Metropolitan Adelaide Research Articles

A 3-year retrospective review of hospital admissions involving opioid toxicity in South Australia.

This article aims to characterise hospital admissions involving opioid toxicity across South Australia to guide future implementation and evaluation of risk mitigation strategies. International Classification of Diseases, 10th Edition codes (T40.0-T40.4) were used to identify admissions involving pre-hospital opioid toxicity in public hospitals across South Australia from 1 June 2017 to 30 August 2020. Demographic and episode of care data were extracted and summarised using descriptive statistics. Admission cost estimates were calculated using Independent Hospital Pricing Authority data. A total of 2046 cases met the criteria for inclusion; over half (56%) were female and median age on admission was 44 years (interquartile range 27 years). Where opioid toxicity was the primary diagnosis, 70% of admissions did not specify the responsible opioid and 23% were related to heroin use. One-fifth of admissions occurred outside of metropolitan Adelaide. Individuals living in an area of relative socio-economic disadvantage were over-represented. Over half of admissions required a stay >24 h; 19% were admitted for ≥5 days, 22% required intensive care and ~10% required mechanical ventilation. The total estimated cost of admissions involving opioid toxicity in South Australia over the 3-year period was $18,230,546.50, equating to $5.6 million per annum. These findings highlight the significant personal, fiscal, and systemic impacts of opioid toxicity-related hospital admissions in South Australia and provide a baseline to evaluate the effectiveness of initiatives to reduce opioid-related harm, including real-time prescription monitoring and take-home naloxone supply.

Improving Population Health and Health Equity: The Potential of Transitioning Public Open Spaces to Optimise the Production of Urban Ecological Services in Adelaide, South Australia

ABSTRACT This research examines the potential of transitioning public “green spaces” to optimise health benefiting urban ecological services in metropolitan Adelaide, South Australia. The research found strengths but also significant weaknesses. The major weaknesses observed were poor quality amenities and facilities within open spaces, low landscape complexity, poor maintenance and inadequate integration with the built form and pedestrian networks of the surrounding neighbourhoods. Previous research has shown that the weaknesses we observed are adversely affecting the health and wellbeing of many residents. In addition, our research shows there are far more strengths and fewer weaknesses in pre-1945 and high-income neighbourhoods.

Fetal Growth and Adiposity of Infants Born Large for Gestational Age in Three Harmonized Randomized Trials.

Infants born large for gestational age (LGA) are at an increased risk of short- and longer-term adverse outcomes. Understanding fetal growth and adiposity and their trajectories may help inform interventions to prevent birth of LGA infants. We aimed to compare fetal growth and adiposity measures of infants born LGA with those born not LGA, to determine whether the discrepancy at birth was primarily due to larger size throughout gestation, or instead to different trajectories of fetal growth. This was a secondary analysis of secondary outcomes of fetal growth and adiposity from three harmonized randomized trials-the LIMIT, GRoW, and Optimise randomized trials. These trials recruited women in early pregnancy, and a singleton gestation, from three major public metropolitan Adelaide maternity hospitals. Maternal body mass index (BMI) ranged from 18.5 to ≥40.0 kg/m2. Data were obtained from enrolled women who underwent research ultrasounds at 28 and 36 weeks' gestation. Outcome measures were ultrasound measures of fetal biometry and adiposity. Infants born LGA had larger fetal biometry measures, and higher growth trajectories, from 20 weeks' gestation. Fetal adiposity measures were consistently larger among infants born LGA and these differences increased over time. We did not find evidence that the differences in biometry and adiposity measurements varied according to maternal BMI. Infants born LGA had larger fetal biometry measures at all time points from 20 weeks' gestation, compared with infants born not LGA suggesting any interventions to prevent LGA likely need to commence earlier in pregnancy or prior to conception. · Infants born LGA had larger fetal biometry measures from 20 weeks' gestation.. · Infants born LGA had larger fetal adiposity measures.. · Interventions to prevent LGA need to start earlier in pregnancy or prior to conception..

Patient experiences and outcomes in a South Australian stand-alone Hospital in the Home program.

