Metropolitan Perth Research Articles

The association of long term exposure to low concentrations of fine particulates and nitrogen oxides and risk of all-cause mortality and stroke-specific mortality and morbidity.

Introduction: There is increasing evidence of the effects of long term exposure to air pollutants and mortality, especially related to cardiovascular outcomes. We investigated the association between long term exposure to low concentrations of fine particulates (PM2.5) and nitrogen oxides (NO2 and NOx) and all-cause mortality as well as stroke-specific mortality and morbidity. Method: We used data from the Health in Men Study (HIMS), a cohort of12,201 elderly men aged 65 years and above, who lived in Perth Metropolitan Area and were followed from 1996 to 2012. Estimation of long term exposure to PM2.5, NO2 and NOx at each participant’s home address was based on land use regression models. The hazard ratios (HR)s and 95% confidence intervals (CI) for the impact of the pollutants and health outcomes were estimated by Cox proportional hazard regression models. Results: The annual average concentrations of PM2.5 was 4.7µg/m3, NO2 11.3µg/m3 and NOx 23.4 µg/m3. There were 6,344 deaths from all causes, 405 deaths from stroke, and 2134 of study participants developed stroke during the follow up. The preliminary analyses indicate the following results: for all causes mortality, the hazard ratio associated with a 5 µg/m3 increase in PM2.5 exposure was 1.05 (95%CI 0.99 – 1.11). Similar associations were found for NO2 and NOx with HR of 1.05 (95%CI 1.02 – 1.09) and 1.03(95%CI 1.01 – 1.04), respectively. The hazard ratio for stroke mortality associated with every 5 µg/m3 increase in the concentrations of PM2.5 was HR:1.05 (95%CI 0.95 – 1.16), for NO2 HR:1.01 (95%CI 0.96 – 1.07) and for NOx HR:1.01 (95%CI 0.98 – 1.03). Similar associations were observed between stroke incidence with all air pollutants. Conclusions: Long term exposure to PM2.5, NO2, and NOx may increase the risk of all-cause mortality and stroke-causes mortality and morbidity in Perth even at low concentrations.

Indigenous persistence and entitlement: Noongar occupations in central Perth, 1988–1989 and 2012

In 1988–1989 and again in 2012 Noongar Aboriginal groups occupied high profile riverside sites in close proximity to the centre of Perth, Western Australia. On both occasions they were claiming rights to land from which their ancestors had been removed in the early nineteenth century by British colonial settlers. During a relatively brief period of struggle and interaction between the Indigenous and settler groups following the proclamation of the Swan River Colony in 1829, the Noongar population of what is now the Perth Metropolitan Area were effectively dispossessed of their land. Indeed, from the mid nineteenth to the mid twentieth century Aboriginal people were required to obtain written permits in order to enter the urban area of Perth. In spite of this, the local Noongar population has maintained an ongoing physical, emotional and spiritual connection to their traditional country and, in particular, to certain sites within it. Two of these sites, Goonininup/the Old Swan Brewery, in 1988–1989, and Matagarup/Heirisson Island, in 2012, have been occupied by Noongar groups asserting their rights to this land. This paper will describe and compare both sites of occupation with particular reference to the methods and motivations of the occupiers and the attitudes and responses of the wider metropolitan population to these events. It will also place them in the wider context of ongoing debates over the acknowledgement of Aboriginal claims to and rights over sites of Indigenous significance and of land occupations as a form of protest.

Development of Land Use Regression models for particulate matter and associated components in a low air pollutant concentration airshed

