Abstract Introduction Variants of uncertain significance (VUS) are commonly reported in cancer with the widespread adoption of diagnostic massive parallel sequencing. The rate of reclassification of VUS in patients with haematological malignancy is not known and we evaluated this retrospectively. We also investigated whether re‐evaluating VUS in 12–24 months or greater than 24 months post‐initial classification was significant. Method A retrospective audit of patients with haematological malignancies referred to the Molecular Medicine Department at the John Hunter Hospital in Newcastle, Australia between September 2018 and December 2021. Data was analysed for VUS, which was then re‐analysed in standard software using current somatic variant guidelines. Proportions of VUS at baseline were compared to post‐re‐analysis. Results The most common diagnoses in the patient cohort ( n = 944) were acute myelogenous leukaemia (41%), myelodysplastic syndrome (31%), and chronic myelomonocytic leukaemia (7%). A total of 210 VUS were re‐analysed. The most common VUS were in the TET2 (20%), RUNX1 (10%) and DNMT3A (9%) genes. A total of 103 were re‐analysed at 24–39 months post‐initial classification and 107 variants were re‐analysed between 12 and 24 months post‐initial classification. Of these, 33 (16%) of VUS were re‐classified at 24–39 months and 12 (11%) were re‐classified at 12–24 months post‐initial classification. The most common variants that were re‐classified in both groups were CSF3R (32%), TET2 (29%), ASXL1 (11%) and ZRSR2 (11%). Conclusion This study on reclassification of VUS in blood cancers demonstrated that one in seven VUS were re‐classified 12 months post initial classification. This can inform practice guidelines and potentially impact the prognosis, diagnosis and treatment of haematological malignancies.
Globally, adolescents experience a significant burden of interpersonal violence, impacting their health, well-being and life trajectory. To address this, decision-makers need reliable evidence on effective interventions across various contexts. Objectives Synthesise the evidence for interventions addressing interpersonal violence experienced by adolescents aged 10–25 years. Methods Six electronic databases were systematically searched. Systematic reviews and meta-analyses published globally between 2010 and 2022 were included if they reported interventions addressing interpersonal violence experienced by adolescents. Results were synthesised narratively. Results 35 systematic reviews were included, of which 16 were also meta-analyses. Majority of reviews included interventions set in high income countries (71%) and implemented in educational settings (91%). Effectiveness was reported in majority of interventions measuring victimisation and/or perpetration of intimate partner violence, sexual violence, bullying and/or cyberbullying (90%), majority of interventions measuring improvements in knowledge and attitudes towards violence (94%) and all interventions measuring bystander behaviour and improvements in well-being and quality of life. However, the quality of included reviews as per Assessment of Multiple Systematic Reviews 2 and National Health and Medical Research Council was low, and equity as per PROGRESS-PLUS was seldom considered. There was also a paucity of interventions addressing interpersonal violence in low-middle income countries (12%) and none of the included interventions specifically addressed interpersonal violence perpetrated in the home such as family violence. Conclusion There is some evidence of promising interventions to address interpersonal violence experienced by adolescents, however there are gaps in scope and implementation. There is a need for equity-oriented public health approaches to comprehensively address the disproportionate burden of interpersonal violence experienced by adolescents globally, including those at the highest risk of harm. PROSPERO registration number CRD42020218969.
