Pragmatic multicentre stepped-wedge cluster randomised trial to investigate the effectiveness of community-based falls prevention programme for older adults with falls risk in Singapore: a protocol paper.

INTRODUCTION: Falls are an important public health issue with consequences that include injuries, quality of life reduction and high healthcare costs. Studies show that falls prevention strategies are effective in reducing falls rate among community-dwelling older adults. However, the evaluation for effectiveness was usually done in a controlled setting with homogeneous population, and thus may not be generalisable to a wider population. This study aims to evaluate the impact of community falls prevention programmes with group-based strength and balance exercises, on falls risk and health outcomes for older adults with falls risk in Singapore. METHODS AND ANALYSIS: This is a pragmatic closed cohort stepped-wedge cluster randomised trial design study, which involves sequential crossover of clusters from the waitlist control condition to the intervention condition, with the sequence of crossover randomly determined. The intervention will be sequentially rolled out to 12 clusters (a minimum of 5 participants/cluster), over 6 time periods with 8-week intervals in Central and North regions of Singapore. The primary analysis will be conducted under the intention-to-treat principle. A general linear mixed model or generalised estimating equation analysis appropriate for a multilevel longitudinal study incorporating an appropriate error distribution and link function will be used. Markov model will be developed to estimate the incremental cost per quality-adjusted life years and incremental cost per fall prevented from the implementation of falls prevention strategies from a societal perspective. Conditional on there being clinically relevant differences in short-term outcomes, we will implement simulation modelling to project the long-term divergence in trajectories for outcomes and costs using the Markov model. ETHICS AND DISSEMINATION: Ethics approval has been obtained. Results will be disseminated in publications and other relevant platforms. TRIAL REGISTRATION NUMBER: NCT04788251.

Use of eco-mapping in health services research: a scoping review protocol.

INTRODUCTION: People with complex health and social needs often require care from different providers and services. Identifying their existing sources of support could assist with addressing potential gaps and opportunities for enhanced service delivery. Eco-mapping is an approach used to visually capture people's social relationships and their linkages to the larger social systems. As it is an emerging and promising approach in the health services field, a scoping review on eco-mapping is warranted. This scoping review aims to synthesise the empirical literature that has focused on the application of eco-mapping by describing characteristics, populations, methodological approaches and other features of eco-mapping in health services research. METHODS AND ANALYSIS: This scoping review will follow the Joanna Briggs Institute methodology. From the date of database construction to 16 January 2023, the following databases in English will be searched: Ovid Medline, Ovid Embase, CINAHL Ultimate (EBSCOhost), Emcare (Ovid), Cochrane Central Register of Controlled Trials (Ovid) and Cochrane Database of Systematic Reviews (Ovid) Study/Source of Evidence selection. The inclusion criteria consist of empirical literature that uses eco-mapping or a related tool in the context of health services research. Two researchers will independently screen references against inclusion and exclusion criteria using Covidence software. Once screened, the data will be extracted and organised according to the following research questions: (1) What research questions and phenomena of interest do researchers address when using eco-mapping? (2) What are the characteristics of studies that use eco-mapping in health services research? (3) What are the methodological considerations for eco-mapping in health services research? ETHICS AND DISSEMINATION: This scoping review does not require ethical approval. The findings will be disseminated through publications, conference presentations and stakeholder meetings. TRIAL REGISTRATION NUMBER: https://doi.org/10.17605/OSF.IO/GAWYN.

JBI systematic review protocol of text/opinions on how to best collect race-based data in healthcare contexts.