Perth, Western Australia represents an area where pollutant concentrations are considered low compared with international locations. Land Use Regression (LUR) models for PM10, PM2.5 and PM2.5 Absorbance (PM2.5Abs) along with their elemental components: Fe, K, Mn, V, S, Zn and Si were developed for the Perth Metropolitan area in order to estimate air pollutant concentrations across Perth. The most important predictor for PM10 was green spaces. Heavy vehicle traffic load was found to be the strongest predictor for PM2.5Abs. Traffic variables were observed to be the important contributors for PM10 and PM2.5 elements in Perth, except for PM2.5 V which had distance to coast as the predominant predictor. Open green spaces explained more of the variability in the PM10 elements than for PM2.5 elements, and population density was more important for PM2.5 elements than for PM10 elements. The PM2.5 and PM2.5Abs LUR models explained 67% and 82% of the variance, respectively, but the PM10 model only explained 35% of the variance. The PM2.5 models for Mn, V, and Zn explained between 70% and 90% of the variability in concentrations. PM10 V, Si, K, S and Fe models explained between 53% and 71% of the variability in respective concentrations. Testing the models using leave one-out cross validation, hold out validation and cross-hold out validation supported the validity of LUR models for PM10, PM2.5 and PM2.5Abs and their corresponding elements in Metropolitan Perth despite the relatively low concentrations.

Connecting land-use and water planning: Prospects for an urban water metabolism approach

The current fabric of urban areas is largely the result of past land development and land-use planning decisions. Historically, there was relatively little consideration of the impact of these decisions upon hydrological systems within and outside urban areas. Despite their close relationship, urban and regional planning and water resources management have typically been carried out separately and guided by different institutional arrangements. The range of impacts of urbanisation on hydrological systems at the city-region scale, and the dependence of urbanised areas upon these systems, call for better integration between the sectors of urban and regional planning and water resources management to ensure the sustainability and resilience of cities and their regions to future changes and uncertainties.This paper evaluates the extent to which planning mechanisms currently support integration between land-use and water resource sectors. The evaluation draws on a comparative analysis of 113 statutory and non-statutory planning mechanisms in three Australian capital city-regions: South East Queensland, and the Melbourne and Perth Metropolitan regions. Results indicate that the function of water at the city-region scale, including its role in supporting environmental connectivity, needs to be better understood and considered by land-use planning systems; improved institutional capacity is required to enable both sectors to deal with future changes and uncertainties related to water resources; and emergent planning trends supportive of the consideration of water connectivity at the city-region scale are yet to be fully implemented. Based on the results, the paper concludes by exploring how the concept of urban metabolism may facilitate better integration between the two sectors, along with the identification of best suited planning mechanisms and needed changes in governance and institutional arrangements conducive to integration.

Depressive symptoms in midlife: the role of reproductive stage.

The aim of the study was to determine the prevalence of depression among community-dwelling women in the premenopause, menopausal transition (MT), and postmenopause stage. We also sought to clarify the direct and indirect contribution of menopausal status on the risk of depression. Cross-sectional survey of 1,612 women aged 45 to 55 years living in the Perth metropolitan region, who were recruited using a random sample of the electoral roll (voting is compulsory in Australia), was conducted. Women with clinically significant symptoms of depression had Patient Health Questionnaire (PHQ-9) scores of at least 10, and those with major depression, reported symptoms consistent with Diagnostic and Statistical Manual of Mental Disorders, 5th ed (DSM-5), criteria. We used past and current gynecological and reproductive data to classify women as premenopausal, undergoing the MT, and postmenopausal. Other study measures included age, place of birth, education, marital status, drinking habit, number of children, medical illnesses, and history of premenstrual syndrome, postnatal depression, and past depression or anxiety. We investigated the direct and indirect effect of reproductive status with mediation/modulation analysis. Among the women included in the survey, 8.2%, 11.5%, and 13.0% of women in premenopause, MT, and postmenopause had PHQ-9 at least 10, whereas major depression was present in 2.2%, 3.4%, and 3.6% of them. Reproductive status did not affect the prevalence of major depression, but more postmenopausal than premenopausal women had PHQ-9 score equal to or greater than 10 (P = 0.013). Compared with premenopausal women, MT was associated with a direct odds ratio (OR) 1.35 (95% confidence interval [CI] = 0.90, 2.01) and indirect OR 1.08 (95% CI = 0.92, 1.26) for PHQ-9 at least 10. Similarly, the direct and indirect effect of the postmenopause on the odds of PHQ-9 at least 10 was OR 1.31 (95% CI = 0.87, 1.98) and OR 1.29 (95% CI = 1.10, 1.52). The slight, but not significant, excess of depressive symptoms during MT and early postmenopause cannot be attributed to a direct effect of reproductive status.

