Determinants of access to chronic illness care: a mixed-methods evaluation of a national multifaceted chronic disease package for Indigenous Australians

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ OBJECTIVES: Indigenous Australians have a disproportionately high burden of chronic illness, and relatively poor access to healthcare. This paper examines how a national multicomponent programme aimed at improving prevention and management of chronic disease among Australian Indigenous people addressed various dimensions of access.DESIGN: Data from a place-based, mixed-methods formative evaluation were analysed against a framework that defines supply and demand-side dimensions to access. The evaluation included 24 geographically bounded 'sentinel sites' that included a range of primary care service organisations. It drew on administrative data on service utilisation, focus group and interview data on community members' and service providers' perceptions of chronic illness care between 2010 and 2013.SETTING: Urban, regional and remote areas of Australia that have relatively large Indigenous populations.PARTICIPANTS: 670 community members participated in focus groups; 374 practitioners and representatives of regional primary care support organisations participated in in-depth interviews.RESULTS: The programme largely addressed supply-side dimensions of access with less focus or impact on demand-side dimensions. Application of the access framework highlighted the complex inter-relationships between dimensions of access. Key ongoing challenges are achieving population coverage through a national programme, reaching high-need groups and ensuring provision of ongoing care.CONCLUSIONS: Strategies to improve access to chronic illness care for this population need to be tailored to local circumstances and address the range of dimensions of access on both the demand and supply sides. These findings highlight the importance of flexibility in national programme guidelines to support locally determined strategies

Conceptualizing the adventure-sports coach

As a comparatively recent development, the adventure-sports coach struggles for a clear and distinct identity. The generic term ‘instructor’ no longer characterizes the role and function of this subgroup of outdoor professionals. Indeed, although the fields of adventure/outdoor education and leadership are comparatively well researched, the arrival of this ‘new kid on the block’ appears to challenge both the adventure-sports old guard and traditional views of sports coaching. In an attempt to offer clarity and stimulate debate, this paper attempts to conceptualize the adventure-sports coach in the context of the existing roles in the field and current motivations for activity in the outdoors. We identify issues that are specific to the adventure-sports coach while also recognizing those skills and competencies shared with other professionals, both in the adventure sports profession and traditional sports coaching fields. Based on this review, we offer a conceptual model which may be used to focus debate, stimulate research and, at a possible later stage, to underpin accreditation, training and professional development

Effects of Catalysts on the Preparation and Properties of Organometallic Compounds

It has been shown that the formation of RM compounds can be accelerated photochemically and by the use of varying quantities of selected reagents. Also, the rates of reaction between RM compounds and various reactants can be accelerated by small quantities of catalysts like cuprous chloride. For example, the time required for complete interaction of benzonitrile and phenylmagnesium bromide is reduced significantly by the addition of small amounts of compounds like cuprous chloride. It appears that these particular catalysts function by first forming very unstable organometallic compounds like phenylcopper, in the case mentioned. Then the phenylcopper decomposes to give copper and diphenyl, probably via free phenyl radicals which then set up chain reactions

Design and performance of ropes for climbing and sailing

Ropes are an important part of the equipment used by climbers, mountaineers, and sailors. On first inspection, most modern polymer ropes appear similar, and it might be assumed that their designs, construction, and properties are governed by the same requirements. In reality, the properties required of climbing ropes are dominated by the requirement that they effectively absorb and dissipate the energy of the falling climber, in a manner that it does not transmit more than a critical amount of force to his body. This requirement is met by the use of ropes with relatively low longitudinal stiffness. In contrast, most sailing ropes require high stiffness values to maximize their effectiveness and enable sailors to control sails and equipment precisely. These conflicting requirements led to the use of different classes of materials and different construction methods for the two sports. This paper reviews in detail the use of ropes, the properties required, manufacturing techniques and materials utilized, and the effect of service conditions on the performance of ropes. A survey of research that has been carried out in the field reveals what progress has been made in the development of these essential components and identifies where further work may yield benefits in the future

An assessment of the strength of knots and splices used as eye terminations in a sailing environment

Research into knots, splices and other methods of forming an eye termination has been limited, despite the fact that they are essential and strongly affect the performance of a rope. The aim of this study was to carry out a comprehensive initial assessment of the breaking strength of eye terminations commonly used in a sailing environment, thereby providing direction for further work in the field. Supports for use in a regular tensile testing machine were specially developed to allow individual testing of each sample and a realistic spread of statistical data to be obtained. Over 180 break tests were carried out on four knots (the bowline, double bowline, figure-of-eight loop and perfection loop) and two splices (three-strand eye splice and braid-on-braid splice). The factors affecting their strength were investigated. A statistical approach to the analysis of the results was adopted. The type of knot was found to have a significant effect on the strength. This same effect was seen in both types of rope construction (three-strand and braid-on-braid). Conclusions were also drawn as to the effect of splice length, eye size, manufacturer and rope diameter on the breaking strength of splices. Areas of development and further investigation were identified

Exploring cross-sectional associations between common childhood illness, housing and social conditions in remote Australian Aboriginal communities

Background:\ud There is limited epidemiological research that provides insight into the complex web of causative and moderating factors that links housing conditions to a variety of poor health outcomes. This study explores the relationship between housing conditions (with a primary focus on the functional state of infrastructure) and common childhood illness in remote Australian Aboriginal communities for the purpose of informing development of housing interventions to improve child health.\ud \ud Methods:\ud Hierarchical multi-level analysis of association between carer report of common childhood illnesses and functional and hygienic state of housing infrastructure, socio-economic, psychosocial and health related behaviours using baseline survey data from a housing intervention study.\ud \ud Results:\ud Multivariate analysis showed a strong independent association between report of respiratory infection and overall functional condition of the house (Odds Ratio (OR) 3.00; 95%CI 1.36-6.63), but no significant association between report of other illnesses and the overall functional condition or the functional condition of infrastructure required for specific healthy living practices. Associations between report of child illness and secondary explanatory variables which showed an OR of 2 or more included: for skin infection - evidence of poor temperature control in the house (OR 3.25; 95%CI 1.06-9.94), evidence of pests and vermin in the house (OR 2.88; 95%CI 1.25-6.60); for respiratory infection - breastfeeding in infancy (OR 0.27; 95%CI 0.14-0.49); for diarrhoea/vomiting - hygienic state of food preparation and storage areas (OR 2.10; 95%CI 1.10-4.00); for ear infection - child care attendance (OR 2.25; 95%CI 1.26-3.99).\ud \ud Conclusion:\ud These findings add to other evidence that building programs need to be supported by a range of other social and behavioural interventions for potential health gains to be more fully realised