INTRODUCTION: Racialized population groups have worse health outcomes across the world compared with non-racialized populations. Evidence suggests that collecting race-based data should be done to mitigate racism as a barrier to health equity, and to amplify community voices, promote transparency, accountability, and shared governance of data. However, limited evidence exists on the best ways to collect race-based data in healthcare contexts. This systematic review aims to synthesize opinions and texts on the best practices for collecting race-based data in healthcare contexts. METHODS AND ANALYSES: We will use the Joanna Briggs Institute (JBI) method for synthesizing text and opinions. JBI is a global leader in evidence-based healthcare and provides guidelines for systematic reviews. The search strategy will locate both published and unpublished papers in English in CINAHL, Medline, PsycINFO, Scopus and Web of Science from 1 January 2013 to 1 January 2023, as well as unpublished studies and grey literature of relevant government and research websites using Google and ProQuest Dissertations and Theses. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement methodology for systematic reviews of text and opinion will be applied, including screening and appraisal of the evidence by two independent reviewers and data extraction using JBI's Narrative, Opinion, Text, Assessment, Review Instrument. This JBI systematic review of opinion and text will address gaps in knowledge about the best ways to collect race-based data in healthcare. Improvements in race-based data collection, may be related to structural policies that address racism in healthcare. Community participation may also be used to increase knowledge about collecting race-based data. ETHICS AND DISSEMINATION: The systematic review does not involve human subjects. Findings will be disseminated through a peer-reviewed publication in JBI evidence synthesis, conferences and media. PROSPERO REGISTRATION NUMBER: CRD42022368270.

Mix Method Study Of Acceleration Of Vaccination Acceptance In Community In Polewali And Campalagian Districts

Objectives: This study examined the effectivity of subsystem components in community which could accept the acceleration of Covid-19 vaccine in Polman Region, therefore it becomes information for decision makers to create better health service management which is equal for everyone. Methods: this study applied mix method exploratory design which was conducted in two respective phases: qualitative and quantitative study. Qualitative study was conducted through focus group discussion on 3 target groups (primary, secondary and tertiary) to identify themes, ideas, perspectives, and believes, which became part of quantitative study to be explored. In quantitative study, 133 respondents were recruited from two boarding schools in the target area. Indepth interview and Focus group Discussion were used to collect data in the qualitative method. Quantitative study used descriptive statistics to describe information with frequency distribution. Results: The main results prove that there were relations between the variables found in the two methods which were significant and there was no internal conflict between the qualitative and quantitative findings. The result of the analysis found that the vaccine acceleration model which can be carried out namely involving local organizations and social groups in the COVID-19 information education system as well as taking preventive measures such as vaccination, and it will also be very effective if there were social relationships between individuals who were able to disseminate information about the importance of maintaining health protocols and also to conduct vaccinations in every level of society that could increase trust and follow-up for those who were still doubt about COVID-19 or about government's recommendation for vaccination. Conclusions: We conclude that each dimension of the social ecology and Health Belief Model was found to be consistent in both qualitative and quantitative research findings. [ FROM AUTHOR] Copyright of Journal of Pharmaceutical Negative Results is the property of ResearchTrentz and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Observational study of organisational responses of 17 US hospitals over the first year of the COVID-19 pandemic.

OBJECTIVES: The COVID-19 pandemic has required significant modifications of hospital care. The objective of this study was to examine the operational approaches taken by US hospitals over time in response to the COVID-19 pandemic. DESIGN, SETTING AND PARTICIPANTS: This was a prospective observational study of 17 geographically diverse US hospitals from February 2020 to February 2021. OUTCOMES AND ANALYSIS: We identified 42 potential pandemic-related strategies and obtained week-to-week data about their use. We calculated descriptive statistics for use of each strategy and plotted percent uptake and weeks used. We assessed the relationship between strategy use and hospital type, geographic region and phase of the pandemic using generalised estimating equations (GEEs), adjusting for weekly county case counts. RESULTS: We found heterogeneity in strategy uptake over time, some of which was associated with geographic region and phase of pandemic. We identified a body of strategies that were both commonly used and sustained over time, for example, limiting staff in COVID-19 rooms and increasing telehealth capacity, as well as those that were rarely used and/or not sustained, for example, increasing hospital bed capacity. CONCLUSIONS: Hospital strategies during the COVID-19 pandemic varied in resource intensity, uptake and duration of use. Such information may be valuable to health systems during the ongoing pandemic and future ones.

