Western Australian Department Of Health Research Articles

Examining the long-term effects of a safe food-handling media campaign

In Australia, food poisoning affects over 4.1 million people annually, with most cases occurring in domestic (i.e., household) environments. Strategies aimed at improving safe food-handling among the community have begun being implemented across Australia. Recently, the ‘Play it Food Safe’ mass media campaign by the Western Australian Department of Health was piloted and shown to have some effectiveness in improving safe food-handling behaviour among consumers following the campaign. However, little is known about whether these changes in safe food-handling behaviours can be maintained in the long-term. Therefore, the aim of this paper was to determine if the Western Australian ‘Play it Food Safe’ campaign could lead to long-term change of safe food-handling knowledge, behaviour, and related psychological constructs (i.e., habit, perceived risk, self-efficacy, and subjective norms) among consumers. Participants (N = 689) completed measures assessing their safe food-handling knowledge, behaviour, and psychological constructs, derived from psychological theories, following the conclusion of the ‘Play it Food Safe’ campaign that was re-run in Perth, Western Australia. Participants completed these measures again approximately eight-weeks later. Data were analysed to determine if there were any changes in these measures over time, or whether scores on these measures were maintained long-term. Results indicated that some psychological constructs improved over time, and knowledge was higher among participants who saw the campaign, however, behaviour remained the same. These findings show that the ‘Play it Food Safe’ campaign may be effective for increasing knowledge, and effective for improving some psychological constructs long-term, though further development of the campaign is needed for further impact on behaviour.

Characteristics and risk of coronary-related events following hospitalisation for chronic coronary disease

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Western Australian Department of Health. Background Chronic coronary heart disease (CCD) is associated with a high healthcare burden and expenditure in Western societies, yet population-level data on CCD are limited. Use of hospitalisation data to investigate CCD epidemiology has not been well explored. Our aim was to describe characteristics of patients hospitalised with CCD and to estimate the long-term risk of coronary outcomes in this cohort. Method We used Western Australian state-wide linked hospitalisation/mortality data to identify all hospitalisations for CCD, comprised stable angina (SA, ICD-10-AM I20.1-I20.9) and chronic ischaemic heart disease (IHD, I25) from 2002 – 2017. Index admissions were defined as the first SA or chronic IHD admission in the study period. 14-years of hospitalisation history data were used to identify prior medical history, including admissions for acute coronary syndromes (ACS) +/- angiography, PCI and CABG. Kaplan-Meier survival analyses were used to estimate risk of readmission for coronary outcomes and procedures using up to 15-years of follow-up from linked morbidity/mortality data. Results There were 32,557 index SA and 29,505 index chronic IHD admissions from 2002-2017. SA index case number declined by -3.9%/year while chronic IHD admissions increased steadily (+5.3%/year, age-adjusted). The mean age was 66 years for SA and chronic IHD index admissions, with women on average 3 years younger than men; median length of stay was 3 days. Women comprised a higher proportion of SA admissions (37.8%) than chronic IHD (26.9%, p<0.0001). SA admissions were more likely to be emergency admissions (45.6% vs 13.4%) and have comorbidities including diabetes, hypertension and stroke. Patients with a chronic IHD admission were more likely to undergo angiography only (65.3% vs 46.7%) or revascularisation (20.6% vs 12.9%) during the index admission. Around 1/3 of SA and chronic IHD patients had a prior ACS admission (n=9964 and 8291 respectively); around half of these prior ACS admissions occurred in the 1-year preceding the index SA and chronic IHD admissions (Figure), with the majority occurring in the 90 days immediately prior to the index admission. Following an index SA or chronic IHD admission, the risk of ACS within the initial year of follow-up was 9.4% in men and 8.6% in women with SA, and 5.6% in chronic IHD men and women. This risk increased to >20% in both groups with 15 years of follow-up. The 15-year risk of CVD mortality was 4.3% in men and 4.2% in women following a chronic IHD admission; similar long-term risks were seen following SA admissions. Conclusion The heterogeneity in clinical profile and outcomes between patients admitted for SA versus chronic IHD requires cautious interpretation of hospitalisation data to inform the epidemiology of CCD. However, while mortality risk is low, the risk of ACS readmission is high, indicating significant ongoing morbidity and healthcare burden of CCD.

