An Exploration of the Experience of Critical Incident Stress Debriefing on Firefighters Within a Region of the New Zealand Fire Service

This study originates from my practice experience working for the New Zealand Fire Service back in the late 1980's and early 1990's as an Occupational Health Nurse where I piloted a Critical Incident Stress Peer Support programme in the No.4 Region. My interest in the area began after attending a seminar on Critical Incident Stress Debriefing based on Mitchell's model of debriefing (1983). I had begun to recognise in my practice what I believed to be work-related stress but was a little uncertain about where this stress originated. After attending the seminar I began to understand that some of this stress was related to Critical Incident Stress (CIS) from firefighters exposure to critical incidents. This study explores four firefighters experience of Critical Incident Stress Debriefing (CISD) within a Region of the New Zealand Fire Service. It explores the application of CISD as one component of Critical Incident Stress Management (CISM), and the Nurse Researcher's philosophy of Clinical Nurse practice in relation to the application of CISD. The knowledge gained from the analysis of the data has the potential to influence professionals understanding of their experience and affect future practice and that of others working in the field of CISM. The aim of the study was to gain a greater indepth understanding of firefighters experience specifically in relation to their participation in a Critical Incident Stress Debriefing (CISD) following their exposure to a critical incident. Much of the literature that supported CISD appeared to offer a rather superficial understanding of the firefighters experience in relation to CISD. I chose to use narratives as the methodology, utilising four individual case studies as a method of social inquiry in order to explore the experience of CISD. The narratives were able to creatively capture the complexity and the dynamic practice of CISD. An overall pattern of the formalised process was uncovered through the participants' narratives. Eight dominant themes were highlighted from the narratives which included safe environment; ventilating the stress reaction; similar feelings; getting the whole picture; peer support; bonding and resolution. While these themes were common to all the participants, each participant had a particular theme/s which was unique to their experience. As a Nurse Researcher with dual practice interests in the area of nursing education and Critical Incident Stress Management (CISM), I am in a position to inform practice and service development. It is my belief that the knowledge gained from this study has the potential to be transferred to others working in the field of CISM. The study results are timely, practical and informative at a time of major change in the New Zealand Fire Service

At the intersection of marginalised identities: Lesbian, gay, bisexual and transgender people’s experiences of injecting drug use and hepatitis C seroconversion

While the levels of injecting drug use among lesbian, gay, bisexual and transgender (LGBT) populations are high we know little about their experiences of injecting drugs or living with hepatitis C virus (HCV) infection. The loss of traditional family and cultural ties means connection to community is important to the wellbeing of LGBT populations. While some kinds of drug-use are normalised within many LGBT communities, injecting drug use continues to be stigmatised. This exploratory qualitative study of people with newly acquired HCV used semi-structured interviews to explore participants’ understandings and awareness of HCV, seroconversion, testing, diagnosis and treatment. We present a secondary thematic analysis of eight LGBT participants of the experience of injecting drugs, living with HCV and having a marginalised sexual or gender identity. Community was central to the participants’ accounts. Drug-use facilitated connection to a chosen community by suppressing sexual or gender desires allows them to fit in to the mainstream; enacting LGBT community norms of behaviour; and connection through shared drug-use. Participants also described feeling afraid to come out about their drug-use to LGBT peers because of the associated stigma of HCV. They described a similar stigma associated with HIV within the PWID community. Thus the combination of being LBGT/living with HIV (a “gay” disease) and injecting drugs/living with HCV (a “junkie’s” disease) left them in a kind of no man’s land. Health professionals working in drug and HCV care services need to develop capacity in providing culturally appropriate health care for LGBT people who inject drugs. Key words: Hepatitis C; HIV; Drug Use; Sexuality; Culturally-appropriate; health car

Indigenous Resiliency Project Participatory Action Research Component: A report on the Research Training and Development Workshop, Townsville, February 2008