Decisional needs assessment for patient-centred pain care in Canada: the DECIDE-PAIN study protocol.

INTRODUCTION: The 2021 Action Plan for Pain from the Canadian Pain Task Force advocates for patient-centred pain care at all levels of healthcare across provinces. Shared decision-making is the crux of patient-centred care. Implementing the action plan will require innovative shared decision-making interventions, specifically following the disruption of chronic pain care during the COVID-19 pandemic. The first step in this endeavour is to assess current decisional needs (ie, decisions most important to them) of Canadians with chronic pain across their care pathways. METHODS AND ANALYSIS: DesignGrounded in patient-oriented research approaches, we will perform an online population-based survey across the ten Canadian provinces. We will report methods and data following the CROSS reporting guidelines.SamplingThe Léger Marketing company will administer the online population-based survey to its representative panel of 500 000 Canadians to recruit 1646 adults (age ≥18 years old) with chronic pain according to the definition by the International Association for the Study of Pain (eg, pain ≥12 weeks). ContentBased on the Ottawa Decision Support Framework, the self-administered survey has been codesigned with patients and contain six core domains: (1) healthcare services, consultation and postpandemic needs, (2) difficult decisions experienced, (3) decisional conflict, (4) decisional regret, (5) decisional needs and (6) sociodemographic characteristics. We will use several strategies such as random sampling to improve survey quality. AnalysisWe will perform descriptive statistical analysis. We will identify factors associated with clinically significant decisional conflict and decision regret using multivariate analyses. ETHICS AND DISSEMINATION: Ethics was approved by the Research Ethics Board at the Research Centre of the Centre Hospitalier Universitaire de Sherbrooke (project #2022-4645). We will codesign knowledge mobilisation products with research patient partners (eg, graphical summaries and videos). Results will be disseminated via peer-reviewed journals and national and international conferences to inform the development of innovative shared decision-making interventions for Canadians with chronic pain.

"Constrained medical oxygen supply chain in India during COVID-19: Red-tapism, the elephant in the room?"

BACKGROUND: Recent disruption of medical oxygen during second wave of COVID-19 has caused nationwide panic. This study attempts to objectively analyze the medical oxygen supply chain in India along the principles of value stream mapping (VSM), identify bottlenecks and recommend systemic improvements. METHODOLOGY: Process mapping of the medical oxygen supply chain in India was done. Different licenses & approvals, their conditions, compliances, renewals among others were factored-in. All relevant circulars (Government Notices), official orders, amendments and gazette notifications pertaining to medical oxygen from April 2020-April 2021 were studied and corroborated with information from Petroleum & Explosives Safety Organization (PESO) official website. FINDINGS: Steps of medical oxygen supply chain right from oxygen manufacture to filling, storage and transport up to the end users; have regulatory bottlenecks. Consequently flow of materials is sluggish and very poor information flow has aggravated the inherent inefficiencies of the system. Government of India has been loosening regulatory norms at every stage to alleviate the crisis. CONCLUSION: Regulatory bottlenecks have indirectly fueled the informal sector over the years, which is not under Government's control with difficulty in controlling black-marketing and hoarding. Technology enabled, data-driven regulatory processes with minimum discretionary human interface can make the system more resilient.

