Drivers to obesity : a study of the association between time spent commuting daily and obesity in the Nepean Blue Mountains area

Obesity has become a public health challenge in every country on this planet, with a substantial contribution to global mortality and morbidity. Studies of the built environment have shown some promise in understanding the drivers of this obesity pandemic. This paper contributes to this knowledge, by focusing on one aspect of the urban environment and asking whether there is an association between commuting and obesity in residents of the Nepean Blue Mountains area on the fringes of Sydney. This is a cross-sectional study with obesity being the dependent variable, and commuting the independent variable, where 45 min or less was defined as local and distant commute was more than 45 min. In the sample of 158 respondents, the risk of obesity was twice as likely in the distant commuters than in the local commuters (OR 2.04, 95% CI 1.051 to 3.962, p = 0.034). Investigation of possible mediators of this association was limited by sample size; however, mode of transport was found to be a significant mediator. The results support the design of cities to provide health supporting environments for all residents, including equitable access to employment at a reasonable distance and effective public transport

Kariye Camii

Taha Toros Arşivi, Dosya No: 102-Camilerİstanbul Kalkınma Ajansı (TR10/14/YEN/0033) İstanbul Development Agency (TR10/14/YEN/0033

Integrating health care in Australia : a qualitative evaluation

With aging populations, a growing prevalence of chronic illnesses, higher expectations for quality care and rising costs within limited health budgets, integration of healthcare is seen as a solution to these challenges. Integrated healthcare aims to overcome barriers between primary and secondary care and other disconnected patient services to improve access, continuity and quality of care. Many people in Australia are admitted to hospital for chronic illnesses that could be prevented or managed in the community. Western Sydney has high rates of diabetes, heart and respiratory diseases and the NSW State Ministry of Health has implemented key strategies through the Western Sydney Integrated Care Program (WSICP) to enhance primary care and the outcomes and experiences of patients with these illnesses. We aimed to investigate the WSICP’s effectiveness through a qualitative evaluation focused on the 10 WSICP strategies. The combined WSICP strategies improved patient and carer experience of healthcare and capacity of GPs to provide care in the community. Information sharing required longer-term investment and support, though benefits were evident by the end of our research

Using community based research frameworks to develop and implement a church-based program to prevent diabetes and its complications for Samoan communities in South Western Sydney

Pasifika communities bear a disproportionate burden of diabetes compared to the general Australian population. Community-based participatory research (CBPR), which involves working in partnership with researchers and communities to address local health needs, has gained prominence as a model of working with underserved communities. This paper describes how Le Taeao Afua (LTA) Samoan diabetes prevention program was underpinned by two CBPR frameworks to develop a culturally tailored church-based lifestyle intervention to prevent diabetes and its complications in the Australian Samoan community. The name LTA, which means ‘a new dawn,’ was chosen by the community to signify a new dawn without diabetes in the Australian Samoan community. Strategies for engaging with the Australian Samoan community in South Western Sydney are discussed mapped to the key principles from the CBPR frameworks. In particular, this paper highlights the steps involved in building relationships with Samoan community leaders and the vital role of community activators and peer support facilitators in the success of delivering the program. Lessons learnt, such as the importance of church and maintaining a Samoan way of life in daily activities, and processes to build effective partnerships and maintain long-term relationships with the Australian Samoan community, are also discussed. Our paper, through providing a case example of how to apply CBPR frameworks, will help guide future community-based health promotion programs for underserved communities

Developing indicators and measures of high-quality for Australian general practice

Background: Rising health costs and health inequity are major challenges in Australia, as internationally. Strong primary health care is well evidenced to address these challenges. Primary Health Networks (PHNs) work with general practices to collect data and support quality improvement; however, there is no consensus regarding what defines high quality. This paper describes the development of an evidence-based suite of indicators and measures of high-quality general practice for the Australian context. Methods: We reviewed the literature to develop a suitable framework and revise quality assurance measures currently in use, then reviewed these in three workshops with general practitioners, practice managers, nurses, consumers and PHN staff in western Sydney. We used a descriptive qualitative research approach to analyse the data. Results: A total of 125 evidence-based indicators were agreed to be relevant, and 80 were deemed both relevant and feasible. These were arranged across a framework based on the Quadruple Aim, and include structure, process and outcome measures. Conclusions: The agreed suite of indicators and measures will be further validated in collaboration with PHNs across Australia. This work has the potential to inform health systems innovation both nationally and internationally

INFLATE : a protocol for a randomised controlled trial comparing nasal balloon autoinflation to no nasal balloon autoinflation for otitis media with effusion in Aboriginal and Torres Strait Islander children

