Signs of progress in the Australian post-2000 COPD experience, but some old problems remain

This study aims to describe current trends in Australia regarding chronic obstructive pulmonary disease (COPD) mortality and morbidity rates, and in its treatment and prevention from 2000 to 2010. The study’s purpose is to better define future directions in curbing COPD. People with COPD and their caregivers who attend patient support groups (n = 21), pulmonary rehabilitation group coordinators (n = 27) within Victoria, and the Australian Lung Foundation provided informed feedback. COPD was a leading underlying cause of death in both sexes during these years. Nevertheless, mortality rates declined from 1980 to 2007, with rates for males almost halving. Its prevalence has also substantially declined. Smoking rates have declined in age groups over 40 years old in both sexes. The COPD-X Plan provides evidence-based guidelines for the management of COPD. Many government, professional, and community initiatives have been recently implemented to promote the Plan. Two studies—one conducted before and one conducted after the publication of the COPD-X Plan—report some progress, but there are still very considerable departures from evidence-based practice. The Australian Lung Foundation estimates that only 1% of patients who could benefit from pulmonary rehabilitation programs have suitable access to such programs. A common priority for all informants was that there needed to be greater awareness of—and a more positive orientation to—COPD in both the Australian and health professional communities. The study concluded that substantial reductions in COPD and smoking cessation rates contrast with more limited progress toward adopting other aspects of evidence-based practice. The “good news” story concerning reductions in COPD disease with improving smoking cessation rates could form the basis for suitable media campaigns

Investigating the aesthetic character of Australian urban Indigenous art: a socio-political fusion

Two distinct geographies inform the practice and production of contemporary Australian Indigenous art: one is desert-based and remote; the other is urban-based (including regional centres). Art historically, urban Indigenous art has been overshadowed by the attention given to desert and remote Indigenous art. From the mid to late 1980s, however, urban Indigenous art built in momentum and proliferated, as its artists channelled in their work, to varying degrees, a connection with matters concerning Indigenous and non-Indigenous relations that were socio-political in nature. Artists interrogated Australia’s colonial paradigm. This thesis investigates the development of the urban Indigenous art movement, for a duration of more than thirty years, establishing how the socio-political connection has significantly motivated its aesthetic character. The research questions bring focus to the definition of a socio-political aesthetic, how artists portray it, and why it is central to the movement of urban Indigenous art. Decolonial theory provides a useful methodological framework for understanding Indigenous perspectives and Indigenous voices that are shown to ideologically underpin this socio-political aesthetic in urban Indigenous art. In employing this theory for analysis, four key objectives guiding artists are evident within the period surveyed: empowerment; defying colonial representation; recovering the Indigenous subject through the analysis of colonialism; and self-determination. Expressions of the socio-political aesthetic within urban Indigenous art are found to be numerous. For some artists, expression is equivalent to participation within the socio-political field. For others, expression operates on sensate and affective levels. Subversion and resistance to previous colonial modes of representing Indigeneity feature highly, as do the processes of destabilisation and undermining of colonial knowledge and power systems. Some artists harness key socio-political events and respond to these using autobiography or collective and cultural memory; others recover Indigenous perspectives in order to achieve historical transparency. Critique, criticality and collectivity are also strategies used to execute a socio-political aesthetic, with Indigenisation of the curated space occupying a key role in dissemination. The thesis contends that not only is a socio-political aesthetic intrinsic to urban Indigenous art, but that such an aesthetic manifests as socio-political agency. Urban Indigenous artists present contemporary art that is authoritative, delivering the message that contemporary Australian Indigenous culture, identity and representation should be managed from a self-determined position that is distinctly Indigenous.Thesis (Ph.D.) -- University of Adelaide, School of Humanities, 201

How do case managers spend time on their functions and activities?

