Systemic isotretinoin in the management of acne – a patient questionnaire survey

Background: The primary aim was to investigate the appropriateness (as outlined in the South African Acne Treatment Guideline1) for the prescription of systemic isotretinoin in the management and counselling of acne in the Nelson Mandela Bay Metropole. Methods: A questionnaire was distributed to patients receiving systemic isotretinoin by 30 community pharmacies. The response rate was 29.2% (57 respondents). Results: The acne medication history revealed that commercial brands of beauty products were used by 57.9% of respondents, topical benzoyl peroxide by 22.8%, and systemic cotrimoxazole by 19.3%. Only nine females used an oral contraceptive as acne treatment prior to isotretinoin. The average daily dose of isotretinoin was 44.2 (SD=16.9) mg. Half of the respondents received a suboptimal cumulative dosage of isotretinoin. The average prescribed duration of isotretinoin therapy was 6.2 months. Adequate counselling was received by only 57.9% of patients. A third of the patients who were able to fall pregnant received recommendations for contraception. Pregnancy tests were conducted in only two females. Just over 40% of patients reported a complete clearance of acne lesions. Conclusions: Many prescribers did not follow the recommendations for isotretinoin prescription. The counselling of patients regarding isotretinoin therapy was substandard, especially with respect to pregnancy prevention

A Qualitative Exploration of Sources of Help for Mental Illness in Arabic-, Mandarin-, and Swahili-Speaking Communities in Sydney, Australia

Despite being disproportionately affected by poor mental health, culturally and linguistically diverse (CaLD) individuals seek help from mental health services at lower rates than others in the Australian population. The preferred sources of help for mental illness amongst CaLD individuals remain poorly understood. The aim of this study was to explore sources of help in Arabic-, Mandarin-, and Swahili-speaking communities in Sydney, Australia. Eight focus-group discussions (n = 51) and twenty-six key informant interviews were undertaken online using Zoom. Two major themes were identified: informal sources of help and formal sources of help. Under the informal sources of help theme, three sub-themes were identified: social, religious, and self-help sources. All three communities strongly recognised the role of social sources of help, with more nuanced roles held by religion and self-help activities. Formal sources of help were described by all communities, although to a lesser extent than informal sources. Our findings suggest that interventions to support help-seeking for all three communities should involve building the capacity of informal sources of help, utilising culturally appropriate environments, and the collaboration between informal and formal sources of help. We also discuss differences between the three communities and offer service providers insights into unique issues that require attention when working with these groups

Conceptualisations of mental illness and stigma in Congolese, Arabic-speaking and Mandarin-speaking communities: a qualitative study

Background: Australia is an ethnically diverse nation. Research has demonstrated an elevated risk of developing a mental illness in culturally and linguistically diverse (CaLD) communities yet uptake of mental health services is low. To improve mental health treatment seeking and outcomes for CaLD individuals in Australia there is an urgent need to deeply understand barriers to treatment such as stigma. Using an exploratory qualitative approach, the aim of the study was to explore how CaLD communities’ conceptualise and interpret mental illness and associated beliefs and experiences of stigma. Methods: The study focused on three key CaLD groups: the Congolese, Arabic-speaking and Mandarin-speaking communities residing in Sydney, Australia. A series of eight focus group discussions (n = 51) and 26 key informant interviews were undertaken online using Zoom during the period of November to December 2021. Focus group discussions and key informant interviews were digitally recorded, transcribed, and analysed using NVivo software. Results: Three major themes were identified. The first theme related to mental illness terminology used in the three communities. Despite variation in the terms used to refer to ‘mental illness’ all three communities generally distinguished between ‘mental illness’, a more severe condition and ‘mental health problems’, considered to arise due to stressors. The second theme centred on beliefs about mental illness; with all three communities identifying migration-related stressors as contributing to mental illness. Culturally related beliefs were noted for the Congolese participants with the perception of a link between mental illness and supernatural factors, whereas Mandarin-speaking participants highlighted lack of inter and intrapersonal harmony and failure to adhere to values such as filial piety as contributing to mental illness. The final theme related to mental illness related stigma and the various ways it manifested in the three communities including presence of collectivist public stigma felt across all three groups and affiliate (family) stigma reported by the Arabic and Mandarin-speaking groups. Conclusions: We found rich diversity in how these communities view and respond to mental illness. Our findings provide some possible insights on both service provision and the mental health system with a view to building effective engagement and pathways to care

Facilitating health and wellbeing is "everybody's role": youth perspectives from Vanuatu on health and the post-2015 sustainable development goal agenda

