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Background Methods Results Discussion Implications for the Profession The uptake of the health assessment for persons aged 75 years and older (75 + HA) remains low. Repeat assessments provide an opportunity to identify areas of change in cognitive function which may mark the onset of dementia. We aimed to explore general practitioner (GP) and practice nurse experiences of implementing the 75 + HA with a focus on clinical considerations for dementia care.An interpretative qualitative study involving interviews with 15 GPs (female = 11, male = 4) and 5 practice nurses (all female). Data were analysed using an inductive thematic approach.The majority of GPs (n = 11) worked in metropolitan settings and four GPs worked in regional settings across NSW. All participants worked in separate clinics, except for two GPs and one practice nurse who worked within the same metropolitan clinic. Distinct themes emerged regarding participants experiences of implementing the 75 + HA for patients with dementia: (1) negotiating aged care is complex and facilitated by a comprehensive assessment; (2) implementing work practices that support the 75 + HA in patients with cognitive decline; and (3) variations in follow up of findings and implications for care.The 75 + HA provides an opportunity for monitoring and acting on emergent physical and cognitive health changes. Increased engagement and support towards implementing the 75 + HA, particularly in the context of dementia, may facilitate the instigation of interventions. While some participants in this study were confident with identifying and managing cognitive decline, the majority relied on geriatricians to confirm dementia diagnosis and refer to community support services. We suggest the need for greater initiatives and clinical guidelines to assist GPs in the identification and management of cognitive decline.From a nursing perspective, this study highlights the valuable role of nurses towards assessment and management of issues raised in the health assessment for persons aged 75 years and older. However, more resources are needed to enable nurse time for adequate follow‐up care. [ABSTRACT FROM AUTHOR]

Abstract Introduction People with intellectual disability experience poorer health outcomes compared with the general population, partly due to the difficulties of accessing preventive care in primary care settings. There is good evidence that structured annual health assessments can enhance quality of care for people with intellectual disability, and their use has become recommended policy in several high-income countries. However, uptake remains low. The Theoretical Domains Framework (TDF) offers a conceptual structure for understanding barriers to implementation and has been usefully applied to inform implementation of health assessments for other high-need groups, but not for people with intellectual disability. We conducted a scoping review of the literature, using the TDF, to identify barriers and facilitators influencing primary care practitioners’ implementation of annual health assessments for people with intellectual disability as part of routine primary care practice. Methods This study was conducted according to the JBI methodological approach for scoping reviews. Searches were conducted in Medline (OVID-SP), Embase (OVID-SP), PsycINFO (OVID-SP), CINHAL (EBSCO), Scopus (Elsevier) and Web of Science (Clarivate) for relevant peer-reviewed publications up to May 2023. Screening, full-text review and data extraction were completed by two independent reviewers. Data were extracted and mapped to the TDF to identify relevant barriers and facilitators. Results The search yielded 1057 publications, with 21 meeting the inclusion criteria. Mapping data to the TDF, the most frequently identified domains were (a) environmental context and resources, (b) skills, (c) knowledge and (d) emotion. Predominant factors impacting on implementation included practitioners’ lack of awareness about health assessments and their identified benefits; inadequate training and experience by practitioners in the delivery of health assessments for people with intellectual disability; insufficient time to provide health assessments; and practitioner burnout. Conclusion Using a theory-informed behavioural framework, our review aids understanding of the barriers and facilitators to improving the implementation of health assessments as part of routine care for people with intellectual disability. However, there is a clear need for further qualitative research to examine the perceptions of primary care practitioners regarding implementation barriers and facilitators to health assessments in general, including views from practitioners who are not currently undertaking health assessments.

Introduction: People with intellectual disability experience poorer health outcomes compared with the general population, partly due to the difficulties of accessing preventive care in primary care settings. There is good evidence that structured annual health assessments can enhance quality of care for people with intellectual disability, and their use has become recommended policy in several high-income countries. However, uptake remains low. The Theoretical Domains Framework (TDF) offers a conceptual structure for understanding barriers to implementation and has been usefully applied to inform implementation of health assessments for other high-need groups, but not for people with intellectual disability. We conducted a scoping review of the literature, using the TDF, to identify barriers and facilitators influencing primary care practitioners' implementation of annual health assessments for people with intellectual disability as part of routine primary care practice. Methods: This study was conducted according to the JBI methodological approach for scoping reviews. Searches were conducted in Medline (OVID-SP), Embase (OVID-SP), PsycINFO (OVID-SP), CINHAL (EBSCO), Scopus (Elsevier) and Web of Science (Clarivate) for relevant peer-reviewed publications up to May 2023. Screening, full-text review and data extraction were completed by two independent reviewers. Data were extracted and mapped to the TDF to identify relevant barriers and facilitators. Results: The search yielded 1057 publications, with 21 meeting the inclusion criteria. Mapping data to the TDF, the most frequently identified domains were (a) environmental context and resources, (b) skills, (c) knowledge and (d) emotion. Predominant factors impacting on implementation included practitioners' lack of awareness about health assessments and their identified benefits; inadequate training and experience by practitioners in the delivery of health assessments for people with intellectual disability; insufficient time to provide health assessments; and practitioner burnout. Conclusion: Using a theory-informed behavioural framework, our review aids understanding of the barriers and facilitators to improving the implementation of health assessments as part of routine care for people with intellectual disability. However, there is a clear need for further qualitative research to examine the perceptions of primary care practitioners regarding implementation barriers and facilitators to health assessments in general, including views from practitioners who are not currently undertaking health assessments. [ABSTRACT FROM AUTHOR]

