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This study's data were collected by telephone and written questionnaires from 15- to 24-year-olds, the age reported to be at high risk for disorders such as depression. The survey revealed that of those contacted, one in four females and one in eight males reported high levels of depressive symptomatology. One in three had suicidal thoughts at some time. There were significant levels of risk-taking behavior including smoking, drinking, taking drugs, and engaging in unprotected sexual activity. Risky behaviors correlated with depression risk, but the direction of causality was not established. Young people in the study did not use traditional mental health services, but tended to rely on family and friends. Seventy-one of the young people who reported that they had attempted suicide did not receive medical assistance or see a mental health professional. Findings provide the basis for recommendations that stress the need for initiatives to decrease risk factors for depression among young people. The study's results also stress the need to enhance young people's interpersonal skills in order to enhance their family attachments and social relationships. (Contains 19 figures, 38 tables, and 53 references.) (JDM)

BackgroundThe existing models of care developed to comprehensively address the needs of people with multimorbid chronic obstructive pulmonary disease (COPD) may not be directly applicable to low- and middle-income countries (LMICs) like Nepal. Therefore, this research sought to co-design, with end-users and stakeholders, an integrated model of care to deliver a comprehensive self-management intervention to people with multimorbid COPD in rural Nepal. MethodsThis research was conducted in two stages: i) a parallel mixed-method descriptive research to understand self-management practices (SMPs), health literacy (HL) and patient activation (PA), along with their barriers and facilitators; and ii) Evaluation of the feasibility and acceptability of a co-design process used to develop a model of care. The descriptive research included a survey of 238 people with multimorbid COPD and qualitative explorations using in-depth interviews (IDIs) of selected stakeholders. The evaluation included qualitative analysis of IDIs, video recordings from co-design workshops and observation notes. Data were collected between September 2018 and December 2019 in the Sunsari district, Nepal.ResultsMore than two-thirds of participants had low levels of SMPs and HL and were less activated. Qualitative exploration identified inadequate family support, inadequate infrastructure and resources at primary care, limited skills of primary level providers and lack of educational materials for COPD, as barriers for SMPs. These findings guided the ideation of an integrated model of care, which was later refined in the prototype stage. This model of care included screening the community for people with COPD and morbidities within primary health care, establishing referral pathways and establishing a community-based support system. Evaluation of the co-design process showed that the approach was well accepted and feasible. A co-design evaluation framework was developed.ConclusionThe descriptive research

BackgroundPerceived risk is an important factor in understanding why and how a population adopts health-prevention interventions. When diseases are perceived as low-risk, motivation to use and adhere to prevention interventions is low, which can aid the spread of highly infectious diseases such as COVID-19. In this study, we assessed risk perception and its associated factors towards COVID-19 infection among the residents of Ondo State, southwest Nigeria. MethodsA community-based, cross-sectional study design using a multi-stage sampling technique was used to recruit 593 heads of households in three local government areas (LGA) in Ondo State. Data were collected using an interviewer-administered questionnaire which captured information on sociodemographic variables, knowledge of COVID-19 prevention, COVID-19 infection prevention and control practices, and risk perception from September 1 to 30, 2021. ResultsThe respondents were mostly males 357 (60.2%). The mean age of respondents was 37.5±14.7 years with 409 (69%) between the age group of 20 to 40 years. Slightly more than one quarter of respondents were civil servants and 78.4% were of Yoruba ethnicity. More than three quarters, 522 (88%), of the respondents had good knowledge of COVID-19 and its preventive measures. The mean risk perception score was 49.0±12.1. Respondents who were civil servants, had good knowledge of COVID-19 and its preventive measures, had lower household income, and were of Yoruba ethnicity had significantly higher risk perception towards COVID-19 infection compared to other groups. Higher risk perception was associated with preventive measures, such as handwashing. ConclusionOur study shows a high-risk perception towards COVID-19 infection among residents in Ondo state, Nigeria. However, there were significant differences between varying knowledge levels, ethnic groups and civil versus non-civil servants. In view of this, we recommend intensified risk communication interventions targeting t

La grande sfida che ci pone la fragilità è la difficoltà a ricondurla a un singolo dominio perché connette le dimensioni biologica e soggettiva di perdita di resistenza e di capacità di adattamento ad eventi stressogeni, a cambiamenti, perché non è peculiare di un'unica fascia di età, anche se fortemente influenzata dall'età avanzata, perché non equivalente alla cronicità, alla politologia e non significa disabilità o non autosufficienza, di cui è però un precursore. Quindi una condizione multifattoriale nella quale intervengono fortemente molti determinanti della salute che se individuata precocemente, trattata e gestita può, in alcuni casi, regredire e/o rallentare il suo decorso. Per questi motivi il Gruppo di Lavoro Primary Health Care di SItI ha deciso, dopo la stesura del position paper La Fragilità in una prospettiva di Sanità Pubblica: principi e strumenti per un approccio "life course" orientato alla prevenzione, di dar voce, in un volume, a tutti i professionisti coinvolti e ai cittadini sui modi per definire e riconoscere la fragilità secondo un approccio multidimensionale che possa diventare guida, riflessione e formazione sulla fragilità ad ampio spettro. In particolare il progetto editoriale si rivolge agli operatori della salute per orientarli, attraverso l'acquisizione di competenze specifiche, nelle attività di prevenzione, monitoraggio, coordinamento ed integrazione dei servizi che si rivolgono a questa ampia fascia di popolazione. Si sono volutamente mantenute le posizioni diversificate degli autori per offrire, in un'unica raccolta, visioni differenti e comunque in evoluzione fra professionisti e ricercatori con estrazioni ed esperienze variegate per sottolineare la necessità di un approccio interdisciplinare ad una tematica che approda a servizi e attività che vanno dal livello territoriale a quello specialistico e "super-specialistico", ma soprattutto che coinvolgono tutta la comunità in una rete di relazioni formali ed i

