Explore the vast range of titles available.

To conduct a systematic review of experimental or quasi-experimental studies that aimed to improve the nutritional status of children under 5 years of age in Ethiopia. Embase, MEDLINE/PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsychINFO, and Academic Search Database were used to locate peer-reviewed studies, and Google Scholar and Open Dissertation were used to locate grey literatures. All searches were conducted between 2000 and November 2022. Ethiopia. Pregnant women and mothers with children aged 0-59 months. Ten cluster randomised controlled trials (RCT), six quasi-experimental studies and two individual RCT were included. Out of the identified eighteen studies, three studies targeted pregnant mothers. Our findings showed that almost two-thirds of published interventions had no impact on childhood stunting and wasting, and more than half had no impact on underweight. Some behaviour change communication (BCC) interventions, food vouchers, micronutrient supplementation and quality protein maize improved stunting. Similarly, BCC and fish oil supplementation showed promise in reducing wasting, while BCC and the provision of quality protein maize reduced underweight. Additionally, water, sanitation and hygiene (WaSH) interventions provided to pregnant mothers and children under 2 years of age were shown to significantly reduce childhood stunting. Future childhood nutritional interventions in Ethiopia should consider adopting an integrated approach that combines the positive effects of interdependent systems such as BCC, food supplemental programmes (e.g. boosting protein and micronutrients), health interventions (e.g. strengthening maternal and childcare), WaSH and financial initiatives (e.g. monetary support and income schemes).

Enduring inequities in rural healthcare provision, underpinned by an inadequately sized and fit-for-purpose workforce, are well known to those invested in or tasked with supporting the sustainability of rural communities. Complex and interrelated issues contribute to the challenges of maintaining a strong rural health workforce. As recent government inquiries in Australia highlight, an inadequate health workforce has wide-ranging and fundamental consequences for the health and wellbeing of rural residents.

Background Addressing wellbeing at the community level, using a public health approach may build wellbeing and protective factors for all. A collaborative, community-owned approach can bring together experience, networks, local knowledge, and other resources to form a locally-driven, place-based initiative that can address complex issues effectively. Research on community empowerment, coalition functioning, health interventions and the use of local data provide evidence about what can be achieved in communities. There is less understanding about how communities can collaborate to bring about change, especially for mental health and wellbeing. Method A comprehensive literature search was undertaken to identify community wellbeing initiatives that address mental health. After screening 8,972 titles, 745 abstracts and 188 full-texts, 12 exemplar initiatives were identified (39 related papers). Results Eight key principles allowed these initiatives to become established and operate successfully. These principles related to implementation and outcome lessons that allowed these initiatives to contribute to the goal of increasing community mental health and wellbeing. A framework for community wellbeing initiatives addressing principles, development, implementation and sustainability was derived from this analysis, with processes mapped therein. Conclusion This framework provides evidence for communities seeking to address community wellbeing and avoid the pitfalls experienced by many well-meaning but short-lived initiatives. Graphical Abstract

Context: The Rural Adversity Mental Health Program (RAMHP) connects people who need mental health assistance in rural and remote New South Wales (NSW), Australia with appropriate services and resources. In 2016, RAMHP underwent a comprehensive reorientation to meet new state and federal priorities. A full assessment of program data collection methods for management, monitoring and evaluation was undertaken. Reliable data were needed to ensure program fidelity and to assess program performance. Issues: The review indicated that existing data collection methods provided limited and unreliable information, were inconvenient for RAMHP coordinators to use and unsuited to their itinerant role. A mobile collection tool (app) was developed to address RAMHP activity data needs. A design and implementation process was followed to optimise data collection and to ensure the successful use of the app by coordinators. Lessons learned: The early planning investment was worthwhile, the app was successfully adopted by the coordinators and a much improved data collection capability was achieved. Moreover, data capture increased, while errors decreased. Data are more reliable, specific, timely and informative and are used for strategic and operational planning and to demonstrate program performance.