ATA2023Annual Conference & ExpoMarch 4–6, 2023San Antonio, Texas

The results suggest that male patients are 12% less likely than females to use telehealth;patients aged 18-44 are 32% more likely to use telehealth than the age group of 65+. For patients in household with between 3 and 10 members, income is significantly (p-value <0.01) associated patients using telehealth across poverty levels B Conclusions: b COVID-19 magnified the burden of telehealth inequities in the low-income communities. Of 13,933 eligible patients, 6,843 (49.1%) patients scheduled a visit, with higher success secondary to reaching the patient within 72 hours post-discharge. B Classification of Research: b Quality Improvement B Method: b Randomized Controlled Trial B Results: b 294 patients with recent SI-A were randomized to either: control (treatment as usual, n = 98), patient alert (patient receives a text message reminder to schedule a follow-up, n = 95), or clinician alert (clinician receives an email alert to complete a check-in call with the at-risk, n = 101). Graph: tmj.2023.29089.s figure1.jpg "In support of improving patient care, this activity has been planned and implemented by the Renal Physicians Association and the University of Virginia School of Medicine and School of Nursing is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.". [Extracted from the article] Copyright of Telemedicine & e-Health is the property of Mary Ann Liebert, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Rhode Island Young Adult Survey Reveals Mental Health Crisis

The article reveals the mental health crisis among young adults, according to the Rhode Island Young Adult Survey. Topics discussed include vulnerability of young adults as they face social and emotional challenges, COVID-19 pandemic as an added stressor of young adulthood, increase in anti-Asian sentiment, xenophobia and racial discrimination exacerbated by the COVID-19 pandemic that lead to traumatic stress and psychopathology, and harm caused by technology to mental health.

Changing from face-to-face to virtual meetings due to the COVID-19 pandemic: protocol for a mixed-methods study exploring the impact on cancer multidisciplinary team (MDT) meetings.

INTRODUCTION: In the UK, the National Cancer Plan (2000) requires every cancer patient's care to be reviewed by a multidisciplinary team (MDT). Since the introduction of these guidelines, MDTs have faced escalating demands with increasing numbers and complexity of cases. The COVID-19 pandemic has presented MDTs with the challenge of running MDT meetings virtually rather than face-to-face.This study aims to explore how the change from face-to-face to virtual MDT meetings during the COVID-19 pandemic may have impacted the effectiveness of decision-making in cancer MDT meetings and to make recommendations to improve future cancer MDT working based on the findings. METHODS AND ANALYSIS: A mixed-methods study with three parallel phases:Semistructured remote qualitative interviews with ≤40 cancer MDT members.A national cross-sectional online survey of cancer MDT members in England, using a validated questionnaire with both multiple-choice and free-text questions.Live observations of ≥6 virtual/hybrid cancer MDT meetings at four NHS Trusts.Participants will be recruited from Cancer Alliances in England. Data collection tools have been developed in consultation with stakeholders, based on a conceptual framework devised from decision-making models and MDT guidelines. Quantitative data will be summarised descriptively, and χ2 tests run to explore associations. Qualitative data will be analysed using applied thematic analysis. Using a convergent design, mixed-methods data will be triangulated guided by the conceptual framework.The study has been approved by NHS Research Ethics Committee (London-Hampstead) (22/HRA/0177). The results will be shared through peer-reviewed journals and academic conferences. A report summarising key findings will be used to develop a resource pack for MDTs to translate learnings from this study into improved effectiveness of virtual MDT meetings.The study has been registered on the Open Science Framework (https://doi.org/10.17605/OSF.IO/D2NHW).

Gaining consensus on clinical quality outcomes for eating disorders: Framework for the development of an Australian national minimum dataset.