ObjectivesThis study aimed to compare clinical outcomes for patients admitted to Hospital in the Home (HITH) and traditional (bricks-and-mortar) hospitals and explore patient and carer experiences.MethodsA mixed methods approach including triangulation of quantitative and qualitative data was used. Quantitative outcomes were compared using augmented inverse propensity weighting to adjust for differences in patient characteristics between groups. Qualitative data was collected by focus groups and interviews and analysed using reflexive thematic analysis. The study took place in metropolitan Adelaide and one adjacent regional health network in 2020-22. Participants were patients discharged from either hospital setting with 1 of 22 eligible diagnoses. Hospital administrative data informed a comparison of outcomes that included mortality, rate of emergency department re-presentations and re-admissions, length of stay and incidence of complications.ResultsPatients treated in HITH were less unwell than traditional hospital patients. There were no safety or quality concerns identified in the clinical outcomes. Of 2095 HITH patients, the in-patient mortality rate was 0.2%, and 2.3% experienced a return to a bricks-and-mortar hospital during the HITH admission. For HITH patients, the mortality rate after 30days was lower (-1.3%, 95% CI -2 to -0.5, P=0.002), as were re-presentations in 28days (-7.2%, 95% CI -9.5 to -5, P<0.0001), re-admissions in 28days (-4.9%, 95% CI -6.7 to -3.2, P<0.001) and complications (-0.6%, 95% CI -0.8 to -0.5, P<0.001). Interviews of 35 patients and six carers found that HITH was highly accepted and preferred by patients. HITH was perceived to free up resources for other, more acutely unwell patients.ConclusionsHITH was preferred by patients and at least as effective in delivering quality health care as a traditional hospital, although the potential for unobserved confounding must be acknowledged.

Common home hazards among healthy older aged adults and potential modifications required for age-friendly housing.

The creation of age-friendly home environments enables middle-aged and older aged people to live independently at home while adapting to age-related changes. Little is currently known about existing home hazards that may potentially hinder healthy older people as they age. Prospective cohort study of healthy adults who received an age-friendly home environment assessment conducted by an occupational therapist. Adults aged 60 and over, without significant disability, living in homes within metropolitan Adelaide, South Australia were recruited through community advertising. Sixty age-friendly home environment assessments were conducted. Common areas where potential hazards were identified, and modifications recommended were bathrooms, toilets and backyards. Gardens were commonly identified as potentially requiring modifications in the future. Participants were more likely to consider moving to new housing if additional modifications were needed to their homes. Affordable and accessible age-friendly housing is required to support an ageing population. Education on age-friendly housing for healthy middle and older aged people is required enabling proactive planning rather than awaiting health crises.

Applying Learning Principles Within Parent Education: Exploring Nurses' Practice and Parents' Experiences.

In parent-education practice nurses use Learning Principles (LPs) when helping parents to develop the knowledge and skills required to care for their children. LPs are basic precepts of learning, comprising people's beliefs, behaviors and reasoning processes. LPs underpin parents' active engagement, confidence building and decision-making, as information provided becomes usable knowledge. However, the ways nurses apply LPs in parent-education practice are poorly explained in healthcare. Likewise, descriptions of parents' learning experiences, associated with the use of LPs in nurse/parent-education interactions, are lacking. This study aimed to explore and describe nurses' perceptions and use of LPs, and parents' learning experiences in one healthcare organization. Using an action research design, 25 nurses and 18 parent participants were purposively recruited across metropolitan Adelaide, Australia. Data were collected through observations and semi-structured interviews and thematically analyzed simultaneously June-December 2017. The LPs nurses used, and those important to parents' learning experiences created three overarching themes: 1) collaborative relationships, 2) deepening learning insights, 3) the learning environment. Despite their apparent use, nurses struggled to explicitly describe how they perceived LPs, believing their knowledge and use was sub-conscious - tacit. However, tacit knowledge hinders communication and explanation of LPs used within parent-education to other nurses. The member-checking of interview data helped to stimulate the nurses' metacognition (thinking about their thinking), unlocking their LPs awareness. Nurses used LPs in practice but their knowledge was tacit. Through metacognition, nurses started to recognize the ways LPs influenced their practice and parents' learning capabilities. Increasing healthcare constraints, including time allowed for parent-education, require nurses to optimize their use of LPs. Future research should identify ways nurses can communicate their use of LPs, potentially enhancing parents' active learning experiences and concordance with health recommendations.

