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Mithen LM, Weaver N, Walker FR, Inder KJ. Feasibility of biomarkers to measure stress, burnout and fatigue in emergency nurses: a cross-sectional study. BMJ Open 2023; 13:e072668. [PMID: 37643845 PMCID: PMC10465916 DOI: 10.1136/bmjopen-2023-072668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Retaining nurses in the workforce is an urgent concern in healthcare. Emergency nurses report high levels of stress and burnout, however, there is no gold standard of how to measure these responses. This study aims to measure stress, burnout, and fatigue in emergency nurses using biomarkers and psychometric instruments. Biomarkers will be used to better understand nurses' levels of stress and burnout and to assess the feasibility of using biomarkers as a viable stress measurement tool in a real-world setting. METHODS AND ANALYSIS A two stage cross-sectional design to measure stress, burnout and fatigue in emergency nurses while they work is proposed. All registered and enrolled nurses working in the emergency department from four hospitals in Australia will be invited to participate. Validated psychometric tools will be used in stage 1 to measure depression, anxiety, acute stress, chronic stress, burnout and fatigue. Biomarkers comprising hair cortisol, saliva alpha amylase and heart rate variability will be collected as an objective measure of stress and burnout in stage 2 over one working shift per participant. Written consent will be sought for stage 2 where nurses will provide one hair sample, wear a heart rate sensor and be asked to collect their saliva at three different time points of one shift. Data analysis will measure the domains of acute stress, chronic stress and burnout and explore relationships and correlation between psychometric measures and biomarkers. ETHICS AND DISSEMINATION Ethics approval obtained from the Human Research Ethics Committee of the Hunter New England Local Health District (approval number: HREC/2020/ETH01684) and University of Newcastle HREC (H-2022-0169). Results will be reported in peer-reviewed publications using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Public dissemination will occur by presenting at conferences and to the participating local health district.
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Affiliation(s)
- Lucinda M Mithen
- School of Nursing & Midwifery, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, HMRI, New Lambton, New South Wales, Australia
| | - Natasha Weaver
- Hunter Medical Research Institute, HMRI, New Lambton, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Frederick R Walker
- Hunter Medical Research Institute, HMRI, New Lambton, New South Wales, Australia
- School of Biomedical Sciences, The University of Newcastle, Callaghan, New South Wales, Australia
- Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Callaghan, New South Wales, Australia
- Centre for Advanced Training Systems, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Kerry J Inder
- School of Nursing & Midwifery, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, HMRI, New Lambton, New South Wales, Australia
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Britton B, Murphy M, Jansson AK, Boyle A, Duncan MJ, Collins CE, Baker AL, Kerr J, Rutherford J, Inder KJ, Plotnikoff RC. Rehabilitation Support via Postcard (RSVP): A Randomised Controlled Trial of a Postcard to Promote Uptake of Cardiac Rehabilitation. Heart Lung Circ 2023; 32:1010-1016. [PMID: 37302865 DOI: 10.1016/j.hlc.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/09/2023] [Accepted: 05/15/2023] [Indexed: 06/13/2023]
Abstract
PURPOSE The aim was to increase cardiac rehabilitation (CR) uptake using a novel intervention, Rehabilitation Support Via Postcard (RSVP), among patients with acute myocardial infarction discharged from two major hospitals in Hunter New England Local Health District (HNELHD), New South Wales, Australia. METHODS The RSVP trial was evaluated using a two-armed randomised controlled trial design. Participants (N=430) were recruited from the two main hospitals in HNELHD, and enrolled and randomised to either the intervention (n=216) or control (n=214) group over a six-month period. All participants received usual care; however, the intervention group received postcards promoting CR attendance between January and July 2020. The postcard was ostensibly written as an invitation from the patient's admitting medical officer to promote timely and early uptake of CR. The primary outcome was CR attendance at outpatient HNELHD CR services in the 30-days post-discharge. RESULTS Fifty-four percent (54%) of participants who received RSVP attended CR, compared to 46% in the control group; however this difference was not statistically significant (odds ratio [OR]=1.4, 95% confidence interval [CI]=0.9-2.0, p=0.11). Exploratory post-hoc analysis among four sub-groups (i.e., Indigeneity, gender, age and rurality), found that the intervention significantly increased attendance in males (OR=1.6, 95%CI=1.0-2.6, p=0.03) but had no significant impact on attendance for other sub-groups. CONCLUSIONS While not statistically significant, postcards increased overall CR attendance by 8%. This strategy may be useful to increase attendance, particularly in men. Alternative strategies are necessary to increase CR uptake among women, Indigenous people, older people and people from regional and remote locations.
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Affiliation(s)
- Ben Britton
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia; Hunter New England Health, Newcastle, NSW, Australia
| | - Maria Murphy
- Centre for Active Living and Learning, University of Newcastle, Newcastle, NSW, Australia
| | - Anna K Jansson
- Centre for Active Living and Learning, University of Newcastle, Newcastle, NSW, Australia; Active Living Research Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Andrew Boyle
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Mitch J Duncan
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia; Centre for Active Living and Learning, University of Newcastle, Newcastle, NSW, Australia; Active Living Research Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Clare E Collins
- School of Health Science, College of Health and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Food and Nutrition Research Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Jane Kerr
- Hunter New England Health, Newcastle, NSW, Australia
| | | | - Kerry J Inder
- School of Nursing and Midwifery, University of Newcastle, Newcastle, NSW, Australia
| | - Ronald C Plotnikoff
- Centre for Active Living and Learning, University of Newcastle, Newcastle, NSW, Australia; Active Living Research Program, Hunter Medical Research Institute, Newcastle, NSW, Australia.
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Dee F, Savage L, Leitch JW, Collins N, Loten C, Fletcher P, French J, Weaver N, Watson O, Orvad H, Inder KJ, McIvor D, Williams T, Davies AJ, Attia J, Wiggers J, Sverdlov AL, Boyle AJ. Management of Acute Coronary Syndromes in Patients in Rural Australia: The MORACS Randomized Clinical Trial. JAMA Cardiol 2022; 7:690-698. [PMID: 35612860 PMCID: PMC10881213 DOI: 10.1001/jamacardio.2022.1188] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/16/2022] [Indexed: 12/12/2022]
Abstract
Importance Treatment of ST-segment elevation myocardial infarction (STEMI) in rural settings involves thrombolysis followed by transfer to a percutaneous coronary intervention-capable hospital. The first step is accurate diagnosis via electrocardiography (ECG), but one-third of all STEMI incidents go unrecognized and hence untreated. Objective To reduce missed diagnoses of STEMI. Design, Setting, and Participants This cluster randomized clinical trial included 29 hospital emergency departments (EDs) in rural Australia with no emergency medicine specialists, which were randomized to usual care vs automatically triggered diagnostic support from the tertiary referral hospital (management of rural acute coronary syndromes [MORACS] intervention). Patients presenting with symptoms compatible with acute coronary syndromes (ACS) were eligible for inclusion. The study was conducted from December 2018 to April 2020. Data were analyzed in August 2021. Intervention Triage of a patient with symptoms compatible with ACS triggered an automated notification to the tertiary hospital coronary care unit. The ECG and point-of-care troponin results were reviewed remotely and a phone call was made to the treating physician in the rural hospital to assist with diagnosis and initiation of treatment. Main Outcomes and Measures The proportion of patients with missed STEMI diagnoses. Results A total of 6249 patients were included in the study (mean [SD] age, 63.6 [12.2] years; 48% female). Of 7474 ED presentations with suspected ACS, STEMI accounted for 77 (2.0%) in usual care hospitals and 46 (1.3%) in MORACS hospitals. Missed diagnosis of STEMI occurred in 27 of 77 presentations (35%) in usual care hospitals and 0 of 46 (0%) in MORACS hospitals (P < .001). Of eligible patients, 48 of 75 (64%) in the usual care group and 36 of 36 (100%) in the MORACS group received primary reperfusion (P < .001). In the usual care group, 12-month mortality was 10.3% (n = 8) vs 6.5% (n = 3) in the MORACS group (relative risk, 0.64; 95% CI, 0.18-2.23). Patients with missed STEMI diagnoses had a mortality of 25.9% (n = 7) compared with 2.0% (n = 1) for those with accurately diagnosed STEMI (relative risk, 13.2; 95% CI, 1.71-102.00; P = .001). Overall, there were 6 patients who did not have STEMI as a final diagnosis; 5 had takotsubo cardiomyopathy and 1 had pericarditis. There was no difference between groups in the rate of alternative final diagnosis. Conclusion and Relevance The findings indicate that MORACS diagnostic support service reduced the proportion of missed STEMI and improved the rates of primary reperfusion therapy. Accurate diagnosis of STEMI was associated with lower mortality. Trial Registration anzctr.org.au Identifier: ACTRN12619000533190.