The Indigenous Resiliency Project proposes to build capacity in Indigenous communities in Australia, New Zealand and Canada to conduct investigations into the factors that may support Indigenous people in responding toblood borne viral (BBV) and sexually transmitted infections (STI). The goal of this international project is to identify strategies related to resiliency that can be incorporated into public health and clinical practice. The Australian arm of the Indigenous Resiliency Project focuses on young adults (aged 16 to 25 years) in urban settings. It employs a range of research methods to gain an understanding of the factors thatmight be strengthened to better protect young Aboriginal and Torres Strait Islander people against BBV and STI. The project has four components, the third being the Participatory Action Research (PAR) project. The PAR has four aims: 1. Build the capacity of Aboriginal Community Controlled Health Services in Participatory Action Research practice. 2. Identify, assess and enhance selected BBV/STI resilience capability of Aboriginal and Torres Strait Islander populations in the study sites. 3. Inform on opportunities to decrease the risk of BBV/STI transmission in these populations. 4. Provide information for local and area health service planning for Aboriginal and Torres Strait Islander BBV/STI prevention. The PAR project is running in three sites: the Townsville Aboriginal and Islander Health Service (TAIHS), Derbarl Yerrigan Medical Service in Perth (DY), and the Aboriginal Medical Service in Redfern (AMS). In each health service, a site research team works together with a research team from the National Centre in HIV Epidemiology and Clinical Research (NCHECR) to develop the project locally. Each site is using the following framework: Phase I: Develop protocols, identifypriority population, and obtain ethics. Phase II: Research training and development workshop. Phase III: Fieldwork – recruitment, observation, and data collection. Phase IV: Focus groups. Phase V: Analysis and dissemination of findings. This report describes the first two phases of the PAR project at the TIAHS.the International Collaborative Indigenous Health Research Program (ICIHRP

Surgery for women with apical vaginal prolapse (Review)