Effectiveness of the Koorliny Moort out-of-hospital health care program for Aboriginal and Torres Strait Islander children in Western Australia.

To determine whether the Koorliny Moort program could reduce emergency department presentations, hospital admissions and length of stay, and improve attendance at out-of-hospital appointments for Aboriginal and Torres Strait Islander children in Western Australia. Children were enrolled in the program from 1 August 2012. Each child acted as their own control. Evaluation data were collected from 1 August 2010 to 31 July 2014. Occasions of service and person-time in days were compared for each child before and after referral to the program. Aboriginal children aged 0-16 years residing in three WA regions (Kimberley, Pilbara, Perth metropolitan) who were referred to the Koorliny Moort program. Partnerships with primary care providers; nurse-led care coordination; and outreach care by paediatricians, nurses and social workers closer to the home of the child. Emergency department presentations; hospital admissions; length of hospital stay; non-attended appointments. A total of 942 children were referred to the program. There were significant decreases after referral to the program in the incidence of emergency department presentations (incident rate ratio [IRR], 0.47; 95% CI, 0.43-0.53; P <0.001), of hospitalisation (IRR, 0.70; 95% CI, 0.62-0.79; P <0.001), and of non-attended appointments (IRR, 0.83; 95% CI, 0.74-0.94; P <0.001), as well as in the mean length of hospital stay (IRR, 0.23; 95% CI, 0.21-0.25; P <0.001). Health-seeking behaviour and health outcomes for Aboriginal children can be improved by engaging Aboriginal families in their health care, providing effective communication between health service providers, and delivering a coordinated program of Aboriginal service provider-led care.

Is it Appropriate for Patients to be Discharged at the Scene by Paramedics?

Background: Outcomes of patients who are discharged at the scene by paramedics are not fully understood. Objective: We aimed to describe the risk of re-presentation and/or death in prehospital patients discharged at the scene. Methods: We conducted a retrospective cohort study using linked ambulance, emergency department (ED), and death data. We compared outcomes in patients who were discharged at the scene by paramedics with those who were transported to ED by paramedics and then discharged from ED between January 1 and December 31, 2013 in metropolitan Perth, Western Australia. Occurrences of subsequent ambulance requests, ED attendance, hospital admission and death were compared between those discharged at the scene and those discharged from ED. Results: There were 47,330 patients during the study period, of whom 19,732 and 27,598 patients were discharged at the scene and from ED, respectively. Compared to those discharged from ED, those discharged at the scene were more likely to subsequently: request an ambulance (6.1% vs. 1.8%, adjusted odds ratio [adj OR] 3.4; 95% confidence interval [CI] 3.0–3.9), attend ED (4.6% vs. 1.4%, adj OR 3.3; 95% CI 2.8–3.8), be admitted to hospital (3.3% vs. 0.8%, adj OR 4.2; 95% CI 3.4–5.1). Those discharged at the scene tended towards an increased likelihood of death (0.2% vs. 0.1%, adj OR 1.8; 95% CI 0.99–3.2) within 24 hours of discharge compared to those discharged from ED. Conclusion: Patients attended by paramedics who were discharged at the scene had more subsequent events than those who were transported to and discharged from ED. Further consideration needs to be given to who is suitable to be discharged at the scene by paramedics.

Desirable Dense Neighbourhoods: An Environmental Psychological Approach for Understanding Community Resistance to Densification

This article examines an environmental psychological approach to exploring the attitudes of urban residents towards what they consider to be a ‘desirable dense’ neighbourhood. Socio-cultural expectations of high-density developments are explored through an analysis of residents’ perceptions of what constitutes a desirable high-density environment. The article presents specific findings identifying influences on residents’ attitudes to urban densification derived from three case studies of designated transit-oriented development (TOD) areas located in the Perth Metropolitan Region. It was found that community resistance towards future higher-density developments is rooted in the current socio-cultural context of the area. Community resistance may be driven by the physical quality of developments (such as building heights, overshadowing), however, deeper concerns are allied to the uncertain social outcomes that are the product of new development. A dominant cultural characteristic such as a disinclination to socialise with diverse people is found to be a negative response to dense neighbourhoods in all the case studies. This characteristic is more evident in populations of high socio-economic status. These areas are usually close to the central business district (CBD) where many infill high-density developments have been proposed.