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Affiliation(s)
- Fiona Dee
- John Hunter Hospital, Department of Cardiovascular Medicine, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Lindsay Savage
- John Hunter Hospital, Department of Cardiovascular Medicine, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - James W. Leitch
- John Hunter Hospital, Department of Cardiovascular Medicine, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Nicholas Collins
- John Hunter Hospital, Department of Cardiovascular Medicine, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Conrad Loten
- John Hunter Hospital, Department of Emergency Medicine, Hunter New England Local Health District Newcastle, New South Wales, Australia
| | - Peter Fletcher
- John Hunter Hospital, Department of Cardiovascular Medicine, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - John French
- Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Natasha Weaver
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Olivia Watson
- John Hunter Hospital, Department of Cardiovascular Medicine, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Helen Orvad
- Tamworth Rural Referral Hospital, Hunter New England Local Health District Tamworth, New South Wales, Australia
| | - Kerry J. Inder
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Dawn McIvor
- John Hunter Hospital, Department of Cardiovascular Medicine, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing University of Newcastle, Callaghan, New South Wales, Australia
| | - Trent Williams
- John Hunter Hospital, Department of Cardiovascular Medicine, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Allan J. Davies
- John Hunter Hospital, Department of Cardiovascular Medicine, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - John Attia
- John Hunter Hospital, Department of Cardiovascular Medicine, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - John Wiggers
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia
- Population Health, Hunter New England Health Local Health District, Newcastle, New South Wales, Australia
| | - Aaron L. Sverdlov
- John Hunter Hospital, Department of Cardiovascular Medicine, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Andrew J. Boyle
- John Hunter Hospital, Department of Cardiovascular Medicine, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia
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Akter S, Davies K, Rich JL, Inder KJ. Community perspectives of barriers indigenous women face in accessing maternal health care services in the Chittagong Hill Tracts, Bangladesh. Ethn Health 2022; 27:1222-1240. [PMID: 33356512 DOI: 10.1080/13557858.2020.1862766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 12/07/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Bangladesh has achieved notable success in improving maternal health by increasing women's access to good quality and low-cost maternal health care (MHC) services. However, the health system of Bangladesh has earned criticism for not ensuring equitable MHC access for all women, particularly for Indigenous women in the Chittagong Hill Tracts (CHT). Little is known about Indigenous communities' perspectives on these inequalities in MHC service access in the CHT. Therefore, this study aimed to explore Indigenous communities' perspectives on challenges and opportunities for improving MHC service access in the CHT. DESIGN This qualitative descriptive study was conducted in two sub-districts of Khagrachhari between September 2017 and February 2018. Eight Indigenous key informants from three Indigenous communities (Chakma, Marma and Tripura) were recruited via snowballing and purposive techniques and participated in face-to-face, semi-structured interviews. Key informants comprised community leaders and health care providers. Data were analysed thematically using Nvivo12 software. RESULTS Findings suggest that distance, poor availability of resources and infrastructure, lack of community engagement in the design of health interventions, Indigenous cultural beliefs, misconceptions about MHC services, and maltreatment from health care providers were the key barriers to accessing MHC services; all are interconnected. Indigenous women faced humiliation and maltreatment from MHC staff. Failure to provide a culturally-safe environment suggests a lack of cultural competency among health staff, including Indigenous staff. CONCLUSION Findings suggest that cultural competency training for all health care providers is needed to improve cultural appropriateness and accessibility of services. Refresher training and undisrupted supply of basic MHC services for front-line care providers will benefit the entire community and will likely be cost-effective for the government. Designing health programmes through extensive community consultation is essential.
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Affiliation(s)
- Shahinoor Akter
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
- Priority Research Centre for Generational Health and Ageing, University of Newcastle, New Lambton Heights, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Department of Anthropology, Jagannath University, Dhaka, Bangladesh
| | - Kate Davies
- School of Humanities and Social Science, Faculty of Education and Arts, University of Newcastle, Callaghan, Australia
| | - Jane L Rich
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
- Priority Research Centre for Brain and Mental Health, University of Newcastle, Callaghan, Australia
| | - Kerry J Inder
- Priority Research Centre for Generational Health and Ageing, University of Newcastle, New Lambton Heights, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
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Gaviola MA, Higgins I, Dilworth S, Holliday E, Inder KJ. Individualised music for people living with dementia and the experiences and perceptions of residential aged care staff: A qualitative study. Australas J Ageing 2021; 41:e8-e15. [PMID: 34351677 DOI: 10.1111/ajag.12987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 06/25/2021] [Accepted: 07/05/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explore the experiences and perceptions of staff regarding the use of individualised music for people with dementia living in residential aged care. METHODS A qualitative descriptive methodology was used. Methods included a focus group and face-to-face interviews, open-ended responses to a pre-post survey and relevant clinical notes about older participants' responses. Qualitative content analysis was used to analyse data. RESULTS There were four themes: (1) transcendental reminiscing, the calm, the joy and the elation; (2) optimism, excitement and the snowball effect; (3) pitching in for older person, it is not rocket science and the hurdles; and (4) music beyond the intervention. CONCLUSIONS Overall, the individualised music was a generally positive experience. While some older participants reported discomfort with the use of headphones, staff concerns related to care and accessibility of music equipment.
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Affiliation(s)
- Minah Amor Gaviola
- School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, Australia
| | - Isabel Higgins
- School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, Australia
| | - Sophie Dilworth
- Hunter Aged Care Assessment Team, Hunter New England Local Health District, New Lambton, NSW, Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton, NSW, Australia
| | - Kerry J Inder
- School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton, NSW, Australia
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Fitzpatrick SJ, Handley T, Powell N, Read D, Inder KJ, Perkins D, Brew BK. Suicide in rural Australia: A retrospective study of mental health problems, health-seeking and service utilisation. PLoS One 2021; 16:e0245271. [PMID: 34288909 PMCID: PMC8294514 DOI: 10.1371/journal.pone.0245271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/02/2021] [Indexed: 11/21/2022] Open
Abstract
Background Suicide rates are higher in rural Australia than in major cities, although the factors contributing to this are not well understood. This study highlights trends in suicide and examines the prevalence of mental health problems and service utilisation of non-Indigenous Australians by geographic remoteness in rural Australia. Methods A retrospective study of National Coronial Information System data of intentional self-harm deaths in rural New South Wales, Queensland, South Australia and Tasmania for 2010–2015 from the National Coronial Information System. Results There were 3163 closed cases of intentional self-harm deaths by non-Indigenous Australians for the period 2010–2015. The suicide rate of 12.7 deaths per 100,000 persons was 11% higher than the national Australian rate and increased with remoteness. Among people who died by suicide, up to 56% had a diagnosed mental illness, and a further 24% had undiagnosed symptoms. Reported diagnoses of mental illness decreased with remoteness, as did treatment for mental illness, particularly in men. The most reported diagnoses were mood disorders (70%), psychotic disorders (9%) and anxiety disorders (8%). In the six weeks before suicide, 22% of cases had visited any type of health service at least once, and 6% had visited two or more services. Medication alone accounted for 76% of all cases treated. Conclusions Higher suicide rates in rural areas, which increase with remoteness, may be attributable to decreasing diagnosis and treatment of mental disorders, particularly in men. Less availability of mental health specialists coupled with socio-demographic factors within more remote areas may contribute to lower mental health diagnoses and treatment. Despite an emphasis on improving health-seeking and service accessibility in rural Australia, research is needed to determine factors related to the under-utilisation of services and treatment by specific groups vulnerable to death by suicide.
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Affiliation(s)
- Scott J. Fitzpatrick
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, Australia
- * E-mail:
| | - Tonelle Handley
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, Australia
| | - Nic Powell
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, Australia
| | - Donna Read
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, Australia
| | - Kerry J. Inder
- School of Nursing and Midwifery, University of Newcastle, Newcastle, Australia
| | - David Perkins
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, Australia
| | - Bronwyn K. Brew
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Women and Children’s Health, University of New South Wales, Sydney, Australia
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Hansen AC, Hazelton M, Rosina R, Inder KJ. Exploring the frequency, duration and experience of seclusion for women in a forensic mental health setting: a mixed-methods study protocol. BMJ Open 2021; 11:e044261. [PMID: 34103312 PMCID: PMC8190054 DOI: 10.1136/bmjopen-2020-044261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Seclusion use is high in forensic mental health settings and is associated with avoidable physical and psychological harm. The use of seclusion causes significant distress and trauma for those secluded and women in these settings are particularly vulnerable. This study protocol aims to identify factors associated with the use of seclusion and the experience of seclusion for women in forensic mental health settings. METHODS AND ANALYSIS This study will use a prospective mixed-methods design. Quantitative data on the frequency and duration of seclusion and potential explanatory demographic and clinical variables will be collected prospectively from consecutive medical records of women admitted to a forensic mental health service over a 2-year period. Data will be analysed using descriptive statistics and logistic regression techniques. Qualitative data will be collected from individual face-to-face semistructured interviews with women who have experienced seclusion about the reason for seclusion, whether they agreed with the reason for seclusion, their experience of the seclusion event and the seclusion environment and support provided while in seclusion using qualitative description methods. Data will be analysed using thematic analysis. ETHICS AND DISSEMINATION Ethical approval has been granted by the University of Newcastle Human Research Ethics Committee (H-2019-0122) and organisational support granted from the participating forensic mental health service. Participation will be voluntary and written informed consent is required. Results will be disseminated via the first author's doctoral thesis, in peer-reviewed journals and at conferences. Results will inform recommendations for policy, and evidence for timely and specific interventions to support the reduction of seclusion for women in forensic mental health settings.
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Affiliation(s)
- Alison Claire Hansen
- School of Nursing & Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- School of Nursing & Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Michael Hazelton
- School of Nursing & Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Robyn Rosina
- School of Nursing & Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Kerry J Inder
- School of Nursing & Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia
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Harmon J, Pitt V, Summons P, Inder KJ. Use of artificial intelligence and virtual reality within clinical simulation for nursing pain education: A scoping review. Nurse Educ Today 2021; 97:104700. [PMID: 33341064 DOI: 10.1016/j.nedt.2020.104700] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 11/02/2020] [Accepted: 11/30/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To explore and map the evidence for virtual reality and artificial intelligence in simulation for the provision of pain education for pre and post registration nurses. DESIGN A scoping review of published and unpublished research from 2009 to 2019. DATA SOURCES Nine electronic databases and hand-searching of reference lists. REVIEW METHODS Studies were included if virtual reality or artificial intelligence interventions were used for education on pain care provision in nursing. Data were extracted and charted using an extraction tool and themes were explored using narrative analysis. RESULTS The review process resulted in the inclusion of four published studies. All studies used mixed methods and used artificial intelligence within clinical simulations as an intervention. No studies using virtual reality for pain education met the inclusion criteria. Participants of three studies were undergraduate nursing students in universities and participants in the fourth study were registered nurses within a hospital. Outcomes measured were user acceptance of the technology and feasibility in all studies. The context was hospital located and focused on acute pain episodes, with one exception being sickle cell pain. Three studies had adult patients and the other pediatric patients. The exclusion of input from a patient perspective was notable, as was a lack of interdisciplinary involvement. CONCLUSION Nurses are integral to the assessment and management of pain in many care settings requiring comprehensive communication and clinical skills. There is a paucity of research on the use of virtual reality or artificial intelligence in pain education for nurses. Current studies are preliminary in nature and/or pilot studies. Further empirical research, with robust design is required to inform nursing education, practice, and policy, thereby supporting the advancement of nursing pain education.
