Design, Delivery, Maintenance, and Outcomes of Peer-to-Peer Online Support Groups for People With Chronic Musculoskeletal Disorders: Systematic Review

Background: Online support groups (OSGs) are one way for people with chronic diseases, their family or friends, and health professionals to communicate, gain information, and provide social support. As the number of peer-to-peer OSGs for chronic musculoskeletal conditions grows, it is important to gain insight into the different designs of groups available, who is accessing them, if and how they may be effective, and what strategies are being used to implement or increase consumer engagement. Objective: The objectives of this systematic review of people with musculoskeletal conditions were to (1) describe the design features (functions, usage options, moderation, and expert input) of peer-to-peer OSGs, (2) describe the characteristics of the individuals using peer-to-peer OSGs, (3) synthesize the evidence on outcomes of participation, and (4) identify strategies used in the delivery and maintenance of OSGs. Methods: A search comprising terms related to the population (people with musculoskeletal disorders) and the intervention (peer-to-peer OSGs) was conducted in 6 databases. Results were filtered from 1990 (internet inception) to February 2019. Studies identified in the search were screened according to predefined eligibility criteria using a 2-step process. Quantitative studies were appraised by 2 reviewers using the Risk Of Bias In Non-Randomized Studies of Interventions tool. Qualitative studies were appraised by 2 different reviewers using the Critical Appraisal Skills Programme checklist. Extracted data were synthesized narratively. Results: We examined 21 studies with low to moderate risk of bias. Of these studies, 13 studies included OSGs hosted on public platforms, 11 studies examined OSGs that were conducted in English, and 6 studies used moderators or peer leaders to facilitate engagement. Studies either reported the number of OSG members (n=1985 across all studies) or the number of posts (range: 223-200,000). The majority of OSG members were females who were not full-time employees and with varied levels of education. There were no randomized controlled trials measuring the efficacy of OSGs. Qualitative and quantitative studies identified empowerment, social support, self-management behavior, and health literacy as primary constructs to measure OSG efficacy. Neutral or marginal improvement was reported in these constructs. Sharing experiences and a greater level of engagement appeared to have an important influence on OSGs efficacy. The extent to which members posted on the website influenced engagement. Conclusions: Across a diverse range of designs, languages, included features, and delivery platforms, peer-to-peer OSGs for chronic musculoskeletal conditions attract predominantly female participants of all ages and education levels. The level of participation of a member appears to be related to their perceived benefit, health literacy, and empowerment. Future studies are needed to identify which design and maintenance strategies have superior efficacy and whether there are concomitant improvements in health outcomes for people with chronic musculoskeletal conditions resulting from participation in OSGs

Nature on the doorstep: Social Perspectives of Urban Nature Reserves

Global urbanisation presents the challenge of how to conserve remnant biodiversity in our cities and maintain human connection with nature. Nature contact has been found to be beneficial for physical and mental health as well as for quality of life and social connectedness. As densities increase, there are less opportunities to retain nature within gardens and streets, so nature will be experienced within urban open spaces and protected areas. Nature invokes a range of social realities depending on your experience. Canberra, a planned city coproduced by humans and nature, defies binary notions about the separation of nature and city, providing an ideal setting for social research. Using place-based case studies, this qualitative research uses ethnographic methods to explore how nature is experienced in urban nature reserves, drawing on perspectives of neighbours and users, practitioners developing near nature reserves and managers, including volunteers. These case studies are supported by topical studies about how societal discourse and norms might influence nature connection and interstate studies that explore alternative models used to manage biodiverse urban nature reserves and people relationships. This research has found nature reserves in Canberra are important social spaces, satisfying a range of human needs by providing valued everyday nature contact and fostering social bonds and cohesion. Regular users and nearby neighbours are strongly place-attached to these nature reserves, as are Park Care stewards. This meaning and belonging is expressed in many ways from human memorials, photos and stories of daily nature experience, to boundary maintenance practices and ecological restoration. This raises questions about how we best manage these places for multiple social values. Ecosystem loss has elevated biodiversity conservation and the bounded governance of nature reserves creates a value hierarchy and imposes rules often at odds with the everyday reality of users and other beneficial societal outcomes. Promoting nature connection is also hitting against heightened elevation of risk in society, communicated through the popular media, and evident in changing social norms around parenting, affecting children's freedom and nature contact. Structuring reserve management around bounded ecological units means social values and knowledge about these places is often overlooked in planning processes. Epistemic authority rests in scientific and administrative knowledge at the expense of other ways of seeing, the place meanings and community knowledge that has evolved through long-term social associations with these reserves. Knowledge and skills based groups like conservation stewards and fire volunteers provide critical capacity for managers and need greater legitimacy within management agencies. The potential is evident in long term collaborations elsewhere where management of nature reserves devolved to community organisations leads to imaginative local programs. By comparing different management responses in the case studies, there is evidence that with early education and visible active management, respectful stewardship behaviours can evolve alongside the conservation purpose. This suggests bounded management is fit for purpose where there is a regular management presence, well-designed and maintained trail infrastructure and targeted education programs. In the older reserves, managers need to recognise the legacies of these lived-in landscapes and explore opportunities for community partnership approaches that devolve autonomy. Writing people into not out of urban nature reserves recognises these social realities as well as the management legacies around their creation and the resource constraints. The experiences from Canberra will have resonance for other cities wrestling with the challenge of managing people and biodiversity in a way that respects the needs and interests of both

