Background:
The angklung is a traditional musical instrument originating from West Java, Indonesia, made from bamboo tubes that produce sound when shaken simultaneously and harmoniously. One person can hold and shake one or more angklungs. Creating beautiful melodies requires good cooperation among the players. Each player needs to know when to shake and when to stop shaking their angklung. Family clinics that form communities of elderly angklung players with degenerative diseases are very rare.

Objective:
To explore the experiences of elderly patients with degenerative diseases who have regularly practiced angklung and their relationship with quality of life.

Method:
A qualitative phenomenological approach was used, conducting interviews with 26 elderly individuals with degenerative diseases such as hypertension and diabetes.

Results:
Psychologically, almost all participants expressed feelings of happiness, enjoyment, and entertainment. In terms of the physical aspect, some experienced improved motor skills, coordination, movement, concentration, memory, and even stabilized blood sugar levels. From a social perspective, nearly everyone expressed pleasure in meeting and gathering with others. Moreover, in terms of the environmental aspect, angklung created harmonization that could be enjoyed together.

Discussion:
Despite the degenerative conditions, engaging in angklung practice can enhance cognitive function.

Conclusion:
Regular angklung practice can improve the quality of life for elderly individuals with degenerative diseases.

Background: Colorectal cancer (CRC) is a leading cause of death globally, with corresponding high rates of diagnosis in Australia. Early detection through screening reduces mortality. A CRC polygenic risk score (PRS) can provide a more accurate risk assessment than using family history alone. This personalised risk can be used to recommend the most appropriate CRC screening. The SCRIPT trial is a RCT comparing the provision of personalised screening recommendations using a PRS to standard care on risk-appropriate CRC screening in adults aged 45-70 attending GPs in Victoria, Australia.
Aims: This qualitative sub-study of the SCRIPT trial explored patients' perspectives on the implementation of a PRS in general practice to tailor CRC screening, identifying how this risk information interacted with enablers and barriers to CRC screening.
Method: Semi-structured interviews were conducted with participants who received their CRC PRS and personalised screening recommendations. Interviews were audio recorded, transcribed and thematically analysed for common themes based on Rosenstock’s (1974) Health Belief Model (HBM).
Results: Results were framed within the HBM, identifying key domains in which aspects of the SCRIPT Trial intervention targeted effectively. Participants understood the PRS and appreciated visual representations of their risk scores. Some found the PRS results reassuring, while others suggested receiving a high PRS would have scared them. Despite acknowledgement of the important role of GPs in motivating patients to screen for CRC, patients described that they only see their GP reactively when unwell and not proactively for preventative health.
Conclusions: These findings will provide evidence to assist in future development and implementation of a PRS to inform patients of their personal risk and encourage action on screening. While patients in this age group stated they most often see their GPs for acute health problems, they identified their key role in motivating and informing patients to screen for CRC.

Rationale: Approximately 40% of Australian Emergency Department (ED) presentations after-hours are classified as “avoidable”. Efforts to reduce ED presentations have focussed on shifting patients into primary care. However, primary care is already managing the largest proportion of afterhours presentations, indicating potential inefficiencies of afterhours services use. Differences between patient and clinician perceived urgency of an issue may be driving “inappropriate” presentations. We investigated the level of agreement between patient and clinicians’ perceptions of urgency and safety to wait for an assessment at primary care after-hours services in Canberra.

Methods: Cross-sectional surveys voluntarily completed by patients and then their clinicians at after-hours medical services were completed in May/June, 2019. Single catagorical responses captured patient and clinician ratings of urgency and safety to wait for assessment. Agreement in ratings of was measured by Fleiss kappa.

