Australian Community Setting Research Articles

Participant observation in obesity research with children: striated and smooth spaces

This article discusses the value of conducting participant observation in obesity research with children in an Australian community setting. Obesity is highly stigmatized, and the use of activity-based interviews exposed the intellectual and embodied consciousness that children negotiate when they take part in research about food and bodies. Instead of opening up possibilities, interview-based activities can lead to a moral correctness about healthy lifestyles. It was through participant observation, in engagement with what Deleuze and Guattari [1988. A Thousand Plateaus: Capitalism and Schizophrenia. London: Athlone Press] call striated and smooth (or regulated and unregulated) spaces of children's everyday activities, that richer understandings of obesity and children's bodies became apparent. We argue that without participant observation, our understandings of what children say and draw about healthy lifestyles may be limited by the striated spaces in which we conduct our research and the constraints that accompany the cultural politics of childhood and obesity.

Exploring Health Care Providers’ Perceptions of the Needs of Stroke Carers: Informing Development of an Optimal Health Program

Background: Health care provider experiences of the carer have been researched, but little is written about how these can inform development of support programs. Objectives: This study aimed to (1) explore health care provider perceptions of stroke carer roles and support needs and (2) examine carer needs across the stroke care trajectory to assist with development of an Optimal Health Program (OHP) to support carers. This study is part of a staged program of research that will evaluate and refine the OHP. Methods: Four dual-moderated semi-structured focus groups of stroke health care providers across acute, subacute, and community rehabilitation services were conducted. Facilitators used a semi-structured focus group schedule to guide discussion. Sessions were recorded, transcribed, and analyzed using thematic and content analysis. Results: Three key themes emerged: transition, information, and impact of stroke. A number of subthemes highlighted the distinct roles of health care providers and carers. Specific elements of the OHP were identified as having the potential to advance support for carers across the stroke care trajectory. Discussion: Findings support the integration of an OHP for carers within existing stroke care services in Australian public hospital and community settings. Conclusion: This study suggests how health care provider experiences could inform a self-management OHP to assist carers in navigating stroke services and to address their health-related concerns.

A decade of community-based outcomes of patients treated with curative radiotherapy with or without chemotherapy for non-small cell lung cancer.

Clinical trials have reported good outcomes for non-small cell lung cancer (NSCLC) patients treated with curative radiotherapy. These populations are highly selected and may not be representative of lung cancer population. We aim to evaluate the outcomes of NSCLC patients treated with radiotherapy ± chemotherapy in Australian community setting and to assess the effect of comorbidity on outcomes. Oncology records at Liverpool and Macarthur Cancer Therapy Centres, Sydney, Australia, were queried to retrieve patient, tumor and treatment data for stage I-III NSCLC patients who were treated with radiotherapy (minimum dose 60 Gy) between 1 January 2000 and 31 December 2010. Simplified comorbidity score (SCS) was used to score comorbidity. Kaplan-Meier and Cox hazards models were used for survival analysis. A total of 160 patients were identified with median follow-up of 22 months. Median age was 69 years (range 36-89); 76 patients received radiotherapy alone, 25 received sequential chemoradiation and 59 received concurrent chemoradiation. Median overall survivals for stages I, II and III were 29, 26 and 18 months, respectively. On multivariate analysis, stage II or III and weight loss > 5% were predictive of cancer-specific survival with hazard ratios of 4.47 (1.08-18.55, P = 0.04) and 2.23 (1.13-4.39, P = 0.02), respectively. Toxicities were grade ≥ 3 pneumonitis in 2% of patients, grade ≥ 3 esophagitis in 6% and grade ≥ 3 febrile neutropenia in 2%. There were no treatment-related deaths. SCS was neither prognostic nor predictive of toxicity or survival. Curative radiotherapy ± chemotherapy is a well-tolerated and effective treatment for inoperable or locally advanced NSCLC. Patients should not be excluded from radiotherapy on basis of comorbidity since higher SCS was not correlated with worse survival.

The Connor-Davidson Resilience Scale: Establishing Invariance Between Gender Across the Lifespan in a Large Community Based Study

Objective The current study sought to examine the measurement invariance of the Connor-Davidson Resilience Scale (CD-RISC) between gender across the lifespan. Methods Data was drawn from three cohorts (aged 28–32, 48–52 and 68–72 years), who had participated in the PATH study from Canberra, Australia. Results Whilst some gender and age differences on item means and variances were reported, measurement invariance of a single CD-RISC factor between gender across the lifespan was mostly supported. Discussion Overall, a single CD-RISC factor was found to be invariant across the lifespan and between gender. Consequently, within an Australian community setting, the CD-RISC can generally be utilised across age and gender.

