ORCID Profile
0000-0002-8514-1763
Current Organisation
Deakin University
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Atomic, Molecular, Nuclear, Particle and Plasma Physics | Degenerate Quantum Gases and Atom Optics | Condensed Matter Imaging | Atomic and Molecular Physics
Expanding Knowledge in the Physical Sciences | Expanding Knowledge in Technology |
Publisher: BMJ
Date: 05-2019
DOI: 10.1136/BMJOPEN-2018-027327
Abstract: Patients are a valuable source of information about ways to prevent harm in healthcare, and can provide feedback about the factors that contribute to safety incidents. The Primary Care Patient Measure of Safety (PC PMOS) is a novel and validated tool that captures patient feedback on safety and can be used by primary care practice teams to identify and prevent safety incidents. The aim of this study is to assess the feasibility of PC PMOS as a tool for data-driven safety improvement and monitoring in Australian primary care. Feasibility will be assessed using a mixed-methods approach to understand the enablers, barriers, acceptability, practicability, intervention fidelity and scalability of C PMOS as a tool for safety improvement across six primary care practices in the south-west region of Victoria. Patients over the age of 18 years attending their primary care practice will be invited to complete the PC PMOS when presenting for an appointment. Staff members at each practice will form a safety improvement team. Staff will then use the patient feedback to develop and implement specific safety interventions over a 6-month period. Data collection methods during the intervention period includes audio recordings of staff meetings, overt observations at training and education workshops, reflexive researcher insights, document collection and review. Data collection postintervention includes patient completion of the PC PMOS and semistructured interviews with staff. Triangulation and thematic analysis techniques will be employed to analyse the qualitative and content data. Analysis methods will use current evidence and models of healthcare culture, safety improvement and patient involvement in safety to inform the findings. Ethics approval was granted by Deakin University Human Ethics Advisory Group, Faculty of Health (HEAG-H 175_2017). Study results will be disseminated through local and international conferences and peer-reviewed publications.
Publisher: Public Library of Science (PLoS)
Date: 14-11-2014
Publisher: Wiley
Date: 06-08-2023
DOI: 10.5694/MJA2.52032
Abstract: University departments of rural health are Commonwealth‐funded to improve recruitment and retention of the rural allied health and nursing (including midwifery) workforce, primarily through student placements. We examined publications by university departments of rural health that were focused on allied health and nursing students undertaking placements in rural Australia, to understand the characteristics, main findings and implications of the research conducted. Interprofessional learning was a key feature of placements and placement education, although other activities such as community engagement added to placement experiences. Factors such as quality supervision and being involved in the community contributed to a positive placement experience and increased rural practice intention. Tracking studies showed a relationship between rural placements, rural practice intention and rural practice. Rural placements occurred across a variety of settings and in locations consistent with the policy framework. Embedding university departments of rural health in rural communities enabled staff to build relationships and increase placement capacity.
Publisher: Wiley
Date: 12-10-2017
DOI: 10.1111/AJCO.12782
Abstract: The link between chemotherapy treatment and cardiotoxicity is well established, particularly for adults with blood cancers. However, it is less clear for children. This analysis aimed to compare the trajectory and mortality of children and adults who received chemotherapy for blood cancers and were subsequently hospitalized for heart failure. Linked data from the Queensland Cancer Registry, Death Registry and Hospital Administration records for initial chemotherapy and later heart failure were reviewed (1996-2009). Of all identified blood cancer patients (N = 23 434), 8339 received chemotherapy, including 817 children (aged ≤18 years at time of cancer diagnosis) and 7522 adults. Time-varying Cox proportional hazards regression models were used to compare the characteristics and survival between the two groups. Of those who were subsequently hospitalized for heart failure, 70% of children and 46% of adults had the index admission within 12 months of their cancer diagnosis. Of these, 53% of the pediatric heart failure population and 71% of the adult heart failure population died within the study period. Following adjustment for age, sex and chemotherapy admissions, children with heart failure had an increased mortality risk compared to their non-heart failure counterparts, a difference which was much greater than that between the adult groups. The impact of heart failure on children previously treated for blood cancer is more severe than for adults, with earlier morbidity and greater mortality. Improved strategies are needed for the prevention and management of cardiotoxicity in this population.
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.PCD.2018.10.006
Abstract: Gestational diabetes (GDM) and Type 2 diabetes pose tremendous health and economic burdens as worldwide incidence increases. Primary care-based systematic diabetes screening and prevention programs could be effective in women with previous GDM. GooD4Mum aimed to determine whether a Quality Improvement Collaborative (QIC) would improve postpartum diabetes screening and prevention planning in women with previous GDM in general practice. Fifteen general practices within Victoria (Australia) participated in a 12-month QIC, consisting of baseline and four quarterly audits, guideline-led workshops and Plan-Do-Study-Act feedback cycles after each audit. The primary outcome measures were the proportion of women on local GDM registers completing a diabetes screening test and a diabetes prevention planning consultation within the previous 15 months. Diabetes screening increased with rates more than doubled from 26% to 61% and postpartum screening increased from 43%-60%. Diabetes prevention planning consultations did not show the same level of increase (0%-10%). The recording of body mass index improved overall (51%-69%) but the number of women with normal body mass index did not. GooD4Mum supported increased diabetes screening and the monitoring of high risk women with previous GDM in general practice.
Publisher: JMIR Publications Inc.
Date: 09-05-2022
Abstract: n March 2020, the Australian Government expanded general practitioner (GP) telehealth services in response to the coronavirus disease 2019 pandemic. his study sought to assess utilisation patterns of GP telehealth services in response to changing circumstances (before and during the COVID-19 pandemic, with or without lockdown) in regional Victoria, Australia. e conducted a secondary analysis of monthly Medicare claims data from July 2019 to June 2021 from 140 regional GP practices in western Victoria. The longitudinal patterns of proportion of GP telehealth consultations stratified by type of consultation (videoconference vs. telephone) and by geographical, consumer and consultation characteristics were analysed. elehealth comprised 25.8% of GP consultations over the two-year period (n total = 2,025,615). After the introduction of the Australian telehealth expansion policy in March 2020, there was a rapid uptake in GP telehealth services (from 0% to 15% of all consultations), with a peak in August 2020 (55%). Thereafter, utilisation declined steadily to 31% in January 2021 and tapered off to 28% in June 2021. Telephone services and shorter consults were the most dominant form, and those aged 15-64 years had higher telehealth utilisation rates than younger or older age groups. The proportion of video consultations was higher during periods with government-imposed lockdown, and higher in the most socioeconomically advantaged areas compared to less socioeconomically advantaged areas. ur findings support the continuation of telehealth use in rural and regional Australia post-pandemic. Future policy must identify mechanisms to reduce existing equity gaps in video consultations and consider patient- and system-level implications of the dominant use of short telephone consults.
Publisher: MDPI AG
Date: 28-01-2022
Abstract: Tasmania has one of the highest bowel cancer incidence and death rates in the world. Public awareness of risk factors, symptoms, and early detection of bowel cancer is important for minimising the burden of disease. This study measured awareness levels of bowel cancer risk factors, symptoms and screening in Tasmania. An online survey of 3703 participants aged 18 years and older found that alcohol consumption, low physical activity levels, and having diabetes were the least known risk factors for bowel cancer. Over half of all participants were unaware the risk of bowel cancer increased with age, and 53 percent were not confident they would notice a bowel cancer symptom. Over a third of survey respondents did not know that screening commenced at the age of 50. The results indicate that a targeted c aign to increase bowel cancer awareness in Tasmania may help reduce the high rates of morbidity and mortality from the disease.
Publisher: Wiley
Date: 13-11-2021
DOI: 10.5694/MJA2.51344
Publisher: BMJ
Date: 10-2015
Publisher: Oxford University Press (OUP)
Date: 15-10-2018
Abstract: Activity monitoring devices are currently being used to facilitate and monitor physical activity. No prior review has examined adherence to the use of activity monitoring devices amongst adults with cardiovascular disease. Literature from June 2012 to October 2017 was evaluated to examine the extent of adherence to any activity monitoring device used to collect objective physical activity data. Randomized control trials comparing usual care against the use of an activity monitoring device, in a community intervention for adults from any cardiovascular diagnostic group, were included. A systematic search of databases and clinical trials registers was conducted using Joanna Briggs Institute methodology. Of 10 eligible studies, two studies reported pedometer use and eight accelerometer use. Six studies addressed the primary outcome. Mean adherence was 59.1% (range 39.6% to 85.7%) at last follow-up. Studies lacked equal representation by gender (28.6% female) and age (range 42 to 82 years). This review indicates that current research on activity monitoring devices may be overstated due to the variability in adherence. Results showed that physical activity tracking in women and in young adults have been understudied.
