The effectiveness of physical activity interventions in improving higher education students' mental health: A systematic review

Traditional interventions aiming to improve students' mental health and quality of life include meditation or canine therapy. The development of physical activity-related interventions has increased over the past decade. We aimed to review all studies using physical activity for improving the mental health and quality of life in higher education students whilst describing the interventions, measurements and effectiveness. A systematic search of six electronic databases including: ProQuest, MEDLINE, Embase, CINAHL, SPORTDiscus and CENTRAL, was conducted following PRISMA guidelines. Randomized or non-randomized controlled trial physical activity-related interventions involving higher education students aiming to improve their mental health and quality of life were included. Searches yielded 58 articles with interventions involving martial arts, sport, mind-body exercises and anaerobic exercises. Psychological measures varied across studies including the State Trait Anxiety Inventory, Beck Depression Inventory and the Perceived Stress Scale. Over half of the studies included in this review (n = 36) were effective in improving students' mental health or quality of life. Findings from our review suggest that interventions aiming to be effective in improving students' mental health quality of life should aim to deliver moderate-vigorous intensity exercises such as dance or Pilates. This systematic review was based on a published protocol in PROSPERO (registration number: CRD42022325975).

Validated frailty measures using electronic primary care records: a review of diagnostic test accuracy

INTRODUCTION

Identification of people who have or are at risk of frailty enables targeted interventions, and the use of tools that screen for frailty using electronic records (which we term as validated electronic frailty measures (VEFMs)) within primary care is incentivised by NHS England. We carried out a systematic review to establish the sensitivity and specificity of available primary care VEFMs when compared to a reference standard in-person assessment.

METHODS

Medline, Pubmed, CENTRAL, CINHAL and Embase searches identified studies comparing a primary care VEFM with in-person assessment. Studies were quality assessed using Quality Assessment of Diagnostic Accuracy Studies revised tool. Sensitivity and specificity values were extracted or were calculated and pooled using StatsDirect.

RESULTS

There were 2,245 titles screened, with 10 studies included. These described three different index tests: electronic frailty index (eFI), claims-based frailty index (cFI) and polypharmacy. Frailty Phenotype was the reference standard in each study. One study of 60 patients examined the eFI, reporting a sensitivity of 0.84 (95% CI = 0.55, 0.98) and a specificity of 0.78 (0.64, 0.89). Two studies of 7,679 patients examined cFI, with a pooled sensitivity of 0.48 (95% CI = 0.23, 0.74) and a specificity of 0.80 (0.53, 0.98). Seven studies of 34,328 patients examined a polypharmacy as a screening tool (defined as more than or equal to five medications) with a pooled sensitivity of 0.61 (95% CI = 0.50, 0.72) and a specificity of 0.66 (0.58, 0.73).

CONCLUSIONS

eFI is the best-performing VEFM; however, based on our analysis of an average UK GP practice, it would return a high number of false-positive results. In conclusion, existing electronic frailty tools may not be appropriate for primary care-based population screening.

The impact of rurality on patient experience and diagnostic pathway intervals in Scotland's cancer patients: Further results from a national cancer diagnosis audit

BACKGROUND

In Scotland 17 % of the population reside rurally and previous research has demonstrated worse cancer outcomes in this group. The underlying reason for this is unclear. This study aims to determine whether patient presenting factors, GP consultation factors or the diagnostic pathways differ between urban and rural patients within Scotland.

METHODS

This study combined two Scottish National Cancer Diagnosis Audits. Participating GPs collected data on the diagnostic pathway from primary to secondary care for cancer patients diagnosed during the audit period. Using the Scottish Government Urban Rural Classification, patients were designated as rural or urban dwellers and compared in descriptive analyses. Key cancer intervals (primary, diagnostic, secondary and treatment interval) were compared between urban and rural dwellers with an additional adjusted analysis for the main cancer sites.

