Key issues in rural health: perspectives of health service providers in Queensland

The Centre for Rural and Remote Area Health (CRRAH) held interactive research workshops in eight towns in Southern Queensland. The purpose of the workshops was to determine what health providers considered were major issues affecting their service and for these results to inform future research strategy of CRRAH. Over 150 organisations identified as either providing health services or having a significant interest in health provision in one or more of the targeted towns were invited to attend. The workshops used the nominal group technique to identify what the participants considered were key health issues in the geographical area in which they worked. These issues were then prioritised by the participants. Thematic analysis of the issues generated a ranking of themes by importance. Results were compared with a similar exercise undertaken in 2003. Participants from organisation directly involved with health care were complemented at the workshops by representatives from local government, the police service and church groups. A total of 85 participants representing 47 services and 41 different organisations attended the eight workshops. Issues generated by the participants were pooled into seventeen themes. Workforce issues were by far the major concern of health providers. Recruitment and retention of health workers were a major concern. The other four highest ranked themes across all workshops were mental health, access to health services, perceptions and expectations of consumers of health services and interagency cooperation. Aged care was an additional theme that generated a lot of concern at several of the workshops. The workshops provided important information to CRRAH for developing research strategy. Additionally, several new alliances among health providers were developed which will support sharing of information and resources. The workshops enabled rural and remote organisations to meet and identify the key health issues and supported research planning. Much need alliances among health providers were forged and collaborative research avenues are being explored. The workshop forum is an excellent means of information exchange

Placemaking from Interstitial Spaces: Participatory planning and collaborative community design as strategies to revitalize a service alleyway in Montreal (Bishop/Mackay)

This project explores participatory planning and community design methodologies (i.e. pattern language design, placemaking, community planning charrettes, planning-in-situ, open planning and peer to peer urbanism) to revitalize a service alleyway in downtown Montreal. The objective of this project is to democratize planning and urban design practices and to engage ordinary citizens in the planning of their own spaces. After a series of visioning workshops, brainstorming sessions and a community planning charrette, this project incorporates inputs from stakeholders, students and ordinary citizens into a collaborative urban design project. The project proposes interventions such as a woonerf, a planning committee, a cubic/fractal scaffolding structure, art murals and wall projections (among others). With the objective of encouraging future adaptations and transformations, this project is published under a Creative Commons license. Adopt and adapt these ideas (but cite and acknowledge accordingly)

A novel Alzheimer disease locus located near the gene encoding tau protein

This is the author accepted manuscript. The final version is available from the publisher via the DOI in this recordAPOE ε4, the most significant genetic risk factor for Alzheimer disease (AD), may mask effects of other loci. We re-analyzed genome-wide association study (GWAS) data from the International Genomics of Alzheimer's Project (IGAP) Consortium in APOE ε4+ (10 352 cases and 9207 controls) and APOE ε4- (7184 cases and 26 968 controls) subgroups as well as in the total sample testing for interaction between a single-nucleotide polymorphism (SNP) and APOE ε4 status. Suggestive associations (P<1 × 10-4) in stage 1 were evaluated in an independent sample (stage 2) containing 4203 subjects (APOE ε4+: 1250 cases and 536 controls; APOE ε4-: 718 cases and 1699 controls). Among APOE ε4- subjects, novel genome-wide significant (GWS) association was observed with 17 SNPs (all between KANSL1 and LRRC37A on chromosome 17 near MAPT) in a meta-analysis of the stage 1 and stage 2 data sets (best SNP, rs2732703, P=5·8 × 10-9). Conditional analysis revealed that rs2732703 accounted for association signals in the entire 100-kilobase region that includes MAPT. Except for previously identified AD loci showing stronger association in APOE ε4+ subjects (CR1 and CLU) or APOE ε4- subjects (MS4A6A/MS4A4A/MS4A6E), no other SNPs were significantly associated with AD in a specific APOE genotype subgroup. In addition, the finding in the stage 1 sample that AD risk is significantly influenced by the interaction of APOE with rs1595014 in TMEM106B (P=1·6 × 10-7) is noteworthy, because TMEM106B variants have previously been associated with risk of frontotemporal dementia. Expression quantitative trait locus analysis revealed that rs113986870, one of the GWS SNPs near rs2732703, is significantly associated with four KANSL1 probes that target transcription of the first translated exon and an untranslated exon in hippocampus (P≤1.3 × 10-8), frontal cortex (P≤1.3 × 10-9) and temporal cortex (P≤1.2 × 10-11). Rs113986870 is also strongly associated with a MAPT probe that targets transcription of alternatively spliced exon 3 in frontal cortex (P=9.2 × 10-6) and temporal cortex (P=2.6 × 10-6). Our APOE-stratified GWAS is the first to show GWS association for AD with SNPs in the chromosome 17q21.31 region. Replication of this finding in independent samples is needed to verify that SNPs in this region have significantly stronger effects on AD risk in persons lacking APOE ε4 compared with persons carrying this allele, and if this is found to hold, further examination of this region and studies aimed at deciphering the mechanism(s) are warranted

