Issue addressed: This article reports the qualitative evaluation of "Artspace," an innovative clinical program combining creative arts with physical and mental health care for young women. The ...program, provided since 2004, comprises weekly visual arts sessions alongside a youth health clinic offering drop-in appointments with a nurse, GP and counsellor.
Methods: A qualitative evaluation of Artspace was conducted between 2016 and 2017.
Results: The evaluation showed that Artspace was particularly beneficial for those clients who had considerable exposure to social adversity and trauma, and were experiencing related serious health impacts. Artspace facilitated their recovery by enabling equitable access facilitation, social inclusion, creating a "holding" environment, and through the directly therapeutic benefits of artist-led arts processes.
Conclusions: Our study highlights the positive impact of artist-led programs such as Artspace. It also attests to the importance of long-term sustainability of services, to allow the time needed for young people to experience genuine and sustained recovery, and to reduce the otherwise likely disadvantages associated with mental and physical health problems, as they move into their adult lives.
So what?: Youth health researchers have been recommending arts programs at health services as a means of engaging young people in health care for over 15 years, however, it remains an underutilised approach in primary care settings. Our evaluation affirms the effectiveness of art programs for this, and also demonstrates that art programs can be a key contributor to recovery from the serious health impacts of adversity and trauma.
Trauma and adversity have serious health consequences, particularly when experienced in early life. These health consequences can be significantly lessened if young people access appropriate care ...when needed. In 2004, the Blue Mountains Women's Health and Resource Centre created a Young Women's Clinic (YWC) that began providing drop-in appointments for women aged 12-25 years with a general practitioner, nurse or counsellor, as well as a group art program.
A qualitative evaluation of services provided by the YWC was conducted, drawing on 13 years of client and staff experiences. The evaluation framework was drawn from the recommendations of the NSW Centre for Advancement of Adolescent Health, the Australian Women's Health Network and the World Health Organization report on People-centred and integrated health services.
The following principles of trauma-informed care were identified in the study: recognising the impact of trauma on consultations; tailoring consultation length to client needs; providing trauma therapy as well as physical healthcare; offering long-term, safe relationships with staff; trauma-sensitive gynaecological care; and the importance of self-care for health practitioners.
Our findings demonstrate the importance of holistic general practice services in preventing and managing the long-term health consequences of adversity and trauma.
Magnetic resonance imaging (MRI) in patients with left ventricular (LV) leads may cause tissue or lead heating, dislodgment, venous damage, or lead dysfunction.
The purpose of this study was to ...determine the safety of MRI in patients with LV pacing leads.
Prospective data on patients with coronary sinus LV leads undergoing clinically indicated MRI at 3 institutions were collected. Patients were not pacemaker-dependent. Scans were performed under pacing nurse, technician, radiologist, and physicist supervision using continuous vital sign, pulse oximetry, and ECG monitoring and a 1.5-T scanner with specific absorption rate <1.5 W/kg. Devices were interrogated pre- and post-MRI, programmed to asynchronous or inhibition mode with tachyarrhythmia therapies off (if present), and reprogrammed to their original settings post-MRI.
MRI scans (n = 42) were performed in 40 patients with non-MRI conditional LV leads between 2005 and 2013 (mean age 67 ± 9 years, n = 16 40% women, median lead implant duration 740 days with interquartile range 125-1173 days). MRIs were performed on the head/neck/spine (n = 35 83%), lower extremities (n = 4 10%), chest (n = 2 5%), and abdomen (n = 1 2%). There were no overall differences in pre- and post-MRI interrogation LV lead sensing (12.4 ± 6.2 mV vs 12.9 ± 6.7 mV, P = .38), impedance (724 ± 294 Ω vs 718 ± 312 Ω, P = .67), or threshold (1.4 ± 1.1 V vs 1.4 ± 1.0 V, P = .91). No individual LV lead changes required intervention.
MRI scanning was performed safely in non-pacemaker-dependent patients with coronary sinus LV leads who were carefully monitored during imaging without clinically significant adverse effect on LV lead function.
Issue addressed: This article reports the qualitative evaluation of "Artspace," an innovative clinical program combining creative arts with physical and mental health care for young women. The ...program, provided since 2004, comprises weekly visual arts sessions alongside a youth health clinic offering drop-in appointments with a nurse, GP and counsellor.
Methods: A qualitative evaluation of Artspace was conducted between 2016 and 2017.
Results: The evaluation showed that Artspace was particularly beneficial for those clients who had considerable exposure to social adversity and trauma, and were experiencing related serious health impacts. Artspace facilitated their recovery by enabling equitable access facilitation, social inclusion, creating a "holding" environment, and through the directly therapeutic benefits of artist-led arts processes.
Conclusions: Our study highlights the positive impact of artist-led programs such as Artspace. It also attests to the importance of long-term sustainability of services, to allow the time needed for young people to experience genuine and sustained recovery, and to reduce the otherwise likely disadvantages associated with mental and physical health problems, as they move into their adult lives.
So what?: Youth health researchers have been recommending arts programs at health services as a means of engaging young people in health care for over 15 years, however, it remains an underutilised approach in primary care settings. Our evaluation affirms the effectiveness of art programs for this, and also demonstrates that art programs can be a key contributor to recovery from the serious health impacts of adversity and trauma.
To date, few studies have examined the social and psychological effects of sexting behaviors. The current study examined how delinquency, social, and psychological factors were associated with ...sexting behavior in a sample of rural, high school students (n = 548). The results demonstrated that property delinquency, bully-victimization, alcohol, marijuana use, and bullying increased odds of sending and receiving nude photos. Gender specific models indicated that females who had participated in sexting behavior were more likely to report using alcohol and being a victim of bullying, while males were more likely to report using marijuana and being a perpetrator of bullying. Implications are discussed.