Publisher: Elsevier BV
Date: 04-2017
DOI: 10.1016/J.DIABRES.2017.02.026
Abstract: To explore the acceptability of a telephone- or a group-delivered diabetes prevention program for women with previous gestational diabetes and to compare the characteristics associated with program engagement. Postpartum women participated in a lifestyle modification program delivered by telephone (n=33) or group format (n=284). Semi-structured interviews on barriers and enablers to program engagement (defined as completing≥80% sessions) were conducted before (Group) and after (Group and Telephone) interventions. The Health Action Process Approach theory was used as the framework for inquiry. Psychological measures were compared between engagement subgroups before and after group-delivered intervention. In the telephone-delivered program 82% participants met the engagement criteria compared with 38% for the group-delivered program. Engaged participants (Group) had significantly higher risk perception, outcome expectancy, and activity self-efficacy at baseline (P<0.05). There was a greater decrease in body weight (-1.45±3.9 vs -0.26±3.5, P=0.024) and waist circumference (-3.56±5.1 vs -1.24±5.3, P=0.002) for engaged vs non-engaged participants following group program completion. Telephone delivery was associated with greater engagement in postpartum women. Engagement was associated with greater reduction in weight and waist circumference. Further studies are required to confirm the effectiveness of telephone-delivered program for diabetes prevention in postpartum women.
Publisher: Hindawi Limited
Date: 21-06-2023
DOI: 10.1155/2023/5556980
Abstract: Increasing evidence of the effects of the COVID-19 pandemic on healthcare workers’ mental health and wellbeing has prompted concerns about the longer-term impacts on healthcare delivery and health workforce sustainability. For rural health services and communities, the pandemic has compounded existing challenges including workforce shortages, potentially leading to further health inequalities. This qualitative interview study aimed to explore factors within and external to the health service environment that influenced health service staff mental health and wellbeing in rural and regional Victoria, Australia, during the first two years of the COVID-19 pandemic (2020-2021). Participants were recruited from nine publicly funded rural and regional health services. Semistructured interviews were conducted via videoconference, audio-recorded, and transcribed. Data were analysed using a five-stage framework approach. Eighteen health service staff from four rural areas participated in the study. A range of factors that were perceived by participants to influence their wellbeing were identified. These were coded to four main themes: (1) rural community relations, (2) the nature of the health workplace, (3) self-care and supportive networks, and (4) public health measures and the unpredictable nature of the pandemic. Factors coded to these themes were described as both positive and negative influences on health staff mental health and wellbeing. Optimising the mental health and wellbeing of rural health staff is imperative to the sustainability of this workforce during and beyond the COVID-19 pandemic. Rural health services must consider the community and health service (meso-level), in idual (microlevel), and broader pandemic context (macrolevel) when developing and implementing strategies to promote staff wellbeing. Strategies must encompass the development of senior leadership capabilities, mechanisms to support effective leadership, and optimal communication processes within health services. Given the potential for community support to positively influence rural health staff wellbeing, community engagement should be a feature of health service wellbeing strategies.
Publisher: Springer Science and Business Media LLC
Date: 29-11-2016
Publisher: Wiley
Date: 04-2021
DOI: 10.1111/AJR.12722
Abstract: Combined, nursing and allied health constitute most of the Australian health workforce yet, little is known about graduate practice destinations. University Departments of Rural Health have collaborated on the Nursing and Allied Health Graduate Outcomes Tracking to investigate graduate entry into rural practice. Data linkage cohort study. Monash University and the University of Newcastle. Graduates who completed their degree in 2017 across seven disciplines. The outcome variable was Australian Health Practitioner Regulation Agency principal place of practice data. Explanatory variables included discipline, age, gender, location of origin, and number and duration of rural placements. Of 1130 graduates, 51% were nurses, 81% females, 62% under 21 years at enrolment, 23% of rural origin, 62% had at least one rural student placement, and 23% had over 40 cumulative rural placement days. At the time of their second Australian Health Practitioner Regulation Agency registration, 18% worked in a ‘Rural principal place of practice.’ Compared to urban, rural origin graduates had 4.45 times higher odds ratio of ‘Rural principal place of practice.’ For graduates who had cumulative rural placement days, compared to zero the odds ratio of ‘Rural principal place of practice’ was the same (odds ratio = 1.10). For those who had 20‐40 rural placement days, the odds ratio was 1.93, and for rural placement days, the odds ratio was 4.54). Rural origin and more rural placement days positively influenced graduate rural practice destinations. Outcomes of cumulative placements days may compare to immersive placements.
Publisher: Wiley
Date: 02-2021
DOI: 10.1111/AJR.12689
Publisher: CSIRO Publishing
Date: 14-08-2023
DOI: 10.1071/AH23098
Publisher: MDPI AG
Date: 19-04-2019
Abstract: The aim of this study was to investigate the impact of bedside discharge education on activity levels and healthcare utilization for patients with acute coronary syndrome (ACS) in the first 30 days post-discharge. Knowledge recall and objective activity and location data were collected by global positioning systems (GPS). Participants were asked to carry the tracking applications (apps) for 30–90 days. Eighteen participants were recruited (6 metropolitan 12 rural) 61% ST elevation myocardial infarction (STEMI), mean age 55 years, 83% male. Recall of discharge education included knowledge of diagnosis (recall = 100%), procedures (e.g., angiogram = 40%), and comorbidities (e.g., hypertension = 60%, diabetes = 100%). In the first 30 days post-discharge, median steps per day was 2506 (standard deviation (SD) ± 369) steps (one participant completed 10,000 steps), 62% visited a general practitioner (GP) 16% attended cardiac rehabilitation, 16% visited a cardiologist, 72% a pharmacist, 27% visited the emergency department for cardiac event, and 61% a pathology service (blood tests). Adherence to using the activity tracking apps was 87%. Managing Big Data from the GPS and physical activity tracking apps was a challenge with over 300,000 lines of raw data cleaned to 90,000 data points for analysis. This study was an ex le of the application of objective data from the real world to help understand post-ACS discharge patient activity. Rates of access to services in the first 30 days continue to be of concern.
Publisher: Wiley
Date: 16-02-2022
DOI: 10.1111/AJR.12846
Abstract: To provide a structured understanding of rural hospital‐based emergency care facility workforce and resources. The resources of regional training hubs were used to survey eligible emergency care facilities in their surrounding region. Rural emergency care facilities manage more than one third of Australia's emergency presentations. These emergency care facilities include emergency departments and less‐resourced facilities in smaller towns. Hospital facilities located outside metropolitan areas that report emergency presentations to the Australian Institute of Health and Welfare. A survey tool was sent by email. Presence of human, diagnostic and other resources as reported on a questionnaire. A completed questionnaire was received from 195 emergency care facilities. Over 60% of Small hospitals had on‐call doctors only. General practitioners/generalists and nurses with extended emergency skills were found in all hospital types. Emergency physicians were present across all remoteness areas, but more commonly seen in larger facilities. All Major/Large facilities and most Medium facilities reported having onsite pathology and radiology. Point of care testing and clinician radiography were more commonly reported in smaller facilities. Among Small hospitals, Very Remote hospitals were more likely than Inner Regional hospitals to have an onsite doctor in the emergency care facility and/or a high dependency unit. Smaller and more remote facilities appear to adapt by using different workforce structures and bedside investigations.
Publisher: Oxford University Press (OUP)
Date: 03-06-2014
Abstract: Several effective methods to facilitate patient self-management of hypertension are available in primary care. These include direct support from community pharmacists and general practice, and the use of home blood pressure (BP) monitoring. The aim of this study is to establish the prevalence of use of key strategies and to determine their independent relationship with patient self-management attributes. A survey of patients with treated hypertension was undertaken in 27 community pharmacies. This established recent use of BP monitoring and advice from health professionals. Patient awareness of BP and targets, appropriateness of BP targets and adherence to anti-hypertensive medications were assessed as indicative self-management outcomes. Predictors of outcomes were determined using binary logistic regression. Overall, 215 surveys were returned. Two-thirds of patients were aged >65 years, and 45% had conditions warranting tighter BP control (<130/80 mmHg). Almost all patients reported monitoring of their BP in the previous year and 63% could report their most recent BP reading. Just 36% reported knowing a target BP, and 78% of reported targets were within guidelines recommendations. One-fifth (22%) monitored their own BP, and 15% reported non-adherence to medication. Doctors provided the large majority of professional advice. Self-monitoring or documentation of BP readings was independently associated with increased likelihood of BP and target BP being known. Regular monitoring of BP does not automatically translate to professional advice. Increased uptake of patient self-monitoring should be promoted as a means of enabling self-management.
