Experiencing integration: A pilot study of consumer and provider experiences of integrated primary health care

This study will provide important insights into if and how integrated primary health care works from the perspectives of both consumers and providers. It will pilot test methods of qualitative and quantitative research into consumer experiences of integrated primary health care in a single-site health care service.The research reported in this paper is a project of the Australian Primary Health Care Research Institute which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research Evaluation and Development Strategy

Experiencing integration: a qualitative pilot study of consumer and provider experiences of integrated primary health care in Australia

Background The terms integration and integrated care describe the complex, patient-centred strategies to improve coordination of healthcare services. Frameworks exist to conceptualise these terms, but these have been developed from a professional viewpoint. The objective of this study was to explore consumers’ and providers’ concepts, expectations and experience of integrated care. A key focus was whether frameworks developed from a professional perspective are effective models to explore people’s experiences. Methods A qualitative pilot study was undertaken at one Australian multidisciplinary primary health care centre. Semi-structured interviews were conducted with consumers (N = 19) and staff (N = 10). Data were analysed using a framework analysis approach. Results Consumers’ experience of integrated care tended to be implicit in their descriptions of primary healthcare experiences more broadly. Experiences related to the typologies involved clinical and functional integration, such as continuity of providers and the usefulness of shared information. Staff focused on clinical level integration, but also talked about a cultural shift that demonstrated normative, professional and functional integration. Conclusions Existing frameworks for integration have been heavily influenced by the provider and organisational perspectives. They are useful for conceptualising integration from a professional perspective, but are less relevant for consumers’ experiences. Consumers of integrated primary health care may be more focussed on relational aspects of care and outcomes of care.This research is a project of the Australian Primary Health Care Research Institute, which is supported by a grant from the Australian Government Department of Health. The information and opinions contained in it do not necessarily reflect the views or policy of the Australian Primary Health Care Research Institute or the Australian Government Department of Health. MB is supported by Australian Research Council Discovery Early Career Researcher Award (DE150100637

Sodium Oxybate-Induced Sleep Driving and Sleep-Related Eating Disorder

Hypnosedative-induced complex behaviors have gained increased attention in recent years as a potential complication of benzodiazepines and benzodiazepine-receptor agonist use. Sodium oxybate (SO), the sodium salt of γ-hydroxybutyrate, an inhibitory neurotransmitter, has been associated with dose-dependent rates of somnambulism; however, there is limited information about complex motor behaviors with SO. We describe a patient with narcolepsy-cataplexy who experienced one episode of sleep-driving and at least two sleep-related eating episodes with therapeutic doses of SO

What motivates Australian health service users with chronic illness to engage in self-management behaviour?

Context Health policy in Australia emphasizes the role of health service users (HSU) in managing their own care but does not include mechanisms to assist HSUs to do so. Objective To describe motivation towards or away from self-management in a diverse group of older Australians with diabetes, chronic heart failure (CHF) or chronic obstructive pulmonary disease (COPD) and suggest policy interventions to increase patient motivation to manage effectively. Design Content and thematic analyses of in-depth semi-structured interviews. Participants were asked to describe their experience of having chronic illness, including experiences with health professionals and health services. Secondary analysis was undertaken to expose descriptions of self-management behaviours and their corresponding motivational factors. Participants Health service users with diabetes, COPD and/or CHF (N=52). Results Participant descriptions exposed internal and external sources of motivation. Internal motivation was most often framed positively in terms of the desire to optimize health, independence and wellness and negatively in terms of avoiding the loss of those attributes. External motivation commonly arose from interactions with family, carers and health professionals. Different motivators appeared to work simultaneously and interactively in individuals, and some motivators seemed to be both positive and negative drivers. Conclusion Successful management of chronic illness requires recognition that the driving forces behind motivation are interconnected. In particular, the significance of family as an external source of motivation suggests a need for increased investment in the knowledge and skill building of family members who contribute to care

The Coping Strategies Assessment Tool (CSAT).pdf

The Coping Strategies Assessment Tool (C-SAT) is a re-development of the novel Distance Affect Regulation Mapping Tool (DARM; Wilkinson & Rowe, 2016). The tool is used to quantify the structure of one’s profile of affect regulation strategies, by identifying the content and size of one’s profile as well as the interacting relationships between the different affect regulation strategies.The development of the CSAT was co-produced through the involvement of lay people, clinical groups, healthcare professionals, and academics and researchers, who recommended improvements to the language, appearance, usability, and accessibility of the tool. The CSAT was subsequently assessed and found to be both a reliable and valid measure.</p