Results: 888 matched surveys (representing 31% of all presentations) showed that overall inter-observer agreement between patients and clinicians on the urgency of presentations was slight (Fleiss kappa=0.166; 95% CI 0.117–0.215, p<0.001). Agreement within specific ratings of urgency ranged from very poor to fair. Overall inter-rater agreement on how long it would be safe to wait for assessment was fair (Fleiss kappa=0.209; 95% CI 0.165–0.253, p<0.001). Agreement on urgency of an issue was more often reported among patients attending their usual health service (often general practice) or seeing their usual clinician (often GP) compared to patients attending an unfamiliar health service or clinician (χ2(1)=7.283, p=0.007 and χ2(1)=16.268, p<0.001, respectively).

Conclusions: Low levels of agreement between patients and clinicians on perceived urgency and safety to wait for issues to be assessed is not surprising given clinicians are highly trained. Agreement on urgency of issues being more common among patients attending a familiar health service or familiar clinician shows the value of relationship based care, commonly fostered in general practice.

Objective: To examine the effects of a multi-component intervention: cognitive training, mind-body physical exercise, and nurse-led risk factor modification (CPR), and a nurse-led risk factor modification (RFM) alone on cognitive function and other health outcomes when compared to health advice (HA) among older adults with MCI.
Methods: This randomised controlled trial included 456 older adults with MCI from the community and primary care in Hong Kong, with 152 participants randomised to CPR, RFM or HA each. CPR and RFM groups met the nurse quarterly over 15 months. CPR group received Tai Chi and cognitive training three times a week for three months. HA group received advice and education booklets from a nurse. All participants met the study clinicians at screening for a detailed medical history and physical examination. Assessments were conducted at baseline, 6, 12, and 15 months. Assessors and data analysist were blinded to group allocation. The primary outcome was the Alzheimer’s Disease Assessment Scale - cognitive subscale (ADAS-Cog) score. Linear mixed model was used for analysis.
Results: Participants were 70.1±4.9 years old, and 72.4% were female. In the first 272 participants who completed the study, pairwise comparison found a significant group difference between CPR and HA (F(1,213)=6.06, p=0.015) adjusting for imbalanced baseline factor (age). No pairwise between-group difference was found between CPR and RFM and between RFM and HA. Both CPR and RFM groups showed significant within-group improvement at 6, 12, and 15 months of follow-up (p<0.05). HA group had significant within-group improvement at 12 and 15 months (p<0.05).
Conclusions: Preliminary results show that the multi-domain intervention CPR is feasible and may reduce cognitive decline in older adults with MCI. A larger sample of this study could inform a potentially effective service model for MCI in primary care.

[Background]
Multimorbidity is a risk factor of physical functional decline among community-dwelling older adults. We aimed to 1) investigate multimorbidity patterns and 2) explore the association between multimorbidity patterns and functional decline of older adults during acute admission due to infectious diseases.
[Methods]
The retrospective cross-sectional study was conducted, using the data of the nation-wide diagnosis procedure combination database in Japan. Participants hospitalized due to acute infectious diseases aged ≥65 years and Barthel Index scored ≥ 40 on admission from 2015 to 2020 were analyzed (N = 953,110). 1) Multiple correspondence analysis was performed to explore multimorbidity patterns. 2) The association between multimorbidity patterns and functional decline or death was investigated by age- and sex-adjusted multivariate logistic regression analysis, treating the functionally stable group as a reference subject. Functional decline was defined by more than 5 points decreasing of Barthel Index during the hospital stay.
[Results]
Among all, three major multimorbidity patterns were identified; 1. bronchial asthma, chronic obstructive pulmonary disease; 2. chronic pain, osteoporosis; 3. dementia, depression, Parkinson's disease. Functional decline and death were 12.6% (119,837) and 4.8% (45,318), respectively. Multimorbidity pattern 2 and 3 were associated with mortality (OR 1.66, 95%CI 1.59 to 1.74 and OR 1.78, 95%CI 1.32 to 2.42, respectively). Conversely, pattern 2 was associated with functional decline, and the pattern 3 showed more marked association (OR 1.06, 95%CI 1.03 to 1.10 and OR 3.67, 95%CI 3.13 to 4.31, respectively).
[Conclusions]
Multimorbidity pattern with dementia, depression and Parkinson's disease was associated with a worse outcome of both physical functioning decline and mortality. In contrary, pattern with chronic pain and osteoporosis was also associated with mortality, but weakly associated with functioning decline. Early recognition of predisposing multimorbidity patterns may be beneficial to predict adverse outcome when providing care for hospitalized older patients due to infectious diseases.

