The ‘PRICE’ of Physical Activity Referral Schemes (PARS): stakeholders’ recommendations for delivering quality care to patients

Evidence-based strategies are needed to curb the growing cases of physical inactivity related morbidities. Delivering holistic care through collaborative shared decision making could boost the effectiveness of physical activity referral schemes (PARS) and foster the quality of care for patients with multimorbidity. A qualitative study involving semi-structured telephone interviews was utilised to gain insights from Australian PARS stakeholders (general practitioners, exercise physiologists, and patients). A pluralistic evaluation approach was employed to explore and integrate participants’ opinions and experiences of PARS and their recommendations were used to develop a model for quality care delivery in PARS initiatives. Five overarching themes: promote, relate, incentivise, communicate, and educate were identified as the ‘PRICE’ for developing effective and functional PARS programmes that foster quality patient care. It was evident that PARS programmes or policies aimed at optimising publicity, encouraging incentives, improving interdisciplinary information sharing and professional relationships between patients and healthcare professionals can transform healthcare delivery and provide top quality PARS care services to patients. Therefore, governments, healthcare systems, and PARS administrators can translate and leverage the insights from this study to optimise the delivery of high quality care to PARS patients

Response to climate change: evaluation of methane emissions in Northern Australian beef cattle on a high quality diet supplemented with Desmanthus using open-circuit respiration chambers and GreenFeed emission monitoring systems

Simple Summary The beef industry in Northern Australia is characterized by an extensive grazing system in dry tropical rangelands defined by climate change indices of very low rainfall, a prolonged dry season and feeds of low nutritive value. In response, beef cattle need to be more efficient in converting the available drought-tolerant feeds to muscle, in an attempt to minimize greenhouse gas emissions. This study addressed the problem of reducing methane emissions from tropical beef cattle with the goal of decreasing the impact of climate change and greenhouse gas emissions in Northern Australia. The primary objective was to compare the effect of supplementing tropical beef cattle with both good quality lucerne and poor quality hay with increasing levels of different Desmanthus cultivars on in vivo methane emission. The results showed that in tropical beef cattle on high-quality diets, irrespective of cultivar and emission evaluation method, Desmanthus does not reduce methane emissions. Abstract The main objective of this study was to compare the effect of supplementing beef cattle with Desmanthus virgatus cv. JCU2, D. bicornutus cv. JCU4, D. leptophyllus cv. JCU7 and lucerne on in vivo methane (CH4) emissions measured by open-circuit respiration chambers (OC) or the GreenFeed emission monitoring (GEM) system. Experiment 1 employed OC and utilized sixteen yearling Brangus steers fed a basal diet of Rhodes grass (Chloris gayana) hay in four treatments—the three Desmanthus cultivars and lucerne (Medicago sativa) at 30% dry matter intake (DMI). Polyethylene glycol (PEG) was added to the diets to neutralize tannin binding and explore the effect on CH4 emissions. Experiment 2 employed GEM and utilized forty-eight animals allocated to four treatments including a basal diet of Rhodes grass hay plus the three Desmanthus cultivars in equal proportions at 0, 15, 30 and 45% DMI. Lucerne was added to equilibrate crude protein content in all treatments. Experiment 1 showed no difference in CH4 emissions between the Desmanthus cultivars, between Desmanthus and lucerne or between Desmanthus and the basal diet. Experiment 2 showed an increase in CH4 emissions in the three levels containing Desmanthus. It is concluded that on high-quality diets, Desmanthus does not reduce CH4 emissions

“God is my only health insurance”: a mixed-methods study on the experiences of persons with disability in accessing sexual and reproductive health services in Ghana

BackgroundAccess to sexual and reproductive health (SRH) services is a fundamental human right, but people with disabilities (PwDs) in low-and middle-income countries often face multiple barriers to utilisation. This study aimed to assess the level of SRH services utilisation and the enabling and inhibiting factors among PwDs in Ghana’s Ashanti region.MethodsA sequential explanatory mixed-methods study design was employed, involving quantitative (n = 402) and qualitative (n = 37) data collection from PwDs. Quantitative data were analysed using descriptive and inferential statistics, while qualitative data were analysed using inductive thematic analysis.ResultsThe study found that only 33.8% of the PwDs had ever used SRH services. Utilisation was associated with sex, marital status and travel duration to health facility. The qualitative data revealed that factors at the individual, family/community and health facility levels influenced utilisation of SRH services, acting as both enablers and barriers.ConclusionPwDs had relatively low utilisation of SRH services in Ghana’s Ashanti region. To increase utilisation, it is recommended to address the stigma and discrimination towards PwDs, provide more training for healthcare providers, improve the accessibility of healthcare facilities, and strengthen the national health insurance scheme. Further research could explore PwDs’ SRH outcomes and strategies to improve these outcomes in Ghana

Influence of crop residue ration supplementation on the attainment of puberty and postpartum reproductive activities of Red Sokoto goats