A Digital Tool for the Self-Assessment of Homes to Increase Age-Friendliness: Validity Study.

Age-friendly environments in homes and communities play an important role in optimizing the health and well-being of society. Older people have strong preferences for remaining at home as they age. Home environment assessment tools that enable older people to assess their homes and prepare for aging in place may be beneficial. This study aims to establish the validity of a digital self-assessment tool by assessing it against the current gold standard, an occupational therapy home assessment. A cohort of adults aged ≥60 years living in metropolitan Adelaide, South Australia, Australia, assessed their homes using a digital self-assessment tool with 89 questions simultaneously with an occupational therapist. Adults who were living within their homes and did not have significant levels of disabilities were recruited. Cohen κ and Gwet AC1 were used to assess validity. A total of 61 participants (age: mean 71.2, SD 7.03 years) self-assessed their own homes using the digital self-assessment tool. The overall levels of agreement were high, supporting the validity of the tool in identifying potential hazards. Lower levels of agreement were found in the following domains: steps (77% agreement, Gwet AC1=0.56), toilets (56% agreement, κ=0.10), bathrooms (64% agreement, κ=0.46), and backyards (55% agreement, κ=0.24). Older people were able to self-assess their homes using a digital self-assessment tool. Digital health tools enable older people to start thinking about their future housing needs. Innovative tools that can identify problems and generate solutions may improve the age-friendliness of the home environment.

Australian strategic planning and socio-spatial vulnerability: the case of metropolitan Adelaide

ABSTRACT This article explores the correlation between contemporary strategic planning and socio-spatial disadvantage, utilizing data from five censuses conducted within the Adelaide metropolitan region. To assess how these two dynamics manifest across Australian cities, we introduce a vulnerability assessment methodology. Taking a historical perspective, the study delves into how ongoing socio-spatial transformations have impacted the Index of Relative Socio-economic Disadvantage (IRSD) over several decades. Employing mixed methods, we analyse the temporal progression of the IRSD from 1991 to 2021 and interpret the implications in the context of contemporary strategic plans. The research findings reveal that strategic plans in metropolitan Adelaide have become linked to the establishment of five interconnected/consolidated regional centres, as well as the relocation of areas of disadvantage from the traditional inner cities to the middle and outer suburbs. This has led to residents experiencing enduring socio-spatial vulnerability for several decades. The investigation illustrates the evolving nature of urban disadvantage in post-industrial Australian cities. This article introduces an innovative method for evaluating strategic plans, specifically monitoring progress in achieving their objectives. This could guide future plans to uplift disadvantaged suburbs from a state of permanent vulnerability.

Development of an initiatives package to increase children's vegetable intake in long day care centres using the Multiphase Optimisation Strategy (MOST) randomised factorial experiment.

To inform a package of initiatives to increase children's vegetable intake while in long day care (LDC) by evaluating the independent and combined effects of three initiatives targeting food provision, the mealtime environment and the curriculum. Using the Multiphase Optimisation Strategy (MOST) framework, a 12-week, eight-condition (n 7 intervention, n 1 control) randomised factorial experiment was conducted. Children's dietary intake data were measured pre- and post-initiative implementation using the weighed plate waste method (1× meal and 2× between-meal snacks). Vegetable intake (g/d) was calculated from vegetable provision and waste. The optimal combination of initiatives was determined using a linear mixed-effects model comparing between-group vegetable intake at follow-up, while considering initiative fidelity and acceptability. LDC centres in metropolitan Adelaide, South Australia. 32 centres, 276 staff and 1039 children aged 2-5 years. There were no statistically significant differences between any of the intervention groups and the control group for vegetable intake (all P > 0·05). The curriculum with mealtime environment group consumed 26·7 g more vegetables/child/day than control (ratio of geometric mean 3·29 (95 % CI 0·96, 11·27), P = 0·06). Completion rates for the curriculum (> 93 %) and mealtime environment (61 %) initiatives were high, and acceptability was good (4/5 would recommend), compared with the food provision initiative (0-50 % completed the menu assessment, 3/5 would recommend). A programme targeting the curriculum and mealtime environment in LDC may be useful to increase children's vegetable intake. Determining the effectiveness of this optimised package in a randomised controlled trial is required, as per the evaluation phase of the MOST framework.

