School of Acute and Primary Health

Permanent link for this collectionhttps://hdl.handle.net/10292/1241

The School of Acute and Primary Health includes Paramedicine, Midwifery, Perioperative Practice and Oral Health.

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Te ara o Manawataki Fatu Fatu-Kaupapa Māori and Pacific Qualitative Co-design Hui to Explore Cardiovascular Disease Care for Māori and Pacific Peoples in Aotearoa New Zealand
(Pasifika Medical Association Group, 2025-11-21) Rahiri, Jamie-Lee; Tuhoe, Jason; Hanchard, Sandra; Houma, Alyssa; Appleby, Noah; Brewer, Karen; Taueetia-Su'a, Tua; Tane, Taria; Ameratunga, Shanthi; Selak, Vanessa; Dicker, Bridget; Grey, Corina; Harwood, Matire
AIM: Cardiovascular disease (CVD) inequities in Aotearoa New Zealand disproportionately affect Māori and Pacific peoples, who experience higher risk factors, hospitalisations and mortality than NZ Europeans. These disparities stem from the historical and contemporary effects of colonisation, including institutional racism, impacting access to healthcare and socio-economic resources. Despite guidelines for earlier CVD risk assessments (CVDRA), gaps in identification and management persist. METHOD: The Manawataki Fatu Fatu (MFF) for Māori and Pacific Hearts in Unison for Achieving Cardiovascular Care in Equity Studies (ACCESS) is a Māori and Pacific-led research programme examining CVD inequities in Aotearoa New Zealand. This study presents phase three, focussing on qualitative co-design hui (meetings) across Aotearoa New Zealand to gather insights from Māori and Pacific patients, whānau (family/supports) and kaimahi (healthcare workers) engaged with CVD services spanning primary to secondary care. RESULTS: A total of 105 participants attended four regional hui focussed on the heart healthcare experiences of Māori and Pacific peoples in Aotearoa New Zealand. Template analysis revealed four key themes for achieving equitable healthcare: the importance of the whānau/community, the need for providers to engage with patients at their level, the persistent barriers faced and a strong commitment to protecting Māori and Pacific communities and kaimahi. CONCLUSION: This study is a comprehensive qualitative investigation into heart healthcare for Māori and Pacific peoples in Aotearoa New Zealand. The findings reiterate that care must align with the realities of Māori and Pacific peoples and that interventions must address long-standing systemic barriers to care.
Independent Qualitative Evaluative Study of Calmbirth Antenatal Classes
(Springer Publishing Company, 2025-02-28) Crowther, S; Hollingshead, B; McAra-Couper, J; Donald, H; Hotchin, C
High childbirth intervention rates impose risk to women and infants. It is imperative that ways to mitigate this are found. Calmbirth is an antenatal program that incorporates a variety of strategies that could be helpful. The aim of this qualitative evaluation was to explore the acceptability and experiences of attending Calmbirth antenatal classes. Eighteen individual and/or couple postnatal interviews were conducted. Analysis using a psycho-emotional conceptual framework was applied to data. The study found that Calmbirth courses empowered participants, increased their health literacy, and provided them with more personal psychosocial coping strategies. While some participants found the classes not helpful, others experienced a positive reframing of childbirth. Although Calmbirth is acceptable and experienced positively by most women and partners, further work is required to address broader sociocultural influences in places of birth.
A Participatory Virtual Audit of the Built Environment for Age-Friendliness
(Springer Science and Business Media LLC, 2025-11-22) Curl, Angela; Watkins, Alison; Smithies, Amanda; Dares, Cushla; Pocock, Tessa; Williman, Jonathan; Todd, Verity; Dicker, Bridget; Keeling, Sally
BACKGROUND: Geospatial studies that consider the relationships between the built environment and health typically rely on researcher-led 'objective' measurement of geospatial attributes of the built environment. Some studies can fail to find expected associations between environments and health outcomes where the geospatial measures do not reflect the experiences or perceptions of people themselves. We took a participatory approach to work with older adults with a concern for falling to assess the built environment in order that we could understand how their assessments relate to researcher assessments. We also wanted to assess whether specific demographic characteristics explained differences in assessments of the built environment between participants. Age-friendly environments can contribute to healthy active ageing. Falling and a fear of falling can lead to restricted outdoor activity. Therefore, understanding how the built environment contributes to fear of falling is important for age-friendly environments. METHODS: The study is a cross-sectional retrospective observational study of the built environment. We worked with older adults in workshop settings to undertake community audits of the built environment in Google Street View. They assessed locations where a fall had occurred. Researchers separately audited the same locations. We used descriptive statistics and ordinal regression cumulative link mixed models to estimate the odds that community members would rank a location one level higher than the researchers. RESULTS: There are significant differences in researcher and community auditor assessments of locations of attractiveness. Site related and individual attributes explain variation in how difficult locations were rated for walking, and for concern about falling. Only individual attributes explained variation in site attractiveness. Locations with more trip hazards and steeper slopes were rated as being more difficult to walk and were associated with greater concern for falling. CONCLUSIONS: Attributes of the built environment influence perceptions of difficulty walking and concern or falling at specific locations. Furthermore, there are some differences in how researchers and community auditors assess the same locations, meaning that geospatial studies which rely only on researcher assessments may be prone to bias. Involving older people in geospatial studies that measure age-friendly environments can make measurement more reflective of their experiences.
