Community-based collaborative care (CBCC) is an internationally recognised model of integrated care that emphasises multidisciplinary teamwork and care coordination. In South Africa, community psychiatry has been integrated into some primary healthcare (PHC) facilities. This study examines healthcare providers’ perceptions of collaboration and its challenges in various integrated care settings. Three main components of CBCC (multidisciplinary teams, communication and case management) were explored through qualitative interviews with 29 staff members in 2 clinics. In Clinic-1, community psychiatry services operate independently in an outbuilding behind the main PHC clinic (“co-located”). In Clinic-2, these services are fully integrated within the PHC clinic (“physically integrated”). Both clinics had multidisciplinary teams, with various staff members conducting case management functions on an ad hoc basis. The physically integrated clinic (due to shared files, physical proximity and a facility manager with mental health experience) had greater levels of communication between the multidisciplinary team. In contrast, the co-located clinic struggled with poor management, unclear reporting structures and reinforced traditional hierarchies, limiting collaboration between the staff members. Integration does not guarantee collaboration. Improving collaboration between mental health and PHC staff requires clear roles, competent managers, CBCC endorsement from PHC clinicians, sufficient human resources and systematic communication channels, such as case review meetings.

Biodesign is a relatively new interdisciplinary field, which has grown rapidly over the last decade (as evidenced for example by the growth in student teams entering the Biodesign Challenge from 9 in 2016 to 52 in 2024).

Assistive technology for older people promises much, but the research evidence suggests that it delivers little. One hypothesis to explain the lack of positive impact is that assistive technology is often implemented with little involvement of older people or other stakeholders, such as family members or care staff. The suggestion is that co-production may ensure that assistive technology solutions are better tailored to people's needs, capacities and living situations. In this article, we review existing studies to examine what works in co-production in relation to processes of design and implementation of assistive technology for older people. Our results show a growing interest in co-production as an approach in this field, with a wide range of approaches being employed. We highlight a number of key lessons from the research, including key issues around who needs to be engaged in the co-production, as well as essential elements of the process itself. Our review suggests that there is considerable potential in using co-production to improve effectiveness of technological solutions to the challenges of age-related impairments. However, we also emphasise the need for more longitudinal research in this area, to examine whether such collaborative approaches can truly deliver the promise of assistive technology for older people.

Research regarding quality of life among older people has predominantly focused on functional elements experienced at individual or dyadic level despite the complex interplay of factors that contribute to quality of life. Perspectives which explore interdependencies within communities and the intersecting environments in which older people exercise agency have seen less study. They do, however, play an important role in influencing quality of life as experienced by older people across community settings. Qualitative data from a co-produced study of dimensions influencing quality of life in older people was subjected to secondary analysis using a critical human ecological approach. Findings demonstrate the importance of community interdependencies in supporting individual quality of life, the expression of active agency to foster quality of life within and across communities, and the importance of state infrastructures and service provision within these interdependencies. This article argues for a movement beyond functional conceptualisations of quality of life towards the inclusion of perspectives regarding communal wellbeing, alongside the role differing types of community play in influencing quality of life. Through developing conceptions of quality of life in social relations and community cohesion, in particular how quality of life is influenced by perceptions of solidarity and social justice including across generations, assessing quality of life at community level will assist in driving cultural change in policy making and practice.

This paper seeks to understand the engagement of people with dementia in creative and arts-based activities by applying a relational model of citizenship and incorporating concepts of contextual and embodied learning from adult learning theory. A theoretically driven secondary analysis of observational and interview data focuses on the engagement of staff, volunteers and people with dementia during an arts-based intervention in a day centre and care home. The processes through which learning is co-constructed between the person with dementia, staff/volunteer facilitators and peers in the group to co-produce a creative engaged experience involves: increasing confidence for learning, facilitating social and physical connections, and affirming creative self-expression. The role of facilitator is central to the process of creative engagement to reinforce a sense of agency amongst participants and recognise people's prior experiences of learning and engagement in creative activities. People with dementia continue to learn and grow through engagement in creative activities to produce positive outcomes for the individual participants and for the care staff who observe and participate in this creativity. Facilitating creativity requires attention to lifelong experiences of learning in addition to the immediate interactional context to integrate arts-based interventions in dementia care successfully.

Background: Few data are available on the neuropsychological, behavioural, or structural brain imaging outcomes in adolescents who underwent corrective surgery in infancy for tetralogy of Fallot. Methods: In this single-centre cross-sectional study, we enrolled 91 adolescents (13–16 years old) with tetralogy of Fallot and 87 referent subjects. Assessments included tests of academic achievement, memory, executive functions, visual-spatial skills, attention, and social cognition, as well as brain magnetic resonance imaging. Results: Genetic abnormalities or syndromes were present in 25% of tetralogy of Fallot patients, who had markedly greater neuropsychological morbidities than did patients without a syndrome. However, even patients without a syndrome performed significantly worse than the referent group or population norms in all of the neuropsychological domains assessed. In multivariable regression in those without a genetic/phenotypic syndrome, the strongest predictors of adverse late neurodevelopmental outcomes included a greater number of complications at the first operation, more total surgical complications across all operations, and occurrence of post-operative seizures. The presence of at least one abnormality on structural magnetic resonance imaging was more frequent in tetralogy of Fallot patients than the referent group (42% versus 8%). Conclusions: Adolescents with tetralogy of Fallot are at increased neurodevelopmental risk and would benefit from ongoing surveillance and educational supports even after childhood.