Remote Areas Statistical Geography in Australia: Notes on the Accessibility/Remoteness Index for Australia (ARIA + version)

© Commonwealth of Australia 2003There have been increasing concerns over a number of years about the difficulties faced by Australians living in rural and remote areas of Australia in accessing services that most Australians take for granted. A parallel concern has been the extent to which the health of people living in these areas is poorer than that of those living in areas with greater accessibility to health, welfare and other services. Government in particular has been interested in finding out more about the circumstances and needs of these populations, and in targeting assistance accordingly. This led the (then) Department of Health and Aged Care (DHAC) to sponsor a project to obtain a standard classification and index of remoteness which would allow the comparison of information about populations based on their access, by road, to service centres (towns) of various sizes. Note that although by specifying towns of various sizes the index implicitly takes account of the education, health, welfare, etc. services likely to be located in towns of those sizes, there is no explicit use in the development of the index of what services should exist. That is, distance is the sole measure of access. The outcome of that project was the Accessibility/ Remoteness Index of Australia (ARIA) (DHAC 1999, superseded by DHAC 2001), based on a methodology developed by the National Centre for Social Applications in GIS (GISCA). More recently, the Australian Bureau of Statistics (ABS) addressed the concept of remoteness, with a view to including it in its classification of areas. The ABS work, also undertaken with GISCA, used ARIA as the underlying methodology for the determination of remoteness. The new classification, described by the ABS as a 'Remoteness Structure', is referred to as ARIA+ (ie., ARIA plus, ABS 2001a), and is an update and refinement of the original ARIA. This report includes a comparison of ARIA with ARIA+. It also examines the characteristics of the population under ARIA+, such as the distribution, age, sex, and includes comparisons by Indigenous status

Nationwide monitoring and surveillance question development: Diabetes mellitus

© Commonwealth of Australia 2003Diabetes is the seventh leading cause of death in Australia, contributing significantly to premature mortality, morbidity, disability and potential years of life lost. From the 1995 National Health Survey (NHS), it was estimated that 430,700 individuals (2.4 per cent of the total population) reported having been diagnosed with diabetes at some stage in their life, and that a further 300,000 (1.5 per cent of the population) have undiagnosed diabetes. In 1996, the Australian Health Ministers declared diabetes as the fifth National Health Priority Area (NHPA), as several of the criteria for priority national attention were met. This discussion paper examines a number of issues related to diabetes and the instruments that have been used to measure diabetes in the population. In particular, the paper looks at health surveillance data collection

Nationwide monitoring and surveillance question development: Asthma

© Commonwealth of Australia 2003Asthma is a chronic inflammatory disorder of the airways that results in variable airflow obstruction in response to certain triggers. Depending on severity, the airflow limitation is accompanied by symptoms of breathlessness, wheezing, chest tightness, and cough. According to the 1995 ABS National Health Survey, it was estimated that approximately 11 per cent of Australians reported asthma as a recent or long-term condition. Asthma is a major cause of disability rather than premature mortality, costing the health system an estimated $478 million in 1993-94 (40 per cent of the total expenditure on chronic respiratory diseases). On the 4th of August 1999 the Australian Health Ministers announced asthma as the sixth National Health Priority Area, in response to the significant burden that asthma places on the Australian community. This discussion paper examines a number of issues related to asthma and the instruments that have been used to measure asthma in the population. In particular, the paper looks at health surveillance data collection

BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes

The contribution of X-linked coding variation to severe developmental disorders

Abstract: Over 130 X-linked genes have been robustly associated with developmental disorders, and X-linked causes have been hypothesised to underlie the higher developmental disorder rates in males. Here, we evaluate the burden of X-linked coding variation in 11,044 developmental disorder patients, and find a similar rate of X-linked causes in males and females (6.0% and 6.9%, respectively), indicating that such variants do not account for the 1.4-fold male bias. We develop an improved strategy to detect X-linked developmental disorders and identify 23 significant genes, all of which were previously known, consistent with our inference that the vast majority of the X-linked burden is in known developmental disorder-associated genes. Importantly, we estimate that, in male probands, only 13% of inherited rare missense variants in known developmental disorder-associated genes are likely to be pathogenic. Our results demonstrate that statistical analysis of large datasets can refine our understanding of modes of inheritance for individual X-linked disorders

COS Ambassadors

A collection of materials and resources for COS ambassadors