HEALTH OF SOUTH AUSTRALIA Research Articles

Codesigning culturally safe oral health care with First Nations Kidney Warriors experiencing kidney disease in South Australia

BackgroundThis paper describes how First Nations Kidney Warriors (Aboriginal and Torres Strait Islander people living with kidney disease), dental hygienists, kidney health care professionals, an Aboriginal hostel accommodation manager and researchers co-designed an approach to improve oral health in South Australia. Kidney Warriors have strong connection to Country, Community and family that underpins health, wellbeing and approaches to research. However, significant colonisation, racism and marginalisation have impacted Kidney Warriors’ social, cultural and financial determinants of health, leading to increased chronic conditions including kidney disease. Access to culturally safe, affordable and responsive oral health care is vital but challenging for First Nations Peoples undergoing dialysis and kidney transplantation; Australian oral health care is generally provided privately, in metropolitan centres, by professionals who may hold unconscious bias about First Nations Peoples and incorrect assumptions regarding equal access to care.MethodsThe AKction – Aboriginal Kidney Care Together Improving Outcomes Now kidney care oral health working group codesigned strategies to address disparities and gaps in care, and co-create more accessible, responsive, culturally safe and sustainable models of care. A decolonising and collaborative participatory action research was informed by Dadirri Deep Listening and Ganma Knowledge Sharing with repeated cycles of Look and Listen, Think and Discuss, Take Action Together. A small pilot evaluation survey of clinical placement in an Aboriginal setting was undertaken.ResultsFour phases of collaboration were undertaken. Community and health professional consultations identified key gaps and priorities. Clinical yarning and cultural safety training and an interprofessional skills day was co-facilitated. Dental hygienist student clinical placement at Kanggawodli Aboriginal Hostel was initiated and evaluated. First Nations Kidney Warriors were positioned as educators and experts of their own lives and health care needs. A new framework for kidney health—oral health cultural safety and clinical education was developed.ConclusionThis codesigned approach involving inter-professional collaboration and joint decision making with community members has significantly informed improvements in oral health care information, services and referral with and for First Nations Peoples with kidney disease. This project provides a working example of how to decolonise health service and education programs from the ground up.Trial registrationNHMRC PAR 2004389.

A history of arts and health in South Australia: Policy and practice

This article traces the history of arts and health in South Australia, using an interview-based methodology to detail how grassroots practice developed into formal arts and health policy. The project interviewed 47 arts and health stakeholders, including former state government ministers, artists and health professionals. South Australia has a long history of arts and health work. However, interviewees describe a lack of momentum for the field since the endorsement of the 2013 National Arts and Health Framework, largely because it did not contain binding commitments which left the field vulnerable to changes associated with political leadership. South Australia thus represents both a case study of how grassroots support can maximize political interest in arts and health to create formal policy as well as a warning on the challenges that occur when this interest wanes.

Comparison of World Health Organization and International Consensus Classification Guidelines for Myeloid Neoplasms Harboring TP53-Mutations Using an Independent International Cohort