Success in Closing the Gap: favourable neonatal outcomes in a metropolitan Aboriginal Maternity Group Practice Program

To report differences in neonatal health outcomes for a community-based antenatal program, the Aboriginal Maternity Group Practice Program (AMGPP; the intervention group), compared with two matched control groups eligible for standard antenatal care. Non-randomised intervention study using data from the Western Australian Midwives Notification System. Regression models were used to report adjusted odds ratios (aORs) for defined neonatal health outcomes. The AMGPP employed Aboriginal grandmothers, Aboriginal Health Officers, and midwives working in partnership with existing antenatal services to provide care for pregnant Aboriginal women residing in south metropolitan Perth. 343 women (with 350 pregnancies) who participated in the AMGPP and gave birth between 1 July 2011 and 31 December 2012; historical and contemporary control groups of pregnant Aboriginal women (each including 350 pregnancies), frequency matched for maternal age and gravidity. Preterm births, birthweight, neonatal resuscitation, neonatal hospital length of stay longer than 5 days. Babies born to AMGPP participants were significantly less likely to be born preterm (AMGPP, 9.1% v historical controls, 15.9% [aOR, 0.56; 95% CI, 0.35-0.92]; v contemporary controls, 15.3% [aOR, 0.75; 95% CI, 0.58-0.95]); to require resuscitation at birth (AMGPP, 17.8% v historical controls, 24.4% [aOR, 0.68; 95% CI, 0.47-0.98]; v contemporary controls, 31.2% [aOR, 0.71; 95% CI, 0.60-0.85]), or to have a hospital length of stay of more than 5 days (AMGPP, 4.0% v historical controls, 11.3% [aOR, 0.34; 95% CI, 0.18-0.64]; v contemporary controls, 11.6% [aOR, 0.56; 95% CI, 0.41-0.77]). Participation in the AMGPP in south metropolitan Perth was associated with significantly improved neonatal health outcomes.

Development of Land Use Regression models for predicting exposure to NO2 and NOx in Metropolitan Perth, Western Australia

This study developed LUR models for predicting exposure to NO2 and NOx among of 12,203 elderly men in Perth. NOx and NO2 concentrations were determined for 2-week periods in summer, autumn, and winter, from January to September 2012, at 43 sites. The LUR models were developed to predict annual average concentrations of nitric oxides based upon land use, population/household density, and traffic variables within different buffer sizes, following the procedures of the European Study of Cohort for Air Pollution Effects program. The sample mean and standard deviation of the annual average concentrations of NO2 and NOx were 10.1 ± 5.3 μg/m3 and 18.7 ± 11.7 μg/m3 respectively, lower than those of ESCAPE study areas. The LUR models explained 69% of the variance in NO2 and 75% variance of NOx. Both the NO2 and NOx models had similar predictors, including traffic intensity on the nearest roads, household density within-1000 m industrial activities within-5000 m, and road length within-50 m.

Constraint-induced aphasia therapy (CIAT): a randomised controlled trial in very early stroke rehabilitation