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Affiliation(s)
- Joanne Harmon
- Clinical and Health Sciences, Rosemary Bryant AO Research Centre, University of South Australia, 101 Currie street, Adelaide, SA 5001, Australia.
| | - Victoria Pitt
- School of Nursing and Midwifery, Faculty of Health and Medicine, The University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Peter Summons
- School of Electrical Engineering and Computing, Faculty of Engineering and Built Environment, The University of Newcastle, NSW, Australia.
| | - Kerry J Inder
- School of Nursing and Midwifery, Faculty of Health and Medicine, The University of Newcastle, University Drive, Callaghan, NSW, Australia.
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Akter S, Rich JL, Davies K, Inder KJ. Prevalence and factors associated with knowledge and access to delivery services at primary health care facilities amongst indigenous women in Khagrachhari district Bangladesh - A cross-sectional study. Midwifery 2020; 90:102798. [PMID: 32717661 DOI: 10.1016/j.midw.2020.102798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/06/2020] [Accepted: 07/17/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To estimate the prevalence of facility delivery knowledge and access during childbirth amongst Indigenous women in the Chittagong Hill Tracts, Bangladesh and to identify factors associated with facility delivery service utilisation. DESIGN A cross-sectional study design using a structured self-report survey. SETTING Two Upazilas (subdistricts) of Kharachhari hill district of the Chittagong Hill Tracts. PARTICIPANTS Indigenous women of reproductive age (15-49 years) within 36 months of delivery. MEASUREMENTS AND FINDINGS A modified national survey about accessing maternal health services, including delivery services was administered to all Indigenous women that met eligibility, guided by community leaders. Data collected included socio-demographic characteristics and reproductive history. Main outcome variables were the proportion of women having prior knowledge about and access to facility delivery services for childbirth in the three years prior to the survey. Secondary outcomes were sources of information about facility delivery services, decision making about delivery place, and factors associated with knowledge and attendance at facility delivery services. Factors associated with knowledge and attendance were estimated using logistic regression with results reported as adjusted odds ratios and 95% confidence intervals. With an 89% response rate, a total of 438 Indigenous women (220 Chakma, 100 Marma, 118 Tripura) participated in the survey, and 75% were aged 16-29 years. Relatives played a vital role as a source of information about delivery services (59%). Nearly three-quarters (73%) were aware of facility delivery services, however, prevalence of accessing delivery services was 33% (n = 143; 95% CI 0.28-0.37). Relatives were the key decision-makers for accessing facility delivery services (60%). Independent factors associated with knowledge about facility delivery were higher household income (AOR 5.3, 95%CI 2.2-13); having knowledge of nearest health care facilities (AOR 5.8, 95%CI 3.0-11); and attending antenatal care visits during last pregnancy (four or more AOR 3.1, 95% CI 1.3-7.2 and one to three visits AOR 2.7, 95% CI 1.5-5.0). Independent factors associated with accessing facility delivery services at childbirth were attending antenatal care visit; having access to media; higher level of education of partners; and residing at Khagrachhari Sadar compared to Matiranga subdistrict. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Indigenous women in Chittagong Hill Tracts, Bangladesh have sub-optimal knowledge of, and attendance at, facility delivery services for childbirth. Maternal health related interventions should target Indigenous women in order to educate and motivate them to access facility delivery services at childbirth. Rigorous research is needed to explore Indigenous cultural practices related to childbirth that might influence their access to facility delivery services.
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Affiliation(s)
- Shahinoor Akter
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia; Priority Research Centre for Generational Health and Ageing, University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton, New South Wales, Australia; Department of Anthropology, Jagannath University, Dhaka, Bangladesh.
| | - Jane L Rich
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia; Priority Research Centre for Brain and Mental Health, Callaghan, New South Wales, Australia.
| | - Kate Davies
- School of Humanities and Social Science, Faculty of Education and Arts, University of Newcastle, Callaghan, New South Wales, Australia.
| | - Kerry J Inder
- Priority Research Centre for Generational Health and Ageing, University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton, New South Wales, Australia; School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.
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10
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Cheesmond N, Davies K, Inder KJ. The role of the peer support worker in increasing rural mental health help-seeking. Aust J Rural Health 2020; 28:203-208. [PMID: 32281184 DOI: 10.1111/ajr.12603] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/21/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Mental health peer support workers draw on lived experience to provide benefit to people experiencing mental distress. People living in rural areas are less likely than their urban counterparts to seek professional help for psychological distress. The aim of this study was to explore the perceived value of rural peer support workers as facilitators to rural mental health help-seeking. DESIGN Data were gathered through a cross-sectional survey distributed by a social media boosted post. SETTING A total of 349 "small" rural towns in New South Wales as defined by the Modified Monash Model classification system as MMM5. PARTICIPANTS A total of 765 adult, rural residents completed the survey. MAIN OUTCOME MEASURE(S) Participants were asked to select, from a list of potential facilitators, those which they felt would make mental health help-seeking easier or harder. RESULTS Study participants felt that a help provider with lived experience of mental illness or distress would make mental health help-seeking easier. Similarly, rural life experience in a help provider was thought to facilitate help-seeking. Participants also believed that flexible and informal meeting settings would make it easier to seek help for mental distress. CONCLUSIONS Engaging rural mental health peer support workers in a flexible/informal setting, as a complement to conventional health service provision, may increase rural help-seeking for mental distress. Increased mental health help-seeking is likely to have a positive impact on instances of serious mental illness.
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Affiliation(s)
- Natalie Cheesmond
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,School of Humanities and Social Science, University of Newcastle, Callaghan, NSW, Australia
| | - Kate Davies
- School of Humanities and Social Science, University of Newcastle, Callaghan, NSW, Australia
| | - Kerry J Inder
- Hunter Medical Research Institute, Newcastle, NSW, Australia.,School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, Australia
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11
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Fitzpatrick SJ, Brew BK, Read DMY, Inder KJ, Hayes A, Perkins D. Rethinking Suicide in Rural Australia: A study Protocol for Examining and Applying Knowledge of the Social Determinants to Improve Prevention in Non-Indigenous Populations. Int J Environ Res Public Health 2019; 16:ijerph16162944. [PMID: 31426302 PMCID: PMC6719075 DOI: 10.3390/ijerph16162944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/13/2019] [Accepted: 08/13/2019] [Indexed: 01/26/2023]
Abstract
Disproportionate rates of suicide in rural Australia in comparison to metropolitan areas pose a significant public health challenge. The dynamic interrelationship between mental and physical health, social determinants, and suicide in rural Australia is widely acknowledged. Advancement of this knowledge, however, remains hampered by a lack of adequate theory and methods to understand how these factors interact, and the translation of this knowledge into constructive strategies and solutions. This paper presents a protocol for generating a comprehensive dataset of suicide deaths and factors related to suicide in rural Australia, and for building a program of research to improve suicide prevention policy and practice to better address the social determinants of suicide in non-indigenous populations. The two-phased study will use a mixed-methods design informed by intersectionality theory. Phase One will extract, code, and analyse quantitative and qualitative data on suicide in regional and remote Australia from the National Coronial Information System (NCIS). Phase Two will analyse suicide prevention at three interrelated domains: policy, practice, and research, to examine alignment with evidence generated in Phase One. Findings from Phase One and Two will then be integrated to identify key points in suicide prevention policy and practice where action can be initiated.
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Affiliation(s)
- Scott J Fitzpatrick
- Centre for Rural and Remote Mental Health, The University of Newcastle, PO Box 8043, Orange East, NSW 2800, Australia.
| | - Bronwyn K Brew
- Centre for Big Data Research in Health and National Perinatal Epidemiology and Statistics Unit, School of Women and Children's Health, University of New South Wales, Level 4, Lowy Cancer Research Centre, Cnr High & Botany St, Kensington, NSW 2052, Australia
| | - Donna M Y Read
- Centre for Rural and Remote Mental Health, The University of Newcastle, PO Box 8043, Orange East, NSW 2800, Australia
| | - Kerry J Inder
- School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Alan Hayes
- Family Action Centre, University of Newcastle, Callaghan, NSW 2308, Australia
| | - David Perkins
- Centre for Rural and Remote Mental Health, The University of Newcastle, PO Box 8043, Orange East, NSW 2800, Australia
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12
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Gaviola MA, Inder KJ, Dilworth S, Holliday EG, Higgins I. Impact of individualised music listening intervention on persons with dementia: A systematic review of randomised controlled trials. Australas J Ageing 2019; 39:10-20. [PMID: 30912616 DOI: 10.1111/ajag.12642] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/11/2019] [Accepted: 02/18/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To summarise the evidence regarding the impact of individualised music listening on persons with dementia. METHODS Six electronic databases (CINAHL, Medline, ProQuest, PsycINFO, Music Periodicals and Cochrane) were searched up to July 2018 for randomised controlled trials (RCTs) evaluating the efficacy of individualised music listening compared to other music and non-music-based interventions. RESULTS Four studies were included. Results showed evidence of a positive impact of individualised music listening on behavioural and psychological symptoms of dementia (BPSDs) including agitation, anxiety and depression and physiological outcomes. Evidence for other outcomes such as cognitive function and quality of life was limited. CONCLUSIONS The limited evidence suggests individualised music listening has comparable efficacy to more resource-intensive interventions. However, there was a small number of RCTs and some outcomes were evaluated by a single study. This limits the conclusions drawn, warranting more RCTs evaluating other outcomes beyond the BPSDs.
