The transition from pediatric to adult health care services for young adults with a disability : an ethical perspective

Young children with disabilities and their carers or parents tend to form a long-term dependent relationship with a paediatrician throughout childhood At some stage when the young person with a disability reaches early adulthood, the relationship is severed This paper draws upon recent research undertaken by the authors that describes the difficulties experienced by young people with disabilities as they go through the transition from paediatric care to adult mainstream health care services. The purpose of this article is to present the argument that the dependent, paternalistic relationship that tends to exist between young people with disabilities (and/or their carers) and paediatricians throughout childhood does not facilitate the successful negotiation of adult mainstream health care services, nor optimally promote the well-being of these young people with disabilities. It is proposed that the promotion of autonomy (or self-determination) via a well planned transition program will increase the likelihood that young adults with disabilities and/or their carers will be empowered to successfully negotiate the current mainstream health care system in Australia, and will enhance the well-being of young adults with disabilities.<br /

Mismanagement of delerium places patients at risk

Objective: This paper discusses the problem of delirium and the challenges of accurately assessing, preventing and managing patients with delirium in an acute care setting.Primary Argument: Acute confusion, also known as delirium, is misdiagnosed and under-treated in up to 94% of older patients in hospitals. With the ageing population, this problem will increase dramatically in the Australian setting. Managing patients with delirium is challenging not only for the management of their basic nursing care needs but also because they are prone to adverse events such as falls and medication problems. In order to address this issue it is vital that health care professionals routinely assess patients for signs of delirium. The current \u27gold standard\u27 for assessing delirium is the use of the Confusion Assessment Method (CAM) which has been developed based on the diagnostic criteria set by the Diagnostic and Statistical Manual of Mental Disorders DSM-IV and can be used by non-psychiatrists. Further, increased attention should be given to the prevention and management of delirium and the use of orientation and validation therapy.Conclusion: Research indicates that early identification and intervention can help to limit any negative effects or adverse events. Increasing knowledge and awareness of early detection and efficient management of delirium is the first step toward prevention.<br /

Sink or swim- ageing in Australia

As the number of people under the age of 65 declines, the number over 65 will double in the next half century. By 2031, it is estimated those over 65 will account for more than a quarter of the Australian population. The fastest rate of growth will be in the over-85-years category, projected to double over the next 20 years and to triple over 50 years to include 2.3 million people. Health care providers cannot afford to wait for the inevitable crises this vast demographic shift will provoke. To meet these future demands, educational and health care institutes should consider establishing interdisciplinary think-tanks for multidisciplinary research, policy development and innovations in aged care and health service delivery.Aust Health Rev 2005: 29(2): 146-150<br /

The Supreme Court: New Hope for the Restoration of Federalism

The recent philosdphical shift of the Supreme Court toward a more restrained or conservative approach to constitutional adjudication brings with it hope for the revitalization of federalism as a constitutional and political principle

Recommendations From the Field: Individual Development Accounts as Part of a Universal Asset-Building System

Recommendations From the Field: Individual Development Accounts as Part of a Universal Asset-Building Syste

Promoting the health and well being of older carers : a proactive strategy

Research has indicated that carers are concerned about their ageing status, their deteriorating health and their ability to continue to care for their dependants. Given that the health care system will become increasingly reliant on carers the health care needs of carers should be a concern for all health care professionals. This paper describes the first stage of a project designed to enhance older carers health promotion knowledge and skills and improve their health promoting behaviours. This stage investigated the mental and physical health status of older carers. It also sought information on older carers\u27 levels of participation in health related and social activities and identification of barriers to participation in these types of activities. The results highlighted that carers responding to the survey experienced compromised physical and mental health. Many carers reported being unable to participate in social and health-type activities as they were unable to leave the care recipient. Of note, is that carers identified their own mental fragility and felt they needed further emotional support.<br /

Health status and participation in a range of activities in an Australian community

