Patient involvement in assessment: How useful is it?

The author unveils a strategy for enquiry that can facilitate identification of best practices for involving real patients in OSCE and WBA competency-based assessments

Australian school stakeholders' perceived strategies for preventing adolescent obesity

Adolescent obesity is a complex multifactorial disease with a combination of environmental, behavioral, psychosocial, biological, cultural and genetic determinants. It remains a global public health issue that presents a major challenge to chronic disease prevention and health into adulthood. Schools have a rich opportunity to improve youth health and tackle obesity, yet they face barriers in fulfilling this function. This study investigated school stakeholders' beliefs and perceptions of the barriers and enablers currently experienced by schools, as well as their recommendations towards preventing adolescent obesity. A sequential explanatory mixed-methods study design was utilised with surveys administered for the quantitative phase and individual interviews for the qualitative phase. Descriptive statistics and inductive thematic analyses were utilised for the survey and interview data, respectively. Triangulation of findings from the quantitative and qualitative phases aided in the better understanding and integration of the overall results. In total, 60 school stakeholders (52 subject teachers, 3 senior teachers and 5 heads of department) from both independent and public high schools in Queensland, Australia responded to the survey, while 14 respondents participated in the interviews. The main perceived causes of obesity were poor eating habits and sedentary lifestyle. Highlighted barriers were busy timetables, shortage of trained staff and funding, lack of robustness in the introduction and implementation of school interventions and insufficient motivation of learners to participate in obesity prevention programs. Enabling factors included parental support, easy access to fitness equipment during recess, supportive government policies, provision of healthier school tuck shop menu options and elimination of sugary drinks from vending machines. A model for the prevention of adolescent obesity was developed based on participants’ perceptions. Tripartite collaboration between the school, government and parents was perceived as fundamental to preventing adolescent obesity. Strategies targeting nutrition, physical activity and overall health, including parental education on health, formal health talks in schools by health professionals and better-targeted advertisement encouraging healthy lifestyle choices, were identified as essential for improved adolescent health outcomes

Functionality of physical activity referral schemes (PARS): a systematic review

Background: Physical activity (PA) is vital to maintaining good health. However, WHO estimates that 60% of the world’s population are inadequately active. To enhance PA, Physical Activity Referral Schemes (PARS) have been established by some countries. Objective: This study examined the functionality of the PARS process across different countries. Methods: This systematic review was performed and reported in accordance with the PRISMA guidelines. Sixteen electronic databases were searched from January 1990 to May 2020. PARS studies, published in English language and in peer-reviewed journals, that reported adherence, outcomes, disease conditions, interventions, facilitators and barriers, were included in this review. Results: Twenty-seven studies conducted across eight countries met the inclusion criteria. Most patients were referred for sedentary/inactivity reasons and supervised group-based activities was the most used intervention. Participants’ average adherence rate was 77.5%. Adherence was either facilitated or hindered by type of support provided during and after intervention period. Inclusion of PA allied health specialist in the intervention enhanced positive health outcomes. Conclusion: PARS is a key driver and motivator for individuals to undertake and adhere to PA interventions. Utilisation of guidelines on evidence-based interventional PA for different types of diseases, effective use of common group supervised activities and the involvement of PA specialists may aid PA adherence and foster positive health outcomes

