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Clinical practice guidelines direct mental health services to provide preventive care to address client chronic disease risk behaviours, however, this care is not routinely provided. The aim of this systematic review was to synthesise evidence regarding the effectiveness of interventions to increase provision of preventive care by mental health services; by care element (ask, assess, advice, assist, arrange) and risk behaviour (tobacco smoking, poor nutrition, harmful alcohol consumption, physical inactivity). Electronic bibliographic databases, Google Scholar, relevant journals, and included study reference lists were searched. Eligible studies were of any design with a comparison group that reported the effectiveness of an intervention to increase the provision of at least one element of preventive care for at least one risk behaviour in a mental health setting. Twenty studies were included, most commonly examining smoking (n = 20) and 'ask' (n = 12). Meta-analysis found interventions involving task shifting were effective in increasing smoking 'advice' (n = 2 RCTs; p = 0.009) and physical activity 'advice' (n = 2 RCTs; p = 0.002). Overall, meta-analysis and narrative synthesis indicated that effective intervention strategies (categorised according to the Effective Practice and Organisation of Care taxonomy) were: task shifting, educational meetings, health information systems, local consensus processes, authority and accountability, and reminders. The most consistent findings across studies were with regard to preventive care for smoking, while conflicting or limited evidence was found regarding other risk behaviours. While further rigorous research examining key risk behaviours is recommended, the findings may inform the selection of strategies for future interventions and service delivery initiatives.

Background and aims: Whole-of-community interventions aim to reduce alcohol and other drug (AOD) use and harms by mobilizing community leaders, organizations and policy-makers to respond effectively to AOD use. The aim of this review is to estimate the effectiveness of whole-of-community interventions in reducing population-level harms arising from AOD use. Design: A systematic review of electronic databases CENTRAL, Embase, Medline, Medline in Process and PsycINFO was conducted from database inception to August 2017. Eligible trials had a parallel comparison group, implemented interventions in two or more community settings, and reported data on AOD use or harms. Setting: Intervention settings included schools, sporting clubs, police and law enforcement agencies, community centres, local media and retail premises. Participants: Twenty-four trials from 63 publications were included (n = 249 125 participants). Measurements: Outcomes from AOD consumption (quantity and frequency), AOD-related crime and AOD-related accidents, injuries and hospital admissions. Data were pooled using random-effects inverse variance meta-analysis in Review Manager version 5.3. Findings: Risk of bias was mostly high, due to lack of random allocation, selective reporting and significant attrition. Meta-analyses indicated significant reductions in risky drinking [Alcohol Use Disorders Identification Scale (AUDIT) > 8; three trials (7 data points), relative risk (RR) = 0.78, 95% confidence interval (CI) = 0.62–0.99)], but found no impact on past-month alcohol use (five trials, RR = 0.95, 95% CI = 0.89–1.02), binge drinking (five trials, RR = 0.97, 95% CI = 0.89–1.06) or 12-month marijuana use (two trials, RR = 0.98, 95% CI = 0.86–1.11). Narrative synthesis indicated some reductions in AOD-related assault rates and arrests, but were equivocal for quantity of alcohol consumed, 12-month illicit drug use, assault or abuse, motor vehicle accidents and hospital admissions. Conclusions: Interventions

Objective: To explore the barriers to help-seeking among men experiencing lower bowel symptoms. Methods: Semi-structured interviews were conducted with 13 men recruited via purposive sampling. Interviews were audio-taped, transcribed, and analyzed thematically. Results: Misinterpretation of the symptoms and the attribution of the symptoms to non-medical causes were common barriers to help-seeking. Other barriers include the cost of consulting a GP, llow level of confidence in consultation, and fear of cancer diagnosis. Some participants did not seek medical advice as the symptoms were intermittent or resolved with over-the-counter medications. Conclusion: There is a need for health promotion campaigns for men with regards to seeking timely medical advice for lower bowel symptoms.

Background: Patients who have been treated for colorectal cancer in Australia can consult their general practitioner (GP) for advice about symptoms or side effects at any time following their treatment. However, there is no evidence that such patients are consistently advised by GPs, and patients experience substantial unmet need for reassurance and advice. Objective: To explore the patient management options selected by GPs to treat a set of patients describing their symptoms following treatment for colorectal cancer. Methods: This was an Internet-based survey. Participants (GPs) viewed 6 video vignettes of actors representing patients who had been treated for colorectal cancer. The actor-patients presented problems that resulted from their treatment. Participants indicated their diagnosis and stated if they would prescribe, refer, or order tests, based on that diagnosis. These responses were then rated against the management decisions for those vignettes as recommended by a team of colorectal cancer experts. Results: In total, 52 GPs consented to take part in the study, and 40 (77%) completed the study. Most GPs made a diagnosis of colorectal cancer treatment side effects/symptoms of recurrence that was consistent with the experts' opinions. However, correct diagnosis was dependent on the type of case viewed. Compared with radiation proctitis, GPs were more likely to recognize peripheral neuropathy (odds ratio, OR, 4.43, 95% CI 1.41-13.96, P=.011) and erectile dysfunction (OR 9.70, 95% CI 2.48-38.03, P=.001), but less likely to identify chemotherapy-induced fatigue (OR 0.19, 95% CI 0.08-0.44). GPs who had more hours of direct patient care (OR 0.38, 95% CI 0.17-0.84, P=.02), were experienced (OR 9.78, 95% CI 1.18-8.84, P=.02), and consulted more patients per week (OR 2.48, 95% CI 1.16-5.30, P=.02) suggested a management plan that was consistent with the expert opinion. Conclusions: In this pilot study, years of experience and direct patient contact hours had a sign

