Identifying challenges and barriers in the delivery of primary healthcare at the district level : A study in one Thai province
- Authors: Tejativaddhana, Phudit , Briggs, David , Fraser, John , Minichiello, Victor , Cruickshank, Mary
- Date: 2013
- Type: Text , Journal article
- Relation: International Journal of Health Planning and Management Vol. 28, no. 1 (2013), p. 16-34
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- Description: In 2001, the universal health coverage policy was adopted by Thailand with primary healthcare (PHC) as the major focus of the policy. In order to understand the structural and institutional factors affecting the implementation of PHC in rural Thailand, a qualitative study, utilising individual interviews with national and provincial policy decision makers, community health directors, heads of hospital primary care units, chiefs of district health offices, heads of health centres and community representatives, from one rural province was undertaken. Findings showed that the sustainability of PHC service provision under the administration of community hospitals is problematic as barriers exist at the policy and operational levels and access to PHC for all citizens may not be achieved until these barriers are addressed. Furthermore, although PHC needs to be acknowledged and implemented by all stakeholders within the health industry and government, the roles and responsibilities of the stakeholders in health services management at the district level need to be clarified. Copyright © 2012 John Wiley & Sons, Ltd.
Impact of demographic change, socioeconomics, and health care resources on life expectancy in Cambodia, Laos, and Myanmar
- Authors: Chan, Moon Fai , Taylor, Beverley
- Date: 2013
- Type: Text , Journal article
- Relation: Public Health Nursing Vol. 30, no. 3 (2013), p. 183-192
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- Description: Objectives: Demographic and socioeconomic changes and the availability of health care resources were collected to examine the impacts on life expectancy in Cambodia, Laos, and Myanmar. Design and Sample: An ecological design collecting 29 years (1980 –2008) data for three Southeast Asian countries. Measures: Life expectancy, demographics, socioeconomic status, and health care resources were collected. Results: The structural equation model indicates that more available health care resources and socioeconomic advantages were more likely to increase life expectancy. By contrast, demographic change was more likely to increase life expectancy by way of health care resources. Conclusions: Results show that factors that had direct impacts on life expectancy in all three countries were socioeconomic status and health care resources. Demographic changes had an indirect influence on life expectancy via health care resources. These findings suggest that policymakers should be focusing on how to remove the barriers that impede access to health care services during economic downturns. In addition, how to increase preventive care for the populations that have less access to health care in communities
In partnership with the genetic question
- Authors: Warelow, Philip
- Date: 2013
- Type: Text , Journal article
- Relation: International Journal of Mental Health Nursing Vol. 22, no. Supplement (October 2013), p. 34-34
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Increasing incidence of hospitalisation for sport-related concussion in Victoria, Australia
- Authors: Finch, Caroline , Clapperton, Angela , McCrory, Paul
- Date: 2013
- Type: Text , Journal article
- Relation: Medical Journal of Australia Vol. 198, no. 8 (2013), p. 427-430
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Full Text: false
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- Description: Objective: To describe trends in hospitalisation for sport-related concussion. Design, setting and patients: Analysis of routinely collected hospital admissions data from all Victorian hospitals (public and private) over the 2002-03 to 2010-11 financial years for patients aged ≥15 years with a diagnosis of concussion and an ICD-10-AM external cause activity code indicating sport. Main outcome measures: Number and cost of hospitalisations; rate of hospitalisation per 100000 participants overall and for specific sports; and percentage change in frequency and hospitalisation rate per 100000 participants over 9 years. Results: There were 4745 hospitalisations of people aged ≥15 years for sport-related concussion, with a total hospital treatment cost of $17944799. The frequency of hospitalisation increased by 60.5% (95% CI, 41.7%-77.3%) over the 9 years, but could only partially be explained by increases in sports participation, as the rate per 100000 participants also increased significantly, by 38.9% (95% CI, 17.5%-61.7%). After adjustment for participation, rates were highest for motor sports, equestrian activities, Australian football, rugby and roller sports. The greatest significant increases in rates were seen in roller sports, rugby, soccer and cycling. Conclusions: The frequency and participation-adjusted rate of hospitalisation for sport-related concussion, both overall and across several sports, increased significantly over the 9 years. These findings, along with high levels of public concern, make prevention of head injury in sport a population health priority in Australia.
- Description: 2003011025
Managing patient deterioration: assessing teamwork and individual performance
- Authors: Cooper, Simon J. , Cant, Robyn , Porter, Joanne , Missen, Karen , Sparkes, Louise , McConnell-Henry, Tracy , Endacott, Ruth
- Date: 2013
- Type: Text , Journal article
- Relation: Emergency Medicine Journal Vol. 30, no. 5 (2013), p.