Effectiveness of integrated health systems in Africa: a systematic review

Background and objective: Traditional medicine (TM) was integrated into health systems in Africa due to its importance within the health delivery setup in fostering increased health care accessibility through safe practices. However, the quality of integrated health systems in Africa has not been assessed since its implementation. The objective of this paper was to extensively and systematically review the effectiveness of integrated health systems in Africa. Materials and Methods: A systematic literature search was conducted from October, 2019 to March, 2020 using Ovid Medline, Scopus, Emcare, Web of Science, Cumulative Index to Nursing and Allied Health (CINAHL), and Google Scholar, in order to retrieve original articles evaluating the integration of TM into health systems in Africa. A quality assessment of relevant articles was also carried out using the Quality Assessment Tool for Studies with Diverse Designs (QATDSS) critical appraisal tool. Results: The results indicated that the formulation and execution of health policies were the main measures taken to integrate TM into health systems in Africa. The review also highlighted relatively low levels of awareness, usage, satisfaction, and acceptance of integrated health systems among the populace. Knowledge about the existence of an integrated system varied among study participants, while satisfaction and acceptance were low among orthodox medicine practitioners. Health service users’ satisfaction and acceptance of the practice of an integrated health system were high in the countries assessed. Conclusion: The review concluded that existing health policies in Africa are not working, so the integration of TM has not been successful. It is critical to uncover the barriers in the health system by exploring the perceptions and experiences of stakeholders, in order to develop solutions for better integration of the two health systems

Individual anthropometric, aerobic capacity and demographic characteristics as predictors of heat intolerance in military populations

Background and objectives: The Australian Defence Force (ADF) engages in combat-related activities in hot climatic conditions, which exposes ADF members to the threat of exertional heat illness (EHI). After an episode of EHI, the heat tolerance test (HTT) is conducted to determine heat tolerance. Heat intolerance is the inability to maintain thermal balance while exercising in a hot environment. This study investigated the predictive roles of individual characteristics (age, gender, aerobic capacity (VO2max) and body composition) on physiological responses to the HTT in a group comprising ADF personnel and civilian volunteers. Materials and Methods: A quasi-experimental design was used and 52 (38 males and 14 females) participants were recruited from the ADF and the general population for the HTT. Heat intolerance was defined following the standard criteria for the HTT (temperature and heart rate). Data were analysed using inferential statistics. Results: The mean age of the participants was 31.1 ± 11.6 years, and 44% (23 people: 19 males and 4 females) of the participants were heat intolerant. Independent samples T-test showed that body mass index (p = 0.011) and body fat% (p = 0.034) of heat-intolerant participants were significantly higher than their heat-tolerant counterparts. Body surface area to mass ratio (p = 0.005) and aerobic capacity (p = 0.001) were significantly lower in heat-intolerant participants. Regression analyses showed that age, gender, aerobic capacity and body fat% were significant (p < 0.001) predictors of heat tolerance outcomes, with R2 values ranging from 0.505 to 0.636. Conclusion: This study showed that aerobic capacity, body fat%, age and gender are predictors of heat intolerance among military and non-military populations. However, there may be a need for future studies to consider identifying other indicators such as clinical biomarkers of heat intolerance, which could be used to develop a more reliable HTT protocol

The development of My Care Hub mobile-phone app to support self-management in Australians with type 1 or type 2 diabetes

Non-adherence to self-management poses a serious risk to diabetes complications. Digital behavioural change interventions have the potential to provide education and motivate users to regularly engage with self-management of diabetes. This paper describes the development of My Care Hub mobile phone application (app) aimed at supporting self-management in people with type 1 or type 2 diabetes. The development of My Care Hub involved a comprehensive process of healthy behavioural change identification, end users’ needs, expert consensus, data security and privacy considerations. The app translation was a highly iterative process accompanied by usability testing and design modification. The app development process included: (1) behaviour change strategy selection; (2) users’ 31 involvement; (3) expert advisory involvement; (4) data security and privacy considerations; (5) design creation and output translation into a smartphone app and (6) two usability testings of the app prototype version. The app features include self-care activities documentation, analytics, personalized and generalized messages for diabetes self-management as well as carbohydrate components of common foods in Australia. Twelve respondents provided feedback on the usability of the app. Initially, a simplification of the documentation features of the app was identified as a need to improve usability. Overall, results indicated good user satisfaction rate

A Systematic Review of the Factors That Influence Teachers’ Occupational Wellbeing