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Affiliation(s)
- Minah Amor Gaviola
- School of Nursing & Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
| | - Kerry J Inder
- School of Nursing & Midwifery, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Sophie Dilworth
- Hunter Aged Care Assessment Team, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Elizabeth G Holliday
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Isabel Higgins
- School of Nursing & Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
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13
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Cheesmond NE, Davies K, Inder KJ. Exploring the role of rurality and rural identity in mental health help-seeking behavior: A systematic qualitative review. ACTA ACUST UNITED AC 2019. [DOI: 10.1037/rmh0000109] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Guilhermino MC, Inder KJ, Sundin D. Education on invasive mechanical ventilation involving intensive care nurses: a systematic review. Nurs Crit Care 2018; 23:245-255. [PMID: 29582522 DOI: 10.1111/nicc.12346] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/24/2018] [Accepted: 01/30/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Intensive care unit nurses are critical for managing mechanical ventilation. Continuing education is essential in building and maintaining nurses' knowledge and skills, potentially improving patient outcomes. AIMS The aim of this study was to determine whether continuing education programmes on invasive mechanical ventilation involving intensive care unit nurses are effective in improving patient outcomes. METHODS Five electronic databases were searched from 2001 to 2016 using keywords such as mechanical ventilation, nursing and education. Inclusion criteria were invasive mechanical ventilation continuing education programmes that involved nurses and measured patient outcomes. Primary outcomes were intensive care unit mortality and in-hospital mortality. Secondary outcomes included hospital and intensive care unit length of stay, length of intubation, failed weaning trials, re-intubation incidence, ventilation-associated pneumonia rate and lung-protective ventilator strategies. Studies were excluded if they excluded nurses, patients were ventilated for less than 24 h, the education content focused on protocol implementation or oral care exclusively or the outcomes were participant satisfaction. Quality was assessed by two reviewers using an education intervention critical appraisal worksheet and a risk of bias assessment tool. Data were extracted independently by two reviewers and analysed narratively due to heterogeneity. RESULTS Twelve studies met the inclusion criteria for full review: 11 pre- and post-intervention observational and 1 quasi-experimental design. Studies reported statistically significant reductions in hospital length of stay, length of intubation, ventilator-associated pneumonia rates, failed weaning trials and improvements in lung-protective ventilation compliance. Non-statistically significant results were reported for in-hospital and intensive care unit mortality, re-intubation and intensive care unit length of stay. CONCLUSION Limited evidence of the effectiveness of continuing education programmes on mechanical ventilation involving nurses in improving patient outcomes exists. Comprehensive continuing education is required. RELEVANCE TO CLINICAL PRACTICE Well-designed trials are required to confirm that comprehensive continuing education involving intensive care nurses about mechanical ventilation improves patient outcomes.
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Affiliation(s)
- Michelle C Guilhermino
- School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, NSW, Australia.,Intensive Care Unit, John Hunter Hospital, Newcastle, NSW, Australia
| | - Kerry J Inder
- School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, NSW, Australia
| | - Deborah Sundin
- School of Nursing and Midwifery, Edith Cowan University, Perth, WA, Australia
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15
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Gunathilake R, Oldmeadow C, McEvoy M, Inder KJ, Schofield PW, Nair BR, Attia J. The Association Between Obesity and Cognitive Function in Older Persons: How Much Is Mediated by Inflammation, Fasting Plasma Glucose, and Hypertriglyceridemia? J Gerontol A Biol Sci Med Sci 2016; 71:1603-1608. [DOI: 10.1093/gerona/glw070] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 03/30/2016] [Indexed: 11/13/2022] Open
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Handley TE, Kelly BJ, Lewin TJ, Coleman C, Stain HJ, Weaver N, Inder KJ. Long-term effects of lifetime trauma exposure in a rural community sample. BMC Public Health 2015; 15:1176. [PMID: 26607329 PMCID: PMC4660633 DOI: 10.1186/s12889-015-2490-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 11/13/2015] [Indexed: 11/22/2022] Open
Abstract
Background This study examines the long-term outcomes of lifetime trauma exposure, including factors that contribute to the development of PTSD, in a sample of rural adults. Methods In 623 rural community residents, lifetime trauma exposure, PTSD, other psychiatric disorders and lifetime suicidal ideation were assessed using the World Mental Health Composite International Diagnostic Interview. Logistic regressions were used to examine relationships between potentially traumatic events (PTEs) and lifetime PTSD and other diagnoses. Results 78.2 % of participants reported at least on PTE. Rates were broadly comparable with Australian national data: the most commonly endorsed events were unexpected death of a loved one (43.7 %); witnessing injury or death (26.3 %); and life-threatening accident (19.3 %). While the mean age of the sample was 55 years, the mean age of first trauma exposure was 19 years. The estimated lifetime rate of PTSD was 16.0 %. Events with the strongest association with PTSD were physical assault and unexpected death of a loved one. Current functioning was lowest among those with current PTSD, with this group reporting elevated psychological distress, higher mental health service use, a greater number of comorbidities, and lower perceived social support. Respondents with a past PTE but no PTSD history were generally similar in terms of their current wellbeing to those with no lifetime PTE. Conclusions PTEs may have diverse psychological and social consequences beyond the development of PTSD. Ensuring that adequate support services are available in rural areas, particularly in the period immediately following a PTE, may reduce the long-term impact of traumatic events.
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Affiliation(s)
- Tonelle E Handley
- Centre for Rural and Remote Mental Health, University of Newcastle, Level 5 McAuley Building, Callaghan, 2308, NSW, Australia. .,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
| | - Brian J Kelly
- Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, NSW, Australia.
| | - Terry J Lewin
- Hunter New England Mental Health Services, Newcastle, NSW, Australia.
| | - Clare Coleman
- Sydney Centre for ATSI Statistics, University of Sydney, Sydney, NSW, Australia.
| | - Helen J Stain
- School of Medicine, Pharmacy and Health, Durham University, Durham, UK.
| | - Natasha Weaver
- Research Services, University of Newcastle, Newcastle, NSW, Australia.
| | - Kerry J Inder
- Centre for Rural and Remote Mental Health, University of Newcastle, Level 5 McAuley Building, Callaghan, 2308, NSW, Australia. .,School of Nursing and Midwifery, University of Newcastle, Newcastle, NSW, Australia.
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17
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Carey M, Yoong SL, Grady A, Bryant J, Jayakody A, Sanson-Fisher R, Inder KJ. Unassisted detection of depression by GPs: who is most likely to be misclassified? Fam Pract 2015; 32:282-7. [PMID: 25722482 DOI: 10.1093/fampra/cmu087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Meta-analyses indicate 50% of cases of depression are not detected by GPs. It is important to examine patient and GP characteristics associated with misclassification so that systems can be improved to increase accurate detection and optimal management for groups at risk of depression. OBJECTIVE To examine patient and GP characteristics associated with GP misclassification of depression for patients classified by the Patient Health Questionnaire-9 as depressed. METHODS A cross-sectional study within general practices in two states of Australia. GPs completed a one-page paper and pencil survey indicating whether they thought each patient was clinically depressed. Patients completed a computer tablet survey while waiting for their appointment to provide demographic information and indicate depression status. Chi-square analyses were used to determine whether patient and GP characteristics were associated with a false-negative and false-positive result. The probability of misclassification was modelled using Generalized Estimating Equations to account for clustering of patients. RESULTS Fifty GPs from 12 practices participated. GPs completed surveys for 1880 patients. Younger patients aged 25-44, and those with a health care card were less likely to have a false-negative assessment. Patients with 0-3 GP visits in the past 12 months, and those with private health insurance were less likely to have a false-positive assessment. GPs who worked five sessions or fewer per week were more likely to make false-positive assessments.
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Affiliation(s)
- Mariko Carey
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, Hunter Medical Research Institute, New Lambton Heights,
| | | | - Alice Grady
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, Hunter Medical Research Institute, New Lambton Heights
| | - Jamie Bryant
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, Hunter Medical Research Institute, New Lambton Heights
| | - Amanda Jayakody
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, Hunter Medical Research Institute, New Lambton Heights
| | - Rob Sanson-Fisher
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, Hunter Medical Research Institute, New Lambton Heights
| | - Kerry J Inder
- Hunter Medical Research Institute, New Lambton Heights, NHMRC Centre for Research Excellence in Mental Health and Substance Use, Centre for Translational Neuroscience and Mental Health, University of Newcastle, Callaghan, Australia
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Handley TE, Hiles SA, Inder KJ, Kay-Lambkin FJ, Kelly BJ, Lewin TJ, McEvoy M, Peel R, Attia JR. Predictors of suicidal ideation in older people: a decision tree analysis. Am J Geriatr Psychiatry 2014; 22:1325-35. [PMID: 24012228 DOI: 10.1016/j.jagp.2013.05.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 05/24/2013] [Accepted: 05/28/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Suicide among older adults is a major public health issue worldwide. Although studies have identified psychological, physical, and social contributors to suicidal thoughts in older adults, few have explored the specific interactions between these factors. This article used a novel statistical approach to explore predictors of suicidal ideation in a community-based sample of older adults. DESIGN Prospective cohort study. PARTICIPANTS AND SETTING Participants aged 55-85 years were randomly selected from the Hunter Region, a large regional center in New South Wales, Australia. MEASUREMENTS Baseline psychological, physical, and social factors, including psychological distress, physical functioning, and social support, were used to predict suicidal ideation at the 5-year follow-up. Classification and regression tree modeling was used to determine specific risk profiles for participants depending on their individual well-being in each of these key areas. RESULTS Psychological distress was the strongest predictor, with 25% of people with high distress reporting suicidal ideation. Within high psychological distress, lower physical functioning significantly increased the likelihood of suicidal ideation, with high distress and low functioning being associated with ideation in 50% of cases. A substantial subgroup reported suicidal ideation in the absence of psychological distress; dissatisfaction with social support was the most important predictor among this group. The performance of the model was high (area under the curve: 0.81). CONCLUSIONS Decision tree modeling enabled individualized "risk" profiles for suicidal ideation to be determined. Although psychological factors are important for predicting suicidal ideation, both physical and social factors significantly improved the predictive ability of the model. Assessing these factors may enhance identification of older people at risk of suicidal ideation.