Adult attachment anxiety is associated with night eating syndrome in UK and UK-based samples: Two cross-sectional studies

Previous research has shown that “attachment anxiety” is a robust predictor of disinhibited eating behaviours and that this relationship is underpinned by difficulties in managing emotion. Night eating syndrome (NES), a proposed eating disorder characterized by evening hyperphagia, nocturnal awakenings to eat, and morning anorexia, is also associated with eating to manage emotion. Across two studies (N = 276 & N = 486), we considered a relationship between attachment anxiety and NES. In Study 1, we hypothesised (pre-registered) that attachment anxiety would predict NES score and that this relationship would be mediated by disinhibited eating. Participants were asked to complete questionnaire measures of attachment orientation, disinhibited eating (emotional and uncontrolled eating) and NES. Our parallel mediation model confirmed a direct relationship between attachment anxiety and NES (p < .001) and showed an indirect path via both emotional (95% CI: 0.15–0.63) and uncontrolled eating (95% CI: 0.001–0.36). In Study 2, we showed that fear of negative evaluation of eating significantly mediated a reversed relationship between attachment anxiety and NES (95% CI: 0.02–0.04). Finally, across both studies we used a novel tool to assess “eating to cope”. We showed a relationship with emotional eating but failed to show a robust relationship with NES. Attachment orientation may represent a potential intervention target for night eating syndrome. Future research should consider a longitudinal approach to strengthen our understanding of directionality amongst these factors

The Influence of Psychosocial Maturity on Adolescent Offenders\u27 Delinquent Behavior

Prior research has demonstrated the predictive utility of psychosocial maturity in understanding adolescents\u27 decison making regarding antisocial behaviors and other legal decisions. This study investigated the influence of psychosocial maturity on adolescent offenders\u27 self-report of delinquent behaviors over a 12-month time period. A total sample of 136 male and female juvenile offenders were recruited from two juvenile justice settings. Consistent with prior research, results indicated significant correlations between psychosocial maturity variables and self-reported delinquent behavior with the current results revealing a moderating effect of gender on these associations. Separate regression analyses were conducted for male and female juvenile offenders. After controlling for age and setting, the psychosocial maturity variable of temperance consistently predicted self-reported total, violent, and nonviolent delinquency for boys

Diet and Acanthosis Nigricans over a Two-Year Period in Children of the Pacific Region

Background: The impact that dietary carbohydrates have on children developing type 2 diabetes remains controversial. Furthermore, there are limited pediatric longitudinal studies on changes in body mass index (BMI) and diet related to the development of acanthosis nigricans (AN), a risk factor associated with type 2 diabetes. Methods: Two 24 h dietary records were collected for 558 children, 2–8 years of age, at baseline and at a 2-year follow-up. Data on age, sex, BMI, and the presence of AN were also collected at each time point from the Children’s Healthy Living Program. Logistic regression was used to determine factors associated with the presence of AN at follow-up. Multinominal regression was used to determine factors associated with changes in AN status. Linear regression was used to measure the associations between changes in dietary intake and in the Burke Score for AN. Results: AN was present in 28 children at baseline and 34 children at follow-up. Adjusting for the presence of AN at baseline, age, sex, study group, baseline BMI, change in BMI z-score, time between assessments, and baseline intake, an increase from baseline for each teaspoon of sugar and serving of carbohydrate-rich food increased the risk for having AN at follow-up by 9% and 8%, respectively (p ≤ 0.05). An increased intake of added sugar (teaspoons) increased the risk of developing AN by 13% (p ≤ 0.01) and an increase in servings of foods rich in starch increased the risk of developing AN by 12% (p ≤ 0.01) compared to children who never had AN. Increasing the intake of fruit was also associated with decreased Burke Scores using multiple regression. However, the intake of energy and macronutrients were not associated with AN. Conclusions: Added sugar and foods rich in starch were independently associated with the occurrence of AN, suggesting the type of carbohydrates consumed is a factor in AN occurrence