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The aim was to examine the social determinants of health on human immunodeficiency virus care quality for children in Indonesia.A qualitative design using constructivist grounded theory methods was utilized.Data were collected between 2019 and 2020 using in-depth- interviews and memo writing. In total, 23 semi-structured individual interviews with healthcare professionals, 12 with children with human immunodeficiency virus, and eight family members were conducted. Data were analysed with the two-step initial coding and focused coding, along with the constant comparative method, theoretical sensitivity and memo writing.Five themes were constructed from participants' perspectives on human immunodeficiency virus care for children: (1) living with a low-socioeconomic status, (2) lacking instrumental support, (3) experiencing complicated procedures for public health insurance, (4) limited Human Immunodeficiency Virus care services for children and (5) lacking care coordination, policies and practices.Children living with human immunodeficiency virus had poor health outcomes, due to having a low-socioeconomic status, reduced access to healthcare, coupled with a lack of social support services.This study demonstrated how the social determinants of health negatively impact the quality of care for Indonesian children with human immunodeficiency virus and their families. Understanding these determinants would benefit health professionals, in particular nurses, to consider these factors in their assessment to create a holistic care plan for children living with human immunodeficiency virus and their families. Addressing the social determinants of health would beneficially enhance outcomes and well-being of children living with human immunodeficiency virus health in Indonesia.

To conduct a systematic review and synthesis of qualitative evidence exploring the factors that influence a parent's decision to seek medical assistance while their child is having an asthma attack.Studies were included if they used qualitative methodologies and explored parent or carers' experience of caring for a child (2 to 12 years) during an acute asthma attack at home or in the community. We searched MEDLINE (OVID interface, 1948 onwards), EMBASE (OVID interface, 1980 onwards) and CINAHL (EBSCO) electronic databases. Quality appraisal was assessed by the Critical Appraisal Skills Program CASP for qualitative research, and the qualitative studies in this review were analyzed by thematic synthesis.From 4798 identified studies, 17 met the inclusion criteria. Synthesis revealed two distinct processes used by parents to aid their decision to seek medical intervention for their child. The first, past experiences informing future decisions and secondly facilitators that drive parents' to actively pursue medical help.This review highlights the importance of providing asthma education that not only focuses on the provision of information on symptoms, triggers, medication, and device use but asthma education that targets parents' unique experience. Using a family strength approach education can impact parents' future behavior when deciding to seek medical assistance for their child when experiencing an asthma attack. There was not a specific funding source, which supported this review. This review was registered with PROSPERO Identification Number CRD4201912740.

To construct a conceptual model of comprehensive care for Indonesian children with Human Immunodeficiency Virus.A qualitative constructivist grounded theory design. Purposive sampling was used to interview 12 children with Human Immunodeficiency Virus and 8 family members with the age of the children ranged from 9 to 18 years, and 23 health professionals, including general practitioners, paediatric specialists, nurses, midwife, and nutritionist from public health centres and provincial hospitals in East Java, Indonesia. Data was analysed using constant comparative coding methods, theoretical sensitivity, memo writing, and diagramming to facilitate the development of the substantive theory.Exploring the perspectives of the participants has revealed the need to enhance the delivery of comprehensive care across the continuum, because HIV care and services for children was sub-optimal. Understanding children's needs and preferences forms the foundation of the development of a framework for the comprehensive care of children with HIV consisting of child-centred care and social support, delivered by integration and coordination of care through a healthcare service.The conceptual model provides new knowledge and has the capacity to bring together optimal care across the continuum addressing the challenges of fragmentation of care for children and their families.The model informs that children with HIV not only need pharmacotherapy, but also other care interventions depending on their individual needs, preferences, and age. Implementing the model may help to resolve such problems, to improve collaborative practice and enhance children's participation, thereby promoting children's health outcomes.

Background Globally, families and communities are impacted by disasters every day. Nurses are integral to assisting in disasters, in the support and enablement of individuals and communities. However, some studies indicate that nurses feel ill-equipped to assist, partially because disaster content is not thoroughly addressed in the undergraduate curriculum. Therefore, nursing schools need to equip undergraduate nursing students with the knowledge and preparation required to assist effectively during and/or following a disaster. Aim To explore priority disaster topic areas aimed at preparing Australian undergraduate nursing students to assist in caring for survivors in the aftermath of disasters. Method This study used an integrative review methodology. Various databases and platforms were searched for literature published between 2000 and 2018 using Medical Subject Heading terms and keywords relating to the undergraduate nursing curriculum. A thematic analysis of the included papers was conducted. Results A total of 10 articles were identified that meet the inclusion criteria. The reviewed studies highlighted that the areas of disaster knowledge, assessment and triage, critical thinking, teamwork, technical skills, mental wellbeing, legal and ethical consideration, and socio-cultural contexts, are relevant for the undergraduate curriculum. Discussion This review highlights disaster education and training topic areas that could be considered for inclusion in Australian undergraduate nursing curricula. The content relating to disaster assistance must be incorporated into nursing schools’ curriculum. Conclusion The incorporation of disaster-related content in the undergraduate nursing curriculum may enhance the disaster preparedness of nursing students and the nursing workforce more broadly.

