NSW Department Research Articles

A ‘Tram Massacre’: Institutionalised destruction in Sydney, 1955–1961

AbstractAt its peak the Sydney tramway system was the second largest in both the British Empire and the Southern Hemisphere. During its busiest years in the mid‐1940s over 404 million fares were sold but despite this popularity the last tram in Sydney ran in 1961, just sixteen years later. This research makes use of the archaeological remains, landscape remnants and a study of the processes of removal of the Sydney tram system as a case study in destruction. By using Buchli and Lucas' (2001) framework of the material processes of remembering and forgetting, an understanding of the processes of destruction, as well as the reasons for removal of specific parts of the system is developed. The framework shows that the symbolic and strategic removal of a system can be used to ensure that it is made unworkable as well as removing it from the public consciousness. Such actions ensured that the system could not be easily restored.

Surgical services: shaping future directions

Advances in surgical techniques and anaesthetic practise have facilitated a significant change in the way surgery is currently delivered. In particular, short stay surgery including ambulatory surgery has become the norm for the majority of surgical conditions. However, the planning of surgical services has not always kept pace with nor capitalised on these clinical advances. Like many major urban centres in Australia, the Greater Sydney region is changing, in terms of population growth and configuration of clinical and operational networks. In conjunction with NSW Department of Health, the ministerially appointed Surgical Services Taskforce was tasked with determining the shape and direction of surgery in Greater Sydney over the next 5 to 10 years. Over 400 clinicians either attended hospitals forums or were contacted by the Surgery Futures project team. From the consultations, three models of service delivery were strongly advocated. These were the development of high volume short stay surgery centres, the establishment of specialty centres and the expansion of the streaming of planned and emergency surgery. These three major recommendations will require a significant reorganisation of surgical services in NSW. However, they are also relevant to surgical services planning elsewhere in Australia. It is imperative that these recommendations are incorporated into long term surgical planning in order to improve the efficiency and sustainability of surgical service delivery.

Comparison of inpatients with comorbid mental health disorders and alcohol- and other-substance-use disorders within general hospitals and psychiatric hospitals in NSW, Australia

Aim: To explore the association of mental health disorders and alcohol- and other-substance-use disorders within general hospitals and psychiatric hospitals in NSW.Method: The data were extracted from the NSW Department of Health Inpatient Statistics Data Collection for the period from 1 July 2006 to 30 June 2007. Statistical analyses were performed using Statistical Analysis System.Results: Of the 1,814,830 admissions, 1,808,095 were in general hospitals (45.7% males, 54.3% females) and 6716 in psychiatric hospitals (60.8% males, 39.2% females). Most admissions were within age groups 20–29 and 30–39 years. Comorbidity rates in psychiatric hospitals were double those of general hospitals (9.5% in general hospitals, 19.7% in psychiatric hospitals). The highest comorbidity rate for males was in age group 30–39 (18.8% in general hospitals, 25.1% in psychiatric hospitals). For females the highest comorbidity rate was in 40–49 years age group in general hospitals (13.3%) and 30–39 years age group in psychiatric hospitals (20.9%).Conclusion: Addressing comorbidity of mental health disorders and alcohol- and other-substance-use disorders in both general hospitals and psychiatric hospitals has important clinical implications for both prevention and treatment. This first investigation of its kind provides important information for policymakers to plan adequate policies and interventions targeting these comorbid patients.

Developing a strategy to promote the generation and effective use of population health research for NSW Health: 2011 - 2015

The Population Health Division of the NSW Department of Health has developed a 5-year strategy to improve the effectiveness of its resource investment in population health research. This paper describes the development of the strategy, Promoting the generation and effective use of population health research in NSW: a Strategy for NSW Health 2011-2015. A review of Australian and international strategic research documents and stakeholder interviews was conducted to support the development of the strategy. The findings from these two processes influenced the structure of the document and supported the inclusion of strategies and actions to assist with identifying research priorities, improving communication, enhancing networks and partnerships, supporting workforce development initiatives, providing research infrastructure, enhancing research and the use of research evidence and streamlining research governance and ethics processes. Small group discussions and a detailed review of literature were conducted to refine the thinking around four of the more complex aspects of the strategy. Finally, a broad consultation process was used to test the face validity of the proposed strategy content.

