The selection of population groups by age for a National Population Health Survey using objective measures

© Commonwealth of AustraliaThis paper identifies a range of age groups in the population that might be included in a proposed Australian Health Measurement Survey (AHMS) program

Early intervention – from evidence to implementation: The policymaker’s tale. A case study

© Commonwealth of AustraliaImplementing evidence from research, into policy, and then practice, is a challenging task, glistening with opportunities and fraught with practical difficulties and political realities. This case study describes a process of taking research evidence, embedding it into policy and then implementing and making it happen 'on the ground', as a 'live' early intervention program in South Australia. Evidence on the level of disadvantage of people living in particular geographic locations in metropolitan Adelaide, and research on effective early intervention programs for disadvantaged families with infants were used to support policy directions and to gain funding to establish a pilot program. A community development approach was adopted, and strategies used to ensure the participation of those communities in the design and establishment of the program are also discussed. A number of key criteria were identified to support the successful transition from research, to policy, to planning and practice, and these are reviewed in the light of experience. This is a sobering tale, with exciting outcomes but a number of important lessons, which may be helpful to others seeking to ensure the successful implementation of early intervention programs for children and their families in Australia

Is it working ... together? Linking research, policy and practice in relation to children and health inequalities in South Australia

Despite an increasing interest in the extent of child health inequalities in Australia and effective strategies to address them, there remains a significant gap between existing research evidence and its incorporation into planning, policy and practice in Australia. Researchers, policy-makers and practitioners face difficulties in bringing research into practice effectively, and local communities are often neglected in the processes. This paper presents a brief summary of data on child health inequalities in South Australia over the last decade. It then reviews the extent to which research findings have been incorporated into human services' policy and practice. Particular barriers for researchers, policy-makers, planners, practitioners and communities are discussed, drawing on local and overseas experience, and possible strategies for addressing some of the barriers are outlined

Use of 3-D navigation to target the site of autologous blood installation for lung volume reduction in bullous emphysema

Bronchoscopic lung volume reduction (BLVR) using intrabullous autologous blood instillation has been reported in single cases where other techniques are not possible. We present the use of three-dimensional navigation to instill autologous blood into emphysematous bullae for BLVR. A 62-year-old man presented with increasing dyspnea, due to emphysema with a conglomerate of giant bullae with two particularly large bullae. Surgical treatment was refused, so bronchoscopic autologous blood instillation into the bronchial segment leading to the large bullae was attempted, but was unsuccessful; blood failed to penetrate into the bullous cavity. Dyspnea worsened over the following year. We therefore performed another bronchoscopy and punctured a large bulla with a needle and created a tunnel from the central airways. Puncture position and direction were determined using a prototype of an electromagnetic navigation system. Under fluoroscopic guidance, a catheter was placed via the tunnel into the bulla and blood was instilled. This resulted in an almost complete shrinkage of the bullae, reduction of residual volume, and marked improvement in dyspnea within 4 months. To our knowledge, this is the first reported case of successful BLVR by navigated bronchoscopy with transbronchial puncture, dilatation, and autologous blood instillation into a giant bulla

Definitions of severity in treatment seeking studies of febrile illness in children in low and middle income countries: a scoping review

Objectives: Understanding treatment seeking for severe febrile illness (SFI) is methodologically challenging. In this scoping review, we investigate definitions of severe febrile illness in treatment seeking studies on children under 5 years of age in low and middle income countries. We analyze the association of SFI definitions with different concepts of treatment seeking and identify related research gaps. Methods: We searched Pubmed, Scopus and WHOLIS, and screened references of included publications for eligibility. Results: Definitions of SFI had either a biomedical perspective (predominantly in quantitative studies) or a caregiver perspective (predominantly in qualitative studies). In quantitative analyses of treatment seeking, severity was more often conceptualized as a determinant rather than an outcome of a treatment seeking process. The majority of quantitative analyses only included surviving children or did not explicitly mention dead children. Conclusion: Different research questions lead to diverse definitions and concepts of severity and treatment seeking outcomes, which limits the comparability of the available evidence. Systematic exclusion of dead children is likely to bias inferences on the association of treatment seeking and health outcomes of children with SFI in low and middle income countries

Hyperlactation - How left-brained \u27rules\u27 for breastfeeding wreak havoc with a natural process

