Real-world utility of overnight oximetry for the screening of obstructive sleep apnea in children.

BACKGROUND: Obstructive sleep apnea (OSA) is a common problem in children and can result in developmental and cognitive complications if untreated. The gold-standard tool for diagnosis is polysomnography (PSG); however, it is an expensive and time-consuming test to undertake. Overnight oximetry has been suggested as a faster and cheaper initial test in comparison to PSG as it can be performed at home using limited, reusable equipment. AIM: This retrospective case control study aims to evaluate the effectiveness of a home oximetry service (implemented in response to extended waiting times for routine PSG) in reducing the time between patient referral and treatment. METHODS: Patients undergoing diagnostic sleep evaluation for suspected OSA who utilized the Queensland Children's Hospital screening home oximetry service in the first year since its inception in 2021 (n = 163) were compared to a historical group of patients who underwent PSG in 2018 (n = 311). Parameters compared between the two groups included time from sleep physician review to sleep test, ENT review, and definitive treatment in the form of adenotonsillectomy surgery (or CPAP initiation for those who had already undergone surgery). RESULTS: The time from sleep physician review and request of the sleep-related study to ENT surgical treatment was significantly reduced (187 days for the HITH oximetry group vs 359 days for the comparable PSG group; p-value <0.05), and time from sleep study request to the report of results was significantly lower for patients in the oximetry group compared to those in the PSG group (11 days vs 105 days; p-value <0.05). CONCLUSION: These results suggest that for children referred to a tertiary sleep center for possible obstructive sleep disordered breathing, a home oximetry service can be effective in assisting sleep evaluation and reducing the time to OSA treatment.

Elements of the Design and Implementation of Interventions to Prevent Violence against Women and Girls Associated with Success: Reflections from the What Works to Prevent Violence against Women and Girls? Global Programme.

Intimate partner violence (IPV) has a large and sustained impact on women's mental health, and so effective prevention is critical. A review of 96 rigorous evaluations of interventions for their impact on violence against women and girls (mostly IPV) found that several intervention approaches were effective. However, not every evaluation of a 'successful approach' showed success in reducing IPV. In order to understand what else impacts success, we analysed practitioners' accounts and documentation of the design and implementation of seventeen interventions evaluated as part of What Works to Prevent Violence against Women and Girls (VAWG). Six features were identified as characteristics of all successful interventions: a rigorously planned intervention with a robust theory of change (ToC), attuned to the local context; addressing multiple drivers of VAWG; support for survivors; working with women and men; implementing at optimal intensity and having sufficient, well-selected, trained and supported staff and volunteers. Four features were necessary for success when relevant for the intervention approach: gender and social empowerment group activities and promoting positive interpersonal relations; participatory learning methods, emphasising empowerment, critical reflection and communication skills; carefully designed user-friendly manuals systematically followed; and when working with children, having an age-appropriate design with time for learning and an engaging pedagogy. This analysis provides the IPV prevention field with critical information for enhancing the impact of group- and community-based interventions in IPV prevention and through this strengthening women's mental health.

All aboard: users' experiences of adapted paddling programs.

PURPOSE: Research has yet to examine the experiences of paddle boarders, or of kayakers with disabilities other than spinal cord injuries. The goal of this study was to explore the experiences of kayakers and paddle boarders in two adaptive paddling programs. METHOD: Participants were children and adults requiring physical, cognitive, and/or psychosocial supports. Using an ethnographic approach, participant observations (n = 24) and semi-structured interviews (n = 11) were completed. Data were analyzed thematically. RESULT: We identified three main themes. "Different Strokes" described the personal meaning participants ascribed to aspects of paddling, including valuing fun, exercise and relaxation. "Turning the Tide" illustrated the process of becoming a paddler, from doubting capacity to feeling competent. "Headwinds" explored paddlers' interactions with the broader social, institutional, and economic environments, such as inadequate funding and program aversion to risk. CONCLUSIONS: Programs offering a variety of adaptive paddle boarding and kayaking configurations enable paddlers to make valued choices about their participation. In addition to providing equipment and support to meet paddlers' functional abilities, program developers and clinicians should also consider individual preferences for exercise, socialization, risk taking, self-presentation of disability, and independence.IMPLICATIONS FOR REHABILITATIONPeople living with physical, cognitive, and/or psychosocial impairments perceive kayaking and paddle boarding as meaningful activities offering opportunities to exercise, have fun, achieve goals, socialize, and/or relax on the water.Kayakers and paddle boarders value equipment options that meet their physical and disability-disclosure preferences.Despite the existence of adaptive paddling programs, participation may be restricted by program availability, risk management policies, and leisure funding.