Background: Apical vaginal prolapse is a descent of the uterus or vaginal vault (post-hysterectomy). Various surgical treatments are available and there are no guidelines to recommend which is the best. Objectives: To evaluate the safety and efficacy of any surgical intervention compared to another intervention for the management of apical vaginal prolapse. Search methods: We searched the Cochrane Incontinence Group's Specialised Register of controlled trials, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched July 2015) and ClinicalTrials.gov (searched January 2016). Selection criteria: We included randomised controlled trials (RCTs). Data collection and analysis: We used Cochrane methods. Our primary outcomes were awareness of prolapse, repeat surgery and recurrent prolapse (any site). Main results: We included 30 RCTs (3414 women) comparing surgical procedures for apical vaginal prolapse. Evidence quality ranged from low to moderate. Limitations included imprecision, poor methodological reporting and inconsistency. Vaginal procedures versus sacral colpopexy (six RCTs, n = 583; one to four-year review). Awareness of prolapse was more common after vaginal procedures (risk ratio (RR) 2.11, 95% confidence interval (CI) 1.06 to 4.21, 3 RCTs, n = 277, I = 0%, moderate-quality evidence). If 7% of women are aware of prolapse after sacral colpopexy, 14% (7% to 27%) are likely to be aware after vaginal procedures. Repeat surgery for prolapse was more common after vaginal procedures (RR 2.28, 95% CI 1.20 to 4.32; 4 RCTs, n = 383, I = 0%, moderate-quality evidence). The confidence interval suggests that if 4% of women require repeat prolapse surgery after sacral colpopexy, between 5% and 18% would require it after vaginal procedures. We found no conclusive evidence that vaginal procedures increaserepeat surgery for stress urinary incontinence (SUI) (RR 1.87, 95% CI 0.72 to 4.86; 4 RCTs, n = 395; I = 0%, moderate-quality evidence). If 3% of women require repeat surgery for SUI after sacral colpopexy, between 2% and 16% are likely to do so after vaginal procedures. Recurrent prolapse is probably more common after vaginal procedures (RR 1.89, 95% CI 1.33 to 2.70; 4 RCTs, n = 390; I = 41%, moderate-quality evidence). If 23% of women have recurrent prolapse after sacral colpopexy, about 41% (31% to 63%) are likely to do so after vaginal procedures. The effect of vaginal procedures on bladder injury was uncertain (RR 0.57, 95% CI 0.14 to 2.36; 5 RCTs, n = 511; I = 0%, moderate-quality evidence). SUI was more common after vaginal procedures (RR 1.86, 95% CI 1.17 to 2.94; 3 RCTs, n = 263; I = 0%, moderate-quality evidence). Dyspareunia was also more common after vaginal procedures (RR 2.53, 95% CI 1.17 to 5.50; 3 RCTs, n = 106, I = 43%, low-quality evidence). Vaginal surgery with mesh versus without mesh (6 RCTs, n = 598, 1-3 year review). Awareness of prolapse - There may be little or no difference between the groups for this outcome (RR 1.08 95% CI 0.35 to 3.30 1 RCT n = 54, low quality evidence). The confidence interval was wide suggesting that if 18% of women are aware of prolapse after surgery without mesh, between 6% and 59% will be aware of prolapse after surgery with mesh. Repeat surgery for prolapse - There may be little or no difference between the groups for this outcome (RR 0.69, 95% CI 0.30 to 1.60; 5 RCTs, n = 497; I = 9%, low-quality evidence). If 4% of women require repeat surgery for prolapse after surgery without mesh, 1% to 7% are likely to do so after surgery with mesh. We found no conclusive evidence that surgery with mesh increases repeat surgery for SUI (RR 4.91, 95% CI 0.86 to 27.94; 2 RCTs, n = 220; I = 0%, low-quality evidence). The confidence interval was wide suggesting that if 2% of women require repeat surgery for SUI after vaginal colpopexy without mesh, 2% to 53% are likely to do so after surgery with mesh. We found no clear evidence that surgery with mesh decreases recurrent prolapse (RR 0.36, 95% CI 0.09 to 1.40; 3 RCTs n = 269; I = 91%, low-quality evidence). The confidence interval was very wide and there was serious inconsistency between the studies. Other outcomesThere is probably little or no difference between the groups in rates of SUI (de novo) (RR 1.37, 95% CI 0.94 to 1.99; 4 RCTs, n = 295; I = 0%, moderate-quality evidence) or dyspareunia (RR 1.21, 95% CI 0.55 to 2.66; 5 RCTs, n = 501; I = 0% moderate-quality evidence). We are uncertain whether there is any difference for bladder injury (RR 3.00, 95% CI 0.91 to 9.89; 4 RCTs, n = 445; I = 0%; very low-quality evidence). Vaginal hysterectomy versus alternatives for uterine prolapse (six studies, n = 667) No clear conclusions could be reached from the available evidence, though one RCT found that awareness of prolapse was less likely after hysterectomy than after abdominal sacrohysteropexy (RR 0.38, 955 CI 0.15 to 0.98, n = 84, moderate-quality evidence). Other comparisons There was no evidence of a difference for any of our primary review outcomes between different types of vaginal native tissue repair (two RCTs), comparisons of graft materials for vaginal support (two RCTs), different routes for sacral colpopexy (four RCTs), or between sacral colpopexy with and without continence surgery (four RCTs). Authors' conclusions: Sacral colpopexy is associated with lower risk of awareness of prolapse, recurrent prolapse on examination, repeat surgery for prolapse, postoperative SUI and dyspareunia than a variety of vaginal interventions. The limited evidence does not support use of transvaginal mesh compared to native tissue repair for apical vaginal prolapse. Most of the evaluated transvaginal meshes are no longer available and new lighter meshes currently lack evidence of safety The evidence was inconclusive when comparing access routes for sacral colpopexy. No clear conclusion can be reached from the available data comparing uterine preserving surgery versus vaginal hysterectomy for uterine prolapse

Conflicting rights: How the prohibition of human trafficking and sexual exploitation infringes the right to health of female sex workers in Phnom Penh, Cambodia