The rates of mental health hospitalisations in Australia are rising. This paper presents the findings of a study undertaken in a regional mental health unit. The aim of the study was to obtain user perspectives to inform the redesign of the unit, which provides inpatient mental health services to rural and regional adults. A qualitative descriptive study with data collected via focus groups and in-depth interviews was undertaken with 38 participants, including current inpatients, carers and 27 staff members of a single regional inpatient mental health unit. The 25-bed mental health inpatient unit accommodates adults from 18+ years of age. The mental health unit sits within a referral hospital precinct and is associated with community-based mental health services within a large regional and rural Australian public health service. The analysis of interviews and focus groups with patients, carers and mental health professionals revealed three major themes congruent with the literature These were: Firstly, Theme 1: Rooms should be designed to promote physical security. Next, Theme 2: Purposeful planning to support interactions between users and systems will promote relational security. And finally, Theme 3: Optimizing service integrity should promote procedural security. Based on the themes arising from the study, a list of recommendations was produced to inform the design of a new build for a regional mental health unit. In particular, all users of the space should expect that the built environment will promote their physical security and psychological safety and accommodate a wide range of diversity and acuity. The aesthetics should align with the promotion of recovery in the context of person-centred and trauma-informed models of care. Designers should plan to alleviate boredom and accommodate meaningful wayfinding. Mental health nurses should have spaces that support their work without compromising their relational security with consumers. Building designers should optimize therapeutic environments to facilitate dignified intensive and stabilizing treatments and eliminate vicarious stigma associated with caring for people with mental illness. This study provides valuable insights from a community of users who have experienced receiving and delivering mental health care within a regional and rural mental health unit.

Background:Mass-gathering events (MGEs) occur regularly throughout the world. As people congregate at MGEs, there is an increased risk of transmission of communicable diseases. Novel respiratory viruses, such as Severe Acute Respiratory Syndrome Coronavirus-1 (SARS-CoV-1), Influenza A Virus Subtype H1N1 Strain 2009 (H1N1pdm09), Middle East Respiratory Syndrome Coronavirus (MERS-CoV), and Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), or Coronavirus Disease 2019 (COVID-19), may require specific infection prevention and control strategies to minimize the risk of transmission when planning MGEs. This literature review aimed to identify and analyze papers relating to novel respiratory viruses with pandemic potential and to inform MGE planning.Method:This paper used a systematic literature review method. Various health care databases were searched using keywords relating to MGEs and novel respiratory viruses. Information was extracted from identified papers into various tables for analysis. The analysis identified infection prevention and control strategies used at MGEs to inform planning before, during, and following events.Results:In total, 27 papers met the criteria for inclusion. No papers were identified regarding SARS-CoV-1, while the remainder reported on H1N1pdm09 (n = 9), MERS-CoV (n = 15), and SARS-CoV-2 (n = 3). Various before, during, and after event mitigation strategies were identified that can be implemented for future events.Conclusions:This literature review provided an overview of the novel respiratory virus epidemiology at MGEs alongside related public health mitigation strategies that have been implemented at these events. This paper also discusses the health security of event participants and host communities in the context of cancelling, postponing, and modifying events due to a novel respiratory virus. In particular, ways to recommence events incorporating various mitigation strategies are outlined.