"I got courage from knowing that even a daughter-in-law can earn her living": Mixed methods evaluation of a family-centred intervention to prevent violence against women and girls in Nepal.

BACKGROUND: We developed, and pilot tested a family focused intervention Sammanit Jeevan "Living with Dignity" to reduce gender-based violence by husbands, change harmful social and gender norms and improve the economic conditions of women through young married women-led income generating activities (IGAs). METHODS: We conducted a modified interrupted time series study and qualitative research to evaluate the intervention in two migrant communities in Baglung district, Nepal. We enrolled young married women, their husbands and in-laws from 100 families. 200 women and 157 men completed questionnaires before the programme, and 6, 12 and 18 months afterwards. 18 in-depth interviews were conducted before the programme and 6 and 12 months later. We analysed the data for trends. RESULTS: The intervention positively impacted young married women's economic conditions, exposure to violence and changed inequitable gender attitudes. Some positive outcomes were observed among older women and men. Young women's past month earnings (35.0% - 81.3%, ß = 0.11, p-value<0.001) and savings (29.0% - 80.2%, ß = 0.14, p-value<0.001) more than doubled over time. Young women experienced much less past year physical IPV over time (10% - 4.4%, ß = -0.08, p-value = 0.077). They also perceived that their mothers-in-law were less cruel (mean 9.0-8.6, ß = -0.03, p-value = 0.035). Improvements were observed in young women's individual (mean 44.4-43.3, ß = -0.04, p-value = 0.297) and perceived community gender attitudes (mean 54.4-51.4, ß = -0.19, p-value<0.001) and they reported that their husbands were less controlling (mean 17.5-16.1, ß = -007, p-value<0.001). These changes were supported by qualitative findings. CONCLUSIONS: Whilst caution is needed in attributing the effect due to lack of control arm, the results suggest that with adequate time and seed funding, Sammanit Jeevan enabled considerable income generation, a strengthened the position of young women in the households and it reduced their exposure to violence in this community. It warrants further research to optimise its impact.

Improving Incidental Finding Documentation in Trauma Patients Amidst Poor Access to Follow-up Care.

BACKGROUND: Incidental findings (IFs) are common among injured patients and create a complex problem with no standardized solution. MATERIALS AND METHODS: This is a retrospective review of adult trauma patients admitted to a level I trauma center from January to May 2017. IFs from abdominal, chest, and neck imaging were categorized based on previously published guidelines focused on clinically significant IFs. Patient demographics related to access to care were collected. Outcome measures included documentation and patient notification of IFs. A univariate analysis was performed to identify characteristics that were associated with these outcomes. RESULTS: Of 1671 patients, 682 met inclusion criteria, and 418 (61.3%) had any IF based on the a priori categorization scheme. In total, 67 (9.8%) were homeless, 58 (8.5%) had no health insurance, and 115 (16.9%) had no established primary care provider prior to admission. Documentation of IFs was included in discharge summaries and instructions 76.5% and 40.2% of the time, respectively. Physicians were statistically more likely to appropriately document IFs when radiologists provided specific recommendations. Transfer to another hospital service prior to discharge and discharge to another acute care facility were associated with reduced rates of successful documentation. No factors significantly affected documentation of patient notification. CONCLUSIONS: Trauma patients are at risk for poor access to follow-up care of IFs. Expanding IF-specific guidelines, collaborating with radiologists to facilitate their inclusion in reports, and ensuring that IFs are part of patient hand-offs could provide systematic methods of improving their documentation.

Factors associated with IPV victimisation of women and perpetration by men in migrant communities of Nepal.

This paper aims to describe the prevalent forms of intimate partner violence (IPV), and the factors associated with IPV among women and men living in the two migrant communities of Baglung district, Nepal. 357 adult women and men were enrolled following a family model, interviewing young married women with daughter-in-law status in the home, their husbands, and mothers-in-law and fathers-in-laws using an electronic questionnaire. Random effects regression modelling compared men and women, as well as young married women with daughter-in-law status and older women with mothers-in-law with status. 28.6% of women had ever experienced physical and/or sexual violence by an intimate partner compared to 18.2% of men ever perpetrated these forms of violence against their wives. Being older, male controlling behaviour and poor relations with husband increased women's IPV in their lifetime while perceptions that the mother-in-law is kind were protective. Being ashamed of being unemployed and childhood trauma were associated with men perpetrating IPV in their lifetime. Borrowing money or food increased young married women's lifetime IPV risk while mother-in-law cruelty and male control increased older married women's lifetime IPV exposure. Factors associated with IPV in the past year among men were being younger, job seeking, experiences of childhood trauma and depression exposure among men while difficulty accessing money for emergencies, holding inequitable gender attitudes, and depression was associated with women's increased IPV exposure. Unemployment stress, holding inequitable gender attitudes and mother-in-law kindness were associated with young women's increased IPV risk and hunger, mother-in-law cruelty and depression with older women's IPV risk. There is a need to critically challenge harmful social and gender norms by using approaches that are sensitive to young married women's position and unequal gender relations in the family. IPV prevention interventions need to employ a holistic approach that combines changing social and gender norms and improving socioeconomic conditions of women living in migrant communities.

