Non-disclosing youth: a cross sectional study to understand why young people do not disclose suicidal thoughts to their mental health professional

Background Prevalence of suicidal ideation increases rapidly in adolescence, and many choose not to seek help and disclose their ideation. Young people who do disclose suicidal ideation, prefer to do so with peers and family compared to mental health professionals, who are best placed to provide evidence-based treatment. This study aimed to identify key factors associated with young people’s decision to, or not to disclose suicidal thoughts to their mental health practitioner. Methods A community-based sample of young Australians (16 - 25 years), who had experienced suicidal ideation and engaged with a mental health professional, completed an online questionnaire (N=513) which assessed demographic characteristics, severity of depression, anxiety, psychological distress, and suicidal ideation, lifetime suicide attempts, exposure to suicide loss, personal suicide stigma, prioritisation of mental health issues, and therapeutic alliance. Logistic regression analyses were used to identify factors associated with disclosure. Results Though the full sample had engaged in therapy, 39% had never disclosed suicidal ideation to their clinician. Those who had disclosed were more likely to report greater therapeutic alliance (OR=1.04, 95% CI=1.02–1.06), personal suicide stigma (OR=1.04, 95% CI=1.01–1.06), prioritisation of suicidal ideation (OR=.24, 95% CI=0.14-0.42), and lifetime history of suicide attempt (OR=.32, 95% CI=0.18-0.57). The most common reason for not disclosing was concern that it would not remain confidential. Conclusion These findings provide new insights into why young people may not seek help by disclosing suicidal ideation, despite having access to a mental health professional, and establish evidence to inform practice decisions and the development of prevention strategies to support young people for suicide.

Transitioning to practice: a qualitative investigation of Australian graduate naturopath’s experiences of being in practice

Background The transition from student to practitioner can be challenging, resulting in stress, burnout and attrition. While there has been ample research examining graduate medical and allied health practitioner experiences of transitioning to practice, there is a paucity of research exploring such experiences in newly qualified naturopathic medicine practitioners. In light of this knowledge gap, the objective of this study was to ascertain the experiences of practicing as a naturopath in Australia within the first 5 years post-graduation. Methods Using a qualitative descriptive approach, recent graduates of an Australian Bachelor of Naturopathy (or equivalent) program were invited to participate in a semi-structured telephone interview to address the study objective. Data were analysed utilising a framework approach. Results A total of 19 new graduates (94.7% female; 57.9% aged 40–59 years) undertook an interview. Five inter-related themes emerged from the data: practitioner, practice, proprietorship, professions, and perceptions. Connected with these themes were contrasting feelings, multiplicity of duties, small business challenges, professional collaboration, and professional identity, respectively. Conclusions Participants were generally content with their decision to become a naturopath. However, most were confronted by a range of challenges as they transitioned from graduate to practitioner, for which many felt ill-prepared. In light of the complexity of the issue, and the potential impact on the sustainability of the profession, it is evident that a multi-pronged, multi-stakeholder approach would be needed to better support graduate naturopath transition to practice.

Implementation of a structured practical activity to analyse student healthcare worker perceptions and compliance with prescribed infection control procedures

Background Non-compliance with infection control guidelines has been reported within healthcare settings. Infection control education in undergraduate healthcare education programs forms a critical component in preparing student healthcare workers for vocational roles. Methods Clinical sciences students (nutrition science, paramedicine, pharmacy, podiatry, optometry studying for qualifications recognised by the Australian Health Practitioner Regulation Agency) self-reported hygiene perceptions and practices and collected microbiological swabs from personal or medical equipment items before and after recommended disinfection procedures. Results Cultivable microorganisms were isolated from 95% of student medical equipment items. Disinfection significantly reduced microbial growth on student medical equipment items (P < 0.05). Conclusions Student perceptions of infection control procedures do not always correlate with infection control practice. Infection control education of undergraduate healthcare students requires ongoing assessment to ensure successful translation into clinical practice.