A variety of arbitrary and often unphysiological rules for breastfeeding are frequently suggested to breastfeeding mothers. Many of these rules duplicate strategies commonly used to increase milk supply, and thus, when undertaken by the many women who already have a generous milk supply, can lead to overproduction. Oversupply, or hyperlactation, is a frequent yet often unrecognized problem that can present with a variety of distressing symptoms for the breastfeeding mother and her infant. Infants may present with symptoms suggesting colic, milk protein allergies, or gastroesophageal reflux, or may present with unusually rapid or slow growth. Mothers may present with tender leaking breasts, sore infected nipples, plugged ducts or mastitis, or even the perception of insufficient milk supply. With an understanding of the pathophysiology of these symptoms, proper diagnosis and breastfeeding management can allow milk production to return to homeostatic levels and provide dramatic symptom relief. March 23, 2012: Author’s note 7 years after publication: Over the 7 years since we wrote this manuscript, we continue to see mothers and babies with these same clinical problems, and we are still learning. Here’s a quick look from 2012 at what we wrote in 2005. Specifics can be found in a link at this site soon. During the last 7 years our treatment strategies have become much more simple and flexible since our earlier strategies encouraged too much of the rigid and rule-based left-brained thinking that often causes or contributes to hyperlactation. In this manuscript, we never once mentioned using hands on the breasts as a strategy for preventing or resolving the problems of hyperlactation, and yet in recent years we’ve found this has revolutionized our management approach. We’ve found that when dealing with hyperlactation, pumping can often be counterproductive. Underweight slow weight gain babies are in a category of their own. Regardless of their symptoms, by definition the underweight baby is NOT drinking too much, and in our experience, typical strategies for addressing hyperlactation can be counterproductive or even dangerous. In particular, staying on one side “to get to the hindmilk” doesn’t work with these sleepy, flow-dependent babies. Side switching may be helpful, but is rarely sufficient, and medical attention is critical. While hyperlactation appears to be increasingly recognized by lactation professionals, left-brained strategies abound, and resolution is often elusive, even by those who correctly identify it. Much more research is needed in all of these areas, as well as in several interesting and related areas discussed in our longer note. Finally, the thoughts and suggestions given here cannot replace appropriate medical attention by a physician or other medical provider. We do not encourage self-treatment, particularly when symptoms are severe. Readers seeking lactation support can locate an International Board Certified Lactation Consultant (IBCLC) in their geographic area at www.ilca.org “Find a Lactation Consultant” http://www.ilca.org/i4a/pages/index.cfm?pageid=343

A review of malaria epidemiology and control in Papua New Guinea 1900 to 2021: progress made and future directions

The research and control of malaria has a long history in Papua New Guinea, sometimes resulting in substantial changes to the distribution of infection and transmission dynamics in the country. There have been four major periods of malaria control in PNG, with the current control programme having commenced in 2004. Each previous control programme was successful in reducing malaria burden in the country, but multiple factors led to programme failures and eventual breakdown. A comprehensive review of the literature dating from 1900 to 2021 was undertaken to summarize control strategies, epidemiology, vector ecology and environmental drivers of malaria transmission in PNG. Evaluations of historical control programs reveal poor planning and communication, and di culty in sustaining financial investment once malaria burden had decreased as common themes in the breakdown of previous programs. Success of current and future malaria control programs in PNG is contingent on adequate planning and management of control programs, effective communication and engagement with at-risk populations, and cohesive targeted approaches to sub-national and national control and elimination

In-vivo-Untersuchung über die subgingivale Penetrationsfähigkeit und Reinigungswirkung eines niedrigabrasiven Pulverstrahlsystems

Ziel dieser Arbeit war es, in vivo die maximale Tiefe der subgingivalen Biofilmentfernung im Rahmen der Parodontitistherapie durch ein niedrigabrasives Pulverstrahlsystem zu bestimmen. 60 nicht erhaltungswürdige Zähne von 60 Probanden wurden laut einer Randomisierungsliste auf drei Gruppen verteilt. Bei der Gruppe Test UPT erfolgte 3 Monate vor der Behandlung mit dem Pulverstrahlsystem ein Scaling, die Gruppe Test Initial wurde direkt behandelt und die Kontrollgruppe blieb unbehandelt. In der Gruppe Test UPT zeigte sich eine komplette Biofilmentfernung bis zu einer histologischen Taschentiefe von 2,07±0,62 mm. Mit 1,86±0,98 mm wies die Gruppe Test Initial eine signifikant niedrigere vollständige Reinigungstiefe auf. Insgesamt unterstützen die Ergebnisse dieser Studie die Effizienz und Sicherheit der subgingivalen Pulverstrahltechnik in der Therapie der parodontalen Biofilminfektion und weisen möglicherweise darauf hin, dass eine Indikation für einen Einsatz in der Initialtherapie besteh