Publisher: Oxford University Press (OUP)
Date: 17-08-2023
Abstract: Access to health care is a universal human right and key indicator of health system performance. Spatial access encompasses geographic factors mediating with the accessibility and availability of health services. Equity of health service access is a global issue, which includes access to the specialized nursing workforce. Nursing research applying spatial methods is in its infancy. Given the use of spatial methods in health research is a rapidly developing field, it is timely to provide guidance to inspire greater application in cardiovascular research. Therefore, the objective of this methods paper is to provide an overview of spatial analysis methods to measure the accessibility and availability of health services, when to consider applying spatial methods, and steps to consider for application in cardiovascular nursing research.
Publisher: Springer Science and Business Media LLC
Date: 22-08-2006
DOI: 10.1007/S10126-006-6023-7
Abstract: Acanthopagrus butcheri completes its entire life history within estuaries and coastal lakes of southern Australia, although adults occasionally move between estuaries via the sea. Consequently, it is expected that populations of A. butcheri in different estuaries will be genetically distinct, with the magnitude of genetic ergence increasing with geographic isolation. However, previous genetic studies of A. butcheri from southeast Australia yielded conflicting results allozyme variation exhibited minimal spatial structuring (theta = 0.012), whereas mitochondrial DNA distinguished the majority of populations analyzed (theta = 0.263) and genetic ergence was positively correlated with geographic isolation. This discrepancy could reflect high male gene flow, which impacts nuclear but not mitochondrial markers. Here we estimated allele frequencies at five nuclear microsatellite loci across 11 southeast Australian populations (595 in iduals). Overall structuring of microsatellite variation was weaker (theta = 0.088) than that observed for mitochondrial DNA, but was able to distinguish a greater number of populations and was positively correlated with geographic distance. Therefore, we reject high male gene flow and invoke a stepping-stone model of infrequent gene flow among estuaries for both sexes. Likewise, management of A. butcheri within the study range should be conducted at the scale of in idual or geographically proximate estuaries for both sexes. The lack of allozyme structuring in southeast Australia reflects either the large variance in structuring expected among loci under neutral conditions and the low number of allozymes surveyed or a recent colonization of estuaries such that some but not all nuclear loci have approached migration-drift equilibrium.
Publisher: Wiley
Date: 21-04-2023
DOI: 10.1111/DME.15109
Abstract: There is increasing evidence that diabetes stigma has negative impacts on behavioural and psychological outcomes among people with type 2 diabetes (T2D). However, research has focused largely on Caucasian and certain Asian groups. The aim of this study was to examine associations of diabetes stigma with diabetes distress and self‐care, and investigate the moderating effects of self‐esteem and social support, in Arabic‐speaking communities. A cross‐sectional study was conducted at 21 outpatient clinics and diabetes‐specialist centres in the United Arab Emirates. Besides the Arabic Type‐2 Diabetes Stigma Assessment Scale, participants completed other validated questionnaires assessing distress, self‐care, social support, and self‐esteem. General linear models were used to estimate the mean difference in diabetes‐specific distress and self‐care for every 1‐point increase in diabetes stigma total score. Among 327 adults with T2D, the mean total score of diabetes stigma was 43.55 ± 13.95. Every 1‐point increase in diabetes stigma was associated with significantly increased diabetes distress ( β = 0.113, 95% CI: 0.078 to 0.147 p = 0.003) and decreased self‐care behaviours: diet ( β = −0.029, 95% CI: −0.048 to −0.009 p = 0.008), physical activity ( β = −0.022, 95% CI: −0.038 to −0.006 p = 0.013) and foot care ( β = −0.043, 95% CI: −0.059 to −0.026 p 0.001). Self‐esteem mitigated the effect of diabetes stigma on diabetes distress. Perceived and experienced diabetes stigma was independently associated with increased diabetes distress and decreased engagement in diabetes self‐care among Arabic‐speaking adults with T2D. These findings are crucial to help clinicians provide more effective assessment and counselling and guide public health interventions to decrease diabetes stigma in these communities.
Publisher: Elsevier BV
Date: 10-2010
Publisher: Elsevier BV
Date: 03-2005
DOI: 10.1016/J.JENVMAN.2004.09.010
Abstract: Estimation of nutrient load production based on multi-temporal remotely sensed land use data for the Glenelg-Hopkins region in south-west Victoria, Australia, is discussed. Changes in land use were mapped using archived Landsat data and computerised classification techniques. Land use change has been rapid in recent history with 16% of the region transformed in the last 22 years. Total nitrogen and phosphorus loads were estimated using an export coefficient model. The analysis demonstrates an increase in modelled nitrogen and phosphorus loadings from 1980 to 2002. Whilst such increases were suspected from past anecdotal and ad-hoc evidence, our modelling estimated the magnitude of such increases and thus demonstrated the enormous potential of using remote sensing and GIS for monitoring regional scale environmental processes.
Publisher: Inter-Research Science Center
Date: 12-03-2013
DOI: 10.3354/MEPS10264
Publisher: Springer Science and Business Media LLC
Date: 06-07-2018
Publisher: Springer Science and Business Media LLC
Date: 18-09-2019
DOI: 10.1186/S12913-019-4489-Z
Abstract: To evaluate the impact of the Dementia Care in Hospitals Program (DCHP) on clinical and non-clinical staff job satisfaction, level of confidence and comfort in caring for patients with cognitive impairment (CI). Staff perceptions of how organisational support and hospital environment met the needs of patients with CI were also assessed. The DCHP was implemented across four acute hospital sites across Australia. Clinical and non-clinical staff received training on CI screening and communication strategies for patients with CI. A staff satisfaction survey was administered pre- and post-implementation of the DCHP. One thousand seven hundred forty-eight staff received DCHP education and 1375 staff participated in the survey. Self-reported confidence and level of comfort in caring for patients with CI significantly improved following implementation. Staff also reported increased job satisfaction and organisational support at all hospital sites. The DCHP implementation within an acute hospital setting was found to show an improvement in staff confidence, comfort, and job satisfaction when caring for patients with CI. This study has significant implications for the improvement of care for patients with CI as well as staff retention and job satisfaction. Further research is required to determine whether these improvements are sustained in the longer term.
Publisher: Elsevier BV
Date: 07-2017
DOI: 10.1016/J.HLC.2016.10.016
Abstract: Population screening and monitoring of cardiovascular risk is suboptimal in Australian primary care. The role of community pharmacy has increased considerably, but without any policy framework for development. The aim of this study was to explore the nature of community pharmacy-based screening models in Australia, capacity to increase delivery of pharmacy screening, and barriers and enablers to increasing capacity. An online survey weblink was emailed to pharmacy managers at every quality-accredited pharmacy in Australia by the Quality Pharmacy Care Program. The 122-item survey explored the nature of screening services, pharmacy capacity to deliver services, and barriers and enablers to service delivery in considerable detail. Adaptive questioning was used extensively to reduce the participant burden. Pharmacy location details were requested to facilitate geo-coding and removal of duplicate entries. A descriptive analysis of responses was undertaken. There were 294 valid responses from 4890 emails, a 6% response rate. Most pharmacies (79%) had private counselling areas. Blood pressure assessment was nearly universal (96%), but other common risk factor assessments were offered by a minority. Most did not charge for assessments, and 59% indicated capacity to provide multiple risk factor assessments. Fewer than one in five (19%) reported any formal arrangements with general practice for care coordination. Financial viability was perceived as a key barrier to service expansion, amid concerns of patient willingness to pay. Support from government and non-governmental organisations for their role was seen as necessary. There appears to be a critical mass of pharmacies engaging in evidence-based and professional services. Considerable additional support appears required to optimise performance across the profession.
Publisher: Springer Science and Business Media LLC
Date: 04-10-2023
Publisher: Public Library of Science (PLoS)
Date: 25-07-2019
Publisher: Cold Spring Harbor Laboratory
Date: 07-12-2021
DOI: 10.1101/2021.12.05.21267329
Abstract: The Monash early pregnancy prediction model calculates risks of developing GDM and is internationally externally validated and implemented in practice, however some gaps remain. To validate and update Monash GDM model, revising ethnicity categorisation, updating to recent diagnostic criteria, to improve performance and generalisability. Routine health data for singleton pregnancies from 2016 to 2018 in Australia included updated GDM diagnostic criteria. The Original Model predictors were included (age, body mass index, ethnicity, diabetes family history, past-history of GDM, past-history of poor obstetric outcomes, ethnicity), with ethnicity revised. Updating model methods were: recalibration-in-the-large (Model A) re-estimation of intercept and slope (Model B), and coefficients revision using logistic regression (Mode1 C1 with original eight ethnicity categories, and Mode1 C2 with updated 6 ethnicity categories). Analysis included ten-fold cross-validation, performance measures (c-statistic, calibration-in-the-large value, calibration slope and expected-observed (E:O) ratio) and closed testing examining log-likelihood scores and AIC compared models. In 26,474 singleton pregnancies (4,756, 18% with GDM), we showed that temporal validation of the original model was reasonable ( c -statistic 0.698) but with suboptimal calibration (E:O of 0.485). Model C2 was preferred, because of the high c-statistic (0.732), and it performed significantly better in closed testing compared to other models. Updating of the original model sustains predictive performance in a contemporary population, including ethnicity data, recent diagnostic criteria, and universal screening context. This supports the value of risk prediction models to guide risk-stratified care to women at risk of GDM. This study was registered as part of the PeRSonal GDM study on the Australian and New Zealand Clinical Trials Registry (ACTRN12620000915954) Pre-results.