Historically, juvenile and subadult green (Chelonia mydas) and hawksbill (Eretmochelys imbricata) sea turtles have been observed in the waters surrounding St. Kitts, West Indies, year-round; however, no formal population or health assessment for these species and cohorts in St. Kitts has been previously conducted. During the study period (2004–2017), 211 juvenile sea turtles (158 hawksbills and 53 greens) were captured at 16 different capture sites in St. Kitts. Once turtles were on shore and restrained, morphometric measurements and mass were collected, untagged animals were tagged, and a health assessment was performed. Blood samples were collected and used to establish reference intervals for hematological and biochemical parameters. These reported reference intervals make it possible to incorporate monitoring programs for infectious diseases and to identify any trends in population and health status. The morphometrics, mass, and number of animals captured enable sound decision-making as it relates to conservation policy development and implementation, which is especially important in countries such as St. Kitts and Nevis where an open harvest for sea turtles still exists. [ABSTRACT FROM AUTHOR]

Health and wellness principles are included in pharmacy education outcomes and standards, supporting the importance of integrating these concepts within pharmacy curricula. The objective of this study was to describe the development, implementation, and assessment of an intensive community pharmacy-based health and wellness introductory pharmacy practice experience (IPPE) focused on immunizations and health assessments. The health and wellness IPPE was a required, one-week rotation developed to provide second-year student pharmacists with direct patient care opportunities to reinforce knowledge, skills, and abilities related to health and wellness principles. Students administered immunizations, performed hypertension and diabetes assessments, and provided education to patients at community pharmacy training sites. Students completed pre- and post-rotation self-assessments. Preceptors completed individual summative student performance evaluations and were surveyed to obtain IPPE feedback. One hundred forty-seven students completed the IPPE across 89 sites. The pre-post analysis of student self-assessment results found statistically significant improvement in student confidence across all survey items. The largest improvements were found within the immunization items, specifically for preparing and administering immunizations. Ninety-nine percent of students agreed or strongly agreed participation in IPPE activities improved their ability to contribute to patient care. Qualitative analysis revealed students gained confidence and skills after practicing in a real-world setting. The integration of the health and wellness IPPE within the curriculum resulted in increased student confidence in providing preventative care services. This study provides a solution to integrating health and wellness principles into pharmacy curricula to meet accreditation standards. [ABSTRACT FROM AUTHOR]

Background: Indigenous youth are navigating the transition from childhood to adulthood while contending with challenges of ongoing colonisation and everyday lived experiences of racism. A comprehensive assessment of Indigenous youth's health could enable early diagnosis and respond to health concerns. This narrative systematic review synthesises evidence about the acceptability and utility of primary health care-based health assessments for improving the health and wellbeing of Indigenous youth. Methods: A systematic search strategy was conducted using 20 electronic databases. Studies were included if they reported on health assessments conducted in primary health care with youth aged 12–24 years who were Indigenous to Australia, New Zealand, Canada, the USA, Taiwan, and the arctic regions of Scandinavia and Russia. A narrative synthesis was undertaken. Results: Of 3061 unique studies identified, seven met the eligibility criteria. Included studies showed that youth health assessments were useful for making new diagnoses, detecting social and emotional wellbeing concerns, and biomedical parameters. Co-created health assessments with Indigenous youth conducted by clinicians familiar to the community were well accepted. Digital health assessments administered using an electronic tablet provide advantages. No health outcomes were reported. Additionally, no health assessments addressed the impacts of colonisation and racism. Conclusion: There is insufficient evidence to make firm conclusions about the benefits of health assessments; however, health assessments can be useful for detecting new diagnoses and concerns regarding social determinants of health, and social and emotional wellbeing. Future development of Indigenous youth health assessments needs to involve Indigenous youth's perspectives and interpretations of health. Indigenous youth are navigating the transition from childhood to adulthood while contending with challenges of ongoing colonisation and everyday lived experiences of racism. A comprehensive assessment of Indigenous youths' health could enable early diagnosis and respond to health concerns. This narrative systematic review synthesises evidence about the acceptability and utility of primary health care-based health assessments for improving the health and wellbeing of Indigenous youth. [ABSTRACT FROM AUTHOR]

Aim: To investigate the effect of health assessments on permanent residential aged care admission for older Australian women with and without dementia. Methods: A total of 1427 older Australian women who had a health assessment between March 2002 and December 2013 were matched with 1427 women who did not have a health assessment in the same period. Linked administrative datasets were used to identify health assessment use, admission to permanent residential aged care, and dementia status. Outcome was time to residential aged care admission from the matched date of health assessment. Results: Women who had health assessments were less likely to be admitted to residential aged care in the short term (100 days), irrespective of dementia status (subdistribution hazard ratio [SDHR] = 0.35, 95% CI = [0.21, 0.59] for women with dementia; SDHR = 0.39, 95% CI = [0.25, 0.61] for women without dementia). However, there were no significant differences at 500‐ and 1000‐days follow‐up. At 2000‐days follow‐up, women who had a health assessment were more likely to be admitted to residential aged care, regardless of dementia status (SDHR = 1.41, 95% CI = [1.12, 1.79] for women with dementia; SDHR = 1.55, 95% CI = [1.32, 1.82] for women without dementia). Conclusions: Benefits from health assessments may depend on the recency of the assessment, with women less likely to be admitted to residential aged care in the short term after a health assessment. Our results add to a growing body of literature suggesting that health assessments may provide benefits to older people, including those with dementia. Geriatr Gerontol Int 2023; 23: 595–602. [ABSTRACT FROM AUTHOR]