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Affiliation(s)
- Tonelle E Handley
- Centre for Translational Neuroscience and Mental Health, University of Newcastle, Callaghan, Australia.
| | - Sarah A Hiles
- Centre for Translational Neuroscience and Mental Health, University of Newcastle, Callaghan, Australia
| | - Kerry J Inder
- Centre for Translational Neuroscience and Mental Health, University of Newcastle, Callaghan, Australia; Hunter Medical Research Institute, Hunter Region Mail Centre, Newcastle, Australia
| | - Frances J Kay-Lambkin
- Centre for Translational Neuroscience and Mental Health, University of Newcastle, Callaghan, Australia; National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Brian J Kelly
- Centre for Translational Neuroscience and Mental Health, University of Newcastle, Callaghan, Australia; Hunter Medical Research Institute, Hunter Region Mail Centre, Newcastle, Australia
| | - Terry J Lewin
- Centre for Translational Neuroscience and Mental Health, University of Newcastle, Callaghan, Australia; Hunter Medical Research Institute, Hunter Region Mail Centre, Newcastle, Australia
| | - Mark McEvoy
- Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, Australia
| | - Roseanne Peel
- Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, Australia
| | - John R Attia
- Hunter Medical Research Institute, Hunter Region Mail Centre, Newcastle, Australia; Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, Australia
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Handley TE, Kay-Lambkin FJ, Inder KJ, Lewin TJ, Attia JR, Fuller J, Perkins D, Coleman C, Weaver N, Kelly BJ. Self-reported contacts for mental health problems by rural residents: predicted service needs, facilitators and barriers. BMC Psychiatry 2014; 14:249. [PMID: 25193400 PMCID: PMC4172961 DOI: 10.1186/s12888-014-0249-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 08/22/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rural and remote Australians face a range of barriers to mental health care, potentially limiting the extent to which current services and support networks may provide assistance. This paper examines self-reported mental health problems and contacts during the last 12 months, and explores cross-sectional associations between potential facilitators/barriers and professional and non-professional help-seeking, while taking into account expected associations with socio-demographic and health-related factors. METHODS During the 3-year follow-up of the Australian Rural Mental Health Study (ARMHS) a self-report survey was completed by adult rural residents (N = 1,231; 61% female; 77% married; 22% remote location; mean age = 59 years), which examined socio-demographic characteristics, current health status factors, predicted service needs, self-reported professional and non-professional contacts for mental health problems in the last 12 months, other aspects of help-seeking, and perceived barriers. RESULTS Professional contacts for mental health problems were reported by 18% of the sample (including 14% reporting General Practitioner contacts), while non-professional contacts were reported by 16% (including 14% reporting discussions with family/friends). Perceived barriers to health care fell under the domains of structural (e.g., costs, distance), attitudinal (e.g., stigma concerns, confidentiality), and time commitments. Participants with 12-month mental health problems who reported their needs as met had the highest levels of service use. Hierarchical logistic regressions revealed a dose-response relationship between the level of predicted need and the likelihood of reporting professional and non-professional contacts, together with associations with socio-demographic characteristics (e.g., gender, relationships, and financial circumstances), suicidal ideation, and attitudinal factors, but not geographical remoteness. CONCLUSIONS Rates of self-reported mental health problems were consistent with baseline findings, including higher rural contact rates with General Practitioners. Structural barriers displayed mixed associations with help-seeking, while attitudinal barriers were consistently associated with lower service contacts. Developing appropriate interventions that address perceptions of mental illness and attitudes towards help-seeking is likely to be vital in optimising treatment access and mental health outcomes in rural areas.
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Affiliation(s)
- Tonelle E Handley
- Centre for Translational Neuroscience and Mental Health, University of Newcastle and Hunter New England Health, Callaghan, NSW Australia ,Centre for Rural and Remote Mental Health, University of Newcastle, Orange, NSW Australia ,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW Australia
| | - Frances J Kay-Lambkin
- Centre for Translational Neuroscience and Mental Health, University of Newcastle and Hunter New England Health, Callaghan, NSW Australia ,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW Australia
| | - Kerry J Inder
- Centre for Translational Neuroscience and Mental Health, University of Newcastle and Hunter New England Health, Callaghan, NSW Australia ,Hunter Medical Research Institute, Locked Bag 1, Hunter Region Mail Centre, Newcastle, NSW Australia
| | - Terry J Lewin
- Centre for Translational Neuroscience and Mental Health, University of Newcastle and Hunter New England Health, Callaghan, NSW Australia
| | - John R Attia
- Hunter Medical Research Institute, Locked Bag 1, Hunter Region Mail Centre, Newcastle, NSW Australia ,Centre for Clinical Epidemiology and Biostatistics, University of Newcastle and Hunter New England Health, Newcastle, NSW Australia
| | - Jeffrey Fuller
- School of Nursing and Midwifery, Flinders University, Adelaide, SA Australia
| | - David Perkins
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, NSW Australia
| | - Clare Coleman
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, NSW Australia
| | - Natasha Weaver
- Hunter Medical Research Institute, Locked Bag 1, Hunter Region Mail Centre, Newcastle, NSW Australia ,Centre for Clinical Epidemiology and Biostatistics, University of Newcastle and Hunter New England Health, Newcastle, NSW Australia
| | - Brian J Kelly
- Centre for Translational Neuroscience and Mental Health, University of Newcastle and Hunter New England Health, Callaghan, NSW Australia
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Carey M, Jones KA, Yoong SL, D'Este C, Boyes AW, Paul C, Inder KJ, Sanson-Fisher R. Comparison of a single self-assessment item with the PHQ-9 for detecting depression in general practice. Fam Pract 2014; 31:483-489. [PMID: 24839267 DOI: 10.1093/fampra/cmu018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Several factors need to be considered when selecting a screening tool for depression including accuracy, level of burden for patients and for staff to administer and follow-up. OBJECTIVE This study aimed to explore the utility of a single self-assessment item in identifying possible cases of depression in primary care by examining sensitivity and specificity with the nine-item Patient Health Questionnaire (PHQ-9) at different thresholds. DESIGN Cross-sectional survey presented on a touchscreen computer. PARTICIPANTS Adult patients attending 12 urban general practices in Australia completed a health status questionnaire (n = 1004). MAIN MEASURES Depression was assessed by the PHQ-9 and a single self-assessment item. Sensitivity, specificity, and positive and negative predictive values were calculated for the single item using a PHQ-9 score of 10 or more as the criterion value. KEY RESULTS A total of 1004 participants (61% female, 48% aged 55 years or older) completed both the PHQ-9 and a single self-assessment item. When using a threshold of mild depression or greater, the single item had adequate specificity (76%, 95% CI: 71-80%), with 76 out of every 100 people defined as non-depressed by the PHQ-9 also identified as not depressed by the single item. Sensitivity was high (91%, 95% CI: 84-95%), with the single item identifying 91 out of every 100 true cases (as defined by the PHQ-9). CONCLUSIONS The single self-assessment item has high sensitivity and moderate specificity to identify possible cases of depression when used at a threshold of mild depression or greater.
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Affiliation(s)
- Mariko Carey
- Priority Research Centre for Health Behaviour (PRCHB), University of Newcastle, Callaghan, New South Wales, Australia, Hunter Medical Research Institute, New Lambton, New South Wales, Australia,
| | - Kimberley A Jones
- Priority Research Centre for Health Behaviour (PRCHB), University of Newcastle, Callaghan, New South Wales, Australia, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Sze Lin Yoong
- Priority Research Centre for Health Behaviour (PRCHB), University of Newcastle, Callaghan, New South Wales, Australia, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Catherine D'Este
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia and
| | - Allison W Boyes
- Priority Research Centre for Health Behaviour (PRCHB), University of Newcastle, Callaghan, New South Wales, Australia, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Christine Paul
- Priority Research Centre for Health Behaviour (PRCHB), University of Newcastle, Callaghan, New South Wales, Australia, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Kerry J Inder
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia, NHMRC Centre for Research Excellence in Mental Health and Substance Use, Centre for Translational Neuroscience and Mental Health, University of Newcastle, New South Wales, Australia
| | - Rob Sanson-Fisher
- Priority Research Centre for Health Behaviour (PRCHB), University of Newcastle, Callaghan, New South Wales, Australia, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
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Inder KJ, Handley TE, Johnston A, Weaver N, Coleman C, Lewin TJ, Slade T, Kelly BJ. Determinants of suicidal ideation and suicide attempts: parallel cross-sectional analyses examining geographical location. BMC Psychiatry 2014; 14:208. [PMID: 25053114 PMCID: PMC4227072 DOI: 10.1186/1471-244x-14-208] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 07/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suicide death rates in Australia are higher in rural than urban communities however the contributors to this difference remain unclear. Geographical differences in suicidal ideation and attempts were explored using two datasets encompassing urban and rural community residents to examine associations between socioeconomic, demographic and mental health factors. Differing patterns of association between psychiatric disorder and suicidal ideation and attempts as geographical remoteness increased were investigated. METHODS Parallel cross-sectional analyses were undertaken using data from the 2007 National Survey of Mental Health and Wellbeing (2007-NSMHWB, n = 8,463), under-representative of remote and very remote residents, and selected participants from the Australian Rural Mental Health Study (ARMHS, n = 634), over-representative of remote and very remote residents. Uniform measures of suicidal ideation and attempts and mental disorder using the World Mental Health Composite International Diagnostic Interview (WMH-CIDI-3.0) were used in both datasets. Geographic region was classified into major cities, inner regional and other. A series of logistic regressions were undertaken for the outcomes of 12-month and lifetime suicidal ideation and lifetime suicide attempts, adjusting for age, gender and psychological distress. A sub-analysis of the ARMHS sample was undertaken with additional variables not available in the 2007-NSMHWB dataset. RESULTS Rates and determinants of suicidal ideation and suicide attempts across geographical region were similar. Psychiatric disorder was the main determinant of 12-month and lifetime suicidal ideation and lifetime suicide attempts across all geographical regions. For lifetime suicidal ideation and attempts, marital status, employment status, perceived financial adversity and mental health service use were also important determinants. In the ARMHS sub-analysis, higher optimism and better perceived infrastructure and service accessibility tended to be associated with a lower likelihood of lifetime suicidal ideation, when age, gender, psychological distress, marital status and mental health service use were taken into account. CONCLUSIONS Rates and determinants of suicidal ideation and attempts did not differ according to geographical location. Psychiatric disorder, current distress, employment and financial adversity remain important factors associated with suicidal ideation and attempts across all regions in Australia. Regional characteristics that influence availability of services and lower personal optimism may also be associated with suicidal ideation in rural communities.