BACKGROUND: Recently proposed World Health Organization (WHO, 5 th edition) and International Consensus Classification (ICC) recognized myeloid neoplasms (MN) harboring TP53-mutated ( TP53mut) as a separate entity. However, there are critical differences between the two classifications regarding allelic-status, variance allele frequency (VAF) cut-off and blast categories, that may lead to under- or overestimation of the risk. METHODS: We analyzed MN harboring TP53mut (VAF ≥2%, n=536) managed at Mayo Clinic (USA) and South Australia Health Network (Australia). ICC (Arber et al, Blood 2022) and WHO (Bluebook, Beta v2) definitions were used to stratify MN harboring TP53mut. RESULTS: Of 536 cases, 379 (71%) had myelodysplastic syndromes (MDS) (<20% blasts) and 157 (29%) had acute myeloid leukemia (AML). Using WHO, 160 (42%) of 379 were classified as MDS-bi TP53 as they harbored 2 TP53mut (n=115; 30%) or 1 TP53mut plus confirmed loss of heterozygosity (LOH) or copy neutral LOH (cnLOH) of TP53 locus (n=45; 12%). Sixty-two (16%) TP53mut MDS with VAF >49% were classified as presumptive MDS-bi TP53. Of the 157 cases with 1 TP53mut VAF ≤49%, 17 confirmed to have an intact wild-type TP53 copy and were classified as monoallelic. While 140 (89%) cases did not have copy number variation (CNV) analysis. We next evaluated the number of TP53mut cases classified differently by WHO and ICC. As WHO does not recognize TP53mut AML as a separate entity, 157 (29%) TP53mut AML were not classifiable. 46% (174/379) of the TP53mut MDS including 48 (30%), 12 (19%) and 79 (65%) of bi TP53, presumptive bi TP53 and monoallelic TP53mut MDS according to WHO were classified differently by ICC ( Figure 1A). Discordance between the two classifications were predominantly driven by: (i) The difference in VAF cut-off. Sixty patients (11%) with TP53mut VAF <10% were excluded from the ICC classification of TP53mut MN as it mandates TP53mut VAF cut-off ≥10%. 11 (18%) and 41 (68%) of these had bi TP53, monoallelic TP53mut MDS by WHO criteria while 8 (13%) had AML. Importantly, within the VAF <10% cohort, median overall survival (OS) of 2 TP53mut or 1 TP53mut with 17p13.1 (hereafter 17p) deletion or complex karyotype (CK, n=30) was significantly poor compared to 1 TP53mut VAF <10% (11.6 vs 32.4 months; P =0.002, Figure 1B), suggesting that ICC may underestimate the poor prognosis of multi-hit or multi-hit equivalent TP53mut MN with VAF <10%. (ii) The difference in bone marrow blast cut-off. The underlying assumption by WHO is that prognosis of bi TP53mut MDS is poor irrespective of blast percentage category (0-9% vs 10-19%). In contrast, ICC considers that TP53mut MDS/AML (blasts 10-19%) is associated with poor prognosis irrespective of TP53 allelic status. Median OS of TP53mut MDS with 10-19% blasts was significantly poor compared to blast 0-9% (6.4 vs 11.6 months, P <0.0001). Second, median OS of bi TP53mut was significantly poor than monoallelic TP53mut in MDS- blast 0-9% (10.1 vs 15.9 months; P =0.0001) but not in blasts 10-19% (6.8 vs 6.2 months; P =0.19). Hence, exclusion of monoallelic TP53mut MDS with blast 10-19% as TP53mut MN from the WHO classification may underestimate the poor prognosis. (iii) The difference in the definition of biallelic and multi-hit TP53 loss. 35 cases with 1 TP53mut VAF ≤49%, had 17p deletion but did not have CNV analysis to confirm the loss of TP53 locus and could not be classified further using WHO. ICC classified 18 (50%) of these cases as multi-hit. Median OS of 1 TP53mut VAF ≤49%, and 17p deletion on karyotype was significantly poor than 1 TP53mut (VAF ≤49%without 17p deletion on karyotype (6.4 vs 14.6 months, P =0.001). (iv) The difference in the definition of multi-hit equivalent. 32% (33/104) WHO defined monoallelic cases without available CNV data, were classified as multi-hit-equivalent by ICC as they harbored CK. However, WHO does not consider CK as presumptive evidence of bi TP53. Median OS of 1 TP53mut VAF ≤49% with CK was significantly poor compared to 1 TP53mut without CK (8.2 vs 26.9 months, P =0.0008). CONCLUSION: Our study provides evidence that poor prognosis of ‘multi-hit’ TP53 with VAF <10% is underestimated by ICC. On the other hand, poor prognosis of monoallelic TP53 MDS with 10-19% blasts as well as 1 TP53mut VAF ≤49% in the presence of CK is underestimated by WHO. These data suggest that both classifications can be further refined.

Public health partner authorities-How a health in all policies approach could support the development of a wellbeing economy.

