Education programs for Indigenous Australians about sexually transmitted infections and bloodborne viruses

As a group, Indigenous Australians experience poorer health outcomes than other Australians, including in the area of sexual health. Indigenous Australians have substantially higher rates of STIs, BBVs and teen pregnancy than non-Indigenous Australians, particularly for chlamydia, gonorrhoea, infectious syphilis, hepatitis B and hepatitis C. Efforts to reduce these high rates are compounded by the historical and social context of Indigenous Australians. Although many Australians may experience elements of shame and embarrassment when they access health services for STIs and BBVs, for many Indigenous Australians there also exists a mistrust of ‘mainstream’ (non-Indigenous specific) health services as a result of past injustices and racially differentiated treatment (Arabena 2006). Historically, Indigenous Australians diagnosed with an STI were segregated and placed into privately run hospitals (‘lock hospitals’) that were in poor condition (Hunter 1998)

Improving the health and wellbeing of Aboriginal and Torres Strait Islander children in Australia

I completed my Masters of Applied Epidemiology during 2017-18 with the NHMRC funded Centre for Research Excellence in Improving Health Services for Aboriginal and Torres Strait Islander Children (CRE ISAC) located at the University of Western Australia. My projects focussed mostly on social epidemiology, with the exception of my outbreak. Chapter two provides a case-control study of a point source outbreak of Salmonella Typhimurium, which occurred at a university residential college in April 2018. Epidemiological and environmental investigation identified the most likely source of the outbreak to be raw eggs used in coleslaw. Public health action was the provision of information on the safe handling of eggs to prevent further outbreaks. Chapter three, public health data analysis, was a population-based birth cohort study using linked datasets with information on a cohort of Aboriginal and Torres Strait Islander children, and their mothers and siblings. The 2009 and 2012 Australian Early Development Census was used to assess developmental vulnerability across five domains of development in Aboriginal children born in Western Australia. Latent class analysis was used identify and describe profiles of risk for developmental vulnerability. Six distinct classes were identified. My surveillance project, provided in chapter four, was the evaluation of the Western Australian population based data linkage Intellectual Disability Exploring Answers (IDEA) surveillance system. I evaluated the usefulness, simplicity, flexibility, data quality, acceptability, representativeness, timeliness, and stability of the IDEA system. This was completed by process observation, semi-structured interviews and data analysis. The IDEA system has successfully been used to understand prevalence rates and inform resource allocation. Advocacy organisations could play an important role in the sustainability of the system. Additional variables or enhanced surveillance for functional capacity could strengthen the system and provide information for people living with intellectual disability and their families. Chapter five is my epidemiology project which was a cross-sectional study of 1554 clinical child health audits and associated systems assessments from 74 primary care services from 2012-2014. Composite process of care indicators (PoCIs) were developed for social and emotional wellbeing, child neurodevelopment and anaemia. Crude and adjusted logistic regression models were fitted clustering for health services. 32.0% (449) of records had a social and emotional wellbeing PoCI, 56.6% (791) had an anaemia PoCI and 49.3% (430) had a child neurodevelopment PoCI. The study found that the need for young Indigenous children aged 24-59 months to receive quality care for important social and health indicators should be a priority. Processes of care and organisational systems within primary care services are important for the optimal management of anaemia in Indigenous children. The final chapter concludes with my lessons from the field. This provided me with an opportunity to deliver a count regression teaching opportunity to my peers

Evidence for global health care interventions for preterm or low birth weight infants: An overview of systematic reviews