The Validation and Improvement of a Food Literacy Behavior Checklist for Food Literacy Programs.

Food literacy is a multidimensional construct required to achieve diet quality. The Food Sensations® for Adults (FSA) program aims to improve the food literacy of low to middle-income adults living in Western Australia and is funded by the Western Australian Department of Health. The original published behavior checklist used to measure change in food literacy has been revised based on experience of the facilitators and the iterative development of the program. This research sought to assess the validity and reliability of the improved food literacy behavior checklist. A total of 1,359 participants completed the checklist over an 18-month period. Content, face, and construct validity were considered in the re-development of the checklist. An exploratory factor analysis of the checklist identified three factors: (1) Plan and Manage, (2) Selection, and (3) Preparation. Cronbach’s alpha coefficients of 0.883, 0.760, and 0.868 were found for each of the three factors respectively. These coefficients indicated good internal consistency and were higher than those found in the original checklist analysis. An external validation was undertaken with the original food literacy behavior checklist, and a strong positive relationship between the two tools was found. In addition to being used to evaluate FSA, this revised and extensively validated tool could provide guidance to others evaluating similar food literacy programs and contribute to international measurement research.

Palliative and End-of-Life Care Service Models: To What Extent Are Consumer Perspectives Considered?

This article presents evidence found in a search of national and international literature for patient preferences concerning settings in which to receive palliative care and the appropriateness of different models of palliative care. The purpose was to inform end-of-life care policy and service development of the Western Australian Department of Health through a rapid review of the literature. It was found that consumer experience of palliative care is investigated poorly, and consumer contribution to service and policy design is limited and selective. Most patients experience a mix of settings during their illness, and evidence found by the review has more to do with qualities and values that will contribute to good end-of-life care in any location. Models of care do not make systematic use of the consumer data that are available to them, although an increasingly common theme is the need for integration of the various sources of care supporting dying people. It is equally clear that most integration models limit their attention to end-of-life care provided by health services. Transitions between settings merit further attention. We argue that models of care should take account of consumer experience not by incorporating generalised evidence but by co-creating services with local communities using a public health approach.

Effectiveness of Foodbank Western Australia's Food Sensations® for Adults Food Literacy Program in Regional Australia.

Background: Food Sensations for Adults, funded by the Western Australian Department of Health, is a four-week nutrition education program focused on food literacy, with demonstrated success amongst Western Australians. In the last two years, 25% of programs have been in regional and remote areas and therefore the aim of this research is to explore the impact of the program in regional areas. Methods: Participants answered validated pre- and post-questionnaires to assess change in food literacy behaviours (2016–2018). Results: Regional participants (n = 451) were more likely to live in low income areas, have lower education levels, and identify as Aboriginal, than metropolitan participants (n = 1398). Regional participants had statistically significantly higher food literacy behaviours in the plan and manage and preparation domains, and lower selection behaviours at baseline than metropolitan participants. Post program, regional participants showed matched improvements with metropolitan participants in the plan and manage, and preparation domains. Food selection behaviour results increased in both groups but were significantly higher in regional participants. Conclusions: The program demonstrates effective behaviour change in all participants; however, the increased disadvantage experienced by people residing outside of major cities highlights the need for additional government support in addressing regional specific barriers, such as higher food costs, to ensure participants gain maximum benefit from future food literacy programs.

Population Data Centre Profile - The Western Australian Data Linkage Branch.