Exploring Strategies Used Following a Group-Based Fatigue Management Programme for People with Multiple Sclerosis (FACETS) via the Fatigue Management Strategies Questionnaire (FMSQ)
(BMJ, 2015-10-20) Thomas, S; Kersten, P; Thomas, PW; Slingsby, V; Nock, A; Jones, R; Smith, AD; Galvin, KT; Baker, R; Hillier, C
Objectives: To explore cross-sectional patterns of use of fatigue management strategies in people with multiple sclerosis (MS) who had attended a groupbased fatigue management programme, Fatigue: Applying Cognitive behavioural and Energy effectiveness Techniques to lifeStyle ('FACETS'). In a multicentre randomised controlled trial (RCT) the FACETS programme was shown to reduce fatigue severity and improve self-efficacy and quality of life. Design: A questionnaire substudy within a RCT involving the self-completed Fatigue Management Strategies Questionnaire (FMSQ). The FMSQ includes: (1) closed questions about the use and helpfulness of fatigue management strategies taught in FACETS and (2) open items about changes to lifestyle, attitudes or expectations, barriers or difficulties encountered and helpful strategies not covered in FACETS. Participants: All had a clinical diagnosis of MS, significant fatigue, were ambulatory and had attended at least 4 of 6 scheduled FACETS sessions. Methods: Participants (n=72) were posted the FMSQ with a prepaid return envelope 4 months after the end of the FACETS programme. Results: 82% (59/72) of participants returned the FMSQ. The fatigue management strategies most frequently used since attending FACETS were prioritisation (80%), pacing (78%), saying no to others (78%), grading tasks (75%) and challenging unhelpful thoughts (71%). Adding in those participants who were already using the respective strategies prior to FACETS, the three most used strategies at 4 months were prioritisation (55/59), grading (54/59) and pacing (53/58). Free-text comments illustrated the complex interplay between attitudes/expectations, behaviours, emotions and the environment. Issues related to expectations featured strongly in participants' comments. Expectations (from self and others) were both facilitators and barriers to effective fatigue management. Conclusions: Individuals' comments highlighted the complex, multifaceted nature of fatigue management. Revising expectations and a greater acceptance of fatigue were important shifts following the programme. Findings support the relevance of a cognitive behavioural approach for fatigue management. Booster sessions might be a useful addition to the FACETS programme.
Improving the Assessment of Quality of Life in the Clinical Care of Myeloma Patients: The Development and Validation of the Myeloma Patient Outcome Scale (MyPOS)
(BioMed Central Ltd., 2015-04-14) Osborne, TR; Ramsenthaler, C; Schey, SA; Siegert, RJ; Edmonds, PM; Higginson, IJ
Background: Multiple myeloma is an incurable cancer with a rising incidence globally. Less toxic treatments are increasingly available, so patients are living longer and treatment decisions are increasingly guided by QOL concerns. There is no QOL assessment tool designed specifically for use in the clinical care of people with myeloma. This study aimed to develop and test the psychometric properties of a new myeloma-specific QOL questionnaire designed specifically for use in the clinical setting - the MyPOS. Methods: The MyPOS was developed using findings from a previously reported literature review and qualitative study. The prototype MyPOS was pretested using cognitive interviews in a purposive sample of myeloma patients and refined prior to field testing. The psychometric properties of the MyPOS were evaluated in a multi-centre, cross sectional survey of myeloma patients recruited from 14 hospital trusts across England. Results: The prototype MyPOS contained 33 structured and open questions. These were refined using cognitive interviews with 12 patients, and the final MyPOS contained 30 items taken forward for field-testing. The cross-sectional survey recruited 380 patients for the MyPOS validation. Mean time to complete was 7 minutes 19 seconds with 0.58% missing MyPOS items overall. Internal consistency was high (α =0.89). Factor analysis confirmed three subscales: Symptoms & Function; Emotional Response and Healthcare Support. MyPOS total scores were higher (worse QOL) in those with active disease compared to those in the stable or plateau phase (F = 11.89, p < 0.001) and were worse in those currently receiving chemotherapy (t = 3.42, p = 0.001). Scores in the Symptoms & Function subscale were higher (worse QOL) in those with worse ECOG performance status (F = 31.33, p < 0.001). Good convergent and discriminant validity were demonstrated. Conclusions: The MyPOS is the first myeloma-specific QOL questionnaire designed specifically for use in the clinical setting. The MyPOS is based on qualitative enquiry and the issues most important to patients. It is a brief, comprehensive and acceptable tool that is reliable and valid on psychometric testing. The MyPOS can now be used to support clinical decision making in the routine care of myeloma patients.