Advanced-stage diagnosis of colorectal cancer (CRC) leads to poor prognosis and reduced survival rates. The current study seeks to explore the reasons for diagnostic delays in a sample of Australian men with CRC. Semi-structured interviews were conducted in a purposive sample of 20 male CRC patients. Data collection ceased when no new data emerged. Interviews were audiotaped, transcribed and thematically analysed using Andersen's Model of Total Patient Delay as the theoretical framework. Most participants (18/20) had experienced lower bowel symptoms prior to diagnosis. Patient-related delays were more common than delays attributable to the health-care system. Data regarding patient delays fit within the first four stages of Andersen's model. The barriers to seeking timely medical advice were mainly attributed to misinterpretation of symptoms, fear of cancer diagnosis, reticence to discuss the symptoms or consulting a general practitioner. Treatment delays were a minor cause for delayed diagnosis. Delay in referral and scheduling for colonoscopy were among the system-delay factors. In many instances, delays resulted from men's failure to attribute their symptoms to cancer and, subsequently, delay in diagnosis.

Objective: To explore the help-seeking pathway for lower bowel symptoms in men diagnosed with benign bowel diseases. Methods: Semi-structured interviews were conducted. The data were analyzed thematically using Andersen's Model of Patient Delay as the theoretical framework. Results: The major delaying factors were attribution of symptoms to self-limiting conditions, failure to make time to visit a GP, low expectation of help from the GP, fear of cancer diagnosis and embarrassment. Conclusion: The major causes of delay in helpseeking were related to the participants, whereas factors associated with treatment delay were less prominent in diagnostic delay.

BACKGROUND: The mental health of children and adolescents is a key area of health concern internationally. Previous empirical studies suggest that resilience may act as a protective mechanism towards the development of mental health problems. Resilience refers to the ability to employ a collection of protective factors to return to or maintain positive mental health following disadvantage or adversity. Schools represent a potential setting within which protective factors of all children and adolescents may be fostered through resilience-focussed interventions. Despite this potential, limited research has investigated the effectiveness of universal school-based resilience-focussed interventions on mental health outcomes in children and adolescents. The objective of the present review is to assess the effects of universal school-based resilience-focussed interventions, relative to a comparison group, on mental health outcomes in children and adolescents. METHODS/DESIGN: Eligible studies will be randomised (including cluster-randomised) controlled trials of universal interventions explicitly described as resilience-focussed or comprising strategies to strengthen a minimum of three internal protective factors, targeting children aged 5 to 18 years, implemented within schools, and reporting a mental health outcome. Screening for studies will be conducted across six electronic databases: MEDLINE, PsycINFO, Educational Resources Information Center (ERIC), Excerpta Medica database (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Central Register of Controlled Trials (CENTRAL). Two reviewers will retrieve eligible articles, assess risk of bias, and extract data. Where studies are sufficiently homogenous and reported outcomes are amenable for pooled synthesis, meta-analysis will be performed. Narrative description will be used to synthesise trial outcome data where data cannot be combined or heterogeneity exists. DISCUSSION: This r

Objective: To examine the role of the theory of planned behavior (TPB) in influencing patients’ intention to attend follow-up visits with a general practitioner (GP). Methods: A questionnaire based on the TPB was used to assess colorectal cancer (CRC) patients’ intention to attend follow-up visits with a GP. Results: TPB factors accounted for 43.3% of the variance of intention for follow-up visits. Attitude alone explained 23.3% of the variance. Attitude and presence of other comorbidities significantly affected intention to visit a GP (attitude: R2=0.23, F [1, 65]=4.35, p < .01; comorbidity: R2=0.13, F [1, 65]=3.02, p < .05). Conclusion: Patients who believe their GP has the skills and knowledge to detect a recurrence and patients with other comorbidities have greater intention to visit their GP following treatment.

