Closing the Gap: The need to consider perceptions about drinking water in rural Aboriginal communities in NSW, Australia

A crucial objective of the Australian Government's Closing the Gap program is to improve Aboriginal health, and to achieve morbidity and mortality rates similar to those for non-Indigenous Australians. Reducing public health risks due to drinking water of unknown quality will help to close the gap. Factors such as hardness, taste, colour and odour of water may influence perceptions of risk and quality. Increased contact and familiarity with a hazard is associated with individuals becoming desensitised and habituated to its presence, so that their risk judgements may reflect their behavioural experiences. Consumption of water of unknown quality, such as rainwater, instead of treated town water in Australian Aboriginal communities may be a community norm, a part of a community's culture or a result of lack of trust in government water suppliers. Partnerships between service providers and communities can ensure that the service is responsive to community needs, is conducted in a culturally appropriate manner and is beneficial to the community. Governance of drinking water in Aboriginal communities cannot be comprehensive without active engagement of the communities involved, and greater understanding of cultural issues, perceptions and behaviours towards drinking water quality. This Perspective article reviews the literature to shed light on the need to consider New South Wales (NSW) Aboriginal perceptions about drinking water and its acceptability. We urge more dialogue and research, and a policy focus that includes partnerships with discrete NSW Aboriginal communities to develop a deeper understanding of perceptions of drinking water and encourage consumption of safe water. © 2016 Jaravani et al

The acceptability to Aboriginal Australians of a family-based intervention to reduce alcohol-related harms

Introduction and Aims: Cognitive-behavioural interventions that use familial and community reinforcers in an individual's environment are effective for reducing alcohol-related harms. Such interventions have considerable potential to reduce the disproportionately high burden of alcohol-related harm among Aboriginal Australians if they can be successfully tailored to their specific needs and circumstances. The overall aim of this paper is to describe the perceived acceptability of two cognitive-behavioural interventions, the Community Reinforcement Approach (CRA) and Community Reinforcement and Family Training (CRAFT), to a sample of Aboriginal people. Design and Methods: Descriptive survey was administered to 116 Aboriginal people recruited through an Aboriginal Community Controlled Health Service and a community-based drug and alcohol treatment agency in rural New South Wales, Australia. Results: Participants perceived CRA and CRAFT to be highly acceptable for delivery in their local Aboriginal community. Women were more likely than men to perceive CRAFT as highly acceptable. Participants expressed a preference for counsellors to be someone they knew and trusted, and who has experience working in their local community. CRA was deemed most acceptable for delivery to individuals after alcohol withdrawal and CRAFT for people who want to help a relative/friend start alcohol treatment. There was a preference for five or more detailed sessions. Discussion and Conclusions: Findings of this study suggest that CRA and CRAFT are likely to be acceptable for delivery to some rural Aboriginal Australians, and that there is potential to tailor these interventions to specific communities. © 2012 Australasian Professional Society on Alcohol and other Drugs

Working with an Aboriginal community to understand drinking water perceptions and acceptance in rural New South Wales

This study explored the Walhallow Aboriginal community's experiences with drinking water to gain a shared understanding about community concerns and to develop ways to address these concerns together. There is a strong connection between people and water, as well as a need to appreciate the social factors associated with the unique cultural and socioeconomic factors that the provision of drinking water has for Aboriginal communities. We used a mixed method design within a community-based participatory action Research (PAR) framework. Water hardness and parental influence were the key factors associated with participants' decisions to drink rainwater. This study provides important insights for water supply authorities when assessing health risks and when choosing appropriate mitigation measures for water quality improvement programs in Aboriginal communities. © 2017, Western University

Adopting narrative pedagogy to improve the student learning experience in a regional Australian university

A growing body of work in the literature describes and explains narrative pedagogy within nursing and midwifery programs. This paper continues the conversation by explaining, with examples, how narrative pedagogy has been interpreted and applied within a new nursing faculty in Australia.The aims of our nursing and midwifery programs are to provide students with a clear professional identity and to prepare them for contemporary Australian nursing practice. As part of these aims, we want students to develop their imaginations and to consciously examine, and challenge, nursing and healthcare paradigms and practices such as the enduring illness model of healthcare and the emphasis on technique-oriented care. Members of our teaching team, working together and individually, have used narrative pedagogy in a variety of ways, developing novel teaching and learning activities for use in real time classroom settings as well as online to provide a regionally and globally relevant educational experience

The effectiveness of a community-based intervention (community reinforcement approach) at reducing substance use and related harms among Aboriginal and non-Aboriginal Australians