Established in 1995, the Western Australian Data Linkage Branch (DLB) is Australia’s longest running data linkage agency. The Western Australian Data Linkage System (WADLS) employs an enduring linkage model spanning over 60 data collections supported by internally developed and supported software and IT infrastructure. DLB has delivered, and continues to deliver, a range of significant data linkage innovations, many of which have been adopted elsewhere. A current restructure within the Western Australian Department of Health (which we will refer to as the Department of Health) will provide an improved funding model geared toward addressing issues with staff retention, capacity and customer service, as well as fostering improvements to data management, governance and availability. Research using linked data provided by DLB has been used in over 800 projects resulting in over 2350 publications and outcomes for policy development, service delivery and public health. Demand continues to grow for data linkage services and with the Department of Health’s bolstered commitment to resourcing, DLB looks forward to a future for data linkage in Western Australia that is sustainable, high quality, efficient, and safe.

Higher Ultraviolet Radiation During Early Life Reduces Risk of Childhood Type 1 Diabetes Among Boys

Background: Ecological studies show an inverse association between type 1 diabetes incidence and ambient UV radiation (UVR) levels. We used large linked datasets to test ambient UVR during early life against type 1 diabetes risk at the individual level. Methods: We conducted a nested case-control study using linked data from state-wide administrative datasets. Cases (n=1819) were all children born in Western Australia from 1980-2014 with a diagnosis of type 1 diabetes on the Western Australian Children’s Diabetes Database between 0-16 years of age. Controls (n=27 259) were randomly selected from all live births in Western Australia and matched to cases on sex and date of birth. Daily UVR data from NASA satellites, that were date-and location-specific for each individual, were used to estimate total UVR dose for each trimester of pregnancy and the first year of life. Findings: Conditional logistic regression showed that type 1 diabetes risk was 44% lower in boys of mothers with UVR levels in the highest quartile (compared to the lowest quartile) during their third trimester of pregnancy (p=0·04). Higher UVR in the first year of life was also associated with a significantly lower risk of type 1 diabetes in later childhood among boys. Among girls, there was no evidence of associations between total UVR dose and type 1 diabetes risk. Interpretations: Higher UVR in the third trimester and first year of life appears to interact with sex-specific factors to lower type 1 diabetes risk among boys (but not girls) in Western Australia. Funding Statement: This research was supported by an Australian Government Research Training Program Scholarship and a PhD Top-Up scholarship from the Children’s Diabetes Centre, Telethon Kids Institute, Perth WA, Australia. The funding sources had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had access to all the data and all authors agreed on the decision to submit for publication. Declaration of Interests: The authors have no conflicts of interest to disclose. Ethics Approval Statement: Use of these data was approved by the Western Australian Department of Health (2016/05) and the University of Western Australia Human Research Ethics Committee.

‘Links2HealthierBubs’ cohort study: protocol for a record linkage study on the safety, uptake and effectiveness of influenza and pertussis vaccines among pregnant Australian women

IntroductionPregnant women and infants are at risk of severe influenza and pertussis infection. Inactivated influenza vaccine (IIV) and diphtheria-tetanus-acellular pertussis vaccine (dTpa) are recommended during pregnancy to protect both mothers...

Fit for purpose - developing a software platform to support the modern challenges of data linkage in Western Australia

The Western Australia Data Linkage System (WADLS) is maintained and operated by the WA Data Linkage Branch (DLB) at the Western Australian Department of Health. DLB has pioneered a number of data linkage innovations, including the facilitation of genealogical research via the Family Connections system and streamlined data delivery via the Custodian Administered Research Extract Server. DLB’s latest innovation is a new data linkage system called “DLS3”, which improves DLB’s capability and capacity to handle the increasing volume and complexity of its routine operations. DLS3 was built entirely in-house and customised to meet the specific challenges that DLB has encountered throughout over twenty years of experience with a wide variety of linkages. This article describes the development and rollout of DLS3, including its design, architecture, benefits and limitations.