RESULTS

A total of 4309 cancer diagnoses were included in the study; 22 % were in patients from rural locations. Rural patients had significantly more consultations and investigations prior to referral than their urban counterparts. There was no difference in prolonged cancer pathways between the two groups except in lung cancer patients where rural patients had a significantly increased odds of a diagnostic interval of >90 days.

CONCLUSION

Our findings suggest differences in the interaction between patients and GPs prior to referral in urban and rural settings. However, this does not appear to lead to prolonged patient pathways, except in lung cancer. Further research is needed to determine whether this delay is clinically significant and contributing to poorer outcomes in Scottish rural dwellers with lung cancer.

Examining service utilisation and impact among consumers of a national mental health stepped care programme in Australia: a protocol using linked administrative data

INTRODUCTION

Mental well-being is a global public health priority with increasing mental health conditions having substantial burden on individuals, health systems and society. 'Stepped care', where services are provided at an intensity to meet the changing needs of the consumer, is the chosen approach to mental health service delivery in primary healthcare in Australia for its efficiencies and patient outcomes; yet limited evidence exists on how the programme is being rolled out and its impact in practice. This protocol outlines a data linkage project to characterise and quantify healthcare service utilisation and impacts among a cohort of consumers of a national mental health stepped care programme in one region of Australia.

METHODS AND ANALYSIS

Data linkage will be used to establish a retrospective cohort of consumers of mental health stepped care services between 1 July 2020 and 31 December 2021 in one primary healthcare region in Australia (n=approx. 12 710). These data will be linked with records from other healthcare service data sets (eg, hospitalisations, emergency department presentations, community-based state government-delivered mental healthcare, hospital costs). Four areas for analysis will include: (1) characterising the nature of mental health stepped care service use; (2) describing the cohort's sociodemographic and health characteristics; (3) quantifying broader service utilisation and associated economic costs; and (4) assessing the impact of mental health stepped care service utilisation on health and service outcomes.

ETHICS AND DISSEMINATION

Approval from the Darling Downs Health Human Research Ethics Committee (HREA/2020/QTDD/65518) has been granted. All data will be non-identifiable, and research findings will be disseminated through peer-reviewed journals, conference presentations and industry meetings.

1013 DIAGNOSTIC TEST ACCURACY OF FRAILTY SCREENING TOOLS USING DATA IN ELECTRONIC PRIMARY CARE RECORDS

Introduction

Targeted interventions aimed at people living with frailty key to NHS Strategy and is incentivised in the NHS England GP contract. eFrailty, and similar risk prediction tools aim to detect frail people automatically from their electronic primary care health-records and can predict mortality and hospital admission. We carried out a systematic review of currently available risk prediction tools to assess frailty using primary care data.

Method

We searched Medline, Pubmed, CENTRAL, CINHAL and Embase to identify studies comparing a frailty assessment utilising primary care records with face-to-face assessment with a healthcare professional. Studies were quality assessed using QUADAS-2. Sensitivity and specificity values were extracted directly or calculated and pooled using StatsDirect.

Results

The initial search generated 2,245 titles with 10 studies remaining for review after screening. This described 3 different index tests (electronic frailty index (eFI), claims-based frailty index (cFI), and polypharmacy. Frailty Phenotype was the reference standard in each study. 1 study of 60 patients, average age 80.2 examined eFI, with a pooled sensitivity of 0.84 (95% CI 0.55,0.98), and specificity of 0.78 (0.64,0.89). 2 studies of 7,679 patients, average age 75.5, examined cFI, with a pooled sensitivity of 0.84 (95% CI 0.55,0.98), and specificity of 0.78 (0.64,0.89). 7 studies of 34,328 patients, average age 77.4, examined a polypharmacy as a screening tool (defined as ≥5 medications) with a pooled sensitivity of 0.84 (95% CI 0.55,0.98), and specificity of 0.78 (0.64,0.89).

Conclusion

eFI performed best however, for an average UK GP practice with a list size of 10,000, 18% of patients aged over 65, of which 20% were frail, eFI would flag 597 as frail, of which 272 would be actually frail, and an additional 51 frail patients would be missed. In conclusion, existing frailty risk prediction tools would have strictly limited value in UK primary care currently.