Publisher: AMPCo
Date: 10-07-2021
DOI: 10.5694/MJA2.51165
Publisher: BMJ
Date: 11-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 24-09-2019
Publisher: Inter-Research Science Center
Date: 16-12-2010
DOI: 10.3354/MEPS08858
Publisher: Wiley
Date: 25-07-2023
DOI: 10.1111/AJR.13023
Publisher: Wiley
Date: 04-2019
DOI: 10.1111/AJR.12503
Publisher: Wiley
Date: 24-03-2022
DOI: 10.1111/AJR.12864
Abstract: To determine the work location (metropolitan, regional, rural and remote) of graduates in nursing, allied health and oral health disciplines who complete their professional training, end‐to‐end training, in a regional or rural area noting the potential inclusion of a metropolitan‐based placement for speciality practice not available in rural or regional Victoria. We tracked the place of employment from the Australian Health Practitioners Regulation Agency (AHPRA) of all graduates from a regional/rural tertiary education provider. The student home address at enrolment, locations where they undertook all placements and their current place of work were described using an objective geographical model of access, the Modified Monash Model. Seventy‐five per cent of 5506 graduates were located in the AHPRA database. About one third of graduates were working in metropolitan areas, 1/3 in regional cities and 1/3 in rural areas. Students' origin accounted for 1/3 of variance in current workplace location. The more placement days students completed in regional/ rural areas was also a significant predictor of working in a regional or rural area. End‐to‐end training in regional/rural areas is an effective approach to retaining a regional/rural workforce. Student origin is a strong predictor of working rural or regionally, as is undertaking placements in rural areas. This suggests that priority for rural/ regional student placements should be given to students in end‐to‐end regional/ rural programs and students from a regional/ rural background.
Publisher: BMJ
Date: 07-09-2015
DOI: 10.1136/BMJ.H4717
Publisher: Elsevier BV
Date: 2017
DOI: 10.1016/J.DIABRES.2017.11.009
Abstract: To compare the diabetes prevention impact and cost of several screening scenarios for diabetes prevention programs with the scenario which included an oral glucose tolerance test (OGTT). We included 4864 participants of the Australian Diabetes, Obesity and Lifestyle study who were aged ≥40 years, did not have known diabetes at baseline, and attended the five year follow-up. The proportions of participants eligible or ineligible for diabetes prevention program were estimated for each scenario. The costs of screening and diabetes prevention programs were also estimated. Screening with OGTT alone identified 21% of participants as eligible for diabetes prevention. While 3.1% of the cohort were identified as high risk and developed diabetes after five years, 1.0% of the cohort were identified as low risk and developed diabetes. The population prevention potential (i.e. sensitivity) for OGTT alone was 76.5%. Screening all Australian adults aged ≥40 years in 2015 by OGTT would have cost a total of AU$2025 million (AU$1031 million on screening and AU$994 million on prevention programs). The total costs of screening and prevention were substantially lower when AUSDRISK was used alone or in combination with a blood test. However, the population prevention potentials were also lower (ranged from 20.1% to 50.7%). A blood test post non-invasive risk assessment is a worthwhile step in the process of enrolling participants in a diabetes prevention program. Nevertheless, there will be ineligible in iduals who proceed to diabetes.
Publisher: Springer Science and Business Media LLC
Date: 11-08-2011
Publisher: Wiley
Date: 02-10-2022
DOI: 10.5694/MJA2.51701
Abstract: Substantially reduced life expectancy for people with serious mental illness compared with the general population is primarily driven by physical health issues, of which cardiovascular disease is the leading cause. In this narrative review, we examine the evidence base for use of metformin and other antidiabetic agents as a means for reducing this excess cardiometabolic disease burden. Evidence from randomised controlled trials (RCTs) suggests substantial potential for metformin to prevent or manage weight gain and glycaemic impairment induced by atypical antipsychotic medications, whereas the impact of metformin on other cardiometabolic risk factors is less consistent. Evidence from RCTs also suggests potential benefits from glucagon-like peptide-1 receptor agonists (GLP-1RAs), particularly for addressing cardiometabolic risk factors in people using atypical antipsychotic medications, but this is based on a small number of trials and remains an emerging area of research. Trials of both metformin and GLP-1RAs suggest that these medications are associated with a high prevalence of mild-moderate gastrointestinal side effects. The heterogeneous nature of participant eligibility criteria and of antipsychotic and antidiabetic drug regimens, alongside short trial durations, small numbers of participants and paucity of clinical endpoints as trial outcomes, warrants investment in definitive trials to determine clinical benefits for both metformin and GLP-1RAs. Such trials would also help to confirm the safety profile of antidiabetic agents with respect to less common but serious adverse effects. The weight of RCT evidence suggests that an indication for metformin to address antipsychotic-induced weight gain is worth considering in Australia. This would bring us into line with other countries.
Publisher: Wiley
Date: 21-11-2018
DOI: 10.1111/AJCO.12828
Abstract: Breast conserving surgery rates are affected by many factors including distance to radiotherapy and tumor-related features. Numerous studies have found women who must travel further for radiotherapy are more likely to choose mastectomy and avoid radiotherapy. We examined relationships between socioeconomic group, distance to radiotherapy services and mastectomy rates across a range of rural and metropolitan settings. We used a dataset extracted from the Evaluation of Cancer Outcomes Barwon South Western Registry, which captured data on new breast cancer diagnoses in the southwest region of Victoria, Australia. Using logistic regression, we modeled treatment choice of women with early breast cancer (mastectomy vs breast conserving surgery) using explanatory variables that included distance to radiotherapy, and area-level socioeconomic data from the Australian Bureau of Statistics, while controlling for clinical factors. Mastectomy was associated with tumor size, nodal burden and younger age at surgery. Distance to a radiotherapy center was also strongly associated with increased rates of mastectomy for women who traveled 100-200 km for radiotherapy (odds ratio = 1.663 P = 0.03) compared to the reference group who were within 100 km of radiotherapy. No socioeconomic differences were seen between the two groups. A strong association between distance to radiotherapy and the type of surgery for early breast cancer was found. Improving access to radiotherapy therefore has the potential to improve breast cancer outcomes for women in regional Australia.
Publisher: Elsevier BV
Date: 11-2006
Publisher: MDPI AG
Date: 02-01-2022
DOI: 10.3390/NU14010205
Abstract: This study aimed to explore the diagnostic accuracy of the Patient-Generated Subjective Global Assessment (PG-SGA) malnutrition risk screening tool when used to score patients based on their electronic medical records (EMR), compared to bedside screening interviews. In-patients at a rural health service were screened at the bedside (n = 50) using the PG-SGA, generating a bedside score. Clinical notes within EMRs were then independently screened by blinded researchers. The accuracy of the EMR score was assessed against the bedside score using area under the receiver operating curve (AUC), sensitivity, and specificity. Participants were 62% female and 32% had conditions associated with malnutrition, with a mean age of 70.6 years (SD 14.9). The EMR score had moderate diagnostic accuracy relative to PG-SGA bedside screen, AUC 0.74 (95% CI: 0.59–0.89). The accuracy, specificity and sensitivity of the EMR score was highest for patients with a score of 7, indicating EMR screen is more likely to detect patients at risk of malnutrition. This exploratory study showed that applying the PG-SGA screening tool to EMRs had enough sensitivity and specificity for identifying patients at risk of malnutrition to warrant further exploration in low-resource settings.
Publisher: Wiley
Date: 04-2021
DOI: 10.1111/AJR.12742
Abstract: To determine the student characteristics and clinical school training pathways that are associated with postgraduate rural practice. A cross‐sectional observational study. Deakin University's School of Medicine, encompassing 3 rural and 2 metropolitan clinical schools, including a rural longitudinal integrated clerkship (LIC) year. A total of 948 School of Medicine medical graduates (2011‐2018) who had an Australian Health Practitioners Regulation Agency registered work location in Australia (September 2019). Graduates' work locations were linked with admission and clinical school training data and analysed for significant associations. Graduates completing a rural LIC year and a regional rural clinical school year were 7 times more likely to be working rurally than metropolitan trainees. A small number of rural background (RB) students completed a rural LIC and rural clinical school year, 66.7% of whom were practising rurally. Further associations with rural practice were attending a rural clinical school for 2 years or a rural LIC for 1 year, student having a RB, rurally bonded course placement and being an international student. The significant influence of a rural LIC year on graduate rural work location is noteworthy, especially when undertaken by students from a RB in combination with a second regional rural clinical school year. These findings support the strategic alignment of rural student selection with rural clinical school training pathways to achieve the greatest impact on rural graduate workforce outcomes.
