“Happy, just talking, talking, talking”: Community strengthening through mobile phone based peer support among refugee women

Resettled refugees face lack of information and support, due to disrupted community and cultural mismatch. In this context, we provided 111 refugee women peer support training and a restricted-dial unlimited-call mobile phone in Melbourne, Australia. We gathered demographic, phone call, pre and post intervention questionnaires, and interview data.The provided resources synergised with existing resources such as social capital and information demand, resulting in changes to resource allocation and social processes, such as economic resource reallocation, information sharing, personal agency, and social support. These changes impacted areas such as employment, education, transportation and domestic violence, leading to improved individual lives and community functioning

"Happy, just talking, talking, talking" : community strengthening through mobile phone based peer support among refugee women

Resettled refugees face lack of information and support, due to disrupted community and cultural mismatch. In this context, we provided 111 refugee women peer support training and a restricteddial unlimited-call mobile phone in Melbourne, Australia. We gathered demographic, phone call, pre and post intervention questionnaires, and interview data. The provided resources synergised with existing resources such as social capital and information demand, resulting in changes to resource allocation and social processes, such as economic resource reallocation, information sharing, personal agency, and social support. These changes impacted areas such as employment, education, transportation and domestic violence, leading to improved individual lives and community functioning

Assessing the Competence of Evidence-Informed Decision-Making Amongst Health Service Managers

Objective: Evidence-informed decision-making (EIDM) amongst health service managers has been positively linked to better decision outcome, hence more effective healthcare provision. Efforts to improve EIDM practice are required to meet the current challenging healthcare environment. One key step to improve such practices is skill enhancement. The purpose of the study is the measure the competence of mid-level managers in two Victorian hospitals in applying EIDM in their roles. Design: The competence of 25 mid-level managers in applying EIDM in their roles was assessed via a 360° process using an online management competency assessment tool (MCAP Tool) and case-study objective assessment tool. Setting: Mid-level managers working in Victorian hospitals were selected. Main outcome measures: The competence of mid-level managers in applying the competency of EIDM was assessed. This paper discusses the areas of improvement identified in enhancing the competence of EIDM amongst mid-level managers in the group, organisational and individual levels Results: EIDM is an important competency for health service managers. Managers who participated in the assessment are competent in applying EIDM in their roles, but require guidance and improvements. Strengths and weaknesses of managers in applying EIDM in their roles varied between organisations. Conclusion: This paper suggests that not only improvement of specific aspects of evidenceinformed decision-making amongst health service managers are required, additional more systematic changes at the organisational and individual management level are essential to achieve competent evidence-informed decision-making practices amongst health service managers. Abbreviations: CCA – Combined Colleagues; CEO – Chief Executive Officer; EIDM – Evidence Informed Decision Making; OA – Objective Assessment; SA – Self Assessment

Chronic Disease Prevalence. A perspective using Administrative Data from Australia

Background Pharmaceutical administrative data can provide an alternative method to assess chronic disease prevalence. The data within prescription exchanges includes the specific nature of the medication dispensed which can be utilised for case definition by proxy of certain chronic diseases. Objectives This study examines the potential of Australian administrative pharmaceutical data to define chronic disease and provide population prevalence estimates. The utility of allocated World Health Organization Anatomical Therapeutic Chemical (ATC) codes to the treatment supplied will be assessed and the validity of the results generated compared with other Australian sources of chronic disease prevalence. Methods 23 chronic conditions were defined by ATC codes within an Australian (administrative) Pharmaceutical Benefits Scheme (PBS) dataset. This enabled calculation of chronic disease prevalences for the period 2003 to 2014 using Australian census data as denominator values. Findings Prevalence estimates from PBS data when compared with questionnaire based studies demonstrated homogeneity overall (Mann-Whitney P>0.05). PBS prevalence estimates of diabetes, gout and asthma showed respective correlations of 0.999, 0.8385 and 0.58 to 0.82 with community surveys. In general, the prevalence of most chronic conditions rose. Cardiovascular disorders, iron deficiency treatment, HIV and prescription pain medication however demonstrated notable increases. Prevalence estimates were influenced by artefactual factors including new government regulation in 2012. For diabetes prevalence estimates this improved the correlation associated with community survey data. Conclusions Australian pharmaceutical administrative data have potential utility for chronic disease prevalence estimates. Advantages include low costs, speed of analysis, high power and good representation. We consider the technique offers a complimentary perspective of chronic disease prevalence providing new insights into population health

