Exploring our relationship with nature: A modified-Delphi study protocol.

Background: A vital element to understanding the the health and wellbeing of both humans and the environment is human-nature interactions. The biophilia hypothesis is referred to when discussing these interactions. This hypothesis suggests that due to evolution, humans have an innate urge to seek out nature. The concept of nature connectedness was developed from this hypothesis and is rooted in the belief that human identity and nature can be intertwined. This research aims to explore the intricate details of how an individual builds this connection in a meaningful way. Methods: This is done using a modified Delphi method. A Delphi study in its typical form aims to gather the consensus of a group of experts in a specific area of interest. This modified Delphi aims to break down the barrier between the public and the experts by creating a second category of participants referred to as our 'expanded experts.' Expand experts are described as individuals with lived experience of being connected to nature in the everyday. This category comprises of artists, city planners, activists and many more. This allows for a much more inclusive and real-world exploration of experiences. The participants will first take part in a semi-structured interview process to investigate their experiences of connecting with nature. Following a hybrid thematic analysis with both deductive and indictive coding will be applied to the interviews. These themes will be shared with participants for them to weigh the importance of the theme to the construct to allow a deeper understanding of our interactions with nature. Results: The results of this project will contribute to and shape the development of a state-of-the-art nature-connectedness scale. Furthermore, understanding how nature connectedness fits into our modern world will allow for more appropriate nature-based interventions for urban residents and beyond.

This interview-based study looks at the interaction's individuals have with the nature around them and how those interactions help them to feel connected to the natural world. Interviews are taking place with fellow researchers, as well as individuals who work with nature in their everyday. Some examples are nature-based therapists and practitioners, poets, artists, farmers and city planners to name a few. By undertaking this research, it is hoped that we will better understand what nature resources urban residents require in their areas to improve their overall health and wellbeing as well as how individuals interact with the resources the already have access to. The end goal is to produce a method to measure these interactions for future research and practical use.

Timely Assessment of Breathing-Related Distress in Community Palliative Care: A Multidisciplinary Collaborative Quality Improvement Project.

Background: Breathlessness is a common symptom for palliative patients that can cause distress and decrease function and quality of life. Palliative care services in Australia aim to routinely assess patients for breathing-related distress, but timely reassessment is not always achieved. Objective: To improve the timeliness of breathlessness reassessment in a home-based community palliative care service in New South Wales for people with moderate-to-severe breathing-related distress. Breathing-related distress was defined as a Symptom Assessment Score for "breathing problems" of four or more. Methods: This collaborative quality improvement (QI) project between SPHERE Palliative Care CAG, Stanford University mentors, and a Sydney metropolitan specialist palliative care service included a: (1) retrospective chart audit; (2) cause and effect analyses using a fishbone diagram; (3) development and implementation of key drivers and interventions; and (4) a pre-and-post evaluation of the timeliness of reassessment of breathing-related distress and changes in Symptom Assessment Scale scores for "breathing problems." Results: Key interventions included multidisciplinary education sessions to facilitate buy-in, with nurses as case managers responsible for breathlessness reassessment and documentation of scores, access and training in electronic palliative care data entry software, fortnightly monitoring and reporting of breathing-related distress scores, and development of an educational flowchart. The proportion of patients reassessed within seven days of an initial nursing assessment of moderate-to-severe breathing-related distress increased from 34% at baseline to 92% at six months. Conclusion: A local QI project increased the proportion of patients with a timely reassessment of their breathing-related distress in a community palliative care service.

Epidemiology and costs of dengue in Thailand: A systematic literature review.

BACKGROUND: Dengue is the fastest-spreading vector-borne viral disease worldwide. In Thailand, dengue is endemic and is associated with a high socioeconomic burden. A systematic literature review was conducted to assess and describe the epidemiological and economic burden of dengue in Thailand. METHODS: Epidemiological and economic studies published in English and Thai between 2011-2019 and 2009-2019, respectively, were searched in MEDLINE, Embase, and Evidence-Based Medicines reviews databases. Reports published by the National Ministry of Public Health (MoPH) and other grey literature sources were also reviewed. Identified studies were screened according to predefined inclusion and exclusion criteria. Extracted data were descriptively summarised and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: A total of 155 publications were included in the review (39 journal articles and 116 grey literature). Overall, dengue incidence varied yearly, with the highest rates per 100,000 population in 2013 (dengue fever (DF) 136.6, dengue haemorrhagic fever (DHF) 100.9, dengue shock syndrome (DSS) 3.58) and 2015 (DF 133.1, DHF 87.4, DSS 2.14). Peak incidence coincided with the monsoon season, and annual mortality was highest for DSS, particularly in the age group 15-24-year-olds. The highest dengue incidence rates were reported in children (10-14-year-olds) and young adults (15-24-year-olds), irrespective of dengue case definition. Economic and societal burdens are extensive, with the average cost per case ranging from USD 41 to USD 261, total cost per year estimated at USD 440.3 million, and an average of 7.6 workdays lost for DHF and 6.6 days for DF. CONCLUSIONS: The epidemiological, economic, and societal burden of dengue in Thailand is high and underreported due to gaps in national surveillance data. The use of expansion factors (EFs) is recommended to understand the true incidence of dengue and cost-benefit of control measures. Furthermore, as dengue is often self-managed and underreported, lost school and workdays result in substantial underestimation of the true economic and societal burden of dengue. The implementation of integrated strategies, including vaccination, is critical to reduce the disease burden and may help alleviate health disparities and equity challenges posed by dengue.