Publisher: Wiley
Date: 07-04-2023
DOI: 10.1111/AJR.12982
Abstract: Farmers face a range of factors that negatively influence their mental health and suicide risk, yet have limited access to appropriate support. Behavioural activation (BA) is an evidence‐based therapy that can be effectively delivered by nonclinical workers. Working with members of farming communities to deliver BA to their peers has the potential to overcome many well‐established barriers to mental health help‐seeking and improve outcomes for this at‐risk group. This paper describes the findings of a co‐design phase informing the development of a peer (farmer)‐led approach for delivering BA for farmers living with depression or low mood. This qualitative study used a co‐design approach involving members of the target community. Focus groups were transcribed and analysed using Thematic Analysis and the Framework approach. Ten online focus groups with 22 participants were held over 3 months. Four overarching, interlinked themes were identified: (i) filling the gap in rural mental health support (ii) alignment with the farming context—tailoring how, where and when we engage about mental health (iii) the ‘messenger’ is as important as the message and (iv) sustainability, governance and support. Findings suggest BA could be a contextually appropriate model of support for the farming community—given its practical and solution‐focused approach—and could help improve access to support. Having peer workers deliver the intervention was viewed as appropriate. Ensuring governance structures are developed to support peers to deliver the intervention will be essential to facilitate effectiveness, safety and sustainability. Insights gained through co‐design have been critical to the success of developing this new model of support for members of farming communities experiencing depression or low mood.
Publisher: Wiley
Date: 07-03-2022
DOI: 10.1111/AJR.12860
Publisher: Wiley
Date: 26-08-2022
DOI: 10.1111/AJR.12911
Abstract: To explore participant experiences of an online co‐design process to develop a web‐based preventative mental health and well‐being intervention targeting primary producers in rural Australia. Rural Victoria, Australia. Participants from a primary producer background, including horticulture, fisheries, animal cultivation and farm consultancy, were eligible for the study if they had participated in both the co‐design and beta testing processes for a primary producer platform. A qualitative study using semi‐structured phone‐based interviews was undertaken. A reflexive inductive approach to data analysis was employed to develop themes. Eleven participants were interviewed, with an average age of 51 years, of which 7 were female. Five main themes were developed. These included: (1) participant ersity, (2) impact of online delivery on co‐design participation, (3) experiences of the co‐design process, (4) maintaining a shared vision and goals and (5) acting on the co‐design recommendations. Use of online methods was a clear enabler to engage participants who were geographically dispersed and offers an alternative to more conventional approaches to co‐design using face‐to‐face methods. Some aspects of participant engagement may need a greater focus when conducted online compared with face‐to‐face. Using an online co‐design method to develop a preventative mental health and well‐being web‐based platform for primary producers was novel. Findings address a gap in the literature around the experience of participants engaging in a co‐design process and identify opportunities to improve participant engagement and experience with the online format.
Publisher: Wiley
Date: 17-08-2022
DOI: 10.1111/AJR.12915
Abstract: This commentary aims to describe a case of how meaningful co‐design between rural health service leaders and a health service‐embedded research unit can identify emerging research priorities and optimise translation. The challenges facing rural health services are unique, and the important role of health service leaders in the research response is increasingly recognised. Poorly‐designed research can contribute to research waste through reduced applicability of results to rural communities, and an opportunity exists to increase research co‐designed with rural health services through the involvement of research users during study planning. In early 2020, leaders at a rural Victorian health service approached the embedded health service research unit to request research be conducted on an emerging issue: rural staff well‐being in the face of the COVID‐19 pandemic. This was based on their concern regarding the lack of available COVID‐19‐specific evidence to inform organisational policy. In collaboration with the rural health service executive, a translation‐focused study of staff well‐being with nine rural Victorian health services was developed. Key co‐design activities of the project included involving research end‐users as study investigators and conducting formal stakeholder engagement regarding study design and outcomes. Meaningful co‐design of research with health services is a multifaceted process that can assist researchers and end‐users alike in identifying and responding to emerging health issues. In the rural setting where there is a vital need for impactful health research, we recommend that researchers should consider employing co‐design processes in order to minimise research waste and optimise the translatability of research findings.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2018
DOI: 10.11124/JBISRIR-2017-003833
Abstract: The question of this review is: Which locations in Australia have chronic disease programs for Aboriginal and Torres Strait Islander adult populations in the primary healthcare context been evaluated? Specific objectives are to:
Publisher: Public Library of Science (PLoS)
Date: 08-08-2018
Publisher: Wiley
Date: 21-05-2022
DOI: 10.1111/AJR.12879
Abstract: Building rural health workforce research capacity is critical to addressing rural health inequalities. Research training is a mainstay research capacity building strategy. This paper describes the delivery and evaluation of a research training program for rural and regional allied health professions (AHPs). A mentored research training program was delivered to AHPs employed public health services in rural and regional Victoria, Australia. The program was evaluated using the Evidence‐Based Practice Knowledge Attitudes and Practice (EBP‐KAP) tool at baseline and 3 months post‐training. Semi‐structured interviews undertaken at 3 and 16 months post‐training explored participants' perspectives of the training, their development and application of EBP and research skills. Survey data were analysed descriptively, and interview data were analysed using a framework approach. Thirty‐four in iduals from 14 organisations attended the first workshop and 31 attended the second. Thirty‐one participants completed the survey at baseline and nine at 3 months post‐training. Sixteen interviews were undertaken with 11 participants, five participating at both time points. Participants had positive EBP attitudes at both time points. Overall, participants' knowledge and incorporation of EBP into their practice, and retrieval of evidence was unchanged 3 months post‐training. Themes identified in the interview data were as follows: (1) in idual research capacity enhanced through supported practice, (2) organisational factors influence in iduals' progression of research and (3) in idual contributions towards research capacity within the organisation. A mentored rural research training program promoted the application of EBP skills at the in idual level and contributed to organisational research capacity.
Publisher: Cambridge University Press (CUP)
Date: 18-12-2012
DOI: 10.1017/S0025315412001695
Abstract: The aim of this study was to apply indicators for monitoring the impacts of harvest in a recreational surf clam fishery. We investigated trends in abundance, biomass and size structure and proportion of sexual maturity for the pipi ( Donax deltoides ) in Venus Bay, Australia. The surf clam stock was s led during the peak harvesting season in the Australian summer (November to February) at four sites exposed to varying degrees of recreational harvest. S ling was based on three transects at each site with 0.027 m 3 (0.3 m × 0.3 m × 0.3 m) quadrats stratified within transects by tidal position. Restricted maximum likelihood mixed model analyses were used to examine fixed effect combinations after including a priori random effect for transect within site. Results demonstrated that relative abundance varied significantly ( P = 0.0090) among s ling months but not among sites. Relative abundance declined across the peak summer harvest season. The proportion of maturity varied significantly ( P = 0.00026) among sites whereas relative biomass varied significantly ( P = 0.0043) among months by sites. Relative biomass and the proportion of maturity were considerably higher at the site exposed to minimal harvest compared to other sites. This study demonstrates that a suite of indictors including biomass, size–frequency and proportion of maturity are likely to provide a more accurate assessment of stock status in recreationally fished surf clam populations, than relative abundance. This highlights the need to develop methods to estimate relative biomass in surf clam populations that are not exploited commercially.
Publisher: Public Library of Science (PLoS)
Date: 26-07-2016
Publisher: Elsevier BV
Date: 02-2011
Publisher: Wiley
Date: 12-2019
DOI: 10.1111/AJR.12594
Publisher: Wiley
Date: 06-10-2023
DOI: 10.1111/AJR.13048
Publisher: Elsevier BV
Date: 09-2023
Publisher: Springer Science and Business Media LLC
Date: 03-07-2019
Publisher: Elsevier BV
Date: 02-2008
Publisher: Springer Science and Business Media LLC
Date: 30-06-0026
Publisher: Elsevier BV
Date: 11-2018
DOI: 10.1016/J.SAPHARM.2017.11.013
Abstract: The benefits of pharmacist-led interventions in achieving desired patient outcomes have been well established. Effective patient-pharmacist relationships are required to provide high-quality pharmacy care. Limited information is available about how Arabic-speaking migrants with diabetes, in Australia, perceive patient-pharmacist relationship and how these perspectives differ from the mainstream society (represented by Caucasian English-speaking people). To examine and compare the patient-pharmacist relationship, medication underuse and adherence levels among Arabic-speaking and Caucasian English-speaking patients with type 2 diabetes. A 98-item survey incorporating several previously-validated measurements was completed by Arabic-speaking migrants (ASMs) and Caucasian English-speaking patients (ESPs) with type 2 diabetes. Participants were recruited from various healthcare settings in the Melbourne metropolitan area and rural Victoria, Australia. This survey-based, cross-sectional study was designed to explore patients' perceptions of the patient-pharmacist relationship. A descriptive analysis of responses was undertaken, and binary logistic regression was used to explore patient-pharmacist relationships. A total of 701 participants were recruited 392 ASMs and 309 ESPs. Of ASMs, 88.3% were non-adherent to their prescribed medication, compared with 45.1% of ESPs. The degree of relationship with community pharmacists differed significantly between ASMs and ESPs. Compared with ASMs, significantly more ESPs reported that they have thought about consulting a pharmacist when they had health problems (P = 0.002). Compared with ESPs, significantly fewer ASMs reported always following pharmacist recommendations (32% versus 61.9% respectively). Arabic-speaking migrants had less-effective relationships with community pharmacists when having their prescriptions filled. Community pharmacists' expertise appeared to be underused. These minimal relationships represent missed opportunities to improve health outcomes.