A global comprehensive review of economic interventions to prevent intimate partner violence and HIV risk behaviours.

BACKGROUND: Intimate partner violence (IPV) and HIV are co-occurring global epidemics, with similar root causes of gender and economic inequalities. Economic interventions have become a central approach to preventing IPV and HIV. OBJECTIVE/METHODS: We undertook a comprehensive scoping review of published evaluations of economic interventions that sought to prevent IPV and/or HIV risk behaviours. RESULTS: Forty-five separate analyses of interventions met our criteria. Broadly, unconditional cash transfer interventions showed either flat or positive outcomes; economic strengthening interventions had mixed outcomes, with some negative, flat and positive results reported; interventions combining economic strengthening and gender transformative interventions tended to have positive outcomes. CONCLUSIONS: The review highlighted a number of gaps. Specifically, there were limited studies evaluating the impact of economic interventions on female sex workers, young women, and men. In addition, there were missed opportunities, with many evaluations only reporting either IPV- or HIV-related outcomes, rather than both, despite overlaps.

Improving the care of people with dementia in hospital.

The Dementia Champions Programme was set up in NHS Dumfries and Galloway, Scotland, to equip nurses with the skills and knowledge to improve the care of people with dementia in hospital. Nurses who complete the programme are known as dementia champions. This article describes the multi-faceted, educational approach to improving the care of adults with dementia.

Picasso Paintings, Moon Rocks, and Hand-Written Beatles Lyrics: Adults' Evaluations of Authentic Objects.

Authentic objects are those that have an historical link to a person, event, time, or place of some significance (e.g., original Picasso painting; gown worn by Princess Diana; your favorite baby blanket). The current study examines everyday beliefs about authentic objects, with three primary goals: to determine the scope of adults' evaluation of authentic objects, to examine such evaluation in two distinct cultural settings, and to determine whether a person's attachment history (i.e., whether or not they owned an attachment object as a child) predicts evaluation of authentic objects. We found that college students in the U.K. (N = 125) and U.S. (N = 119) consistently evaluate a broad range of authentic items as more valuable than matched control (inauthentic) objects, more desirable to keep, and more desirable to touch, though only non-personal authentic items were judged to be more appropriate for display in a museum. These patterns were remarkably similar across the two cultural contexts. Additionally, those who had an attachment object as a child evaluated objects more favorably, and in particular judged authentic objects to be more valuable. Altogether, these results demonstrate broad endorsement of "positive contagion" among college-educated adults.

The effect of divided attention on inhibiting the gravity error.

Children who could overcome the gravity error on Hood's (1995) tubes task were tested in a condition where they had to monitor two falling balls. This condition significantly impaired search performance with the majority of mistakes being gravity errors. In a second experiment, the effect of monitoring two balls was compared in the tubes task and a spatial transposition task not involving gravity. Again, monitoring two objects produced impaired search performance in the gravity task but not in the spatial transposition task. These findings support the view that divided attention disrupts the ability to exercise inhibitory control over the gravity error and that the performance drop on this task is not due to the additional task demands incurred by divided attention.

Development of a tissue viability nursing competency framework.

In 1999, a sub-group of the National Association for Tissue Viability Nurse Specialists (Scotland) agreed to lead the production of a competency framework. The aims were to define tissue viability specialist nursing, to provide a framework for tissue viability nurse specialists (TVNSs) that would form a basis for clinical supervision and mentorship, and to inform curricular for tissue viability education. Using a combination of models, a framework evolved which defines the multifaceted nature of the role. The framework lists competencies, which are further broken down into specific role elements, matched with measurable performance criteria for the TVNS. The competency statements that are provided within the publication describe the attitude, knowledge and skills required to fulfil the TVNS role. The document, 'A Route to Enhanced Competence for Tissue Viability Nurse Specialists', was published in June 2002. This initiative meets the national need for definition of specialist practice and provides a standard by which the public can be assured of quality care from TVNSs in Scotland.