This Perspective Paper explores the challenges of implementing local initiatives guided by the tenets of the Collective Impact (CI) approach. As such, it draws implications of CI for integrated health and social care efforts to improve and sustain health and social outcomes within a community-wide context, based on our efforts to deploy a CI intervention in the regional town of Muswellbrook, New South Wales (NSW) Australia. A program of health and wellbeing activities providing mental health and wellness messages and activities was implemented in the township over 2 years by the Family Action Centre (FAC), University of Newcastle, Australia. A key takeaway was the importance of authentic community engagement and active involvement as opposed to mere consultation.

Introduction: Adverse childhood experiences (ACEs) are associated with health and social problems in later life, with an early intervention highly desirable for better outcomes.Description: The Family-Referral-Services-In-Schools (FRSIS) is an early-intervention case management program for children and families with complex unmet needs, providing access to family support, housing, mental health care, and/or drug and alcohol services. The in-school trial setting was aimed at improving service uptake which was low in its community counterpart.Discussion: FRSIS was a well-regarded intervention that reduced barriers to access for vulnerable families. The school setting and non-government agency service provision led to increased acceptability and trust. The program reached 5% of the student population. Support was tailored to family need, which was often complex and involved both children and caregivers. Initially, the multi-agency partnership and governance oversight group championed the service and enabled the pilot to be established, however funding uncertainty and competing priorities saw leadership support ebb away despite operational success.Conclusion: The FRSIS model breaks down numerous barriers to accessing care for vulnerable families by its generalist nature and tailored approach and represents a high-trust approach to brokering appropriate care. Consistency in leadership support was a missed opportunity for program sustainability.

In many countries, a clear dose–response relationship exists between ACEs score and mental illness, addiction, poor diet, medication non-adherence, utilisation of health services and chronic morbidity throughout one’s lifespan.1 2 During childhood, exposure to multiple ACEs is associated with delayed brain and cognitive development, impaired mental health, compromised academic performance and social-behavioural issues.1 In later life, experiencing four or more ACEs is associated with risk behaviours including smoking, alcohol and drug use, sexual risk-taking, interpersonal and self-directed violence, and homelessness.1 2 Consequently, individuals with higher ACEs scores are at an elevated risk of developing non-communicable diseases (NCDs), including cancers, circulatory diseases, chronic respiratory diseases and metabolic disorders in adulthood.2 The burden resulting from childhood abuse and/or neglect is significantly higher among specific sociodemographic groups. The ‘Aboriginal health gap’ refers to long-standing disparities between Australian Indigenous and non-Indigenous populations observed with various health indicators, including life expectancy, NCD prevalence, health service access, nutrition and overall well-being. [...]there continues to be a substantial difference in socioeconomic conditions, and healthcare access that further exacerbates the gaps.10 11 The Australian Institute of Health and Welfare’s (2019) estimates reveal a consistent and substantial disparity in disease-specific age-standardised mortality rates for the leading causes of death between Indigenous and Non-Indigenous Australians (figure 2).12 Indigenous Australians experience a 1.5-fold higher age-standardised mortality rate (229 per 100 000 people) for heart diseases and cancers compared with non-indigenous Australians (151 per 100 000 people), while for diabetes, this rate is 5-fold higher (74 per 100 000 compared with 16 per 100 000).12 From 2006 to 2019, there was an annual average increase of 67 per 100 000 people in age-standardised mortality rates for Indigenous Australians, whereas non-Indigenous Australians experienced a decrease of 6 per 100 000 people during the same period.12 Figure 2. Beyond genetic predisposition, the connection of intergenerational trauma and exposure to ACEs in Indigenous Australians is influenced by systemic racism resulting in overlapping economic deprivation, compromised family dynamics, poor physical and mental health, and substance dependence.14 15 Available studies suggest no substantial difference in the prevalence of at least one childhood trauma between Indigenous people (64%) and the general population (62%).4 16–19 However, consensus among these studies indicates that Indigenous populations have a notably higher prevalence of multiple ACEs, including physical, sexual abuse and domestic violence, compared with the non-Indigenous population (table 1).4 16–19 Table 1 ACEs spectrum by Indigenous status Indigenous population (%) General population (%) ACEs≥4 64.0 28.0 Abuse  Physical abuse 17.3 8.5  Sexual abuse 14.6 7.7  Physical and sexual abuse 23.1 13.4 Neglect (physical and emotional) 52.5 18.0 Household dysfunction  Parental mental illness† – 33.0  Parental incarceration† – 10.0  Parental substance abuse 52.2 24.0  Domestic violence 41.2 18.0  Parental divorce† – 37.0  Housing instability 56.6 18.0 *Data sources:

