Explore the vast range of titles available.

Introduction:Disasters are part of the Australian landscape. Bushfires, floods, cyclones, and drought reoccurring consistently across the continent. Primary Health Networks (PHNs) and general practitioners (GPs) are scattered across Australia and are inevitably involved when disasters strike their local communities. Limited guidance exists to guide their systematic involvement within the broader disaster response system. In October 2013, large bushfires swept through the NSW Blue Mountains. The response was unusual in its inclusion of NSW general practice networks within the response system, most crucially the local (now) Nepean Blue Mountains Primary Health Network (NBMPHN).Methods:The lessons learned by GPs and NBMPHN during the fires highlighted the need for GP preparedness to improve recovery outcomes. This led to the development of a living discussion document “Emergency management: the role of the GP,” created with input from the various GP groups. More recently, a PHN emergency preparedness guide aimed at strengthening communication and formalizing the role of the PHNs and GPs before, during, and after a natural disaster.Results:Clarity and implementation of a process for disaster preparedness have enabled a more proactive and coordinated approach to local emergency management with a distinct role for both the PHN and local GPs when responding to a natural disaster.Discussion:This presentation discusses lessons learned and the preparedness strategy now in place in the Nepean Blue Mountains PHN region, and launches the emergency preparedness guide that can be used and adapted by GPs and other PHNs across Australia.

Background It is widely recognised that complex public health interventions roll out in distinct phases, within which external contextual factors influence implementation. Less is known about relationships with external contextual factors identified a priori in the pre-implementation phase. We investigated which external contextual factors, prior to the implementation of a community-centred approach to reducing alcohol harm called ‘Communities in Charge of Alcohol’ (CICA), were related to one of the process indicators: numbers of Alcohol Health Champions (AHCs) trained. Methods A mixed methods design was used in the pre-implementation phase of CICA. We studied ten geographic communities experiencing both high levels of deprivation and alcohol-related harm in the North West of England. Qualitative secondary data were extracted from pre-implementation meeting notes, recorded two to three months before roll-out. Items were coded into 12 content categories using content analysis. To create a baseline ‘infrastructure score’, the number of external contextual factors documented was counted per area to a maximum score of 12. Descriptive data were collected from training registers detailing training numbers in the first 12 months. The relationship between the baseline infrastructure score, external contextual factors, and the number of AHCs trained was assessed using non-parametric univariable statistics. Results There was a positive correlation between baseline infrastructure score and total numbers of AHCs trained (R s  = 0.77, p  = 0.01). Four external contextual factors were associated with significantly higher numbers of lay people recruited and trained: having a health care provider to coordinate the intervention ( p  = 0.02); a pool of other volunteers to recruit from ( p  = 0.02); a contract in place with a commissioned service ( p  = 0.02), and; formal volunteer arrangements ( p  = 0.03). Conclusions Data suggest that there were four key components that significantly influenced establishing an Alcohol Health Champion programme in areas experiencing both high levels of deprivation and alcohol-related harm. There is added value of capturing external contextual factors a priori and then testing relationships with process indicators to inform the effective roll-out of complex interventions. Future research could explore a wider range of process indicators and outcomes, incorporating methods to rate individual factors to derive a mean score. Trial registration ISRCTN81942890, date of registration 12/09/2017.

Background Communities In Charge of Alcohol (CICA) takes an Asset Based Community Development (ABCD) approach to reducing alcohol harm. Through a cascade training model, supported by a designated local co-ordinator, local volunteers are trained to become accredited ‘Alcohol Health Champions’ to provide brief opportunistic advice at an individual level and mobilise action on alcohol availability at a community level. The CICA programme is the first time that a devolved UK region has attempted to coordinate an approach to building health champion capacity, presenting an opportunity to investigate its implementation and impact at scale. This paper describes the protocol for a stepped wedge randomised controlled trial of an Alcohol Health Champions programme in Greater Manchester which aims to strengthen the evidence base of ABCD approaches for health improvement and reducing alcohol-related harm. Methods A natural experiment that will examine the effect of CICA on area level alcohol-related hospital admissions, Accident and Emergency attendances, ambulance call outs, street-level crime and anti-social behaviour data. Using a stepped wedged randomised design (whereby the intervention is rolled out sequentially in a randomly assigned order), potential changes in health and criminal justice primary outcomes are analysed using mixed-effects log-rate models, differences-in-differences models and Bayesian structured time series models. An economic evaluation identifies the set-up and running costs of CICA using HM Treasury approved standardised methods and resolves cost-consequences by sector. A process evaluation explores the context, implementation and response to the intervention. Qualitative analyses utilise the Framework method to identify underlying themes. Discussion We will investigate: whether training lay people to offer brief advice and take action on licensing decisions has an impact on alcohol-related harm in local areas; the cost-consequences for health and criminal justice sectors, and; mechanisms that influence intervention outcomes. As well as providing evidence for the effectiveness of this intervention to reduce the harm from alcohol, this evaluation will contribute to broader understanding of asset based approaches to improve public health. Trial registration ISRCTN 81942890 , date of registration 12/09/2017.