OBJECTIVES: Eating disorders (EDs) are complex psychiatric illnesses requiring multidisciplinary care across both mental and medical healthcare settings. Currently, no nationally comprehensive, consistent, agreed on or mandated data set or data collection strategy exists for EDs in Australia: thus, little is known about the outcomes of care nor treatment pathways taken by individuals with EDs. InsideOut Institute was contracted by the Australian Government Department of Health to develop a minimum dataset (MDS) for the illness group with consideration given to data capture mechanisms and the scoping of a national registry. DESIGN: A four-step modified Delphi methodology was used, including national consultations followed by three rounds of quantitative feedback by an expert panel. SETTING: Due to social distancing protocols throughout the global SARS-CoV-2 pandemic, the study was conducted online using video conferencing (Zoom and Microsoft Teams) (Step 1), email communication and the REDCap secure web-based survey platform (Steps 2-4). PARTICIPANTS: 14 data management organisations, 5 state and territory government departments of health, 2 Aboriginal and Torres Strait Islander advising organisations and 28 stakeholders representing public and private health sectors across Australia participated in consultations. 123 ED experts (including lived experience) participated in the first quantitative round of the Delphi survey. Retention was high, with 80% of experts continuing to the second round and 73% to the third. MAIN OUTCOME MEASURES: Items and categories endorsed by the expert panel (defined a priori as >85% rating an item or category 'very important' or 'imperative'). RESULTS: High consensus across dataset items and categories led to the stratification of an identified MDS. Medical status and quality of life were rated the most important outcomes to collect in an MDS. Other items meeting high levels of consensus included anxiety disorders, depression and suicidality; type of treatment being received; body mass index and recent weight change. CONCLUSIONS: Understanding presentation to and outcomes from ED treatment is vital to drive improvements in healthcare delivery. A nationally agreed MDS has been defined to facilitate this understanding and support improvements.

Implementing a State-Funded Peer-Run Mental Health Warmline During the COVID-19 Pandemic

The advent of COVID-19 was associated with an upsurge of "warmlines," or telephone lines staffed by non-clinicians that provide non-crisis mental health support. This paper describes a state-funded warmline initiative that was part of a public health approach to mitigating the harms of COVID-19 among people living with mental illness.

Stress load and volunteer motivation of patient volunteers in Fangcang shelter hospitals in Shanghai, China during the COVID-19 pandemic: a cross-sectional survey.

OBJECTIVES: This study aims to assess the volunteer motivation and stress load of patient volunteers in the Fangcang shelter hospitals (FSHs), examine their associations, and explore the potential influence factors of volunteer motivation. DESIGN: Cross-sectional online survey conducted from 21 April to 20 May 2022. SETTING: Questionnaires were collected from patient volunteers selected by random cluster sampling in the FSHs in Shanghai, China. PARTICIPANTS: 197 participants who met the inclusion criteria as patients who were asymptomatic or presenting with mild symptoms in the FSHs and who volunteered to assist with routine work under quarantined settings. OUTCOME MEASURES: We investigated sociodemographic information, stress load and volunteer motivation through an online survey using the Volunteer Function Inventory and the Stress Overload Scale. Comparisons between groups were conducted by applying t-tests or analysis of variance. The correlation between volunteer motivation and stress was analysed by Pearson correlation. Influencing factors of volunteer motivation were determined by multivariable linear regression models. A value of p<0.05 was used to declare statistical significance. RESULTS: The mean score of volunteer motivation of patient volunteers was 73.24 (SD 12.00), while that of stress load was 46.08 (SD 21.28). The mean scores of the personal vulnerability (PV) and event load (EL), two dimensions of stress load, were 26.99 (SD 12.46) and 19.09 (SD 9.63), respectively. The majority of the participants (136, 69.04%) were grouped in the low (PV)-low (EL) stress category. Participants' volunteer motivation was negatively correlated with stress load (r=-0.238, p<0.001), as well as PV (r=-0.188, p<0.01) and EL (r=-0.283, p<0.001). Multivariable linear regression analysis identified that the potential influencing factors of volunteer motivation were occupation (B=1.100, 95% CI 0.037 to 2.164, p=0.043), health condition (B=-3.302, 95% CI -5.287 to -1.317, p<0.001) and EL (B=-0.434, 95% CI -0.756 to -0.111, p=0.009). Participants who worked in the public sector, had better health conditions and had lower EL were more likely to have higher volunteer motivation. CONCLUSIONS: Our study suggested that reducing stress load might be a possible pathway to encourage and maintain volunteerism in the FSH context. Implications and suggestions for future research on patient volunteer recruitment and management could be drawn from our findings.