Understanding if, how and why non-adherent decisions are made in an Australian community sample: a key to sustaining medication adherence in chronic disease?

Adherence to medications for chronic disease is sub-optimal. Current adherence-enhancing strategies do not seem to adequately address the fundamental need to sustain adherence or prevent non-adherence. Intentional non-adherence, involving active medication-taking decisions, is not well described within the Australian community setting. Understanding if, how and why non-adherent decisions are made may help develop strategies to sustain adherence in chronic disease. This study aimed to describe intentional non-adherent behavior in chronic disease within the Australian community setting and identify the factors that promote and prevent non-adherent decisions. In-depth, semi-structured interviews were conducted with 21 patients (12 rural, 9 metropolitan; New South Wales) prescribed medications for a diverse range of chronic conditions. Using the Theory of Planned Behavior as the theoretical framework, an iterative thematic framework analysis method was used to characterize the intentions and the decisions underlying non-adherent behavior. Data were indexed and charted within the thematic framework using Excel, and linked themes were combined, and associations and explanations drawn. Although there was a strong intent to follow prescribers' recommendations, most patients described instances of intentionally non-adherent behavior. Trading between perceived treatment inefficacy, unfavorable side effects and unaffordable medication costs promoted non-adherent decisions; trusting prescriber-patient relationships, positive family values and lack of perceived control over treatment choice maintained adherent intentions. Intentional non-adherence was mostly temporary. Intentional medication non-adherence in chronic disease appears reversible and amenable to interventions that address treatment-related barriers such as medication affordability. Strategies that strengthen patient-prescriber relationships and empower patients as informed decision-makers may help maintain adherence intentions. Crucially, regular and sustained interventions that are refreshed to meet the changing needs of patients are needed to curb the temporal decline in adherence to chronic disease medications.

Effectiveness of a Mindfulness‐Based Childbirth Education Pilot Study on Maternal Self‐Efficacy and Fear of Childbirth

This pilot study tested the feasibility and effectiveness of using Mindfulness-Based Childbirth Education (MBCE), a novel integration of mindfulness meditation and skills-based childbirth education, for mental health promotion with pregnant women. The MBCE protocol aimed to reduce fear of birth, anxiety, and stress and improve maternal self-efficacy. This pilot study also aimed to determine the acceptability and feasibility of the MBCE protocol. A single-arm pilot study of the MBCE intervention using a repeated-measures design was used to analyze data before and after the MBCE intervention to determine change trends with key outcome variables: mindfulness; depression, anxiety, and stress; childbirth self-efficacy; and fear of childbirth. Pregnant women (18-28 weeks' gestation) and their support companions attended weekly MBCE group sessions over 8 weeks in an Australian community setting. Of the 18 women who began and completed the intervention, missing data allowed for complete data from 12 participants to be analyzed. Statistically significant improvements and large effect sizes were observed for childbirth self-efficacy and fear of childbirth. Improvements in depression, mindfulness, and birth outcome expectations were underpowered. At postnatal follow-up significant improvements were found in anxiety, whereas improvements in mindfulness, stress, and fear of birth were significant at a less conservative alpha level. This pilot study demonstrated that a blended mindfulness and skills-based childbirth education intervention was acceptable to women and was associated with improvements in women's sense of control and confidence in giving birth. Previous findings that low self-efficacy and high childbirth fear are linked to greater labor pain, stress reactivity, and trauma suggest the observed improvements in these variables have important implications for improving maternal mental health and associated child health outcomes. Ways in which these outcomes can be achieved through improved childbirth education are discussed.

Study design of ASPirin in Reducing Events in the Elderly (ASPREE): A randomized, controlled trial