Introduction Internationally, research has shown Lesbian, Gay, Bisexual, Transgender/gender diverse, and Queer (LGBTQ+) people experience multifaceted challenges within school contexts. However, there is only a small emergent body of research on how LGBTQ+ community members might also experience positive, joyful, or euphoric experiences in these same spaces. Using euphoria and minority stress models, this article aims to consider whether schools themselves can be supportive and protective environments for LGBTQ+ people, how features of the school environment and school community might enable experiences of LGBTQ+ -related euphoria, and how euphoric experiences may be similar for students, staff and parents, and cisgender and gender diverse (GD) members of the LGBTQ+ community.MethodsThe study employed elements of grounded theory to analyse survey responses of LGBTQ+ students (n = 706), school staff (n = 107), and parents (n = 57). The survey data was collected online from 2021 to 2022 and explored LGBTQ+ community members’ experiences in, and perceptions of, Australian schools.ResultsEuphoria was predominantly related to school social contexts (such as supportive social climates), followed by school practices (such as LGBTQ+ representation), and internal experiences (such as pride). These events were shared by students, staff, and parents similarly. Euphoric events were shared by cisgender and GD participants, although gender-affirming social contexts and school practices were valued particularly by GD students, parents, and staff.ConclusionsSchools can act as supportive contexts for LGBTQ+ students, staff, and parents in terms of social characteristics and school practices using mostly similar methods. Implications for policy development include school-wide interventions that include and reflect all LGBTQ+ people in all education-based roles, via school curricula and activities, public education, and awareness-raising endeavours.Policy ImplicationsImplications for policy development include school-wide interventions that include and reflect all LGBTQ+ people in all education-based roles, via school curricula and activities, public education and awareness-raising endeavours.

BackgroundHematopoietic stem cell transplant (HSCT) is well established as a corrective treatment for many inborn errors of immunity (IEIs) presenting in childhood. Due to improved techniques, more transplants are undertaken and patients are living longer. However, long-term complications can significantly affect future health and quality of life. Previous research has focused on short-term medical outcomes and little is known about health or psychosocial outcomes in adulthood.ObjectiveThis project aimed to ascertain the long-term social and psychological outcomes for adults who underwent HSCT for IEI during childhood.MethodsAdult patients, who had all undergone HSCT for IEI during childhood at two specialist immunology services at least 5 years previously, were invited to participate in the study. Questionnaires and practical tasks assessed their current functioning and circumstances. Information was also gathered from medical notes. Data was compared with population norms and a control group of participant-nominated siblings or friends.ResultsEighty-three patients and 46 matched controls participated in the study. Patients reported significantly better physical health-related quality of life than the general population norm, but significantly worse than matched controls. Patient’s self-reported physical health status and the perceived impact of their physical health on everyday life were worse than matched controls and patients reported higher levels of anxiety and lower mood than the general population. For those where their IEI diagnosis was not associated with a learning disability, cognitive function was generally within the normal range.ConclusionsPatients who have had a HSCT in childhood report mixed psychosocial outcomes in adulthood. More research is needed to establish screening protocols and targeted interventions to maximize holistic outcomes.Clinical ImplicationsScreening for holistic needs and common mental health difficulties should be part of routine follow-up. Information should be provided to patients and families in order to support decision-making regarding progression to transplant and the early identification of any difficulties.

Abstract Purpose Allogeneic hematopoietic stem cell transplant (HSCT) remains the treatment of choice for patients with inborn errors of immunity (IEI). There is little published medical outcome data assessing late medical complications following transition to adult care. We sought to document event-free survival (EFS) in transplanted IEI patients reaching adulthood and describe common late-onset medical complications and factors influencing EFS.MethodsIn this landmark analysis, 83 adults surviving 5 years or more following prior HSCT in childhood for IEI were recruited. The primary endpoint was event-free survival, defined as time post-first HSCT to graft failure, graft rejection, chronic infection, life-threatening or recurrent infections, malignancy, significant autoimmune disease, moderate to severe GVHD or major organ dysfunction. All events occurring less than 5 years post-HSCT were excluded.ResultsEFS was 51% for the whole cohort at a median of 20 years post HSCT. Multivariable analysis identified age at transplant and whole blood chimerism as independent predictors of long-term EFS. Year of HSCT, donor, conditioning intensity and underlying diagnosis had no significant impact on EFS. 59 events occurring beyond 5 years post-HSCT were documented in 37 patients (45% cohort). A total of 25 patients (30% cohort) experienced ongoing significant complications requiring active medical intervention at last follow-up.ConclusionAlthough most patients achieved excellent, durable immune reconstitution with infrequent transplant-related complications, very late complications are common and associated with mixed chimerism post-HSCT. Early intervention to correct mixed chimerism may improve long-term outcomes and adult health following HSCT for IEI in childhood.