Background:Dedicated on-site medical services have long been recommended to improve health outcomes at mass-gathering events (MGEs). In many countries, they are being reviewed as a mandatory requirement. While it is known that perceptions of risk shape substance use plans amongst outdoor music festival (OMF) attendees, it is unclear if attendees perceive the presence of on-site medical services as a part of the safety net. The aim of this paper is to better understand whether attendees’ perceptions of on-site medical services influence high-risk behaviors like alcohol and recreational drug use at OMFs.Method:A questionnaire was distributed to a random sample of attendees entering and attending two separate 20,000-person OMFs; one in Canada (Festival A) and one in New Zealand (Festival B). Responses focused on demographics, planned alcohol and recreational drug use, perceptions of medical services, and whether the absence of medical services would impact attendees’ planned substance use.Results:A total of 851 (587 and 264 attendees for Festival A and Festival B, respectively) attendees consented and participated. Gender distribution was equal and average ages were 23 to 25. At Festival A, 48% and 89% planned to use alcohol and recreational drugs, respectively, whereas at Festival B, it was 92% and 44%. A great majority were aware and supportive of the presence of medical services at both festivals, and a moderate number considered them a factor in attendance and something they would not attend without. There was significant (>10%) agreement (range 11%-46%; or 2,200-9,200 attendees for a 20,000-person festival) at both festivals that the absence of medical services would affect attendees’ planned use of alcohol and recreational drugs.Conclusions:This study found that attendees surveyed at two geographically and musically distinct OMFs had high but differing rates of planned alcohol and recreational drug use, and that the presence of on-site medical services may impact attendees’ perceptions of substance use risk. Future research will aim to address the limitations of this study to clarify these findings and their implications.

Background:Standardizing and systematizing the reporting of health outcomes from mass gatherings (MGs) will improve the quality of data being reported. Setting minimum standards for case reporting is an important strategy for improving data quality. This paper is one of a series of papers focused on understanding the current state, and shaping the future state, of post-event case reporting.Methods:Multiple data sources were used in creating a lean, yet comprehensive list of essential reporting fields, including a: (1) literature synthesis drawn from analysis of 54 post-event case reports; (2) comparison of existing data models for MGs; (3) qualitative analysis of gaps in current case reports; and (4) set of data domains developed based on the preceding sources.Findings:Existing literature fails to consistently report variables that may be essential for not only describing the health outcomes of a given event, but also for explaining those outcomes. In the context of current and future state reporting, 25 essential variables were identified. The essential variables were organized according to four domains, including: (i) Event Domain; (ii) Hazard and Risk Domain; (iii) Capacity Domain; and (iv) Clinical Domain.Discussion:The authors propose a first-generation template for post-event medical reporting. This template standardizes the reporting of 25 essential variables. An accompanying data dictionary provides background and standardization for each of the essential variables. Of note, this template is lean and will develop over time, with input from the international MG community. In the future, additional groups of variables may be helpful as “overlays,” depending on the event category and type.Conclusions:This paper presents a template for post-event medical reporting. It is hoped that consistent reporting of essential variables will improve both data collection and the ability to make comparisons between events so that the science underpinning MG health can continue to advance.

Introduction:Without a robust evidence base to support recommendations for first aid, health, and medical services at mass gatherings (MGs), levels of care will continue to vary. Streamlining and standardizing post-event reporting for MG medical services could improve inter-event comparability, and prospectively influence event safety and planning through the application of a research template, thereby supporting and promoting growth of the evidence base and the operational safety of this discipline. Understanding the relationships between categories of variables is key. The present paper is focused on theory building, providing an evolving conceptual model, laying the groundwork for exploring the relationships between categories of variables pertaining the health outcomes of MGs.Methods:A content analysis of 54 published post-event medical case reports, including a comparison of the features of published data models for MG health outcomes.Findings:A layered model of essential conceptual components for post-event medical reporting is presented as the Data Reporting, Evaluation, & Analysis for Mass-Gathering Medicine (DREAM) model. This model is relational and embeds data domains, organized operationally, into “inputs,” “modifiers,” “actuals,” and “outputs” and organized temporally into pre-, during, post-event, and reporting phases.Discussion:Situating the DREAM model in relation to existing models for data collection vis a vis health outcomes, the authors provide a detailed discussion on similarities and points of difference.Conclusion:Currently, data collection and analysis related to understanding health outcomes arising from MGs is not informed by robust conceptual models. This paper is part of a series of nested papers focused on the future state of post-event medical reporting.

Aim:The aim of this paper is to further develop an existing data model for mass-gathering health outcomes.Background:Mass-gathering events (MGEs) occur frequently throughout the world. Having an understanding of the complexities of MGEs is important to determine required health resources. Environmental, psychosocial, and biomedical domains may be a logical starting point to determine how data are being collected and reported in the literature; however, it may be that other factors influencing health resources are not identified within these domains.Method:Based on an exhaustive literature synthesis, this paper is the final paper in a series that explores the collection of variables that impact biomedical presentations associated with attendance/participation in MGEs.Findings:The authors propose further evolution of the Arbon model to include the addition of several domains, including: event environment; command, control, and communication (C3); public health; health promotion; and legacy when reporting the health outcomes of an event.Conclusions:Including a variety of domains that contribute to an MGE allows for formal evaluation of the event, which in turn informs future knowledge and skill development for both the event management group and the wider community.