Network Analysis of Mindfulness Facets, Affect, Compassion, and Distress
(Springer, 2020-11-26) Medvedev, Oleg; Cervin, M; Barcaccia, B; Siegert, RJ; Roemer, A; Krägeloh, Chris
Objectives: Mindfulness, positive affect, and compassion may protect against psychological distress but there is lack of understanding about the ways in which these factors are linked to mental health. Network analysis is a statistical method used to investigate complex associations among constructs in a single network and is particularly suitable for this purpose. The aim of this study was to explore how mindfulness facets, affect, and compassion were linked to psychological distress using network analysis. Methods: The sample (n = 400) included equal numbers from general and student populations who completed measures of five mindfulness facets, compassion, positive and negative affect, depression, anxiety, and stress. Network analysis was used to explore the direct associations between these variables. Results: Compassion was directly related to positive affect, which in turn was strongly and inversely related to depression and positively related to the observing and describing facets of mindfulness. The non-judgment facet of mindfulness was strongly and inversely related to negative affect, anxiety, and depression, while non-reactivity and acting with awareness were inversely associated with stress and anxiety, respectively. Strong associations were found between all distress variables. Conclusions: The present network analysis highlights the strong link between compassion and positive affect and suggests that observing and describing the world through the lens of compassion may enhance resilience to depression. Taking a non-judging and non-reacting stance toward internal experience while acting with awareness may protect against psychological distress. Applicability of these findings can be examined in experimental studies aiming to prevent distress and enhance psychological well-being.
New Zealand Physiotherapists’ and General Practitioners’ Treatment Knowledge and Referral Decisions for Knee Osteoarthritis: A Vignette-Based Study
(Physiotherapy New Zealand, 2021) O'Brien, DW; Siegert, RJ; Bassett, S; Baldwin, JN; Wright-St Clair, V
Physiotherapists’ and general practitioners’ (GPs) treatment knowledge affects the management of people with knee osteoarthritis (OA), but little is known about the OA referral decisions and treatment knowledge of these clinicians in New Zealand. Data were collected from New Zealand registered physiotherapists and GPs (n = 272) using an online vignette-based questionnaire. Approximately two-thirds (63%, n = 172) of participants stated they would likely refer the hypothetical patient with knee OA to another profession. Participants indicated they would refer the woman between the two professions (73%, n = 57 GPs would refer to a physiotherapist; 47%, n = 92 physiotherapists would refer to a GP). However, few participants indicated they would refer the woman to other health professionals (such as 19%, n = 52 would refer to a dietitian). The majority of participants reported they would recommend education (98%, n = 267), therapeutic exercises (92%, n = 251) and weight-loss advice (87%, n = 237) as treatments for knee OA. These results indicate that first-line knee OA treatment knowledge of New Zealand GPs and physiotherapists are generally in keeping within international guidelines. However, promoting interprofessional collaboration with other health professions, such as dietetics, and providing education regarding treatments not recommended for OA is needed to meet all first-line treatment recommendations.
Educating Emergency Department Nurses About Trauma Informed Care for People Presenting with Mental Health Crisis: A Pilot Study
(BioMed Central Ltd., 2016-03-24) Hall, A; McKenna, B; Dearie, V; Maguire, T; Charleston, R; Furness, T
Background: Practicing with trauma informed care (TIC) can strengthen nurses' knowledge about the association of past trauma and the impact of trauma on the patient's current mental illness. An aim of TIC is to avoid potentially re-traumatising a patient during their episode of care. A TIC education package can provide nurses with content that describes the interplay of neurological, biological, psychological, and social effects of trauma that may reduce the likelihood of re-traumatisation. Although mental health nurses can be TIC leads in multidisciplinary environments, the translation of TIC into clinical practice by nurses working in emergency departments (EDs) is unknown. However, before ED nurses can begin to practice TIC, they must first be provided with meaningful and specific education about TIC. Therefore, the aims of this study were to; (1) evaluate the effectiveness of TIC education for ED nursing staff and (2) describe subsequent clinical practice that was trauma informed. Methods: This project was conducted as exploratory research with a mixed methods design. Quantitative data were collected with an 18-item pre-education and post-education questionnaire. Qualitative data were collected with two one-off focus groups conducted at least three-months after the TIC education. Two EDs were involved in the study. Results: A total of 34 ED nurses participated in the TIC education and 14 ED nurses participated in the focus groups. There was meaningful change (p < 0.01, r ≥ 0.35) in 9 of the 18-items after TIC education. Two themes, each with two sub-themes, were evident in the data. The themes were based on the perceived effectiveness of TIC education and the subsequent changes in clinical practice in the period after TIC education. Conclusion: Emergency department nurses became more informed of the interplay of trauma on an individual's mental health. However, providing care with a TIC framework in an ED setting was a considerable challenge primarily due to time constraints relative to the day-to-day ED environment and rapid turnover of patients with potentially multiple and complex presentations. Despite this, nurses understood the effect of TIC to reduce the likelihood of re-traumatisation and expressed a desire to use a TIC framework.