“PEOPLE NOT PIGEONHOLES”

Private O. T. Practitioner specialising in problems of neurological dysfunction — notably in relation to CVA patients and children with specific learning difficulties in normal school situation. This article discusses an aspect of the author's work in relation to children with specific learning difficulties. Through the support and good offices of her local primary school headmaster, there is a current application before the NSW Department of Education School Based Initiatives Program Committee, proposing the employment of an occupational therapist to conduct a remedial program in that school. It proposes that a pilot study document and attempt to define the advantages and desirable extent of such a program, not only for the particular school, but in the development of future Departmental policy. On a recent visit to U.K. the author found her concept hailed enthusiastically as a significant initiative in the present search to deal effectively with the estimated one in five children and young adults who will have some form of special educational needs as evidenced in the report by the Warnock Committee of Enquiry 1978.

The development and initiation of the NSW Department of Health interprofessional Fetal welfare Obstetric emergency Neonatal resuscitation Training project

The Fetal Welfare Obstetric emergency Neonatal resuscitation Training (FONT) project was initiated on a background of rising notifications of adverse events in NSW maternity units, the significant proportion of which were related to fetal welfare assessment. The aim of the study is to describe the development and introduction of the NSW state-wide interprofessional FONT project. Following development and risk assessment, FONT was launched in February 2008. The project consists of an online component and two face-to-face training days to be completed each 3 years; the first day for fetal welfare assessment and the second for obstetric and newborn emergencies. Eight, 2-day training sessions were conducted throughout NSW for FONT trainers. Each trainer underwent pre- and post-testing for changes in knowledge of fetal welfare assessment. The 2005-2008 NSW adverse event report numbers were assessed. From 20 February to 17 April 2008, 240 trainers had been trained in fetal welfare assessment, and by the end of 2008 these trainers had trained 954 clinicians. There were significant improvements in the interpretation and management planning of electronic fetal heart rate patterns following training. Analysis of Severity Assessment Codes 1 and 2 showed no significant trend in the number of notifications for adverse events related to fetal welfare assessment. In the first 11 months, 25% of the state's maternity practitioners had received training in the first stage of the FONT project. The FONT project has shown short-term improvements in learning and communication skills and in the participants of the project.

In a child presenting with features consistent with a diagnosis of juvenile idiopathic arthritis, what clinical features or laboratory findings (at presentation) predict a diagnosis of acute lymphoblastic leukaemia?

In a child presenting with features consistent with a diagnosis of juvenile idiopathic arthritis, what clinical features or laboratory findings (at presentation) predict a diagnosis of acute lymphoblastic leukaemia?jpc_1807 442..445 Damien McKay, Louisa Adams, Genevieve Ostring and Davinder Singh-Grewal Department of Rheumatology, The Children’s Hospital at Westmead, Sydney, New South Wales, Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW Department of Immunology, Allergy, Infectious Diseases, Sydney Children’s Hospital, Randwick, The John Hunter Chidren’s Hospital, Newcastle and The University of New South Wales School of Women’s and Children’s Health, Sydney, New South Wales, Australia

Transgressing Non-Crossable Borders: Disability, Law, Schooling, and Nations

This paper looks at a recent High Court of Australia Case ‘Purvis v. NSW Department of Education’ through the lenses of a Derridan framework and explores what the case says about disability, education and imaginary borders of nation.

Supporting refugee students in school education in Greater Western Sydney

Rarely do refugee students entering Australian schools possess the multiple forms of social, linguistic and cultural capital that are taken for granted in mainstream classrooms. While refugees of high-school age are assisted initially through Intensive English Centres (IECs), the transition from IECs to mainstream classrooms presents substantial challenges. This paper outlines the perceived impacts of a partnership program known as Refugee Action Support (RAS) that assists secondary school students, predominantly African humanitarian refugees, as they seek to make the transition from IECs to mainstream settings. Implemented by the Australian Literacy and Numeracy Foundation, the University of Western Sydney and the NSW Department of Education and Training, the program is based on school-based tutoring centres that use pre-service teachers as tutors. The paper explores the perceived effects on refugee students participating in RAS from the perspectives of teachers who assist in the coordination of the program at the various school sites.

Azathioprine and allopurinol: A two‐edged interaction

The thiopurines, azathioprine and 6-mercaptopurine (6-MP), are immunosuppressive drugs used in a number of clinical settings, such as following transplantation and for the management of inflammatory conditions like inflammatory bowel disease (IBD). Allopurinol, a xanthine oxidase inhibitor used in the treatment of gout, is not infrequently coincidentally co-prescribed with the thiopurines. A recent safety report from the New South Wales Department of Health (NSW, Australia) highlights the potential risk with the co-administration of these two drugs. This commentary reviews the interaction of these drugs and highlights important precautions that should be taken by clinicians when using them together.

