Improving type 2 diabetes care and self-management at the individual level by incorporating social determinants of health

Objective: Suboptimal social determinants of health impede type 2 diabetes self-management. They are usually considered at population and community levels, not individually. The study objective was to draw on perspectives of people who have type 2 diabetes to identify and explore the impact of social determinants on self-management and ways to incorporate them into individual care. Methods: Purposively selected participants chose to partake in focus groups or interviews. Data were analysed and themes identified through deductive and inductive thematic analysis. Results: Social issues hinder type 2 diabetes self-management. Additionally, an individual’s feelings and poor mental health, competing priorities and understanding about diabetes are important considerations. Support was provided via health professionals, community supports, financial support, personal support and informal self-management support. Conclusions: Social determinants of health could be formally incorporated into individual care for people with type 2 diabetes if a socio-ecological view of health is taken as it considers the broader social and environmental circumstances in peoples lives. Implications for public health: Care for people with type 2 diabetes could be transformed if social determinants of health are formally assessed and responded to at an individual level. A socio-ecological view of health in individual care and clinical settings would enable social determinants of health to be formally incorporated into type 2 diabetes care

A comprehensive systematic review of stakeholder attitudes to alternatives to prospective informed consent in paediatric acute care research

Background: A challenge of performing research in the paediatric emergency and acute care setting is obtaining valid prospective informed consent from parents. The ethical issues are complex, and it is important to consider the perspective of participants, health care workers and researchers on research without prospective informed consent while planning this type of research. Methods: We performed a systematic review according to PRISMA guidelines, of empirical evidence relating to the process, experiences and acceptability of alternatives to prospective informed consent, in the paediatric emergency or acute care setting. Major medical databases and grey sources were searched and results were screened and assessed against eligibility criteria by 2 authors, and full text articles of relevant studies obtained. Data were extracted onto data collection forms and imported into data management software for analysis. Results: Thirteen studies were included in the review consisting of nine full text articles and four abstracts. Given the heterogeneity of the methods, results could not be quantitatively combined for meta-analysis, and qualitative results are presented in narrative form, according to themes identified from the data. Major themes include capacity of parents to provide informed consent, feasibility of informed consent, support for alternatives to informed consent, process issues, modified consent process, child death, and community consultation. Conclusion: Our review demonstrated that children, their families, and health care staff recognise the requirement for research without prior consent, and are generally supportive of enrolling children in such research with the provisions of limiting risk, and informing parents as soon as possible. Australian data and perspectives of children are lacking and represent important knowledge gaps

A synthesis and review of Primary Industries Health and Safety Partnership Publications

Injuries and illness in the Primary Industries sector represent a significant burden on the Australian economy. In 2010-11, Primary Industries had the highest workplace fatality rate (17.64 deaths / 100,000 people), which was nine times higher than the all industry fatality rate (1.93 / 100,000 people). Australia’s Primary industries are among the country's most challenging workplaces, requiring a range of skills and knowledge to be successful, and including individual enterprises, often operating with small or reduced workforces compared to workloads. While there has been a reduction in the number of deaths, the primary industries sector remains the most dangerous in which to work. To address this burden, the Primary Industries Health and Safety Partnership (PIHSP) funded a range of health and safety research projects over the 17 years it has been operating, addressing health and safety in Australia's primary industries. To date, a comprehensive review of this body of research has not been completed. As the PIHSP moves into its next phase of work addressing the challenges of implementing strategies to reduce injury and illness, there is a need to collate previous research findings and identify key lessons, outcomes, outputs and recommendations. The review will highlight areas where future action is required to enhance OHS in the Primary Industries

A synthesis and review of Primary Industries Health and Safety Partnership Publications

Injuries and illness in the Primary Industries sector represent a significant burden on the Australian economy. In 2010-11, Primary Industries had the highest workplace fatality rate (17.64 deaths / 100,000 people), which was nine times higher than the all industry fatality rate (1.93 / 100,000 people). Australia’s Primary industries are among the country's most challenging workplaces, requiring a range of skills and knowledge to be successful, and including individual enterprises, often operating with small or reduced workforces compared to workloads. While there has been a reduction in the number of deaths, the primary industries sector remains the most dangerous in which to work. To address this burden, the Primary Industries Health and Safety Partnership (PIHSP) funded a range of health and safety research projects over the 17 years it has been operating, addressing health and safety in Australia's primary industries. To date, a comprehensive review of this body of research has not been completed. As the PIHSP moves into its next phase of work addressing the challenges of implementing strategies to reduce injury and illness, there is a need to collate previous research findings and identify key lessons, outcomes, outputs and recommendations. The review will highlight areas where future action is required to enhance OHS in the Primary Industries