BACKGROUND: Progress towards achievement of the Millennium Development Goals (MDGs) amongst Pacific island countries (PICs) has seen mixed results. As focus shifts to formulation of new health-related development goals beyond 2015, there is a need for bringing community consultation into this process. For this purpose, Go4Health is a global consortium examining the development of these goals, with Work Package 2 capturing viewpoints of marginalised populations regarding health. This paper examines the perspectives of youth in Vanuatu on essential health needs in the context of the post-2015 development agenda, to make these concerns more visible for their communities, stakeholders and health policy decision makers. METHODS: As part of a larger investigation undertaken in Vanuatu involving 100 residents from various rural and urban communities, this paper explores the perspectives of twenty 17-year old secondary school students gathered through two focus group discussions during September 2013. Questions sought viewpoints across areas including health ideals, essential needs, responsibility for health services and their governance. Focus group discussions were conducted in English and digitally recorded, with resulting transcripts subjected to thematic analysis. RESULTS: This youth cohort from Vanuatu had a strong understanding of the social determinants of health. They placed value on all aspects of health, indicating the need for youth to have access to positive lifestyle opportunities (sport, community participation) and also increased protection from the impact of harmful substances and causes of chronic illness. Participants identified barriers to health due to unevenly distributed health services throughout Vanuatu, with members at all levels of society ultimately perceived as responsible for improving health throughout the nation. CONCLUSION: Against a background of a weak health system and significant challenges to public health, young people are acutely aware that improving Vanuatu’s health status requires a communal effort. While contributing factors to health depend on actions taken at individual, local, national and global levels, no single actor currently provides enough support to cover all essential health needs. As a consequence, they see health in the Pacific as “everybody’s role”, of importance for the post-2015 sustainable development goal agenda and health policy makers in general

Good practice in health care for migrants: views and experiences of care professionals in 16 European countries

<p>Abstract</p> <p>Background</p> <p>Health services across Europe provide health care for migrant patients every day. However, little systematic research has explored the views and experiences of health care professionals in different European countries. The aim of this study was to assess the difficulties professionals experience in their service when providing such care and what they consider constitutes good practice to overcome these problems or limit their negative impact on the quality of care.</p> <p>Methods</p> <p>Structured interviews with open questions and case vignettes were conducted with health care professionals working in areas with high proportion of migrant populations in 16 countries. In each country, professionals in nine primary care practices, three accident and emergency hospital departments, and three community mental health services (total sample = 240) were interviewed about their views and experiences in providing care for migrant patients, i.e. from first generation immigrant populations. Answers were analysed using thematic content analysis.</p> <p>Results</p> <p>Eight types of problems and seven components of good practice were identified representing all statements in the interviews. The eight problems were: language barriers, difficulties in arranging care for migrants without health care coverage, social deprivation and traumatic experiences, lack of familiarity with the health care system, cultural differences, different understandings of illness and treatment, negative attitudes among staff and patients, and lack of access to medical history. The components of good practice to overcome these problems or limit their impact were: organisational flexibility with sufficient time and resources, good interpreting services, working with families and social services, cultural awareness of staff, educational programmes and information material for migrants, positive and stable relationships with staff, and clear guidelines on the care entitlements of different migrant groups. Problems and good care components were similar across the three types of services.</p> <p>Conclusions</p> <p>Health care professionals in different services experience similar difficulties when providing care to migrants. They also have relatively consistent views on what constitutes good practice. The degree to which these components already are part of routine practice varies. Implementing good practice requires sufficient resources and organisational flexibility, positive attitudes, training for staff and the provision of information.</p

Challenges in Evaluating Aboriginal Healing Programs: Definitions, Diversity and Data

© 2017 Australasian Evaluation Society. Indigenous people around the world have long healing traditions. Contemporary Aboriginal and Torres Strait Islander healing projects are designed to empower individuals, families and communities; strengthen connections to culture; and reduce the damaging effects of colonisation and government policies such as the forcible removal of children (the Stolen Generations). Evidence on the conditions necessary for healing to occur, and how healing works for different people and in different contexts, is limited. Evaluations that will help identify good practice and document the full range of outcomes are sorely needed. This paper is based largely on experiences and learnings from Stolen Generations projects around Australia funded by the Aboriginal and Torres Strait Islander Healing Foundation, and the reflections of experienced scholar-practitioners. It argues that evaluations that are responsive to, and ultimately owned and led by, Aboriginal and Torres Strait Islander communities need to be designed and implemented differently to mainstream evaluations. Timeframes, methods, relationships between evaluators and stakeholders, and the identification and measurement of outcomes all need to be carefully considered. Challenges include definitions of healing, diversity of landscapes and programs, and data collection. Qualitative methods that preference and support Indigenous cultural frameworks and ways of creating and sharing knowledge work well. In addition to ensuring culturally sensitive methodologies and tools, working ethically and effectively in the Indigenous healing space means emphasising and enabling safety for participants, workers and organisations

Towards a national approach to telehealth evaluation: the work of the Australian New Zealand Telehealth Committee

Telehealth is a rapidly growing field, with developments in all Australian States and Territories and New Zealand. In the complex environment of the health system, strenuous efforts must be made to establish meaningful statistics and data against which the costs and benefits of new initiatives can be measured and compared with alternative approaches. Since its establishment in 1996 the Australian New Zealand Telehealth Committee has been actively engaged in developing a standard and system-wide approach to monitoring and evaluation that will meet both project and strategic needs. The Committee has developed a national telehealth evaluation framework that incorporates a standard approach to project evaluation, and conducts an annual survey of telehealth activity across Australia. In conjunction with the Department of Health and Aged Care, the Committee is currently pursuing the development and trial of a generic evaluation methodology to establish the relative clinical and cost-effectiveness of key telehealth applications. Important work is also being done in the area of data definitions, with elaboration of a telehealth data framework and development of a set of standard telehealth data definitions, and ongoing work towards a national minimum data set and performance indicators for telehealth