Cost-effective strategies to maintain healthy active lifestyle in aging populations are required to address the global burden of age-related diseases. ASPREE will examine whether the potential primary prevention benefits of low dose aspirin outweigh the risks in older healthy individuals. Our primary hypothesis is that daily oral 100mg enteric-coated aspirin will extend a composite primary endpoint termed ‘disability-free life’ including onset of dementia, total mortality, or persistent disability in at least one of the Katz Activities of Daily Living in 19,000 healthy participants aged 65years and above (‘US minorities’) and 70years and above (non-‘US minorities’). ASPREE is a double-blind, randomized, placebo-controlled trial of oral 100mg enteric-coated acetyl salicylic acid (ASA) or matching placebo being conducted in Australian and US community settings on individuals free of dementia, disability and cardiovascular disease (CVD) events. Secondary endpoints are all-cause and cause specific mortality, fatal and non-fatal cardiovascular events, fatal and non-fatal cancer (excluding non-melanoma skin cancer), dementia, mild cognitive impairment, depression, physical disability, and clinically significant bleeding. To 20 September 2013 14,383 participants have been recruited. Recruitment and study completion are anticipated in July 2014 and December 2018 respectively. In contrast to other aspirin trials that have largely focused on cardiovascular endpoints, ASPREE has a unique composite primary endpoint to better capture the overall risk and benefit of aspirin to extend healthy independent lifespan in older adults in the US and Australia.

Attracting and retaining qualified nurses in aged and dementia care: outcomes from an Australian study

To identify key issues and factors affecting retention of qualified nurses who care for older people and persons with dementia in Australian acute, subacute, community and residential health-care settings. As the number of older people with chronic conditions needing health care continues to increase research is needed to optimize nurse retention. Qualified nurses were surveyed with a set of items derived from four published nurse workforce questionnaires (Cronbach's alpha range 0.75-0.96). There were 3983 complete responses and 10 focus groups with 58 volunteer survey respondents. In addition to reporting a number of workplace issues, nurses also reported reasonable levels of satisfaction. Intrinsic factors related to caregiving, work relations and colleague support. Extrinsic factors included professional opportunities and organisational support. Altruism is a primary motivation for choosing to nurse older people and persons with dementia. Nurses are most positive when they feel valued and supported by their organisation and colleagues, through education, training, supervision, mentoring opportunities and appropriate remuneration. Nursing managers need to take positive steps to address the organisational factors outlined in this paper that either inhibit or promote nurse retention.

From the Australian Commission on Safety and Quality in Health Care: Improving clinical handover in Australian hospitals and community settings

Medical Journal of AustraliaVolume 195, Issue 11-12 p. 642-642 In brief From the Australian Commission on Safety and Quality in Health Care: Improving clinical handover in Australian hospitals and community settings First published: 12 December 2011 https://doi.org/10.5694/mja11.n1205AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume195, Issue11-12Christmas issueDecember 2011Pages 642-642 RelatedInformation

Metformin and lactic acidosis in an Australian community setting: the Fremantle Diabetes Study

To determine the incidence of lactic acidosis in community-based patients with type 2 diabetes, with special reference to metformin therapy. Substudy within a longitudinal observational study, the Fremantle Diabetes Study (FDS). 1279 patients from a postcode-defined population of 120 097 people in Western Australia. Confirmed hospitalisation with lactic acidosis identified through the WA Data Linkage System during two periods: (1) from study entry, between 1993 and 1996, and study close in November 2001; and (2) from study entry to 30 June 2006. At entry, 33.3% of patients were metformin-treated, and 23.1% of these had one or more contraindications to metformin (55.1% and 38.0%, respectively, after 5 years' follow-up). Five confirmed cases of lactic acidosis were identified during 12 466 patient-years of observation; all had at least one other potential cause, such as cardiogenic shock or renal failure. From study entry to close, the incidence was 0/100,000 patient-years in both metformin-treated and non-metformin-treated patients. Between study entry and 30 June 2006, incidence was 57/100,000 patient-years (95% CI, 12-168) in metformin-treated patients and 28/100,000 patient-years (95% CI, 3-100) in the non-metformin-treated group, an incidence rate difference of -30 (-105 to 46) (P=0.4). The incidence of lactic acidosis in patients with type 2 diabetes is low but increases with age and duration of diabetes, as cardiovascular and renal causes become more prevalent. Metformin does not increase the risk of lactic acidosis, even when other recognised precipitants are present.

Dialectic Behaviour Therapy: A 12-Month Collaborative Program in a Local Community Setting

AbstractThis study focuses on examining the efficacy of dialectic behaviour therapy (DBT) on female clients who meet the criteria of borderline personality disorder (BPD) within a community setting. A clinical sample of 11 women with BPD was provided with a 6-month DBT program that was collaboratively developed and delivered by Logan Women's Health service and Logan Central Adult Mental Health. Results indicate that DBT is an effective treatment for parasuicidal behaviour and decreased the frequency of medically severe suicide attempts. In addition, the duration of telephone contact, face-to-face contact and number and duration of hospital admissions decreased during the DBT program. The participants' psychological, social and occupational functioning improved. Of significance, depression levels also decreased on completion of the program. Future studies would benefit from a larger sample and a control group. This study demonstrates that DBT is an effective treatment for BPD clients within an Australian community setting and has many clinical benefits.