Contex: Twenty-four research questions (framed as population, intervention, comparator, and outcomes) for global health care interventions for preterm and low birth weight (LBW) infants were identified at a World Health Organization guideline development group expert meeting in December 2020. Objective: To describe which systematic reviews had addressed these research questions in the last 3 years. Data sources: Medline (Ovid); the Cochrane Database of Systematic Reviews; the Cochrane Database of Systematic Review Protocols; and the PROSPERO International prospective register of systematic reviews databases from January 1, 2019 to December 31, 2021 were used.Randomized controlled trials or observational studies. Two reviewers independently extracted data. Results: We found 9 systematic reviews. Eight reviews of 121 studies and 25 465 preterm or LBW infants published in the last 36 months fully addressed 8 of our 24 research questions (donor human milk, multicomponent fortifier, formula milk, probiotics, emollients, continuous positive airways pressure [CPAP] any, CPAP early, CPAP prophylactic); and 1 systematic review found no trials (mother\u27s own milk). All received a high AMSTAR quality rating. Fifteen research questions (kangaroo mother care, early initiation, responsive feeding, advancement, exclusive breastfeeding duration, iron, zinc, vitamin D, vitamin A, calcium and phosphorous, multiple micronutrients, CPAP pressure source, methyl xanthines, family involvement, and family support) had no systematic review. Limitations include that we restricted our search to those interventions identified as a priority at a World Health Organization scoping meeting. Other interventions that may be of importance to preterm or LBW infants were not able to be considered. Conclusions: Almost a third of our research questions were addressed by high quality systematic reviews. We found gaps in thermal care, feeding, and familysupport interventions, which need to be addressed

Explaining adults’ mental health help-seeking through the lens of the theory of planned behavior: A scoping review

Background: Despite evidence-based efficacy, mental health services are underutilized due to low rates of help-seeking, leaving unmet mental health needs a global concern. The Theory of Planned Behavior (TPB) has been applied to understand the help-seeking process and in the development of behavior change interventions. The aim of this scoping review was to map the literature on the TPB as applied to mental health help-seeking in adults aged \u3e 18 years. Methods: This scoping review was conducted based on the methodology presented by Arksey and O’Malley (2005). Six databases (CINAHL, PsycINFO, MEDLINE, ProQuest Health and Medicine, ProQuest Dissertations and Theses, Web of Science) and two grey literature sources (OpenGrey, Google Scholar) were systematically searched in February 2018 and updated in March 2020. Studies that explicitly discussed the TPB in the context of mental health help-seeking were initially selected; only studies that explored formal help-seeking for mental health problems and were published in English were retained. Data were extracted using Microsoft Excel. Results: Initially, 8898 records were identified. Of these, 49 met the selection criteria and were included: 32 were journal articles and 17 were theses. Forty-three papers reported on non-intervention studies and seven articles reported on TPB-based interventions. Most studies (n = 39) identified predictors of help-seeking intentions. Attitudes and perceived behavioral control were significant predictors of intentions in 35 and 34 studies, respectively. Subjective norms were a significant predictor of intentions in 23 studies. Few studies aimed to predict help-seeking behavior (n = 8). Intentions and perceived behavioral control were significant predictors of behavior in seven and six studies, respectively. Only six TPB-based interventions were identified, all used digital technology to influence help-seeking, with mixed results. Conclusions: The present scoping review identified a considerable evidence base on the TPB for predicting mental health help-seeking intentions. Attitudes and perceived behavioral control were frequently found to be significant predictors of help-seeking intentions. Knowledge on the TPB for predicting mental health help-seeking behavior, and on TPB-based interventions, is limited. Thus, the role of the TPB in developing help-seeking interventions remains unclear. Recommendations are presented to address such research gaps and inform policy and practice

Theory-based behaviour change intervention to promote mental health help-seeking among older adults in Australia: Initial dissemination and acceptability

Objective: Rates of help-seeking for mental health problems among older adults are low and initiatives to increase help-seeking in older populations are limited. To our knowledge, no interventions have aimed to promote help-seeking among older adults by tapping internal motivations to seek help. In this paper, we describe the development of a theory-based intervention designed to promote mental health help-seeking among older adults in Australia, using an internal motivation paradigm. Methods: The intervention was co-designed through a consultative process with nine key stakeholders who represented five main groups: primary health-care providers, mental health professionals, health-care executives, community organisations and consumers. Development was an iterative process, based on best practice guidelines. Nineteen older adults (≥65 years) provided feedback on the acceptability of the intervention. Results: The intervention consisted of a help-seeking brochure with behaviour change messages based on the Theory of Planned Behaviour (TPB). Messages targeted older adults\u27 attitudes towards help-seeking, subjective norms, perceived behavioural control and barriers to seeking help. Most participants (74%) responded with agree/strongly agree to 10 items measuring the acceptability of the intervention, indicating the intervention is relevant, clear, appropriate and appealing. Conclusions: The present intervention appears to be an acceptable way to promote help-seeking for mental health problems among older adults. A larger, robust trial is warranted to determine the effectiveness of the intervention in improving help-seeking attitudes, intentions and behaviour. The intervention has the potential to increase older adults\u27 engagement with mental health support and improve health outcomes in this population