To date, little is known regarding if and how healthy eating is discussed, and how the concept of healthy eating is used in everyday interactions of families with a low socioeconomic position (SEP). This is an underrepresented study population in which many health benefits can be gained. By deploying an interactional approach to healthy eating, this study explored how healthy eating is constructed and oriented to during evening mealtimes in families with a low SEP. The data corpus comprised video recordings of 79 mealtimes from ten families with a low SEP. Healthy eating was rarely oriented to explicitly, as shown by the identification of only sixteen cases in which family members referred to (un)healthy eating. Using discursive psychology and conversation analysis, the examination of these cases showed that, how and with what function health claims were produced and designed as either identity-centered health claims or food-centered health assessments. By deploying identity-centered health claims parents constructed a desired prospective identity for their children to manage their eating behavior, whereas by deploying food-centered health assessments speakers accounted for their own behavior, particularly eating or providing food. The findings give a unique insight into how healthy eating is oriented to and constructed in the everyday life of families with a low SEP. In addition, the findings extend the discursive psychological body of literature on healthy eating talk during family mealtimes, and add to the knowledge base on discursive practices deployed to get children to eat.

Beluga whales (Delphinapterus leucas) from Cook Inlet (CI), Alaska, are listed as “endangered” because of dramatic declines in abundance, with no indications of population recovery. Serum samples from this population are exceedingly rare. Longitudinal samples from aquarium (AQ) belugas can potentially provide health assessment reference ranges for free-ranging beluga, including reproductive and metabolic hormones. We analysed serum hormone concentrations from CI (n = 6, three females and three males) and Bristol Bay (Alaska; BB; n = 5, four males and one female), alongside AQ (n = 3, two females and one male) belugas, to conduct physiological comparisons of reproductive hormones (progesterone, testosterone and total oestrogens) and metabolic hormones (total thyroxine, triiodothyronine and cortisol) in beluga serum. Oestrogen and progesterone profiles from January through May from two AQ female beluga were typical of non-pregnant, cycling females. CI and BB sex steroid concentrations were within AQ hormone ranges, with the exception of elevated progesterone concentrations in four potentially pregnant females. Both CI and BB belugas had elevated metabolic hormones, which may indicate greater metabolic effort required in the wild environment or capture response. Because sample collection from CI belugas is rare, analysis of even the few samples that we analysed may contribute to the conservation of the small and declining population of genetically distinct CI beluga whales. It is important that each sample collected from free-range CI belugas provides the maximum biological information possible. Continued comparison of hormones in AQ and free-ranging beluga will enhance the interpretation of health data in both groups.

Abstract Objective: To assess the use of Medicare‐subsidised health services by women with and without dementia. Methods: Data from women of the 1921–26 birth cohort of the Australian Longitudinal Study on Women's Health were linked to various administrative datasets to ascertain dementia diagnosis. The use of subsidised general practitioner (GP) services (75+ health assessments [HAs], chronic disease management meetings [CDMs], multidisciplinary case conferences [MCCs]) and specialist and allied health services between 2000 and 2013 for these women was analysed using longitudinal GEE models. Results: A total of 9,683 women were included with 1,444 (15%) women identified as having dementia. Compared to women with no dementia indication, women with dementia had more yearly non‐emergency GP attendances (short [30 minutes] IRR=1.11 [1.04, 1.19]) and fewer specialist attendances (IRR=0.91 [0.85, 0.97]) and were more likely to have an emergency GP attendance (OR=2.29 [2.05, 2.57]). There were no significant differences in the odds of having either a HA or CDM or using allied health services for women with and without dementia indicators. Conclusions: The overall use of services designed to improve the prevention and coordination of the care of older people with chronic conditions was low. Women with dementia were no more likely to access these services. Implications for public health: There is underuse of some primary and allied healthcare services designed for people with complex chronic conditions. These could be better used by women with dementia to improve the management of complex comorbidities (e.g. CDMs), to prevent the onset of disability (e.g. physiotherapy), and enhance needs assessment and service access (e.g. HAs).