General practitioners' perspectives on the management of refugee health: a qualitative study.

OBJECTIVE: To explore general practitioners' (GPs) perceptions of the challenges and facilitators to managing refugee healthcare needs in regional Australia. SETTING: A regional community in Australia involved in the resettlement of refugees. PARTICIPANTS: Nine GPs from five practices in the region. DESIGN: A qualitative study based on semistructured interviews conducted between September and November 2020. RESULTS: The main challenges identified surrounded language and communication difficulties, cultural differences and health literacy and regional workforce shortages. The main facilitators were clinical and community supports, including refugee health nurses and trauma counselling services. Personal benefits experienced by GPs such as positive relationships, satisfaction and broadening scope of practice further facilitated ongoing healthcare provision. CONCLUSIONS: Overall, GPs were generally positive about providing care to refugees. However, significant challenges were expressed, particularly surrounding language, culture and resources. These barriers were compounded by the regional location. This highlights the need for preplanning and consultation with healthcare providers in the community both prior to and during the settlement of refugees as well as ongoing support proportional to the increase in settlement numbers.

Global evidence of gender equity in academic health research: a scoping review.

OBJECTIVES: To chart the global literature on gender equity in academic health research. DESIGN: Scoping review. PARTICIPANTS: Quantitative studies were eligible if they examined gender equity within academic institutions including health researchers. PRIMARY AND SECONDARY OUTCOME MEASURES: Outcomes related to equity across gender and other social identities in academia: (1) faculty workforce: representation of all genders in university/faculty departments, academic rank or position and salary; (2) service: teaching obligations and administrative/non-teaching activities; (3) recruitment and hiring data: number of applicants by gender, interviews and new hires for various rank; (4) promotion: opportunities for promotion and time to progress through academic ranks; (5) academic leadership: type of leadership positions, opportunities for leadership promotion or training, opportunities to supervise/mentor and support for leadership bids; (6) scholarly output or productivity: number/type of publications and presentations, position of authorship, number/value of grants or awards and intellectual property ownership; (7) contextual factors of universities; (8) infrastructure; (9) knowledge and technology translation activities; (10) availability of maternity/paternity/parental/family leave; (11) collaboration activities/opportunities for collaboration; (12) qualitative considerations: perceptions around promotion, finances and support. RESULTS: Literature search yielded 94 798 citations; 4753 full-text articles were screened, and 562 studies were included. Most studies originated from North America (462/562, 82.2%). Few studies (27/562, 4.8%) reported race and fewer reported sex/gender (which were used interchangeably in most studies) other than male/female (11/562, 2.0%). Only one study provided data on religion. No other PROGRESS-PLUS variables were reported. A total of 2996 outcomes were reported, with most studies examining academic output (371/562, 66.0%). CONCLUSIONS: Reviewed literature suggest a lack in analytic approaches that consider genders beyond the binary categories of man and woman, additional social identities (race, religion, social capital and disability) and an intersectionality lens examining the interconnection of multiple social identities in understanding discrimination and disadvantage. All of these are necessary to tailor strategies that promote gender equity. TRIAL REGISTRATION NUMBER: Open Science Framework: https://osf.io/8wk7e/.

NASADAD update on Synar: Raising the age, and COVID‐19

The National Association of State Alcohol and Drug Abuse Directors (NASADAD) last week released an updated fact sheet for provisions of the Synar Amendment, including revisions made as a result of COVID‐19. The Synar Amendment, named for the late former Congressman Mike Synar (D‐Okla.), requires states to prohibit the sale or distribution of tobacco products to minors. The update, by NASADAD's Lacy Adams, noted the following events.

MH service delivery, 988 gratitude, on readers' minds in 2023

Editor's note: Last week in Mental Health Weekly's Annual 2023 Preview Issue, we featured some of your responses to the most pressing challenges and new opportunities that await you in the new year. Here are more of your responses. Thanks to all who submitted comments.