Epidemiology (2012-2019) and costs (2009-2019) of dengue in Malaysia: a systematic literature review.

OBJECTIVES: A systematic literature review was conducted to assess the epidemiology and economic burden of dengue in Malaysia. METHODS: Embase, MEDLINE, Evidence-Based Reviews databases, and gray literature sources were searched for English and Malay studies and surveillance reports on the epidemiology (between 2012 and 2019) and costs (between 2009 and 2019) of dengue in Malaysia. Independent screening of titles/abstracts, followed by full texts was performed using prespecified criteria. RESULTS: A total of 198 publications were included (55 peer-reviewed and 143 gray literature). Dengue incidence has been increasing in recent years, with 130,101 cases (dengue fever 129,578 cases; dengue hemorrhagic fever 523 cases) reported in 2019, which is the highest since 2012. All dengue virus serotypes co-circulated between 2004 and 2017, and major outbreaks occurred in a cyclical pattern, often associated with a change in the predominant circulating serotype. Economic impacts are substantial, including the societal impact of lost work (7.2-8.8 days) and school days (3.2-4.1 days) due to dengue. CONCLUSION: The rising incidence and high cost of dengue, coupled with overlapping diseases, will likely result in further pressures on the healthcare system. To appropriately mitigate and control dengue, it is critical to implement integrated strategies, including vaccination, to reduce the burden of dengue.

Epidemiology and costs of dengue in Brazil: a systematic literature review.

OBJECTIVES: Dengue infection is a growing public health problem, with the number of reported cases increasing in the Americas and worldwide. This review characterized the epidemiological and economic burden of dengue in Brazil. METHODS: Embase, MEDLINE, evidence-based review databases, and gray literature sources were searched for published literature and surveillance reports on epidemiology (between 2000 and 2019) and costs (between 2009 and 2019) of dengue in Brazil. Studies were included if they reported data on incidence, seroprevalence, serotype distribution, expansion factors, hospitalization, mortality, or costs. Data were summarized descriptively and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: A total of 344 publications were included (167 peer-reviewed and 177 gray literature). Dengue outbreaks increased in incidence and frequency, with the highest incidence observed in 2015 at 807 cases per 100,000 population. Outbreaks were related to alternating predominant serotypes. Dengue was more frequent in young adults (aged 20-39 years) and in the Midwest. Cost and societal impacts are substantial and varied across regions, age, and public/private delivery of healthcare services. CONCLUSION: The burden of dengue in Brazil is increasing and likely underestimated. Therefore, developing and implementing new strategies, including vaccination, is essential to reduce the disease burden.

Environmental regulation in transition: Policy officials' views of regulatory instruments and their mapping to environmental risks.

This study re-analysed 14 semi-structured interviews with policy officials from the UK Department for Environment, Food and Rural Affairs (Defra) to explore the use of a variety of regulatory instruments and different levels of risk across 14 policy domains and 18 separately named risks. Interviews took place within a policy environment of a better regulation agenda and of broader regulatory reform. Of 619 (n) coded references to 5 categories of regulatory instrument, 'command and control' regulation (n = 257) and support mechanisms (n = 118) dominated the discussions, with a preference for 'command and control' cited in 8 of the policy domains. A framing analysis revealed officials' views on instrument effectiveness, including for sub-categories of the 5 key instruments. Views were mixed, though notably positive for economic instruments including taxation, fiscal instruments and information provision. An overlap analysis explored officials' mapping of public environmental risks to instrument types suited to their management. While officials frequently cite risk concepts generally within discussions, the extent of overlap for risks of specific significance was low across all risks. Only 'command and control' was mapped to risks of moderate significance in likelihood and impact severity. These results show that policy makers still prefer 'command and control' approaches when a certainty of outcome is sought and that alternative means are sought for lower risk situations. The detailed reasons for selection, including the mapping of certain instruments to specific risk characteristics, is still developing.

Aging in Canada: state of the art and science.