Collaboration and partnerships across sectors are critical to the realisation of a wellbeing economy. Wellbeing SA-a government agency in South Australia-utilises a partnership mechanism under the state's public health legislation to achieve collaborative action for improved population health and wellbeing: Public Health Partner Authorities (PHPAs). The establishment and implementation of PHPAs draws strongly on the principles and practices of South Australia's Health in All Policies (HiAP) approach. This includes the utilisation of cross-sectoral partnerships to facilitate the implementation of co-design and co-benefits principles to deliver policies that support improved population health and wellbeing, while simultaneously delivering other societal benefits. Partnerships also facilitate the sharing of knowledge and resources, and the creation of joint solutions to complex policy issues. PHPAs have been reported to offer a valuable, evidence-based and practical mechanism for embedding key concepts of wellbeing into the policies, practices and programs of other sectors, and provide the potential as one important tool for the formation of a wellbeing economy. The achievement of a wellbeing economy is dependent on collaboration within and between sectors, and through strong community engagement. Developing a joint and inclusive understanding of wellbeing and its importance as a societal goal is critical, and can only be achieved through collaborative approaches. The implementation of PHPAs in South Australia has demonstrated the importance of partnerships to address complex issues across sectors, and has identified key elements to successful partnerships. SO WHAT?: South Australia's experience in implementing PHPAs and HiAP has demonstrated how health promotion practice, policy and research that incorporate successful partnerships can support high quality, effective intersectoral collaboration for the benefit of citizens, including some lessons that may be worth considering in the development and realisation of a wellbeing economy.

A call for culture-centred care: exploring health workers' perspectives of positive care experiences and culturally responsive care provision to Aboriginal women and their infants in mainstream health in South Australia

BackgroundAboriginal women and their infants experience significant disadvantage in health outcomes compared to their non-Aboriginal counterparts. Access to timely, effective, and appropriate maternal and child health care can contribute to reducing these existing health disparities. This research sought to explore factors that contribute to continuity of care for Aboriginal women and their infants living in metropolitan South Australia. This paper reports on the perspectives of health care workers in mainstream health services from the antenatal period to the end of an infants’ second birthday. It explores health workers’ perspectives of what contributes to positive care experiences and satisfaction with care provided to Aboriginal women and their infants in mainstream health.MethodsEight focus groups were held with 52 health professionals. Participants included Aboriginal Cultural Child and Family Support Consultants (n = 7), Aboriginal Maternal Infant Care Workers (n = 3), Midwives (n = 3) and Child and Family Nurses (n = 39). Data was inductively coded and thematically analysed.ResultsThree key themes emerged: the system takes priority, culture is not central in approaches to care, and ‘we’ve got to be allowed to do it in a different way’.ConclusionsThis research highlights a lack of continuity of care for Aboriginal families accessing mainstream health services from the antenatal period through to an infants’ first 1000 days of life. This research has implications for communities, and it calls for strategies to enhance continuity, and healthcare services to provide appropriate and culturally safe care. Findings will inform and guide future changes to improve continuity of care for Aboriginal families and infants in the first 1000 days.

Microplastics in intertidal water of South Australia and the mussel Mytilus spp.; the contrasting effect of population on concentration

Microplastics, plastic particles <5 mm in size, are of global concern as human-caused pollutants in marine and fresh waters, and yet little is known of their distribution, behaviour and ecological impact in the intertidal environment of South Australia. This study confirms for the first time, the presence of microplastic in the South Australian intertidal ecosystem by quantifying the abundance of particles in intertidal water and in the keystone species, the blue mussel, Mytilus spp., an important fisheries species, at ten and six locations respectively, along the South Australian coastline. For a remote region known for its pristine environment, microplastic concentration in intertidal water was found to be low to moderate (mean = 8.21 particles l−1 ± 4.91) relative to global levels and microplastic abundance in mussels (mean = 3.58 ± 8.18 particles individual−1) was within the range also reported globally. Microplastic particles were ubiquitous across sites and bioavailable by size in water (mean = 906.36 μm) and in mussel (mean = 983.29 μm) raising concerns for the health of South Australia's unique coastal ecosystems and for the human food chain. Furthermore, a positive correlation was found between human coastal population size and microplastic concentration in intertidal water, irrespective of influences from industry - tourism, fishing and shipping ports. FTIR analysis determined plastic type to include polyamide (PA), polyethylene (PE), polypropylene (PP), acrylic resin, polyethyleneterephthalate (PET) and cellulose, suggesting synthetic and semi-synthetic particles from single-use, short-life cycle products, fabrics, ropes and cordage. Our findings shed light on the urgent need to establish the local sources of microplastic pollution in order to assist the community, industry and government to reduce the impact of microplastic on the fragile marine systems within South Australian intertidal waters and on the organisms associated with the human food chain.