Background Nurses working with children often encounter child maltreatment. Nurses' roles in mandatory reporting are well-documented, but less is known about additional ways nurses respond to child maltreatment. This is important because children experiencing less extreme maltreatment may have unmet needs without receiving a child protection intervention. Objectives This paper reports one key finding from a qualitative study exploring nurses' perceptions and experiences of keeping children safe from maltreatment. Specifically, it reports nurses' perspectives of their relational skills used to support children experiencing maltreatment. Design and methods Qualitative inductive thematic analysis followed by a secondary analysis using a social constructionist framework. Data were collected through in-depth, semi-structured interviews and data saturation was achieved. Transcripts were inductively analysed with support of NVivo software. Participants Registered nurses (n = 21) working with children in Australia. Results Nurses saw relational practice as core to addressing child maltreatment. Key themes were: 1) ‘Walking the line’: relationships in the context of surveillance, 2) ‘You are a good mum’: focusing on the positives and 3) Seeing and being the voice of the child. Conclusions Nurses are uniquely positioned to identify and respond to child maltreatment through relational practices. Nurses maintained therapeutic relationships with parents to ensure ongoing access to vulnerable children. Although nurses recognised the importance of a child-centred approach, its enactment was varied and required ongoing critical reflection. This highlights the importance of supporting nurses to develop, maintain and continually improve their relational practices to enhance outcomes for children.

The risk of alcohol related harm is experienced disproportionality by young people aged 15-24 years. Harmful use of alcohol has serious effects on individual physical and mental wellbeing and is considered by the World Health Organization to be one of the main risk factors for poor health globally. It is crucial to understand the factors that influence drinking behavior in young people in order to inform prevention strategies to prevent problematic drinking. This is particularly paramount during the transition into young adulthood (around 18-25 years), when risky health behaviors are likely to become embedded. This pilot study adopted a qualitative descriptive methodology that facilitates exploration of what young people say about their own experiences and behavior, as it relates to SNS use and alcohol consumption. Semi-structured interviews were conducted in Newcastle, NSW Australia. An inductive, semantic approach to thematic analysis was selected to analyze the data as this method supported the exploratory nature of the pilot study and ensured that the themes identified were strongly linked to the data. Four main organizing themes that arose from the collected data were: organizing friends; safety amongst friends, planning not to plan; and different event - different plans. All of the participants stated they preferred to use Facebook Messenger™ to connect and share in a group conversation with peers. Convenience, cost and accessibility emerged as the main reasons for using SNSs to plan nights out. Planning for a night out using SNSs allows young people to impulsively plan and change plans - making planning fluid and asynchronous. To date, despite the global use of SNSs, the influence of SNSs in young adults' planning for events during which alcohol is served is relatively unknown. This pilot study gives us a some understanding of how young people use SNSs to plan and prepare for a night out where alcohol is served. Further research needs to be conducted to determine whether SNSs can be used effectively to promote health behavior change or be used as forums for advice seeking and support when attending events where alcohol is served, with the ultimate goal of lowering risky behaviors and thereby improving health outcomes for young people.

Background Nurses who work in regional and rural hospitals face unique challenges to disaster preparedness and response. Geographical location and isolation, decreased resources and subsequent workforce, along with organizational and financial restraints are some of the hurdles these individuals and communities face [1,2]. Method The Disaster Preparedness Evaluation Tool was applied a population of Regional and Rural Emergency Nurses in New South Wales. Result Thirty-two nurses participated in this study. Their level of disaster preparedness was at a moderate level for knowledge, skills and preparation for disaster management. Their experiences broadly mirrored those found in earlier research. Conclusion Results highlighted the nature of and delivery of continuing professional development in relation to disaster preparedness; mechanisms to encourage emergency department nurses to develop personal and family preparedness plans (to improved disaster preparedness); increased training in relation to psychological assessment of patients, and identification of biological agent signs and symptoms.

The present research aimed to investigate the relative effectiveness of three types of alcohol reduction intervention. Participants were 354 university students from an Australian university. After completing an initial survey, they were randomly assigned to either (a) follow national guidelines for alcohol consumption, (b) set their own personal alcohol consumption reduction goal, or (c) work with their peers to set a goal. Participants then recorded their alcohol consumption in a drinking diary over a period of four weeks. The results showed that participants in the personal goal condition reported significantly higher alcohol consumption than those in the national guidelines conditions, with participants in the group goal condition reporting mid-level alcohol consumption. This effect was moderated by binge drinking propensity. Personal goal setting was most likely to lead to higher alcohol consumption when participants scored relatively high on measures of binge drinking propensity. These findings highlight the point that different types of alcohol reduction interventions may be effective for different types of people. In particular, people who have a relatively high propensity for binge drinking should be encouraged to follow goals that have been set by authorities (e.g., national guidelines) rather than by themselves.

