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Abstract Chronic Obstructive Pulmonary Disease is a progressive lung disease associated with anxiety, depression, and reduced health-related quality of life. Pulmonary rehabilitation (PR) is a cost-effective and transformative treatment, but 31% of referred patients do not take up their PR appointment. The study aimed to develop user requirements for an intervention to increase PR uptake. A systems approach, the Engineering Better Care framework, was used to develop a system map of the PR pathway, translate evidence-based user needs into user requirements, and validate the user requirements in a stakeholder workshop. Eight user requirements addressed patient and health care practitioner needs to understand what PR entails, understand the benefits of PR and have positive conversations about PR to address patient concerns. The solution-independent user requirements can be applied to the development of any intervention sharing similar goals. The study demonstrates potential in taking a systems approach to more challenges within respiratory medicine.

Abstract Background Indigenous adolescents access primary health care services at lower rates, despite their greater health needs and experience of disadvantage. This systematic review identifies the enablers and barriers to primary health care access for Indigenous adolescents to inform service and policy improvements. Methods We systematically searched databases for publications reporting enablers or barriers to primary health care access for Indigenous adolescents from the perspective of adolescents, their parents and health care providers, and included studies focused on Indigenous adolescents aged 10–24 years from Australia, Canada, New Zealand, and United States of America. Results were analyzed against the WHO Global standards for quality health-care services for adolescents. An additional ninth standard was added which focused on cultural safety. Results A total of 41 studies were included. More barriers were identified than enablers, and against the WHO Global standards most enablers and barriers related to supply factors – providers’ competencies, appropriate package of services, and cultural safety. Providers who built trust, respect, and relationships; appropriate package of service; and culturally safe environments and care were enablers to care reported by adolescents, and health care providers and parents. Embarrassment, shame, or fear; a lack of culturally appropriate services; and privacy and confidentiality were common barriers identified by both adolescent and health care providers and parents. Cultural safety was identified as a key issue among Indigenous adolescents. Enablers and barriers related to cultural safety included culturally appropriate services, culturally safe environment and care, traditional and cultural practices, cultural protocols, Indigenous health care providers, cultural training for health care providers, and colonization, intergenerational trauma, and racism. Nine recommendations were identified which aim to address the enablers and barriers associated with primary health care access for Indigenous adolescents. Conclusion This review provides important evidence to inform how services, organizations and governments can create accessible primary health care services that specifically meet the needs of Indigenous adolescents. We identify nine recommendations for improving the accessibility of primary health care services for Indigenous adolescents.

IntroductionAnaerobic digestion of manure, together with other biowastes, produces biogas that can substitute fossil energy and thereby reduce CO2 emissions and post- digestion greenhouse gas emissions. The final digestate of the process is an organic fertilizer rich in plant nutrients and recalcitrant organic constituents. The digestate characteristics and quality depend on several parameters, such as input feedstocks and operational conditions of the biogas plants. In Denmark, the rapid expansion of the biogas sector in recent years has resulted in a great variety of feedstocks used in the plants. The first generation of biogas plants mainly treated manure, industrial wastes, and energy crops with short retention times, while the new generation of biogas plants are co-digesting manure with higher amounts of lignocellulosic feedstocks and operating with longer retention times. This study evaluated whether this shift in feedstock composition could impact the fertilizer quality and post-digestion greenhouse gases and ammonia emissions during storage and application of digestate.MethodsDigestate samples from 2015 to 2023 were collected and analyzed for composition and residual methane yields. The efficiencies of solid–liquid separation applied to several digestate samples from the new generation of biogas plants were investigated and the nutrients contents of the liquid and solid fractions of digestate were evaluated.Results and discussionThe most evident change caused by the feedstock transition was an average increase of 52% in the total solids content of digestate, which can negatively impact ammonia emissions during digestate application. In contrast, similar average residual methane yields on a fresh matter basis of approximately 5 L/kg indicated comparable risks of methane emissions during storage. The liquid fraction of industrially separated digestate presented, on average, nutrient concentrations similar to those of unseparated digestate, while the solid fraction presented similar K, lower total ammoniacal nitrogen, and higher organic N and P contents than unseparated digestate on a fresh matter basis. The average residual methane yield of the industrially separated solid fraction of digestate was 101 L/kg volatile solids, while the average calorific value was 21 MJ/kg volatile solids, indicating its potential for additional energy generation.

Summary: Background: To address inequitable diagnostic access and improve time-to-treatment for First Nations peoples, molecular point-of-care (POC) testing for chlamydia, gonorrhoea and trichomonas was integrated into 49 primary care clinics across Australia. We conducted an observational evaluation to determine clinical effectiveness and analytical quality of POC testing delivered through this national program. Methods: We evaluated (i) implementation by measuring trends in mean monthly POC testing; ii) clinical effectiveness by comparing proportions of positive patients treated by historical control/intervention period and by test type, and calculated infectious days averted; (iii) analytical quality by calculating result concordance by test type, and proportion of unsuccessful POC tests. Findings: Between 2016 and 2022, 46,153 POC tests were performed; an increasing mean monthly testing trend was observed in the first four years (p

The uptake of HIV prevention services is lower among youth than adults in sub-Saharan Africa. Existing youth livelihood trainings offer a potential entry point to HIV prevention services. We determined feasibility and preliminary effectiveness of integrating HIV prevention into youth clubs implementing an empowerment and livelihood for adolescents (ELA) intervention in rural Uganda. Staff conducted community mobilization for youth (15-24 years) over one month. Clubs met (3×/week) over six months, with local peer mentors trained to teach life-skills and sexual/reproductive health education. We integrated mentor-led education on HIV prevention, including pre- and post-exposure prophylaxis (PrEP/PEP). Clubs offered on-site HIV testing, a field trip to a local clinic and PrEP referrals after one month and six months. Surveys were conducted at baseline and six months. Forty-two participants (24 adolescent girls/young women (AGYW) and 18 adolescent boys/young men (ABYM)) joined the clubs. At baseline, no participants accepted referral for PrEP, whereas 5/18 (28%) sexually active, HIV-negative AGYW requested PrEP referral at follow-up. One ABYM requested PEP referral. Integration of HIV prevention services into an established ELA curriculum at mentor-led youth clubs in rural Uganda was feasible. PrEP uptake increased among sexually active AGYW. Evaluation of this approach for HIV prevention among youth merits further study.

Abstract Globally, there is a growing acknowledgment of Indigenous Peoples’ rights to control data related to their communities. This is seen in the development of Indigenous Data Governance standards. As health data collection increases, it’s crucial to apply these standards in research involving Indigenous communities. Our study, therefore, aims to systematically review research using routinely collected health data of Indigenous Peoples, understanding the Indigenous Data Governance approaches and the associated advantages and challenges. We searched electronic databases for studies from 2013 to 2022, resulting in 85 selected articles. Of these, 65 (77%) involved Indigenous Peoples in the research, and 60 (71%) were authored by Indigenous individuals or organisations. While most studies (93%) provided ethical approval details, only 18 (21%) described Indigenous guiding principles, 35 (41%) reported on data sovereignty, and 28 (33%) addressed consent. This highlights the increasing focus on Indigenous Data Governance in utilising health data. Leveraging existing data sources in line with Indigenous data governance principles is vital for better understanding Indigenous health outcomes.