Beluga whales (Delphinapterus leucas) from Cook Inlet (CI), Alaska, are listed as "endangered" because of dramatic declines in abundance, with no indications of population recovery. Serum samples from this population are exceedingly rare. Longitudinal samples from aquarium (AQ) belugas can potentially provide health assessment reference ranges for free-ranging beluga, including reproductive and metabolic hormones. We analysed serum hormone concentrations from CI (n = 6, three females and three males) and Bristol Bay (Alaska; BB; n = 5, four males and one female), alongside AQ (n = 3, two females and one male) belugas, to conduct physiological comparisons of reproductive hormones (progesterone, testosterone and total oestrogens) and metabolic hormones (total thyroxine, triiodothyronine and cortisol) in beluga serum. Oestrogen and progesterone profiles from January through May from two AQ female beluga were typical of non-pregnant, cycling females. CI and BB sex steroid concentrations were within AQ hormone ranges, with the exception of elevated progesterone concentrations in four potentially pregnant females. Both CI and BB belugas had elevated metabolic hormones, which may indicate greater metabolic effort required in the wild environment or capture response. Because sample collection from CI belugas is rare, analysis of even the few samples that we analysed may contribute to the conservation of the small and declining population of genetically distinct CI beluga whales. It is important that each sample collected from free-range CI belugas provides the maximum biological information possible. Continued comparison of hormones in AQ and free-ranging beluga will enhance the interpretation of health data in both groups. [ABSTRACT FROM AUTHOR]

Health assessments (HAs) are available for community-dwelling older people to receive annually from general practitioners (GPs), but have low uptake. Little is known regarding the views of GPs and practice nurses (PNs) towards older person HAs and whether this might contribute to the low uptake. The objective of this study was to explore the attitudes of GPs and PNs towards older person HAs. Fifty-eight participant responses to an online questionnaire were analysed through descriptive statistics and content analysis. Most participants (77%) found older person HAs to be useful. Participants felt HAs identified health problems that may otherwise be missed (n = 21). The main barriers to delivery of HAs were patient refusal (n = 25) and insufficient practitioner time (n = 19). The most requested change to HAs was increased patient education and public awareness regarding older person HAs (n=10). Health professionals felt increased patient education and public awareness, particularly to address patient misconceptions regarding older person HAs, may improve HA uptake. [ABSTRACT FROM AUTHOR]

Soil geochemistry and phytoavailable trace elements were investigated in 80 paddy soil samples and corresponding rice grains from the Mekong River Delta in Vietnam. Soil parameters like Fe-, Al-, and Mn-phases, organic matter, and pH-value determine element concentrations in soil and affect their transfer into rice grains. Arsenic exceeded the allowed limit for Vietnamese agricultural soils in 11% of the samples, presumably caused by natural processes. Lead surpassed the limit in one soil sample. Other toxic elements were close to their natural concentrations and far below allowable limits for agricultural soil. There was no clear correlation of trace element concentrations in soils with those in corresponding grains, even if the different soil parameters and the large pH-range between 3.7 and 6.8 were considered. To assess health risks of critical elements in rice, the thresholds of tolerable upper intake level for total food and drinking water (UL) and of permissible maximum concentration (MC) for rice grains were evaluated. Surprisingly, rice grains grown on non- or low-polluted soils can surpass the upper limits. According to the UL concept, 12% of the grains exceeded the UL of As, 29% that of Cd, and 27% that of Pb for each gender. According to the MC concept, 5% of the rice grains exceeded the MC of inorganic As for adults and 38% that for young children. 24% of the grains surpassed the MC of Pb, while Cd in all grains was below the MC. The differing results of the UL and MC approaches show an urgent need for revision and harmonization concerning As, Cd, and Pb limits, especially regarding countries with high rice consumption. [ABSTRACT FROM AUTHOR]

Abstract Background The organisation of health assessments by preventive health services focusing on children’s health and educational performance needs to be improved due to evolving health priorities such as mental health problems, reduced budgets and shortages of physicians and nurses. We studied the impact on the school professionals’ perception of access to school health services (SHS) when a triage approach was used for population-based health assessments in primary schools. The triage approach involves pre-assessments by SHS assistants, with only those children in need of follow-up being assessed by a physician or nurse. The triage approach was compared with the usual approach in which all children are assessed by physicians and nurses. Methods We conducted a cross-sectional study, comparing school professionals’ perceptions of the triage and the usual approach to SHS. The randomly selected school professionals completed digital questionnaires about contact frequency, the approachability of SHS and the appropriateness of support from SHS. School care coordinators and teachers were invited to participate in the study, resulting in a response of 444 (35.7%) professionals from schools working with the triage approach and 320 (44.6%) professionals working with the usual approach. Results Respondents from schools using the triage approach had more contacts with SHS and were more satisfied with the appropriateness of support from SHS than respondents in the approach-as-usual group. No significant differences were found between the two groups in terms of the perceived approachability of SHS. Conclusions School professionals were more positive about access to SHS when a triage approach to routine assessments was in place than when the usual approach was used. Countries with similar population-based SHS systems could benefit from a triage approach which gives physicians and nurses more opportunities to attend schools for consultations and assessments of children on demand.