Validating a scale to measure respectful maternity care in Australia: Challenges and recommendations

OBJECTIVE

Respectful maternity care is a pervasive human rights issue, but little is known about its realisation in Australia. Two scales, developed in North America, measure key aspects of respectful maternity care: the Mothers on Respect Index and Mothers Autonomy in Decision Making scale. This study aimed to validate these two scales in Queensland, Australia, and to determine the extent to which women currently experience respectful maternity care and autonomy in decision making.

DESIGN

A sequential two-phase study. A focus group reviewed the scales, made adaptations to scale items and completed a Content Validation Survey. The Respectful Maternity Care in Queensland survey, comprising the validated Australian scales and demographic questions was distributed online in early 2020.

SETTING

Queensland, Australia.

PARTICIPANTS

Focus group involved women (n=10) who were aged over 18, English-speaking, and had given birth during the preceding two years. All women who had birthed in Queensland between September 2019 and February 2020, were eligible to participate in the cross-sectional survey. 161 women participated in the survey.

MEASUREMENTS AND FINDINGS

Item content validity (>0.78) was established for all but one item. Scale content validity was established for both scales (0.92 and 0.99 respectively). Survey participants (n= 161) were mostly married/partnered (95%), heterosexual (93%), tertiary educated (47%), Caucasian (88%), and had experienced a range of maternity models of care. Median scores on each scale (74 and 26 respectively) indicated that participants felt well respected and highly autonomous. Free-text comments highlighted the importance of relationship-based care.

KEY CONCLUSIONS

Both scales appear valid for use in Australia. Although most participants reported high levels of respect and autonomy, the proportion of participants who had experienced continuity of midwifery care was also high.

IMPLICATIONS FOR PRACTICE

Both scales could be routinely deployed as patient reported experience measures in Australia, broadening the data that informs maternity service planning and delivery.

Immersive 3D Experience of Osmosis Improves Learning Outcomes of First-Year Cell Biology Students

biological processes that occur at the submicroscopic level, such as osmosis and diffusion, are inherently difficult for many students to conceptualize when traditional learning and teaching methods are used. This study introduced an immersive 320° three-dimensional (3D) experience of osmosis in which students became engaged with the cellular environment in a Cave Automatic Virtual Environment. The aims of this study were: 1) to explore whether a textbook diagram of osmosis recreated as an immersive 3D learning experience would be a meaningful tutorial activity for first-year cell biology students at a regional Australian university; and 2) to gather preliminary evidence of the utility of the tutorial by examining student performance data. The experience was perceived by students to be fun, useful, and educational. Performance of all students improved on a multiple-choice exam question, with the percentage of students choosing the osmosis distractor answer decreasing from 26 to 15% (p < 0.001). Those students with moderate to high base-level knowledge also performed better on short-answer questions about the cell membrane and osmosis (10-14% better, depending on base-level knowledge, p < 0.001). We give recommendations for future studies to investigate using immersive visualization in science teaching.

Longitudinal study of intravenous versus subcutaneous immunoglobulin replacement therapy in hematological malignancy

AIM

To present findings from a longitudinal study on infection risk, mortality, and patient perspective of intravenous immunoglobulin (IVIg) and subcutaneous immunoglobulin (SCIg) treatment for patients with hypogammaglobulinemia secondary to hematological malignancy or its treatment (abbreviated as SID).

METHODS

Observational study period included final year of IVIg (13 patients) and of the first 3 years of SCIg (17 patients) with SID. Data were collected on clinical outcomes from medical records and patient perception via study specific questionnaire.

RESULTS

The median age was 63 years (53-76 years), and for 82.4% of patients their hematological malignancy was in complete remission. The annual mean serum IgG trough levels remained stable over the 4 years and were 7.0 g/L (±2.77 g/L) with IVIg, and 8.0 g/L (±1.75 g/L), 8.7 g/L (±2.75 g/L), and 7.6 g/L (±2.89 g/L) (year 1, 2, and 3, respectively) with SCIg. While the annual infection rate was similar, the rate of hospitalization due to infection fluctuated, with 37%, 9%, 15%, and 32% in year 1, 2, 3, and 4 respectively. There were no systemic adverse events with IVIg or SCIg. Patients reported a strong preference for SCIg. One patient died due to progression of underlying disease and infection within the study period.