Parameter-Free Solution of the Bohr Hamiltonian for Actinides Critical in the Octupole Mode

An analytic, parameter-free (up to overall scale factors) solution of the Bohr Hamiltonian involving axially symmetric quadrupole and octupole deformations, as well as an infinite well potential, is obtained, after separating variables in a way reminiscent of the Variable Moment of Inertia (VMI) concept. Normalized spectra and B(EL) ratios are found to agree with experimental data for 226-Ra and 226-Th, the nuclei known to lie closest to the border between octupole deformation and octupole vibrations in the light actinide region.Comment: 11 pages, LaTeX, including 5 .eps figure

Estimates of mortality rates in people with diabetes and cardiovascular disease using administrative pharmaceutical data

Background Quantifying the mortality risk for people with diabetes is challenging because of associated comorbidities. The recording of cause specific mortality from accompanying cardiovascular disease in death certificate notifications has been considered to underestimate the overall mortality risk in persons with diabetes. Main Aim Develop a technique to quantify mortality risk from pharmaceutical administrative data and apply it to persons diagnosed with diabetes, and associated cardiovascular disease and dyslipidaemia before death. Methods Persons with diabetes, cardiovascular disease and dyslipidaemia were identified in a publicly available Australian Pharmaceutical data set using World Health Organization anatomic therapeutic codes assigned to medications received. Diabetes associated multi-morbidity cohorts were constructed and a proxy mortality (PM) event determined from medication and service discontinuation. Estimates of mortality rates were calculated from 2004 for 10 years and compared persons with diabetes alone and associated cardiovascular disease and dyslipidemia. Results This study identified 346,201 individuals within the 2004 calendar year as having received treatments for diabetes (n=51,422), dyslipidaemia (n=169,323) and cardiovascular disease including hypertension (n=280,105). Follow up was 3.3 x 106 person-years. Overall crude PM was 26.1 per 1000 person-years. PM rates were highest in persons with cardiovascular disease and diabetes in combination (47.5 per 100 person years). Statin treatments significantly improved the mortality rates in all persons with diabetes and cardiovascular disease alone and in combination over age groups >44 years (p<.001). Age specific diabetes PM rates using pharmaceutical data correlated well with Australian data from the National Diabetes Service Scheme (r=0.82) Conclusion Proxy mortality events calculated from medication discontinuation in persons with chronic conditions can provide an alternative method to estimate disease mortality rates. The technique also allows the assessment of mortality risk in persons with chronic disease multi-morbidity

An evidence-based approach to understanding the competency development needs of the health service management workforce in Australia

Background: Competent managers are essential to the productivity of organisations and the sustainability of health systems. Effective workforce development strategies sensitive to the current competency development needs of health service managers (HSMs) are required. Purpose: To conduct a 360° assessment of the competence of Australian HSMs to identify managerial competence levels, and training and development needs. Methods: Assessment of 93 middle-level HSMs from two public hospitals (n = 25) and five community health services (CHS) (n = 68), using the Managerial Competency Assessment Partnership (MCAP) framework and tool, conducted between 2012 and 2014 in Victoria, Australia. Results: Mean competency scores from both self- and combined colleagues' assessments indicated competence (scores greater than five but less than six) without guidance, but many HSMs have not had extensive experience. Around 12% of HSMs were unable to demonstrate the competency of 'evidence-informed decision-making' and 4% of HSMs were unable to demonstrate the competency of 'enabling and managing change'. Conclusion: The assessments confirmed managerial competence for the majority of middle-level HSMs from hospitals and CHS in Victoria, but found competency gaps. In addition, the assessment confirmed managerial strengths and weaknesses varied across management groups from different organisations. These findings suggest that the development of strategies to strengthen the health service management workforce should be multifaceted. Practice implications: A focus on competency in performance evaluation and development using the MCAP framework and tool not only provides insights into performance of HSMs, but also has the potential to provide an organisation strategic advantage through succession planning and advancing managers' competence via learning needs analysis and targeted professional development. Linking competencies of HSMs to organisational objectives and strategies provides optimal use of the human resource capacity, improving the organisation's productivity and sustainability

A comparison of opioids and benzodiazepines dispensing in Australia.