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- Description: Objective To assess the ability of rural Australian nurse teams to manage deteriorating patients. Methods This quasi-experimental design used pre- and post-intervention assessments and observation to evaluate nurses' simulated clinical performance. Registered nurses (n=44) from two hospital wards completed a formative knowledge assessment and three team-based video recorded scenarios (Objective Structured Clinical Examinations (OSCE)). Trained patient actors simulated deteriorating patients. Skill performance and situation awareness were measured and team performance was rated using the Team Emergency Assessment Measure. Results Knowledge in relation to patient deterioration management varied (mean 63%, range 27–100%) with a median score of 64%. Younger nurses with a greater number of working hours scored the highest (p=0.001). OSCE performance was generally low with a mean performance of 54%, but performance was maintained despite the increasing complexity of the scenarios. Situation awareness was generally low (median 50%, mean 47%, range 17–83%, SD 14.03) with significantly higher levels in younger participants (r=−0.346, p=0.021). Teamwork ratings averaged 57% with significant associations between the subscales (Leadership, Teamwork and Task Management) (p<0.006), the global rating scale (p<0.001) and two of the OSCE measures (p<0.049). Feedback from participants following the programme indicated significant improvements in knowledge, confidence and competence (p<0.001). Conclusion Despite a satisfactory knowledge base, the application of knowledge was low with notable performance deficits in these demanding and stressful situations. The identification and management of patient deterioration needs to be taught in professional development programmes incorporating high fidelity simulation techniques. The Team Emergency assessment tool proved to be a valid measure of team performance in patient deterioration scenarios.
Medical-attention injuries in community Australian football: A review of 30 years of surveillance data from treatment-sources
- Authors: Ekegren, Christina , Finch, Caroline , Gabbe, Belinda
- Date: 2013
- Type: Text , Journal article
- Relation: Journal of Science and Medicine in Sport Vol. 16, no. Supplement 1 (December 2013 2013), p. e56
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- Description: Introduction: Australian football (AF) consistently outranks other team sports in the frequency of hospitalisations and emergency department (ED) presentations for sports injury treatment. Understanding the profile of these and other ‘medical-attention’ injuries is important for developing preventative strategies and thereby reducing the health-care burden resulting from AF injuries. Currently, hospital and ED surveillance systems provide the only ongoing source of epidemiological data on community sports injuries at the population level. The purpose of this review was to describe the frequency and profile of medical-attention injuries resulting from AF reported in hospital, ED and other treatment-source datasets.
Puberty, health and sexual education in Australian regional primary schools : Year 5 and 6 teacher perceptions
- Authors: Duffy, Bernadette , Fotinatos, Nina , Smith, Amanda , Burke, Jenene
- Date: 2013
- Type: Text , Journal article
- Relation: Sex Education Vol. 13, no. 2 (2013), p. 186-203
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- Description: The research reported in this paper investigates why teachers in regional primary schools in the Ballarat region of Victoria, Australia, are choosing to outsource the teaching of sexuality education. A survey was conducted of 29 Year 5 and Year 6 teachers from local primary schools. The teachers provided information about: their confidence in delivering sexuality-related topics; their perceptions of the relevance of given sexuality topics to their students; the teachers' own professional development preferences; and what they saw as their personal limitations in teaching sexuality education. Teachers tended to report low confidence in teaching topics that are considered 'sensitive', such as menstruation, wet dreams and sexual intercourse. Furthermore, they indicated a need for professional development in teaching sexuality education. The greatest hurdle identified lies in identifying how to motivate, engage and support teachers to take a professional interest in teaching sexuality education. © 2013 Copyright Taylor and Francis Group, LLC.
