The quality of older adults'involvement in clinical communication with general practitioners:evidence from rural towns in Australia

Objective:A study was conducted about the putative links of older rural Australians'health knowledge and preparation with their quality of involvement in patient-general practitioner(GP)communication during health intake visits.Methods:It was a cross-sectional study between January 2021 and April 2022.The 32-item quality of involvement in communication scale was designed and incorporated into the SurveyGizmo software.This online survey was administered by sending an email request to the Renmark Rotary Club,which actively promoted this study across five rural towns in South Australia.121 participants completed the surveys.Mean-sum scores were calculated based on the questionnaire responses to evaluate outcomes,specifically initiation of information,active participation,and emotional expression.We employed different methods including t-tests,ANOVA,and leaner regressions to analyse data.Results:The demographic profile of participants characterised by a female predominance(58.7%,71/121),a majority falling within the 65-<70 age bracket(47.1%,57/121),and a high level of educational attainment(58.7%had completed high school or higher,71/121).Additionally,35%of the participants predominantly spoke a language other than English at home.Regarding the initiation of information with GPs,the mean sum-score was(20.5+3.7),indicating a marginally above-average level of engagement.Contrarily,the active participation was suboptimal,as suggested by a mean sum score of(35.9±6.3).Furthermore,the emotional expression was relatively low,with a mean score of(13.9±1.8).Substantial variations were discerned in the quality of patient-GP communication,contingent upon factors such as educational background,language spoken at home,health literacy,and preparatory measures for clinical visits.Participants who predominantly spoke a language other than English at home demonstrated significantly lower levels of information initiation with their GPs(P<0.o01).Higher educational attainment was positively correlated with increased active participation(P<0.001).Enhanced health literacy and thorough visit preparation were significantly associated with increased levels of active participation(P<0.001).Conclusion:Meaningful engagement through recognition,empowerment,and support(health literacy programs)for older rural adults is suggested for improving their quality of involvement in communication with GPs.

RAD51 potentiates synergistic effects of chemotherapy with PCI-24781 and cis-diamminedichloroplatinum on gastric cancer

AIM:To explore the efficacy of PCI-24781,a broadspectrum,hydroxamic acid-derived histone deacetylase inhibitor,in the treatment of gastric cancer(GC).METHODS:With or without treatment of PCI-24781and/or cis-diamminedichloroplatinum(CDDP),GC cell lines were subjected to functional analysis,including cell growth,apoptosis and clonogenic assays.Chromatin immunoprecipitation and luciferase reporter assays were used to determine the interacting molecules and the activity of the enzyme.An in vivo study was carried out in GC xenograft mice.Cell culture-based assays were represented as mean±SD.ANOVA tests were used to assess differences across groups.All pairwise comparisons between tumor weights among treatment groups were made using the Tukey-Kramer method for multiple comparison adjustment to control experimental-wise typeⅠ error rates.Significance was set at P<0.05.RESULTS:PCI-24781 significantly reduced the growth of the GC cells,enhanced cell apoptosis and suppressed clonogenicity,and these effects synergized with the effects of CDDP.PCI-24781 modulated the cell cycle and significantly reduced the expression of RAD51,which is related to homologous recombination.Depletion of RAD51 augmented the biological functions of PCI-24781,CDDP and the combination treatment,whereas overexpressing RAD51 had the opposite effects.Increased binding of the transcription suppressor E2F4 on the RAD51 promoter appeared to play a major role in these processes.Furthermore,significant suppression of tumor growth and weight in vivo was obtained following PCI-24781 treatment,which synergized with the anticancer effect of CDDP.CONCLUSION:These data suggest that RAD51 potentiates the synergistic effects of chemotherapy with PCI-24781 and CDDP on GC.