Problem The prevalence of prediabetes and type 2 diabetes (T2D) is increasing in adolescents worldwide. Most studies have focused on the clinical features, treatment, and complications for adolescents and so the need to generate insight into the risk factors and prevalence of undiagnosed prediabetes and T2D in adolescents across the globe remains. Eligibility criteria Relevant articles that were published from 2007 up to and including January 2017 were identified through electronic searches of CINAHL, Cochrane, Medline, PsycInfo, PubMed, Scopus, Web of Science, and Sociological Abstracts (Proquest). Four independent researchers examined the articles for eligibility. Sample Sixteen studies were included that investigated the risk and prevalence of undiagnosed prediabetes and T2D in adolescents aged 12–19. Results The most commonly measured risk factors included obesity/overweight, family history, and ethnicity. Other studies measured risk factors associated with insulin resistance, including hypertension, acanthosis nigricans, and dyslipidemia. Prevalence of undiagnosed prediabetes and T2D varied among regions globally with rates ranging from 3.3 to 14.3% and 0.1 to 2.2%, respectively. Conclusions Undiagnosed prediabetes and T2D and the associated risk factors are prevalent in many regions in countries worldwide, significantly impacting adolescents and their families. Implications Future research is required to inform interventions aimed at preventative measures for early screening and detection of prediabetes and T2D in adolescents, as well as the development of multi-disciplinary teams that include pediatric nurses and the specialized care they provide.

Aim:This paper discusses the need for consistency in mass-gathering research and evaluation from an environmental reporting perspective.Background:Mass gatherings occur frequently throughout the world. Having an understanding of the complexities of mass gatherings is important to inform health services about the possible required health resources. Factors within the environmental, psychosocial, and biomedical domains influence the usage of health services at mass gatherings. A minimum data set (MDS) has been proposed to standardize collection of biomedical data across various mass gatherings, and there is a need for an environmental component. The environmental domain includes factors such as the nature of the event, availability of drugs or alcohol, venue characteristics, and meteorological factors.Method:This research used an integrative literature review design. Manuscripts were collected using keyword searches from databases and journal content pages from 2003 through 2018. Data were analyzed and categorized using the existing MDS as a framework.Results:In total, 39 manuscripts were identified that met the inclusion criteria.Conclusion:In collecting environmental data from mass gatherings, there must be an agreed-upon MDS. A set of variables can be used to collect de-identified environmental variables for the purpose of making comparisons across societies for mass-gathering events (MGEs).

Due to its location in the ‘Pacific Ring of Fire”, Indonesia is frequently prone to natural disasters. Therefore, Indonesian nurses need to have the ability to assist in disaster situations as they are considered an important element of the workforce in disaster preparedness and response. However, the current nursing curricula in Indonesia does not adequately prepare nurses to respond in these situations. The primary aim of this study is to understand the experiences of Master of Nursing students’ roles and experiences in disaster settings in a nursing school in East Java, Indonesia. A single-case study design has been used. Data colection occurred via semi-structured interviews. The participants were enrolled in the Master of Nursing in a School of Nursing at a University in East Java. The data for the study were thematically analysed. Four main themes were identified: ‘personal feelings’, ‘working outside their scope of practice’, ‘lack of disaster preparedness’, and ‘a lack of mental health knowledge and care’. This study found that the Master of Nursing students in a nursing school in East Java, Indonesia were not adequately prepared for responding to disaster situations. This study found that a lack of disaster preparedness, working outside scope of practice, and a lack of mental health knowledge were the prominent issues for these Master of Nursing students. As well as commencing disaster training earlier in their education, providing training in the psychological context of disaster preparedness is recommended.

This grounded theory study aimed to explore the subjective experiences of children living with Human Immunodeficiency Virus (HIV) from the perspective of children and their families in Indonesia. Twenty participants were interviewed, consisting of 12 children aged 9–18 years and eight family members. Using grounded theory analysis, this study identified three categories: ‘coping with diagnosis’, ‘disclosing their status’ and ‘living with the stigma of HIV’. Participants responded with shock, denial, sadness, secrecy and often had misconceptions about the virus to the diagnosis of themselves or their children. After diagnosis, children with HIV and their families continuously lived with stigma stemming from individual and societal beliefs about the virus. This stigma manifested in actions such as isolation, disclosure avoidance, secrecy, deception and social rejection. Because of these stigmatisations, many of the participants decided not to disclose the child’s HIV status and used status strategies such as telling lies, keeping secrets and keeping their distance. The participants offered insight into the need for comprehensive programs to address care gaps. This study highlights that health professionals need to develop practical guidelines to support families during the disclosure process, provide psychosocial care for children, and create stigma reduction interventions for children with HIV.