This is ongoing work and results will be presented at the conferernce in October.

Abstract:
Background: The Africa Forum for Primary Health Care Network (AfroPHC) plays a crucial role in advancing primary health care (PHC) in Africa. To further strengthen its impact, it is imperative to assess the research capacity of its members in order to establish Practice Based Research Networks fro Family Medicine and PHC.This study aims to conduct a comprehensive survey to determine the research capacity of AfroPHC members.

Methods: A cross-sectional survey will be conducted among AfroPHC members using a validated questionnaire. The survey will comprise of two sections: demographics and research capacity assessment. Demographic data will include information about the participant's professional background, academic qualifications, and research experience. The research capacity assessment section will include questions related to research skills, knowledge, access to resources, funding opportunities, and collaborations.

Results: Descriptive statistics will be used to summarize the demographic data and research capacity indicators of AfroPHC members. Research capacity will be assessed based on various dimensions such as research skills, publication track record, engagement in research projects, access to research funding, and collaborations. The results will be presented as frequencies, percentages, and means as appropriate. Chi-square or Fisher's exact tests will be used to explore associations between demographic variables and research capacity indicators.

Conclusion: This study aims to provide valuable insights into the research capacity of AfroPHC members in order to guide the establishment of Practice Based research networks(PBRNs). The findings will inform the development of targeted interventions and strategies to enhance research capacity among PHC professionals in Africa. Strengthening research capacity will enable AfroPHC members to generate evidence-based solutions, contribute to policy development, and improve the overall delivery of primary health care services in the region. The outcomes of the study will inform establishment of PBRNs.

Background: Multimorbidity is associated with increased healthcare utilisation, including GP consultations, prescriptions, and hospitalisations. Older adults with multimorbidity have limited physical function and adverse impacts on activities of daily living.

Aims: To examine the impact of multimorbidity clusters and risk of admission to aged residential care (ARC) and mortality at five years follow-ups, comparing to the number of conditions.

Methods: Multimorbidity was ascertained using routinely collected primary care data. The study sample included adults aged 65+ (55+ Māori and Pasifika) registered with Tū Ora COMPASS Health on 1/1/2016. Aged residential care (ARC) admissions from interRAI and mortality from the Ministry of Health New Zealand. Latent class analyses were used to identify multimorbidity patterns, and Cox regression models were used to examine the association between multimorbidity and health outcomes.

Results: The sample comprises 45,178 adults: Māori (8%) and Pasifika (4%), and non-Māori/non-Pasifika (88%). The average age for Māori was 64.6, Pasifika 65.6, and NonM/nonP 74.7. The average number of conditions was 1.6. Three clusters were identified for Māori and Pasifika, respectively, and four for NonM/nonP. We found that the number of conditions predicts mortality risk better than multimorbidity clusters. However, multimorbidity clusters better predict ARC admission for Māori and nonM/nonP adults aged ≥80. The adjusted HazardRatio (aHR) for Māori in cluster-3 (worst) was 2.69 (95% CI 1.81-4.01), compared to ≥4 conditions aHR (95% CI) 2.31(1.49-3.59). In nonM/nonP adults aged ≥80, aHR (95% CI) for ARC admission in clusters 3 and 4 (mean±SD conditions 4±1) were 1.43(1.23-1.66) and 4.08(3.67-4.53), respectively; ≥4 conditions aHR (95% CI) 2.11(1.90-2.34). We will present these clusters' profiles and condition memberships at the conference.