CONCLUSION

SCIg was the preferred treatment mode over IVIg in our cohort, but both were well tolerated without any systemic adverse events in 4-year follow up. The dosage and serum IgG levels were stable throughout. However, the number of infections requiring hospitalization fluctuated. It is anticipated that these findings encourage more hospitals to offer SCIg for SID patients.

Implementation of a guideline of early administration of tranexamic acid for severe primary postpartum haemorrhage: a retrospective comparative study

BACKGROUND

Since the WOMAN trial, intravenous tranexamic acid (TXA) has been increasingly used in severe postpartum haemorrhage (PPH) but research evaluating use in high-income settings is limited.

AIMS

To assess whether implementation of a new guideline involving early administration of 1 g intravenous TXA in active PPH with blood loss ≥ 1000 mL, was associated with a change in maternal morbidity.

MATERIALS AND METHODS

Retrospective study of all singleton, term, vaginal births from November 2016 to June 2019 with a PPH of ≥1000 mL, before and after hospital adoption of a guideline recommending early (within three hours of birth) administration of TXA for women with active PPH ≥ 1000 mL. Univariate analysis assessed the impact of this guideline implementation on a primary outcome of maternal morbidity, defined as one or more of haemoglobin < 90 g/L, administration of blood products, hysterectomy or intensive care admission. Secondary outcomes were adverse events related to administration of TXA, use of an intrauterine balloon or postpartum iron infusion.

RESULTS

There was no difference in morbidity (odds ratio (OR) 0.86, 95% CI 0.57-1.29, P = 0.46) or postpartum iron infusion (OR 1.44, 95% CI 0.92-2.27, P = 0.11), but there was a reduction in the use of intrauterine balloon tamponade after the implementation of the TXA guideline (OR 0.33, 95% CI 0.16-0.67, P < 0.01).

CONCLUSIONS

This retrospective analysis showed a reduced use of intrauterine balloon but failed to show a benefit in maternal morbidity with early administration of TXA for severe postpartum haemorrhage in a high-income setting.

Undergraduate Students Experience of Nutrition Education Using the Flipped Classroom Approach: A Descriptive Cohort Study

OBJECTIVE

To explore undergraduate students self-reported learning experience in a foundation nutrition education course/unit delivered using a flipped classroom approach (FCA), which requires students to complete independent learning before and after interactive in-class learning experiences.

METHODS

A descriptive cohort study design used selected items from a self-report flipped classroom student engagement questionnaire to assess Australian undergraduate student (n = 105) engagement in the course/unit and compared with nonflipped courses, preference for FCA, academic achievement, learning behaviors for 3 FCA learning phases, and more or less engaging aspects of the course/unit.

RESULTS

Most (66.5%) students were engaged or very engaged, with half (55%) more engaged in this course/unit compared with other nonflipped courses/units with a preference for the FCA (53%). Almost half of the students agreed the FCA improved their academic performance (grade) (45%) and other academic skills (ie, teamwork) (48.5%). Most student comments related to the value of participate phase activities.

CONCLUSIONS AND IMPLICATIONS

The FCA engaged most students in learning and is an emerging learning and teaching approach appropriate for undergraduate nutrition dietetic education.

Access and outcomes of general practitioner obstetrician (rural generalist)-supported birthing units in Queensland

OBJECTIVE

To describe characteristics and outcomes of women birthing within GP-obstetrician (rural generalist) supported rural (level 3) obstetric units in Queensland.

DESIGN

Retrospective descriptive study.

SETTING

21 GP-obstetrician supported birthing units in Queensland.

PARTICIPANTS

Women (n = 3111) birthing from January 2017 to December 2017.