Shadows is an individualized, hands-on, real-world career experience that provides students with a structured look at the future world of work in health care. The program helps students build a bridge between school-based learning and established health care skills standards. Shadows focuses on expanding the student's horizons beyond the classroom and the neighborhood, paying special attention to broadening the student's health career awareness and pointing out connections between a student's current academics and future goals. It requires a clear understanding of, and commitment to, the value of educational experiences beyond the classroom. Through the Shadows program, students practice skills in nine core areas: academic foundation; oral and written communication; organizational systems; employability skills; legal responsibilities; ethical considerations; safety practices; teamwork and handling conflict; and health maintenance practices. Students are individually placed with a volunteer from government, business, higher education, or non-profit organizations. These professionals welcome students into their place of work, answer career-related questions, encourage observation of daily activities, and serve as role models. This booklet outlines the roles and responsibilities of Shadows students, hosts, program managers, and school staff. Handouts for student activities are included. (MKA)

The Insights program begins the journey of becoming ready to work by introducing students to the varied career opportunities, skills, and technologies in today's health care industry. Students travel as a class or group to the host site for a series of seminars. While on site, the students and their accompanying teachers meet with professionals who can orient them to the work environment. During the program, participants visit a variety of host sites including area colleges and/or universities where they learn about the demands of higher education, entrance requirements, financial aid possibilities, and other aspects of college life. Within the program, students practice skills in nine core areas: academic foundation; oral and written communication; organizational systems; employability skills; legal responsibilities; ethical considerations; safety practices; teamwork and handling conflict, and health maintenance practices. Insights not only provides an avenue for high school student career exploration, it also serves as a means for keeping participating teachers attuned to the challenges their students face after high school. This booklet outlines the roles and responsibilities of students, hosts, program managers and school staff involved in the program. The student handouts are provided. (MKA)

Designed as the final step in a carefully articulated work-readiness program, Mentors provides students interested in health care careers with an opportunity to develop superior employability skills, while striking a balance between work and school. The Mentors program links the school community, the student, and host organizations in a mutually respectful program geared toward developing a student's workplace behaviors. Participants receive the benefit of a volunteer mentor, continue to participate in a school-based support program, and whenever possible, receive a salary through a local funding source. The mentor/student match is closely monitored and the student is evaluated at each level of the program. Through the Mentors program students practice skills in nine core areas: academic foundation; oral and written communication; organizational systems; employability skills; legal responsibilities; ethical considerations; safety practices; teamwork and handling conflict; and health maintenance practices. This booklet contains the activities used in the Mentors program. Student handouts are designed for the pre-mentor, on-site mentor, and post-mentor levels. Handouts for worksite mentors, as well as schools and program managers are also included. (MKA)

BackgroundImproving chronic care delivery is a priority in Australian primary care. Patient experience is a useful indicator of how well services are meeting patient needs. Currently there is limited knowledge about the experiences of people with chronic conditions in Australian general practice, and the use of this information to improve service delivery. In this context and setting, this study aimed to answer the following: What are the care experiences of importance to these patients? and; How can this information inform service improvement?MethodsThis qualitative study incorporated findings from: Thematic analysis of semi-structured interviews with people managing chronic conditions in general practice, carers, and general practice providers in Sydney (n=40); and Qualitative content analysis of cross-sectional survey data from Australian and international primary care experts (n=20). Data was collected between October 2016 and January 2019.ResultsBarriers were identified in patients’ physical and timely access to care, based on their capacities and backgrounds, and the responsiveness of services to patient needs. Patients most strongly prioritised relational aspects of their general practice experience. This was informed by their expectations of care and how these were managed by their GPs. Positive experience based on repeated interactions facilitated relational continuity and improved self-management.Primary care experts agreed that patient experience data – commonly collected through surveys – is valuable in informing reflective, team-based learning in clinical practice. Appropriate planning of surveys around a clearly defined purpose was recommended. Participants emphasised the need to support general practice staff in carefully interpreting this data. Caution was raised regarding the use of this information at levels beyond individual practices.ConclusionHealth services should monitor and address the current access barriers encountered by people with chroni