The release of extracellular vesicles (EVs) is important for both normal physiology and disease. However, a basic understanding of the targeting of EV cargoes, composition and mechanism of release is lacking. Here we present evidence that the divalent metal ion transporter (DMT1) is unexpectedly regulated through release in EVs. This process involves the Nedd4-2 ubiquitin ligase, and the adaptor proteins Arrdc1 and Arrdc4 via different budding mechanisms. We show that mouse gut explants release endogenous DMT1 in EVs. Although we observed no change in the relative amount of DMT1 released in EVs from gut explants in Arrdc1 or Arrdc4 deficient mice, the extent of EVs released was significantly reduced indicating an adaptor role in biogenesis. Furthermore, using Arrdc1 or Arrdc4 knockout mouse embryonic fibroblasts, we show that both Arrdc1 and Arrdc4 are non-redundant positive regulators of EV release. Our results suggest that DMT1 release from the plasma membrane into EVs may represent a novel mechanism for the maintenance of iron homeostasis, which may also be important for the regulation of other membrane proteins.

The Rural Adversity Mental Health Program (RAMHP) was founded in 2007 with the specific focus of responding to drought-related mental health needs among farmers in rural and remote New South Wales (NSW), Australia. Successive re-funding enabled the program to evolve strategically and increase its reach. Over a decade, the program's focus has expanded to include all people in rural and remote NSW in need of mental health assistance, and not just in times of adversity such as drought. The program's longest re-funding period, 2016-2020, provided the opportunity for a comprehensive review and longer term planning. Several priorities influencing program renewal were evident at this time: the need to improve data collection and evaluation methods, a reassessment of the program's primary focus and the need to align with significant government mental health reforms. A program logic model (PLM) was developed, in collaboration with frontline RAMHP coordinators, to steer reorientation, clarify objectives, activities and outcomes, and improve data collection. A PLM is a graphic depiction of a program, showing the rationale of how inputs and activities lead to outcomes. Four key lessons were identified. (1) The development of the PLM in collaboration with the RAMHP coordinators (frontline staff) was found to be an important vehicle for ensuring their acceptance and adoption of strategic changes. (2) The collaborative development process also provided the opportunity to decide upon consistent terminology to describe the program, facilitating communication of the value of RAMHP to external stakeholders. (3) The PLM enabled a clear but flexible program structure that aligned with changes in the mental health system to be described. (4) The PLM provided the foundation for the development of an evaluation framework, including a mobile app, to aid data collection to underpin accountability. Investing in the development of a PLM early in program reorientation provided many benefits for RAMHP, including improved role clarity and communication, staff commitment to program changes and a foundation for comprehensive program evaluation that integrates with program planning. The PLM proved a key foundational tool to reorient RAMHP by producing a clear program structure that was agreed upon by all staff.

Integrated care implies sustained change in complex systems and progress is not always linear or easy to assess. The Central Coast integrated Care Program (CCICP) was planned as a ten-year place-based system change. This paper reports the first formative evaluation to provide a detailed description of the implementation of the CCICP, after two years of activity, and the current progress towards integrated care. Progress towards integrated care achieved by the CCICP was evaluated using the Project INTEGRATE Framework data in a mixed methods approach included semi-structured interviews (n = 23) and Project INTEGRATE Framework based surveys (n = 27). All data collected involved key stakeholders, with close involvement in the program, self-reporting. Progress has been mixed. Gains had most clearly been made in the areas of clinical and professional integration; specifically, relationship building and improved collaboration and cooperation between service providers. The areas of systemic and functional integration were least improved with funding uncertainty being an ongoing significant problem. The evaluation also showed that the Project INTEGRATE framework provided a consistent language for CCICP partners and for evaluators and consistent indicators of progress. The framework also helped to identify key facilitators and barriers. The findings highlight the willingness and commitment of key staff but also the importance of leadership, good communication, relationship building, and cultural transformation.