Exploratory systematic review and meta-analysis on period poverty

BACKGROUNDPeriod poverty is a global health and social issue that needs to be addressed.It has been reported that many females compromise their education,employment,and social commitments during their menstruation days due to a number of reasons,including lack of access to toilets or menstrual products.AIM To provide a comprehensive understanding on period poverty,including outcomes associated with menstruation.METHODS All observational and randomised clinical trials reporting menstruation challenges,menstrual poverty and menstrual products were included.Our search strategy included multiple electronic databases of PubMed,Web of Science,ScienceDirect,ProQuest and EMBASE.Studies published in a peer review journal in English between the 30th of April 1980 and the 30th of April 2022 were included.The Newcastle-Ottawa Scale was used to assess the risk of bias of the systematic included studies.Pooled odds ratios(ORs)together with 95%confidence intervals(CIs)are reported overall and for sub-groups.RESULTS A total of 80 studies were systematically selected,where 38 were included in the meta-analysis.Of the 38 studies,28 focused on children and young girls(i.e.,10-24 years old)and 10 included participants with a wider age range of 15-49 years.The prevalence of using disposable sanitary pads was 45%(95%CI:0.35-0.58).The prevalence of menstrual education pre-menarche was 68%(95%CI:0.56-0.82).The prevalence of good menstrual hygiene management(MHM)was 39%(95%CI:0.25-0.61).Women in rural areas(OR=0.30,95%CI:0.13-0.69)were 0.70 times less likely to have good MHM practices than those living in urban areas.CONCLUSION There was a lack of evidence,especially from low-and middle-income countries.Further research to better understand the scope and prevalence of period poverty should be considered.This will enable the development of improved policies to increase access to menstrual products and medical support where necessary.

Navigating Interoperability in Disaster Management:Insights of Current Trends and Challenges in Saudi Arabia

In this rapid review,we critically scrutinize the disaster management infrastructure in Saudi Arabia,illuminating pivotal issues of interoperability,global cooperation,established procedures,community readiness,and the integration of cuttingedge technologies.Our exploration uncovers a significant convergence with international benchmarks,while pinpointing areas primed for enhancement.We recognize that continual commitments to infrastructural progression and technology adoption are indispensable.Moreover,we underscore the value of robust community involvement and cross-border collaborations as key factors in bolstering disaster response capabilities.Importantly,we spotlight the transformative influence of emerging technologies,such as artificial intelligence and the Internet of Things,in elevating the effectiveness of disaster management strategies.Our review champions in all-encompassing approach to disaster management,which entails harnessing innovative technologies,nurturing resilient communities,and promoting comprehensive disaster management strategies,encapsulating planning,preparedness,response,and recovery.As a result of our analysis,we provide actionable recommendations to advance Saudi Arabia's disaster management framework.Our insights are timely and crucial,considering the escalating global focus on disaster response in the face of increasing disaster and humanitarian events.

High-intensity Interval Training for the Management of Nonalcoholic Steatohepatitis: Participant Experiences and Perspectives

Background and Aims:High-intensity interval training(HIIT)is a therapeutic option for people with nonalcoholic steatohepatitis(NASH).However,the perspectives and experiences of HIIT for people with NASH are unknown,limiting translation of research.We explored the experiences and perspectives of both professionally supervised and self-directed HIIT in people with NASH and evaluated participant-reported knowledge,barriers,and enablers to commencing and sustaining HIIT.Methods:Twelve participants with NASH underwent 12 weeks of supervised HIIT(3 days/week,4×4 minutes at 85–95%maximal heart rate,interspersed with 3 minutes active recovery),followed by 12-weeks of selfdirected(unsupervised)HIIT.One-on-one,semistructured participant interviews were conducted by exercise staff prior to HIIT and following both supervised and self-directed HIIT to explore prior knowledge,barriers,enablers,and outcomes at each stage.Interviews were audio-recorded,transcribed,coded,and thematically analyzed by two independent researchers.Results:Four dominant themes were identified:(1)no awareness of/experience with HIIT and ambivalence about exercise capabilities;(2)multiple medical and social barriers to commencing and continuing HIIT;(3)exercise specialist support was a highly valued enabler,and(4)HIIT was enjoyed and provided holistic benefits.Conclusions:People with NASH may lack knowledge of and confidence for HIIT,and experience multiple complex barriers to commencing and continuing HIIT.Exercise specialist support is a key enabler to sustained engagement.These factors need to be addressed in future clinical programs to augment the uptake and long-term sustainability of HIIT by people with NASH so they can experience the range of related benefits.