Economic and cost considerations of delivering and using mobile X-ray services in residential aged care facilities: Aqualitative study.

To describe the economic and cost considerations of mobile X-ray services (MXS) in residential aged care facilities (RACFs), according to stakeholders (involved in residents' healthcare), residents living in RACFs and informal carers (ICs) of residents. Semistructured interviews were conducted with 20 residents and 27 ICs recruited from six RACFs across metropolitan Adelaide (South Australia, Australia), and 22 stakeholders, on their perspectives of using MXS in RACFs. Data relating to economic and cost considerations were extracted and analysed using thematic analysis. Residents' mean age was 85 years, 60% were women and 40% had experienced an MXS in the last 12 months. Most ICs were daughters (70%) and wives (11%) and 30% had a family member who had experienced an MXS in the last 12 months. Stakeholders included RACF staff, GPs, a hospital avoidance program clinician, paramedics, emergency department clinicians, MXS radiographers and manager, and a radiologist. Four themes were presented: (1) business considerations, where private providers found it necessary to charge residents a co-payment to deliver MXS; (2) cost and payment process as a potential barrier to using MXS, with varied willingness and ability to pay for an MXS co-payment, and equity concerns; (3) overcoming cost and payment barriers, with staff and consumers sometimes using strategies to overcome cost barriers; and (4) perceived cost benefits of MXS to the healthcare system, residents and ICs. Mobile X-ray services providers charge residents an upfront co-payment for business viability, which can be a barrier to some residents wishing to access MXS.

Ear disease and hearing loss: a descriptive study of Aboriginal children living in metropolitan South Australia

ObjectiveThis article aims to describe the rates of middle ear disease in Aboriginal children living in metropolitan Adelaide. MethodsData from the Under 8s Ear Health Program (population-based outreach screening) were analysed to identify rates of ear disease and the referral outcomes for children identified with ear conditions during screening. ResultsIn total, 1598 children participated in at least one screening between May 2013 and May 2017. Males and females were equally represented; 73.2% had one or more abnormal findings on otoscopy at the first screening visit, 42% had abnormal tympanometry, and 20% registered a “fail” on otoacoustic emission testing. The referral pathway for children with abnormal findings included referrals to their GP, Audiology, and Ear Nose Throat (ENT) Departments. Also, 35% (562/1598) of the children screened required referral either to a GP or Audiology, and 28% of those referred (158/562) or 9.8% (158/1598) of the total number of children screened required further ENT management. ConclusionsHigh rates of ear disease and hearing problems in urban Aboriginal children were detected in this study. Existing social, environmental, and clinical interventions need to be evaluated. Closer monitoring including data linkage may assist to better understand the effectiveness, timeliness, and challenges of public health interventions and follow-up clinical services to a population-based screening program. Implications for Public HealthAboriginal-led population-based outreach programs such as the Under 8s Ear Health Program augmented by seamless integration with education, allied health and tertiary health services should be prioritised for expansion and continued funding.

Parent and early childhood educator perspectives of unstructured nature play for young children: A qualitative descriptive study.

Nature play is growing in popularity, with many early childhood settings transforming their outdoor play environments to incorporate more natural elements. Current research highlights the benefits of engaging in unstructured nature play for children's health and development; yet little is known about the experiences of key nature play end-users such as parents and early childhood educators, even though they directly impact the application of nature play within early childhood settings. This study aimed to address this knowledge gap by exploring parent and early childhood educator (ECE) perspectives to gain an understanding about their experiences with nature play. Using a qualitative descriptive approach, semi-structured in-person and telephone interviews were conducted with 18 ECE and 13 parents across four early childhood centres (from various socio-economic regions) across metropolitan Adelaide, South Australia during 2019-2020. Interviews were audio-recorded and transcribed verbatim. Thematic analysis identified five main themes; positive affirmations of nature play, factors influencing nature play engagement, defining nature play, outdoor play space design and risky play. Children's connection to the natural world, learning about sustainability, emotional regulation, and children discovering their own capabilities were perceived advantages of engaging in nature play. Despite the benefits, ECE's described institutional barriers such as resourcing, adhering to policies and scheduling conflicts, whereas, parents described time, getting dirty and proximity to nature play spaces as barriers to nature play engagement. Parents and ECEs alike described adults as gatekeepers for play, especially when other daily tasks compete for their time, or when faced with weather-imposed barriers (cold, rain, extreme heat in summer). The findings suggest that parents and ECEs may need additional resources and guidance on how to engage with nature play and how to overcome barriers within early childhood settings and the home environment.