Active Lives South Australia health economic analysis: an evidence base for the potential of health promotion strategies supporting physical activity guidelines to reduce public health costs while improving wellbeing

AimThe COVID-19 pandemic has threatened individual and population wellbeing and strategies to jointly address these challenges within budget constraints are required. The aim of our research is to analyse evidence from the Active Lives South Australia study to consider the potential of physical activity (PA) health promotion strategies to be health-system cost saving while addressing wellbeing challenges.MethodsThe Active Lives South Australia study compares adult populations who meet and do not meet physical activity (PA) guidelines (150+ minutes of weekly physical activity) with respect to their subjective wellbeing and health care utilisation.Subject and resultsAdults who met PA guidelines had better wellbeing across all aspects with and without adjustment for age, sex and income covariates. Analysis showed significant associations between meeting guidelines and lower probabilities of visiting and utilisation of GPs, specialist doctors, other health professionals, hospital inpatient admissions, outpatient clinic and emergency department visits, and an overall A$1760 lower cost per person annually. Controlling for age, sex and income, health expenditure for adults who met PA guidelines was significantly lower by A$1393 per person annually. That translated to A$804 million potential annual SA health system cost saving by shifting all adults to meeting PA guidelines.ConclusionThere is significant potential for effective health promotion strategies to be net cost saving while addressing wellbeing challenges of COVID-19 recovery where they can shift target populations from not meeting to meeting PA guidelines.

Health care need and health disparities: Findings from the Regional South Australia Health (RESONATE) survey.

Regional South Australia has some of the highest rates of psychological distress, chronic disease and multimorbidity of any Australian State or Territory. Yet, the healthcare needs of this population are still not completely understood. To better understand the healthcare needs of regional South Australians, we invited adults living in the region to complete the 44-item consumer utilisation, expectations and experiences of healthcare instrument (CONVERSATIONS), online or in hard-copy. The survey was conducted between April 2017 and March 2018. A multi-modal recruitment campaign was utilised to promote the survey. We examined associations between study outcomes and remoteness area, and drew comparisons between our findings and other surveys reporting pertinent outcomes in the urban SA population. The questionnaire was completed by 3,926 adults (52.5% females; 37.6% aged 60+years). Among the 264 distinct health conditions reported by participants, the most prevalent were hypertension (31.6%), depression (25.7%), anxiety (23.5%) and hypercholesterolaemia (22.9%). The lifetime prevalence of these conditions among participants exceeded rates reported in urban SA. The largest regional-urban health disparities were observed for eczema/dermatitis, skin cancer, other cancer types and cataracts, where prevalence rates were 2075%, 400%, 373% and 324% higher, respectively, than that reported in urban SA. Participants also reported higher levels of multimorbidity (37.7% higher) relative to urban South Australians. By contrast, participants appeared to be exposed to fewer lifestyle risk behaviours (e.g. smoking, alcohol, inadequate fruit or vegetable intake) than their urban counterparts. In summary, there was a high level of healthcare need, and considerable health disparity among participants when compared with urban settings (particularly for skin and eye conditions). These findings highlight the need for a more targeted approach to delivering health services and health promotion activities in regional areas.

Expressed Demand for Health Care Services in Regional South Australia: A Cross-sectional Study.