Implementation of Telerehabilitation in Response to COVID-19: Lessons Learnt from Neurorehabilitation Clinical Practice and Education
(New Zealand Journal of Physiotherapy, 2020-01-01) Signal, Nada; Martin, T; Leys, A; Maloney, R; Bright, Felicity
The health response to the COVID-19 pandemic has had significant impacts on neurorehabilitation provision both internationally and in New Zealand. Telerehabilitation, the delivery of rehabilitation at a distance using information and communication technologies, was advocated as a means of addressing the rehabilitation needs of our patients while maintaining physical distancing and reducing the risk of viral transmission. Despite research evidence indicating that telerehabilitation is as effective as in-person rehabilitation for people with neurological conditions, there were significant challenges in delivering and sustaining telerehabilitation practice. We draw upon our experiences in delivering telerehabilitation in neurorehabilitation clinical practice and education to reflect on the process of practice change and to consider how these experiences can inform practice development in the future. We propose that rehabilitation organisations and physiotherapists continue to develop capability to provide telerehabilitation; that physiotherapists and the physiotherapy profession focus on translating their communicative, relational and clinical skills to the digital space to ensure they are competent in telerehabilitation; and that, as a profession, we focus on what constitutes “best practice” in telerehabilitation, and how in-person and telerehabilitation can be integrated to provide engaging, evidence-based and person-centred rehabilitation.
Telerehabilitation After Stroke Using Readily Available Technology: A Randomized Controlled Trial
(Sage, 2020) Saywell, Nicola; Vandal, AC; Mudge, S; Hale, L; Brown, P; Feigin, V; Hanger, C; Taylor, D
Background: The number of people living with stroke has increased demand for rehabilitation. A potential solution is telerehabilitation for health care delivery to promote self-management. One such approach is the Augmented Community Telerehabilitation Intervention (ACTIV). This structured 6-month program uses limited face-to-face sessions, telephone contact, and text messages to augment stroke rehabilitation. Objective: To investigate whether ACTIV improved physical function compared with usual care. Methods: This 2-arm, parallel randomized controlled trial was conducted in 4 New Zealand centers. Inclusion criteria were patients with first-ever stroke, age >20 years, and discharged home. A blinded assessor completed outcome measurement in participants’ homes at baseline, postintervention, and 6 months postintervention. Stratified block randomization occurred after baseline assessment, with participants allocated to ACTIV or usual care control. Results: A total of 95 people were recruited (ACTIV: n = 47; control: n = 48). Postintervention intention-to-treat analysis found a nonsignificant difference between the groups in scores (4·51; P =.07) for physical function (measured by the physical subcomponent of the Stroke Impact Scale). The planned per-protocol analysis (ACTIV: n = 43; control: n = 48) found a significant difference in physical function between the groups (5·28; P =.04). Improvements in physical function were not maintained at the 12-month follow-up. Conclusions: ACTIV was not effective in improving physical function in the ACTIV group compared with the usual care group. The per-protocol analysis raises the possibility that for those who receive more than 50% of the intervention, ACTIV may be effective in preventing deterioration or even improving physical function in people with stroke, in the period immediately following discharge from hospital.