Aim: The aim of this research was to obtain user perspectives of adolescent patients to inform the redesign of an adolescent mental health inpatient facility ward unit in regional Australia. Background: It is well established that the consumer will use and understand unit space differently than the health professional, because of their unique positioning and depth of experience. The participation of young people in the design of ward environments and programs is essential. Methods: A combination of focus groups and interviews was undertaken with eight participants. Results: This study found that, in its current form, the unit revolves around routines, tasks, and patient safety, which in turn are driven by secure spaces and surveillance of the patients. Due to these routines and tasks, the aspects of individualized patient care and personal impetus and comfort are lost. Adolescent patients are able to identify solutions to enhance their hospital stay in the mental health context without being excessive and unrealistic in their suggestions. Conclusions: When designing an adolescent unit, there needs to be some consideration as to how the group using the unit understands space. Through their role and depth of hospital experience, the adolescent patient will use and understand unit space differently from that of the health professional whose role is a worker. Therefore, it is necessary to gain the perspectives of adolescent patients for efficient and effective functioning of such an environment and to suit the needs of those it is “built for,” the adolescent patient.

Child and family health nurses (CFHNs) work in a variety of settings with families to promote optimal growth and development in infants and children from birth to 5 years. Literature is available about models of care that CFHNs use in their work, but there is limited information about how CFHNs enact care specifically for infants and children. The aim of this scoping review was to identify and contextualize existing knowledge of how CFHNs, both in Australia and internationally, care for infants and children. Arksey and O'Malley’s (2005) framework was used to review 27 studies from Australia, Sweden, Finland, United Kingdom (UK), United States of America (USA), Ireland, Netherlands, Denmark and Canada. It was identified that CFHNs, equipped with a range of assessment tools for early intervention and health promotion, use a partnership approach when working with parents to promote the health and well-being of infants and children. The literature revealed the complexity of the roles undertaken by CFHNs when caring for infants and children. Review findings indicated that CFHNs’ work is distinctive because it is conducted in home and community settings, is relational and salutogenic in nature and is also located in the domain of preventative health and early intervention.

BackgroundAround 2 billion people globally were affected by natural disasters between 2008-2018. The World Health Organization requires countries and governments to have disaster plans and emergency health workers ready and prepared at all times.ObjectivesTo conduct an integrative review of literature of emergency healthcare workers' perceived preparedness for disaster management.MethodologyAn integrative literature review using the PRISMA checklist guidelines was conducted to explore physicians, nurses, emergency medical services and allied medical professionals' preparedness for disasters. Literature was searched from 2005, published in the English language and from MEDLINE (PubMed), Google Scholar, EMBASE, PsycINFO, SCOPUS, ProQuest and CINAHL databases. Reviews, case reports, clinical audits, editorials and short communications were excluded. Studies were critically appraised using the Mixed Methods Appraisal Tool.ResultsThe initial search yielded 9589 articles. Twenty-seven articles were included following application of the eligibility criteria. Included studies were geographically diverse including North America, the Middle East and the Asia Pacific. Most studies (n = 24) assessed the knowledge of healthcare workers in general disasters. Studies using the Disaster Preparedness Evaluation Tool reported moderate disaster preparedness and knowledge, while studies using other instruments largely reported inadequate disaster preparedness and knowledge. Regional variations were recorded, with high-income countries' reporting a higher perceived preparedness for disasters than low-income countries.ConclusionThe majority of the emergency healthcare workers appear to have inadequate disaster preparedness. Previous disaster experience and training improved disaster preparedness. Future research should focus on interventions to improve emergency healthcare workers preparedness for disasters.

