Working at the interface in Aboriginal and Torres Strait Islander health: focussing on the individual health professional and their organisation as a means to address health equity

Background: Aboriginal and Torres Strait Islander people experience inequity in health outcomes in Australia. Health care interactions are an important starting place to seek to address this inequity. The majority of health professionals in Australia do not identify as Aboriginal and/or Torres Strait Islander people and the health care interaction therefore becomes an example of working in an intercultural space (or interface). It is therefore critical to consider how health professionals may maximise the positive impact within the health care interaction by skilfully working at the interface. Methods: Thirty-five health professionals working in South Australia were interviewed about their experiences working with Aboriginal people. Recruitment was through purposive sampling. The research was guided by the National Health and Medical Research Council Values and Ethics for undertaking research with Aboriginal communities. Critical social research was used to analyse data. Results: Interviews revealed two main types of factors influencing the experience of non-Aboriginal health professionals working with Aboriginal people at the interface: the organisation and the individual. Within these two factors, a number of sub-factors were found to be important including organisational culture, organisational support, accessibility of health services and responding to expectations of the wider health system (organisation) and personal ideology and awareness of colonisation (individual). Conclusions: A health professional’s practice at the interface cannot be considered in isolation from individual and organisational contexts. It is critical to consider how the organisational and individual factors identified in this research will be addressed in health professional training and practice, in order to maximise the ability of health professionals to work with Aboriginal and Torres Strait Islander people and therefore contribute to addressing health equity.Annabelle M. Wilson, Janet Kelly, Anthea Magarey, Michelle Jones and Tamara Mackea

The clinical significance of loss of DNA mismatch repair in ovarian cancer patients: an immunohistochemical study

Loss of mismatch repair (MMR) and, in particular, loss of MLH1 is associated with acquired cisplatin resistance of ovarian tumour cell line models. The aim of this thesis is to examine in ovarian cancer patients the clinical prognostic significance of the MMR proteins MLH1 and MSH2 when measured at disease presentation. We have developed immunohistochemistry (IHC) and a scoring system for the expression of MLH1 and MSH2 in paraffin embedded tissues. We have scored both the intensity of staining (I-score) and percentage of cells staining (%-score). We have validated this technique with good agreement in scoring over time, between blocks and between observers (inter-observer kappa scores of ≥ 0.629, intra-observer kappa scores of > 0.646 and intra-slide kappa scores of ≥ 0.583). There was a positive correlation of Ki67, (a proliferation marker), with I-MLH1, %-MLHl and %-MSH2 scores (p=0.002; <0.001 and 0.001) but not with p53 scores.We examined prechemotherapy samples from 58 patients with a histological diagnosis of advanced ovarian carcinoma, who were then treated with primary chemotherapy regimens containing cisplatin. Advanced stage was associated with increased percentage cells positive for MLH1, MSH2 and Ki67 (p = 0.0092, 0.0049 and 0.0054 respectively). We performed a multivariate analysis allowing for known clinical prognostic factors, (i.e. type of chemotherapy given, stage, performance status and residual disease). Patients with a loss of intensity of staining for MMR proteins prechemotherapy showed a poor survival (Hazard Ratio, HR=3.64; p=0.0012) and poor progression free survival (HR=2.37; p=0.016). Similarly patients showing a reduced intensity of MLH1 staining showed a poor overall survival (HR=2.17; p=0.031). There was no correlation of MMR proteins and tumour response to treatment.Loss of mismatch repair (MMR) in ovarian tumour cells after cisplatin-based chemotherapy has been shown in both in vitro and in vivo. We have examined paired samples pre and post chemotherapy in 26 ovarian cancer patients. We have seen no consistent changes in MMR proteins, p53 or Ki67 pre and post chemotherapy. On multivariate analysis change in MMR expression did not correlate with survival but it was found that a reduction in intensity of MSH2 staining post chemotherapy was associated with a longer progression free survival (HR 0.52; p=0.011).Although further prospective validation studies will be necessary, our observations support the proposal that low MLH1 and/or MSH2 expression is associated with resistance in vivo of ovarian tumours to cisplatin and hence poor survival of patients after cisplatin-based chemotherapy

Генеалогія влади та повсякденності: досвід підрадянських дисидентів

У статті розглядається взаємозв’язок тематизацій «влада» та «повсякденність». Він підкреслюється прикладом історичної повсякденності. У висновку дослідження автор доходить висновку, що влада як силове відношення реалізується у суперечливому прагненні, водночас спрямованому як на подолання повсякденності, так і на розчинення у ній.В статье рассматривается взаимосвязь тематизаций «власть» и «повседневность». Она подчеркивается примером исторической повседневности. В результате исследования автор приходит к выводу, что власть как силовое отношение реализуется в противоречивом стремлении, одновременно направленном как на преодоление повседневности, так и на растворение в ней.In the presented article the interrelation themes «the power» and «the routine» is considered. It is underlined by an example of historical routine. As a result of research the author comes to conclusion, that the power as the power relation is realized in inconsistent aspiration simultaneously directed both on the routine overcoming, and on dissolution in it

Effectiveness of Remotely Delivered Motivational Conversations on Health Outcomes in Patients Living with Musculoskeletal Conditions: A Systematic Review and Meta-Analysis