While repressive laws and policies in relation to sex work have the potential to undermine HIV prevention efforts, empirical research on their interface has been lacking. In 2008, Cambodia introduced anti-trafficking legislation ostensibly designed to suppress human trafficking and sexual exploitation. Based on empirical research with female sex workers, this article examines the impact of the new law on vulnerability to HIV and other adverse health outcomes. Following the introduction of the law, sex workers reported being displaced to streets and guesthouses, impacting their ability to negotiate safe sex and increasing exposure to violence. Disruption of peer networks and associated mobility also reduced access to outreach, condoms, and health care. Our results are consistent with a growing body of research which associates the violation of sex workers’ human rights with adverse public health outcomes. Despite the successes of the last decade, Cambodia’s AIDS epidemic remains volatile and the current legal environment has the potential to undermine prevention efforts by promoting stigma and discrimination, impeding prevention uptake and coverage, and increasing infections. Legal and policy responses which seek to protect the rights of the sexually exploited should not infringe the right to health of sex workers.NIH grants: U01AI0154241, 1R21 DA025441, and 1R01NR010995 and additional funding from a Faculty Initiative grant from the Pacific Rim Research Program of the University of California. Lisa Maher is supported by a National Health and Medical Research Council Senior Research Fellowshi

Enhancing Aboriginal and Torres Strait Islander young people’s resilience to blood borne and sexually transmitted infections: Findings from a community-based participatory research project

Issue addressed: Health services are fundamental to reducing the burden of blood-borne and sexually transmitted infections (BBV/STI) in Indigenous communities. However, we know very little about young Indigenous people’s use of mainstream and community-controlled health services for the prevention and treatment of these infections, or how health services can best support young people’s efforts to prevent infection. Methods: University-researchers, a site coordinator and peer researchers developed a project and conducted interviews with 45 Aboriginal and Torres Strait Islander people aged 17 to 26 years. Thematic analysis of interviews notes identified key themes around health service use and experiences of Aboriginal Community-Controlled Health Services (ACCHS). Results: Most participants had accessed health services for the prevention or treatment of BBV/STI, with positive experiences characterised by the provision of information and feeling cared for. Participants described the comfort and understanding they experienced at ACCHS; personal relationships and having an Indigenous care provider present were important factors in the overwhelmingly positive accounts. Young people reported strategies for overcoming challenges to prevention and accessing treatment services, including being proactive by carrying condoms, persisting with behavioural intentions despite feeling shame. . Conclusion: Our findings reinforce the important role both mainstream and community-controlled health services have in the prevention and treatment of BBV/STI blood borne and sexually transmitted infections in young Indigenous people. We highlight opportunities to build on young people’s strengths, such as their valuing of their health, their persistence, and their offers to support peers, to better prevent transmission of infections and enhance access to treatment.the International Collaboration in Indigenous Health Research Program, a trilateral partnership between the National Health and Medical Research Council of Australia, the Canadian Institutes of Health Research, and the Health Research Council of New Zealan

Young Indigenous Australians’ sexually transmitted infection prevention practices: A Community-based Participatory Research project

Funded by the International Collaborative Indigenous Health Research Partnership (ID: 361621), a trilateral partnership between the National Health and Medical Research Council of Australia, the Canadian Institutes of Health Research, and the Health Research Council of New ZealandNational surveillance data indicate marked differences between Indigenous and other Australians in the prevalence of many sexually transmitted infections (STIs). Young Indigenous people bear a particularly high burden of these infections. A collaboration of university researchers, Indigenous health workers and young Indigenous people conducted 45 field interviews to examine how young Indigenous Australians keep themselves healthy and protected against STIs. Our findings emphasise the complexity of health behaviours, where individuals are rarely always ‘risky’ or always ‘safe’, as well as subtle gender differences in health practices. Preventive strategies employed by the young people were contingent on beliefs and knowledge about sexual partners, the type of relationship, the context of the sexual encounter, and access to condoms. Tangible strengths identified by our study should be celebrated and bolstered to enhance young Indigenous people’s ability to protect themselves against adverse health outcomes and enhance their resilience against STIs. Focusing on strengths helps to counter the deficit model of health commonly deployed in Indigenous health research and draws attention to health issues facing young Indigenous people and their communities, without reinforcing negative stereotypes or focusing solely on individual risk behaviour. We provide concrete recommendations for health promotion and education. Keywords Sexual health; STI prevention; young people; Indigenous people; AustraliaInternational Collaborative Indigenous Health Research Partnership (ID: 361621