Barriers to mental health help-seeking among older adults with chronic diseases

Objective: Older adults often delay seeking professional help, particularly for mental health problems. This is of great concern for older adults with chronic diseases, who are at risk of mental health declines. This study explored barriers to help-seeking among older adults with chronic diseases and identified factors that influence older adults’ perceptions of such barriers. Method: This was a cross-sectional study with 106 adults ≥ 65 years, diagnosed with cardiovascular disease, respiratory disease, and/or type 2 diabetes. Demographic variables and barriers to help-seeking were measured using self-report questionnaires. Results: The most common barriers to help-seeking were wondering whether the mental health problem is significant enough to warrant treatment (51.9%) and not having a regular primary health care provider to speak with (39.6%). Participants who had sought help in the past had less endorsement of these barriers than those who had never sought help. Conclusions: Many older adults with chronic diseases have difficulties knowing when to seek help, and apprehensions about disclosing mental health concerns. Integrated intervention is needed involving the community (e.g., reduce stigma), older adults with chronic diseases (e.g., increase mental health literacy), and physicians (e.g., increase training in ageing and mental health) to alleviate common barriers to help-seeking in this population

Help-seeking for mental health problems among older adults with chronic disease: An application of the theory of planned behaviour

Objective: Despite high risk for mental health problems, older adults with chronic diseases underutilise mental health services. This study applied the Theory of Planned Behaviour (TPB) to understand mental health help-seeking intentions among this population and identified factors which influence help-seeking intentions. Method: We conducted a cross-sectional study with a non-clinical sample of 108 older adults aged 65 years or over, living with cardiovascular disease, respiratory disease, and/or type 2 diabetes. TPB variables (attitudes, subjective norms, and perceived behavioural control), intentions to seek help, and additional factors (past help-seeking behaviour, quality of life, and physical health) were assessed using standardised questionnaires. Multiple linear regressions were conducted to identify predictors of help-seeking intentions. Results: 41% of the participants did not intend to seek help, and all three TPB variables were associated with help-seeking intentions. The traditional TPB model accounted for 69.7% of the variance in intentions, and the extended TPB model accounted for an additional 1.6% of the variance. Conclusions: Attitudes and perceived behavioural control have the strongest association with help-seeking intentions among older adults with chronic disease. Further research is needed to identify predictors of mental health help-seeking behaviour and to develop interventions to promote help-seeking in this population. KEY POINTS What is already known about this topic: 1. Older adults aged 65 years or over living with chronic disease are at an increased risk of mental health decline. 2. Older adults underutilise mental health services, and consequently mental health problems often go undiagnosed and untreated in this population. 3. A growing body of research has demonstrated the utility of the Theory of Planned Behaviour in predicting intentions to seek mental health support services. What this topic adds: 1. Most older adults with chronic disease have some intention to seek professional mental health support when needed. 2. Older adults with chronic disease have a high perceived ability to seek professional help. 3. Promoting favourable attitudes towards mental health help-seeking is likely to facilitate the greatest change in help-seeking intentions in the present population

Mother\u27s own milk compared with formula milk for feeding preterm or low birth weight infants: Systematic review and meta-analysis