Background: Case management has been a widely accepted approach to practice in various care settings. This study aimed to explore how community aged care case managers allocated their time to case management functions, how frequently they performed specific case management activities, and what factors influenced the frequency of their activities. Methods: The study involved 154 survey participants, or 17.1 % of the target case managers in the State of Victoria, Australia. Key information collected included participants’ socio-demographic characteristics, proportions of time allocated to six core case management functions, and frequency ratings of 41 specific activities within seven case management functions. Ordinal regression analyses were performed to determine significant factors associated with participants’ frequency ratings of their activities. Results: Participants allocated the largest proportion of time to care coordination (22.0 %), and the smallest proportion of time to outcome evaluation (8.0 %). Over 70 % of the participants assigned high frequency ratings to 31 of the 41 case management activities. The remaining ten activities, including all four outcome evaluation activities, three needs assessment activities, one care planning activity, one care coordination activity, and one general functions-related activity were less commonly performed very frequently. The regression analyses indicated that some case manager and client factors were significantly associated with frequency ratings of nine of the ten activities aforementioned. The two main findings of the regression analyses were: First, emphasising achieving more case management goals was significantly associated with higher frequency of three outcome evaluation activities; second, longer work experience was significantly associated with higher frequency of one care coordination activity and one outcome evaluation activity. Conclusions: The frequent performance of most case management activities and relative absence of factors influencing their frequency suggest a uniformity of practice in community aged care case managers’ practice. What is not clear is whether the frequency of these activities (in particular less frequent performance of outcome evaluation activities) conforms to expectations

Managing mood disorders in patients attending pulmonary rehabilitation clinics

Background: There is good evidence for the positive benefits of pulmonary rehabilitation (PR) in the prevention of hospital admissions, lower mortality, and improved health-related quality of life. There is also increasing evidence about the impact of PR on mental health and, in particular, mood disorders. We aimed to identify how depression in chronic obstructive pulmonary disease (COPD) patients in Victoria, Australia, is being managed in PR, to identify the prevalence of depressive symptoms among COPD patients who attend PR, and to determine whether patients with depressive symptoms or anxiety symptoms dropped out of PR early. Method: Of 61 PR clinics, 44 were invited and 22 agreed to participate. Telephone interviews were conducted to see how depression and anxiety in COPD patients were being recognized and managed in these clinics. A total of 294 questionnaires were distributed to patients by clinic coordinators to determine the prevalence of anxiety/depression, as measured by the Hospital Anxiety and Depression Scale. Coordinators were contacted to provide information on whether respondents dropped out of rehabilitation early or continued with their treatment at 2–4 months post program. Results: Seven clinics were not aware of local guidelines on assessment/treatment/management of mood. Four clinics did not use any screening tools or other aids in the recognition and management of depression and/or anxiety. Overall, eight clinics participating in this study requested advice on suitable screening tools. The patient survey indicated that the mean depression score on the Hospital Anxiety and Depression Scale was 5.0 (standard deviation 3.0, range 1–13). The mean anxiety score was 5.5 (standard deviation 3.4, range 0–18). There was no evidence of a link between failure to complete rehabilitation and depression or anxiety scores, as only three of 105 patients failed to complete their rehabilitation. Discussion: Awareness of management guidelines for depression and anxiety in COPD patients was variable across the clinics recruited into our study. We found no link between compliance with rehabilitation and depression, but our sample had limitations. Conclusion: Future research needs to investigate how best to encourage more use of available guidelines regarding integrating psychological and psychosocial support to supplement the exercise and education that are currently offered routinely by all PR clinics studied in Victoria, Australia

Impact of standalone and embedded telephone triage systems on after hours primary medical care service utilisation and mix in Australia