- Description: 2003009651
The Importance of Foot Care in Older People With Diabetes
- Authors: Fortington, Lauren , Geertzen, Jeertzen , Van Netten, Jaap , Van Baal, Jeff , Bus, Sicco , Schaper, Nicolaas
- Date: 2013
- Type: Text , Journal article
- Relation: Journal of the American Medical Directors Association Vol. 14, no. 2 (February 2013 2013), p. 136
- Full Text: false
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- Description: C1
The role of psychopathic traits and substance abuse in predicting violent victimization in patients with schizophrenia spectrum disorders
- Authors: Dolan, Mairead , O'Malley, Kate , McGregor, Kate
- Date: 2013
- Type: Text , Journal article
- Relation: Personality and Mental Health Vol. 7, no. 1 (2013), p. 28-38
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- Description: We examined the relationship between psychopathic traits and substance abuse and violent victimization in 94 community patients meeting DSM-IV criteria for schizophrenia spectrum disorders in contact with public mental health services in Victoria, Australia. Data on violence and victimization were collated from multiple sources and combined to categorize patients into victims of serious violence (VV; n=74) and those who were not victims of serious violence (NVV; n=20) groups. The VV group had higher rates of unemployment and previous violence but did not differ from the NVV on current symptom ratings. The VV group has significantly higher substance abuse and psychopathy scores, but only psychopathy score significantly contributed to the prediction of victimization. All psychopathy facets were reasonably good predictors of victimization status, but the antisocial facet contributed most to the prediction of victimization. A better understanding of the role and contribution of antisocial (particularly psychopathic) traits in violent victimization in mentally ill populations is needed to better inform community management plans. © 2012 John Wiley & Sons, Ltd.
Ventilatory efficiency in juvenile elite cyclists
- Authors: Brown, Stephen , Stannard, Stephen , Raman, Aaron , Schlader, Zachary
- Date: 2013
- Type: Text , Journal article
- Relation: Journal of Science and Medicine in Sport Vol. 16, no. 3 (2013), p. 266-270
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- Description: OBJECTIVES: Ventilation ( [Formula: see text] ) as a function of CO2 output, and oxygen uptake ( [Formula: see text] ) as a function of [Formula: see text] , define cardio-respiratory efficiency, although few data compare efficiency with maximum oxygen uptake ( [Formula: see text] ), or consider reproducibility. Currently there are no data for trained juveniles. DESIGN: Twenty-five trained juvenile cyclists (mean age 14.7 years), performed maximal exercise testing on two occasions, separated by 16 weeks. METHODS: [Formula: see text] vs. [Formula: see text] slope, oxygen uptake efficiency slope, and [Formula: see text] were measured during cycle ergometer exercise to volitional exhaustion on two occasions, 16 weeks apart. RESULTS: Mean (SD) [Formula: see text] vs. [Formula: see text] slope, oxygen uptake efficiency slope, and [Formula: see text] were 28.14 (3.89), 4.16 (0.73), and 75.4 (8.9) mlkg(-1)min(-1) on visit 1, and 27.92 (4.63), 4.22 (0.76), and 73.6 (9.3) mlkg(-1)min(-1) on visit 2. Good reproducibility (differences ≤2.4%), but poor correlations (r≤0.29) between efficiency and [Formula: see text] were recorded. CONCLUSIONS: Reproducibility of efficiency measures was comparable to [Formula: see text] , however, poor associations between efficiency and [Formula: see text] suggested independence. Efficient ventilation may be of limited importance in determining the [Formula: see text] in a trained juvenile cyclist.
Working with your team to minimize the impact of anticipatory anxiety in relation to aggression towards nurses
- Authors: Edward, Karen-Leigh , Warelow, Philip , Ousey, Karen , Lui, Steve
- Date: 2013
- Type: Text , Journal article
- Relation: International Journal of Mental Health Nursing Vol. 22, no. Supplement S1 (October 2013), p. 8-9
- Full Text: false
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- Description: C1
A letter to the editor is presented in response to the article "A consideration of severity is sufficient to focus our prevention efforts," by J. Langley and C. Cryer in the January 2012 issue.
- Authors: Finch, Caroline
- Date: 2012
- Type: Text , Journal article
- Relation: Injury Prevention Vol. 18, no. 5 (2012), p. 356
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A prospective study of coping and adjustment in adolescents with craniofacial conditions
- Authors: Roberts, Rachel , Shute, Rosalyn
- Date: 2012
- Type: Text , Journal article
- Relation: Children's Health Care Vol. 41, no. 2 (2012), p. 111-128
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- Description: This study aimed to examine the role of coping strategy use in concurrent and later adjustment in adolescents with craniofacial anomalies (CFAs). It was expected that better adjustment at both baseline and 12 months would be related to greater baseline perceived coping efficacy, greater use of active coping and social support seeking, and less use of avoidance strategies. Eighty adolescents with CFAs and their parents completed measures of adjustment, coping strategy use, and efficacy in response to CFA-related stressful situations. Fifty-five families completed these measures again 12 months later. Overall, the predicted pattern of correlations between coping and adjustment was found. However, coping and efficacy at baseline did not explain a significant proportion of the variance in adjustment measures 1 year later, after controlling for baseline adjustment. Such prospective findings are beginning to bring into question the assumed importance of coping in pediatric adjustment. © 2012 Copyright Taylor and Francis Group, LLC.
