Working towards co-production in rehabilitation and recovery services

PurposeThis paper outlines the work of a service provider, service user and carer group created to develop a strategy for service user and carer co-production.ApproachA reflective narrative account is given of the process through which the group formed and began to develop a working model aimed at shaping a cultural shift towards more co-produced services. The paper has been co-produced and includes the collaborative voices of service users, carers, multi-disciplinary staff, third sector representatives, managers and colleagues from associated services.FindingsThe model developed outlines 3 stages for services to work through in order to achieve meaningful and sustainable co-produced services. The importance of developing associated policies related to such areas as recruitment, payment, support and training is also outlined. Challenges to co-production are noted along with suggested approaches to overcoming these.Implications and ValueThe ethos of co-production is relatively new in the UK and so knowledge of the process and model may help guide others undertaking similar work

Tenure, mobility and retention of nurses in Queensland, Australia: 2001 and 2004

[Abstract]: Aim: Data were collected on tenure, mobility and retention of the nursing workforce in Queensland to aid strategic planning by the Queensland Nurses’ Union. Background: Shortages of nurses negatively affect the health outcomes of patients. Population rise is increasing the demand for nurses in Queensland. The supply of nurses is affected by recruitment of new and returning nurses, retention of the existing workforce and mobility within institutions. Methods: A self-reporting, postal survey was undertaken of Queensland Nurses Union members from the major employment sectors of aged care, public acute and community health and private acute and community health. Results: Only 60% of nurses had been with their current employer more than five years. In contrast 90% had been nursing for five years or more and most (80%) expected to remain in nursing for at least another five years. Breaks from nursing were common and part-time positions in the private and aged care sectors offered flexibility. Conclusion: The study demonstrated a mobile nursing workforce in Queensland although data on tenure and future time in nursing suggested that retention in the industry was high. Concern is expressed for replacement of an aging nursing population

Australian radiation therapy - Part Two: Reflections of the past, the present, the future

INTRODUCTION: Documentation on the history of Australian radiotherapy is limited. This study provides radiation therapists' (RTs) perspectives of the people, workplace, and work practices in Australian radiotherapy centres from 1960 onwards. It provides a follow-up to our previous study: Australian radiation therapy: An overview – Part one, which outlines the history and development of radiotherapy from conception until present day. METHODS: Four focus groups were conducted on separate occasions in 2010, one in South Australia and three in Victoria, Australia. Participants who worked in radiotherapy were purposively selected to ensure a range of experience, age, and years of work. RESULTS: From a RT perspective, radiotherapy has evolved from a physically demanding ‘hands-on’ work environment, often with unpleasant sights and smells of disease, to a more technology-driven workplace. CONCLUSION: Understanding these changes and their subsequent effects on the role of Australian RTs will assist future directions in advanced role development

Relative magnitudes of sources of uncertainty in assessing climate change impacts on water supply security for the southern Adelaide water supply system

The sources of uncertainty in projecting the impacts of climate change on runoff are increasingly well recognized; however, translating these uncertainties to urban water security has received less attention in the literature. Furthermore, runoff cannot be used as a surrogate for water supply security when studying the impacts of climate change due to the nonlinear transformations in modeling water supply and the effects of additional uncertainties, such as demand. Consequently, this study presents a scenario-based sensitivity analysis to qualitatively rank the relative contributions of major sources of uncertainty in projecting the impacts of climate change on water supply security through time. This can then be used by water authorities to guide water planning and management decisions. The southern system of Adelaide, South Australia, is used to illustrate the methodology for which water supply system reliability is examined across six greenhouse gas (GHG) emissions scenarios, seven general circulation models, six demand projections, and 1000 stochastic rainfall time series. Results indicate the order of the relative contributions of uncertainty changes through time; however, demand is always the greatest source of uncertainty and GHG emissions scenarios the least. In general, reliability decreases over the planning horizon, illustrating the need for additional water sources or demand mitigation, while increasing uncertainty with time suggests flexible management is required to ensure future supply security with minimum regret.F.L. Paton, H.R. Maier and G.C. Dand

Breast cancer screening-opportunistic use of registry and linked screening data for local evaluation

Rationale: Screening has been found to reduce breast cancer mortality at a population level in Australia, but these studies did not address local settings where numbers of deaths would generally have been too low for evaluation. Clinicians, administrators, and consumer groups are also interested in local service outcomes. We therefore use more common prognostic and treatment measures and survivals to gain evidence of screening effects among patients attending 4 local hospitals for treatment. Aims and objectives: To compare prognostic, treatment, and survival measures by screening history to determine whether expected screening effects are occurring. Methods: Employing routine clinical registry and linked screening data to investigate associations of screening history with these measures, using unadjusted and adjusted analyses. Results: Screened women had a 10‐year survival from breast cancer of 92%, compared with 78% for unscreened women; and 79% of screened surgical cases had breast conserving surgery compared with 64% in unscreened women. Unadjusted analyses indicated that recently screened cases had earlier tumor node metastasis stages, smaller diameters, less nodal involvement, better tumor differentiation, more oestrogen and progesterone receptor positive lesions, more hormone therapy, and less chemotherapy. Radiotherapy tended to be more common in screening participants. More frequent use of adjunctive radiotherapy applied when breast conserving surgery was used. Conclusions: Results confirm the screening effects expected from the scientific literature and demonstrate the value of opportunistic use of available registry and linked screening data for indicating to local health administrations, practitioners, and consumers whether local screening services are having the effects expected.David Roder, Gelareh Farshid, Grantley Gill, Jim Kollias, Bogda Koczwara, Chris Karapetis, Jacqui Adams, Rohit Joshi, Dorothy Keefe, Kate Powell, Kellie Fusco, Marion Eckert, Elizabeth Buckley, Kerri Beckman