Accessibility and availability of health care services/providers is an increasing concern for many regional communities, particularly regional South Australia. Assessing the level of health service/provider utilization within a region (ie, expressed demand) can be useful in determining health care need and health service/workforce demand. The regional South Australia health (RESONATE) survey aimed to determine the expressed demand for health care services and the health workforce in a regional South Australian population. The study was open to adults living in regional South Australia and was promoted using a comprehensive multimodal recruitment campaign. Data were collected between April 2017 and March 2018 using the consumer utilization, expectations and experiences of healthcare instrument. A total of 3,926 adults completed the questionnaire. Participants reported using 47 different health care providers in the previous 12 months. Whilst almost all (92.9%) participants had seen a general practitioner in the past 12 months, yoga instructors, chiropractors, pharmacists, and physiotherapists were visited most frequently. Proportionally fewer participants in more remote locations received conventional services/treatments, though a significantly greater proportion of those in more remote locations had received complementary medicine services/treatments (relative to inner regional areas). Findings of the RESONATE survey point to a high level of expressed demand for conventional and complementary health care services among study participants, possibly higher than that reported in the general population. Examining the extent to which the health needs of this and other regional populations are met should be the focus of further research to better inform future health workforce/services planning.

Implementation and Outcomes of a Clozapine-Associated Myocarditis Screening Program in a Region of South Australia-Lessons Learned.

Clozapine-associated myocarditis (CAM) is a serious complication, mostly occurring in the first month of treatment. Public mental health in South Australia introduced a screening protocol in 2011 using baseline and weekly C-reactive protein and troponin. The aim of this study was to assess protocol adherence and management of cases with positive screening results. We identified all patients commenced on clozapine in our area between 2012 and 2015. Those with abnormal C-reactive protein and/or troponin in the first 4 weeks of treatment were identified (potential cases). For those, we collected clinical characteristics and test results and reviewed their management. Protocol compliance increased to 80%. We identified 24 potential CAM cases, 8 at high risk based on established definition (7.6% of new commencements) and 9 formally diagnosed from 143 commenced on clozapine. Potential cases not meeting CAM definition were significantly more likely commenced on clozapine for the first time and have preexisting respiratory disease. Likely CAM cases were younger, and more often prescribed additional antipsychotics, specifically quetiapine. Seven (78%) of 9 patients diagnosed with CAM met published CAM definition. In 14 undiagnosed potential cases, 10 (71%) did not have timely testing to exclude CAM. Maintaining a high index of suspicion, clinical monitoring and timely testing is important to supplement CAM screening protocols. More research is needed to identify those that can be safely rechallenged or even continue clozapine treatment with monitoring.

SERUM BIOCHEMISTRY OF FREE-RANGING SOUTHERN HAIRY-NOSED WOMBATS (LASIORHINUS LATIFRONS).

Listed as near-threatened by the International Union for Conservation of Nature (IUCN), the southern hairy-nosed wombat (SHNW, Lasiorhinus latifrons) faces threats such as drought, habitat degradation and loss, disease, and persecution because of competition with agriculture. To assist with evaluation of wombat health, this study reports serum biochemical reference intervals (RIs) for wild-caught SHNW from South Australia established from 126 apparently healthy SHNW using a Beckman Coulter AU480® Automated Chemistry Analyzer using RefVal Advisor. Partitioning of RIs for male and female wombats and for the two methods of sampling was performed as appropriate, and additional significant differences (P < 0.05) in biochemical profiles were identified across age class and season examined. A number of differences were observed between male and female wombats, most notably higher creatinine, urea, and sodium in females. Subadult and juvenile wombats had significantly lower total protein, globulin, and ALT activity, and significantly higher ALP activity than adults. Wombats sampled in winter and spring had significantly higher total protein, albumin, potassium, bicarbonate, and enzyme activities (ALP, ALT, AST, GGT, GLDH, lipase), and significantly lower glucose and creatinine when compared to individuals sampled in summer and autumn. Differences in CK activity and anion gap observed between the two methods of sampling likely reflect delay and handling of animals between capture and blood collection. The serum biochemical RIs documented here are considered representative of a population of healthy SHNW, providing a tool for health assessment and monitoring of SHNW health in South Australia and elsewhere.