Abnormal microRNA expression in cardiac hypertrophy and the regulation of the Endog gene
- Authors: Quarrell, Sean , Marques, Francine , Jayaswal, Vivek , Curl, Claire , Nankervis, Scott , Yang, Jean , Delbridge, Lea , Harrap, Stephen , Charchar, Fadi
- Date: 2012
- Type: Text , Journal article
- Relation: Heart, Lung and Circulation Vol. 21, no. Supplement 1 (2012), p. s7
- Full Text: false
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- Description: A deficiency in the gene for endonuclease G (Endog) was recently described as a genetic determinant of cardiac hypertrophy. The mechanisms involved in the regulation of Endog, however, are still to be elucidated. Therefore we hypothesised that Endog, being regulated by small regulatory non-coding RNAs called microRNAs (miRNAs), could contribute to the cardiac hypertrophy of the Hypertrophic Heart Rat (HHR), a human polygenic model of cardiac hypertrophy. From birth the HHR has less and smaller cardiomyocytes, which leads to hypertrophy and cardiac failure later in life. In this study, we examined genome-wide miRNA expression by Agilent Rat miRNA Microarray Kit Release 16.0 and Endog mRNA levels by real-time PCR in the left ventricle of neonatal HHR compared to age-matched rats from its authentic control, the Normal Heart Rat (NHR). Endog mRNA was significantly under-expressed in the HHR (fold change=−4.7; P=0.0001). Sixty-seven miRNAs (FDR P<0.05 and fold change>1.1) were differentially expressed between HHR and NHR (n=16). We then performed an in silico analysis to predict the miRNAs that are able to bind to the 3′ untranslated region of Endog mRNA, and therefore could regulate Endog levels. We discovered that the miRNAs let-7b, miR-338 and miR-347 are predicted to bind to Endog mRNA. Functional studies are being undertaken to determine whether these miRNAs can regulate Endog mRNA levels in vitro and their role in the pathological processes leading to cardiac hypertrophy. These miRNAs could be a new target for the prevention and treatment of cardiac hypertrophy in humans
Chronic kidney disease and automatic reporting of estimated glomerular filtration rate: new developments and revised recommendations
- Authors: Johnson, David , Jones, Graham , Mathew, Timothy , Ludlow, Marie , Doogue, Matthew , Jose, Matthew , Langham, Robyn , Lawton, Paul , McTaggart, Steven , Peake, Michael , Polkinghorne, Kevan , Usherwood, Timothy
- Date: 2012
- Type: Text , Journal article
- Relation: Medical Journal Of Australia Vol. 197, no. 4 (2012), p. 222-223
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- Description: The publication of the Australasian Creatinine Consensus Working Group’s position statements in 2005 and 2007 resulted in automatic reporting of estimated glomerular filtration rate (eGFR) with requests for serum creatinine concentration in adults, facilitated the unification of units of measurement for creatinine and eGFR, and promoted the standardisation of assays. New advancements and continuing debate led the Australasian Creatinine Consensus Working Group to reconvene in 2010.
Closing the gap between injury prevention research and community safety promotion practice: Revisiting the public health model
- Authors: Hanson, Dale , Finch, Caroline , Allegrante, John , Sleet, David
- Date: 2012
- Type: Text , Journal article
- Relation: Public Health Reports Vol. 127, no. 2 (March 2012), p. 147-155
- Full Text: false
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Community-dwelling older people hospitalised for fall-related injury: characterising high length of stay users
- Authors: Vu, Trang , Finch, Caroline , Day, Lesley
- Date: 2012
- Type: Text , Journal article
- Relation: Injury Prevention Vol. 18, no. Supplement 1 (2012), p. A121
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- Description: Background: Nearly half to 60% of falls in community-dwelling older people aged 65+ years result in physical injuries and 20%–50% of these require medical attention, including emergency department visit and hospitalisation. Fallers who stay in hospital longer than would be expected based on the primary injury diagnosis create an excess financial burden on the health system and represent a priority target group for fall prevention. Objectives: To identify and characterise high-length-of-stay (HLOS) patients among community-dwelling older people aged 65+ years hospitalised for fall-related injury. Methods: We analysed hospital discharge data from Victoria, Australia, to identify and characterise HLOS patients among community-dwelling older people aged 65+ years hospitalised for fall-related injury. We defined an episode as HLOS if the length of stay (LOS) was more than three times the average LOS for a particular diagnosis-related group. Results: Between 2005/06 and 2007/08 6822 patients (14.2% of the study group of which 73.8% were women) had ≥1 episode classified as HLOS. The HLOS patients accounted for 19.9% of episodes and 39.9% of bed days. HLOS patients were similar to non-HLOS patients in terms of indigenous status, in-hospital mortality and ethnicity. However, HLOS patients were older, less likely to be married, less likely to have hospital insurance and more likely to have comorbidity than non-HLOS patients. Significance/Contribution to the Field: This study identifies priority groups for a targeted prevention approach.