The Micro-politics of Caring: Tinkering with Person-Centered Rehabilitation
(Taylor & Francis, 2019-04-12) Gibson, BE; Terry, Gareth; Setchell, J; Bright, Felicity; Cummins, Christine; Kayes, NM
Purpose: In this paper, we critically investigate the implementation of person-centered care with the purpose of advancing philosophical debates regarding the overarching aims and delivery of rehabilitation. While general agreement exists regarding person centered care’s core principles, how practitioners reconcile the implementation of these principles with competing practice demands remains an open question. Materials and methods: For the paper, we drew on post-qualitative methods to engage in a process of “diffractive” analysis wherein we analyzed the micro-doings of person-centered care in everyday rehabilitation work. Working from our team members’ diverse experiences, traditions, and epistemological commitments, we engaged with data from nine “care events” generated in previous research to interrogate the multiple forces that co-produce care practices. Results: We map our analyses under three categories: scripts mediate practice, securing compliance through “benevolent manipulations”, and care(ful) tinkering. In the latter, we explore the notion of tinkering as a useful concept for approaching person centered care. Uncertainty, humility, and doubt in one’s expertise are inherent to tinkering, which involves a continual questioning of what to do, what is best, and what is person centered care within each moment of care. The paper concludes with a discussion of the implications for rehabilitation and person-centered care.Implications for rehabilitation Determinations of what constitutes good, better, or best rehabilitation practices are inevitably questions of ethics. Person-centered care is promoted as good practice in rehabilitation because it provides a framework for attending to the personhood of all engaged in clinical encounters. Post-critical analyses suggest that multiple interacting forces, conditions, assumptions, and actions intersect in shaping each rehabilitation encounter such that what constitutes good care or person-centered care cannot be determined in advance. “Tinkering” is a potentially useful approach that involves a continual questioning of what to do, what is best, and what is person-centered care within each moment of care.
Protecting Children in Aotearoa New Zealand: A Review on Legal and Professional Frameworks for Oral Health Practitioners
(Informa UK Limited, 2024-12) Han, Heuiwon; Koziol-McLain, Jane; Diesfeld, Kate; Carrington, Samuel D; Morse, Zac; Lees, Amanda B
The United Nations Convention on the Rights of the Child asserts that all children have the right to protection from abuse and exploitation. In Aotearoa New Zealand, the prevalence of child maltreatment requires vigilant action from oral health practitioners (OHPs), who are often among the first in the position to recognise signs of abuse and neglect due to their frequent interactions with children in dental settings. The Dental Council of New Zealand sets professional requirements, highlighting practitioners’ roles in responding to potential signs of maltreatment. Multiple statutes, including the Oranga Tamariki Act 1989 and the Family Violence Act 2018, govern OHPs’ responses. Despite this, there is a notable gap in OHPs’ confidence and understanding of their child protection roles, underlining the need for clear guidance on the legal and professional requirements that inform their responsibilities. This paper critically examines the professional responsibilities and policies governing OHPs in Aotearoa New Zealand regarding child protection responses. It also proposes the development of equity-focused guidelines, that are informed by Te Tiriti o Waitangi, emphasising culturally responsive practices, collaborations with Māori health providers and clear protocols for child protection responses.
Cardiometabolic Outcomes among Adults with Abdominal Obesity and Normal Body Mass Index
(American Medical Association (AMA), 2025-10-17) Ahmed, KY; Aychiluhm, SB; Thapa, S; Tegegne, TK; Ketema, DB; Kassa, ZY; Kibret, GD; Duko, B; Shifti, DM; Bore, MG; Nezenega, ZS; Bedaso, A; Hailegebireal, AH; Bizuayehu, HM; Dadi, AF; Beyene, T; Shaikh, MF; Hassen, TA; Seid, A; Astawesegn, FH; Belachew, SA; Leshargie, CT; Berhe, FT; Mondal, UK; Little, D; Hewa Marambage, KA; Mahmood, S; Ross, AG
Importance: Cardiometabolic disorders are the leading causes of death and disability worldwide, with abdominal obesity being a major contributor to these conditions. Data on normal-weight abdominal obesity and its association with cardiometabolic outcomes are limited. Objective: To investigate the global prevalence of normal-weight abdominal obesity and its association with cardiometabolic outcomes. Design, Setting, and Participants: This cross-sectional study used data from the World Health Organization Stepwise Approach to Surveillance of Noncommunicable Disease Risk Factors survey datasets between 2000 and 2020. The surveys were from 91 countries across Africa, the Americas, the Eastern Mediterranean region, Europe, Southeast Asia, and the Western Pacific region. Adults aged 15 to 69 years or 18 to 69 years (based on participating countries' national definitions of adult) were included. The data were analyzed between April 2024 and January 2025. Exposure: Normal-weight abdominal obesity, which is defined as a normal body mass index (BMI) of 18.5 to 24.9 (calculated as weight in kilograms divided by height in meters squared) but high waist circumference (female, ≥80 cm; male, ≥94 cm). Main Outcomes and Measures: The main outcomes were hypertension, diabetes, cholesterol, and triglycerides. Associations with these cardiometabolic