Introduction and Aims: The Community Reinforcement Approach (CRA) is a community-based cognitive-behavioural intervention for problem drinkers. CRA has recently been tailored for Aboriginal Australians. This study aims to: (i) implement the CRA program with Aboriginal and non-Aboriginal Australians; and (ii) measure the effectiveness of the CRA program on reducing substance use and increasing social and emotional wellbeing. Design and Methods: Participants were recruited through a drug and alcohol treatment agency in rural New South Wales. Data were collected through interviews pre-intervention, four weeks and three months after CRA treatment started. Measures include demographics, substance misuse (Alcohol, Smoking and Substance Involvement Screening Test), psychological distress (Kessler-5) and empowerment (Growth and Empowerment Measure). The effectiveness of CRA was analysed using a pre- and post-program delivery demonstration study design.Results: Overall, 55 participants (44% identified as Aboriginal) completed a pre-intervention interview.Thirty-two participants completed the four week interview and 31 participants completed the three month follow-up interview. Alcohol, cannabis and stimulant misuse scores were lower four weeks after CRA started (t = 3.25, P < 0.005; t = 3.10, P < 0.005; t = 2.16, P = 0.04 respectively). Stimulant use and harm scores were significantly reduced three months after CRA started compared to baseline scores (t = 2.67, P = 0.01). Psychological distress and empowerment scores were not reduced post-intervention. Discussion and Conclusions: Pre- and post-program analyses on the effectiveness of CRA have demonstrated support for the CRA program in reducing substance use and related harms. This finding has implications for public health treatment initiatives and future research pertaining to alcohol use and related harms for Aboriginal and non-Aboriginal Australians

A stepped wedge trial of efficacy and scalability of a virtual clinical pharmacy service (VCPS) in rural and remote NSW health facilities

Background: Medication errors are a leading cause of mortality and morbidity. Clinical pharmacy services provided in hospital can reduce medication errors and medication related harm. However, few rural or remote hospitals in Australia have a clinical pharmacy service. This study will evaluate a virtual clinical pharmacy service (VCPS) provided via telehealth to eight rural and remote hospitals in NSW, Australia. Methods: A stepped wedge cluster randomised trial design will use routinely collected data from patients' electronic medical records (n = 2080) to evaluate the VCPS at eight facilities. The sequence of steps is randomised, allowing for control of potential confounding temporal trends. Primary outcomes are number of medication reconciliations completed on admission and discharge. Secondary outcomes are length of stay, falls and 28 day readmissions. A cost-effectiveness analysis (CEA) and cost-benefit analysis (CBA) will be conducted. The CEA will answer the question of whether the VCPS is more cost-effective compared to treatment as usual; the CBA will consider the rate of return on investing in the VCPS. A patient experience measure (n = 500) and medication adherence questionnaire (n = 100 pre and post) will also be used to identify patient responses to the virtual service. Focus groups will investigate implementation from hospital staff perspectives at each site. Analyses of routine data will comprise generalised linear mixed models. Descriptive statistical analysis will summarise patient experience responses. Differences in medication adherence will be compared using linear regression models. Thematic analysis of focus groups will identify barriers and facilitators to VCPS implementation. Discussion: We aim to demonstrate the effectiveness of virtual pharmacy interventions for rural populations, and inform best practice for using virtual healthcare to improve access to pharmacy services. It is widely recognised that clinical pharmacists are best placed to reduce medication errors. However, pharmacy services are limited in rural and remote hospitals. This project will provide evidence about ways in which the benefits of hospital pharmacists can be maximised utilising telehealth technology. If successful, this project can provide a model for pharmacy delivery in rural and remote locations. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR)-ACTRN12619001757101 Prospectively registered on 11 December 2019. Record available from: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378878&isReview=true © 2020 The Author(s)

The efficacy and safety of venetoclax therapy in elderly patients with relapsed, refractory chronic lymphocytic leukaemia

Elderly chronic lymphocytic leukaemia (CLL) patients treated outside of trials have notably greater toxicity with the Bruton's tyrosine kinase inhibitor ibrutinib compared to younger patients. It is not known whether the same holds true for the B‐cell lymphoma 2 inhibitor venetoclax. We provide a comprehensive analysis of key safety measures and efficacy in 342 patients comparing age categories ≥75 and <75 years treated in the relapsed, refractory non‐trial setting. We demonstrate that venetoclax has equivalent efficacy and safety in relapsed/refractory CLL patients who are elderly, the majority of whom are previous ibrutinib‐exposed and therefore may otherwise have few clear therapeutic options.<br

The first UK measurements of nitryl chloride using a chemical ionization mass spectrometer in central London in the summer of 2012, and an investigation of the role of Cl atom oxidation

The first nitryl chloride (ClNO2) measurements in the UK were made during the summer 2012 ClearfLo campaign with a chemical ionization mass spectrometer, utilizing an I− ionization scheme. Concentrations of ClNO2 exceeded detectable limits (11 ppt) every night with a maximum concentration of 724 ppt. A diurnal profile of ClNO2 peaking between 4 and 5 A.M., decreasing directly after sunrise, was observed. Concentrations of ClNO2 above the detection limit are generally observed between 8 P.M. and 11 A.M. Different ratios of the production of ClNO2:N2O5 were observed throughout with both positive and negative correlations between the two species being reported. The photolysis of ClNO2 and a box model utilizing the Master Chemical Mechanism modified to include chlorine chemistry was used to calculate Cl atom concentrations. Simultaneous measurements of hydroxyl radicals (OH) using low pressure laser‐induced fluorescence and ozone enabled the relative importance of the oxidation of three groups of measured VOCs (alkanes, alkenes, and alkynes) by OH radicals, Cl atoms, and O3 to be compared. For the day with the maximum calculated Cl atom concentration, Cl atoms in the early morning were the dominant oxidant for alkanes and, over the entire day, contributed 15%, 3%, and 26% toward the oxidation of alkanes, alkenes, and alkynes, respectively