Extending and validating a human papillomavirus (HPV) knowledge measure in a national sample of Canadian parents of boys

As the human papillomavirus (HPV) vaccine is now recommended for males, a reliable, comprehensive HPV knowledge measurement tool which addresses issues relevant to males is needed. We aimed to replicate, validate and test the comprehensiveness of an existing general HPV and an HPV vaccination knowledge scale in English and French. We also measured parental HPV knowledge and changes over time. An online questionnaire was administered in February (Time 1; T1) and November 2014 (Time 2; T2) to a nationally representative sample of Canadian parents of boys. Dimensionality, internal consistency and model fit were evaluated at both time points and separately in English and French sub-samples. Differences in knowledge scores were measured. Analyses were performed on 3117 participants at T1 and 1427 at T2. The 25-item HPV general knowledge and an 11-item HPV vaccination scale were unidimensional, showed high internal consistency (α>0.87, α>0.73) and had good model fit. Both general HPV and vaccine-specific knowledge significantly increased over time in both languages, but remained low at T2, with only about half of the items being answered correctly. Correct responses at T2 are best explained by correct responses at T1, with some small changes from 'Don't know' at T1 to correct at T2. The extended general and vaccine-specific knowledge scales are valid, reliable and comprehensive, and could be used among parents of boys, in both English and French. Educational interventions could target specific knowledge gaps and focus on providing information rather than correcting misconceptions

Virtual discussions to support climate risk decision making on farms

Climate variability represents a significant risk to farming enterprises. Effective extension of climate information may improve climate risk decision making and adaptive management responses to climate variability on farms. This paper briefly reviews current agricultural extension approaches and reports stakeholder responses to new web-based virtual world ‘discussion-support’ tools developed for the Australian sugar cane farming industry. These tools incorporate current climate science and sugar industry better management practices, while leveraging the social-learning aspects of farming, to provide a stimulus for discussion and climate risk decision making. Responses suggest that such virtual world tools may provide effective support for climate risk decision making on Australian sugar cane farms. Increasing capacity to deliver such tools online also suggests potential to engage large numbers of farmers globally

Common mental disorders among Indigenous people living in regional, remote and metropolitan Australia: a cross-sectional study

Objective: To determine, using face-to-face diagnostic interviews, the prevalence of common mental disorders (CMD) in a cohort of adult Indigenous Australians, the cultural acceptability of the interviews, the rates of comorbid CMD and concordance with psychiatrists’ diagnoses. Design: Cross-sectional study July 2014–November 2016. Psychologists conducted Structured Clinical Interviews for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision Axis I Disorders (SCID-I) (n=544). Psychiatrists interviewed a subsample (n=78). Setting: Four Aboriginal Medical Services and the general community located in urban, regional and remote areas of Southern Queensland and two Aboriginal Reserves located in New South Wales. Participants: Indigenous Australian adults. Outcome measures: Cultural acceptability of SCID-I interviews, standardised rates of CMD, comorbid CMD and concordance with psychiatrist diagnoses. Results: Participants reported that the SCID-I interviews were generally culturally acceptable. Standardised rates (95% CI) of current mood, anxiety, substance use and any mental disorder were 16.2% (12.2% to 20.2%), 29.2% (24.2% to 34.1%), 12.4% (8.8% to 16.1%) and 42.2% (38.8% to 47.7%), respectively—6.7-fold, 3.8-fold, 6.9- fold and 4.2-fold higher, respectively, than those of the Australian population. Differences between this Indigenous cohort and the Australian population were less marked for 12-month (2.4-fold) and lifetime prevalence (1.3-fold). Comorbid mental disorder was threefold to fourfold higher. In subgroups living on traditional lands in Indigenous reserves and in remote areas, the rate was half that of those living in mainstream communities. Moderate-to- good concordance with psychiatrist diagnoses was found. Conclusions: The prevalence of current CMD in this Indigenous population is substantially higher than previous estimates. The lower relative rates of non-current disorders are consistent with underdiagnosis of previous events. The lower rates among Reserve and remote area residents point to the importance of Indigenous peoples’ connection to their traditional lands and culture, and a potentially important protective factor. A larger study with random sampling is required to determine the population prevalence of CMD in Indigenous Australians

Can digital discussion support tools provide cost-effective options for agricultural extension services?