MAIN OUTCOME MEASURES

Patient, pregnancy and labour characteristics and key maternal and neonatal outcomes routinely recorded in the Queensland Perinatal Data Collection and Queensland Hospital Admitted Patient Data Collection were compared to Queensland public hospital aggregate data.

RESULTS

Women birthing in rural maternity units were significantly more likely to be Aboriginal or Torrs Strait Islander (16% v 9%), < 20 years old (7% v 4%), term deliveries (96% v 91%), achieve spontaneous onset of labour (67% v 51%), and birth (71% v 60%) (p<0.001) compared with all Queensland public hospitals. They were significantly less likely to be nulliparous (36% v 40%), use pharmacological analgesia (65% v 69%), or have continuous electronic fetal monitoring in labour (54% v 66%) (p<0.001). Neonatal outcomes were comparable; with no significant difference in stillbirth rate between rural units and all Queensland public hospitals (4.8 v 7.3 per 1000 births). Precipitate delivery was the most common labour complication (36% v 33%) (p<0.001).

CONCLUSION

GP-obstetrician (rural generalist) supported rural birthing units in Queensland provide important access for low and medium risk women to deliver locally, with strong indicators of quality and safety.

Resilience and workplace stress in Australian and New Zealand obstetrics and gynaecology trainees: A cross-sectional survey

BACKGROUND

Obstetrics and gynaecology training is a demanding vocation; there is a paucity of data on trainee resilience and well-being in this field.

AIM

To investigate resilience, support and perceived levels of stress and burnout in Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) trainees.

MATERIALS AND METHODS

A cross-sectional survey of RANZCOG trainees in Australia and New Zealand (n = 638) was distributed electronically in May 2018.

RESULTS

Two-hundred and thirty-one (36%) valid responses were received. The mean resilience score was moderate (mean = 77; SD = 11). Resilience was significantly associated with general health (F = 7.5, P = 0.007), depression in the last two weeks (F = 4.4, P = 0.013) and seriously considering leaving the program at some point (F = 15.4, P < 0.001). Most participants (204; 88%) stated improvements could be made to the level of trainee support; with over half identifying the support they received from RANZCOG to be low or very low (132; 57%). One-third of participants (76; 33%) rated the support from their direct supervisor as low to very low. Over half of all participants identified high to very high responses to: burnout (127; 55%); personal stress (134; 58%); workplace stress (143; 62%) and depression (103; 45%).

CONCLUSION

RANZCOG trainees exhibit moderate resilience levels, yet they report high levels of perceived stress, depression and burnout and low-level support from direct supervisors. This may highlight the need for enhanced support and working conditions to allow trainees to remain resilient and thrive in their careers.

Identifying the risk: a prospective cohort study examining postpartum haemorrhage in a regional Australian health service

Background

In industrialised countries the incidence of postpartum haemorrhage (PPH) is increasing, for which exact etiology is not well understood. Studies have relied upon retrospective data with estimated blood loss as the primary outcome, known to be underestimated by clinicians. This study aimed to explore variables associated with PPH in a cohort of women birthing vaginally in coastal Queensland, Australia, using the gravimetric method to measure blood loss.

Methods

Women were prospectively recruited to participate using an opt-out consent process. Maternal demographics; pregnancy history; model of care; mode of birth; third stage management practices; antenatal, intrapartum and immediate postpartum complications; gravimetric and estimated blood loss; and haematological laboratory data, were collected via a pre-designed data collection instrument. Descriptive statistics were used for demographic, intrapartum and birthing practices. A General Linear Model was used for multivariate analysis to examine relationship between gravimetric blood loss and demographic, birthing practices and intrapartum variables. The primary outcome was a postpartum haemorrhage (blood loss > 500 ml).