BACKGROUND: The Australian government sponsored five local trials aimed at addressing problems in after hours (AH) primary medical care (PMC). The study's objective was to determine if the four trials, where telephone triage was the sole innovation, led to a reduction in AH service utilisation and change in service mix towards AH GP clinics. Changes in utilisation and mix of AH GP clinic and home visits, ED and ambulance use were monitored in the trial areas, and in a national sample to adjust for the effects of secular trend. Pre- and post-trial telephone surveys of two separate random samples of approximately 350 AH PMC user households in each area were conducted. RESULTS: Some types of AH PMC use became more frequent in both of the standalone services using nurse-administered proprietary call centre software, which were aimed at better addressing population need (Statewide call centre; Regional call centre). Service use overall (95%CI: 1.03–1.83) and GP clinic use (95%CI: 1.07–2.00) increased in the metro area of the Statewide call centre and in GP clinic (95%CI: 1.04–2.14) and home visits (95%CI: 1.03–3.91) in the non-metro area of the Regional call centre. Service mix only changed in the non-metro area of the Regional call centre with increased contact in GP home visits (95%CI: 1.02–4.38). Levels of use remained unchanged in both embedded services using other than proprietary software, which were established to support the GP workforce (Deputising service; Local triage centre). Service mix only changed in the Deputising service with a change away from AH GP clinics in both contact (95%CI: 0.39–0.97) and frequency (95% CI: -2.12 – -0.7). CONCLUSION: Bearing in mind limitations in estimating AH PMC utilisation levels and mix, it is concluded that the impacts of telephone triage were generally smaller in Australia than reported elsewhere. There were different impacts on levels of service utilisation and service mix in standalone call centres and embedded services. Impacts of telephone triage on service utilisation and mix are influenced by the type of telephone triage offered, the goals of the agency providing the service, as well as local factors. (345 words

Comparison of the uptake of health assessment items for Aboriginal and Torres Strait Islander people and other Australians: Implications for policy

BACKGROUND: Health Assessment (HA) items were introduced in 1999 for Aboriginal and Torres Strait Islander people aged at least 55 years and all Australians aged over 75 years. In 2004 a new item was introduced for HAs among adult Aboriginal and Torres Strait Islander people aged 15–54 years. The new item has been applauded as a major policy innovation however this enthusiasm has been tempered with concern about potential barriers to its uptake. In this study we aim to determine whether there are disparities in uptake of HA items for Aboriginal and Torres Strait Islander people compared to other Australians. METHOD: The analysis was based on Health Insurance Commission data. Indigenous status was ascertained based on the item number used. Logistic regression was used to compare uptake of HA items for older people among Aboriginal and Torres Strait Islander people compared to other Australians. Adjustments were made for dual eligibility. Uptake of the HA items for older people was compared to the uptake of the new item for Aboriginal and Torres Strait Islander people aged 15–44 years. RESULTS: Our analyses suggest a significant and persistent disparity in the uptake of items for older patients among Aboriginal and Torres Strait Islander people compared to other Australians. A similar disparity appears to exist in the uptake of the new adult Aboriginal and Torres Strait Islander HA item. CONCLUSION: Further engagement of primary care providers and the community around the uptake of the new HA items may be required to ensure that the anticipated health benefits eventuate

How Significant is Partnership Formation in Area-Based Projects to Increase Parental Attendance at Maternal and Child Health Services?

Objectives: In this study, we assess the importance of area-based partnerships in an initiative to improve access to Maternal and Child Health (MCH) services (known as Best Start) in socially disadvantaged communities in Victoria, Australia. Methods: The study assessed changes in MCH attendance rates, parental attitudes and local partnership formation before and after the introduction of Best Start projects. Partners involved in Best Start projects were surveyed regarding the extent of local partnership formation (before 54; after 84). Data was collected for MCH attendance using routine records for Best Start with MCH projects (before 1,739; after 1437) and the rest of the State (before 45,497; after 45,953). Two cross-sectional surveys of parents of 3-year old children were used to assess changes in parent's knowledge about, and confidence in using relevant services as well as parental confidence more generally (before 1666; after 1838). Results: Best Start was significantly associated with improving: levels of partnership formation (5 of 7 relevant factors) attendance at the 3.5 year MCH visit in Best Start Sites with MCH projects between 2001/02-2004/05. parent's access to information (partnership effect); confidence about attending the 3.5 year MCH visits (partnership effect); and overall parental confidence (project effect only). Conclusion: Best Start improves participation in the MCH attendance. This is related most directly to improving parent's access to information and overall parental confidence either through local partnership or direct project effects