Publisher: Wiley
Date: 10-2021
DOI: 10.1111/AJR.12805
Abstract: To describe the population distribution and socio‐economic position of residents across all states and territories of Australia, stratified using the 7 Modified Monash Model classifications. The numerical summary, and the methods described, can be applied by a variety of end users including workforce planners, researchers, policy‐makers and funding bodies for guiding future investment under different scenarios, and aid in evaluating geographically focused programs. The Commonwealth Department of Health is transitioning to the Modified Monash Model to objectively describe geographical access. This change applies to the Rural Health Multidisciplinary Training Program, one of the Australian Government's key policies to address the maldistribution of the rural health workforce. Unlike the previously applied Australian Statistical Geography Standard‐Remoteness Areas, a summary of the population in each Modified Monash Model classification is not available, nor is a socio‐economic overview of the communities within these areas. Spatial analysis of Australian Bureau of Statistics data (Modified Monash Model, population data and the Index of Relative Socio‐economic Advantage and Disadvantage collected or derived from the 2016 census) at the Statistical Area 1—the smallest unit for the release of census data. Linking the Modified Monash Model, a socio‐economic index and granular population data at the national level highlights the disadvantage of many residents in small rural towns (Modified Monash 5). The Modified Monash Model does not exhibit a continuum of the largest population residing in the most accessible classification and the smallest population residing in the least accessible classification that is seen in the Australian Statistical Geography Standard‐Remoteness Areas. Coupled with policy relevance, the advantage of using the Modified Monash Model as the basis for analysis is that it highlights areas that have both a critical mass of residents and differing levels of socio‐economic advantage and disadvantage. This will help end users to target funding to those regions where there is potential to improve access to services for the greatest number of rural residents.
Publisher: Wiley
Date: 08-2012
Publisher: Elsevier BV
Date: 12-2021
Publisher: Springer Science and Business Media LLC
Date: 17-06-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2014
Publisher: Springer Science and Business Media LLC
Date: 23-11-2013
DOI: 10.1186/1471-2458-13-1090
Abstract: In rural and remote Australia, cardiovascular mortality and morbidity rates are higher than metropolitan rates. This study analysed cardiovascular and other chronic disease risk factors and related health behaviours by occupational status, to determine whether agricultural workers have higher cardiovascular disease (CVD) risk than other rural workers. Cross-sectional surveys in three rural regions of South Eastern Australia (2004-2006). A stratified random s le of 1001 men and women aged 25-74 from electoral rolls were categorised by occupation into agricultural workers (men = 214, women = 79), technicians (men = 123), managers (men = 148, women = 272) and ‘home duties’ (women = 165). Data were collected from self-administered questionnaire, physical measurements and laboratory tests. Cardiovascular disease (CVD) and coronary heart disease (CHD) risk were assessed by Framingham 5 years risk calculation. Amongst men, agricultural workers had higher occupational physical activity levels, healthier more traditional diet, lower alcohol consumption, lower fasting plasma glucose, the lowest proportion of daily smokers and lower age-adjusted 5 year CVD and CHD risk scores. Amongst women, managers were younger with higher HDL cholesterol, lower systolic blood pressure, less hypertension, lower waist circumference, less self-reported diabetes and better 5 year CVD and CHD risk scores. Agricultural workers did not have higher cardiovascular disease risk than other occupational groups. Previous studies have suggested that farmers have higher risks of cardiovascular disease but this is because the risk has been compared with non-rural populations. In this study, the comparison has been made with other rural occupations. Cardiovascular risk reduction programs are justified for all. Programs tailored only for agricultural workers are unwarranted.
Publisher: BMJ
Date: 06-2023
DOI: 10.1136/BMJOPEN-2022-069475
Abstract: This study sought first to empirically define dietary patterns and to apply the novel Dietary Inflammation Score (DIS) in data from rural and metropolitan populations in Australia, and second to investigate associations with cardiovascular disease (CVD) risk factors. Cross-sectional study. Rural and metropolitan Australia. Adults over the age of 18 years living in rural or metropolitan Australia who participated in the Australian Health survey. A posteriori dietary patterns for participants separated into rural and metropolitan populations using principal component analysis. Secondary outcomes: association of each dietary pattern and DIS with CVD risk factors was explored using logistic regression. The s le included 713 rural and 1185 metropolitan participants. The rural s le was significantly older (mean age 52.7 compared with 48.6 years) and had a higher prevalence of CVD risk factors. Two primary dietary patterns were derived from each population (four in total), and dietary patterns were different between the rural and metropolitan areas. None of the identified patterns were associated with CVD risk factors in metropolitan or rural areas, aside diet pattern 2 being strongly associated with from self-reported ischaemic heart disease (OR 13.90 95% CI 2.29 to 84.3) in rural areas. There were no significant differences between the DIS and CVD risk factors across the two populations, except for a higher DIS being associated with overweight/obesity in rural areas. Exploration of dietary patterns between rural and metropolitan Australia shows differences between the two populations, possibly reflective of distinct cultures, socioeconomic factors, geography, food access and/or food environments in the different areas. Our study provides evidence that action targeting healthier dietary intakes needs to be tailored to rurality in the Australian context.
Publisher: BMJ
Date: 12-2017
DOI: 10.1136/BMJOPEN-2017-017725
Abstract: With the rising prevalence of type 2 diabetes in Australia, screening and earlier diagnosis is needed to provide opportunities to intervene with evidence-based lifestyle and treatment options to reduce the in idual, social and economic impact of the disease. The objectives of the Pharmacy Diabetes Screening Trial are to compare the clinical effectiveness and cost-effectiveness of three screening models for type 2 diabetes in a previously undiagnosed population. The Pharmacy Diabetes Screening Trial is a pragmatic cluster randomised controlled trial to be conducted in 363 community pharmacies across metropolitan, regional and remote areas of Australia, randomly allocated by geographical clusters to one of three groups, each with 121 pharmacies and 10 304 screening participants. The three groups are: group A: risk assessment using a validated tool (AUSDRISK) group B: AUSDRISK assessment followed by point-of-care glycated haemoglobin testing and group C: AUSDRISK assessment followed by point-of-care blood glucose testing. The primary clinical outcome measure is the proportion of newly diagnosed cases of type 2 diabetes. Primary outcome comparisons will be conducted using the Cochran-Mantel-Haenszel test to account for clustering. The secondary clinical outcomes measures are the proportion of those who (1) are referred to the general practitioner (GP), (2) take up referral to the GP, (3) are diagnosed with pre-diabetes, that is, impaired glucose tolerance or impaired fasting glucose and (4) are newly diagnosed with either diabetes or pre-diabetes. The economic outcome measure is the average cost (direct and indirect) per confirmed new case of diagnosed type 2 diabetes based on the incremental net trial-based costs of service delivery and the associated incremental longer term health benefits from a health funder perspective. The protocol has been approved by the Human Research Ethics Committees at University of Sydney and Deakin University. Results will be available on the Sixth Community Pharmacy Agreement website and will be published in peer reviewed journals. ACTRN12616001240437 Pre-results.