Oral prednisolone in preschool children with virus-associated wheeze: a prospective, randomised, double-blind, placebo-controlled trial

Children of preschool age often have episodes of virus-associated wheeze, and research assessing efficacy of corticosteroids for paediatric wheeze exacerbations is inconclusive. This non-inferiority, randomised, double-blind, placebo-controlled trial was to compare the efficacy of placebo versus oral prednisolone in children aged 24-72 months presenting with virus-associated wheeze at the paediatric emergency department of Princess Margaret Hospital in Perth, WA, Australia. Eligible participants were randomly assigned (1:1) using a computer-generated random number program to receive placebo or prednisolone (1 mg/kg per day) for 3 days. The primary outcome was total length of stay in hospital until ready for discharge. Following an analysis to test the hypothesis that placebo is non-inferior to prednisolone, a post-hoc superiority analysis was done to test the hypothesis that prednisolone was superior to placebo. A non-inferiority margin of 10% was used to establish non-inferiority. Efficacy analyses were on a modified intention-to-treat basis, whereby patients were excluded from the final efficacy analysis if consent was withdrawn, two doses of study drug were vomited, or paperwork was lost. All participants were included in safety analyses. This study is registered with the Australian and New Zealand Clinical Trials Registry, number ACTRN12612000394842. Between June 11, 2012, and June 10, 2015, we screened 3727 patients for eligibility. 624 eligible patients were randomly assigned to treatment, and 605 patients were included in the modified intention-to-treat analysis (300 patients from the placebo group, 305 patients from the prednisolone group). The median length of stay until ready for discharge was longer in the placebo group (540 min [IQR 124-971]) than in the prednisolone group (370 min [121-709]); placebo was inferior to prednisolone. In the post-hoc superiority analysis of 605 patients, the unadjusted ratio of geometric mean for length of stay was 0·79 (95% CI 0·64-0·97; p=0·0227) for the prednisolone group relative to the placebo group. No serious adverse events were reported during the study or follow-up period. One child in the placebo group had a non-specific maculopapular rash, which resolved spontaneously. Two children (one from each group) were reported to be hyperactive during follow-up assessments. Oral prednisolone had a clear benefit over placebo at reducing the length of stay in children presenting to a paediatric emergency department with virus-associated wheeze and was well tolerated. Western Australian Department of Health.

Impact of consumer copayments for subsidised medicines on health services use and outcomes: a protocol using linked administrative data from Western Australia

IntroductionAcross the world, health systems are adopting approaches to manage rising healthcare costs. One common strategy is a medication copayments scheme where consumers make a contribution (copayment) towards the cost...

Health professionals’ perceptions of clinical leadership. A pilot study

Aim: To identify how clinical leadership was perceived by Health Professionals (HPs) (excluding nurses and doctors) and to understand how effective clinical leadership relates to initiating and establishing a culture of change and progression in the health services. Methodology: This pilot study used a mixed methods approach, although quantitative methodological principles dominated. An on-line (SurveyMonkey) questionnaire was distributed via email links to HPs throughout the Western Australian Department of Health. Qualitative data was analysed by Statistical Product and Service Solutions (Version 21). Results: A total of 307 complete surveys were returned. Participants represented 6.1% of the total WA HP workforce and a wide range of HP disciplines. The majority of respondents were female (86.5%), the median age was 38.9 years and the majority of respondents worked in acute hospital environments (59.9%) and in a metropolitan location (73.7%). Most participants (79.2%) saw themselves or were reportedly seen by others (76.2%) as clinical leaders. The main attributes associated with clinical leadership were; effective communicator, clinical competence, approachability, role model and supportive. The main attribute identified least with clinical leadership was “controlling”. Only 22.2% saw clinical leaders as managers, while the majority saw a clinical focus as important (85.3%). Clinical leaders were perceived as having an impact on how clinical care is delivered, staff support and leading change and service improvement. Many respondents (81.4%) suggested barriers hindered their effectiveness as clinical leaders. Conclusions: Improvements in clinical care and changes in practice can be initiated by clinical leaders.