Background: Communication outcomes following stroke are improved when treatments for aphasia are administered early, within the first 3 months after stroke, and provided for more than 2 hours per week. However, uncertainty remains about the optimal type of aphasia therapy.Aims: We compared constraint-induced aphasia therapy (CIAT) with individual, impairment-based intervention, both administered early and daily after acute stroke.Methods & Procedures: This prospective, single-blinded, randomised, controlled trial recruited participants with mild to severe aphasia within 10 days of an acute stroke from acute/subacute Perth metropolitan hospitals (n = 20). Participants were allocated by computer-generated block randomisation method to either the CIAT (n = 12) or individual, impairment-based intervention group (n = 8) delivered at the same intensity (45–60 min, 5 days a week) for 20 sessions over 5 weeks (15–20 hours total). The primary outcome, measured after completing the intervention, was the Aphasia Quotient (AQ) from the Western Aphasia Battery. Secondary outcomes were the AQ at 12 and 26 weeks post stroke, a Discourse Analysis (DA) score and the Stroke and Aphasia Quality of Life Scale (SAQoL), measured at therapy completion, 12 and 26 weeks post stroke. There was a 10% (n = 2) dropout at the primary end point, both participants were in the CIAT group. The estimates for each treatment group were compared using repeated measures ANOVAs. Data from the 26-week follow-up assessment are presented, however, were not included in the between-group comparisons due to the low number of data points in each group.Outcomes & Results: Within groups analyses comparing performance at baseline, therapy completion, and 12 weeks post stroke revealed a statistically significant treatment effect for the AQ (p < .001), DA (p = .002), and SAQoL (p < .001). Between groups analysis found there was no significant difference between the CIAT and individual therapy groups on any outcome measure.Conclusions: CIAT and individual therapy produced comparable amounts of change in the very early phase of recovery suggesting a standard, intensive daily dose of therapy within this period of recovery is feasible and beneficial. There were no significant differences between the two groups demonstrating that CIAT, which is provided in a group format, may be a viable option in the very early phase of aphasia recovery. The study highlights the need for further research into the impact of therapy type in very early aphasia therapy.

Study Protocol:Missing Voices– Communication Difficulties after Stroke and Traumatic Brain Injury in Aboriginal Australians

Background:Aboriginal and Torres Strait Islander Australians experience stroke and traumatic brain injury (TBI) with much greater frequency than non-Aboriginal Australians. Acquired communication disorders (ACD) can result from these conditions and can significantly impact everyday life. Yet few Aboriginal people access rehabilitation services and little is known about Aboriginal peoples’ experiences of ACD. This paper describes the protocol surrounding a study that aims to explore the extent and impact of ACD in Western Australian Aboriginal populations following stroke or TBI and develop a culturally appropriate screening tool for ACD and accessible and culturally appropriate service delivery models.Method/Design:The 3-year, mixed methods study is being conducted in metropolitan Perth and five regional centres in Western Australia. Situated within an Aboriginal research framework, methods include an analysis of linked routine hospital admission data and retrospective file audits, development of a screening tool for ACD, interviews with people with ACD, their families, and health professionals, and drafting of alternative service delivery models.Discussion:This study will address the extent of ACD in Aboriginal populations and document challenges for Aboriginal people in accessing speech pathology services. Documenting the burden and impact of ACD within a culturally secure framework is a forerunner to developing better ways to address the problems faced by Aboriginal people with ACD and their families. This will in turn increase the likelihood that Aboriginal people with ACD will be diagnosed and referred to professional support to improve their communication, quality of life and functioning within the family and community context.

Not Just "A Walking the Dog": Dog Walking and Pet Play and Their Association With Recommended Physical Activity Among Adolescents.

To examine the role of pet play and dog walking in children's and adolescents' leisure time, and the relationship between these activities and physical activity. The study design was observational. The study setting was metropolitan Perth and nonmetropolitan regions in Western Australia. The study included 1097 primary school (mean age, 10.1 years; SD, 1.6 years) and 657 secondary school (mean age, 14.0 years; SD, 1.3 years) students. Validated measures of total physical activity, dog walking, and pet play activity (prevalence and time) were calculated. Generalized linear models tested for differences between proportions, while adjusting for socioeconomic status, age, and school-level clustering. Approximately one third of primary school and one quarter of secondary school students reported that they walked the dog at least once in the last week. Pet play was the most common play activity for primary and secondary school girls, and the second and third most popular play activity for secondary and primary school boys, respectively. Secondary school students who walked the dog or played with pets spent an average of 1 hour per week on each activity, and they were significantly more likely (p < .005) to meet national physical activity recommendations than secondary school students not reporting these activities. Given the significant proportion of young people who frequently engage in dog walking and pet play, and the high level of pet ownership in many Western countries, promotion of these activities to support young people's health is warranted.