General Practitioners perspectives on infant telomere length screening after a pregnancy complication: a qualitative analysis.

Pregnancy complications can impact the mother and child's health in the short and longterm resulting in an increased risk of chronic disease later in life. Telomere length is a biomarker of future cardiometabolic diseases and may offer a novel way of identifying offspring most at risk for future chronic diseases. To qualitatively explore General Practitioners' (GPs) perspectives on the feasibility and uptake for recommending a telomere screening test in children who were born after a pregnancy complication. Twelve semi-structured interviews were conducted with GPs within metropolitan Adelaide, South Australia. Interviews were audio recorded, transcribed verbatim, and analysed for codes and themes. Two themes were generated: ethical considerations and practical considerations. Ethically, the GP participants discussed barriers including consenting on behalf of a child, parental guilt, and the impact of health insurance, whereas viewing it for health promotion was a facilitator. For practical considerations, barriers included the difficulty in identifying people eligible for screening, maintaining medical communication between service providers, and time and financial constraints, whereas linking screening for telomere length with existing screening would facilitate uptake. GPs were generally supportive of potential telomere screening in infants, particularly via a saliva test that could be embedded in current antenatal care. However, several challenges, such as lack of knowledge, ethical considerations, and time and financial constraints, need to be overcome before such a test could be implemented into practice.

Post COVID-19 Transformation in the Frequency and Location of Traffic Crashes Involving Older Adults

Although numerous studies have been conducted to discover the spatial patterns of road crashes, relatively few have focused on the patterns of road crashes suffered by socially disadvantaged groups, while simultaneously accounting for urban environmental features. This study used advanced econometric (negative binomial regression) and spatial (geographically weighted Poisson regression) approaches to capture latent geographical diversity in crash patterns. The police-reported crash data for the over-65 population in metropolitan Adelaide, Australia, were investigated for two periods: before and after COVID-19. Using both spatial and nonspatial models, the effects of land use mix, population density, road network design, distance to the central business district, and accessibility of public transit on crash frequency, and location at the neighborhood level were investigated. The findings revealed that, in addition to sociodemographic factors, the aforementioned components had nonlinear effects in varied geographical contexts. Although the number of crashes fell by 20% during the periods studied, the fundamental reasons for such incidents did not change. The results of the study could assist academics and policy makers in Australia to better understand the multidimensional implications of the built environment on the road safety of the elderly—a vulnerable group in society who were disproportionately affected by the global pandemic. The hybrid technique presented in this research has the potential to be useful in other scenarios experiencing varying crash patterns.

Transcendental Meditation for Women Affected by Domestic Violence: A Pilot Randomised, Controlled Trial

Abstract Purpose Domestic and family violence is a major public health issue impacting one in three women worldwide. The implications of such violence are considerable. Transcendental Meditation® (TM) represents a promising treatment option for women impacted by domestic violence given its demonstrable effects on mental and trauma-related symptoms. This study set out to compare the effectiveness of TM to group support, on quality of life, perceived stress and mood in female survivors of domestic violence. Methods This 16-week pilot randomised controlled trial recruited women from metropolitan Adelaide, who survived any type of domestic violence in their lifetime. Outcomes included health-related quality of life, severity of depression, anxiety and perceived stress, symptoms of post-traumatic stress disorder, and subjective experience. Data were analysed by intention-to-treat using linear mixed-effects models. Results Forty-two women were randomly assigned to the TM (n = 21) and support (n = 21) groups. Adjusting for random effects, TM was shown to be significantly more effective than support at improving Australian Quality of Life (AQoL-8D) utility scores (p = .011), and Depression Anxiety and Stress Scale (DASS-21) severity scores for depression (p = .029), anxiety (p = .017) and stress (p = .021) over the 16 weeks. There was no statistically significant time-group interaction effect for PTSD Checklist for DSM-5 (PCL-5) total symptom severity scores. Conclusions TM is shown to have promising effects on quality of life, perceived stress and mood among women exposed to domestic violence, suggesting that it may represent an effective alternative to group support. Trial Registration ACTRN12620000467932 (09/04/2020).