Medication-related problems commonly occurring in an Australian community setting.

This study characterised medication-related problems in 1000 Australian patients living in the community, and who were considered at risk of medication misadventure. A review was undertaken of 1000 clinical case notes, developed during the delivery of medication management reviews. Patient demographics, medications used, medical conditions and medication-related problems were categorised according to established classification systems. Descriptive analyses were undertaken. Overall, 2222 problems were identified. Ninety per cent of patients had at least one medication-related problem. One in three people were found to require additional monitoring, one in four required additional medication, one in four were using the wrong or inappropriate medication and one in five were using insufficient medication. Cardiovascular, nervous system, alimentary and respiratory medicines were most commonly implicated, accounting for 69% of the medication-related problems. This analysis reveals the need for ongoing vigilance of, and support for, people at high risk of medication misadventure. This information is also useful for informing the design of public health or health promotion strategies aiming to reduce the prevalence of these problems.

A brief integer scorer for the SF-12: validity of the brief scorer in Australian community and clinic settings.

The SF-36 and the shorter SF-12 are widely used in clinical research and increasingly so in practice. Scoring is complex and the validity of a brief scorer for the SF-12 in a community and a clinic sample was examined. The sample comprised respondents with complete data on the SF-12 from the community sample in the 1997 Australian National Survey of Mental Health and Well-being (n = 10,641) and from a clinical sample from the Clinical Research Unit for Anxiety and Depression (n = 1,725). Each SF-12 was scored by the standard method (using weights to five decimal places) or by the brief method (using weights that are integers only). Scores generated by the standard scorer correlated almost perfectly with the brief scorer in both the community and clinic samples. Means and standard deviations were similar and no individual scores deviated by more than 2.89 in the community sample or by 3.06 in the clinical sample. The brief, rounded integer scorer for the SF-12 is an appropriate substitute for the standard scorer when hand scoring is an advantage.

National Study of Pharmacy Practice in Australian Community Settings in 2002

Journal of Pharmacy Practice and ResearchVolume 32, Issue 1 p. 16-16 Letter to the EditorFree Access National Study of Pharmacy Practice in Australian Community Settings in 2002 Con Berbatis MSc(Syd), FPS(WA), Corresponding Author Con Berbatis MSc(Syd), FPS(WA) Lecturer, Curtin University of Technology Chief Investigator, National Survey of Community PharmaciesGPO Box U 1987 Perth WA 6845. E-mail: berbatis@git.com.auSearch for more papers by this author Con Berbatis MSc(Syd), FPS(WA), Corresponding Author Con Berbatis MSc(Syd), FPS(WA) Lecturer, Curtin University of Technology Chief Investigator, National Survey of Community PharmaciesGPO Box U 1987 Perth WA 6845. E-mail: berbatis@git.com.auSearch for more papers by this author First published: 01 March 2002 https://doi.org/10.1002/jppr200232116AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume32, Issue1March 2002Pages 16-16 ReferencesRelatedInformation

Accuracy of mammography in an Australian community setting.

The records of three surgeons in a Sydney suburban practice have been reviewed to compare the histopathological data from breast biopsies with the clinical assessment, and the mammographic and ultrasound reports, and to assess the extent of the delay before presentation to a surgeon to determine the diagnostic accuracy of the three modalities, and whether mammography contributed to this delay. Two hundred and nineteen breast biopsies that were performed in the years 1984 to 1986 inclusive were reviewed. Of these, 72 were cancerous lesions and 147 were benign lesions. The accuracy (true-positive rate) of mammography for the detection of cancer was 83% with a false-negative rate of 11%. We found no evidence that mammography contributed significantly to the delay before patients presented to specialist surgeons, nor to any delay before they underwent a biopsy.

A factor analytic study of the 60-item general health questionnaire in Australian community and general practice settings.

A factor analytic study of responses to a 60-item General Health Questionnaire of people in general practice and in the community in Perth, Western Australia, was performed. Five identified factors, accounting for 46% of the variance, were very similar to factors identified in an English general practice study but differed from two published Australian studies. The statistic of a relative GHQ profile was generated to compare these factors in various sets of data. There was no significant difference between the relative GHQ profile in the community and general practice data or between demographic factors such as sex, social class and country of birth. The major positive finding was of an excess of overtly psychological factors in 'cases' compared with an excess of more physical factors in 'non-cases'.