROM, serum CK, serum IL-6, or serum glutathione at any time point following the exercise bout. These results demonstrate that NAC has no effect on recovery of strength following eccentric muscle injury

The Second Demographic Transition theory in practice: The case of Israel

The goal of this dissertation was to examine several aspects of the demographic and social change in Israel within the conceptual frameworks of the second demographic transition theory and emancipation theory. Attitude and value change along with the changes in marriage and fertility behaviour in Israel in the last decades were the main object of study. It was argued that focusing on a single case study is beneficial for analyzing the underlying mechanisms and studying the transition as an integrated process, which is interconnected with broader cultural and economic changes. Such in-depth inquiry reveals the issues at stake from the individual point of view, which are often missing in many studies of demographic changes. It also discloses information about the contextual, path-dependent and historical factors that might hamper the onset and slow the further progression of the demographic transition in Israel

Record Linkage Techniques: Exploring and developing data matching methods to create national record linkage infrastructure to support population level research

In a world where the growth in digital information and systems continues to expand, researchers have access to unprecedented amounts of data. These large and complex data reservoirs require creative, innovative and scalable tools to unlock the potential of this ‘big data’. Record linkage is a powerful tool in the ‘big data’ arsenal. This thesis demonstrates the value of national record linkage infrastructure and how this has been achieved for the Australian research community

(How) does the way maternity care is provided affect the health and well-being of young women and their babies?

Access to timely, quality maternity care improves health outcomes for mothers and babies. Inadequate antenatal care (defined as 1-5 visits) is associated with an increase in the risk of preterm birth and neonatal morbidity; even after controlling known confounders. Pregnant adolescents typically live in circumstances of socio-economic deprivation, which is exemplified by poorer general health status, domestic violence, mental health issues, inadequate nutrition, and smoking and illicit drug use. Adolescent pregnancy is associated with higher rates of preterm birth, low birth weight, and neonatal intensive care unit admission; along with lower rates of breastfeeding initiation

Multidimensional Epidemiological Transformations: Addressing Location-Privacy in Public Health Practice

The following publications arose directly from this research: AbdelMalik P, Boulos MNK: Multidimensional point transform for public health practice. Methods of Information in Medicine. (In press; ePub ahead of print available online) http://dx.doi.org/10.3414/ME11-01-0001 AbdelMalik P, Boulos MNK, Jones R: The Perceived Impact of Location Privacy: A web-based survey of public health perspectives and requirements in the UK and Canada. BMC Public Health, 8:156 (2008) http://www.biomedcentral.com/1471-2458/8/156 The following papers were co-authored in relation to this research: Khaled El Emam, Ann Brown, Philip AbdelMalik, Angelica Neisa, Mark Walker, Jim Bottomley, Tyson Roffey: A method for managing re-identification risk from small geographic areas in Canada. BMC Medical Informatics and Decision Making. 10:18 (2010) http://www.biomedcentral.com/1472-6947/10/18 Maged N. Kamel Boulos, Andrew J. Curtis, Philip AbdelMalik: Musings on privacy issues in health research involving disaggregate geographic data about individuals. International Journal of Health Geographics. 8:46 (2009) http://www.ij-healthgeographics.com/content/pdf/1476-072X-8-46.pdf Khaled El Emam, Ann Brown, Philip AbdelMalik: Evaluating predictors of geographic area population size cut-offs to manage re-identification risk. Journal of the American Medical Informatics Association, 16:256-266 (2009)The ability to control one’s own personally identifiable information is a worthwhile human right that is becoming increasingly vulnerable. However just as significant, if not more so, is the right to health. With increasing globalisation and threats of natural disasters and acts of terrorism, this right is also becoming increasingly vulnerable. Public health practice – which is charged with the protection, promotion and mitigation of the health of society and its individuals – has been at odds with the right to privacy. This is particularly significant when location privacy is under consideration. Spatial information is an important aspect of public health, yet the increasing availability of spatial imagery and location-sensitive applications and technologies has brought location-privacy to the forefront, threatening to negatively impact the practice of public health by inhibiting or severely limiting data-sharing. This study begins by reviewing the current relevant legislation as it pertains to public health and investigates the public health community’s perceptions on location privacy barriers to the practice. Bureaucracy and legislation are identified by survey participants as the two greatest privacy-related barriers to public health. In response to this clash, a number of solutions and workarounds are proposed in the literature to compensate for location privacy. However, as their weaknesses are outlined, a novel approach - the multidimensional point transform - that works synergistically on multiple dimensions, including location, to anonymise data is developed and demonstrated. Finally, a framework for guiding decisions on data-sharing and identifying requirements is proposed and a sample implementation is demonstrated through a fictitious scenario. For each aspect of the study, a tool prototype and/or design for implementation is proposed and explained, and the need for further development of these is highlighted. In summary, this study provides a multi-disciplinary and multidimensional solution to the clash between privacy and data-sharing in public health practice.Partially sponsored by the Public Health Agency of Canad