Sexual health through the eyes of Indigenous youth: Community-based participatory research with young Indigenous people in Townsville

The project had the following aims: 1. Build the capacity of Aboriginal Community Controlled Health Services in research practice; 2. Identify, assess and enhance the blood borne viral and sexually transmitted infection (BBV/STI) resilience capability of Aboriginal and Torres Strait Islander people; 3. Inform on opportunities to decrease the risk of BBV /STI transmission in site communities; 4. Provide information for local and area health service planning for Aboriginal and Torres Strait Islander BBV/STI. 1.2 Methods A Community-Based Participatory Research framework was used to develop a qualitative study of young people’s perspectives on blood borne and sexually transmitted infections...The Indigenous Resiliency Project is funded by the International Collaboration in Indigenous Health Research Program, a trilateral partnership between the National Health and Medical Research Council of Australia, the Canadian Institutes of Health Research, and the Health Research Council of New Zealand

Young Indigenous Australians’ sexually transmitted infection prevention practices: A Community-based Participatory Research project

National surveillance data indicate marked differences between Indigenous and other Australians in the prevalence of many sexually transmitted infections (STIs). Young Indigenous people bear a particularly high burden of these infections. A collaboration of university researchers, Indigenous health workers and young Indigenous people conducted 45 field interviews to examine how young Indigenous Australians keep themselves healthy and protected against STIs. Our findings emphasise the complexity of health behaviours, where individuals are rarely always ‘risky’ or always ‘safe’, as well as subtle gender differences in health practices. Preventive strategies employed by the young people were contingent on beliefs and knowledge about sexual partners, the type of relationship, the context of the sexual encounter, and access to condoms. Tangible strengths identified by our study should be celebrated and bolstered to enhance young Indigenous people’s ability to protect themselves against adverse health outcomes and enhance their resilience against STIs. Focusing on strengths helps to counter the deficit model of health commonly deployed in Indigenous health research and draws attention to health issues facing young Indigenous people and their communities, without reinforcing negative stereotypes or focusing solely on individual risk behaviour. We provide concrete recommendations for health promotion and education. Keywords Sexual health; STI prevention; young people; Indigenous people; AustraliaInternational Collaborative Indigenous Health Research Partnership (ID: 361621

Long-acting injectable buprenorphine for opioid use disorder: A systematic review of impact of use on social determinants of health

Objectives: This systematic review synthesizes evidence on both the effects and perspectives of the use of novel long-acting injectable buprenorphine (LAIB) as part of medication-assisted treatment (MAT) and its impact on social determinants of health (SDH), specifically abstinence, accessibility, employment, forensic matters, and gender and social relationships via a framework approach. Methods: The study team searched three databases between January 2010 and June 2020 to identify English-language original research published in peer reviewed journals. This search yielded 9253 papers. A comprehensive search followed by 67 full text publication screenings by two independent reviewers yielded 15 papers meeting inclusion criteria. The study included three randomized control trials, one open label safety study, two case series, and six qualitative papers examining patient perspectives toward the LAIB prior to use. The team assessed the quality of studies via standardized quality assessment tools. Results: The LAIB was positively associated with improvements in abstinence, accessibility, employment, social relationships, and forensic matters. Limited evidence exists on gender equity within the current literature. The qualitative papers highlighted the importance of patients' preferences and individualization of treatment planning to ensure the success of MAT. Conclusion: The quality of evidence was rated as medium or high risk of bias, which does limit interpretation of the results. Overall, the LAIB was positively associated with SDH and should be offered as part of MAT in alignment with the recovery model. Future research should evaluate the implementation and longitudinal impacts of LAI buprenorphine compared to treatment as usual (TAU)