Canada shares many similarities with other industrialized countries around the world, including a rapidly aging population. What sets Canada uniquely apart is the collaborative approach that has been enacted in the health care system and the aging research initiatives. Canada has tremendous pride in its publicly funded health care system that guarantees universal coverage for health care services on the basis of need, rather than ability to pay. It is also distinguished as a multicultural society that is officially bilingual. Aging research has developed rapidly over the past decade. In particular, the Canadian Longitudinal Study on Aging is one of the most comprehensive research platforms of its kind and is expected to change the landscape of aging research.

Evaluation of an evidence-based education program for health professionals: the Canadian Falls Prevention Curriculum© (CFPC).

INTRODUCTION: A staged, mixed methods approach was applied to the development and evaluation of an evidence-based education program for health care professionals and community leaders on how to design, implement and evaluate a fall prevention program. Stages included pre-development, development, pilot testing and impact on practice. The goal of the evaluation was to determine if the Canadian Falls Prevention Curriculum met the needs of the target audience and had an impact on learning and practice. METHODS: Methods included a needs assessment, systematic reviews, pre-post tests of learning, follow-up surveys and interviews, and descriptive reports of stakeholder involvement. The needs assessment and systematic review of existing programs indicated that there was a demand for a comprehensive, evidence-based curriculum on fall prevention and that no similar curricula existed. Pre-post test findings showed significant increases in learning and follow-up surveys showed a positive impact on practice. IMPACT ON INDUSTRY: Evidence shows that the most effective fall prevention efforts are those that address the multifactorial nature of fall risk, with proven interventions provided by trained clinicians. The Canadian Falls Prevention Curriculum provides evidence-based training for clinicians and community leaders using a public health approach to fall prevention that includes instruction on how to define the problem, assess the risk, examine best practices, implement the program, and conduct evaluation of the program's effectiveness.

Quality of life associated with adult day centers.

The purpose of this study was to describe the quality of life (QOL) of current adult day center (ADC) clients and their family caregivers in one region of Canada. Semi-structured interviews were conducted with 10 ADC clients and 10 caregivers. Data analysis used a modified constant comparative method. The major categories relating to QOL that emerged in the analysis included Physical Health and Well-Being, Social Networks/Relationships, Aging in Place, Safety, Respite, Activation, Respect and Inclusion, and Adequate Health Care Services. These themes are consistent with those of other studies of QOL of older adults. It was evident that ADCs played an important role in maintaining and improving the QOL of both the older adults and caregivers participating in this study.

Falls prevention training for community health workers: strategies and actions for independent living (SAIL).

This article describes a quasi-experimental study on falls prevention for clients of home support services in British Columbia, Canada. The study tested a nurse-designed multifactorial intervention, delivered by community health workers. The intervention consisted of 1 day of falls surveillance and prevention training for 51 community health workers, followed by 6 months of evidence-based interventions with their clients (n = 70) using a pretested Checklist and Action Plan. Study findings showed a 43% reduction (chi2 = 8.742, p < .01) in falls and a 44% reduction (chi2 = 5.739, p < .05) for fallers (those who fell once or more) from the 6-month preintervention period to postintervention. The proportion of falls resulting in any injury did not decrease; however, fractures were reduced from seven in the 6-month preintervention period to one following the intervention. The results indicate this intervention is an effective and inexpensive falls prevention strategy for frail recipients of home support services.

Home care or long-term care facility: factors that influence the decision.

In order to answer the research question--What factors determine if a long-term care client will be cared for at home or in a long-term care facility?--data were collected in five provinces in Canada in urban and rural sites, through focus groups with community care coordinators. A questionnaire provided information about the 89 participants and their workload. Factors are grouped under organizational, system, client, informal provider, formal provider, and case manager factors. Discussion focuses on changes needed to foster more long-term care in the home.

Ethical dilemmas in home care case management.

The role of case manager is fraught with challenges in a healthcare environment characterized by rapid aging of the population, a move against institutionalization of seniors, and the need to contain healthcare costs. This study examined experiences of 89 case managers through focus groups in five urban and five rural regions of Canada to identify ethical dilemmas and issues encountered in their role. Overall, the case managers expressed frustration for the lack of support for their work as evidenced by inadequate resources and few agency policies. The analysis of the focus group data revealed four main themes in relation to ethical concerns and dilemmas: (1) issues related to equity, (2) beneficence, (3) non-maleficence, and (4) autonomy and power imbalances. The situation facing these workers is grave and steps must be taken to provide them with ongoing training, support, and resources to continue in this vital role. System changes that would reduce some of the ethical conflicts experienced by case managers include funding for long-term care to keep pace with growing demands, better management of client waitlists to ensure that the most needy are given the highest priority, more supportive housing options that provide for some on-site coordination of services, better opportunities for health promotion, and better interdisciplinary teamwork so that case managers are not left making decisions in the absence of other key service providers.