An Evaluation of Multisystemic Therapy with Australian Families.

This study aims to evaluate the effectiveness of the Multisystemic Therapy (MST) intervention for Australian families invloved with the Specialist Child and Adolescent Mental Health Service (CAMHS). This program was implemented within the Western Australian Department of Health in 2005, and has continually operated two small clinical teams within the Perth metropolitan area since then. This intervention was specifically chosen to improve service access, engagement, and intervention with vulnerable families having young persons with a history of significant and enduring behavioural problems. The study reports on data collected from July 2007 to July 2013 which includes baseline, post‐treatment, 6‐month, and 12‐month follow‐up. There were 153 MST families participating in the research at all time points (71% male; 11% Australian Aboriginal; average youth age was 13.6 years). Caregivers completed a set of questionnaires including Child Behaviour Checklist, Parenting Styles and Dimensions Questionnaire, and Depression, Anxiety and Stress Scale. One‐way repeated measure ANOVA were used to measure changes over time. Significant caregiver‐reported improvements in all measures were reported at post‐treatment, and most improvements were maintained at the follow‐up periods of 6 and 12 months post‐intervention. These preliminary outcomes demonstrate that the 4–5 month MST intervention significantly reduces behavioural problems and emotional difficulties in young Australians and these improvements are generally maintained by caregivers over time. Primary caregivers reported improved skills and mental health functioning that were also maintained over the follow‐up period. A proposed randomised controlled trial of the program will address potential placebo and selection bias effects.

Efficacy of infant simulator programmes to prevent teenage pregnancy: a school-based cluster randomised controlled trial in Western Australia

Infant simulator-based programmes, which aim to prevent teenage pregnancy, are used in high-income as well as low-income and middle-income countries but, despite growing popularity, no published evidence exists of their long-term effect. The aim of this trial was to investigate the effect of such a programme, the Virtual Infant Parenting (VIP) programme, on pregnancy outcomes of birth and induced abortion in Australia. In this school-based pragmatic cluster randomised controlled trial, eligible schools in Perth, Western Australia, were enrolled and randomised 1:1 to the intervention and control groups. Randomisation using a table of random numbers without blocking, stratification, or matching was done by a researcher who was masked to the identity of the schools. Between 2003 and 2006, the VIP programme was administered to girls aged 13-15 years in the intervention schools, while girls of the same age in the control schools received the standard health education curriculum. Participants were followed until they reached 20 years of age via data linkage to hospital medical and abortion clinic records. The primary endpoint was the occurrence of pregnancy during the teenage years. Binomial and Cox proportional hazards regression was used to test for differences in pregnancy rates between study groups. This study is registered as an international randomised controlled trial, number ISRCTN24952438. 57 (86%) of 66 eligible schools were enrolled into the trial and randomly assigned 1:1 to the intervention (28 schools) or the control group (29 schools). Then, between Feb 1, 2003, and May 31, 2006, 1267 girls in the intervention schools received the VIP programme while 1567 girls in the control schools received the standard health education curriculum. Compared with girls in the control group, a higher proportion of girls in the intervention group recorded at least one birth (97 [8%] of 1267 in the intervention group vs 67 [4%] of 1567 in the control group) or at least one abortion as the first pregnancy event (113 [9%] vs 101 [6%]). After adjustment for potential confounders, the intervention group had a higher overall pregnancy risk than the control group (relative risk 1·36 [95% CI 1·10-1·67], p=0·003). Similar results were obtained with the use of proportional hazard models (hazard ratio 1·35 [95% CI 1·10-1·67], p=0·016). The infant simulator-based VIP programme did not achieve its aim of reducing teenage pregnancy. Girls in the intervention group were more likely to experience a birth or an induced abortion than those in the control group before they reached 20 years of age. Western Australian Health Promotion Foundation (Healthway), Lotteries WA, the Western Australian Department of Education and Training, and the Western Australian Department of Health.