Agricultural extension that delivers timely, targeted, and cost-effective support to farmers will help ensure the sustainability and adaptive capacity of agriculture, enhancing both food security and environmental security. Leveraging advances in agriclimate science and adult education, innovative digital technologies offer significant new opportunities to engage with farmers and to support decision making. In this study, animated video clips (machinimas), developed using the Second LifeTM virtual world gaming platform, model conversations around climate risk and critical on-farm decisions in the Australian sugarcane farming industry. Early evaluation indicates that this is an engaging format that promotes discussion by leveraging farmers’ natural modes of information gathering and social learning. Comparison with conventional extension practices indicates that these discussion support tools may be a cost effective addition to existing approaches. The format’s flexibility means machinimas are readily updated with new information and customized to meet the needs of different farmer groups. Rapid growth in digital access globally and the scalability of such approaches promise greater equity of access to high-value information, critical to better risk management decision making, at minimal cost, for millions of farmers

The association of health literacy with adherence in older 2 adults, and its role in interventions: a systematic meta-review

Background: Low health literacy is a common problem among older adults. It is often suggested to be associated with poor adherence. This suggested association implies a need for effective adherence interventions in low health literate people. However, previous reviews show mixed results on the association between low health literacy and poor adherence. A systematic meta-review of systematic reviews was conducted to study the association between health literacy and adherence in adults above the age of 50. Evidence for the effectiveness of adherence interventions among adults in this older age group with low health literacy was also explored. Methods: Eight electronic databases (MEDLINE, ERIC, EMBASE, PsycINFO, CINAHL, DARE, the Cochrane Library, and Web of Knowledge) were searched using a variety of keywords regarding health literacy and adherence. Additionally, references of identified articles were checked. Systematic reviews were included if they assessed the association between health literacy and adherence or evaluated the effectiveness of interventions to improve adherence in adults with low health literacy. The AMSTAR tool was used to assess the quality of the included reviews. The selection procedure, data-extraction, and quality assessment were performed by two independent reviewers. Seventeen reviews were selected for inclusion. Results: Reviews varied widely in quality. Both reviews of high and low quality found only weak or mixed associations between health literacy and adherence among older adults. Reviews report on seven studies that assess the effectiveness of adherence interventions among low health literate older adults. The results suggest that some adherence interventions are effective for this group. The interventions described in the reviews focused mainly on education and on lowering the health literacy demands of adherence instructions. No conclusions could be drawn about which type of intervention could be most beneficial for this population. Conclusions: Evidence on the association between health literacy and adherence in older adults is relatively weak. Adherence interventions are potentially effective for the vulnerable population of older adults with low levels of health literacy, but the evidence on this topic is limited. Further research is needed on the association between health literacy and general health behavior, and on the effectiveness of interventions

The Development of Virtual World Tools to Enhance Learning and Real World Decision Making in the Australian Sugar Farming Industry

In farming, the outcome of critical decisions to enhance productivity and profitability and so ensure the viability of farming enterprises is often influenced by seasonal conditions and weather events over the growing season. This paper reports on a project that uses cutting-edge advances in digital technologies and their application in learning environments to develop and evaluate a web-based virtual ‘discussion-support’ system for improved climate risk management in Australian sugar farming systems. Customized scripted video clips (machinima) are created in the Second Life virtual world environment. The videos use contextualized settings and lifelike avatar actors to model conversations about climate risk and key farm operational decisions relevant to the real-world lives and practices of sugarcane farmers. The tools generate new cognitive schema for farmers to access and provide stimuli for discussions around how to incorporate an understanding of climate risk into operational decision-making. They also have potential to provide cost-effective agricultural extension which simulates real world face-to-face extension services but is accessible anytime anywhere

Virtual Discussions to Support Climate Risk Decision Making on Farms

Climate variability represents a significant risk to farming enterprises. Effective extension of climate information may improve climate risk decision making and adaptive management responses to climate variability on farms. This paper briefly reviews current agricultural extension approaches and reports stakeholder responses to new web-based virtual world ‘discussion-support’ tools developed for the Australian sugar cane farming industry. These tools incorporate current climate science and sugar industry better management practices, while leveraging the social-learning aspects of farming, to provide a stimulus for discussion and climate risk decision making. Responses suggest that such virtual world tools may provide effective support for climate risk decision making on Australian sugar cane farms. Increasing capacity to deliver such tools online also suggests potential to engage large numbers of farmers globally