outcomes were quantified using multivariable binary logistic regression models. Results: The study included 471228 participants (mean [SD] age, 40.4 [15.9] years; 57.8% female). Globally, 21.7% (95% CI, 21.5%-21.8%) of participants with a normal BMI had abdominal obesity, ranging from 15.3% (95% CI, 15.0%-15.7%) in the Western Pacific region to 32.6% (95% CI, 31.9%-33.3%) in the Eastern Mediterranean region. Lebanon had the highest prevalence of normal-weight abdominal obesity (58.4%; 95% CI, 54.1%-62.6%), while Mozambique had the lowest (6.9%; 95% CI, 5.9%-8.1%). Factors associated with abdominal obesity included primary and secondary or higher education (odds ratio [OR], 1.53 [95% CI, 1.50-1.57] and 2.38 [95% CI, 2.33-2.43], respectively), unemployment (OR, 1.25 [95% CI, 1.23-1.27]), low fruits and vegetables intake (OR, 1.22 [95% CI, 1.20-1.24]), and physical inactivity (OR, 1.60 [95% CI, 1.57-1.63]). Additionally, having a normal BMI and abdominal obesity was consistently associated with hypertension (OR, 1.29 [95% CI, 1.25-1.33]), diabetes (OR, 1.81 [95% CI, 1.72-1.90]), high total cholesterol (OR, 1.39 [95% CI, 1.35-1.44]), and high triglycerides (OR, 1.56 [95% CI, 1.48-1.64]). Conclusions and Relevance: In this cross-sectional study, more than 1 in 5 adults worldwide with a normal BMI had abdominal obesity. Relying solely on BMI may be insufficient to identify these high-risk individuals and provide timely interventions. The findings have implications for the United Nations' Sustainable Development Goal targets 2.2 (ending all forms of malnutrition) and 3.4 (reducing premature mortality from noncommunicable diseases).
HIV Testing and Access in Palembang, South Sumatra, Indonesia During the 2021 COVID-19 Pandemic
(Faculty of Public Health of Sriwijaya University, 2025-08-08) Najmah, Najmah; Adelliani, Namirah; Popita, Mawaddah Dyah; Nurqanita, Ajeng Fathia; Rosyada, Amrina; Budi, Iwan Stia; Aprina, Fenty; Dewi, Yulyana Kusuma; Setiawan, Yudhi; Andajani, Sari
HIV testing is one of the most effective strategies for accelerating access to prevention and treatment services, supporting efforts to end the AIDS epidemic by 2030 through the 95-95-95 targets. This study describes the socio-demographic characteristics and spatial distribution of HIV cases and screening among key and general populations in Palembang City in 2021. Data were extracted from the HIV/AIDS Information System and analyzed using descriptive and ecological spatial analysis within the key and general populations. Findings indicate the rates of HIV are 4.2 per 100 among Men having Sex with Men (MSM) and 7.8 per 100 transgender individuals accessing HIV testing. Among women and pregnant women, rates were zero and 1.04 %, respectively, while among children (0-19 years old), the rate was nearly 2 per 100 children. A higher level of HIV testing in health facilities was correlated with increased detection of HIV cases. Among low-risk groups of women and children, one subdistrict, Kemuning, reported 30 HIV- positive cases in women and children – markedly higher than the 0 to 6 HIV-positive cases reported in other subdistricts. The observed disparity underscores a critical public health challenge: the potential for a hidden HIV epidemic among pregnant women in Palembang, a situation likely exacerbated by service disruptions during the COVID-19 pandemic.
High Ratio of Plasma to Red Cells in Contemporary Resuscitation of Haemorrhagic Shock After Trauma: A Secondary Analysis of the PATCH-Trauma Trial
(Springer Science and Business Media LLC, 2025-10-02) Mitra, B; Reade, MC; Bernard, S; Dicker, B; Maegele, M; Gruen, RL
Background: Plasma transfusion is recommended as an initial intervention in most major haemorrhage protocols for trauma resuscitation. With availability of newer blood components, therapeutic agents and investigations for coagulopathy, the marginal benefits of high ratios of plasma to red cells is uncertain. The aim of this study was to report the association of high ratios of plasma: red cells and 28-day mortality in patients with major trauma. Methods: The PATCH-Trauma trial enrolled critically bleeding patients at high risk of trauma induced coagulopathy and randomised them to receive prehospital tranexamic acid or placebo. The sub-group of patients who were managed with massive transfusions in hospital (> 4 units of red cells in first 4 h) were included for this post-hoc analysis. Associations of high ratios of plasma (more than 1 unit of plasma for every 2 units of red cells) and 28-day mortality were reported using multivariable logistic regression analysis after adjustment for potential confounders including age, neurological injury, injury severity, coagulopathy and administration of platelets, fibrinogen concentrates, cryoprecipitate and tranexamic acid. Results: Among 1310 patients enrolled in the PATCH-trauma trial, 372 patients were included for this analysis; 213 (57.3%) received high ratios of plasma: red cells and 116 (31.4%) deaths were recorded at 28 days. High ratios of plasma: red cells were associated with lower mortality (adjusted odds ratio; aOR 0.50; 95%CI: 0.26–0.96). Older age (aOR 1.02; 95%CI: 1.01–1.03), initial Glasgow Coma Scale 3–8 (aOR 6.57; 95%CI: 2.92–14.80) and trauma induced coagulopathy (aOR 5.64; 95%CI: 2.87–11.1) on hospital arrival were associated with higher mortality. Conclusions: Among patients with critical bleeding managed with massive transfusions, high ratios of plasma: red cells were associated with lower mortality, after controlling for potential confounders. Ongoing provision of early plasma for management of critical bleeding is indicated with consideration to prehospital plasma. Registration: ClinicalTrials.gov number, NCT02187120 (Registered 09 July 2014).