Prevalence of childhood lead poisoning and respiratory disease associated with lead smelter emissions

BackgroundThe city of Port Pirie in South Australia has been a world leading centre for lead and zinc smelting and processing since 1889 that continues to cause contamination of its environment and resident population. This study quantifies the effect of lead and SO2 emissions from Nyrstar Port Pirie Pty Ltd's smelter on blood lead and respiratory health outcomes, respectively, and establishes what air quality values are required to better protect human health. MethodBlood lead and emergency department presentation data collected by South Australia Health (SA Health) and lead in air and SO2 data collected by the South Australian Environment Protection Authority (SAEPA) were obtained and analysed to quantify health outcomes due to smelter emissions in Port Pirie. Regression analysis was used to assess the relationship between the concentration of lead in air and children's blood lead levels between the years of available data: 2003 to 2017. Ambient SO2 concentrations (SAEPA) measured continuously between 2008 and 2018 were 24-hour averaged and compared to daily local emergency department respiratory presentation rates (available from July 2012 to October 2018). Rates of emergency department respiratory presentations at Port Pirie and regional comparators were calculated as age-standardised rates. ResultsThe data show that increases in ambient SO2 concentrations are associated with increased rates of emergency department respiratory presentations of Port Pirie residents, in which children are over-represented. The 30-day rolling average of respiratory presentations was significantly associated (p < 0.05) with incremental increases in SO2. Analysis of the relationship between lead in air and blood lead shows that annual geometric mean air lead concentrations need to be <0.11 μg/m3 to ensure the geometric mean blood lead of Port Pirie children under 5 years is ≤5 μg/dL. For children aged 24 months, lead in air needs to be no greater than 0.082 μg/m3 (annual geometric mean) to ensure geometric mean blood lead does not exceed 5 μg/dL. ConclusionCurrent smelting emissions continue to pose a clear risk of harm to Port Pirie children. Allowable emissions must be lowered significantly to limit adverse childhood health outcomes including respiratory illness and IQ, academic achievement and socio-behavioural problems that are associated with lead exposure at levels experienced by Port Pirie children. Current SO2 levels are likely to be responsible for increased rates of emergency department respiratory presentations in Port Pirie compared with other South Australian locations. As a minimum, Australian SO2 air quality standards need to be enforced in Port Pirie to better protect human health. Lead in air needs to be approximately 80% lower than the current national standard (0.5 μg/m3) to ensure that the geometric blood lead of children under 5 years is less than or equal to 5 μg/dL.

Regional South Australia Health (RESONATE) survey: study protocol

IntroductionAccess to quality healthcare services is considered a moral right. However, for people living in regional locations, timely access to the services that they need may not always be possible...

OP160 Enhancing Innovation Through HTA: Experience From South Australia

Introduction:A statewide health technology assessment (HTA) program was implemented to increase equity of access and support robust assessment of technologies, with a focus on those that are high-cost, high-risk, or have state-wide impact.Methods:Local hospital networks and clinicians refer technologies to the South Australia Policy Advisory Committee on Technology (SAPACT) for assessment. Independently produced, comprehensive HTA reports are developed using internationally recognized evidence and critical appraisal methodologies. Clinical and economic systematic analyses are utilized, with extensive clinical consultation, to develop recommendations for new technologies and their role in models of care. Feasibility of adoption and local implementation are considered, including existing service delivery and appropriate training and credentialing. For approved technologies, SAPACT may also develop audit criteria and seek implementation reports on clinical outcomes.Results:The HTA framework has been successfully adopted across South Australia Health, increasing the incorporation of evidence-based decision making in the use of high-cost and high-risk health technologies. Over 35 evidence evaluations for high-risk and high-cost health technologies have been conducted for a broad range of treatment interventions. SAPACT develops and utilizes HTA decision-making criteria for transparency of Committee considerations. The program recommends adoption or rejection of technologies, or it may request a re-submission due to safety concerns or a lack of proven effectiveness. SAPACT has also granted temporary approval through adoption under clinical evaluation to inform investment decisions. A key component is working with clinicians to define specific treatment criteria and patient selection. SAPACT continues to strengthen relationships with all stakeholders, increase patient input through the development of public summary documents for technologies, and improve monitoring and reporting of clinical outcomes.Conclusions:The HTA program has been very productive and positively received. The success of the program is underpinned by its engagement with clinicians, hospital networks, and consumers. The completion of SAPACT HTA reviews and the publication of the SAPACT decision-making criteria have increased the credibility of decisions, supporting enhancements in patient care and cost efficiency for the state government.

