Enhancing research quality and reporting: why the Journal of Comorbidity is now publishing study protocols

The Journal of Comorbidity was launched in 2011 and has since become established as a high-quality journal that publishes open-access, peer-reviewed articles, with a focus on advancing the clinical management of patients with comorbidity/multimorbidity. To further enhance research quality and reporting of studies in this field, the journal is now offering authors the opportunity to publish a summary of their study protocols – a move designed to generate interest and raise awareness in ongoing clinical research and to enable researchers to detail their methodologies in order that replication by scientific peers is possible

What needs to change to increase chlamydia screening in general practice in Australia? The views of general practitioners

<p>Abstract</p> <p>Background</p> <p>Australia is considering implementing a chlamydia screening program in general practice. The views of general practitioners (GPs) are necessary to inform the design of the program. This paper aimed to investigate Australian GPs' views on how chlamydia screening could work in the Australian context.</p> <p>Methods</p> <p>This project used both qualitative interviews and a quantitative questionnaire. GPs were randomly selected from a national database of medical practitioners for both the qualitative and quantitative components. Semi-structured interviews were conducted with GPs and a thematic analysis conducted. The results of the interviews were used to design a quantitative postal questionnaire for completion by a larger sample of GPs. Up to three reminders were sent to non-responders.</p> <p>Results</p> <p>Twenty one GPs completed an interview and 255 completed the postal questionnaire. The results of the postal survey were in strong concordance with those of the interview. GPs identified a number of barriers to increased screening including lack of time, knowledge of GPs and the public about chlamydia, patient embarrassment and support for partner notification. GPs felt strongly that screening would be easier if there was a national program and if the public and GPs had a greater knowledge about chlamydia. Incentive payments and mechanisms for recall and reminders would facilitate screening. Greater support for contact tracing would be important if screening is to increase.</p> <p>Conclusion</p> <p>Chlamydia screening in general practice is acceptable to Australian GPs. If screening is to succeed, policy makers must consider the facilitators identified by GPs.</p

Take the sex out of STI screening! Views of young women on implementing chlamydia screening in General Practice

<p>Abstract</p> <p>Background</p> <p>Australia is developing a chlamydia screening program. This study aimed to determine the attitudes of young women to the introduction of chlamydia screening in Australian General Practice.</p> <p>Methods</p> <p>In-depth face-to-face interviews with 24 young women from across Victoria, Australia, attending a randomly selected sample of general practices.</p> <p>Results</p> <p>Young women reported that they would accept age-based screening for chlamydia in general practice, during both sexual-health and non-sexual-health related consultations. Trust in their general practitioner (GP) was reported to be a major factor in the acceptability of chlamydia screening. The women felt chlamydia screening should be offered to <it>all </it>young women rather than targeted at "high risk" women based on sexual history and they particularly emphasised the importance of normalising chlamydia screening. The women reported that they did not want to be asked to provide a sexual history as part of being asked to have a chlamydia test. Some reported that they would lie if asked how many partners they had had</p> <p>Conclusion</p> <p>Women do not want a sexual history taken when being asked to have a chlamydia test while attending a general practitioner. They prefer the offer of chlamydia screening to be based on age rather than assessment of sexual risk. Chlamydia screening needs to be normalised and destigmatised.</p

First-Year Maternal Employment and Child Outcomes: Differences Across Racial and Ethnic Groups

We use data from the Fragile Families and Child Wellbeing Study to examine associations between first-year maternal employment and child outcomes for 3-year-old white, Black, and Hispanic children. We find that first-year maternal employment is associated with lower vocabulary scores for white, but not Black or Hispanic, children and with elevated levels of aggressive behavior problems for Hispanic, but not white or Black, children. Factors such as the timing and intensity of employment, family structure, and maternal education sometimes moderate these associations, but do not explain differences across racial and ethnic groups. Child care and parenting behaviors do not appear to mediate associations between first-year maternal employment and children’s outcomes and cannot explain racial and ethnic differences in these associations.

Challenging the status quo : results of an acceptability and feasibility study of hypertensive disorders of pregnancy (HDP) management pathways in Indonesian primary care