Background: Otitis media with effusion (OME) is common and occurs at disproportionately higher rates among Indigenous children. Left untreated, OME can negatively affect language, development, learning, and health and wellbeing throughout the life-course. Currently, OME care includes observation for 3 months followed by consideration of surgical ventilation tube insertion. The use of a non-invasive, low-cost nasal balloon autoinflation device has been found beneficial in other populations but has not been investigated among Aboriginal and Torres Strait Islander children. Methods/design: This multi-centre, open-label, randomised controlled trial will determine the effectiveness of nasal balloon autoinflation compared to no nasal balloon autoinflation, for the treatment of OME among Aboriginal and Torres Strait Islander children in Australia. Children aged 3–16 years with unilateral or bilateral OME are being recruited from Aboriginal Health Services and the community. The primary outcome is the proportion of children showing tympanometric improvement of OME at 1 month. Improvement is defined as a change from bilateral type B tympanograms to at least one type A or C1 tympanogram, or from unilateral type B tympanogram to type A or C1 tympanogram in the index ear, without deterioration (type A or C1 to type C2, C3, or B tympanogram) in the contralateral ear. A sample size of 340 children (170 in each group) at 1 month will detect an absolute difference of 15% between groups with 80% power at 5% significance. Anticipating a 15% loss to follow-up, 400 children will be randomised. The primary analysis will be by intention to treat. Secondary outcomes include tympanometric changes at 3 and 6 months, hearing at 3 months, ear health-related quality of life (OMQ-14), and cost-effectiveness. A process evaluation including perspectives of parents or carers, health care providers, and researchers on trial implementation will also be undertaken. Discussion: INFLATE will answer the important clinical question of whether nasal balloon autoinflation is an effective and acceptable treatment for Aboriginal and Torres Strait Islander children with OME. INFLATE will help fill the evidence gap for safe, low-cost, accessible OME therapies. Trial registration: Australia New Zealand Clinical Trials Registry ACTRN12617001652369. Registered on 22 December 2017. The Australia New Zealand Clinical Trials Registry is a primary registry of the WHO ICTRP network and includes all items from the WHO Trial Registration data set. Retrospective registration.</p

Patient-centred health care for people with chronic skin conditions

Patient‐centredness has been expressed as clinicians trying to see the illness through the patient's eyes. People with psoriasis and other chronic skin conditions can perceive that treating clinicians discount the importance of their symptoms. In particular, the psychological sequelae of such conditions can be unacknowledged and poorly managed, contributing to poor relationships with general practitioners and dermatologists. Dermatologists do recognize the need to detect and manage mental health problems in people with psoriasis, but can disagree as to the extent of their role in ensuring this happens. This may be related in part to concerns about dermatologists’ skills and confidence in mental health management and a resulting preference for standardized screening and referral to colleagues if mental health problems are detected.8 However, openness to exploring patients’ well‐being and their concerns while providing care for their chronic skin condition does not require mental health training. Rather, it can be seen as a core dimension of expert dermatological care and a well‐accepted expectation of quality doctor–patient interactions

Social inclusion and medical practitioners

Medical practitioners, regardless of their roles or career paths, should understand social inclusion and exclusion and their effects on health and health risk factors, health-care accessibility, treatments and health promotion. Social inclusion is both a treatment and a therapeutic goal in health. This chapter discusses the relevance of social inclusion to medical practitioners, ways that social inclusion can be improved, and how medical education can prepare students and trainees to practice socially inclusive care. Medical practitioners have an important role in ensuring that health services are inclusive and welcoming for all people, given that socially excluded individual and groups are also the most likely to be excluded from needed health care. Strategies medical practitioners can use to promote social inclusion for their patients include utilizing team care, addressing patient social support needs as well as medical issues, social prescribing, and linking with community services and organizations. The importance of social accountability in medical education is well recognized. A whole of medical school or residency training mission can address health and social inequities in the communities which they serve through teaching, research, and service delivery. Strategies include leadership, inclusive staffing and student selection, embedding an equity lens into medical curricula and assessment, and ensuring dedicated time for learning related to social inclusion which includes experiential learning

Supporting the Mental Health and Wellbeing of the Residents of Airds - During and Beyond Housing Renewal

The suburb of Airds and surrounding areas in South-Western Sydney are currently undergoing housing renewal, changing from predominantly social housing to a mixed-housing community. Current evidence suggests that housing renewal can improve quality of life for residents depending on the way it is done. This research was undertaken to gain insight into the mental health and wellbeing of Airds residents during the time of housing renewal and how to best support their needs, through the views of local service providers and volunteers. At the time of this study, housing renewal was proceeding, with demolishing and new building of houses taking place. Some social housing tenants were moving away from Airds and private owners moving in

Too many of us have gone early : priorities in heart health education for Aboriginal people

Aboriginal people have a higher burden of cardiovascular risk factors and heart disease and poorer outcomes after heart attacks when compared with other Australians. Indigenous status is also a risk factor for delayed response to heart attack symptoms. A community DVD about preventing and managing heart disease was made at the Aboriginal Medical Service Western Sydney in 2005. The aim of this article is to reflect on the process of making the DVD as a community driven health promotion activity and to explore questions raised and insights gained about heart health education for Aboriginal people in the context of the existing literature. The importance of education about heart attack symptom recognition and prompt hospital presentation, as well as risk factor management, by general practitioners and other health practitioners working with Aboriginal people, is highlighted