Learning evidence-based medicine (EBM) skills is now integral to university medical education. GPs who trained before the introduction of EBM in the late 1990s have identified a lack of training in ...this area. Evidence-based journal clubs (EBJCs) aim to promote the application of research evidence to clinical decision making. GPs meet regularly to develop EBM skills and apply these to questions arising in their clinical practice. Over 4 years, 47 GP clinical supervisors of medical students participated in a series of EBJCs offered by a university medical school. This article presents a qualitative exploration of their views and experiences. GPs noted that participating in EBJCs improved their use of EBM in clinical practice by making them more independent learners, facilitating consistent management approaches in group practices and aligning their skills in EBM with those of current students. Barriers such as time constraints and limited access to EBM resources were also noted, and GPs discussed strategies for managing these. Opportunities for GPs who act as clinical supervisors to increase their skills in EBM are important, particularly for those GPs transitioning from a traditional medical education model to an EBM model, as they role model highest-quality patient care to students, including the need for ongoing learning.
This paper explores the roles of university departments of primary health care (PHC) and general practice in promoting health equity. The coronavirus disease 2019 (COVID-19) pandemic has exposed ...long-standing health and workforce inequities in Australia, as elsewhere. Addressing these inequities will require wide-ranging responses particularly focussed on PHC and the PHC workforce. Well-resourced university departments of PHC and general practice have potential to lead research informing PHC transformation and strategies to reduce health inequity, as well as to train and inspire a future PHC workforce. Examples from such academic departments in Australia and internationally are briefly described, and the experience of a recently established department of general practice is considered, in order to recommend enablers including institutional support, curriculum design, and partnerships with communities and between institutions. Support for community-based clinical schools, practice-based research networks and strengthening PHC research capacity will enable the PHC and general practice academy to engage more effectively in addressing health inequity.
Background:A steady gait relies on a delicate balance between automatic brain responses and the use of cognitive resources, specifically executive control. The Dual Task (DT) paradigm is the accepted ...method to evaluate the equilibrium between gait automaticity and executive control and involves assessing performance on a single task, such as walking, as well as simultaneously with an additional task (i.e., DT). Previous research has shown that pain may influence the equilibrium necessary for a steady gait and can result in mobility deficits. Despite recent advances there is a lack of clarity regarding the relationships between gait and pain. The majority of previous studies have focused on chronic pain patients with many confounding factors that limit the ability to extract insights in this regard.Aim:This study aimed to explore the relationships between gait automaticity and pain response in a laboratory setting, through the implementation of a rigorous randomized cross-over study combining a DT walking paradigm and an experimental tonic pain model.Methods:Eighty-two subjects (32 men and 50 women) with no history of chronic pain were recruited. Each subject participated in seven tasks, each lasting 80 seconds. Tasks included: single walking (W) measured by distance and stride to stride variability; single cognitive (C) measured by the number of correct answers on the serial sevens subtraction test; single tonic cold pain (P) induced by cylindrical ice packs held in each hand, where pain intensity was measured every 20 seconds and the mean of the four measures was considered as the cold pain response; and combinations of all three factors ( i.e., WC, WP, CP and WCP). The order of the tasks was randomly assigned based on a two block structure (single tasks and combined tasks).Results:(1) significant differences were found in distance between the single walking task of W (mean 89.6±14.0 m) and WC (mean 77.6±15.0), and between W and WCP (mean 79.1±13.9). Additionally, significant differences were found between WP (average of 90.3±13.5) and WC. No differences were found between W and WP or between CP and WCP. (RM-ANOVA, F(3,79)=38.2, p<0.001). (2) A significant difference was found in stride to stride variability (scale 0-1) between the single task of W (average 0.07±0.01) and WCP(average 0.14±0.15). No significant differences were found relevant to the tasks of WP (average 0.1±0.17) or WC (average 0.11±0.12). (RM-ANOVA F(3,71=4.70, p<0.005). (3) significant differences were found on the cognitive test between the single task of C( average 18.4±10.5) and both of the dual tasks and triple task (average CP 16.8±11.4; average CW 14.5±9.8; average WCP 16.4±10.6). Additionally, significant differences were found between the dual tasks of WC and CP and between WC and WCP. No difference was found between CP and WCP. (RM-ANOVA F(3,79)=13.3, p<0.001). (4) significant differences were found in pain intensity (scale 0-100) between the single task of P(average 63.4±22.4) and both of the dual tasks and triple task. (WP average 56.2±21.3; CP average 47.1±24.2; WCP average 44.4±23.4). Additionally, significant differences were found between the dual tasks of WP and CP and between WP and WCP. No difference was found between CP and WCP. (RM-ANOVA F(3,79))=37.0, p<0.001). Taken together, the main findings revealed an overall decrease in pain intensity during dual task and triple task execution; a decline in cognitive performance during dual tasks and triple tasks; and negative effects on gait during dual tasks involving cognitive performance and during triple tasks.Conclusions:The current results confirm the conclusions of previous studies that there is a mutual relationship between pain and gait automaticity. Specifically, the painful stimuli resulted in a decreased ability to maintain a steady gait and dual and triple task execution were effective at distracting from the stimuli thereby reducing pain intensity. These findings can constitute a platform for future research involving the exploration of how pain affects motor stability. Future clinical trials may use this paradigm to pinpoint people at risk for motor dysfunction or risk of falls in a population suffering from pain.
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