Objectives: We assessed the effect of feeding preterm or low birth weight infants with infant formula compared with mother\u27s own milk on mortality, morbidity, growth, neurodevelopment, and disability. Methods: We searched Medline (Ovid), Embase (Ovid), and Cochrane Central Register of Controlled Studies to October 1, 2021. Results: Forty-two studies enrolling 89 638 infants fulfilled the inclusion criteria. We did not find evidence of an effect on mortality (odds ratio [OR] 1.26, 95% confidence interval [CI] 0.91-1.76), infection (OR 1.52, 95% CI 0.98-2.37), cognitive neurodevelopment (standardized mean difference -1.30, 95% CI -3.53 to 0.93), or on growth parameters. Formula milk feeding increased the risk of necrotizing enterocolitis (OR 2.99, 95% CI 1.75-5.11). The Grading of Recommendations Assessment, Development, and Evaluation certainty of evidence was low for mortality and necrotizing enterocolitis, and very low for neurodevelopment and growth outcomes. Conclusions: In preterm and low birth weight infants, low to very low-certainty evidence indicates that feeding with infant formula compared with mother\u27s own milk has little effect on all-cause mortality, infection, growth, or neurodevelopment, and a higher risk of developing necrotizing enterocolitis

Economic evaluation of interventions delivered by primary care providers to improve neurodevelopment in children aged under 5 years: protocol for a scoping review

Background: Frequently cited benefit-cost ratios suggest that interventions to improve neurodevelopment have high economic returns when implemented during pregnancy and early childhood. However, there are many challenges when primary care providers implement these interventions at scale, and it is unclear how many research studies or programmes have examined cost-effectiveness and which methods were used. There are no current scoping or systematic reviews which have assessed economic evaluations of interventions delivered by primary care providers to improve child neurodevelopment. Methods/design: The aim of this review is to describe the economic evaluations of interventions delivered by primary care providers to improve neurodevelopment in children aged 0–4 years. Specific subgroup analyses will include income level of country (high, middle and low); population type (universal vs targeted); time period when intervention was implemented (antenatal vs infancy [0–11 months] vs early childhood [12–59 months]); and setting (research study vs programmes evaluation at scale). All study designs will be included. The primary outcomes of interest are cost per neurodevelopmental or cognitive health gain in children aged 0–4 years. All measures of cost, neurodevelopment or cognitive function that have been previously validated as an appropriate test in this domain will be included. Databases such as MEDLINE (OVID), PsycINFO (OVID), EMBASE (OVID), CINAHL, Cochrane Library (including CENTRAL, DARE, HTA and NHS EED), Paediatric Economic Database Evaluation (PEDE) and WHO databases and reference lists of papers will be searched for relevant articles. Five phases will be followed: identifying the research question, identifying relevant studies, study selection, charting data and collating, summarising and reporting results. We will present cost and effectiveness data descriptively. Discussion: This review appears to be the first to be conducted in this area. The findings will be an important resource for future systematic reviews on interventions that have a cost component. This information will be valuable for policy makers and programmers who work in public health or primary care settings

Maintaining social and emotional wellbeing among older adults during periods of increased social isolation: Lessons from the COVID-19 pandemic

Objective: Older adults are vulnerable to isolation and poor emotional wellbeing during COVID-19, however, their access to appropriate supports is unknown. The aim of this study was to explore older adults’ experiences accessing social and emotional support during the COVID-19 pandemic in Australia. Method: Ten older adults from Western Australia (Australia) aged 68 to 78 years participated in individual semi-structured interviews between December 2020 and January 2021. Responses were investigated using thematic analysis. Results: Three key themes emerged: adaptability and self-sufficiency; informal support-seeking; and digital and online technologies. Older adults were adaptable to COVID-19 restrictions; however, some were anxious about reconnecting with their social networks once restrictions had eased. Older adults relied on their informal support networks to maintain their social and emotional wellbeing during lockdown. Digital platforms (e.g., Zoom, social media) enabled older adults to stay connected with others, yet some older people were unable or reluctant to use technology, leaving them vulnerable to social isolation. Conclusions: Older adults are resilient to the challenges of COVID-19. Informal supports and digital technologies are important to maintaining social and emotional wellbeing during lockdown. Local governments and community groups may benefit from increased funding to deliver services that promote social connectedness during times of crisis