O19.2 Pre-exposure prophylaxis and risk compensation: evidence of decreased condom use at three-month follow-up among predominantly gay male participants in the vicprep study

Introduction Pre-exposure prophylaxis (PrEP) decreases HIV risk among uninfected people, but risk compensation may affect prevention benefits. PrEP trials and extensions found no decrease in condom use, but included extensive prevention education. We investigated condom use in the VicPrEP study, the first implementation study of PrEP in routine practice in Australia. Methods Enrollment commenced in June 2014, with capacity for 115 at risk HIV negative gay/bisexual men, transgender people and heterosexual serodiscordant couples seeking to conceive. Participants are recruited from three GP clinics, one sexual health clinic, and one hospital clinic in Melbourne. Participants consent to using daily Truvada for at least one year, and complete baseline and three-monthly clinical evaluations and self-report behavioural surveys. Results At 31 March 2015, 92 participants completed baseline surveys, and 76 completed three-month follow-up; all gay/bisexual men (mean age 37.7 years; 67.4% university educated; 75.0% Australian born). In the past three months half had regular partners (Baseline: 48.9%, Follow-up: 55.8%; ns); nearly all had casual partners (Baseline: 90.2%, Follow-up: 88.2%; ns). Mean frequency of intercourse in the past three months remained stable for regular partners (Baseline: 19.0, Follow-up: 18.9; ns), and decreased for casual partners (Baseline: 19.1, Follow-up: 16.0; p = 0.056). Condom use was assessed on a 5-point scale (1 = never, 5 = always), and decreased with regular partners (Baseline: mean 2.0 [SD 1.6], Follow-up: mean 1.7 [SD 1.3]; p = 0.048), and casual partners (Baseline: mean 3.0 [SD 1.3], Follow-up: mean 2.5 [SD 1.4]; p = 0.002). Serosorting, viral load sorting, strategic positioning and withdrawal remained unchanged with regular and casual partners. Conclusion This is the first study documenting a decrease in condom use amongst HIV-negative gay/bisexual men using PrEP. Findings highlight the potential for risk compensation to reduce benefits of PrEP when implemented in routine practice, if adherence is insufficient. This underscores the continued importance of promoting sexual risk reduction practices, including condom use. Disclosure of interest statement The VicPrEP study was funded by the Victorian Department of Health and study drug was supplied by Gilead. John de Wit receives research funding from the National Health and Medical Research Council, the Australian Government Department of Health, the NSW Ministry of Health, the Victorian Department of Health, Queensland Health, Western Australian Department of Health, Gay Men9s Health SA, ACT Health, Tasmanian Council on AIDS, Hepatitis and Related Diseases, the Netherlands Institute of Public Health and Environment (RIVM), AIDS Fonds, The Netherlands, and UNESCO Bangkok. He has received lecture sponsorship from BMS Australia, is a board member of ACON Health Inc and a member of the Steering Committee of the HIV in Europe initiative. Dean Murphy receives funding from the Australian Government Department of Health and a research grant from the Victorian Department of Health. Luxi Lal has no interests to disclose. Jennifer Audsley has no interests to disclose. Norman Roth has received honoraria for Advisory Boards and/or educational events from ViiV, MSD, Gilead and Bristol Myers Squibb. Richard Moore has received financial assistance for education from Gilead, Viiv and Merck. BK Tee has no interests to disclose. Tim Read works at Melbourne Sexual Health Centre which receives study payments from Gilead. Edwina Wright receives funding from a research grant from NIH, research funding from the Victorian Department of Health and unrestricted research funds from Gilead, Abbott, Janssen Cilag, MSD and Boehringer Ingelheim. She has also received funding that has been used for research purposes only from ViiV, Merck, Gilead, and Abbott for consultancy work, payment for lectures from ViiV and payment for developing educational resources for ViiV, MSD and Gilead.