Results

522 singleton births were included in the analysis. Maternal mean age was 29 years; 58% were multiparous. Most participants received active (291, 55.7%) or modified active management of third stage (191, 36.6%). Of 451 births with valid gravimetric blood loss recorded, 35% (n = 159) recorded a loss of 500 ml or more and 111 (70%) of these were recorded as PPH. Gravimetric blood loss was strongly correlated with estimated blood loss (r = 0.88; p < 0.001). On average, the estimated blood loss was lower than the gravimetric blood loss, about 78% of the measured value. High neonatal weight, perineal injury, complications during labour, separation of mother and baby, and observation of a gush of blood were associated with PPH. Nulliparity, labour induction and augmentation, syntocinon use were not associated with PPH.

Conclusions

In contrast to previous study findings, nulliparity, labour induction and augmentation were not associated with PPH. Estimation of blood loss was relatively accurate in comparison to gravimetric assessment; raising questions about routine gravimetric assessment of blood loss following uncomplicated births. Further research is required to investigate type and speed of blood loss associated with PPH.

Home away from home: Health and wellbeing benefits of men's sheds

ISSUE ADDRESSED

Improving the health of men is a national policy priority. The Men's Shed program is one health promoting initiative that seeks to improve the health and wellbeing of men. This study assessed Men's Shed members' perceptions of the health and wellbeing benefits of Men's Shed activity in a large regional Queensland Men's Shed.

METHODS

Data were collected via a self-administered questionnaire from 147 and three group interviews with 17 shedders. Wilcoxon signed-rank test was used to determine differences in shedders perceived health and wellbeing measures retrospectively just before joining the Men's Shed and currently. Thematic analysis was used to analyse qualitative data.

RESULTS

There was no change in overall self-assessed health of shedders before and after joining the Men's Shed. Shedders expanded their social networks, and experienced less felt need for social interaction. Shedders' level of satisfaction with feeling part of the community and life as a whole increased. Health and wellbeing benefits of Men's Shed included fellowship, sense of belonging, access to equipment, and learning new and sharing their own skills.

CONCLUSIONS

The Men's Shed appeared to provide social health and wellbeing benefits to its members, and an environment for quality social interaction. The Men's Shed is seen as a place for and about members - men. SO WHAT?: Men's Shed may have a unique role in supporting the social health and wellbeing of men beyond that already available from other community groups by providing an environment for the fellowship of men and activities of interest in an unstructured way.

The relationship between midwife-led group-based versus conventional antenatal care and mode of birth: a matched cohort study

Background

Midwife facilitated, group models of antenatal care have emerged as an alternative to conventional care both within Australia and internationally. Group antenatal care can be offered in a number of different ways, however usually constitutes a series of sessions co-ordinated by a midwife combining physical assessment, antenatal education and peer support in a group setting. Midwife-led group antenatal care is viewed positively by expectant mothers, with no associated adverse outcomes identified in the published literature for women or their babies when compared with conventional care. Evidence of an improvement in outcomes is limited. The aim of this study was to compare mode of birth (any vaginal birth with caesarean birth) between pregnant women accessing midwife-led group antenatal care and conventional individual antenatal care, in Queensland, Australia.

Methods

This was a retrospective matched cohort study, set within a collaborative antenatal clinic between the local university and regional public health service in Queensland, Australia. Midwife-led group antenatal care (n = 110) participants were compared with controls enrolled in conventional antenatal care (n = 330). Groups were matched by parity, maternal age and gestation to form comparable groups, selecting a homogeneous sample with respect to confounding variables likely to affect outcomes.

Results

There was no evidence that group care resulted in a greater number of caesarean births. The largest increase in the odds of caesarean birth was associated with a previous caesarean birth (p < 0.001), no previous birth (compared with previous vaginal birth) (p < 0.003), and conventional antenatal care (p < 0.073). The secondary outcomes (breastfeeding and infant birth weight) which were examined between the matched cohorts were comparable between groups.

Conclusions

There is no evidence arising from this study that there was a significant difference in mode of birth (caesarean or vaginal) between group and conventional care. Group care was associated with a lower risk of caesarean birth after controlling for previous births, with the highest chance for a vaginal birth being a woman who has had a previous vaginal birth and was in group care. Conversely, the highest risk of caesarean birth was for women who have had a previous caesarean birth and conventional care.