Distribution and Location Stability of the Australian Ophthalmology Workforce: 2014–2019

Objective: To investigate the ophthalmology workforce distribution and location stability using Modified Monash Model category of remoteness. Methods: Whole of ophthalmologist workforce analysis using Australian Health Practitioner Registration Agency (AHPRA) data. Modified Monash Model (MMM) category was mapped to postcode of primary work location over a six-year period (2014 to 2019). MMM stability was investigated using survival analysis and competing risks regression. Design: Retrospective cohort study. Setting: Australia. Participants: Ophthalmologists registered with AHPRA. Main outcome measures: Retention within MMM category of primary work location. Results: A total of 948 ophthalmologists were identified (767 males, 181 females). Survival estimates indicate 84% of ophthalmologists remained working in MMM1, while 79% of ophthalmologists working in MMM2–MMM7remained in these regions during the six-year period. Conclusion: The Australian ophthalmology workforce shows a high level of location stability and is concentrated in metropolitan areas of Australia. Investment in policy initiatives designed to train, recruit and retain ophthalmologists in regional, rural and remote areas is needed to improve workforce distribution outside of metropolitan areas.

The Role of Health Profession Regulation in Health Services Improvement

<p>This research investigates the role of health practitioner regulation in health service improvement. Over the last 25 years, service improvement has included management reforms, quality and redesign programmes, multidisciplinary teamwork, the integration of clinical information systems, and new roles for health professionals. Yet despite sustained effort, improvements tend to be localised rather than organisation or system-wide. Remedies have included attention to leadership, change management and service culture. Through the same period, there have been changes to expand and strengthen health practitioner regulation, but scant attention to whether this regulation could contribute to difficulties with health service improvement. A critical realist methodology was used to build an explanation of how regulatory policies could condition health professionals and health service organisations in ways that limit the progress of service improvement. A multilevel approach was used to discover the mechanisms that could operate among policy-makers and the health workforce, generating effects in health service organisations. The study concluded that this explanation contributes new insights to explain persistent difficulties in health service improvement. The research began with the 19th century to understand the social conditions in the construction of the health workforce and health service organisations. Next, it identified the network of modern regulatory stakeholders in healthcare, along with the potential for their policies to operate in conflict or concert depending on the circumstances. Deficiencies were identified in the traditional accounts of health practitioner regulation, which assumes a single profession and sole practice. ‘Regulatory privilege’ was developed as an alternative theory that describes the operation of nine historically constructed regulatory levers among the multiple health professions employed in health service organisations. This theory linked the regulatory and practice levels, to observe the interactions between health practitioner regulation and policies for health service improvement. Drawing on the recent history of health reforms, eight elements were identified that characterise directions for service improvement in healthcare. Investigation of interactions between these nine levers and eight elements identified sources for policy interactions through six sector levels. Interactive effects were identified in: policy design influenced by health practitioner regulation; the leadership and management capability in health service organisations, the design options for delivery of services, the means available to coordinate services, the role opportunities and practice arrangements for health professionals, and the experience of service fragmentation by consumers. This multilevel explanation shows how health practitioner regulation could contribute to difficulties with service improvement, even when health services have adopted best practice in their implementations. It shows how poor alignment between the regulatory and practice levels makes it unlikely that health service organisations could address certain difficulties in the ways suggested by some scholars. Given the sustained directions for health service improvement, these findings could contribute to policy thinking around how to better align the regulatory and practice levels to realise organisation or systemwide improvements in the delivery of healthcare.</p>