20 years of exploitation of the Yarragadee aquifer in the Perth Basin of Western Australia for direct-use of geothermal heat

Aquifers in the Perth Metropolitan Region of Western Australia have been explored and exploited for water supply since the late 19th century. Throughout the early 20th century, the availability of warm groundwater from the Yarragadee confined aquifer at relatively shallow depths was popular with laundries, public baths and for industrial applications but it was not until 1997 that the first direct-use geothermal project for bathing and swimming was implemented. By 2016, a dozen commercially successful geothermal schemes will use low enthalpy geothermal water supplies from the Yarragadee aquifer at depths ranging from 750 to 1150m for heating leisure centres, building air and outdoor pools. With distributed heat estimated to more than 110×103GJ per year and up to 180×103GJ when considering projects currently at construction stage but not yet commissioned, Perth currently has the biggest concentration of operating geothermal direct-use projects in Australia. The development of geothermal projects in Perth was made possible by early achievements pioneered by designers from the groundwater industry. This paper presents the hydrogeological setting of the Yarragadee aquifer which is the main geothermal resource in Perth, the well and surface heat exchanger design criteria, the economic and environmental considerations, and the best practices and circumstances that led to the 100% success rate of direct-use geothermal projects in Perth.

Optimising Children's Readiness to Learn through Mediating Social Disadvantage: Exploring Models of Best Practice

THIS ARTICLE DISCUSSES THE importance of early support for families in increasing their children's readiness to learn and optimising their developmental outcomes. It reports the findings of the evaluation of the It Takes a Village: Multicultural Early Learning Program, a research project undertaken in 2009–2011 by a research team from Edith Cowan University, Western Australia. The unique model and characteristics of the program are discussed in the context of its role in facilitating children's developmental potential, through the mediation of social disadvantage of the new migrant and humanitarian entrant families in the south-east corridor of Perth's metropolitan area.

Small steps: physical health promotion for people living with mental illness

Physical health promotion for people with mental illness is vital if the life expectancy of this population group is to be improved. While there is promising evidence of physical health promotion initiatives in the literature in this population group, it is unclear whether these have resulted in long-term gains and actually reduced morbidity and mortality. We aimed to identify which physical health promotion strategies and resources were most likely to resonate with people who have long-term mental health problems and live in the community. We facilitated three focus groups in metropolitan Perth with 27 participants who experienced long-term serious mental health problems for this qualitative study. Participants were clear about which health promotion resources and approaches they did or did not consider would engage them. Participants wanted health messages that were positive, clear and not too wordy. They tended to dislike pamphlets and preferred DVDs. They also preferred to participate in health promot...

Vitamin D concentration and its association with past, current and future depression in older men: The Health In Men Study

BackgroundVitamin D deficiency has been associated with depression in later life, but it remains unclear whether this association is truly causal. MethodsObservational study examining the retrospective, cross-sectional and prospective associations between vitamin D concentration and depressed mood in a community-derived sample of 3105 older men living in metropolitan Perth, Western Australia. We measured the plasma concentration of 25-hydroxyvitamin D using standard procedures. Past depression was ascertained by direct questioning and through the use of administrative health data linkage. A geriatric depression scale score equal or greater 7/15 established the presence of current depression. Incident depression was established by a patient health questionnaire (PHQ-9) score ≥10 or by administrative health data linkage during the 6-year follow up (range 0.1–10.9 years). ResultsVitamin D concentration <50nmol/L was associated with greater odds of current (OR=1.65, 95% CI=1.13, 2.42) but not past depression (OR=1.15, 95% CI=0.83, 1.58). Of the 2740 men with no past or current history of depression, 81 developed clinically significant symptoms during follow up. The adjusted hazard ratio of incident depression for men with plasma vitamin D <50nmol/L was 1.03 (95% CI=0.59, 1.79; adjusted for age, living arrangements, season, and prevalent cardiovascular diseases). ConclusionsOur results do not support a role for vitamin D in the causation of depression, although a small antidepressant effect of vitamin D cannot be entirely discarded. Large randomised placebo-controlled trials are required to dismiss or establish with certainty the causal link between vitamin D deficiency and depression.