The general objective of this study was to come up with an appropriate, affordable and locally available crop residue supplementation package that would enhance reproductive performance in small ruminants. Specifically, 28 Red Sokoto weaner does between 3 and 4 months of age weighing between 2 and 3 kg were used in the first experiment to determine the influence of crop residue supplementation on age and weight at puberty as determined by blood progesterone levels. In the second experiment, another 28 adult does (equal to or greater than 2 years old) of the same breed in the same flock with lactation numbers between 1 and 3 were used to determine the length of postpartum acyclic period. In both experiments, a 3 x 2 factorial experimental design comprising three dietary supplements (A, B, C) at two feeding levels (1% and 2% of body weight) fed in addition to a basal diet of Digitaria smutsii hay and natural pasture ad libitum with an unsupplemented negative control group (D) and four goats per treatment was utilized. In ration A, a conventional concentrate supplement consisting of maize, wheat offal, cottonseed cake and bonemeal was utilized; in rations B and C, the supplement consisted of guinea-corn bran, cowpea husk and groundnut haulms; and maize offal, groundnut shells and groundnut haulms respectively. Unsupplemented (ration D) weaner does reached puberty at a later age and had lighter body weights than all the others. Weaner does on ration 2A (concentrate fed at 2% of body weight) attained puberty at the earliest age and heaviest body weight, although the age at puberty was not significantly different from those on rations 1A (concentrate fed at 1% body weight), 1C and 2C. Blood progesterone profiles before and after puberty ranged from 0.05 to 9.0 ng/ml, respectively, and was highest in does fed rations A and C and least in the unsupplemented does. The mean interval between kidding and initiation of ovarian activity was 54.28 plus or minus 17.61 days and the mean interval between kidding and conception was 63.04 plus or minus 25.34 days. Only 25% of the unsupplemented does conceived again during the period under study compared with 100% in rations 1A, 2A, 1C and 2C; 75% in ration 2B and 50% in ration 1B. It was concluded that implementation of supplementary feeding in the dry season improves reproductive performance in the Red Sokoto doe. Furthermore, ration C, a crop residue-based ration, was a suitable dry season supplementation alternative to the expensive conventional concentrate ration for the smallholder goat farmer in the subhumid tropics of Nigeria

Users' preferences and design recommendations to promote engagements with mobile apps for diabetes self-management: Multi-national perspectives.

BackgroundMobile phone applications (apps) offer motivation and support for self-management of diabetes mellitus (DM), but their use is limited by high attrition due to insufficient consideration of end-users perspectives and usability requirements. This study aimed to examine app usage and feature preferences among people with DM, and explore their recommendations for future inclusions to foster engagement with diabetes apps.MethodsThe study was conducted internationally on adults with type 1 or type 2 DM using online questionnaire (quantitative) to investigate usage and preferences for app features that support diabetes self-management and semi structured telephone interview (qualitative) to explore suggestions on fostering engagement and specific educational information for inclusion into diabetes apps. Survey and interview data were analysed using descriptive/ inferential statistics and inductive thematic analysis respectively.ResultsA total of 217 respondents with type 1 DM (38.25%) or type 2 DM (61.8%), from 4 continents (Australia, Europe, Asia and America) participated in the survey. About half of the respondents (48%) use apps, mainly with features for tracking blood glucose (56.6%), blood pressure (51.9%) and food calories (48.1%). Preferred features in future apps include nutrient values of foods (56.7%), blood glucose (54.8%), physical exercise tracker (47%), health data analytics (42.9%) and education on diabetes self-management (40.6%). Irrespective of the type of DM, participants proposed future apps that are user friendly, support healthy eating, provide actionable reminders and consolidate data across peripheral health devices. Participants with type 1 DM recommended customised features with news update on developments in the field of diabetes. Nominated specific educational topics included tips on problem solving, use of insulin pump therapy, signs of diabetes complication and transitioning from paediatric into adult care.ConclusionsThe study has highlighted patients' perspectives on essential components for inclusion in diabetes apps to promote engagement and foster better health outcomes

Optimising care coordination strategies for physical activity referral scheme patients by Australian health professionals.

Physical activity (PA) has been identified as an essential tool for the prevention and management of multi-morbidity in patients. Coordination of patients' care through interventions like physical activity referral schemes (PARS) could foster the utilization of PA. This study explored the views of General Practitioners (GPs) and Exercise Physiologists (EPs) as key stakeholders, for optimizing patient care and efficiency of PARS. Sequential explanatory mixed methods design was used to explore the perceptions of these health professionals on PA and coordination strategies for PARS patient care. Data analyses included descriptive and inferential statistics for questionnaires and theoretical framework analysis for the semi-structured interviews. Participants demonstrated a good knowledge of PA and valued PARS. However, the findings unravelled external factors, inter-organisational mechanisms, and relational coordination obstacles that hinder efficient coordination of PARS patient care and delay/limit beneficial health outcomes for patients. Incentivising the PARS initiative and empowering patients to seek referral into the programme, are strategies that could boost PARS efficiency. Improving inter-professional relationships between GPs and EPs could lead to enhanced PARS functionality and efficient coordination of care for patients with chronic diseases