Background: Lower bowel symptoms are common, may impact on the health related quality of life (HRQoL) and predispose to colorectal cancer. Men have a higher risk of colorectal cancer (CRC) than women but are more likely to delay seeking medical advice for lower bowel symptoms. The current study provides an understanding of the barriers to consult a General Practitioner (GP) and of the trajectory of men’s health seeking between the onset of symptoms and diagnosis of CRC. Aim: This study seeks to explore the health-seeking trajectory of men experiencing lower bowel symptoms. Methods: In-depth semi-structured interviews were conducted among participants recruited via purposive sampling from three sub-groups: men experiencing lower bowel symptoms but never sought medical advice recruited from community (n=14), and men diagnosed with benign bowel conditions (n=19) and those with CRC (n=20) from tertiary care hospital. Interview data was audiotaped and transcribed verbatim and subsequently analyzed thematically. Andersen’s Model of Patient Delay was used as a theoretical framework.Results: The attribution of symptoms to benign conditions or to the participants' occupations, and the fear of cancer diagnosis were common barriers to health seeking across all groups of participants. The time and money needed to consult a GP and participants’ lack of trust in the medical system were other barriers among those who never sought advice. Some participants did not seek medical advice as the symptoms were intermittent or resolved spontaneously with changes in diet and lifestyle or with over the counter medication. Conclusions: The data highlights various reasons for delay in seeking medical advice for potential CRC symptoms among men. Barriers to health-seeking in primary care identified in this study may provide insight into more focused health-education and health-promotion campaigns for men with regards to timely diagnosis and treatment resulting in improved prognisis and HRQoL a

BACKGROUND: Treatment for colorectal cancer (CRC) may result in physical, social, and psychological needs that affect patients' quality of life post-treatment. A comprehensive assessment should be conducted to identify these needs in CRC patients post treatment, however, there is a lack of tools and processes available in general practice. AIMS: This study aimed to develop a patient-completed needs screening tool that identifies potentially unmet physical, psychological, and social needs in CRC and facilitates consultation with a general practitioner (GP) to address these needs. METHODS: The development of the self-assessment tool for patients (SATp) included a review of the literature; face and content validity with reference to an expert panel; psychometric testing including readability, internal consistency, and test-retest reliability; and usability in clinical practice. RESULTS: The SATp contains 25 questions. The tool had internal consistency (Cronbach's alpha 0.70-0.97), readability (reading ease 82.5%), and test-retest reliability (kappa 0.689-1.000). A total of 66 patients piloted the SATp. Participants were on average 69.2 (SD 9.9) years old and had a median follow-up period of 26.7 months. The SATp identified a total of 547 needs (median 7 needs/per patient; IQR [3-12.25]). Needs were categorised into social (175[32%]), psychological (175[32%]), and physical (197[36%]) domains. CONCLUSION: SATp is a reliable self-assessment tool useful for identifying CRC patient needs. Further testing of this tool for validity and usability is underway.

Background: There is mounting emphasis to transfer follow-up care of cancer patients to general practice due to the increasing number of patients at hospital cancer clinics. Uptake of this approach is rather slow despite rigorous research work done in this field. Issues that affect endorsement of this approach have not been fully determined and, in particular, patient factors that may affect uptake of this programme have not been explored. Objective: To examine the role of comorbidities in the theory of planned behaviour (TPB) in influencing patients’ intention to attend follow-up visits with a general practitioner (GP). Methods: A self-administered questionnaire was developed based on the TPB to assess colorectal cancer (CRC) patients’ intention to attend follow-up visits with a GP. Results: Sixty-six patients participated in the study. All factors [attitude, subjective norms and perceived behaviour control (PBC)] accounted for 43.3% of the variance on future follow-up visits. Attitude explained 23.3% of the variance, but PBC and subjective norms did not account for any significant variance on future intention to attend a follow-up visit. Univariate analysis suggested that attitude and the presence of a coexisting chronic illness significantly affected future intention to visit a GP (attitude: R2 = 0.233, F [1, 65] = 4.345, p < 0.01; comorbidity: R2 = 0.128, F [1, 65] = 3.019, p < 0.05). Conclusion: Two factors, CRC patients’ attitude and having a coexisting chronic illness, had the greatest influence on their intention to seek advice from a GP post treatment. By triaging patients with existing concomitant illnesses and improving patients’ knowledge on what CRC issues GPs can address, more CRC survivors may seek medical advice from a GP.

Background: Colorectal cancer (CRC) is a major global health problem with survival varying according to stage at diagnosis. The incidence of CRC is much higher in patients with lower bowel symptoms. The symptoms are non-specific and are commonly experienced in the general population. Biological and environmental factors account for the high incidence and poor prognosis of CRC in men.Objective: To review the behavioural factors influencing patient delay in seeking help for lower bowel symptoms using a gender lens.Methods: An extensive literature search was performed using various databases including Medline, PubMed, CINAHL Plus, EMBASE and PsycINFO (1993–2013). Various search terms including rectal bleeding, prevalence, colorectal cancer, consultation, help-seeking, gender differences and men were used. A systematic methodology including systematic data extraction and narrative synthesis was applied.Results: Thirty-two studies were included in the review. All studies except four were quantitative. Although there is some evidence that men delay more compared with women, there has not been any major improvement in the help-seeking behaviour for such symptoms over the past two decades. Several behavioural and demographic factors were associated with low rates of help-seeking.Conclusion: There are limited studies focusing on men's help-seeking behaviour for lower bowel symptoms. To facilitate timely help-seeking in men, it is important to understand their patterns of helpseeking for such symptoms. Further research to understand men's help-seeking behaviour is warranted.