Background: In the context of a syphilis outbreak in neighboring states, a multifaceted systems change to increase testing for sexually transmitted infections (STIs) among young Aboriginal people aged 15 to 29 years was implemented at an Aboriginal Community Controlled Health Service (ACCHS) in New South Wales, Australia. The components included electronic medical record prompts and automated pathology test sets to increase STI testing in annual routine health assessments, the credentialing of nurses and Aboriginal health practitioners to conduct STI tests independently, pathology request forms presigned by a physician, and improved data reporting., Objective: We aimed to determine whether the systems change increased the integration of STI testing into routine health assessments by clinicians between April 2019 and March 2020, the inclusion of syphilis tests in STI testing, and STI testing uptake overall. We also explored the understandings of factors contributing to the acceptability and normalization of the systems change among staff., Methods: We used a mixed methods design to evaluate the effectiveness and acceptability of the systems change implemented in 2019. We calculated the annual proportion of health assessments that included tests for chlamydia, gonorrhea, and syphilis, as well as an internal control (blood glucose level). We conducted an interrupted time series analysis of quarterly proportions 24 months before and 12 months after the systems change and in-depth semistructured interviews with ACCHS staff using normalization process theory., Results: Among 2461 patients, the annual proportion of health assessments that included any STI test increased from 16% (38/237) in the first year of the study period to 42.9% (94/219) after the implementation of the systems change. There was an immediate and large increase when the systems change occurred (coefficient=0.22; P=.003) with no decline for 12 months thereafter. The increase was greater for male individuals, with no change for the internal control. Qualitative data indicated that nurse- and Aboriginal health practitioner-led testing and presigned pathology forms proved more difficult to normalize than electronic prompts and shortcuts. The interviews identified that staff understood the modifications to have encouraged cultural change around the role of sexual health care in routine practice., Conclusions: This study provides evidence for the first time that optimizing health assessments electronically is an effective and acceptable strategy to increase and sustain clinician integration and the completeness of STI testing among young Aboriginal people attending an ACCHS. Future strategies should focus on increasing the uptake of health assessments and promote whole-of-service engagement and accountability., (©Heather McCormack, Handan Wand, Christy E Newman, Christopher Bourne, Catherine Kennedy, Rebecca Guy. Originally published in JMIR Medical Informatics (https://medinform.jmir.org), 30.11.2023.)

Background: The organisation of health assessments by preventive health services focusing on children's health and educational performance needs to be improved due to evolving health priorities such as mental health problems, reduced budgets and shortages of physicians and nurses. We studied the impact on the school professionals' perception of access to school health services (SHS) when a triage approach was used for population-based health assessments in primary schools. The triage approach involves pre-assessments by SHS assistants, with only those children in need of follow-up being assessed by a physician or nurse. The triage approach was compared with the usual approach in which all children are assessed by physicians and nurses.Methods: We conducted a cross-sectional study, comparing school professionals' perceptions of the triage and the usual approach to SHS. The randomly selected school professionals completed digital questionnaires about contact frequency, the approachability of SHS and the appropriateness of support from SHS. School care coordinators and teachers were invited to participate in the study, resulting in a response of 444 (35.7%) professionals from schools working with the triage approach and 320 (44.6%) professionals working with the usual approach.Results: Respondents from schools using the triage approach had more contacts with SHS and were more satisfied with the appropriateness of support from SHS than respondents in the approach-as-usual group. No significant differences were found between the two groups in terms of the perceived approachability of SHS.Conclusions: School professionals were more positive about access to SHS when a triage approach to routine assessments was in place than when the usual approach was used. Countries with similar population-based SHS systems could benefit from a triage approach which gives physicians and nurses more opportunities to attend schools for consultations and assessments of children on demand. [ABSTRACT FROM AUTHOR]

Land transformation reduced the habitat ofPsammobates geometricusto small isolated fragments, rendering the species vulnerable to extinction. Field biologists often use erythrocyte metrics to assess wildlife health but need baseline values to distinguish normal variations from disease or chronic stress. Here we characterise erythrocyte types and features ofP. geometricusand assess if age, sex and environmental fluctuations influence their frequencies and metrics. We collected blood from males, females and juveniles over four seasons to prepare smears for cytological evaluation. We treated the smears with May–Grünwald–Giemsa stains and used imaging software to measure size, shape and colour intensity of erythrocyte types. The blood of all groups contained immature, mature and senescent erythrocytes, and the appearance of each cell type corresponded to descriptions for other chelonians. Season had a strong effect on the occurrence of erythrocyte types and features with few group differences. The frequency of immature erythrocytes was high in winter and spring, the wet season, reflecting increased erythropoiesis. Mature erythrocytes dominated in summer and autumn, but frequencies of senescent cells, poikilocytosis, cytoplasmic inclusions and cytoplasmic vacuoles increased in autumn, indicating that water and food shortages caused physiological stress. The small size and elongated shape of summer and autumn erythrocytes would facilitate oxygen exchange when high temperatures increase metabolic needs of ectotherms. Lower temperatures and energy demands in the wet season counter the lower oxygen capacity of round, immature cells. Our results provide baseline information on erythrocyte physiology and metrics for health assessments of geometric tortoises. [ABSTRACT FROM AUTHOR]

Seventy-four males aged 13-16 years old cared for by local authorities took part in this study when they were cared for in a Scottish residential centre for young people with severe emotional and behavioural difficulties. This group of vulnerable young people are known to have poor health, educational and social outcomes (Residential Care Health Project, 2004, Scottish Government, 2014). Children and young people in local authority care feature on the agenda of all aspects of public care including health, social care, criminal justice and education. It was found that 44% of the young people's health records were not available at the time of their health assessment despite the fact that young people had on average at least four previous placements prior to being admitted to the Centre. While a range of systems have been put in place to improve the health outcomes of children in care, lack of such key information may compromise the assessment process. Over three observations (at admission, 12 and 24 weeks) the young people had a comprehensive health assessment where some positive differences were found in dental intervention, vision problems, immunisation uptake, reduction in alcohol, substance use and sexual health concerns. Between the first and last assessment there was a decrease in the number of young people who have a healthy Body Mass Index (BMI). [ABSTRACT FROM AUTHOR]