A reduction in blood morphine concentrations amongst heroin overdose fatalities associated with a sustained reduction in street heroin purity

To determine the effects of a sudden and sustained reduction in heroin purity on the toxicology of heroin overdose, 959 consecutive heroin overdose cases autopsied at the NSW Department of Forensic Medicine (1/1/1998–31/12/2006) were analysed. There was a significant reduction in blood morphine concentration across the study period ( β = −0.07), declining from a median of 0.50 mg/L in the years 1998–2000 prior to 0.40 mg/L in the period 2001–2006. There was no significant change in the proportion of alcohol positive cases, but the proportion of benzodiazepine positive cases increased across time (OR 1.11), as did methadone positive cases (OR 1.12). The decline in blood morphine concentrations remained significant after controlling for these factors ( β = −0.07). In determining toxic and lethal morphine concentrations, the fact that the toxicology of overdose is responsive to changes in the opioid street market needs to be borne in mind.

Improving the health of sex workers in NSW: maintaining success

NSW has a diverse sex industry that is limited in its size by modest demand. There is no evidence that decriminalisation in 1995 increased the frequency of commercial sex in NSW. Though the largest sector, female brothels, is now mainly staffed by Asian women, condom use for vaginal and anal sex exceeds 99% and sexually transmissible infection rates are at historic lows. These gains are attributable to the long-term support of the NSW Department of Health in collaboration with the community-based Sex Workers Outreach Project and sexual health services, facilitated by the removal of criminal sanctions without the expense and access barriers of licensing systems.

Pandemic (H1N1) 2009 influenza in NSW: an overview of the public health response

In April 2009, a new influenza A virus, pandemic (H1N1) 2009 influenza, was identified in Mexico and the United States of America. The NSW response was co-ordinated by the Public Health Emergency Operations Centre through an incident control structure that included planning, operations and logistics teams with designated roles and responsibilities for the public health response. The emphasis of public health action changed as the pandemic moved through three response phases: DELAY, CONTAIN and PROTECT. This article describes the NSW public health response to the 2009 influenza pandemic from the perspective of the NSW Department of Health.

Guest Editorial: Pandemic (H1N1) 2009 influenza in NSW

In April 2009, a new influenza A virus, pandemic (H1N1) 2009 influenza, was identified in Mexico and the United States of America. The NSW response was co-ordinated by the Public Health Emergency Operations Centre through an incident control structure that included planning, operations and logistics teams with designated roles and responsibilities for the public health response. The emphasis of public health action changed as the pandemic moved through three response phases: DELAY, CONTAIN and PROTECT. This article describes the NSW public health response to the 2009 influenza pandemic from the perspective of the NSW Department of Health. Paula J. SpokesA,C, Michelle A. CretikosA and John G. WardA ACommunicable Diseases Branch, NSW Department of Health BAIDS/Infectious Diseases Branch, NSW Department of Health CCorresponding author. Email: pspok@doh.health.nsw.gov.au community. The public health response used the framework described in the Australian Health Management Plan for Pandemic Influenza 2008.3 Management of the pandemic moved through three phases: DELAY (of the virus into Australia); CONTAIN (early identification of cases and contacts to contain transmission in the community); and PROTECT (identification of high-risk groups to protect those most at risk of severe illness) (Table 1). The public health response was co-ordinated through an incident management system that included an incident controller and separation of activities into three areas: planning, operations and logistics (Figure 1).4 DELAY and CONTAIN phases The first case of pandemic (H1N1) 2009 influenza in Australia was reported from Queensland on 8 May.5 The first NSW case was not identified until 20 May in a traveller returning from the USA.6 This case was considered non-infectious. Australia moved to the next response phase, CONTAIN, on 22 May in response to the identification of suspected community transmission in Victoria.7,8 Planning Planning for an influenza pandemic had been in progress in NSW since at least 2005. The NSW Interim Influenza Pandemic Action Plan 20059 and the Australian Health Management Plan for Pandemic Influenza 20083 formed the basis of the public health response to the pandemic. The National Action Plan for a Human Influenza Pandemic10 and the NSW Human Influenza Pandemic Plan11 described the inter-government and inter-agency responsibilities to this situation. A number of recent public health emergencies (including severe acute respiratory syndrome (SARS) and equine influenza) and events such as World Youth Day 2008 and exercises also contributed to NSW planning and preparedness for an influenza pandemic.12–17 The planning team co-ordinated a number of aspects of the public health response, including: • forward planning and forecasting • communication (web-based, media and written updates) • preparation and dissemination of situation reports on the progress and impact of the epidemic • surveillance

The Healthy Built Environments Program: a joint initiative of the NSW Department of Health and the University of NSW

The built environment is increasingly viewed as an important determinant of human health. Consequently creating environments that promote health and wellbeing is one of the NSW Department of Health's key preventive health priorities. This article describes a new program focused on improving health through the quality of the built environment. Recently established in the City Futures Research Centre, Faculty of the Built Environment, University of NSW, the Healthy Built Environments Program receives funding from the NSW Department of Health. The Program will foster cross-disciplinary research, deliver education and workforce development, and advocate for health as a primary consideration in built environment decision making. The Program brings the combined efforts of researchers, educators, practitioners and policymakers from the built environment and health sectors to the prevention of contemporary health problems. The Program's vision is that built environments will be planned, designed, developed and managed in ways that promote and protect the health of all people.