Publisher: Springer Science and Business Media LLC
Date: 17-10-2013
Abstract: Gestational diabetes mellitus (GDM) is defined as glucose intolerance with its onset or first recognition during pregnancy. Post-GDM women have a life-time risk exceeding 70% of developing type 2 diabetes mellitus (T2DM). Lifestyle modifications reduce the incidence of T2DM by up to 58% for high-risk in iduals. The Mothers After Gestational Diabetes in Australia Diabetes Prevention Program (MAGDA-DPP) is a randomized controlled trial aiming to assess the effectiveness of a structured diabetes prevention intervention for post-GDM women. This trial has an intervention group participating in a diabetes prevention program (DPP), and a control group receiving usual care from their general practitioners during the same time period. The 12-month intervention comprises an in idual session followed by five group sessions at two-week intervals, and two follow-up telephone calls. A total of 574 women will be recruited, with 287 in each arm. The women will undergo blood tests, anthropometric measurements, and self-reported health status, diet, physical activity, quality of life, depression, risk perception and healthcare service usage, at baseline and 12 months. At completion, primary outcome (changes in diabetes risk) and secondary outcome (changes in psychosocial and quality of life measurements and in cardiovascular disease risk factors) will be assessed in both groups. This study aims to show whether MAGDA-DPP leads to a reduction in diabetes risk for post-GDM women. The characteristics that predict intervention completion and improvement in clinical and behavioral measures will be useful for further development of DPPs for this population. Australian New Zealand Clinical Trials Registry ANZCTRN 12610000338066
Publisher: MDPI AG
Date: 27-01-2022
Abstract: Redressing the maldistribution of the health workforce in regional, rural, and remote geographical areas is a global issue and crucial to improving the accessibility of primary health care and specialist services. Geographical classification systems are important as they provide an objective and quantifiable measure of access and can have direct policy relevance, yet they are not always consistently applied in rural health research. It is unclear how research focusing on the graduate health workforce in Australia has described, measured, and analyzed place of practice. To examine approaches used, this review systematically scopes Australian rural studies focusing on dentistry, medicine, nursing, and allied health graduates that have included place of practice as an outcome measure. The Joanna Brigg’s Institute Scoping Review Methodology was used to guide the review. Database searches retrieved 1130 unique citations, which were screened, resulting in 62 studies for inclusion. Included studies were observational, with most focusing on the practice locations of medical graduates and predicators of rural practice. Variations in the use of geographical classification approaches to define rurality were identified and included the use of systems that no longer have policy relevance, as well as adaptations of existing systems that make future comparisons between studies challenging. It is recommended that research examining the geographical distribution of the rural health workforce use uniform definitions of rurality that are aligned with current government policy.
Publisher: Wiley
Date: 04-08-2017
DOI: 10.1111/AJR.12365
Publisher: Springer Science and Business Media LLC
Date: 10-09-2011
Publisher: MDPI AG
Date: 14-08-2020
Abstract: In-patient malnutrition leads to poor outcomes and mortality, and it is largely uninvestigated in non-urban populations. This study sought to: (1) retrospectively estimate the prevalence of malnutrition as diagnosed by dietetics in the rural Australian setting (2) establish the proportion of all patients at “nutritional risk” and (3) explore associations between demographic and clinical factors with malnutrition diagnosis and nutritional risk. A retrospective census was undertaken of medical files of all patients aged ≥18 years admitted to a rural hospital setting over a 12-month period. Logistic regression was used to explore associations between malnutrition diagnosis, nutritional risk and patient-related factors. In total, 711 admissions were screened during the 12-month period comprising 567 patients. Among the 125 patients seen by dietitians, 70.4% were diagnosed with malnutrition. Across the total s le, 77.0% had high levels of nutrition related symptoms warranting a need for further assessment by dietitians. Malnutrition diagnosis by dietitians was associated with being over the age of 65 years, and patients had higher odds of being admitted to a residential aged care facility following discharge. In this rural s le, the diagnosis rate of malnutrition appeared to be high, indicating that rural in-patients may be at a high risk of malnutrition. There was also a high proportion of patients who had documentation in their files that indicated they may have benefited from dietetic assessment and intervention, beyond current resourcing.
Publisher: Wiley
Date: 10-2021
DOI: 10.1111/AJR.12816
Abstract: To describe the distribution of 3 allied health professionals—occupational therapists, physiotherapists and podiatrists—in South Australia stratified by the Modified Monash Model and the Index of Relative Socio‐Economic Disadvantage. A descriptive data linkage cross‐sectional study. The state of South Australia, Australia. Distribution of the 3 registered allied health professional groups stratified by Modified Monash Model and Index of Relative Socio‐Economic Disadvantage. The largest proportion of the 3 allied health professional groups (occupational therapists, physiotherapists and podiatrists) were found in areas classified as Modified Monash 1 and Modified Monash 2 (86.5%). The lowest proportion of allied health professionals were found in Modified Monash 7. The largest number of allied health professionals per 10 000 population was found in areas classified as Modified Monash 1 and Modified Monash 2. The lowest number of allied health professionals per 10 000 population was found in Modified Monash 7 areas. The largest number of allied health professionals per 10 000 population was found in areas with Index of Relative Socio‐Economic Disadvantage quintile 2, while the lowest number of allied health professionals per 10 000 population was found in areas with Index of Relative Socio‐Economic Disadvantage quintile 1. The distribution of allied health professionals according to geographical remoteness, socio‐economic disadvantage and per 10 000 population varies widely in South Australia. The number of allied health professionals per 10 000 population was lowest in rural and remote/very remote areas, explaining the typically poor access to allied health services for communities in these areas. The number of allied health professionals per 10 000 population according to Index of Relative Socio‐Economic Disadvantage was variable within the context of both urban and rural areas.
Publisher: MDPI AG
Date: 24-04-2019
DOI: 10.3390/NU11040922
Abstract: Weight gain after childbirth is a significant risk factor for type 2 diabetes (T2DM) development after gestational diabetes mellitus (GDM). The level of weight loss achieved in diabetes prevention programs for women after GDM is often low but its effects on the cardiometabolic risk are not known. In a secondary analysis of a diabetes prevention program in postpartum women with history of gestational diabetes, we evaluated the effect of weight change on the cardiometabolic outcomes at 1-year follow-up. Of the 284 women randomized to the intervention arm, 206 with the final outcome measurements were included in the analyses. Participants were categorized into weight loss ( kg, n = 74), weight stable (±2 kg, n = 74) or weight gain ( kg, n = 58) groups. The weight loss group had significantly greater decrease in glycated hemoglobin (HbA1c) than the weight gain group (−0.1 + 0.4% vs. 0 + 0.4%, p = 0.049). The weight loss group had significantly greater decrease in total cholesterol and low-density lipoprotein cholesterol cholesterol than the other two groups (p 0.05). The weight gain group had significantly greater increase in triglyceride and triglyceride:high-density lipoprotein cholesterol ratio compare with the other groups (p 0.01). Overall, a small amount of weight loss and prevention of further weight gain was beneficial to the cardiometabolic outcomes of postpartum women after GDM.
Publisher: Springer Science and Business Media LLC
Date: 06-11-2010
DOI: 10.1007/S00128-009-9897-Z
Abstract: The Anzali Ramsar Convention wetland is located in an ecologically and economically important region in Iran. The wetland is largely surrounded by agriculture, natural forests and rangelands (approximately 36% and 63%, respectively). Urban areas consist of less than 1% of the total area. Urban land use produces the highest rates of nutrient transfer into the lake as TN, TP and BOD5 equal to 24, 2.4 and 79 Kg/ha/year, respectively, whilst, natural land use produces the lowest rate as 10, 1.3 and 27 kg/ha/year. These results will inform the future sustainable management of this important wetland in this ever increasingly water stressed region in Iran.
Publisher: Wiley
Date: 10-2021
DOI: 10.1111/AJR.12817
Publisher: WIT Press
Date: 27-05-2008
DOI: 10.2495/WP080161
Publisher: Springer Science and Business Media LLC
Date: 10-01-2019
Publisher: American Diabetes Association
Date: 08-03-2014
DOI: 10.2337/DC12-2647
Abstract: The Australian lifestyle intervention program Life! is only the second reported, large-scale diabetes prevention program. This article describes the genesis and the successful establishment of Life! and its key outcomes for participants and implementation. Life!, a behavior-change intervention, comprises six group sessions over 8 months. The Victorian Department of Health funded Diabetes Australia–Victoria to implement the program. Experience of the Greater Green Triangle diabetes prevention implementation trial was used for intervention design, workforce development, training, and infrastructure. Clinical and anthropometric data from participants, used for program evaluation, were recorded on a central database. Life! has a statewide workforce of 302 trained facilitators within 137 organizations. Over 29,000 Victorians showed interest in Life!, and 15,000 in iduals have been referred to the program. In total, 8,412 participants commenced a Life! program between October 2007 and June 2011, and 37% of the original participants completed the 8-month program. Participants completing sessions 1 to 5 lost an average of 1.4 kg weight (P & 0.001) and waist circumference of 2.5 cm (P & 0.001). Those completing six sessions lost an average of 2.4 kg weight (P & 0.001) and waist circumference of 3.8 cm (P & 0.001). The weight loss of 2.4 kg represents 2.7% of participants’ starting body weight. The impact of Life! is attributable to applying available evidence for the system’s design of the intervention and collaboration between policy makers, implementers, and evaluators using the principles of continuous quality improvement to support successful, large-scale recruitment and implementation.