Shared decision making in rural general practices:a qualitative exploration of older rural South Australians'perceived involvement in clinical consultations with doctors

Background:Shared decision-making(SDM)implementation is a priority for Australian health systems,including general practices but it remains complex for specific groups like older rural Australians.We initiated a qualitative study with older rural Australians to explore barriers to and facilitators of SDM in local general practices.Methods:We conducted a patient-oriented research,partnering with older rural Australians,families,and health service providers in research design.Participants who visited general practices were purposively sampled from five small rural towns in South Australia.A semi-structured interview guide was used for interviews and reflexive thematic coding was conducted.Results:Telephone interviews were held with 27 participants.Four themes were identified around older rural adults’involvement in SDM:(1)Understanding of"patient involvement";(2)Positive and negative outcomes;(3)Barriers to SDM;and(4)Facilitators to SDM.Understanding of patient involvement in SDM considerably varied among participants,with some reporting their involvement was contingent on the“opportunity to ask questions”and the“treatment choices”offered to them.Alongside the opportunity for involvement,barriers such as avoidance of cultural care and a lack of continuity of care are new findings.Challenges encountered in SDM implementation also included resource constraints and time limitations in general practices.Rural knowledge of general practitioners and technology integration in consultations were viewed as potential enablers..Conclusion:Adequate resources and well-defined guidelines about the process should accompany the implementation of SDM in rural general practices of South Australia.Innovative strategies by general practitioners promoting health literacy and culturally-tailored communication approaches could increase older rural Australians'involvement in general.

Experiences of type 2 diabetes in sub-Saharan Africa:a scoping review

Background:The prevalence of diabetes in Sub-Saharan Africa(SSA)is growing rapidly.Qualitative research on experiences of type 2 diabetes in SSA is emerging,but no qualitative synthesis has been attempted.This scoping review aims to redress this lack of synthesis and to extract policy-relevant suggestions from the literature.Methods:Scoping review methodology was employed.Eleven online databases were searched(CINAHLplus,Cochrane Library,EBESCOhost,GALE Group,MEDLINE,Pro-Quest,Pscyhinfo,Pubmed,SCOPUS,Web of Science,WorldCat),using terms designed to identify qualitative studies of experiences of diabetes in SSA.Findings from records identified in the search were analysed inductively in NVivo 10 in three stages,to produce an analytical synthesis of studies of diabetes experiences in SSA.Results:Searches were conducted in 2017 and identified 2743 records,which were reduced to 21 after screening.The earliest identified record was published in 2003 and there was a clustering of records published between 2014 and 2016.The 21 records were based in eight SSA countries:Cameroon,Ethiopia,Ghana,Senegal,South Africa,Tanzania,Uganda,and Zimbabwe.A majority of the studies were conducted in Ghana(5)and South Africa(5),limiting the generalisability of our findings.The analytical synthesis produced five themes:identifying type 2 diabetes(how participants conceptualise and position their illnesses);hybridity of diabetes care(how multiple forms of care are often blended and/or pursued concurrently);impediments,improvisation and diabetes management(describing challenges faced,how these are responded to and management via diet and physical activity);sources of support(who supports participants and how);and diabetes and HIV/AIDs(the ways in which the two conditions are sometimes confused and how stigma is often experienced).Conclusions:The experiences of people with type 2 diabetes in SSA are under-researched across the region,pointing to a gap in knowledge.Interpreting our analytical synthesis,we suggest three priority areas for policy makers and implementers.Firstly,uncertainties relating to access to diabetes treatment need to be reduced.Secondly,more needs to be done to acknowledge and alleviate the economic struggles that those with diabetes face.Finally,high-quality information and education would improve recognition and management of the condition.