The effect of item and relational processing on incidental long-term memory for order

[Abstract]: While stimulus similarity and levels of processing are often manipulated in long-term episodic tasks that test item memory, little attention has been paid to how these variables affect long-term memory for temporal order. The effects of these variables on order memory was tested using a task that required the reconstruction of the initial presentation order of short lists after a filled delay. Initial learning of the lists always involved incidental processing procedures ranging from low-level item processes to high-level relational processes. In all experiments, changes in stimulus similarity and processing tasks had similar effects on order memory to the effects found in tasks involving long-term item memory. An interpretation of the data was proposed, based upon the joint contribution of distinctive item and relational processing, and poor encoding of order information with shallow processing. It was concluded that item information must play a significant role in the long-term order reconstruction task

A systematic review of psychometric evidence and expert opinion regarding the assessment of faecal incontinence in older community-dwelling adults

[Abstract]: Objectives: This review had two objectives: (i) to determine what is required in an assessment of faecal incontinence issues for older community-dwelling adults; and (ii) to determine the psychometric tools most effective for assessment of faecal incontinence in older community-dwelling adults. Inclusion criteria: For the review of psychometric tools, studies were included if they were concerned with people living in the community, included a significant proportion of the sample aged 65 years or over, and either examined psychometric properties of assessment tools or assessed sensitivity of assessment tools to non-surgical interventions available in the community setting. For the review of expert opinion, the search was limited to expert opinion provided by an expert in faecal incontinence that related to community-based assessment. Only articles published in English were eligible for inclusion and no limits were placed on publication dates. Search strategy: An initial search of Medline and CINAHL databases identified terminology frequently used in the literature with regard to assessment of faecal incontinence. An extensive search was then undertaken using all identified key words and index terms. The third step involved a search of reference lists and bibliographies of all relevant articles. Methodological quality: All identified studies that met the inclusion criteria were assessed for methodological validity in the case of studies considered for inclusion in the psychometric review. Validity of expert text was also assessed prior to it being included in the review. Results: The final search strategy identified approximately 7000 references. Full-text versions of 144 references were critically appraised for inclusion in the review. Of these, 25 sources were included in the review of expert opinion and 16 in the review of psychometric properties. In the review of expert opinion, 254 conclusions were extracted for synthesis. The 31 thematic categories were organised under five major themes: History-taking, bowel assessment, psychosocial aspects, physical examination and specialist referral. From the sources that survived critical appraisal, 52 conclusions relating to psychometric properties of assessment tools were derived. There was limited, if any, analysis of psychometric properties for the majority of assessment tools. The Wexner and Vaizey symptom severity scales demonstrated acceptable test–retest reliability and convergent validity. The Fecal Incontinence Quality of Life Scale (FIQLS) demonstrated reasonable reliability and good convergent and criterion-related validity. There was, however, some evidence questioning its discriminant validity. Conclusions: This systematic review represents an important first stage in developing guidelines for assessment of faecal incontinence in community-dwelling older people. Assessment should be comprehensive in nature. Gaps in expert opinion are evident regarding issues such as assessment of cognitive decline and specialist referral. Continence advisors need to be appropriately trained in using and interpreting results from assessment tools and conducting physical examinations. Although studies in the review of psychometric properties suffer from limitations such as inadequate sample sizes, the Vaizey and Wexner scales would appear to be the tools of choice. The FIQLS is clearly the tool of choice at this stage for measuring faecal incontinence quality of life. Further validation of tests used in faecal incontinence assessments is required