A New Emergency Procedure for Cardiac Arrests Aims to Save More Lives – Here’s How It Works
(The Conversation, 2024-02-12) Withanarachchie, Vinuli; Dicker, Bridget; Maessen, Sarah E
A Survey of Oral Health-related Quality of Life for Adults With Cerebral Palsy in Australia
(MDPI AG, 2025-09-04) Lansdown, Karen; Bulkeley, Kim; McGrath, Margaret; Irving, Michelle; Zagreanu, Claudia; Smithers-Sheedy, Hayley
Objective: Our aim was to investigate the oral health-related quality of life (OHRQoL) and dental care experiences of adults with Cerebral Palsy (CP). Methods: In 2023, adults with CP and their caregivers from four Australian states completed questionnaires, including the Oral Health Impact Profile-14 (OHIP-14). Non-parametric tests were conducted to analyze associations between demographic and CP-related variables and OHRQoL. Results: A total of 69 respondents participated, including n = 22 adults with CP and n = 47 caregivers of adults with CP. Most adults with CP were diagnosed with a spastic motor type (46/69, 66%), with bilateral spasticity being the most common (30/46, 65%). The mean OHIP-14 score was 10.3 ± 9.3 (mean ± SD). Nearly 70% reported challenges cleaning their teeth, over 25% lacked a dentist, more than 60% found dental exams challenging, and nearly 50% required specialized dental care. In bivariate analysis, OHIP-14 was associated with daily oral care routines (p = 0.012) and “simple dental check-up” (p = 0.017). There was a statistically significant relationship between socio-economic status and scores for the handicap dimension (p = 0.040). Higher OHIP-14 scores were associated with greater levels of impairment regarding gross motor (p = 0.199), manual functioning limitations (p = 0.001), speech (p = 0.123), and communication function scales (p = 0.319). Conclusion: Adults with CP reported challenges participating in and maintaining oral health and accessing dental care, influenced by physical, functional, and socio-economic factors. These findings indicate the need for inclusive care and strategies to support access to services.
Manaaki Mamao—To Care From a Distance: Evaluating a Telehealth Service for Māori and Pacific Peoples With Hypertension
(New Zealand Medical Association, 2025-08-15) Neary, Tiffany; Lim, Kwan-Lyn; Betham, Vola; Coley, Nick; Maessen, Sarah
Life expectancy is 6.6 and 6.1 years shorter for Māori and Pacific peoples, respectively, compared to the non-Māori/non-Pacific population of Aotearoa New Zealand (Aotearoa). Cardiovascular disease (CVD) is the largest avoidable contributor to this health gap. Hypertension (raised blood pressure [BP]) is a major CVD risk factor, with higher BP exponentially increasing risk for coronary heart disease and stroke. Conversely, effective BP management reduces this risk dramatically. In Aotearoa, hypertension is managed in primary care, but over a quarter of New Zealanders have unmet primary healthcare needs due to long waits or cost. Māori and Pacific peoples are more likely to have a hypertension diagnosis and also face greater barriers to primary healthcare access. Accessible CVD risk-management programmes for these groups are therefore essential, with research showing that respectful, reciprocal communication and relationships are critical to culturally safe cardiac care. Telemonitoring services utilise clinician-led education and interactive digital interventions to enhance hypertension management through improved monitoring and health literacy.6 Manaaki Mamao is a 6-month telehealth-based programme delivered by Hato Hone St John that aims to reduce health inequities for Māori and Pacific peoples by taking a culturally safe, people led and technology enabled approach to hypertension management. It supports home-based hypertension monitoring and management with flexibility to meet individuals’ needs. The aim of this study was to evaluate patient outcomes and engagement with Manaaki Mamao over the first 2 years of the programme.