Background: National statistics have shown that only about 40% of asylum seekers actually attend the optional health assessment offered upon their arrival in Sweden, but the reasons for this have not been fully explored. Health assessments for newly arrived asylum seekers have become a regular practice in most EU countries, but what is performed, how it is organized and whether it is mandatory or not varies between countries. Aim: The aim of the study was to explore and improve our understanding of how former asylum seekers from Eritrea perceived and experienced the health assessment during their asylum-seeking process. Methods: We used a qualitative research approach guided by grounded theory. Semi-structured interviews were conducted with 11 former asylum seekers from Eritrea. Data were analysed based on constant comparative analysis. Findings: The asylum seekers expressed feelings of ambiguity and mistrust and felt that they were seen only as objects by the Swedish healthcare system during their asylum-seeking process. Poor communication and inability to overcome language and cultural barriers seemed to be the most important findings in the narratives. The core category was defined as ‘A state of limbo – in transition between two contexts’. Conclusions: There are reasons to believe that these issues with communication negatively affected both the quality of the health assessment and the number of asylum seekers attending the health assessment. Improved communication by the authorities towards the asylum seekers is, therefore, of vital importance. [ABSTRACT FROM AUTHOR]

Background The vast health inequities experienced by people with intellectual disability remain indisputable. Persistent and contemporary challenges exist for primary healthcare providers and researchers working to contribute to improvements to the health and wellbeing of people with intellectual disability. Over two decades after the only review of supports for primary healthcare providers was published, this paper contributes to an evolving research agenda that aims to make meaningful gains in health-related outcomes for this group. Methods The present authors updated the existing review by searching the international literature for developments and evaluations of multinational models of care. Results Based on our review, we present three strategies to support primary healthcare providers: (i) effectively using what we know, (ii) considering other strategies that offer support to primary healthcare professionals and (iii) researching primary health care at the system level. Conclusions Strengthening primary care by supporting equitable provision of health-related care for people with intellectual disability is a much needed step towards improving health outcomes among people with intellectual disability. More descriptive quantitative and qualitative research, as well as intervention-based research underpinned by rigorous mixed-methods evaluating these strategies at the primary care level, which is sensitive to the needs of people with intellectual disability will assist primary care providers to provide better care and achieve better health outcomes. [ABSTRACT FROM AUTHOR]

Health literacy (HL) is associated with short- and long-term health outcomes, and this is particularly relevant in Hispanics, who are disproportionally affected by lower HL. Hispanics have become the largest minority population in the United States. Also, Hispanics experience higher burdens of chronic diseases such as type 2 diabetes mellitus (T2DM) than non-Hispanic whites. Thus, effectively choosing culturally appropriate validated instruments that measure a marker found in health assessments should be a serious consideration. Using a systemized approach, we identified and reviewed 33 publications and found eight different HL and numeracy (separate or combined) instruments. We assessed the study designs and instrument structures to determine how HL was measured across these studies. We categorized the results into direct and indirect measurements of HL. The Test of Functional Health Literacy in Adults (TOFHLA) family of HL instruments was favored for direct measures of HL, while the Brief Health Literacy Screen (BHLS) instrument was favored for indirect measures. Despite identified trends in instruments used, more comprehensive measurement tools have been developed but not validated in Hispanic populations. In conclusion, further validation of more comprehensive HL instruments in adult Hispanic populations with T2DM could better assess HL levels and improve health promotion efforts.

Introduction: People with intellectual disability (ID) comprise 2-3% of the Australian population. They mostly rely on their GP for primary health care. In rural areas where there are issues with health workforce shortages, there is a risk that people with ID may not get timely access to primary care or may not be aware of the range of healthcare services available to support them. Internationally, research has shown that regular health assessments are beneficial for people with ID. Annual comprehensive health assessments (ACHAs) have been shown to result in increased detection of medical conditions and could assist in reducing the gap in mortality between people with ID and the broader population. In Australia, people with ID have been eligible to access ACHAs under Medicare since 2007. These provide for a regular review of the person’s physical, psychological and social functioning. This study explored the extent to which rural people with ID were accessing these ACHAs, and factors which affected their access to ACHAs. Methods: In this qualitative study in-depth interviews were conducted with 18 participants including people with ID, carers/support workers and rural doctors. Interviews were then coded and analysed for themes. Results: Seven themes were identified: (1) healthcare barriers in rural areas; (2) cohesion of rural communities; (3) the way rural doctors practice; (4) lack of knowledge/understanding; (5) venturing into new territory; (6) the role of the practice nurse; and (7) the health communication triangle. Conclusion: Despite the well-known problems of lack of services and distance to specialists in rural Australia, there are compensatory factors which were perceived as improving the wellbeing of people with ID, such as increased social cohesion and community connectedness. More education is needed to ensure that the rationale for ACHAs for people with ID is understood and that doctors feel confident to use them. The number of Medicare reforms implemented in a relatively short period presented change-management challenges for rural practices with rural workforce pressures. The role of the carer/support worker is crucial in the health assessment process and can improve the transfer of information about a client with ID between the disability and health sectors and within the health sector. [ABSTRACT FROM AUTHOR]