Teachers belong to a high-demand occupational group and experience work-related challenges and discretely diverse emotional turmoils of varying intensity while teaching and interacting with students. These experiences often result in high stress levels that contribute to burnout and, consequently, a breach of teachers’ occupational wellbeing. Promoting positive teacher wellbeing substantially influences teaching quality, with a flow-on effect on student wellbeing and academic development. This literature review utilised a framework to systematically explore the factors that impact the occupational wellbeing of kindergarten, primary, and secondary schoolteachers. Thirty-eight (38) studies from an initial 3766 peer-reviewed articles sourced from various databases (CINAHL, Emcare, PychINFO, Scopus, ERIC, and PsycARTICLES) were utilized for this systematic review. Four major factors were identified, including personal capabilities, socioemotional competence, personal responses to work conditions, and professional relationships. Findings highlight the importance of teachers’ occupational wellbeing in dealing with numerous challenges and competing demands, with the need for a high level of self-efficacy for instruction and behavioural management being critically significant. Teachers require adequate organisational support to successfully carry out their roles with stronger resilience and efficient job execution. Teachers also need to have social–emotional competence to be able to create a high-quality classroom environment and a conducive atmosphere that supports healthy teacher–student relationships, reduces stress and increases the occupational wellbeing of teachers. Collaborating with other relevant stakeholders such as parents, colleagues, and a school’s leadership team is critical for creating a positive work environment. A good workplace has the potential to contribute to teachers’ occupational wellbeing and provide a supportive platform for student learning and engagement. This review clearly points to the beneficial effects of prioritising teachers’ occupational wellbeing and its intentional inclusion in the professional development plan of practising teachers. Finally, while primary school teachers and secondary school teachers share many similarities in terms of the challenges they face, there are also some differences in how these challenges impact their wellbeing, and these warrant further investigation

Methane emissions and the use of Desmanthus in beef cattle production in Northern Australia

The Australian beef industry is a major contributor to the economy with an estimated annual revenue generation of over seven billion dollars. The tropical state of Queensland accounted for 48% of Australian beef and veal production in 2018. As the third biggest beef exporter in the world, Australia supplies 3% of the world’s beef exports and its agricultural sector accounts for an estimated 13.2% of its total greenhouse gas emissions. About 71% of total agricultural emissions are in the form of methane and nitrous oxide. In this review, an overview of the carbon footprint of the beef cattle production system in northern Australia is presented, with emphasis on the mitigation of greenhouse gases. The review also focuses on the tropical legume, Desmanthus, one of the more promising nutritional supplements for methane abatement and improvement of animal growth performance. Among the review’s findings is the need to select environmentally well-adapted and vigorous tropical legumes containing tannins that can persistently survive under the harsh northern Australian conditions for driving animal performance, improving meat quality and reducing methane emissions. The paper argues that the use of appropriate legumes such as Desmanthus, is a natural and preferred alternative to the use of chemicals for the abatement of methane emanating from tropical beef cattle production systems. It also highlights current gaps in knowledge and new research opportunities for in vivo studies on the impact of Desmanthus on methane emissions of supplemented tropical beef cattle

Physical activity promotion: a systematic review of the perceptions of healthcare professionals

Physical activity (PA) is a cost-effective and non-pharmacological foundation for the prevention and management of chronic and complex diseases. Healthcare professionals could be viable conduits for PA promotion. However, the evidence regarding the effectiveness and benefits of the current forms of PA promotion are inconclusive. Healthcare professionals’ perceptions on key determinants impact on the optimum promotion of PA were explored in this review. Thirty-four (34) studies were identified after systematically searching seven databases for peer-reviewed articles published within the last decade. PA advice or counselling was the most recorded form of PA promotion, limited counselling time was the most reported obstacle while providing incentives was viewed as a key facilitator. There is widespread consensus among healthcare professionals (HCPs) on some aspects of PA promotion. Utilisation of all PA promotional pathways to their full potential could be an essential turning point towards the optimal success of PA promotional goals. Hence, strategies are required to broaden chronic disease treatment methods to include preventive and integrative PA promotion approaches particularly, between frontline HCPs (e.g., GPs) and PA specialists (e.g., EPs). Future studies could explore the functionality of GP to EP referral pathways to determining what currently works and areas requiring further development

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