Conclusions: We found that multimorbidity clusters better differentiated ARC admission risk than quantifying conditions. Multimorbidity clusters are likely to offer a strategic approach to manage multimorbidity better in older adults in primary care settings.

Introduction:
Young physicians are said to be the healthy life style advocates. Physician well-being have recently become the focus of international concern.
Aim: to draw a life style profile of undergraduate young physicians in 2023 registered at the faculty of medicine of Sousse, Tunisia.

Methods:
we conducted a cross-sectional study via an online survey. All the undergraduate medical students registered at the faculty of medicine of Sousse during the university year 2022-2023 were eligible to participate. A ten-item structured questionnaire inspired from the world health organization (WHO) healthy lifestyle criteria was developed to assess the lifestyle among young physicians. It was and distributed over three months in 2023.

Results:
A total of 141 undergraduate medical students were enrolled. Females accounted for 70.4% of them. Only 41.5% reported engaging in physical exercise for more than thirty minutes each day. Regarding dietary habits, 41.5% of participants managed to meet the recommended daily intake of three portions of fruits and vegetables.
Regarding tobacco use, 85.2%, identified themselves as non-smokers. A majority of participants, specifically 78%, reported abstaining from alcohol consumption. And 33.1% reported experiencing insufficient sleep. Emotional stability rated for 52.1% of participants,.
In terms of medication use, 17.6% of them reported frequently relying on painkillers.
Only 50% experienced regularities in their daily routines. Financial problems were reported by 14.8% of the young physicians. Lastly, 24.6% of the participants expressed dissatisfaction with their social lives.

Conclusion:
Our study reveals a mixed picture of positive and negative findings among young physicians' lifestyle profiles. While certain aspects, such as non-smoking, absence of alcohol consumption and emotional stability, show promise, areas like physical exercise, dietary habits, sleep quality, financial challenges, medication use, daily routines, and social satisfaction require attention. It is imperative to address these issues and consider tailored interventions to promote healthier lifestyles.

Vitamin D is a prohormone that plays a crucial role in various biological processes, including immunological responses, phosphocalcic metabolism, and detoxification. Recent discoveries have fueled research interest in understanding the diverse functions of vitamin D. However, determining the optimal level of 25(OH)D3, the major circulating form of vitamin D, remains a subject of debate, with studies suggesting potential overestimation of deficiency prevalence and controversies surrounding supplementation in healthy individuals.

The COVID-19 pandemic has led to lifestyle changes that may impact vitamin D synthesis, such as modified diets, reduced outdoor activities, and decreased exercise. This study aimed to explore differences in mean vitamin D concentrations between the pre-pandemic and pandemic periods (2018-2021) using 8905 laboratory-based samples from a private laboratory in Quito.

The results showed significant differences in average vitamin D deficiency between the pre-pandemic and pandemic periods. However, there was an increase in the prevalence of vitamin D toxicity during the pandemic, with toxicity rates rising from 0.12% in 2018 to 0.88% in 2021. Over the study period, average annual serum 25OHD levels increased by 2.4 ng/mL.

Addressing both deficiency and toxicity issues through supplementation interventions and public education is crucial. By providing insights into the impact of the pandemic on vitamin D levels, this study emphasizes the importance of maintaining optimal vitamin D status for overall health.