Prehospital Cardiac Arrest Resuscitation Practices Differ Around the Globe
(Elsevier BV, 2025-09-01) Kjær, J; Milling, L; Brøchner, AC; Lippert, F; Blomberg, SN; Christensen, HC; Holgate, R; Morrison, LJ; Bakhsh, A; Mikkelsen, S; Alsulimani, LK; Popela, S; Vidunová, JK; Peran, D; Gregor, R; Papousek, R; Simić, A; Cairol, A; Ingelmo, VSB; Björnsson, HM; Stammet, P; Escalante-Kanashiro, R; Nikolaidou, O; Karageorgos, V; Aslanidis, T; Wallner, B; Rief, M; Eichinger, M; Chakra Rao, SSC; SinghMD, B; Birkun, AA; Aguilera, P; Bakker, J; Zaher, MS; Alwajeeh, SA; Tanabe, S; Iwami, T; Saito, S; Fraga-Sastrias, JM; Kittivo, JE; Achiro, KO; Ndinda, C; Monsieurs, K; Snijders, E; Abdullah, N; Stanton, D; Meyer, JT; Crawford, SJ; Loghmari, D; Turkia, HB; Barbaria, W; Wijesuriya, N; Dilruk Indika Rathnayake, RM; Woltman, N; Mesa-Gaerlan, FJ; Convocar, P; Velasco, BP; Alihodžić, H; Alrawashdeh, A; Alwidyan, MT; Soares-Oliveira, M; Mota, M; Cao, Y; Yao, P; Kin Lam, RP; Cheung, ACK; Bogár, B; Temesvari, P; Gebei, R; Karaaslan, P; Sofuoglu, T; Ciocan, L; Jaeger, D; Sung, CW; Chen, CH; Gellerfors, M; Wahlin, RR; Schell, CO; Gardiner, F; Nichols, M; Perillo, S; Reid, D; Mohrsen, S; Corfield, AR; Allen, M; Falcetta, S; Menarini, M; Rehn, M; Kramer-Johansen, J; Bredmose, PP; Olasveengen, TM; Uleberg, O; Wilson, T; Lindner, TW; Jacobsen, L; Formo, A; Elden, T; Olsen, MS; Kowalski, M; Derkowski, T; Swain, Andrew
Background: Out-of-hospital cardiac arrest (OHCA) is a major public health problem. This study aims to describe the international variations in the practices related to the initiation, termination, and refraining from resuscitation of adult patients (≥18 years) with a non-traumatic OHCA. Methods: An exploratory descriptive study was conducted using a cross-sectional online survey. The respondents were recruited using snowball sampling technique. Framework analysis was used to identify key themes in responses, with descriptive statistics summarising data trends. Results: The study collected responses from 59 countries. Our findings reveal that respondents from 59.3% of countries reported that they initiate resuscitation in all cases where the patients do not show obvious signs of irreversible death or do not have confirmed advance directives. Respondents from 15.3% of countries reported that once started, prehospital resuscitation attempts are not terminated. Prehospitally respondents from 20.3% of the countries reported that they rely exclusively on specific criteria to decide when to terminate resuscitation efforts while in 45.8%, these decisions are made at the discretion of the provider. Respondents from most countries (91.5%) reported that they refrain from resuscitation in the presence of obvious signs of irreversible death. Respondents from 57.6% of countries, reported that they refrained from resuscitation if the patient had a confirmed do-not-attempt-cardiopulmonaryresuscitation (DNACPR), while 15.3% mentioned staff safety as a reason to abstain from attempting resuscitation. Conclusion: This study reveals global variation in EMS resuscitation practices, reflecting disparities in resources, healthcare infrastructure, EMS system design, community acceptability given cultural and societal norms, and legislation.
Havening: A Psycho-Sensory Therapy for Enhancing Emotional Resilience and Psycho-emotional Wellbeing Across the Perinatal Period
(Frontiers Media SA, 2025-07-08) Crowther, Susan; Mellor, Christine; Sun, Kimm
Havening, a psycho-sensory therapy, is increasingly recognized for its potential in supporting perinatal psycho-spiritual and emotional health. By employing gentle touch and guided imagery, Havening aims to reduce distressing emotions and enhance well-being. This article explores its application on emotional processing in perinatal care, with a particular focus on its impact on the amygdala, the brain's emotional processing center. The theoretical foundations proposed by Dr. Ronald Ruden regarding Havening's neurobiological effects are discussed, followed by the presentation of four case studies and respective outcomes that demonstrate the potential of Havening in perinatal mental health.

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