Who Uses the Internet as a Source of Nutrition and Dietary Information? An Australian Population Perspective.

BackgroundThe Internet contains a plethora of nutrition information. Health organizations are increasingly using the Internet to deliver population-wide health information and interventions. Effective interventions identify their target population and their needs; however, little is known about use of the Internet as a source of nutrition information.ObjectiveThe aim was to assess the change in prevalence and demographic characteristics of Western Australian adults accessing the Internet as a source of nutrition information and identify specific information needs.MethodsData were pooled from the Western Australian Department of Health’s 3-yearly Nutrition Monitoring Survey Series telephone survey between 1995 and 2012 of 7044 participants aged 18 to 64 years. Outcome variables were the main sources of nutrition information used in the last year and yes/no responses to 4 suggestions to what would make it easier to eat a healthy diet. Sociodemographic variables were collected.ResultsThe proportion of respondents using the Internet for nutrition information increased from <1% in 1995-2001 to 9.1% in 2004 and 33.7% in 2012. Compared to 2004, logistic regression showed that the odds of using the Internet for this information increased significantly in 2009 (OR 2.84, 95% CI 2.07-3.88) and 2012 (OR 5.20, 95% CI 3.86-7.02, P<.001). Respondents using the Internet as a source were more likely to be female (OR 1.30, 95% CI 1.05-1.60, P=.02), live in a metropolitan area (OR 1.26, 95% CI 1.03-1.54, P=.03), born in countries other than Australia/UK/Ireland (OR 1.41, 95% CI 1.07-1.85, P=.02), more educated (university: OR 2.46, 95% CI 1.77-3.42, P<.001), and were less likely to be older (55-64 years: OR 0.38, 95% CI 0.25-0.57, P<.001). The majority of respondents agreed the following information would assist them to make healthier choices: more ways to prepare healthy foods (72.0%, 95% CI 70.7-73.3), quicker ways to prepare healthy foods (79.0%, 95% CI 77.8-80.1), how to choose healthy foods (68.8%, 95% CI 67.5-70.1), and knowing more about cooking (54.7%, 95% CI 53.3-56.1). Those using the Internet for nutrition information were more likely than nonusers to want to know quicker ways to prepare healthy foods (83.0% vs 78.1%, P=.005) and information on choosing healthy foods (76.3% vs 67.3%, P<.001).ConclusionsUse of the Internet as a main source of nutrition information has grown rapidly since 2004; one-third of Western Australian adults reported using the Internet for this purpose in 2012. Information on preparing healthy foods (ideas, quicker ways), choosing ingredients, and knowing more about cooking would make it easier to eat a healthy diet. For Internet users, emphasis should be on quicker ways and choosing ingredients. These finding have implications for policy makers and practitioners and suggest that traditional health promotion tactics should continue to be used to reach the broader population.

Use of mechanical airway clearance devices in the home by people with neuromuscular disorders: effects on health service use and lifestyle benefits.