Introduction:Without a robust evidence base to support recommendations for medical services at mass gatherings (MGs), levels of care will continue to vary and preventable morbidity and mortality will exist. Accordingly, researchers and clinicians publish case reports and case series to capture and explain some of the health interventions, health outcomes, and host community impacts of MGs. Streamlining and standardizing post-event reporting for MG medical services and associated health outcomes could improve inter-event comparability, thereby supporting and promoting growth of the evidence base for this discipline. The present paper is focused on theory building, proposing a set of domains for data that may support increasingly comprehensive, yet lean, reporting on the health outcomes of MGs. This paper is paired with another presenting a proposal for a post-event reporting template.Methods:The conceptual categories of data presented are based on a textual analysis of 54 published post-event medical case reports and a comparison of the features of published data models for MG health outcomes.Findings:A comparison of existing data models illustrates that none of the models are explicitly informed by a conceptual lens. Based on an analysis of the literature reviewed, four data domains emerged. These included: (i) the Event Domain, (ii) the Hazard and Risk Domain, (iii) the Capacity Domain, and (iv) the Clinical Domain. These domains mapped to 16 sub-domains.Discussion:Data modelling for the health outcomes related to MGs is currently in its infancy. The proposed illustration is a set of operationally relevant data domains that apply equally to small, medium, and large-sized events. Further development of these domains could move the MG community forward and shift post-event health outcomes reporting in the direction of increasing consistency and comprehensiveness.Conclusion:Currently, data collection and analysis related to understanding health outcomes arising from MGs is not informed by robust conceptual models. This paper is part of a series of nested papers focused on the future state of post-event medical reporting.

Introduction Ambulance service design is often reminiscent of the economic status of a country, with pre-hospital care in low to medium income countries relying on basic life support services and an historical ‘swoop and scoop’ Anglo-American emergency medical service model. The connection between pre-hospital intervention and patient outcome in low to medium income countries is unclear. This scoping study undertook an examination of the literature to establish the level and quality of patient care data collection, especially as it impacts ambulance case times in Malaysia and Indonesia. Methods A scoping review methodology with topic specific keywords including ‘ambulance’, ‘emergency medical service’, ‘pre-hospital’ (and their variants) using MEDLINE, CINAHL, Cochrane and EMBase databases was used. Results Of the 202 articles returned, 185 were screened, 85 full text articles were reviewed for relevance. Forty-three publications were included in the study with a number of other relevant from the grey literature. Conclusion The scoping study found there is no consistency in data collection methods in Indonesian or Malaysia, with some organisations collecting high quality data while others do not collect pre-hospital data. The study recommends deeper investigation into the status of standardisation of emergency medical services in the two countries and the manner in which the data is reported.

Introduction As the number of mass gathering events increases, so too does the reliance on tertiary emergency healthcare services. Approximately 1% of event attendees may present to a local emergency department for clinical assessment and/or management. Often, these attendees are transported by ambulance services. The purpose of this study is to determine the frequency and location of events held in New South Wales (NSW), Australia. This information may be used by event and health service personnel to further inform event planning such as staffing, equipment and economic considerations when large events in the community occur. Methods This descriptive study used data scraping of an established data warehouse to identify events held in the 2017 calendar year by name, type, location (within the state of NSW) and duration. Using Google Maps, the distance and travel time between these events and the nearest emergency department (ED) was determined. Data was analysed using simple descriptive statistics. Results Of the 722 events in NSW analysed, 395 were single-day events. The majority of these were concerts (n=284, 39%), followed by festivals (n=259, 36%) and sporting events (n=176, 24%). The average distance and time to arrive at an ED from an event was 15.0 (±35.8) kilometres and 15.4 (±27.2) minutes, respectively. Conclusion Existing literature has highlighted that event attendees are regularly transported to emergency departments from events. This research has demonstrated that events occur frequently with varying vicinity to nearest EDs, with the majority of events occurring near territory care centres. However, there is limited research on the impact on emergency healthcare services resulting from an event.

Aim:This review discusses the need for consistency in mass-gathering research and evaluation from a psychosocial perspective.Background:Mass gatherings occur frequently throughout the world. Having an understanding of the complexities of mass gatherings is important to determine required health resources. Factors within the environmental, psychosocial, and biomedical domains influence the usage of health services at mass gatherings. A standardized approach to data collection is important to identify a consistent reporting standard for the psychosocial domain.Method:This research used an integrative literature review design. Manuscripts were collected using keyword searches from databases and journal content pages from 2003 through 2018. Data were analyzed and categorized using the existing minimum data set as a framework.Results:In total, 31 manuscripts met the inclusion criteria. The main variables identified were use of alcohol or drugs, crowd behavior, crowd mood, rationale, and length of stay.Conclusion:Upon interrogating the literature, the authors have determined that the variables fall under the categories of alcohol or drugs; maladaptive and adaptive behaviors; crowd behavior, crowd culture, and crowd mood; reason for attending event (motivation); duration; and crowd demographics. In collecting psychosocial data from mass gatherings, an agreed-upon set of variables that can be used to collect de-identified psychosocial variables for the purpose of making comparisons across societies for mass-gathering events (MGEs) would be invaluable to researchers and event clinicians.