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Affiliation(s)
- Kerry J Inder
- Centre for Translational Neuroscience and Mental Health, University of Newcastle, Callaghan, Newcastle, New South Wales (NSW), Australia.
| | - Tonelle E Handley
- Centre for Rural and Remote Mental Health, University of Newcastle, Newcastle, NSW Australia
| | - Amy Johnston
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW Australia
| | - Natasha Weaver
- Hunter Medical Research Institute, Newcastle, NSW Australia ,School of Medicine and Public Health, University of Newcastle, Callaghan, Newcastle, NSW Australia
| | - Clare Coleman
- Sydney Centre for Aboriginal and Torres Strait Islander Statistics, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Terry J Lewin
- Centre for Translational Neuroscience and Mental Health, University of Newcastle, Callaghan, Newcastle, New South Wales (NSW) Australia ,Hunter New England Mental Health Service, Newcastle, NSW Australia
| | - Tim Slade
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW Australia
| | - Brian J Kelly
- Centre for Translational Neuroscience and Mental Health, University of Newcastle, Callaghan, Newcastle, New South Wales (NSW) Australia
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Hamall KM, Heard TR, Inder KJ, McGill KM, Kay-Lambkin F. The Child Illness and Resilience Program (CHiRP): a study protocol of a stepped care intervention to improve the resilience and wellbeing of families living with childhood chronic illness. BMC Psychol 2014; 2:5. [PMID: 25945251 PMCID: PMC4416421 DOI: 10.1186/2050-7283-2-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 02/26/2014] [Indexed: 11/27/2022] Open
Abstract
Background Families of children living with chronic illness are more vulnerable to mental health problems, however this can be ameliorated by a family’s resilience. The Child Illness and Resilience Program (CHiRP) will develop and evaluate a parent-focussed family intervention designed to increase the resilience and wellbeing of families living with childhood chronic illness. Methods/Design The study will be conducted in an Australian regional paediatric hospital and will use a stepped care intervention that increases in intensity according to parental distress. All parents of children discharged from the hospital will receive a family resilience and wellbeing factsheet (Step 1). Parents of children attending selected outpatient clinics will receive a family resilience and wellbeing activity booklet (Step 2). Parents who receive the booklet and report psychological distress at three-month follow-up will be randomised to participate in a family resilience information support group or waitlist control (Step 3). The Step 3 control group will provide data to compare the relative effectiveness of the booklet intervention alone versus the booklet combined with the group intervention for distressed parents. These participants will then receive the information support group intervention. All parents in Step 2 and 3 will complete baseline, post-intervention and six month follow up assessments. The primary outcomes of the study will be changes in scores between baseline and follow-up assessments on measures of constructs of family resilience, including parental wellbeing, family functioning, family beliefs and perceived social support. Qualitative feedback regarding the utility and acceptability of the different intervention components will also be collected. Discussion It is hypothesised that participation in the CHiRP intervention will be associated with positive changes in the key outcome measures. If effective, CHiRP will provide an opportunity for the health sector to deliver a standardised stepped care mental health promotion intervention to families living with childhood chronic illness. Trial registration Australian clinical Trials Registry ACTRN 12613000844741 Universal Trial Number (UTN): 1111-1142-8829
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Affiliation(s)
- Katrina M Hamall
- Hunter Institute of Mental Health, Hunter New England Local Health District, Newcastle, Australia ; School of Medicine and Public Health, University of Newcastle, PO Box 833, Newcastle, NSW 2300 Australia
| | - Todd R Heard
- School of Medicine and Public Health, University of Newcastle, PO Box 833, Newcastle, NSW 2300 Australia ; Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia
| | - Kerry J Inder
- NHMRC Centre for Research Excellence in Mental Health and Substance Use, Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, Australia
| | - Katherine M McGill
- Hunter Institute of Mental Health, Hunter New England Local Health District, Newcastle, Australia
| | - Frances Kay-Lambkin
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia ; Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, Australia
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Guilhermino MC, Inder KJ, Sundin D, Kuzmiuk L. Education of ICU nurses regarding invasive mechanical ventilation: findings from a cross-sectional survey. Aust Crit Care 2013; 27:126-32. [PMID: 24296161 DOI: 10.1016/j.aucc.2013.10.064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 10/21/2013] [Accepted: 10/31/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Continuing education for intensive care unit nurses on invasive mechanical ventilation is fundamental to the acquisition and maintenance of knowledge and skills to optimise patient outcomes. PURPOSE We aimed to determine how intensive care unit nurses perceived current education provided on mechanical ventilation, including a self-directed learning package and a competency programme; identify other important topics and forms of education; and determine factors associated with the completion of educational programmes on invasive mechanical ventilation. METHODS A cross-sectional, 30-item, self-administered and semi-structured survey on invasive mechanical ventilation education was distributed to 160 intensive care nurses. Analysis included descriptive statistics and logistic regression was used to determine factors associated with current education completion, reported as adjusted odds ratios (AOR) and 95% confidence intervals (CIs). FINDINGS Eighty three intensive care unit nurses responded and the majority (63%) reported not receiving education about mechanical ventilation prior to working in intensive care. Using a Likert rating scale the self-directed learning package and competency programme were perceived as valuable and beneficial. Hands-on-practice was perceived as the most important form of education and ventilator settings as the most important topic. Multivariate analysis determined that older age was independently associated with not completing the self-directed learning package (AOR 0.20, 95% CI 0.04, 0.93). For the competency programme, 4-6 years intensive care experience was independently associated with completion (AOR 17, 95% CI 1.7, 165) and part-time employment was associated with non-completion (AOR 0.23, 95% CI 0.08, 0.68). CONCLUSION Registered nurses are commencing their ICU experience with limited knowledge of invasive MV therefore the education provided within the ICU workplace becomes fundamental to safe and effective practice. The perception of continuing education by ICU nurses from this research is positive regardless of level of ICU experience and may influence the type of continuing education on invasive MV provided to ICU nurses in the future, not only in the ICU involved in this study, but other units throughout Australia.
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Affiliation(s)
| | - Kerry J Inder
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.
| | - Deborah Sundin
- School of Nursing, Midwifery and Post Graduate Medicine, Edith Cowan University, Perth, WA, Australia.
| | - Leila Kuzmiuk
- Intensive Care Services, John Hunter Hospital, Hunter New England Local Health District, Newcastle, NSW, Australia.
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Robertson J, McElduff P, Pearson SA, Henry DA, Inder KJ, Attia JR. Erratum To: The health services burden of heart failure: an analysis using linked population health data-sets. BMC Health Serv Res 2013. [PMCID: PMC3669610 DOI: 10.1186/1472-6963-13-179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Handley TE, Attia JR, Inder KJ, Kay-Lambkin FJ, Barker D, Lewin TJ, Kelly BJ. Longitudinal course and predictors of suicidal ideation in a rural community sample. Aust N Z J Psychiatry 2013; 47:1032-40. [PMID: 23798718 DOI: 10.1177/0004867413495318] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Suicide rates in rural Australia are higher than in urban areas. No existing research has explored the long-term patterns and predictors of change in suicidal ideation within rural areas. This report uses longitudinal data and multiple time points to determine predictors of the trajectory of suicidal ideation in rural Australia. METHOD Participants in the Australian Rural Mental Health Study (ARMHS) completed self-report surveys at baseline, 12 and 36 months, reporting their psychological and social well-being, and suicidal ideation. Generalised linear mixed models explored these factors as correlates and predictors of suicidal ideation across 3 years using multiple data points. RESULTS A total of 2135 participants completed at least one wave of ARMHS, and hence were included in the current analysis. Overall, 8.1% reported suicidal ideation during at least one study wave, 76% of whom reported suicidal ideation intermittently rather than consistently across waves. Across the three time points, suicidal ideation was significantly associated with higher psychological distress (OR 1.30, 95% CI 1.23 to 1.37), neuroticism (OR 1.15, 95% CI 1.04 to 1.27), and availability of support (OR 0.80, 95% CI 0.69 to 0.92), with a non-significant association with unemployment (OR 1.73, 95% CI 0.93 to 3.24) even after controlling for the effects of perceived financial hardship. Future suicidal ideation was significantly predicted by distress (OR 1.16, 95% CI 1.09 to 1.23) and neuroticism (OR 1.17, 95% CI 1.03 to 1.32), with a non-significant association with unemployment (OR 2.11, 95% CI 0.41 to 2.27). Predictive effects for marital status, social networks, sense of community and availability of support did not remain significant in the full multivariate analysis. CONCLUSIONS Fluctuations in suicidal ideation are common, and may be associated with changes in psychological and social well-being. Public health strategies, focusing on encouraging help-seeking among those with higher psychological distress, lower social support, and unstable or absent employment opportunities, may be a useful long-term initiative to reduce the prevalence of suicidal ideation in the general rural community.
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Affiliation(s)
- Tonelle E Handley
- 1Centre for Translational Neuroscience and Mental Health, University of Newcastle, Callaghan, Australia
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26
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Allen J, Inder KJ, Lewin TJ, Attia JR, Kay-Lambkin FJ, Baker AL, Hazell T, Kelly BJ. Integrating and extending cohort studies: lessons from the eXtending Treatments, Education and Networks in Depression (xTEND) study. BMC Med Res Methodol 2013; 13:122. [PMID: 24093910 PMCID: PMC3856520 DOI: 10.1186/1471-2288-13-122] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 09/25/2013] [Indexed: 01/15/2023] Open
Abstract
Background Epidemiologic studies often struggle to adequately represent populations and outcomes of interest. Differences in methodology, data analysis and research questions often mean that reviews and synthesis of the existing literature have significant limitations. The current paper details our experiences in combining individual participant data from two existing cohort studies to address questions about the influence of social factors on health outcomes within a representative sample of urban to remote areas of Australia. The eXtending Treatments, Education and Networks in Depression study involved pooling individual participant data from the Australian Rural Mental Health Study (T0 N = 2639) and the Hunter Community Study (T0 N = 3253) as well as conducting a common three-year follow-up phase (T1 N = 3513). Pooling these data extended the capacity of these studies by: enabling research questions of common interest to be addressed; facilitating the harmonization of baseline measures; permitting investigation of a range of psychosocial, physical and contextual factors over time; and contributing to the development and implementation of targeted interventions for persons experiencing depression and alcohol issues. Discussion The current paper describes the rationale, challenges encountered, and solutions devised by a project aiming to maximise the benefits derived from existing cohort studies. We also highlight opportunities for such individual participant data analyses to assess common assumptions in research synthesis, such as measurement invariance, and opportunities for extending ongoing cohorts by conducting a common follow-up phase. Summary Pooling individual participant data can be a worthwhile venture, particularly where adequate representation is beyond the scope of existing research, where the effects of interest are small though important, where events are of relatively low frequency or rarely observed, and where issues are of immediate regional or national interest. Benefits such as these can enhance the utility of existing projects and strengthen requests for further research funding.