Public Health Career Development Action Plan: Post Graduate Student Career Development Support and Learning Activities for the Discipline of Public Health and Tropical Medicine

A feature of university study, including postgraduate study, is to move into and within the labour force, and obtain meaningful employment. As such, universities and students are keen to ensure employability is embedded into curriculum. The discipline of Public Health and Tropical Medicine at James Cook University has a large postgraduate cohort and represents about 19% of the university’s postgraduate students in 2018. This report outlines the stages in the creation of a career development action plan for the discipline of Public Health and Tropical Medicine. An audit of existing employability related content within subjects was undertaken and from this a consideration of opportunities for extension within curriculum informed by the action plan components. An antecedent to these considerations which informed the proposed next steps is that understanding student motivation for enrolment is an important pre-requisite for directing career and employability into curriculum. A model has been created to reflect the proposed interactions between student motivation, career development, adaptability and employability; although more work is required to determine whether this model fits the postgraduate student journey. The JCU Career Action Plan for Curriculum (CAP-C) is an online planning tool developed by the JCU Careers and Employability Team to assist staff in boosting career development, employability and entrepreneurship learning strategies and activities into curriculum. The CAP-C was developed with a focus on undergraduate courses and as such a slightly modified CAP-C was used for exploring employability within a postgraduate specific cohort. This modified CAP-C was used to audit a selection of subject offerings within public health and tropical medicine. Each subject offering was considered against 29 action points from the CAP-C that were seen by the project team as being relevant to postgraduate study. Additional points of reflection, for staff who were completing the audit, related to perceived value and how time intensive embedment activities would be for those action points not already embedded. A total of 24 subjects of the 39 available were audited. Key findings were that career and employability content was embedded into some subjects, although the included content varied depending on the subject focus and also by delivery mode. Career and employability related content that already exists relates to a provision of staff career snapshots, problem based activities, use of professional online networks , assessment items which establish knowledge acquisition and build practical skills relevant to potential future work situations. Examples of best practice for these existing embedded action points are outlined. A number of key action items for the discipline of Public Health and Tropical Medicine are outlined including to boost student networking and communication opportunities, clearly articulate the employment services available, to enable past students to illustrate their career trajectory after graduation and their associated tips and thoughts on success. Key opportunities for future enhancement relate to promoting practical skill acquisition, showing the diversity of career paths and trajectories in public health, encouraging student networking during and post study. A number of easy actions can be undertaken without creating additional workloads but provide value. Examples include supporting students to explore opportunities and to be future orientated, promote communication within and beyond subjects and to highlight the relevance of the material with respect to careers and future work related roles. Through undertaking an audit of current examples of embedding of employability and career content in the postgraduate Public Health and Tropical Medicine offerings it was determined that a number of existing actions are being undertaken. There is always room for improvement, but importantly these actions need not be time intensive for staff to implement to have value. Some key action points for the discipline have been articulated as well as some Meta considerations regarding strengths, weaknesses, opportunities and threats with respect to the disciplines engagement and championing of employability and career embedment. It is hoped that through this audit process it will lead to improvements for the disciplines’ students (current and future) but also might offer some insights for other disciplines

Incorporating social determinants of health into individual care—a multidisciplinary perspective of health professionals who work with people who have type 2 diabetes

Social determinants of health (SDoH) and type 2 diabetes mellitus (T2DM) are interrelated. The prevalence of T2DM is increased amongst those with suboptimal SDoH. Poor SDoH can also negatively impact T2DM self-management. Social determinants of health are mostly considered at population and community levels, rather than individually or clinically. This qualitative study combines the perspectives of a multidisciplinary cohort of health professionals to identify and explore the impact of social determinants on self-management, and ways they could be incorporated into individual clinical care. Purposively selected participants chose to partake in an in-depth, semi-structured, one-on-one interview or focus group. Data were analysed, and themes identified using a combination of deductive and inductive thematic analysis. Fifty-one health professionals volunteered for the study. Two small focus groups (n = 3 and n = 4) and 44 one-on-one interviews were conducted. The identified themes were: 1) Support for incorporating SDoH into T2DM care, 2) Effect of SDoH on T2DM self-management, 3) Identifying and addressing social need, 4) Requirements for incorporating SDoH into T2DM individual clinical care. Health professionals reported that poor social determinants negatively affect an individual’s ability to self manage their T2DM. Person-centred care could be enhanced, and people with T2DM may be more likely to achieve self-management goals if SDoH were included in individual clinical care. To achieve successful and sustained self-management for people with T2DM, health professionals require a thorough understanding of T2DM and the effect of social determinants, respect for client privacy, client trust and rapport, effective communication skills, validated tools for assessing SDoH, team champions, teamwork, ongoing education and training, adequate resources, guiding policies and procedures, and management support. Incorporating SDoH into individual, clinical care for people with T2DM was strongly supported by health professionals. If embraced, this addition to care for individuals with T2DM could improve self-management capacity and enhance person-centred care