This work, a conceptual forward-looking article, examines the management of audiences at music festivals now and indicates a critical maneuver of focus for the future. The theoretical objectives and conclusions of a body of work by Robertson—discussing and then proposing future models of festival leadership to support place and event sustainability—are applied to bodies of work by Hutton and colleagues, ranging from 2011 to 2017, and Brown and colleagues in 2012, 2013, and 2016. It is argued that a more holistic construct of civic responsibility will emerge in what will necessarily be a postcocreative, coproductive future for many critical mass meeting experiences. Hutton and Brown provide vital insight as to how consideration of the social psychological domain of the outdoor music festival (OMF) audience is critical to a design of the experience that is both experientially satisfying/fulfilling and, importantly, safe. This work uses literature related to festival management and critical transformation to propose a theoretical position arising from a construct of: transformative civic responsibility; social trust (as a component of social capital); and positive psychology. The work considers the dynamics and importance of outdoor music festivals in turbulent socioeconomic times, and the potential limitations of a behaviorist approach to future music festival crowd management. A case study research project was undertaken at a series of OMFs staged in South Australia and the results are used as examples of new forms of dynamic research for critical and turbulent times.

BackgroundThere is a growing body of literature relating to mass-gathering events. A common thread amongst this literature, particularly the literature relating to music festivals, is the incidence of patients presenting with substance and/or alcohol intoxication. However, the impact of alcohol and/or drugs on the provision of in-event health care services has not been explored in detail.AimThe goal of this review was to develop an understanding of the impact of alcohol and/or drugs on in-event health care services at mass-gathering events.MethodThis paper used integrative review as a methodology. The articles included in this literature review were sourced by searching databases inclusive of Medline (Ovid; US National Library of Medicine, National Institutes of Health; Bethesda, Maryland USA), Scopus (Elsevier; Amsterdam, Netherlands), PsycINFO (Ovid; American Psychological Association; Washington DC, USA), and Pub Med (National Center for Biotechnology Information, National Institutes of Health; Bethesda, Maryland USA). Identified manuscripts that met the inclusion criteria were thematically analyzed.ResultsIn total, 12 manuscripts met the inclusion criteria for this review. A thematic analysis of these manuscripts identified three main themes: (i) predictive factors, (ii) patient presentation rates, and (iii) levels of care.Conclusion:Substance use and/or intoxication can place a strain on in-event medical services at mass-gathering events. Of the various types of mass-gathering events, music festivals appear to be the most affected by substance use and intoxication.BullockM, RanseJ, HuttonA.Impact of patients presenting with alcohol and/or drug intoxication on in-event health care services at mass-gathering events: an integrative literature review. Prehosp Disaster Med. 2018;33(5):539–542.

This qualitative research article explored the convergences and divergences of perceptions of adolescent romantic experience between a group of adolescents and parents in China. One-to-one, in-depth interviews were conducted with 38 adolescents (aged 15-18 years; 26 girls, 12 boys) and 27 parents (aged 40-52 years; 16 mothers, 11 fathers) from the urban areas of a northern Chinese city. Data analysis was conducted using thematic analysis and interpreted using a socio-ecological approach. Four major themes were identified: opportunities and risks, acceptable versus unacceptable sexual intimacy, generational difference, and girls’ vulnerability and “self-respect.” In these themes, congruity and divergence of perceptions were found between the groups of adolescents and parents. These perceptions were largely influenced by traditional cultural beliefs of education, sexuality, gender, and family as well as the current socio-cultural context of modernization and globalization in China. The findings provide implications regarding how to support both adolescents and parents in managing adolescent romantic experience for adolescent health-promoting romantic and sexual behaviors.

Background The emergency department (ED) is a familiar place for the emergency nurse who spends their working days inside it. A disaster threatens that familiarity and creates changes that make working in the ED during a disaster response different from the everyday experience of working in the ED. Methods This research reports on an aspect of the findings from a larger study about the experience of working as a nurse in the ED during a disaster response. Thirteen nurses from 8 different countries were interviewed about their experience. Results The findings from this research demonstrate that a disaster event leads to a chain reaction of changes in process, space and practice. Nurses' respond to the news of a disaster event with shock and disbelief. The ED may change as a result of the event requiring nurses to work in an altered environment or a completely different setting. These changes provoke nurses to alter their behaviour and practice and reflect on the experience after the response. Conclusions Emergency nurses have a high likelihood of participating in disaster response and as such should be adequately prepared. This highlights how disaster response is different and leads to recommendations to enhance training for emergency nurses which will better prepare them Disasterresponse is not normal business ramped up. There are a number of challenges and changes that should be considered when preparing emergency nurses for the realities of disaster response.