Characteristics of analytically confirmed gamma-hydroxybutyrate (GHB) positive patients in the emergency department: presentation, poly-drug use, disposition and impact on intensive care resource utilisation

Background Gamma-hydroxybutyrate is a potent central nervous system depressant with a narrow recreational dose window and analytical detection time. We describe data relating to intoxicated patients presenting to emergency departments across metropolitan Adelaide who tested positive for gamma-hydroxybutyrate. This work was part of the Emergency Department Admission Blood Psychoactive Testing study. Methods Over a 15-month period, patients presenting to four metropolitan emergency departments with symptoms of drug intoxication were enrolled in the study. The methodology involved the collection of demographic and clinical data and a de-identified blood sample which underwent comprehensive toxicological analysis. Gamma-hydroxybutyrate was determined using an acid-catalysed cyclisation followed by liquid-liquid extraction and gas chromatography-mass spectrometry. Data relating to samples positive for gamma-hydroxybutyrate were examined. Results and discussion A total of 1120 patients were enrolled between March 2019 and May 2020, 309 of whom were positive for gamma-hydroxybutyrate (27.6%). Of these, 256 (83%) were also positive for metamfetamine (methamphetamine). The most common clinical observation in gamma-hydroxybutyrate-positive patients was central nervous system depression (89%). There was a significant relationship between gamma-hydroxybutyrate status and sex; although males outnumbered females in absolute terms, a higher proportion of females (32%) tested positive for gamma-hydroxybutyrate than males (25%, P = 0.0155). Blood gamma-hydroxybutyrate concentrations ranged from 10 to 651 mg/L (0.096–6.2 mmol/L) and increasing gamma-hydroxybutyrate concentration correlated with severe toxicity. The presence of gamma-hydroxybutyrate had a significant impact on the patient discharge destination: the majority (69.2%) of gamma-hydroxybutyrate-positive patients were managed and discharged from the emergency department or their attached short stay wards. A significantly higher proportion of gamma-hydroxybutyrate-positive patients were admitted to the intensive care unit (28.2%) compared with gamma-hydroxybutyrate-negative patients (12.7%, chi-squared = 36.85, P <0 .001). Gamma-hydroxybutyrate positive cases accounted for 45.8% of all study-related intensive care unit admissions. Conclusions Gamma-hydroxybutyrate is commonly detected in illicit drug-related emergency department presentations and is detected disproportionately in the patient cohort who require intensive care unit level care.

Road crashes in Adelaide metropolitan region, the consequences of COVID-19

BackgroundMany countries instituted lockdown rules as the COVID-19 pandemic progressed, however, the effects of COVID-19 on transportation safety vary widely across countries and regions. In several situations, it has been shown that although the COVID-19 closure has decreased average traffic flow, it has also led to an increase in speeding, which will indeed increase the severity of crashes and the number of fatalities and serious injuries. MethodsAt the local level, Generalized linear Mixed (GLM) modelling is used to look at how often road crashes changed in the Adelaide metropolitan area before and after the COVID-19 pandemic. The Geographically Weighted Generalized Linear Model (GWGLM) is also used to explore how the association between the number of crashes and the factors that explain them varies across census blocks. Using both no-spatial and spatial models, the effects of urban structure elements like land use mix, road network design, distance to CBD, and proximity to public transit on the frequency of crashes at the local level were studied. ResultsThis research showed that lockdown orders led to a mild reduction (approximately 7%) in crash frequency. However, this decrease, which has occurred mostly during the first three months of the lockdown, has not systematically alleviated traffic safety risks in the Greater Adelaide Metropolitan Area. Crash hotspots shifted from areas adjacent to workplaces and education centres to green spaces and city fringes, while crash incidence periods switched from weekdays to weekends and winter to summer. ImplicationsThe outcomes of this research provided insights into the impact of shifting driving behaviour on safety during disorderly catastrophes such as COVID-19.