BackgroundPeople with neuromuscular disorders (NMD) exhibit weak coughs and are susceptible to recurrent chest infections and acute respiratory complications, the most frequent reasons for their unplanned hospital admissions. Mechanical insufflation-exsufflation (MI-E) devices are a non-invasive method of increasing peak cough flow, improving cough efficacy, the clearance of secretion and overcoming atelectasis. There is limited published evidence on the impact of home use MI-E devices on health service utilisation. The aims of the study were: to assess the self-reported health and lifestyle benefits experienced as a result of home use of MI-E devices; and evaluate the effects of in-home use of MI-E devices on Emergency Department (ED) presentations, hospital admissions and inpatient length of stay (LOS).MethodsIndividuals with NMD who were accessing a home MI-E device provided through Muscular Dystrophy Western Australia were invited to participate in a quantitative survey to obtain information on their experiences and self-assessed changes in respiratory health. An ad-hoc record linkage was performed to extract hospital, ED and mortality data from the Western Australian Department of Health (DOHWA). The main outcome measures were ED presentations, hospital separations and LOS, before and after commencement of home use of an MI-E device.ResultsThirty seven individuals with NMD using a MI-E device at home consented to participate in this study. The majority (73%) of participants reported using the MI-E device daily or weekly at home without medical assistance and 32% had used the machine to resolve a choking episode. The survey highlighted benefits to respiratory function maintenance and the ability to manage increased health care needs at home. Not using a home MI-E device was associated with an increased risk of ED presentations (RR = 1.76, 95% CI 1.1-2.84). The number of hospital separations and LOS reduced after the use of MI-E device, but not significantly. No deaths were observed in participants using the MI-E device at home.ConclusionsHome use of a MI-E device by people living with NMD may have a potential impact on reducing their health service utilisation and risk of death. Future research with greater subject numbers and longer follow-up periods is recommended to enhance this field of study.Electronic supplementary materialThe online version of this article (doi:10.1186/s13023-015-0267-0) contains supplementary material, which is available to authorized users.

The negotiations of involved fathers and intensive mothers around shared-bed sleeping with infants (co-sleeping)

This article discusses some emerging issues that arose during a much wider evaluative investigation of the Western Australian Health Department's bed-sharing policy and how effectively health professionals provided advice to parents. The broader evaluation report was developed for a clinical and health bureaucratic, policy-making audience. In contrast, this article adopts an approach that is more sociologically informed to tease out some of the social and cultural discourses that influence how bed-sharing advice was interpreted and used by the mothers interviewed for the study. We ponder the influence of current parenting discourses on parental decision-making, including those that construct fathers as ‘involved’ and mothers as ‘intensive’, as well as the theory of ‘attachment parenting’, which has enjoyed something of a resurgence in Australia. We also touch on and alert to the differences in responses to this information reported by the Aboriginal and non-Aboriginal women interviewed for the study. This article highlights areas that may require further consideration and investigation by social and health researchers in maternal and child health, as well as practitioners involved in the development or delivery of bed-sharing information for parents.

Evaluation of long-term clinical and health service outcomes following coronary artery revascularisation in Western Australia (WACARP): a population-based cohort study protocol

IntroductionCoronary artery bypass grafting (CABG) and percutaneous coronary interventions (PCI) are procedures commonly performed on patients with significant obstructive coronary artery disease to relieve symptoms of ischaemia, improve survival or...

A pragmatic approach to embedding patient blood management in a tertiary hospital

We describe the implementation and impact of a patient blood management program (PBMP) in an Australian teaching hospital. A PBMP was introduced at a single tertiary care hospital in 2009 as a pilot for the Western Australian Health Department statewide PBMP. The first 3 years of interventions aimed to make effective use of preoperative clinics, manage perioperative anemia, improve perioperative hemostasis, reduce blood sample volumes, and implement restrictive transfusion triggers and a single-unit transfusion policy. Between 2008 and 2011, admissions to Fremantle Hospital and Health Services increased by 22%. Using 2008 as a reference year, the mean number of red blood cell (RBC) units per admission declined 26% by 2011. Use of fresh-frozen plasma and platelets showed 38 and 16% declines, respectively. Cryoprecipitate increased 7% over the 4-year period. For elective admissions between 2008 and 2011, the leading decline in RBC transfusion rate was seen in cardiothoracic surgery (27.5% to 12.8%). The proportion of single RBC unit use increased from 13% to 28% (p < 0.001), and the proportion of double units decreased from 48% to 37% (p < 0.001). This is the first tertiary hospital in Australia to establish a multidisciplinary multimodal PBMP. Interventions across disciplines resulted in decreased use of RBC units especially in orthopedic and cardiothoracic surgery. Continuing education and feedback to specialties will maintain the program, improve patient outcomes, and decrease the transfusion rate.