Objective: to evaluate the efficacy of remotely delivered motivational conversations on health outcomes in musculoskeletal populations. Methods: four electronic databases (inception-March 2022) were searched and combined with grey literature. Randomised control trials (RCTs) evaluating the effect of remotely delivered motivational conversation-based interventions within musculoskeletal populations, using valid measures of pain, disability, quality of life (QoL), or self-efficacy were included. Overall quality was assessed using GRADE criteria. Meta-analyses were performed using random effects models with pooled effect sizes expressed as standardised mean differences (±95%CIs). Results: twelve RCTs were included. Meta-analyses revealed very-low to moderate quality evidence that remote interventions have a positive effect on pain and disability both immediately post intervention and at long-term follow-up compared to control, and have a positive effect on self-efficacy immediately post intervention. There was no effect on QoL immediately post intervention or at long-term follow up. Conclusion: remotely delivered motivation-based conversational interventions have a positive effect on pain, disability, and self-efficacy but not on QoL.Practice Implications: motivational conversations, delivered remotely, may be effective in improving some health-related outcomes in MSK populations. However, higher quality evidence is needed to determine optimal intervention durations, and dosing frequencies using sufficient sample sizes and follow-up time frames.<br/

Indigenous and non-Indigenous theories of wellbeing and their suitability for wellbeing policy

A growing interest among governments in policies to promote wellbeing has the potential to revive a social view of health promotion. However, success may depend on the way governments define wellbeing and conceptualize ways to promote it. We analyze theories of wellbeing to discern twelve types of wellbeing theory and assess the suitability of each type of theory as a basis for effective wellbeing policies. We used Durie’s methodology of working at the interface between knowledge systems and Indigenous dialogic methods of yarning and deep listening. We analyzed selected literature on non-Indigenous theories and Indigenous theories from Australia, New Zealand, Canada and the United States to develop a typology of wellbeing theories. We applied political science perspectives on theories of change in public policy to assess the suitability of each type of theory to inform wellbeing policies. We found that some theory types define wellbeing purely as a property of individuals, whilst others define it in terms of social or environmental conditions. Each approach has weaknesses regarding the theory of change in wellbeing policy. Indigenous relational theories transcend an ‘individual or environment’ dichotomy, providing for pluralistic approaches to health promotion. A broad theoretic approach to wellbeing policy, encompassing individual, social, equity-based and environmental perspectives, is recommended

Patient and provider experiences with relationship, information, and management continuity

From 2003 to 2014, the Health Quality Council of Alberta (HQCA) monitored patient experiences with healthcare services through a biennial Satisfaction and Experience with Healthcare Services (SEHCS) survey. The findings consistently showed a direct link between coordination of care, an aspect of continuity of care, and healthcare outcomes. Specifically, it showed that better coordination is linked to positive outcomes; the reverse is also true. Given the critical role continuity of care plays in the healthcare system, the HQCA conducted in-depth interviews, interactive feedback sessions and focus groups with patients and providers to explore factors that influence both seamless and fragmented patient journeys. Continuity of care refers to “the degree to which a series of discrete healthcare events is experienced as coherent and connected and consistent with the patient’s healthcare needs and personal context”. Reviews of international literature have identified three major subtypes of continuity across healthcare settings: relationship, information, and management continuity. This study showed that from the patient perspective, relationship continuity is most valued and is foundational for experiencing information and management continuity. A trusting, patient-centred, and respectful relationship with a primary healthcare provider is central to this. From the provider perspective, information continuity is most important. Primary care providers get frustrated if information is withheld or delayed, and if other providers change treatment plans or medications. Patients highly value timely access to their own information. They also value having enough time during an appointment with a family doctor who listens and communicates effectively. Both patients and providers value and benefit from management continuity, which was described by many as a partnership or shared responsibility for managing and coordinating healthcare services. Future conversations about health system design should focus on how all providers and services can work together, and engage patients, to co-design a system that is built around patient-centred relationships

A State-Space Model for Abundance Estimation from Bottom Trawl Data with Applications to Norwegian Winter Survey

We study a hierarchical dynamic state-space model for abundance estimation. A generic data fusion approach for combining computer simulated posterior samples of catch output data with observed re- search survey indices using sequential importance sampling is pre- sented. Posterior samples of catch generated from a computer soft- ware are used as a primary source of input data through which sheries dependent information is mediated. Direct total stock abundance es- timates are obtained without the need to estimate any intermediate parameters such as catchability and mortality. Numerical results of a simulation study show that our method provides a useful alternative to existing methods. We apply the method to data from the Barents Sea Winter survey for Northeast Arctic cod (Gadus morhua). The re- sults based on our method are comparable to results based on current methods.Innsendt manuskript - Preprin

Organizational impact of evidence-informed decision making training initiatives : a case study comparison of two approaches

Background The impact of efforts by healthcare organizations to enhance the use of evidence to improve organizational processes through training programs has seldom been assessed. We therefore endeavored to assess whether and how the training of mid- and senior-level healthcare managers could lead to organizational change. Methods We conducted a theory-driven evaluation of the organizational impact of healthcare leaders’ participation in two training programs using a logic model based on Nonaka’s theory of knowledge conversion. We analyzed six case studies nested within the two programs using three embedded units of analysis (individual, group and organization). Interviews were conducted during intensive one-week data collection site visits. A total of 84 people were interviewed. Results We found that the impact of training could primarily be felt in trainees’ immediate work environments. The conversion of attitudes was found to be easier to achieve than the conversion of skills. Our results show that, although socialization and externalization were common in all cases, a lack of combination impeded the conversion of skills. We also identified several individual, organizational and program design factors that facilitated and/or impeded the dissemination of the attitudes and skills gained by trainees to other organizational members. Conclusions Our theory-driven evaluation showed that factors before, during and after training can influence the extent of skills and knowledge transfer. Our evaluation went further than previous research by revealing the influence—both positive and negative—of specific organizational factors on extending the impact of training programs