The baby-friendly hospital initiative and breastfeeding duration: relating the evidence to the Australian context

The Baby Friendly Hospital Initiative (BFHI) is an effort by UNICEF and WHO to improve society's health through promoting, protecting and supporting breastfeeding. The key strategy in this initiative is in transforming care of newborn infants in maternity hospitals. The recently published Australian Breastfeeding Leadership Plan (ABLP)1 strongly advocates, as part of its overall plan to increase breastfeeding rates in Australia, the use of public funding and support to implement the BFHI in Australian hospitals. The purpose of this review is to present evidence related to the BFHI's impact upon breastfeeding duration, comment upon the relevance of this evidence to the Australian context, with a view to engendering discussion about the value of the BFHI in an environment where enhancement of breastfeeding duration appears to be the primary goal

Australian nurses access and attitudes to information technology - a national survey

[Abstract]: Competencies by nurses in information technology (IT) are essential to health care in Australia yet data suggest deficiencies in access and use. A study commissioned by the Australian Government aimed to determine the extent of access and use and the barriers to the use of IT among nurses across Australia. A survey was distributed to 10,000 members of the Australian Nursing Federation with a 43% overall response rate. Fewer than 15% of nurses did not use computers as part of their work. The greatest use was for client records, patient pathology and radiology results and professional development. IT uptake in health is supported by nurses who are, however frustrated by limitations to access and software that is not fit for purpose. A lack of confidence in using IT was noted by many nurses. Fewer than 20% had received pre-registration training in any aspect of IT and only 30% post registration. In addition to training, high work load, numbers of computers and inadequate technical support were the major barriers to computer use

Aged care nursing in Queensland - the nurses' view

Aims and objectives: Through comparison of two studies undertaken three years apart the opinions of nurses working in aged care facilities in Queensland were determined. Results will support policy planning for the Queensland Nurses Union. Background: An ageing population in Australia is placing increased demands on residential aged care facilities. In Queensland the national situation is exacerbated by an influx of retirees from other states and territories. The ongoing problem of shortages of nurses in the workforce may be addressed by gaining further insight into the nurses’ own views of their conditions and experiences. Methods: 1000 nurses working in public and privately owned residential aged care facilities were surveyed by postal questionnaire in 2004. Results were compared with data collected in an identical study in 2001. Results: Respondents offered their opinions on working hours and conditions, professional development and experiences in nursing. The predominately female aged care nursing workforce is aging. Reported work place violence has increased substantially since 2001. Some improvements are reported in staff numbers, skill mix and workplace policies. Nurses expressed very serious concerns about pay, workload, stress, physical and emotional demands and staff morale. Conclusion: Working conditions for nurses in the residential aged care sector in Queensland must be addressed in order to retain the current nurses and to encourage new nurses to replace those that retire. Relevance to clinical practice: The findings of this study provide information not only for the Queensland Nurses Union but also policy makers and nurse managers both nationally and internationally on areas that need to be addressed to maintain the required workforce within the aged care sector

Nurses and information technology

[Executive Summary]: Synopsis: A study of 10,000 nurses in Australia (44% response rate) on their use of information technology has clearly identified that nurses recognise benefits to adopting more information technology in the workplace. They are however frustrated by limitations of access to the technology; software that is not always fit for purpose; and lack of opportunities for training. The level of use of information technology and information management systems is generally low and confidence in use is low even among those nurses who are users. There is evidence that familiarity, use and confidence in use are slightly higher in nurses who have recent tertiary education. Nurses feel poorly informed about information technology health initiatives and poorly consulted about implementation of these initiatives. Workload, number of computers, inadequate technical support and lack of training are principal barriers to the use of information technology. Technical support is especially poor in more remote locations. Neither the full potential of information technology in the provision of health and aged care nor the recognition by all nurses that information technology is an integral part of nursing will be realised until these limitations are addressed