The Role of Health Profession Regulation in Health Services Improvement

<p>This research investigates the role of health practitioner regulation in health service improvement. Over the last 25 years, service improvement has included management reforms, quality and redesign programmes, multidisciplinary teamwork, the integration of clinical information systems, and new roles for health professionals. Yet despite sustained effort, improvements tend to be localised rather than organisation or system-wide. Remedies have included attention to leadership, change management and service culture. Through the same period, there have been changes to expand and strengthen health practitioner regulation, but scant attention to whether this regulation could contribute to difficulties with health service improvement. A critical realist methodology was used to build an explanation of how regulatory policies could condition health professionals and health service organisations in ways that limit the progress of service improvement. A multilevel approach was used to discover the mechanisms that could operate among policy-makers and the health workforce, generating effects in health service organisations. The study concluded that this explanation contributes new insights to explain persistent difficulties in health service improvement. The research began with the 19th century to understand the social conditions in the construction of the health workforce and health service organisations. Next, it identified the network of modern regulatory stakeholders in healthcare, along with the potential for their policies to operate in conflict or concert depending on the circumstances. Deficiencies were identified in the traditional accounts of health practitioner regulation, which assumes a single profession and sole practice. ‘Regulatory privilege’ was developed as an alternative theory that describes the operation of nine historically constructed regulatory levers among the multiple health professions employed in health service organisations. This theory linked the regulatory and practice levels, to observe the interactions between health practitioner regulation and policies for health service improvement. Drawing on the recent history of health reforms, eight elements were identified that characterise directions for service improvement in healthcare. Investigation of interactions between these nine levers and eight elements identified sources for policy interactions through six sector levels. Interactive effects were identified in: policy design influenced by health practitioner regulation; the leadership and management capability in health service organisations, the design options for delivery of services, the means available to coordinate services, the role opportunities and practice arrangements for health professionals, and the experience of service fragmentation by consumers. This multilevel explanation shows how health practitioner regulation could contribute to difficulties with service improvement, even when health services have adopted best practice in their implementations. It shows how poor alignment between the regulatory and practice levels makes it unlikely that health service organisations could address certain difficulties in the ways suggested by some scholars. Given the sustained directions for health service improvement, these findings could contribute to policy thinking around how to better align the regulatory and practice levels to realise organisation or systemwide improvements in the delivery of healthcare.</p>

The practice of environmental health in an era of sustainable development

Environmental health practice is concerned with assessing, controlling, and preventing factors in the environment that can potentially affect human health. This chapter briefly discusses the roots and origins of environmental health practice from earliest times to the present day, against a backdrop of current international initiatives highlighting health, environment, and sustainable development issues of global concern. The concept and scope of environmental health is discussed, before highlighting environmental health issues and the burden of environmentally related disease, which are of importance in directing the work of the environmental health practitioner. It then addresses the multifactorial nature of environmental health effects, the role of epidemiology and toxicology, and the basic elements of the risk assessment process. Next, tools to aid decision-making are introduced followed by a discussion on the role of intersectoral action and partnerships. The final section of the chapter addresses policy elements and actions which can be taken to address environmental health issues, and the implications for environmental health management and service delivery. A greater capacity to influence policy agendas outside of the health sector will be needed in future.

Introducing evidence based public health practice through a journal club for public health officers in Somaliland

Evidence based public health is one of the basic training tools of public health students and young officers in decision making. The training tools for early career specialists and trainees in public health is journal clubs (JC). It keeps the knowledge of professionals up to date and assist them in receiving information to design, plan, implement health care services, policies and strategies. The intention of the JC team was to raise awareness of methods for public health literature search, appraising it and applying this knowledge in their daily practices. A senior public health practitioner in Somaliland (the corresponding author) invited medical students and residents to have JCs as a part of their training. They did not accept the offer so the organizer invited practicing junior public health professionals instead. The JC team members were a general practitioner and 3 public health workers from Ministry of Health, public hospital physician, public health school and field public health officer. A weekly or twice weekly journal club took place to train them in critical appraisal. This continued for 15 months in a hybrid mentorship for the health care professionals. The team mentor selected a paper for discussion. Mentees choose a study design appraisal tool from the Critical Appraisal Skills Program (CASP) that matched the study to present. In the process of appraisal, a team member led the discussion using the checklist. The mentees presented their critical appraisal either orally or via a presentation. The checklist and paper were compared for assessing the study design and structure of the paper of the week. This approach of empowering junior public health officers in Somalia is a way forward for encouraging the professionals to use evidence based practice in their daily practices. This will improve their selection of research tools and translating the scientific work into their practice and services.