Many recommended best practices exist for clinical and community diabetes management and prevention. However, in many cases, these recommendations are not being fully utilized. It is useful to gain a sense of currently utilized and needed practices when beginning a partnership building effort to ameliorate such practice problems. The purpose of this study was to assess current practices in clinical settings within the Brazos Valley in preparation for beginning a community-based participatory research project on improving diabetes prevention and management in this region. Fifty-seven physicians with admission privileges to a regional health system were faxed a survey related to current diabetes patient loads, knowledge and implementation of diabetes-related best practices, and related topics. Both qualitative and quantitative examination of the data was conducted. Fifteen percent of responding providers indicated they implemented diabetes prevention best practices, with significant differences between primary-care physicians and specialists. Respondents indicated a need for educational and counseling resources, as well as an increased health-care workforce in the region. The utilization of a faxed-based survey proved an effective means for assessing baseline data as well as serving as a catalyst for further discussion around coalition development. Results indicated a strong need for both clinical and community-based services regarding diabetes prevention and management, and provided information and insight to begin focused community dialogue around diabetes prevention and management needs across the region. Other sites seeking to begin similar projects may benefit from a similar process. [ABSTRACT FROM AUTHOR]

Objectives: To test the validity, reliability, and uses of the multidimensional Salutogenic Wellness Promotion Scale (SWPS). Methods: Self-reported (n=2 140) demographic and scale data from a large university (23,000+ students) were collected and analyzed. Dependent measures included grade point average (GPA) and perceived health. Results: Analyses confirmed the SWPS's 7-factor multidimensional structure and its use for describing and predicting associated outcomes. The analyses of frequency distributions, means, correlations, and regressions found significant relationships between measured health behaviors, perceived health, and GPA. Conclusions: The SWPS provides valid and reliable information about positive health potential for research and field health professionals. [ABSTRACT FROM AUTHOR]

Abstract Our objective was to explore the perceptions of allied health professionals who conducted over 3000 home-based health assessments within the general-practice-dominated Australian primary healthcare system. A series of semistructured qualitative interviews were carried out within the Department of Veterans’ Affairs ‘Preventive Care Trial’, where health assessments are undertaken by health professionals in the homes of participating veterans and war widows. Health professionals were employed within the Preventive Care Trial to conduct assessments in 10 areas of New South Wales and Queensland. Subjects were mainly registered nurses, but also included a social worker, an occupational therapist, a physiotherapist and a psychologist. The health professionals described positive attitudes towards the health assessments, and showed that they have the broad range of necessary personal and professional skills to undertake them. Home visits were seen as an essential component and the most useful aspects included direct observation of home safety and medications. This study demonstrates that health assessments for older people can be acceptably and competently undertaken by suitably qualified allied health professionals, and that an effective collaborative approach to patient care can be achieved through such a system. [ABSTRACT FROM AUTHOR]

Exposure to PM 2.5 is associated with many adverse health effects, leading to additional social costs. The Blue Sky Protection Campaign (BSPC) has been implemented in 2018 in the Beijing-Tianjin-Hebei (BTH) area to control air pollution. This study assesses PM 2.5 -related health and economic benefits of the BSPC in the BTH region. Results show that by 2020, PM 2.5 reduction can avoid 3561 thousand morbidity cases (equivalent to a 24% reduction in the 2020 baseline scenario) and 24 thousand premature deaths (12%) in the BTH region, with the majority benefit in Hebei. By 2030, the avoided morbidity and mortality cases will be 2943 (18%) thousand and 20 (9%) thousand, respectively. PM 2.5 reductions are highly effective in reducing work time loss, which will decrease the total annual work time by 1.7 × 108 h (24%) in the BTH region by 2020. From the economic aspect, the reduced PM 2.5 concentration will save 30 million USD (25%) health expenditures and avoid 60 billion USD (13%) economic loss by using the value of statistical life (VSL) by 2020. In 2030, the health expenditures and economic loss will also decrease significantly, with 17 million USD (18%) and 63 billion USD (10%), respectively, in the BTH region. Besides, the economic benefits far exceed the policy costs of the BSPC, and the Δ benefit/Δ cost ratios of Beijing are significantly higher than those of Hebei. The BSPC in BTH has significant positive health and economic impacts. This study can provide a basis for future PM 2.5 -related health risk studies at an urban level in China. [Display omitted] • Implementing Blue Sky Protection Campaign has positive health and economic impacts. • The PM 2.5 reductions are highly effective in reducing work time loss. • A sum of 60 billion USD in value of statistical life will be avoided in BTH by 2020. • The Δ benefit/Δ cost ratio in Beijing is the highest, followed by Tianjin and Hebei. [ABSTRACT FROM AUTHOR]

Fatigue is one of the most common subjective symptoms of abnormal health state, there is still no reliable and stable evaluation method to distinguish disease fatigue and non-disease fatigue. Studies have shown that tongue diagnosis and pulse diagnosis are the reflection of overall state of the body. This study aims to explore the distribution rules and correlation of data of tongue and pulse in population with disease fatigue and sub-health fatigue and provide a new method of clinical diagnosis of fatigue from the perspective of tongue diagnosis and pulse diagnosis. In this study, a total of 736 people were selected and divided into healthy controls (n = 250), sub-health fatigue group (n = 242), and disease fatigue group (n = 244). TFDA-1 tongue diagnosis instrument and PDA-1 pulse diagnosis instrument were used to collect tongue image and sphygmogram, simple correlation analysis and canonical correlation analysis were used to analyze the correlation of tongue and pulse data about the two groups of fatigue people. The study had shown that tongue and pulse data could provide a certain reference for the diagnosis of different types of fatigue, tongue and pulse data in disease fatigue and sub-health fatigue population had different distribution rules, and there was a simple correlation and canonical correlation in the disease fatigue population, the coefficient of canonical correlation was .649 (P <.05).