E-Mental health in South Australia: impact of age, gender and region of residence

Respondents to the 2008 South Australian Health Omnibus survey (n=2996) indicated whether, in the previous 12 months, they had searched for information on the Internet relating to emotional issues such as depression, anxiety or relationship problems. Logistic regression was used to examine the penetration of e-mental health in rural and metropolitan areas (region of residence), and determine if other demographic variables (age group, gender) also impacted on the likelihood of an individual reporting that they had used the Internet to obtain such information. Overall, 9% of respondents reported that they had used the Internet for this purpose. The multivariate model was significant, F(11, 2985)=4.82, P<0.0001, with middle-aged rural females most likely to report doing so (18.1%), whereas older rural males were least likely to report doing so (2.2.%). These findings have important implications for the design of e-mental health promotional programs that provide information and interventions to improve mental health.

Sustaining respecting patient choices® (RPC) advance care planning

The Central and Northern Adelaide Local Health Networks in South Australia (SA) oversee four major hospitals and a range of sub-acute and primary health care services. The Respecting Patient Choices...

The South Australia Health Chronic Disease Self-Management Internet Trial

To evaluate the effectiveness of an online chronic disease self-management program for South Australia residents. Data were collected online at baseline, 6 months, and 12 months. The intervention was an asynchronous 6-week chronic disease self-management program offered online. The authors measured eight health status measures, seven behaviors, and four utilization measures; self-efficacy; and health care satisfaction. Two hundred fifty-four South Australian adults with one or more chronic conditions completed baseline data. One hundred forty-four completed 6 months and 194 completed 1 year. Significant improvements (p < .05) were found at 6 months for four health status measures, six health behaviors, self-efficacy, and visits to emergency departments. At 12 months, five health status indicators, six health behaviors, self-efficacy, and visits to emergency departments remained significant. Satisfaction with health care trended toward significance. The peer-led online program was both acceptable and useful for this population. It appeared to decrease symptoms, improve health behaviors, self-efficacy, and reduce health care utilization up to 1 year. This intervention also has large potential implications for the use of a public health education model for reaching large numbers of people. It demonstrates that an Internet self-management program, which includes social media, can reach rural and underserved people as well as be effective and reduce health care costs. If this intervention can be brought to scale, it has the potential for improving the lives of large numbers of people with chronic illness. It represents a way the medical care and public health sectors can interact.

Facilitating recruitment of podiatrists to rural health in South Australia through a joint academic-clinical appointment

Recruiting medical, nursing and paramedical or allied health staff to rural positions is an international problem. An example of this is the difficulty in recruitment and retention of podiatrists in rural South Australia. Increasing the proportion of undergraduate university students from rural areas is just one approach to the problem. It has also been established that students who undertake rural placements often return to a rural area to work on completion of their course. An innovative approach to addressing the recruitment and retention of rural podiatrists in South Australia involved the establishment of a joint rural academic-clinical position. The introduction of this joint position has enabled a mentored and supported increase in rural clinical exposure and education for undergraduate podiatry students. The aim of the appointment was to improve the recruitment of podiatrists to South Australian rural areas; however, an number of other benefits have become apparent.

The formulation of Australia's National Health Policy on Alcohol.

The formulation of a health policy in relation to alcohol is described by the Chairman of the Committee responsible for its drafting in the context of Australia's pursuance of a National Campaign Against Drug Abuse. The fate of particular proposals included in the draft document, but excluded from the final endorsed policy, is discussed in relation to the activities of the alcohol industry and, in particular, the intervention of the Minister for Health in South Australia, Australia's premium wine growing region. Inferences are drawn about the negotiation of public health policy in this area, the role of research and the need to demonstrate widespread public support for the recommendations of such research.

THE APPROACH TO PUBLIC HEALTH IN SOUTH AUSTRALIA

THE APPROACH TO PUBLIC HEALTH IN SOUTH AUSTRALIA