Volume 21 Number 5 & 6

The NSW Public Health Bulletin is published by CSIRO PUBLISHING on behalf of the Population Health Division of the NSW Department of Health. Its purpose is to enable the timely communication of information on public health issues and contribute to the development of a well-trained and informed public health workforce in NSW. Although the Bulletin core audience includes the public health workforce within NSW Health and throughout NSW, it also has readers in the other states and territories of Australia and overseas who have an interest in public health.

Responding to pandemic (H1N1) 2009 influenza in Aboriginal communities in NSW through collaboration between NSW Health and the Aboriginal community-controlled health sector.

As a vulnerable population, Aboriginal people in NSW were thought likely to be at more risk of serious illness from pandemic (H1N1) 2009 influenza than non-Aboriginal people. As such, the importance of consulting with Aboriginal people and communities was recognised early in the pandemic. This consultation was to enable key messages to be disseminated appropriately and to facilitate access to health care. Key stakeholders in the response were the NSW Department of Health, Area Health Services, the NSW Aboriginal Health and Medical Research Council, and Aboriginal Community Controlled Health Services. Regular teleconferences between the key stakeholders facilitated the flow of information and assisted with the identification of issues. A consultation process between Hunter New England Area Health Service and six Aboriginal communities helped inform the development of resources as well as the planning and delivery of pandemic-related services. Aboriginal people were four times more likely to be admitted to hospital with pandemic (H1N1) 2009 influenza than non-Aboriginal people.

Erratum to: Chronic disease and climate change: understanding co-benefits and their policy implications

The NSW Public Health Bulletin is published by CSIRO PUBLISHING on behalf of the Population Health Division of the NSW Department of Health. Its purpose is to enable the timely communication of information on public health issues and contribute to the development of a well-trained and informed public health workforce in NSW. Although the Bulletin core audience includes the public health workforce within NSW Health and throughout NSW, it also has readers in the other states and territories of Australia and overseas who have an interest in public health.

Women’s work or creative work? Embroidery in New South Wales high schools

Embroidery is traditionally regarded as women’s work and the teaching of embroidery as a means of preparing young women for domesticity, a view which has been reinforced by historians studying changes in the high school art curriculum that occurred with the introduction of the Wyndham Scheme in New South Wales in the early 1960s. This paper argues that those involved in promoting and teaching embroidery in NSW high schools at that time had a different agenda. They wanted embroidery to be seen as a legitimate form of creative work. The paper considers the relationship that developed in the 1960s between the Embroiderers’ Guild of NSW and the NSW Department of Education. This relationship resulted in a series of ventures intended to promote embroidery as creative, artistic expression rather than as domestic work. The paper argues that, in this context, embroidery was a vehicle for women’s agency and self‐determination.

Impacts of flood mitigation works on coastal wetlands in New South Wales.

Agricultural and urban development of the coastal floodplains of New South Wales has involved major changes in the extent of natural habitats and in the decline of the state’s coastal wetlands – the programme of structural flood mitigation works in all major river systems. The stated aims of these works are to reduce the frequency of flooding in low-lying control areas, to facilitate removal of floodwaters after floods and to control flooding which cannot be prevented (NSW Department of Public Works, 1973). In practice, the pursuit of these aims has led to the elimination of reduction in value of much freshwater and estuarine wetland. While the benefits of flood mitigation to agricultural and urban economics have been significant and well documented (eg/ Macleay River County Council et al., 1963; Executive Committee for Councils, 1968) assessment of the adverse effects, particularly environmental impacts, has been limited (McGregor, 1979; Middleton et al., in press). Of the recent studies which have considered environmental aspects of specific proposals, few have included a systematic analysis of major potential impacts. Fewer still have generated new background information on the areas concerned and the authors know of no study which has considered all flora and fauna potentially affected. Notably, this general lack of environmental research applies to the recent series of floodplain management studies on major river systems in coastal New South Wales, few of which analysed the specific impacts of existing or proposed works.