An audit and feedback intervention for reducing antibiotic prescribing in general dental practice:the RAPiD Cluster Randomised Controlled Trial

Acknowledgments: We thank the TRiaDS Research Methodology Group, including Irene Black, Debbie Bonetti, Heather Cassie, Martin Eccles, Sandra Eldridge, Jill J. Francis, Jeremy M. Grimshaw, Lorna Macpherson, Lorna McKee, Susan Michie, Nigel Pitts, Derek Richards, Douglas Stirling, Colin Tilley, Carole Torgerson, Shaun Treweek, Luke Vale, and Alan Walker for their guidance and contribution to the design and development of the study. We also thank Maria Prior for overseeing the running of the study, drafting of the published protocol, and her contribution to the design and analysis of the process evaluation. Thanks are also extended to Jill Farnham, Jenny Eades, Sarah Blackburn, and Lorna Barnsley for providing invaluable administrative support for this study. The views expressed in this article are those of the authors and may not reflect those of the funder. Funding: This study was conducted as part of the TRiaDS programme of implementation research which is funded by NHS Education for Scotland (NES). The Health Services Research Unit which is funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates supported the study. The funder had no influence over the design, conduct, analysis and write up of the study. Data Availability: Researchers can request to access the data from the Information Services Division of NHS National Services Scotland http://www.isdscotland.org/. Some restrictions may apply for the protection of privacy and appropriate usage of the data.Peer reviewedPublisher PD

Common mental disorders among Indigenous people living in regional, remote and metropolitan Australia: a cross-sectional study

Objective To determine, using face-to-face diagnostic interviews, the prevalence of common mental disorders (CMD) in a cohort of adult Indigenous Australians, the cultural acceptability of the interviews, the rates of comorbid CMD and concordance with psychiatrists' diagnoses. Design Cross-sectional study July 2014–November 2016. Psychologists conducted Structured Clinical Interviews for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision Axis I Disorders (SCID-I) (n=544). Psychiatrists interviewed a subsample (n=78). Setting Four Aboriginal Medical Services and the general community located in urban, regional and remote areas of Southern Queensland and two Aboriginal Reserves located in New South Wales. Participants Indigenous Australian adults. Outcome measures Cultural acceptability of SCID-I interviews, standardised rates of CMD, comorbid CMD and concordance with psychiatrist diagnoses. Results Participants reported that the SCID-I interviews were generally culturally acceptable. Standardised rates (95% CI) of current mood, anxiety, substance use and any mental disorder were 16.2% (12.2% to 20.2%), 29.2% (24.2% to 34.1%), 12.4% (8.8% to 16.1%) and 42.2% (38.8% to 47.7%), respectively—6.7-fold, 3.8-fold, 6.9-fold and 4.2-fold higher, respectively, than those of the Australian population. Differences between this Indigenous cohort and the Australian population were less marked for 12-month (2.4-fold) and lifetime prevalence (1.3-fold). Comorbid mental disorder was threefold to fourfold higher. In subgroups living on traditional lands in Indigenous reserves and in remote areas, the rate was half that of those living in mainstream communities. Moderate-to-good concordance with psychiatrist diagnoses was found. Conclusions The prevalence of current CMD in this Indigenous population is substantially higher than previous estimates. The lower relative rates of non-current disorders are consistent with underdiagnosis of previous events. The lower rates among Reserve and remote area residents point to the importance of Indigenous peoples' connection to their traditional lands and culture, and a potentially important protective factor. A larger study with random sampling is required to determine the population prevalence of CMD in Indigenous Australians

The Imperforate Anus Psychosocial Questionnaire (IAPSQ): Its construction and psychometric properties

The origin of the present study was to develop the liaison work between the disciplines of child and adolescent psychiatry and paediatric surgery and nursing, so as to improve the quality of treatment and care of a group of children with imperforate anus (IA) and their families. Imperforate anus is a congenital disease involving a deformity of the anorectum. The early surgery and invasive follow-up treatment associated with IA may affect the child psychosocially, including the child-parent relationship. By developing and testing a questionnaire for children born with anorectal anomalies, a tool for measuring psychosocial functioning can be realized