Background: Hypertensive disorders of pregnancy (HDP) are the leading cause of maternal mortality in Indonesia. Focused HDP management pathways for Indonesian primary care practice have been developed from a consensus development process. However, the acceptability and feasibility of the pathways in practice have not been explored. This study reports on the implementation process of the pathways to determine their acceptability and feasibility in Indonesian practice. Methods: The pathways were implemented in three public primary care clinics (Puskesmas) in Yogyakarta province for a month, guided by implementation science frameworks of Medical Research Council (MRC) and the Practical Robust Implementation and Sustainability Model (PRISM). The participating providers (general practitioners (GPs), midwives, and nurses) were asked to use recommendations in the pathways for a month. The pathway implementation evaluations were then conducted using clinical audits and a triangulation of observations, focus groups (FGs), and interviews with all of the participants. Clinical audit data were analysed descriptively, and qualitative data were analysed using a mix of the inductive-deductive approach of thematic analysis. Results: A total of 50 primary care providers, four obstetricians, a maternal division officer in the local health office and 61 patients agreed to participate, and 48 of the recruited participants participated in evaluation FGs or interviews. All of the providers in the Puskesmas attempted to apply recommendations from the pathways to various degrees, mainly adopting preeclampsia risk factor screenings and HDP monitoring. The participants expressed that the recommendations empowered their practice when it came to HDP management. However, their practices were challenged by professional boundaries and hierarchical barriers among health care professionals, limited clinical resources, and regulations from the local health office. Suggestions for future scale-up studies were also mentioned, such as involving champion obstetricians and providing more patient education toolkits. Conclusion: The HDP management pathways are acceptable and feasible in Indonesian primary care. A further scale-up study is desired and can be initiated with investigations to minimise the implementation challenges and enhance the pathways’ value in primary care practice

The Journal of Comorbidity affiliates with the Society for Academic Primary Care

No abstract available

Embedding effective depression care: using theory for primary care organisational and systems change

Background: depression and related disorders represent a significant part of general practitioners (GPs) daily work. Implementing the evidence about what works for depression care into routine practice presents a challenge for researchers and service designers. The emerging consensus is that the transfer of efficacious interventions into routine practice is strongly linked to how well the interventions are based upon theory and take into account the contextual factors of the setting into which they are to be transferred. We set out to develop a conceptual framework to guide change and the implementation of best practice depression care in the primary care setting.Methods: we used a mixed method, observational approach to gather data about routine depression care in a range of primary care settings via: audit of electronic health records; observation of routine clinical care; and structured, facilitated whole of organisation meetings. Audit data were summarised using simple descriptive statistics. Observational data were collected using field notes. Organisational meetings were audio taped and transcribed. All the data sets were grouped, by organisation, and considered as a whole case. Normalisation Process Theory (NPT) was identified as an analytical theory to guide the conceptual framework development.Results: five privately owned primary care organisations (general practices) and one community health centre took part over the course of 18 months. We successfully developed a conceptual framework for implementing an effective model of depression care based on the four constructs of NPT: coherence, which proposes that depression work requires the conceptualisation of boundaries of who is depressed and who is not depressed and techniques for dealing with diffuseness; cognitive participation, which proposes that depression work requires engagement with a shared set of techniques that deal with depression as a health problem; collective action, which proposes that agreement is reached about how care is organised; and reflexive monitoring, which proposes that depression work requires agreement about how depression work will be monitored at the patient and practice level. We describe how these constructs can be used to guide the design and implementation of effective depression care in a way that can take account of contextual differences.Conclusions: ideas about what is required for an effective model and system of depression care in primary care need to be accompanied by theoretically informed frameworks that consider how these can be implemented. The conceptual framework we have presented can be used to guide organisational and system change to develop common language around each construct between policy makers, service users, professionals, and researchers. This shared understanding across groups is fundamental to the effective implementation of change in primary care for depressio

First-year maternal employment and child outcomes: Differences across racial and ethnic groups

We use data from the Fragile Families and Child Wellbeing Study to examine associations between first-year maternal employment and child outcomes for 3-year-old White, Black, and Hispanic children (N = 1483). Results from OLS regressions and propensity score matching models indicate that first-year maternal employment is associated with lower vocabulary scores for White, but not Black or Hispanic, children and with elevated levels of behavior problems for Hispanic, but not White or Black, children. Factors such as type of child care, maternal depressive symptoms and stress, and parenting behaviors (including measures of discipline, nurturance, and provision of cognitively stimulating materials) do not mediate these associations between first-year maternal employment and children's outcomes or explain the differential associations across racial and ethnic groups, suggesting the need to look at other explanations for these associations, as well as the need for better measurement of parenting, especially mother–child interaction

The influence of socioeconomic deprivation on multimorbidity at different ages:a cross-sectional study

Multimorbidity occurs at a younger age in individuals in areas of high socioeconomic deprivation but little is known about the 'typology' of multimorbidity in different age groups and its association with socioeconomic status

Hierarchical variation in phenotypic flexibility across timescales and associated survival selection shape the dynamics of partial seasonal migration

We thank everyone from UK Centre for Ecology & Hydrology and University of Aberdeen (UoA) who contributed to data collection, particularly Hannah Grist and Jenny Sturgeon; NatureScot for access to the Isle of May National Nature Reserve; Scottish Ornithologists' Club (SOC) for their support; and all volunteer observers, particularly Raymond Duncan and Moray Souter. This work was funded by Natural Environment Research Council (NERC; award NE/R000859/1 and award NE/R016429/1 as part of the UK-SCaPE programme delivering National Capability), Norwegian Research Council (SFF-III grant 223257), NTNU, UK Royal Society, Marine Alliance for Science and Technology for Scotland (MASTS), SOC and UoA.Peer reviewedPostprin