The engagement of individuals in self-management of their chronic illnesses has been a policy focus of the Australian federal government and health services for over two decades, seeking to address the prevalence of chronic illnesses and the associated burden on health systems and communities. Governments, health services and community agencies have invested in self-management support initiatives to enhance individuals’ engagement in illness management. Concurrently, research has evaluated the support initiatives, developed theories of self-management, and identified factors that facilitate or hinder engagement. Despite this, a lack of agreement remains on how engagement in self-management is conceptualised, particularly from the view of consumers, and operationalised in practice. There is also a lack of research evaluating the consistency of consumer engagement in self-management beyond limited follow-up periods.This PhD study analysed data collected as part of a randomised controlled trial of a generic self-management group education program conducted in Sydney, New South Wales, Australia. The PhD study involved 16 participants with various chronic illnesses. A modified grounded theory approach was used to inductively develop and identify primary variables or components of the self-management process, contextual factors and a typology of engagement. A mixed methods analysis was undertaken to explore associations between the primary variables and establish a Conceptual Model of Consistency in Self-Management Engagement.The resulting model suggested different primary factors are associated with levels of engagement (high, low). Key factors associated with a high consistency of engagement included: where the purpose of engagement was to control the illnesses and promote a healthy lifestyle; where responsibility was delegated to the provider for illness-management decisions; and where the type of engagement was either shared with, or dependent upon, a significant othe

ObjectiveTo conceptualise a practically adequate theory and methodology of Human Rights Health Impact Assessment (HRHIA) using critical realist (CR) ontological perspectives and research approaches. Research designA CR framework for theory development and verification was applied. It involved four interrelated and iterative steps: description and analytic resolution of events and their effects; explication of structure using abductive and retroductive reasoning; assessment of explanatory power and contextualisation; and verification and concretisation of emergent theory.Application of the framework involved analysis and theorising of data from 23 international human rights (HR) and health impact assessment (HIA) experts; existing case studies of HIAs (11 case studies, 33 interviews) and a HR-based initiative (1 case study, 12 interviews); my own recollections and introspections on HIA projects; and relevant literature.FindingsA methodology is conceptualised as an entity with specific properties that give it the power to guide an overall process intended to achieve a defined outcome or purpose. Methodologies can exist in four states: conceptualised, intended, enacted, and experienced. The properties that empower the guidance mechanisms of a methodology include interrelated points of view concerning: the (health rights) environment that the methodology is intended to respond to and influence; relevant knowledge properties of people involved in use of the methodology; the intended purpose and goals of the methodology; the methodology rationale; conceptual frameworks about HRHIA and HR environments that inform decision-making; processes for enacting the methodology that subsume methods, tools and conditions associated with their use; and criteria and standards for evaluating the methodology, and the outcomes when the methodology is enacted. This definition and framework were used to develop an HRHIA-specific methodology framework (state 1) and some aspects of an intende

У статті наводяться досягнення в області профілактики цукрового діабету (ЦД) 2-го типу. На даний час проведені різні дослідження з профілактики ЦД з різним дизайном, видом втручання, тривалістю спостереження і механізмом дії. Один із можливих механізмів впливу полягає в тому, щоб загальмувати темп досягнення пікової поширеності ЦД. Другий сценарій стосується більшості перевірених медикаментозних втручань, за допомогою яких вдається знизити темп конверсії порушень толерантності до глюкози в маніфестації ЦД. Третя можлива превентивна модель полягає в досягненні стійкої стабілізації толерантності до глюкози. Після виявлення передумов для розвитку ЦД 2-го типу профілактичні заходи повинні проводитися протягом 10–12 років, поки бета-клітини функціонально активні., В статье приводятся достижения в области профилактики сахарного диабета (СД) 2-го типа. В настоящее время проведены различные исследования по профилактике СД с разным дизайном, видом вмешательства, длительностью наблюдения и механизмом действия. Один из возможных механизмов влияния заключается в том, чтобы затормозить темп достижения пиковой распространенности СД. Второй сценарий касается большинства проверенных медикаментозных вмешательств, с помощью которых удается снизить темп конверсии нарушений толерантности к глюкозе в манифестации СД. Третья возможная превентивная модель заключается в достижении стойкой стабилизации толерантности к глюкозе. После выявления предпосылок для развития СД 2-го типа профилактические мероприятия должны проводиться на протяжении 10–12 лет, пока бета-клетки функционально активны., This article presents the key achievements in the field of diabetes mellitus prevention. Currently, various researches have been conducted on the prevention of diabetes mellitus, with different designs, types of intervention, duration of follow-up and mechanisms of action. One of the possible mechanisms is aimed to slow down the rate of the peak prevalence of the diabetes mellitus. The second possibility is concerned the majority of medical interventions conducted, which enable to decrease the rate of impaired glucose tolerance in manifestation of diabetes mellitus. The third preventive mo­del consists in a strong stabilization of glucose tolerance. After detection of pre-conditions, which result in diabetes mellitus, preventive methods should be tested for 10–12 years, while beta cells are functionally active.