Exploring the barriers and facilitators to adoption of improved work practices for safety in the primary industries

[Extract] High rates of work-related injury and illness within Australia's primary industries demonstrate that the creation of safe work environments remains a significant problem. There are many Work Health and Safety (WHS) programs designed to improve outcomes on farming and fishing enterprises; however, it appears that these programs are underutilised by those in the primary industries sector. The Primary Industries Health and Safety Partnership (PIHSP), as part of the Rural Industries Research and Development Corporation (RIRDC), have been working to improve the health and safety of Australia's farming and fishing communities. This project aims to explore the barriers to adoption of improved work health and safety (WHS) practices and develop a strategy to address these barriers which would lead to a reduction in workplace injuries and illness. The objectives of this project are targeted at primary industries (with focus on Cotton, Fisheries, Grains, Sugar, Meat and Livestock and Meat Processing)

Exploring the barriers and facilitators to adoption of improved work practices for safety in the primary industries

[Extract] High rates of work-related injury and illness within Australia's primary industries demonstrate that the creation of safe work environments remains a significant problem. There are many Work Health and Safety (WHS) programs designed to improve outcomes on farming and fishing enterprises; however, it appears that these programs are underutilised by those in the primary industries sector. The Primary Industries Health and Safety Partnership (PIHSP), as part of the Rural Industries Research and Development Corporation (RIRDC), have been working to improve the health and safety of Australia's farming and fishing communities. This project aims to explore the barriers to adoption of improved work health and safety (WHS) practices and develop a strategy to address these barriers which would lead to a reduction in workplace injuries and illness. The objectives of this project are targeted at primary industries (with focus on Cotton, Fisheries, Grains, Sugar, Meat and Livestock and Meat Processing)

Queensland agriculture, forestry and fishing Work Health and Safety prosecutions: repercussions

Context: Agriculture, forestry and fishing industries are among the most dangerous industries in which to work, in Australia and internationally. Australia and its states & territories have robust work health and safety regulation, enforcement and prosecution systems outlined via Work Health and Safety(WHS) Acts (and Regulations), in Queensland the new regulations came into effect in 2011. The acts require employers to provide a safe place of work, to protect workers (via procedures and other mechanisms) and to train workers in matters relating to WHS. Process: In Queensland, details of WHS and electrical safety law breaches, against which a prosecution and conviction have occurred, are made publicly available. Analysis: A review of the agriculture, forestry and fishing prosecutions in this public registry was performed focused on incident type, industry and outcomes. Suggestions for system related improvements are outlined. Outcomes: Since 2014 (at 27 February 2020), 33 prosecutions have been successfully brought against defendants of which a third were due to a death. Penalty costs ranged from $5k to$400k. The common injuries from the incidents included amputation, fractures and crush injuries. Prevention options will be discussed. Learning Outcomes: The public register exists to serve as a deterrent to others, concurrently discouraging non-compliance and promoting improvements in safety practices and systems. A key consideration when trying to promote safety practice and system improvements is to create meaningful change, whilst also balancing the onerous nature of change. This is particularly pertinent as many agriculture-related ventures in Queensland are small to medium sized enterprises

Protocol: a comprehensive systematic review of alternatives to prospective informed consent in paediatric emergency research

There is a community expectation that children presenting to emergency departments receive the best possible care, and that decisions are based on high-level evidence. Clinical research in children is necessary for paediatric emergency medicine to continue to advance, but research in emergency settings is challenging. One of the many challenges researchers face in conducting emergency research is the difficulty of obtaining prospective informed consent in ED research, and this has historically been a barrier to conducting research in this setting. Guiding principles for use of alternatives to prospective informed consent in emergency research are outlined in the Declaration of Helsinki and in local documents such as the NHMRC National Statement on Ethical Conduct in Human Research which allows consent to occur after an intervention in certain circumstances. To ensure that ethical research can continue to be performed in this group, within the expatiations of the community, it is important to explore and understand the perceptions and experiences of parents, health care workers and researchers to alternatives to informed consent in paediatric emergency research