Media Representations of Nature in the City

The State of Australian Cities (SOAC) national conferences have been held biennially since 2003 to support interdisciplinary policy-related urban research. This paper was presented at SOAC 6, held in Sydney from 26-29 November 2013. SOAC 6was the largest conference to date, with over 180 papers published in collected proceedings. All papers presented at the SOAC 2013 have been subject to a double blind refereeing process and have been reviewed by at least two referees. In particular, the review process assessed each paper in terms of its policy relevance and the contribution to the conceptual or empirical understanding of Australian cities

Do expert assessments converge? An exploratory case study of evaluating and managing a blood supply risk

Abstract Background Examining professional assessments of a blood product recall/withdrawal and its implications for risk and public health, the paper introduces ideas about perceptions of minimal risk and its management. It also describes the context of publicly funded blood transfusion in Canada and the withdrawal event that is the basis of this study. Methods Interviews with 45 experts from administration, medicine, blood supply, laboratory services and risk assessment took place using a multi-level sampling framework in the aftermath of the recall. These experts either directly dealt with the withdrawal or were involved in the management of the blood supply at the national level. Data from these interviews were coded in NVivo for analysis and interpretation. Analytically, data were interpreted to derive typifications to relate interview responses to risk management heuristics. Results While all those interviewed agreed on the importance of patient safety, differences in the ways in which the risk was contextualized and explicated were discerned. Risk was seen in terms of patient safety, liability or precaution. These different risk logics are illustrated by selected quotations. Conclusions Expert assessments did not fully converge and it is possible that these different risk logics and discourses may affect the risk management process more generally, although not necessarily in a negative way. Patient safety is not to be compromised but management of blood risk in publicly funded systems may vary. We suggest ways of managing blood risk using formal and safety case approaches.</p

Two pyridinium metabolites of haloperidol are present in the brain of patients at post-mortem

We have shown in patients taking the antipsychotic drug haloperidol (HP) that two pyridinium metabolites (HPP and RHPP) are present in blood and urine in nM concentrations. These metabolites are structurally analogous to MPP, the neurotoxic metabolite of the well-known parkinsonian-producing protoxin, MPTP. In this study we measured the concentrations of HPP and RHPP in seven regions of the brain (putamen, substantia nigra, globus pallidus, caudate, hippocampus, cerebellum and occipital cortex) obtained at post-mortem from three patients who were taking HP before death. Blood, urine, and bile from one patient were analysed as well. HPP was present in all regions (except for substantia nigra in one patient and globus pallidus in another); the amount/g ranged from 1.6-8.3 pMol but there was no preferential sequestration of the metabolite in dopaminergic regions. Similarly, RHPP was present relatively uniformly in all regions; the amount/g ranged from 1.1-7.6 pMol. The concentrations of HPP and RHPP in one patient were 24 and 13 nM in blood, 660 and 230 nM in urine, and 13.0 and 1.4 μM in bile, respectively. The presence of these pyridinums in brain adds another important piece of information to the case that, at least for HP, metabolite-induced neurotoxicity could contribute to the extrapyramidal side-effects in patients receiving long-term therapy

Exploratory study of 6-month pain trajectories in individuals with predominant patellofemoral osteoarthritis: A cohort study

Knowledge of patellofemoral osteoarthritis (OA) pain trajectories is vital to helping clinicians and patients make shared disease-specific decisions regarding treatment options and coping strategies