Exploring social and cultural norms to promote ecologically sensitive residential garden design

Western Australia (WA) is experiencing severe water shortages associated with a drying climate. Suburban gardens in and around WA's capital city of Perth however, continue to be dominated by water dependent European style gardens featuring green lawns and introduced species. One area in metropolitan Perth going against this norm is the local government district of Fremantle. Residents within this city council have shown widespread adoption of native gardens: a seemingly obvious means of reducing water use and increasing local biodiversity. In an endeavour to understand the differences in garden design preferences, the aim of this research was to explore cultural and psychological drivers of native gardening within the city of Fremantle. Twelve in-depth, face-to-face semi-structured interviews were conducted with Fremantle homeowners. Participants had converted their garden from a traditional European design in favour of an aesthetic based on native species. Drivers such as knowledge, functionality, and social norms emerged, and interestingly resembled the same sorts of drivers previously identified as driving European style gardening practices in Australia. We account for the tension of same drivers yet different design due to differences in social and cultural values. Specifically, the dominant worldview in Fremantle is pro-environmental and this driver appears to shape the social context in which gardening decisions are made, making for a more accepting setting for residents to adopt alternative garden designs. Findings from this research are of value to water and environmental policy makers, urban local governments, and environmental educators.

Turtle Watch: Community engagement and action

AbstractMany threats face the freshwater turtle, Chelodina colliei, also known as the oblong turtle. A community education project, Turtle Watch, focused on this target species and enabled effective conservation action to be implemented. Turtle Watch was conducted in the Perth Metropolitan Area of Western Australia, as the oblong turtle inhabits the wetlands of Perth. Predation, habitat loss, road deaths and climate change are key threats to this species. Nest predation issues arose during stage 1 of Turtle Watch (2005–2008), so Turtle Watch 2 (2010–2012) aimed to identify predators and foster community partnerships, including citizen science, to promote awareness and conservation of turtles. Turtle Watch 2 focused on four eco education centres and involved collaboration between government and community groups concerned about turtles. Camera surveillance was undertaken to determine predators. Various strategies were also adopted to promote community education and participation, such as, public talks, fair...

Depression, Frailty, and All-Cause Mortality: A Cohort Study of Men Older than 75 Years

BackgroundDepression is associated with increased mortality, but it is unclear if this relationship is truly causal. ObjectivesTo determine the relative mortality associated with past and current depression, taking into account the effect of frailty. Design, Setting, and ParticipantsProspective longitudinal cohort study of 2565 men aged 75 years or over living in metropolitan Perth, Western Australia, who completed the third wave of assessments of the Health In Men Study throughout 2008. Main Outcome and MeasuresAll-cause mortality data were derived from Australian death records up to June 17, 2013. History of past depression and age of onset of symptoms were obtained from direct questioning and from electronic health record linkage. Diagnosis of current major depressive symptoms followed Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision guidelines. We considered that participants were frail if they showed evidence of impairment in 3 or more of the 5 domains on the fatigue, resistance, ambulation, illnesses, and loss of weight (FRAIL) scale. Other measured factors included age, education, living arrangements, smoking and alcohol history, and physical activity. Results558 participants died during mean period of follow-up of 4.2 ± 1.1 years. The annual death rate per thousand was 50 for men without depression, 52 for men with past depression, and 201 for men with major depressive symptoms at baseline. The crude mortality hazard was 4.26 (95% confidence interval = 2.98, 6.09) for men with depression at baseline compared with never depressed men, and 1.79 (95% confidence interval = 1.21, 2.62) after adjustment for frailty. Further decline in mortality hazard was observed after adjustment for other measured factors. ConclusionsCurrent, but not past, depression is associated with increased mortality, and this excess mortality is strongly associated with frailty. Interventions designed to decrease depression-related mortality in later life may need to focus on ameliorating frailty in addition to treating depression.