Abstract Background Arts‐based methodologies and methods (ABM) can elicit rich and meaningful data with seldom‐heard groups and empower participants in research. Young people with complex psychosocial needs could be better engaged in research using arts‐based approaches to overcome communication and literacy issues as well as distrust of those with power, including researchers. A critical review of the use and impact of ABM among this population is timely. The purpose of this review is to synthesize and examine the experience and use of ABM with young people with complex psychosocial needs. Methods A systematic narrative literature review was conducted with a search of the literature from 2009 to 2021. All abstracts were reviewed independently by two authors and full papers were screened for eligibility against inclusion and exclusion criteria. Data synthesis focused on a descriptive numerical summary and a thematic analysis focused on key patterns across papers relating to the review objectives. Results and Discussion A total of 25 papers were included. The most common issues of focus were mental health ( n = 10) and homelessness ( n = 11) and methods using Photovoice ( n = 12) and Body Mapping ( n = 5). Individual interview data ( n = 20) were the most commonly analysed, followed by created works ( n = 19). Less than half the studies involved young people in the interpretation of the data collected. Knowledge translation was not described in almost half the studies, with public exhibits ( n = 7) and forums with service providers ( n = 4) being the most common activities. Key themes across the studies were valued over traditional methods in eliciting data, ABM as an approach to engage these young people in research and the impact of the use of ABM on participants and on key stakeholders through knowledge translation. Conclusions The growing field of ABM presents opportunities to enhance research with young people with complex psychosocial needs by promoting meaningful exploration of experiences, engaging participants in research and strengthening knowledge translation. The involvement of young people in the interpretation of data and ensuring that knowledge translation occurs are key areas for future attention. Patient or Public Contribution The findings of this review will inform future research to improve the engagement of young people with complex psychosocial needs in research and promote power sharing between researchers and research participants.
In Australia there is no official national death toll for femicide. This is despite the prevalence of femicide in Australia and its disproportionate burden experienced by Aboriginal and Torres Strait Islander women and women born outside of Australia. The official data that is available does not recognise femicide or collect the contextual factors contributing to fatal violence against women, and where more in-depth data is collected, it is restricted to deaths in the context of domestic and family violence. The available data is not timely and lacks rigour, and thus, the structural determinants and true burden of femicide in Australia are not known. The community-led Counting Dead Women Australia femicide census aims to fill this gap by capturing and reporting femicide data in Australia.
Young people (10-24 years old) with mental health concerns are increasingly presenting to hospital emergency departments (EDs). The purpose of this review was to identify the core components and outcomes of mental health interventions for young people that are initiated in the ED, such that they are delivered in the ED and/or by ED health workers.Six electronic databases were systematically searched. Primary peer-reviewed qualitative or quantitative studies describing an ED-initiated mental health intervention for young people published between 2009 and 2020 were included.Nine studies met the inclusion criteria. The included studies demonstrated that compared with traditional ED care, ED-initiated mental health interventions lead to improved efficiency of care and decreased length of stay, and a core component of this care was its delivery by allied health practitioners with mental health expertise. The studies were limited by focusing on service efficiencies rather than patient outcomes. Further limitations were the exclusion of young people with complex mental health needs and/or comorbidities and not measuring long-term positive mental health outcomes, including representations and whether young people were connected with community health services.This systematic review demonstrated that ED-initiated mental health interventions result in improved service outcomes, but further innovation and robust evaluation are required. Future research should determine whether these interventions lead to better clinical outcomes for young people and staff to inform the development of best practice recommendations for ED-initiated mental health care for young people presenting to the ED.
It is demonstrated that primary health care (PHC) providers are sought out by women who experience violence. Given the disproportionate burden of violence experienced by Aboriginal and Torres Strait Islander women, it is essential there is equitable access to appropriate PHC services. This review aimed to analyse whether Australian PHC policy accounts for the complex needs of Aboriginal and Torres Strait Islander women experiencing violence and the importance of PHC providers responding to violence in culturally safe ways.
It is imperative that access to primary health care services is equitable as health care practitioners are often the first responders to women who experience violence. This is of particular importance for First Nations women who disproportionately experience interpersonal and structural violence when compared to non-First Nations women, as well as the ongoing impact of colonization, racism, and intergenerational trauma. To understand how primary health care services can provide equitable and effective care for First Nations women, we explored how trauma and violence informed care is integrated in primary health care settings through the lens of an equity-oriented framework. A systematic search of electronic databases included Medline (via Ovid), Scopus, Informit, and PubMed and grey literature. Six studies were included in the review and we undertook a narrative synthesis using the equity-oriented framework to draw together the intersection of trauma and violence informed care with culturally safe and contextually tailored care. This review demonstrates how equity-oriented primary health care settings respond to the complex and multiple forms of violence and intergenerational trauma experienced by First Nations women and thus mitigate shame and stigma to encourage disclosure and help seeking. Key attributes include responding to women’s individual contexts by centering family, engaging elders, encouraging community ownership, which is driven by a culturally competent workforce that builds trust, reduces retraumatization, and respects confidentiality. This review highlights the importance of strengthening and supporting the workforce, as well as embedding cultural safety within intersectoral partnerships and ensuring adequate resourcing and sustainability of initiatives.