Publisher: Public Library of Science (PLoS)
Date: 13-02-2015
Publisher: Informa UK Limited
Date: 16-12-2018
Publisher: Wiley
Date: 24-05-2021
DOI: 10.1111/FAF.12572
Abstract: Commercial fishers face a range of stressors that impact physical and mental health. However, there is limited research on the level of mental ill‐health among fishers and on the nature of stressors that contribute to their psychological distress. This paper focuses on the experiences of commercial wild‐catch fishers and analyses the results of an Australian national survey conducted in 2017 ( n = 872) (Appendix S1). We first assess underlying themes in perceived stressors, identifying three distinct categories termed ‘traditional risks’, ‘modern uncertainties’ and ‘future concerns’. Second, we assess the level of self‐reported psychological distress, demonstrating higher occurrence of high to very high psychological distress among commercial fishers in comparison with the national population. Third, we examine the relationship between different groups of stressors and psychological distress, finding that stronger perceptions of both ‘traditional risks’ and ‘modern uncertainties’ are associated with greater levels of psychological distress among fishers. Fourth, recognizing ersity within the industry, we examine differences in these relationships among skippers and crew (work role), and inshore versus offshore fishers (fishing location). Our analysis demonstrates that ‘traditional risks’ and ‘modern uncertainties’ differentially impact on fisher mental health and depend on the in idual's role in the industry and their fishing location. The findings suggest that changes to factors associated with modern uncertainty stressors—including government management techniques, red tape, media representation and political support—could significantly improve mental health in the commercial fishing sector. [Correction added on 09 June 2021, after first online publication: Abstract has been corrected in this version.]
Publisher: Wiley
Date: 25-03-2013
DOI: 10.1002/ECE3.535
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.MIDW.2018.12.005
Abstract: Prior to implementation of a Normal Labour and Birth Bundle (NLBB) at a regional maternity service in Victoria, Australia, this study aimed to understand clinician factors that may influence the uptake, acceptance and use of the NLBB. This was a mixed methods study in which The Theory of Planned Behaviour (TPB) provided the framework for the conduct and analysis of the staff survey and focus groups. Descriptive and multiple regression were used to analyse the survey data and thematic analysis was used for the focus group data. Participants for the survey and focus groups included clinicians providing publicly funded care and management of labour for women birthing at the health service. Maternity care clinicians were invited to participate in both the survey and the focus groups. Seventy-six clinicians (88.8%) responded to the survey. Mean scores for TPB constructs were well above the mid-scale score of 4, indicating strong positive attitudes, high levels of self-efficacy and positive social pressure to use the NLBB and strong intentions to use it in the future. Self-efficacy was the strongest independent predictor (β = 0.45, p < 0.001) of intention to use the NLBB (overall model R2=0.38). A valued consequence of implementing standardised and objective guidelines, highlighted in the focus groups, was the positive impact on clinicians' confidence in their decision-making. This study found that midwives and obstetricians were in favour of using a normal labour and birth care bundle and perceived the bundle to align with the expectations of work colleagues and the women they care for. The findings of this study show that clinicians at the health service had strong intentions to use the normal labour and birth care bundle in the future. Implementation science is important in embedding and sustaining practice change. Understanding staff perceptions is an essential first step of this process.
Publisher: Springer Science and Business Media LLC
Date: 14-08-2019
Publisher: BMJ
Date: 02-2022
DOI: 10.1136/BMJOPEN-2021-054558
Abstract: Despite extensive evidence of its benefits and recommendation by guidelines, cardiac rehabilitation (CR) remains highly underused with only 20%–50% of eligible patients participating. We aim to implement and evaluate the Country Heart Attack Prevention (CHAP) model of care to improve CR attendance and completion for rural and remote participants. CHAP will apply the model for large-scale knowledge translation to develop and implement a model of care to CR in rural Australia. Partnering with patients, clinicians and health service managers, we will codevelop new approaches and refine/expand existing ones to address known barriers to CR attendance. CHAP will codesign a web-based CR programme with patients expanding their choices to CR attendance. To increase referral rates, CHAP will promote endorsement of CR among clinicians and develop an electronic system that automatises referrals of in-hospital eligible patients to CR. A business model that includes reimbursement of CR delivered in primary care by Medicare will enable sustainable access to CR. To promote CR quality improvement, professional development interventions and an accreditation programme of CR services and programmes will be developed. To evaluate 12-month CR attendance/completion (primary outcome), clinical and cost-effectiveness (secondary outcomes) between patients exposed (n=1223) and not exposed (n=3669) to CHAP, we will apply a multidesign approach that encompasses a prospective cohort study, a pre-post study and a comprehensive economic evaluation. This study was approved by the Southern Adelaide Clinical Human Research Ethics Committee (HREC/20/SAC/78) and by the Department for Health and Wellbeing Human Research Ethics Committee (2021/HRE00270), which approved a waiver of informed consent. Findings and dissemination to patients and clinicians will be through a public website, online educational sessions and scientific publications. Deidentified data will be available from the corresponding author on reasonable request. ACTRN12621000222842.
Publisher: American Chemical Society (ACS)
Date: 25-01-2023
Publisher: Springer Science and Business Media LLC
Date: 14-09-2008
DOI: 10.1007/S10661-007-9918-5
Abstract: Plant-based management systems implementing deep-rooted, perennial vegetation have been identified as important in mitigating the spread of secondary dryland salinity due to its capacity to influence water table depth. The Glenelg Hopkins catchment is a highly modified watershed in the southwest region of Victoria, where dryland salinity management has been identified as a priority. Empirical relationships between the proportion of native vegetation and in-stream salinity were examined in the Glenelg Hopkins catchment using a linear regression approach. Whilst investigations of these relationships are not unique, this is the first comprehensive attempt to establish a link between land use and in-stream salinity in the study area. The results indicate that higher percentage land cover with native vegetation was negatively correlated with elevated in-stream salinity. This inverse correlation was consistent across the 3 years examined (1980, 1995, and 2002). Recognising the potential for erroneously inferring causal relationships, the methodology outlined here was both a time and cost-effective tool to inform management strategies at a regional scale, particularly in areas where processes may be operating at scales not easily addressed with on-site studies.
Publisher: BMJ
Date: 10-2015
Publisher: Springer Science and Business Media LLC
Date: 30-01-2014
Publisher: JMIR Publications Inc.
Date: 07-02-2023
DOI: 10.2196/39384
Abstract: In March 2020, the Australian Government expanded general practitioner (GP) telehealth services in response to the COVID-19 pandemic. This study sought to assess use patterns of GP telehealth services in response to changing circumstances (before and during the COVID-19 pandemic and with or without a lockdown) in regional Victoria, Australia. We conducted a secondary analysis of monthly Medicare claims data from July 2019 to June 2021 from 140 regional GP practices in Western Victoria. The longitudinal patterns of proportion of GP telehealth consultations stratified by type of consultation (ie, videoconference vs telephone) and by geographical, consumer, and consultation characteristics were analyzed. Telehealth comprised 25.8% (522,932/2,025,615) of GP consultations over the 2-year period. After the introduction of the Australian telehealth expansion policy in March 2020, there was a rapid uptake in GP telehealth services (including telephone and video services), from 0% before COVID-19 to 15% (11,854/80,922) of all consultations in March 2020, peaking at 55% (50,828/92,139) in August 2020. Thereafter, the use of telehealth declined steadily to 31% (23,941/77,344) in January 2021 and tapered off to 28% (29,263/103,798) in June 2021. Telephone services and shorter consultations were the most dominant form, and those aged 15-64 years had higher telehealth use rates than younger or older age groups. The proportion of video consultations was higher during periods with government-imposed lockdowns and higher in the most socioeconomically advantaged areas compared to less socioeconomically advantaged areas. Our findings support the continuation of telehealth use in rural and regional Australia post pandemic. Future policy must identify mechanisms to reduce existing equity gaps in video consultations and consider patient- and system-level implications of the dominant use of short telephone consultations.
Publisher: Public Library of Science (PLoS)
Date: 19-04-2012
Start Date: 2016
End Date: 2017
Funder: Flinders University
View Funded ActivityStart Date: 2010
End Date: 2015
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2009
End Date: 2014
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2018
End Date: 2020
Funder: Cancer Council Tasmania
View Funded ActivityStart Date: 2017
End Date: 2018
Funder: Kardinia Health
View Funded ActivityStart Date: 2018
End Date: 2019
Funder: Department of Health, Australian Government
View Funded ActivityStart Date: 2020
End Date: 2022
Funder: European Commission
View Funded ActivityStart Date: 2019
End Date: 2020
Funder: Ross Trust
View Funded ActivityStart Date: 2020
End Date: 2023
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2019
End Date: 2022
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2020
End Date: 2023
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2017
End Date: 06-2021
Amount: $765,500.00
Funder: Australian Research Council
View Funded Activity