Impact of telephone triage on emergency after hours GP Medicare usage: a time-series analysis

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Risk of death or hospital admission among community-dwelling older adults living with dementia in Australia

Background: Older people living with dementia prefer to stay at home to receive support. But they are at high risk of death and/or hospital admissions. This study primarily aimed to determine risk factors for time to death or hospital admission (combined) in a sample of community-dwelling older people living with dementia in Australia. As a secondary study purpose, risk factors for time to death were also examined. Methods. This study used the data of a previous project which had been implemented during September 2007 and February 2009. The original project had recruited 354 eligible clients (aged 70 and over, and living with dementia) for Extended Aged Care At home Dementia program services during September 2007 and 2008. Client information and carer stress had been collected from their case managers through a baseline survey and three-monthly follow-up surveys (up to four in total). The principal data collection tools included Global Deterioration Scale, Modified Barthel Index, Instrumental-Dependency OARS, Adapted Cohen-Mansfield Agitation Inventory, as well as measures of clients' socio-demographic characteristics, service use and diseases diagnoses. The sample of our study included 284 clients with at least one follow-up survey. The outcome variable was death or hospital admission, and death during six, nine and 16-month study periods. Stepwise backwards multivariate Cox proportional hazards analysis was employed, and Kaplan-Meier survival analysis using censored data was displayed. Results: Having previous hospital admissions was a consistent risk factor for time to death or hospital admission (six-month: HR = 3.12; nine-month: HR = 2.80; 16-month: HR = 2.93) and for time to death (six-month: HR = 2.27; 16-month: HR = 2.12) over time. Previously worse cognitive status was a consistent risk factor over time (six- and nine-month: HR = 0.58; 16-month: HR = 0.65), but no previous use of community care was only a short-term risk factor (six-month: HR = 0.42) for time to death or hospital admission. Conclusions: Previous hospital admissions and previously worse cognitive status are target intervention areas for reducing dementia clients' risk of time to death or hospital admission, and/or death. Having previous use of community care as a short-term protective factor for dementia clients' time to death or hospital admission is noteworthy

Wavelength-induced shedding frequency modulation of seal whisker inspired cylinders

The spanwise undulated cylinder geometry inspired by seal whiskers has been shown to alter shedding frequency and reduce fluid forces significantly compared to smooth cylindrical geometry. Undulation wavelength is systematically investigated in order to explore its effect on unsteady lift force and shedding frequency. Prior research has parameterized the whisker-inspired geometry and demonstrated the relevance of geometric variations on force reduction properties. Among the geometric parameters, undulation wavelength was identified as a significant contributor to forcing changes. To analyze the effect of undulation wavelength, a thorough investigation isolating changes in wavelength is performed to expand upon previous research that parameterized whisker-inspired geometry and the relevance of geometric variations on the force reduction properties. A set of five whisker-inspired models of varying wavelength are computationally simulated at a Reynolds number of 250 and compared with an equivalent aspect ratio smooth elliptical cylinder. Above a critical nondimensional value, the undulation wavelength reduces the amplitude and frequency of vortex shedding accompanied by a reduction in oscillating lift force. Frequency shedding is tied to the creation of wavelength-dependent vortex structures which vary across the whisker span. These vortices produce distinct shedding modes in which the frequency and phase of downstream structures interact to decrease the oscillating lift forces on the whisker model with particular effectiveness around the wavelength values typically found in nature. The culmination of the these location-based modes produces a complex and spanwise dependent lift frequency spectra at those wavelengths exhibiting maximum force reduction. Understanding the mechanisms of unsteady force reduction and the application of this geometry to vibration tuning and passive flow control for vortex-induced vibration (VIV) reduction