Effects of rainfall in the arid zone on waterbird abundance at a wastewater treatment plant in coastal South Australia

We investigated which species of waterbirds at Bolivar, a wastewater treatment plant in Metropolitan Adelaide, South Australia, are likely to have been immigrants from the ephemeral wetlands in the arid zone. To do this, we compared the abundance of waterbird species observed at Bolivar during the dry period in the eastern arid zone of late 2018 and 2019 with that during the subsequent wet period 2020–2022. Pink-eared Duck Malacorhynchus membranaceus, Grey Teal Anas gracilis, Australasian Shoveler Spatula rhynchotis, Hardhead Aythya australis and Blue-billed Duck Oxyura australis were all more abundant during the arid-zone dry period. By contrast, Australian Shelduck Tadorna tadornoides, Eurasian Coot Fulica atra and Black Swan Cygnus atratus showed increased abundance in spring and early summer in all years, with no marked differences between the dry and wet periods in the arid zone. Wader species that breed in the Northern Hemisphere – Sharp-tailed Sandpiper Calidris acuminata and Red-necked Stint C. ruficollis – also tended to be more abundant during the arid-zone dry year, as did Red-necked Avocet Recurvirostra novaehollandiae, whereas Pied Stilt Himantopus leucocephalus tended to be more abundant in the arid-zone wet years, with breeding by this species taking place in spring. These data suggest that Bolivar is a critically important conservation site for waterbirds and that various species use this location as a refuge during dry times in the arid zone of eastern Australia.

P049 Barriers and facilitators to the delivery of insomnia management by general practice nurses: a qualitative analysis of patient perspectives

Abstract Introduction With insufficient providers of insomnia care, alternative approaches to the delivery of insomnia treatments are being explored. Research has demonstrated that insomnia can be successfully managed by primary care nurses but patient attitudes towards this care are largely unknown. This study explored patient perspectives towards barriers and facilitators to practice nurse-delivered care to inform the development of patient-centred models of care for insomnia. Methods A qualitative sub-study within a process evaluation of sleep health care delivered in a pilot study in one general practice in metropolitan Adelaide. Semi-structured telephone interviews were conducted with patients with insomnia offered nurse-delivered or nurse-supported insomnia management. Thematic Analysis was used to identify themes within the data. Results Eleven patients participated (6 males; age mean [range] 59 years [29-72]; time at practice 14.3 years [4-21]; Sleep Condition Indicator 9.5 [3-14]). Two major themes were identified: 1. Patients are supportive of nurses providing care for uncomplicated insomnia; 2. Trust in practice nurse-delivered insomnia care is influenced by relationships with the GP, the practice, and the nurse. Participants reported confidence in practice nurses providing insomnia management provided that they had sufficient knowledge. Established relationships with the GP and the practice, along with previous appointments with the nurse, increased patient confidence in nurse-delivered insomnia care. Discussion Patient acceptance of practice nurse-delivered insomnia care supports further research into developing a role for practice nurses within insomnia management. The findings of this work will be tested and explored further within a large implementation study conducted in multiple general practices.

INVESTIGATION OF URBAN GREEN SPACE (UGS) ACCESSIBILITY IN ADELAIDE METROPOLITAN AREA USING NETWORK ANALYST

Abstract. Urban Green Space (UGS) is one of the essential components of the urban systems for promoting quality of life in urban areas and sustainability. Planning and designing accessible public green spaces are critical for urban life as cities' most available natural environment. Walkable accessibility of UGS is one of the essential indicators of people's health and wellbeing. This paper aims to evaluate the walking accessibility of UGS through Adelaide Metropolitan Area at the local councils level using Network Analyst in GIS. The results show that the councils of Norwood Payneham and St Peters, Charles Sturt and the City of Adelaide have the most walking accessibility to UGS for the residents in their area. In contrast, Mount Barker, Playford and Adelaide Hills councils have the least walking accessibility. Therefore, UGS distribution is unequal throughout the study area, and local councils close to or around the inner part of the metropolitan area have more accessible green spaces.