Different injury settings require different cost severity thresholds
- Authors: Finch, Caroline
- Date: 2012
- Type: Text , Journal article
- Relation: Injury Prevention Vol. 18, no. 5 (2012), p. 356
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Full Text: false
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Identifying risk factors for contact injury in professional rugby league players - Application of a frailty model for recurrent injury
- Authors: Gabbett, Tim , Ullah, Shahid , Finch, Caroline
- Date: 2012
- Type: Text , Journal article
- Relation: Journal of Science and Medicine in Sport Vol. 15, no. 6 (November 2012), p. 496-504
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Full Text: false
- Reviewed:
- Description: Objectives: Well-developed physical qualities may protect against contact injuries. However, the potential contribution of physical qualities as risk or protective factors to contact injury risk is yet to be determined for rugby league. This study applied a frailty survival model that accounts for recurrent injury to identify risk factors for all physiotherapist-reported contact injury in professional rugby league players. Design: Prospective cohort study. Methods: Sixty-six professional rugby league players participated in this three successive year prospective study. At the start of each season, all players underwent measurements of standard anthropometry (height, body mass, and sum of seven skinfolds), speed (10 m and 40 m sprint), muscular strength (1 repetition maximum [RM] bench press, 1RM squat, 1RM weighted chin-ups), power (vertical jump, bench throw, 1RM power clean, jump squat), and endurance (maximum repetition bench press with 60 kg resistance), repeated-sprint ability (12 × 20 m sprints performed on a 20 s cycle), prolonged high-intensity intermittent running ability (8 × 12 s maximal effort shuttles performed on a 48 s cycle), and maximal aerobic power (multi-stage fitness test). Data was used to demonstrate the application of the frailty model extension of the Cox proportional regression model for recurrent events to identify factors associated with a high hazard ratio (HR) of injury. Results: Heavier (body mass, HR = 2.6, 95% CI = 1.2-5.7), and faster (40 m sprint, HR = 2.1, 95% CI = 1.0-4.2) players, and those with poorly developed prolonged high-intensity intermittent running ability (HR = 2.9, 95% CI = 1.7-5.0) and upper-body strength (chin-up, HR = 2.2, 95% CI = 1.3-3.7) had a higher incidence of contact injuries. Conclusions: This study demonstrates application of a novel statistical approach for the analysis of injury data that is recurrent in nature. This approach identified that the greater impact forces generated from heavier players with faster speed may result in an increase in recurrent contact injury rates. However, the development of prolonged high-intensity intermittent running ability and upper-body strength and power may assist to reduce the risk of contact injury in professional rugby league players.
Managing projected midwifery workforce deficits through collaborative partnerships
- Authors: McIntyre, Meredith , Patrick, Alison , Jones, Linda , Newton, Michelle , McLachlan, Helen , Morrow, Jane , Morton, Harriet
- Date: 2012
- Type: Text , Journal article , Review
- Relation: Australian Health Review Vol. 36, no. 1 (2012), p. 75-78
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- Description: To address workforce shortages, the Australian Government funded additional nursing and midwifery places in 2009 pre-registration courses. An existing deficit in midwifery clinical placements, combined with the need to secure additional clinical placements, contributed to a serious shortfall. In response, a unique collaboration between Midwifery Academics of Victoria (MIDAC), rural and metropolitan maternity managers (RMM andMMM)groups and Department of Health (DOH) Victoria was generated, in order to overcome difficulties experienced by maternity services in meeting the increased need. This group identified the large number of different clinical assessment tools required to be being completed by midwives supervising students as problematic. It was agreed that the development of a Common Assessment Tool (CAT) for use in clinical assessment across all pre-registration midwifery courses in Victoria had the potential to reduce workload associated with student assessments and, in doing so, release additional placements within each service. The CAT was developed in 2009 and implemented in 2010. The unique collaboration involved in the development of theCATis a blueprint for future projects. The collaboration on this project provided a range of benefits and challenges, as well as unique opportunities for further collaborations involving industry, government, regulators and the tertiary sector. © 2012 AHHA.