BackgroundInappropriate utilization of prescription opioids and benzodiazepines is a public health problem. This study examined and compared user-types and trends in dispensing of these medicines, and identified associated factors related to the duration of dispensing in Australia.MethodsA random 10% sample of unit-record data of opioids and benzodiazepines dispensed nationally during 2013-2016 was analyzed. Users were categorized into four types: single-quarter (i.e., three months), medium-episodic (dispensed 2-6 quarters), long-episodic (dispensed 7-11 quarters), chronic (dispensed 12-16 quarters). Dispensing quantity was computed in defined daily dose (DDD). Generalized multilevel ordinal models were developed to examine the factors associated with the duration of dispensing.ResultsThere were similarities in terms of trends of dispensing of opioids and benzodiazepines in Australia. Overall, more people were dispensed opioids than benzodiazepines. Around 52% of opioids users and 46% of benzodiazepines users were dispensed these medicines for a single quarter. However, chronic users were dispensed 60% of opioids and 50% of benzodiazepines in DDD/1000 people/day, respectively. On average, 16.6 DDD/1000 people/day of opioids and 14.2 DDD/1000 people/day of benzodiazepines were dispensed in Australia during the study period. Tasmania was dispensed the highest quantity (in DDD/1000 people/day) of these medicines, followed by South Australia and Queensland. Women compared to men, and clients of age-group 20-44, 45-64 and 65+ compared to age-group 0-19, were significantly more likely to have dispensed opioids/benzodiazepine for a relatively long duration. Clients with a history of dispensing of one of these two medicines were significantly more likely to have dispensed the other for a relatively long period.ConclusionsThere were similarities in patterns of dispensing of opioids and benzodiazepines in terms of user characteristics and structural variables. Consistent use of real-time drug monitoring program and tailored intervention are recommended

A comparison of opioids and benzodiazepines dispensing in Australia.

BackgroundInappropriate utilization of prescription opioids and benzodiazepines is a public health problem. This study examined and compared user-types and trends in dispensing of these medicines, and identified associated factors related to the duration of dispensing in Australia.MethodsA random 10% sample of unit-record data of opioids and benzodiazepines dispensed nationally during 2013-2016 was analyzed. Users were categorized into four types: single-quarter (i.e., three months), medium-episodic (dispensed 2-6 quarters), long-episodic (dispensed 7-11 quarters), chronic (dispensed 12-16 quarters). Dispensing quantity was computed in defined daily dose (DDD). Generalized multilevel ordinal models were developed to examine the factors associated with the duration of dispensing.ResultsThere were similarities in terms of trends of dispensing of opioids and benzodiazepines in Australia. Overall, more people were dispensed opioids than benzodiazepines. Around 52% of opioids users and 46% of benzodiazepines users were dispensed these medicines for a single quarter. However, chronic users were dispensed 60% of opioids and 50% of benzodiazepines in DDD/1000 people/day, respectively. On average, 16.6 DDD/1000 people/day of opioids and 14.2 DDD/1000 people/day of benzodiazepines were dispensed in Australia during the study period. Tasmania was dispensed the highest quantity (in DDD/1000 people/day) of these medicines, followed by South Australia and Queensland. Women compared to men, and clients of age-group 20-44, 45-64 and 65+ compared to age-group 0-19, were significantly more likely to have dispensed opioids/benzodiazepine for a relatively long duration. Clients with a history of dispensing of one of these two medicines were significantly more likely to have dispensed the other for a relatively long period.ConclusionsThere were similarities in patterns of dispensing of opioids and benzodiazepines in terms of user characteristics and structural variables. Consistent use of real-time drug monitoring program and tailored intervention are recommended

Methodology For Creating a Sample Subset of Dynamic Taxonomy to Use in Navigating Medical Text Databases

The amount of text available in electronic form is increasing, especially since the rise of the web � So too are the potential interconnections between concepts, given the advent of ontologies and other relationship based data sources� Text could be navigated using the structure from the ontologies, specifically, using dynamic taxonomies to navigate the is-a relationships� Dynamic taxonomies are rooted index structures that dynamically prune themselves in response to zoom requests� The use of dynamic taxonomies with existing ontologies, and in the medical field, is unexplored � This paper details the process of connecting index terms from a medical text database to a taxonomy extracted from an existing medical ontology