Shift work and night work in particular have been associated with sleep difficulties, general malaise, fatigue, peptic ulceration, ischaemic heart disease, cigarette smoking and adverse pregnancy outcome. The medical conditions previously regarded as making individuals unsuitable for shift work show wide ranging patho-physiological activity and there is no published evidence for any such condition to be regarded an absolute reason to exclude an individual from shift work. The fulfilment of the legal obligations of the Working Time Regulations 1998 is neither prescribed nor constrained in any way. It is advisable therefore to build on existing health procedures where they are in effect. Periodic health questionnaires can offer health professionals an opportunity to detect any disorder likely to be aggravated by shift work or by a combination of shift work, job demands and workplace conditions. A further purpose of the questionnaire is the assessment of ability to undertake shift work duties. However, health questionnaires are neither sensitive nor specific enough to be used to select applicants or employees for shift work, since they do not consistently predict tolerance of shift work or subsequent health problems. Whether employers should offer anything more than a simple questionnaire will depend on the culture of the company and accessibility of health services. Screening programmes affect many people relative to the few who benefit and with existing knowledge, periodic general health examinations performed in asymptomatic subjects have limited predictive or preventive value. [ABSTRACT FROM PUBLISHER]

Objective: To assess the use of Medicare-subsidised health services by women with and without dementia., Methods: Data from women of the 1921-26 birth cohort of the Australian Longitudinal Study on Women's Health were linked to various administrative datasets to ascertain dementia diagnosis. The use of subsidised general practitioner (GP) services (75+ health assessments [HAs], chronic disease management meetings [CDMs], multidisciplinary case conferences [MCCs]) and specialist and allied health services between 2000 and 2013 for these women was analysed using longitudinal GEE models., Results: A total of 9,683 women were included with 1,444 (15%) women identified as having dementia. Compared to women with no dementia indication, women with dementia had more yearly non-emergency GP attendances (short [<30 minutes] IRR=1.11 [1.07, 1.13]; long [>30 minutes] IRR=1.11 [1.04, 1.19]) and fewer specialist attendances (IRR=0.91 [0.85, 0.97]) and were more likely to have an emergency GP attendance (OR=2.29 [2.05, 2.57]). There were no significant differences in the odds of having either a HA or CDM or using allied health services for women with and without dementia indicators., Conclusions: The overall use of services designed to improve the prevention and coordination of the care of older people with chronic conditions was low. Women with dementia were no more likely to access these services. Implications for public health: There is underuse of some primary and allied healthcare services designed for people with complex chronic conditions. These could be better used by women with dementia to improve the management of complex comorbidities (e.g. CDMs), to prevent the onset of disability (e.g. physiotherapy), and enhance needs assessment and service access (e.g. HAs)., (© 2021 The Authors.)

The range of Geometric Tortoises is restricted to a small region in the southwestern Cape where a few populations still survive in isolated habitat fragments. Apart from habitat destruction and degradation, the species' most severe threat is high mortality due to wildfires, which over recent decades increased in frequency. In January 2012, a wildfire destroyed the largest remaining habitat fragment, and killed most Geometric Tortoises on the nature reserve. Tortoises saved by a subsequent search-and-rescue operation were then used to initiate an in-situ head-start program. The aim of the program is to facilitate survival of hatchlings and juveniles, and ultimately boost the wild population by introducing the head-started sub-adults into the reserve. Captive adult tortoises are housed in two one-hectare camps within natural habitat, surrounded with electrified fences to protect the tortoises against terrestrial predators. The cryptic colour of the tortoises makes them difficult to find; consequently, each adult tortoise was fitted with a radio-transmitter to facilitate regular monitoring, reproductive evaluation of females, and annual health assessments. Female tortoises are examined once per month by ultrasound to identify females with calcified eggs. Those females are placed into one of two nesting camps inside one of the fenced camps, and kept there until the subsequent ultrasound examination showed that the eggs have been laid. At the start of the hatching season, the nesting camps are covered with avian netting to protect the hatchlings from aerial predation, and search daily for new hatchlings. When found, hatchlings are transferred to a large predator-proof nursery, which houses raised boxes, filled with soil and planted with natural vegetation. Up to six hatchlings are housed in a box, where they have ample hiding spaces and receive food and water daily. After two years the juveniles are transferred to predator-proof juvenile tunnels, where they have access to natural vegetation and receive supplementary food and water. The hatchlings and juveniles receive a mixture of natural food plants, collected daily from a variety of species on the reserve, and edible plants grown from commercial seeds. This program had many challenges, which we overcame, and thus offer guidelines for similar head-starting project on threatened tortoises. [ABSTRACT FROM AUTHOR]