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Affiliation(s)
- Joanne Allen
- Centre for Translational Neuroscience and Mental Health, University of Newcastle and Hunter New England Health, Newcastle, NSW, Australia.
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Handley TE, Kay-Lambkin FJ, Baker AL, Lewin TJ, Kelly BJ, Inder KJ, Attia JR, Kavanagh DJ. Incidental treatment effects of CBT on suicidal ideation and hopelessness. J Affect Disord 2013; 151:275-83. [PMID: 23820094 DOI: 10.1016/j.jad.2013.06.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 06/01/2013] [Accepted: 06/01/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Depression and alcohol misuse are among the most prevalent diagnoses in suicide fatalities. The risk posed by these disorders is exacerbated when they co-occur. Limited research has evaluated the effectiveness of common depression and alcohol treatments for the reduction of suicide vulnerability in individuals experiencing comorbidity. METHODS Participants with depressive symptoms and hazardous alcohol use were selected from two randomised controlled trials. They had received either a brief (1 session) intervention, or depression-focused cognitive behaviour therapy (CBT), alcohol-focused CBT, therapist-delivered integrated CBT, computer-delivered integrated CBT or person-centred therapy (PCT) over a 10-week period. Suicidal ideation, hopelessness, depression severity and alcohol consumption were assessed at baseline and 12-month follow-up. RESULTS Three hundred three participants were assessed at baseline and 12 months. Both suicidal ideation and hopelessness were associated with higher severity of depressive symptoms, but not with alcohol consumption. Suicidal ideation did not improve significantly at follow-up, with no differences between treatment conditions. Improvements in hopelessness differed between treatment conditions; hopelessness improved more in the CBT conditions compared to PCT and in single-focused CBT compared to integrated CBT. LIMITATIONS Low retention rates may have impacted on the reliability of our findings. Combining data from two studies may have resulted in heterogeneity of samples between conditions. CONCLUSIONS CBT appears to be associated with reductions in hopelessness in people with co-occurring depression and alcohol misuse, even when it is not the focus of treatment. Less consistent results were observed for suicidal ideation. Establishing specific procedures or therapeutic content for clinicians to monitor these outcomes may result in better management of individuals with higher vulnerability for suicide.
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Affiliation(s)
- Tonelle E Handley
- Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, NSW 2308, Australia.
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Perkins D, Fuller J, Kelly BJ, Lewin TJ, Fitzgerald M, Coleman C, Inder KJ, Allan J, Arya D, Roberts R, Buss R. Factors associated with reported service use for mental health problems by residents of rural and remote communities: cross-sectional findings from a baseline survey. BMC Health Serv Res 2013; 13:157. [PMID: 23631501 PMCID: PMC3655863 DOI: 10.1186/1472-6963-13-157] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 04/24/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The patterns of health service use by rural and remote residents are poorly understood and under-represented in national surveys. This paper examines professional and non-professional service use for mental health problems in rural and remote communities in Australia. METHODS A stratified random sample of adults was drawn from non-metropolitan regions of New South Wales, Australia as part of a longitudinal population-based cohort. One-quarter (27.7%) of the respondents were from remote or very remote regions. The socio-demographic, health status and service utilization (professional and non-professional) characteristics of 2150 community dwelling residents are described. Hierarchical logistic regressions were used to identify cross-sectional associations between socio-demographic, health status and professional and non-professional health service utilization variables. RESULTS The overall rate of professional contacts for mental health problems during the previous 12 months (17%) in this rural population exceeded the national rate (11.9%). Rates for psychologists and psychiatrists were similar but rates for GPs were higher (12% vs. 8.1%). Non-professional contact rates were 12%. Higher levels of help seeking were associated with the absence of a partner, poorer finances, severity of mental health problems, and higher levels of adversity. Remoteness was associated with lower utilization of non-professional support. A Provisional Service Need Index was devised, and it demonstrated a broad dose-response relationship between severity of mental health problems and the likelihood of seeking any professional or non-professional help. Nevertheless, 47% of those with estimated high service need had no contact with professional services. CONCLUSIONS An examination of self-reported patterns of professional and non-professional service use for mental health problems in a rural community cohort revealed relatively higher rates of general practitioner attendance for such problems compared with data from metropolitan centres. Using a measure of Provisional Service Need those with greater needs were more likely to access specialist services, even in remote regions, although a substantial proportion of those with the highest service need sought no professional help. Geographic and financial barriers to service use were identified and perception of service adequacy was relatively low, especially among those with the highest levels of distress and greatest adversity.
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Affiliation(s)
- David Perkins
- Centre of Research Excellence in Rural and Remote Primary Health Care and Department of Rural Health, University of Sydney, Broken Hill, NSW, Australia
| | - Jeffrey Fuller
- School of Nursing and Midwifery, Flinders University, Adelaide, SA, Australia
| | - Brian J Kelly
- Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, NSW, Australia
| | - Terry J Lewin
- Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, NSW, Australia
- Mental Health Services, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Michael Fitzgerald
- Centre for Epidemiology and Biostatistics, University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Clare Coleman
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, NSW, Australia
| | - Kerry J Inder
- Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - John Allan
- Mental Health and Drug & Alcohol Office, NSW Health, Sydney, Australia
| | - Dinesh Arya
- Department of Health, Northern Territory Government, Darwin, Australia
| | - Russell Roberts
- Mental Health and Drug and Alcohol, Western NSW Local Health District, Dubbo, NSW, Australia
| | - Richard Buss
- Mental Health Services, Northern NSW Local Health District, Lismore, NSW, Australia
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Allen J, Inder KJ, Lewin TJ, Attia JR, Kelly BJ. Construct validity of the Assessment of Quality of Life - 6D (AQoL-6D) in community samples. Health Qual Life Outcomes 2013; 11:61. [PMID: 23590808 PMCID: PMC3639231 DOI: 10.1186/1477-7525-11-61] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 03/28/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Assessment of Quality of Life - 6D scale (AQoL-6D) is a self-report instrument designed to provide a sensitive multidimensional evaluation of health related quality of life. The current paper assesses the construct, concurrent and convergent validity of the AQoL-6D in a combined longitudinal population sample drawn from across urban, regional and remote areas of Australia. METHODS The AQoL-6D was administered within the Hunter Community Study and the Australian Rural Mental Health Study over time (mean years lag = 3.90, SD = 1.30). Observations with sufficient data were used to confirm the construct validity of the AQoL-6D domains and higher-order structure using confirmatory factor analyses (CFA, N = 7915). The stability of this structure across cohorts and over time was assessed using multi-group CFA. Additionally, the concurrent validity (against the SF-36) and convergent validity of AQoL-6D domains and factors were assessed. RESULTS The construct validity of the AQoL-6D domains was considered satisfactory. Two higher-order factors, representing the physical and psychological components of quality of life were identified (CFA model fit: RMSEA = .07, SRMR = .03; TLI = .96, CFI = .98). These factors displayed group and temporal invariance, as well as concurrent and convergent validity against a range of measures. Recommendations for the derivation of summary scores are provided, together with a provisional set of norms. CONCLUSIONS The AQoL-6D is a useful tool for assessing quality of life impairment in epidemiological cohort studies, both cross-sectionally and over time. It displays appropriate levels of construct, concurrent and convergent validity. Conceptualisation of higher-order factors as representing the physical and psychological aspects of quality of life impairment may increase the sensitivity and appeal of the AQoL-6D, particularly for studies examining predictors of and changes in social and psychological outcomes.
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Affiliation(s)
- Joanne Allen
- Centre for Translational Neuroscience and Mental Health, University of Newcastle and Hunter New England Health, Newcastle, NSW, Australia.
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Allen J, Inder KJ, Lewin TJ, Attia J, Kelly BJ. Social support and age influence distress outcomes differentially across urban, regional and remote Australia: an exploratory study. BMC Public Health 2012; 12:928. [PMID: 23110446 PMCID: PMC3536674 DOI: 10.1186/1471-2458-12-928] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 10/08/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The variation of determinants of mental health with remoteness has rarely been directly examined. The current research aims to examine whether the association of psychosocial factors with psychological distress outcomes varies with increasing remoteness. METHODS Participants were persons aged 55 and over from two community cohorts sampling from across rural and urban New South Wales (N = 4219; mean age = 69.00 years; 46.1% male). Measures of social support from these studies were calibrated to facilitate comparison across the sample. Remoteness was assessed using a continuous measure, the Accessibility/Remoteness Index of Australia. The association between demographic characteristics, social support, remoteness, and their interactions with remoteness in the prediction of high psychological distress (cut-off > 21 on the Kessler 10) were examined using logistic regression. RESULTS Not being in a married or defacto relationship (OR 0.69; 99% CI 0.51-0.94), lower education (OR 0.52; 99% CI 0.38-0.71) and decreased social support (OR 0.36; 99% CI 0.31-0.42) significantly predicted psychological distress. There was a significant interaction of age and remoteness (OR 0.84; 99% CI 0.67-1.00), indicating that as remoteness increases, older persons are less likely to be highly distressed, as well as a significant interaction of social support and remoteness (OR 1.22; 99% CI 1.04-1.44), indicating that as remoteness decreases, persons with low levels of social support are more likely to be highly distressed. CONCLUSIONS Remoteness may moderate the influence of social support and age on psychological distress outcomes.
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Affiliation(s)
- Joanne Allen
- Centre for Translational Neuroscience and Mental Health, University of Newcastle and Hunter New England Health, Newcastle, NSW, Australia.