Introduction: The aim of the research was to determine the relationship between levels of participation in a community and self-assessed health status of people in a rural and regional setting.Method: A cross-sectional design, using a mailed, self-administered questionnaire was used. Questionnaires were mailed to a random sample of people aged 18 years and over who were registered on the electoral roll of a regional city and rural area, the Barwon and Otway regions of Victoria, Australia. The sample consisted of 1752 participants: 990 females (57%), 739 males (42%) and 23 sex undisclosed (1%). The range of participants was 18-98 years, and the mean age was 50.53 years (SD = 17.19).Results: Self-assessed physical and mental health were measured using the SF-12 scale. Participants with low incomes, and those with low self-assessed physical and mental health scores, were significantly more likely than other participants to agree with one or more of the social isolation items, indicating that they experienced some social isolation. Low levels of participation in social, sports, leisure or support activities were associated with low self-assessed physical and mental health. Disengagement with the local community was associated with low levels of self-assessed mental health. While younger people were more likely than older people to participate in social, sports, leisure or support activities, they were less involved as members of their community. Females were more likely than males to have been involved in five or more sports, leisure or support activities. Participation in civic activities was associated with high income. Levels of participation in the four different types of activities were combined (social activities, sport, leisure or support activities, community and group activities, and civic activities). Participants classified as low participators were more likely to be older participants, to have a low income and to have low scores for both physical and mental health.Conclusions: An association was found between health and community participation in a range of activities, and between health and engagement with the community in this rural and regional population. These findings are consistent with those reported from similar research with a metropolitan population sample. The current research suggests that the groups of people of most concern in terms of low participation rates, are people who have low incomes, people aged over 65 years, people who may be defined as possessing poor physical health and people who may be defined as possessing poor mental health. The relationship between age, community participation and health is complex and needs further exploration because it is not known whether poor health reduces community participation or whether reduced community participation results in poor health. However, current research suggests that developing and implementing strategies to promote people\u27s engagement with and involvement in their local community is one important way of promoting the health of the community as a whole.<br /

Assessing and evaluating student contribution to electronic discussions

Tutors in face-to-face teaching and learning contexts, evaluate students\u27 participation in order to provide assessment that contributes towards the students\u27 final grade. Similarly, in on-line learning environments, there is a perceived need to reward the quantity and quality of student interactivity. However, the different nature of the context presents new challenges. Specifically, without the visual cues and immediate feedback, so important in face-to-face communication, the evaluation of students\u27 contributions to on-line learning activities and interaction demands new instructional and assessment skills. A unit of study at an Australian university, using computer mediated communication, was reviewed to address questions related to the appropriateness of an on-line evaluative process.<br /

Systematic review of dyadic psychoeducational programs for persons with dementia and their family caregivers

Aims and Objectives Synthesising evidence for effects of dyadic psychoeducational support programs on both people with dementia and their caregivers\u27 health and well-being. Background There is an increasing need for psychoeducational support programs for people with dementia and their caregivers; therefore, it is important to identify the benefits and practical implications of the programs on the dyads. Methods Guided by Joanna Briggs Institute (JBI) methodology, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, a systematic search of literature was conducted on dyadic psychoeducational programs published in English between January 2012 and January 2021 from four electronic databases. Results Twenty-four studies evaluating 27 psychoeducational programmes were included in this review. Programs varied in activity types, intensity and duration. Outcome effects on people with dementia were grouped into seven categories: quality of life, cognitive function, psychological and mental health, physical health, changed behaviours, communication and relationship, institutionalisation or mortality. Outcome effects on caregivers were grouped into six: psychological and mental health, quality of life, impact of caregiving, communication and relationship, physical health, and competency. Dyadic psychoeducational programs which were goal oriented and tailored to address individual needs had consistent benefits on various aspects of health and quality of life for the dyads. Conclusions Multicomponent psychoeducational support programs combined with addressing individual needs, identifying goals and providing support to attain specific outcomes are recommended. Given the progressive deterioration of people with dementia, and the increased needs for homecare by family members, delivering long-term, support programs are recommended to maintain the positive effects on the dyads. Relevance to Clinical Practice The findings contribute to dementia-care provision and policy making and inform the development of person-centred interventions and governance. Patient or Public Contribution This systematic review was a part of a larger service evaluation project which involved a dementia consumer advisory group