Mapping the visibility of smokers across a large capital city

BACKGROUND: Smoking visibility may affect smoking norms with implications for tobacco initiation, particularly amongst youths. Understanding how smoking is distributed across urban environments would contribute to the design and implementation of tobacco control policies. Our objective is to estimate the visibility of smokers in a large urban area using a novel GIS-based methodological approach. METHODS: We used systematic social observation to gather information about the presence of smokers in the environment within a representative sample of census tracts in Madrid city in 2016. We designed a GIS-based methodology to estimate the visibility of smokers throughout the whole city using the data collected in the fieldwork. Last, we validated our results in a sample of 40 locations distributed across the city through direct observation. RESULTS: We mapped estimates of smokers’ visibility across the entire city. The visibility was higher in the central districts and in streets with a high density of hospitality venues, public transportation stops, and retail shops. Peripheral districts, with larger green areas and residential or industrial land uses, showed lower visibility of smokers. Validation analyses found high agreement between the estimated and observed values of smokers’ visibility (R=0.845, p=<0.001). DISCUSSION: GIS-based methods enable the development of novel tools to study the distribution of smokers and their visibility in urban environments. We found differences in the visibility by population density and leisure, retail shops and business activities. The findings can support the development of policies to protect people from smoking

Australian health policy and end of life care for people with chronic disease: An analysis

End of life care for people with advanced chronic disease is a growing international imperative, with the majority of deaths in the world now related to chronic disease. The provision of care that meets the needs of people with advanced chronic disease must be guided by appropriate policy. The key policy areas impacting directly on end of life care are related to chronic disease, palliative care and, increasingly, aged care. This paper describes the outcomes of an audit of Australian chronic disease and end of life/palliative care policies. We identified that chronic disease health policies/strategies demonstrate a focus on prevention, early intervention and management, with scant recognition of end of life care needs. The majority assume that a referral to palliative care will address end of life care needs for people with chronic disease. By contrast, palliative care policies recognise the need for the incorporation of a palliative approach into advanced chronic disease care, but there are few connections between these two policy areas. Whilst palliative care policies intersect with carer and advance care planning policies, chronic disease policy does not. Key concerns requiring consideration when developing policy in this area are discussed and possible policy options identified.Teresa Burgess, Annette Braunack-Mayer, Gregory B. Crawford, Justin Beilb

Eating disorder features in indigenous Aboriginal and Torres Strait Islander Australian Peoples

<p>Abstract</p> <p>Background</p> <p>Obesity and related cardiovascular and metabolic conditions are well recognized problems for Australian Aboriginal and Torres Strait Islander peoples. However, there is a dearth of research on relevant eating disorders (EDs) such as binge eating disorder in these groups.</p> <p>Methods</p> <p>Data were obtained from interviews of 3047 (in 2005) and 3034 (in 2008) adults who were participants in a randomly selected South Australian household survey of individuals' age > 15 years. The interviewed comprised a general health survey in which ED questions were embedded. Data were weighted according to national census results and comprised key features of ED symptoms.</p> <p>Results</p> <p>In 2005 there were 94 (85 weighted) First Australian respondents, and in 2008 65 (70 weighted). Controlling for secular differences, in 2005 rates of objective binge eating and levels of weight and shape influence on self-evaluation were significantly higher in indigenous compared to non-indigenous participants, but no significant differences were found in ED features in 2008.</p> <p>Conclusions</p> <p>Whilst results on small numbers must be interpreted with caution, the main finding was consistent over the two samples. For First Australians ED symptoms are at least as frequent as for non-indigenous Australians.</p

A stakeholder analysis of the perceived outcomes of developing and implementing England’s obesity strategy 2008–2011

Background International recommendations urge governments to implement population-based strategies to reduce the burden of obesity. This study assesses the development and implementation of the obesity strategy in England 2008–2011, Healthy Weight, Healthy Lives (HWHL). The aim was to identify if stakeholders perceived HWHL to have made any difference to the action to address obesity in England, with the ultimate objective of identifying insights that could inform the development and implementation of future obesity strategies in England and elsewhere. Methods Qualitative study using semi-structured interviews and thematic framework analysis. 40 stakeholders involved in the development and implementation of the obesity strategy were interviewed. Results Evidence from this study suggests that HWHL was perceived to have made a positive difference to efforts to address obesity in England. It was credited with creating political buy-in, engaging more stakeholders, stimulating and facilitating action, enhancing knowledge and changing attitudes. But it was reported to have failed to fully catalyse action across all government departments and sectors, or to develop adequate mechanisms for learning about the effectiveness of the different elements and actions in the Strategy. Key elements of the Strategy contributing towards to the perceived positive differences included its multi-faceted, inclusive nature; governance structures; monitoring programme to assess progress against national and local targets; child-focus; and funding. The development of the Strategy was said to be stimulated and aided by the prior synthesis of a critical mass of scientific evidence. Conclusions The English experience of HWHL lends support to the recommendations to develop population-based obesity strategies. It indicates that in order to stimulate comprehensive, inter-sectoral action, obesity strategies need to take a population-based, multi-faceted approach, be implemented through a clear governance structure, follow a systematic process of aligning goals, objectives and agendas between government departments and sectors with a stake in obesity, and have a clear system of reporting changes in obesity rates against a target. In order to design effective policies and to build the case for continued investment, obesity strategies also need to incorporate a national framework for learning and evaluation from the outset