医疗系统管理共病患者遇到的挑战

共病现象越来越引起重视,给全世界的医疗系统带来巨大挑战。共病与衰老有关。但是,现在许多研究证明其是一种社会形态。这种社会形态在社会经济高度落后的地区正在变得普遍且患病年龄也逐年降低。目前关于此方向的研究并不充足。多数指南均是根据单一症状制定。过多给药在共病患者中十分常见,其引起的药品-疾病和药品-药品之间相互影响正在增加。共病患者需要全面的护理。但是二级护理通常相当专业化,共病患者护理过程常被打断,护理工作量加倍,从而使得共病患者的治疗费用增加。共病患者的医疗费用高通常是由于高频率的初级与二级护理咨询和计划外的入院治疗造成。精神问题与身体状况的结合增加了护理的支出及其复杂性。精神疾病与生理疾病共患在物质匮乏地区尤为常见。全科医师和基层护理团队通过运用以患者为中心的多种方法在管理共病患者中扮演着重要的角色。为了提高患者的生活质量,会诊的时长和护理的连续性应该被充分地加强。为了有效地应对这些挑战,医疗系统组织和资金运用的方式需要做出巨大的改变。

Methological Quality of Systematic Reviews and Meta-Analyses on Acupuncture for Stroke: A Review of Review

Objective： To assess the methodological quality of systematic reviews and meta-analyses regarding acupuncture intervention for stroke and the primary studies within them. Methods： Two researchers searched Pub Med, Cumulative index to Nursing and Allied Health Literature, Embase, ISI Web of Knowledge, Cochrane, Allied and Complementary Medicine, Ovid Medline, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang and Traditional Chinese Medical Database to identify systematic reviews and meta-analyses about acupuncture for stroke published from the inception to December 2016. Review characteristics and the criteria for assessing the primary studies within reviews were extracted. The methodological quality of the reviews was assessed using adapted Oxman and Guyatt Scale. The methodological quality of primary studies was also assessed. Results： Thirty-two eligible reviews were identified, 15 in English and 17 in Chinese. The English reviews were scored higher than the Chinese reviews（P=0.025）, especially in criteria for avoiding bias and the scope of search. All reviews used the quality criteria to evaluate the methodological quality of primary studies, but some criteria were not comprehensive. The primary studies, in particular the Chinese reviews, had problems with randomization, allocation concealment, blinding, dropouts and withdrawals, intent-to-treat analysis and adverse events. Conclusions： Important methodological flaws were found in Chinese systematic reviews and primary studies. It was necessary to improve the methodological quality and reporting quality of both the systematic reviews published in China and primary studies on acupuncture for stroke.

卫生经济学评价报告标准共识（CHEERS）声明

卫生干预的经济学评价对报告提出特殊挑战,有必要统一和更新已有的指南并促进其以一种用户友好的方式使用。卫生经济学评价报告标准共识（CHEERS）声明是对以前的卫生经济学评价指南的继承和更新，并将其转化为与时俱进的实用报告指南，CHEERS声明的主要读者是报告经济学评价结果的研究人员和评估经济学评价结果的编辑和审稿人。对医学编辑的调查确定了需要新的报告指南，基于系统综述创建了可能的条目清单。之后进行了两轮改进的德尔菲专家咨询，这些专家来自学术界、临床医生、企业、政府和编辑。从44个候选条目中确定了24个条目及建议。这些建议包含在一个用户友好的24条目清单里。声明、清单和这个报告可在ISPOR网站的卫生经济学评价指南工作组网站上找到 （www. ispor, org/TaskForces/EeonomicPub （;uidelines. asp ）我们希望CHEERS带来更好的报告，最终带来更好的卫生决策，为了便于传播和获取，CHEERS声明刊登在10种卫生经济学和医学期刊上。我们鼓励其他期刊和团体支持CHEERS。作者团队计划在5年后更新清单，卫生经济学评价是用来辅助资源分配决策的，经济学评价被定义为“依照它们的成本和效果对可供选择的行动方案进行比较分析”,所有经济学评价都评估成本，但测量和评估健康干预效果的方法可能有所不同（框图1）。经济学评价已广泛应用于卫生政策，包括干预项目（如疫苗接种、筛检和健康促进）、诊断、治疗（如药物和外科手术）、护理和康复的评估。经济学评价越来越多地用于决策，并且是国际卫生技术评估项目的一个重要组成部分^2。