Background: Informal caregivers are essential figures that deal with the effects of dependence in the elderly. However, they suffer from poorer health-related quality of life, particularly regarding mental health. Social support is crucial, but this was suspended or dramatically reduced during the Covid-19 pandemic. Salutogenesis theory explores the contributing factors for the promotion and maintenance of health. Considering all these, we offered caregivers the opportunity to join a participatory project aimed at creating communication spaces where they could share experiences, think together about potential solutions, and explore which salutogenic actions they used in their daily basis and how they had changed during Covid-19 restrictions.
Method: We used a qualitative methodology with a socio-constructivist and phenomenological approach and purposive sampling. We organized two focus groups consisting of online semi-structured discussions with seven participants in total. Conversations were videotaped and transcribed and we conducted content thematic analyses using the NVivo software.
Results: Caregiving in our setting are primarily women with high levels of education that do not always feel comfortable with this load because it interferes with their personal and professional lives. The pandemic increased caregivers feelings of loneliness, resignation, and burden, directly affecting their mental health. Furthermore, the disappearance of prevention programs and the difficulties to access healthcare services produced negative consequences on the already fragile elderly and their family caregivers.
Conclusions: The pandemic and its restrictions exacerbated the problematics affecting informal caregivers. Although these people are aware of their situation and have valued knowledge of how to improve their health, they cannot always put it into practice. We call policymakers to reframe interventions aimed at caregivers by introducing the voice of the community in the planning and to rethink the management of vulnerable people and their carers in other potential health crises.

Introduction
University students, particularly those in medical schools, frequently encounter various stressful situations and preoccupations. Medical schools, are renowned for their highly competitive and stress-inducing environment.
The aim of our study was to assess stress predictors in Ibn El jazzar medical school, Sousse (Tunisia).

Methods
We conducted a cross-sectional study among all the undergraduate medical students registered at the faculty of medicine of Sousse during the university year 2022-2023. Perceived stress was assessed via the perceived stress scale (PSS). The questionnaire was hosted on Google Forms and electronically distributed over three months in 2023.

Results
A total of 141 participants were included, with a female predominance (70.4%). The majority of participants had a moderate stress level (73.9%), while only 12% reported low stress levels and 14.1% reported high stress levels. Individuals who were spiritually satisfied had a lower percentage of high stress levels than those who lacked spiritual satisfaction (7.4% vs. 20.9%, p=0.05). We also found that 28% of those who had frequent use of painkillers (such as for chronic diseases) had high stress levels compared to 10.8% of those who didn’t use those medications (p=0.049). On the other hand, factors such as gender, medical school course of study satisfaction, emotional stability, environmental satisfaction, and social satisfaction were not found to be predictors of lower stress levels in medical students.

Conclusion
It is important to address spiritual well-being as a protective factor against stress in the medical education setting. Further research is warranted to better understand the underlying mechanisms and to explore other stress predictors.

Aim: The aim of this presentation is to upskill General Practitioners (GPs) regarding the latest evidence in the role of physical activity (PA) in cancer care, during and after treatment, and providing practical tips for GPs to facilitate patients to become physically active, by providing PA recommendations and directing to programs available to patients.

Content: Physical activity has numerous benefits for people diagnosed with cancer, including improved sleep quality, muscle mass, quality of life, and reduced fatigue, cancer recurrence and mortality. With 67% of cancer survivors not meeting PA guidelines, GPs are in a crucial position to support the 151,000 Australians diagnosed with cancer annually to support their PA. GPs play an integral role in shared cancer follow-up care, and are well positioned to implement PA.

Given the significant barriers that GPs face with time and competing priorities within consultations, this presentation provides concise recommendations that can be used within consultations, designed by GPs, an Accredited Exercise Physiologist and researchers. These recommendations include summarising evidence-based guidelines including brief advice (e.g. resistance and aerobic exercise at home), counselling on PA benefits, providing written or video material (e.g. Cancer Council), a PA prescription (e.g. step count or minutes/week goal), and/or referral to an exercise professional (e.g. Accredited Exercise Physiologist via Chronic Disease Management Plan) or community programs (e.g. Get Healthy NSW Cancer Support Program).

Goals: The goals of this presentation are to equip GPs with tools to promote PA in cancer patients, to reduce their morbidity, and improve their quality of life and clinical outcomes. Given that referral pathways between tertiary cancer and community exercise professionals and programs are not established nationwide, GPs are in a pivotal position to bridge this gap when patients transition to community care, by discussing, recommending and referring PA, aligning with Australian guidelines.