Utilization of complementary and traditional medicine practitioners among middle-aged and older adults in India: results of a national survey in 2017–2018

Background Lack of information exists about the use of traditional and complementary medicine (TCM) use among middle-aged and older adults in India, which led to studying the estimates of past-12-month Ayurveda/Yoga/Naturopathy/Unani/Siddha/Homeopathy (AYUSH) practitioner and traditional health practitioner (THP) utilization in India. Methods The study included 72,262 individuals (45 years and older) from the cross-sectional 2017–2018 Longitudinal Ageing Study in India (LASI) Wave 1. Results The prevalence of past 12-month AYUSH practitioner utilization was 6.5%, THP use 7.0%, and AYUSH or THP use 13.0%. The rate of AYUSH practitioner utilization was determined by older age (≥60 years) (Adjusted Odds Ratio-AOR: 1.20, 95% Confidence Interval-CI: 1.07–1.34), having pain (AOR: 1.48, 95% CI: 1.29–1.69), any bone or joint diseases (AOR: 1.57, 95% CI: 1.35–1.82), current tobacco use (AOR: 1.30, 95% CI: 1.12–1.50), male sex (AOR: 0.76, 95% CI: 0.68–0.85), high subjective socioeconomic status (AOR: 0.72, 95% CI: 0.60–0.87), urban residence (AOR: 0.71, 95% CI: 0.57–0.88), diabetes (AOR: 0.66, 95% CI: 0.55–0.81), chronic heart disease (AOR: 0.52, 95% CI: 0.37–0.73), and having a health insurance cover (AOR: 0.36, 95% CI: 0.30–0.44). The rate of THP utilization was determined by depressive symptoms (AOR: 1.17, 95% CI: 1.01–1.35), sleep problems (AOR: 1.28, 95% CI: 1.08–1.51), having pain (AOR: 1.82, 95% CI: 1.55–2.15), current tobacco use (AOR: 1.35, 95% CI: 1.22–1.51), having health insurance cover (AOR: 0.41, 95% CI: 0.33–0.51), hypertension (AOR: 0.82, 95% CI: 0.71–0.95), diabetes (AOR: 0.50, 95% CI: 0.39–0.65), urban residence (AOR: 0.25, 95% CI: 0.19–0.34), and high subjective socioeconomic status (AOR: 0.70, 95% CI: 0.58–0.85). Conclusion A moderate prevalence of AYUSH practitioner and THP use among middle-aged and older adults in India was found and several factors associated with AYUSH practitioner and THP use were identified.

Physical and Mental Health Effects of Bushfire and Smoke in the Australian Capital Territory 2019–20

The 2019–20 bushfire season in south-eastern Australia was one of the most severe in recorded history. Bushfire smoke-related air pollution reached hazardous levels in major metropolitan areas, including the Australian Capital Territory (ACT), for prolonged periods of time. Bushfire smoke directly challenges human health through effects on respiratory and cardiac function, but can also indirectly affect health, wellbeing and quality of life. Few studies have examined the specific health effects of bushfire smoke, separate from direct effects of fire, and looked beyond physical health symptoms to consider effects on mental health and lifestyle in Australian communities. This paper describes an assessment of the health impacts of this prolonged exposure to hazardous levels of bushfire smoke in the ACT and surrounding area during the 2019–20 bushfire season. An online survey captured information on demographics, health (physical and mental health, sleep) and medical advice seeking from 2,084 adult participants (40% male, median age 45 years). Almost all participants (97%) experienced at least one physical health symptom that they attributed to smoke, most commonly eye or throat irritation, and cough. Over half of responders self-reported symptoms of anxiety and/or feeling depressed and approximately half reported poorer sleep. Women reported all symptoms more frequently than men. Participants with existing medical conditions or poorer self-rated health, parents and those directly affected by fire (in either the current or previous fire seasons) also experienced poorer physical, mental health and/or sleep symptoms. Approximately 17% of people sought advice from a medical health practitioner, most commonly a general practitioner, to manage their symptoms. This study demonstrated that prolonged exposure to bushfire smoke can have substantial effects on health. Holistic approaches to understanding, preventing and mitigating the effects of smoke, not just on physical health but on mental health, and the intersection of these, is important. Improved public health messaging is needed to address uncertainty about how individuals can protect their and their families health for future events. This should be informed by identifying subgroups of the population, such as those with existing health conditions, parents, or those directly exposed to fire who may be at a greater risk.