Housing is a social determinant of health that impacts the health and well-being of children and families. Screening and referral to address social determinants of health in clinical and social service settings has been proposed to support families with housing problems. This study aims to identify housing screening questions asked of families in healthcare and social services, determine validated screening tools and extract information about recommendations for action after screening for housing issues.The electronic databases MEDLINE, PsycINFO, EMBASE, Ovid Emcare, Scopus and CINAHL were searched from 2009 to 2021. Inclusion criteria were peer-reviewed literature that included questions about housing being asked of children or young people aged 0-18 years and their families accessing any healthcare or social service. We extracted data on the housing questions asked, source of housing questions, validity and descriptions of actions to address housing issues.Forty-nine peer-reviewed papers met the inclusion criteria. The housing questions in social screening tools vary widely. There are no standard housing-related questions that clinical and social service providers ask families. Fourteen screening tools were validated. An action was embedded as part of social screening activities in 27 of 42 studies. Actions for identified housing problems included provision of a community-based or clinic-based resource guide, and social prescribing included referral to a social worker, care coordinator or care navigation service, community health worker, social service agency, referral to a housing and child welfare demonstration project or provided intensive case management and wraparound services.This review provides a catalogue of housing questions that can be asked of families in the clinical and/or social service setting, and potential subsequent actions.
This study aimed to describe mental health emergency department (ED) presentations among young people aged 8-26 years in New South Wales, Australia, and to identify key characteristics associated with higher risk of ED mental health re-presentation.Retrospective analysis of linked ED data records for mental health presentations between 1 January 2015 and 30 June 2018.The main outcome was the total number of mental health ED re-presentations within 1 year, following initial presentation. Count regression models were fitted to estimate factors associated with higher likelihood of re-presentations.Forty thousand two hundred and ninety patients were included in the analyses, and 9713 (~25%) re-presented during the following year; 1831 (20%) presented at least three times. On average, patients re-presented 0.61 times per 365 person-days, with average time until first re-presentation of ~92 days but greatest risk of re-presentation within first 30-60 days. Young people with self-harm or suicidal diagnoses at initial presentation were more likely to re-present. Re-presentations were highest among young people <15 years (IRR 1.18 vs ≥20 years old), female (IRR=1.13 vs male), young people residing outside of major cities (IRR 1.08 vs major cities) and Aboriginal and Torres Strait Islander young people (IRR 1.27 vs non-Indigenous).ED mental health re-presentation is high among young people. We demonstrate factors associated with re-presentation that EDs could target for timely, high-quality care that is youth friendly and culturally safe, with appropriate referral pathways into community-based primary and mental healthcare services.
ABSTRACTCertain student populations including youth formerly in foster care, first-generation college students, those with mental illness and substance abuse issues, and racial and ethnic minority students, face persistent challenges to their pursuit of college education, contributing to low graduation rates compared to their peers. This article details one university's pilot program using social work practicum placements in multiple departments providing direct interventions with vulnerable students to increase retention and graduation rates with a focus on identifying barriers to success and connecting students to supports. Efforts were interprofessional, incorporating student support services, and social and emotional support. Placement in academic support services provided an interprofessional practice setting to intervene with students at risk of leaving college and continue to shape ongoing interventions. Implications for collaborative field education are explored, with the aim of describing the program's successful interventions with vulnerable students and how they provided social work practicum students with crucial interprofessional settings to practice and refine their social work skills. Disclosure statementNo potential conflict of interest was reported by the authors.Additional informationNotes on contributorsStephanie A. SaulnierStephanie A. Saulnier is the MSW Program Director at Eastern Kentucky University.Natasha WalkerNatasha Walker is a graduate of the MSW Program at Eastern Kentucky University.
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