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Abstract
BACKGROUND In Australia, rural areas have higher proportions of older persons than metropolitan areas, where ageing poses many challenges related to social isolation, reduced mobility, more chronic disease and comorbidity, greater socio-economic disadvantage, limited access to services, and economic restructuring. Although Australian national data indicate an age-dependent decline in the prevalence of mental disorders, physical ill health is clearly associated with mental disorder in the elderly. There are conflicting findings regarding rural-urban differences in the prevalence of mental disorder, reflecting the complexity of definitions of rurality, and the geographic, ethnic and cultural diversity that underpins location and its influence on health outcomes. AIMS This study aims to investigate the determinants of well-being in a sample of older adults from rural and remote communities, with particular focus on the role of social factors. METHODS Baseline cross-sectional survey data were used from the Australian Rural Mental Health Study, a population-based longitudinal cohort of adults aged 18-85 years randomly selected from electoral rolls. We compared measures of mental health and well-being in adults aged 65 years and over with middle-aged and younger adults living in rural and regional New South Wales. Factors associated with positive well-being and psychological distress in the older group were examined using multivariate logistic regressions, reporting adjusted odds ratios (AOR) and 99% confidence intervals (CI). RESULTS Of the 2,624 participants, 722 (28%) were aged between 65 and 85 years. Well-being was generally higher among those aged 65 years or older, compared with younger groups, with the notable exception of perceived physical health. Among those aged 65 years or older, poorer well-being was independently associated with older age (AOR 0.29, 99% CI 0.13-0.64), one or more chronic diseases (AOR 0.34, 99% CI 0.17-0.69), and a history of depression, stress or anxiety (AOR 0.31, 99% CI 0.12-0.76). Having increased community and personal support (AOR 4.7, 99% CI 2.5-8.9) significantly increased well-being in the older participants. A comparable profile emerged for the predictors of psychological distress, with higher trait neuroticism also making a substantial contribution (AOR 6.4, 99% CI 2.3-7.8). CONCLUSIONS Despite increased rates of chronic illness and poorer physical health, older rural Australians reported better well-being than younger groups, possibly reflecting a survivor effect or perhaps a generational effect, in terms of greater resilience or stoicism in the older generation. Higher levels of perceived community and personal support improve current well-being and are protective for moderate to high psychological distress.
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Affiliation(s)
- Kerry J Inder
- McAuley Centre, Centre for Translational Neuroscience and Mental Health, University of Newcastle, Australia.
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Fragar L, Inder KJ, Kelly BJ, Coleman C, Perkins D, Lewin TJ. Unintentional injury, psychological distress and depressive symptoms: is there an association for rural Australians? J Rural Health 2012; 29:12-9. [PMID: 23289650 DOI: 10.1111/j.1748-0361.2012.00423.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the association between unintentional injury and mental health in Australian rural communities. METHODS Using cross-sectional baseline data for a longitudinal study from randomly selected adults in nonmetropolitan Australia, we fitted logistic regression models for the outcomes of domestic or public setting injury and injury in high-risk settings, using prior depression and demographic factors. OR and 99% CI were reported and also calculated for current mental health including psychological distress, depressive symptoms and risky alcohol consumption, comparing those injured with those not. FINDINGS Of 2,639 participants who completed the injury component, 364 (13.8%) reported injury requiring treatment from a doctor or a hospitalization in the previous 12 months. Of those requiring treatment or hospitalization, 147 (40.4%) reported being injured in a domestic or public setting and 207 (56.9%) in a high-risk setting. The most common types and mechanisms of injury were sprains and strains, and falls, trips and slips, respectively. Preinjury depression was independently associated with unintentional injury in a domestic or public setting. Being injured in this setting was associated with double the odds of experiencing current depressive symptoms. The likelihood of a high-risk setting injury was significantly associated with male gender. High-risk setting injury was associated with current psychological distress and higher levels of alcohol usage. CONCLUSIONS This study supports the hypothesis that pre-existing depression is associated with unintentional injury in a rural sample and indicates the important role of prior depression in management of injury, given the high rate of injury in rural communities. Mechanisms by which prior depression increases likelihood of unintentional injury will be further investigated using longitudinal data.
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Affiliation(s)
- Lyn Fragar
- Australian Centre for Agricultural Health and Safety, University of Sydney, Moree, NSW, Australia.
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Handley TE, Inder KJ, Kelly BJ, Attia JR, Lewin TJ, Fitzgerald MN, Kay-Lambkin FJ. You've got to have friends: the predictive value of social integration and support in suicidal ideation among rural communities. Soc Psychiatry Psychiatr Epidemiol 2012; 47:1281-90. [PMID: 21989656 DOI: 10.1007/s00127-011-0436-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 09/16/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE To explore the role of social integration and support in the longitudinal course of suicidal ideation (SI) in a rural population. METHODS Baseline and 12-month data were obtained from participants within the Australian Rural Mental Health Study, a longitudinal study of community residents within rural and remote New South Wales, Australia. SI was assessed using the Patient Health Questionnaire. Individual psychological factors, family and community characteristics were examined alongside personal social networks (Berkman Syme Social Network Index), availability of social support (Interview Schedule for Social Interaction) and perception of local community (Sense of Community Index). RESULTS Thirteen hundred and fifty-six participants were included in the analysis (39% male, mean age 56.5 years). Sixty-one participants reported recent SI at baseline, while 57 reported SI at follow-up. Baseline SI was a strong predictor of SI at 12 months [odds ratio (OR) 19.0, 95% confidence interval (CI) 8.6-42.3); significant effects were also observed for baseline values of psychological distress (OR 1.4, 95% CI 1.0-1.9) and availability of social support (OR 0.76, 95% 0.58-1.0) on 12-month SI. The emergence of SI at 12-month follow-up was predicted by higher psychological distress (OR 1.8, 95% CI 1.3-2.4); there was a marginal effect of lower availability of support (OR 0.74, 95% CI 0.55-1.0); neither of these variables predicted SI resolution. CONCLUSIONS This study investigated factors associated with SI over a 12-month period in a rural cohort. After controlling for known risk factors for SI, low availability of social support at baseline was associated with greater likelihood of SI at 12-month follow-up.
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Affiliation(s)
- Tonelle E Handley
- Centre for Brain and Mental Health Research, University of Newcastle, Newcastle, NSW, Australia.
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Inder KJ, Handley TE, Fitzgerald M, Lewin TJ, Coleman C, Perkins D, Kelly BJ. Individual and district-level predictors of alcohol use: cross sectional findings from a rural mental health survey in Australia. BMC Public Health 2012; 12:586. [PMID: 22853803 PMCID: PMC3491021 DOI: 10.1186/1471-2458-12-586] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 06/25/2012] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Excessive alcohol use is a significant problem in rural and remote Australia. The factors contributing to patterns of alcohol use have not been adequately explained, yet the geographic variation in rates suggests a potential contribution of district-level factors, such as socio-economic disadvantage, rates of population change, environmental adversity, and remoteness from services/population centres. This paper aims to investigate individual-level and district-level predictors of alcohol use in a sample of rural adults. METHODS Using baseline survey data (N = 1,981) from the population-based Australian Rural Mental Health Study of community dwelling residents randomly selected from the Australia electoral roll, hierarchal logistic regression models were fitted for three outcomes: 1) at-risk alcohol use, indicated by Alcohol Use Disorders Identification Test scores ≥8; 2) high alcohol consumption (> 40 drinks per month); and 3) lifetime consequences of alcohol use. Predictor variables included demographic factors, pre-dispositional factors, recent difficulties and support, mental health, rural exposure and district-level contextual factors. RESULTS Gender, age, marital status, and personality made the largest contribution to at-risk alcohol use. Five or more adverse life events in the past 12 months were also independently associated with at-risk alcohol use (Adjusted Odds Ratio [AOR] 3.3, 99%CI 1.2, 8.9). When these individual-level factors were controlled for, at-risk alcohol use was associated with having spent a lower proportion of time living in a rural district (AOR 1.7, 99%CI 1.3, 2.9). Higher alcohol consumption per month was associated with higher district-level socio-economic ranking, indicating less disadvantage (AOR 1.2, 99%CI 1.02, 1.4). Rural exposure and district-level contextual factors were not significantly associated with lifetime consequences of alcohol use. CONCLUSIONS Although recent attention has been directed towards the potential adverse health effects of district or community level adversity across rural regions, our study found relatively few district-level factors contributing to at-risk alcohol consumption after controlling for individual-level factors. Population-based prevention strategies may be most beneficial in rural areas with a higher socio-economic ranking, while individual attention should be focused towards rural residents with multiple recent adverse life events, and people who have spent less time residing in a rural area.
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Affiliation(s)
- Kerry J Inder
- Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Tonelle E Handley
- Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, NSW, Australia
| | - Michael Fitzgerald
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- Centre for Epidemiology and Biostatistics, University of Newcastle, Newcastle, NSW, Australia
| | - Terry J Lewin
- Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, NSW, Australia
| | - Clare Coleman
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, NSW, Australia
| | - David Perkins
- Department of Rural Health, Broken Hill, University of Sydney, Sydney, NSW, Australia
| | - Brian J Kelly
- Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, NSW, Australia
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, NSW, Australia
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Zareie H, Quain DA, Parsons M, Inder KJ, McElduff P, Miteff F, Spratt NJ, Levi C. The Influence of Anterior Cerebral Artery Flow Diversion Measured by Transcranial Doppler on Acute Infarct Volume and Clinical Outcome in Anterior Circulation Stroke. Int J Stroke 2012; 8:228-34. [DOI: 10.1111/j.1747-4949.2012.00801.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Introduction Anterior cerebral artery flow diversion, measured by transcranial Doppler ultrasound, is correlated with leptomeningeal collateral flow on digital subtraction angiography in the setting of middle cerebral artery occlusion. We aimed to assess the influence of flow diversion as a marker of leptomeningeal collateralization on infarct size and penumbral volume. Methods We assessed consecutive patients presenting within six-hours of ischaemic stroke. Anterior cerebral artery flow diversion, defined as ipsilateral mean velocity of at least 30% greater than the contralateral artery, was used as the Doppler index of leptomeningeal collateralization. Multivariable regression analysis was performed to assess the impact of anterior cerebral artery flow diversion, controlling for other important clinical variables. Leptomeningeal collateralization was also graded on computed tomography angiography. Infarct core and penumbral volumes were defined using computed tomography perfusion thresholds of cerebral blood volume and mean transit time. Infarct volume, reperfusion, and vessel status were measured at 24 h using magnetic resonance techniques. Results Fifty-three patients qualified for analysis. Anterior cerebral artery flow diversion was associated with good collateral flow on computed tomography angiography ( P < 0·001) and was an independent predictor of admission infarct core volume ( P < 0·001), and 24 h infarct volume ( P < 0·001). The likelihood of a favourable outcome (modified Rankin Score 0–2) was higher (odds ratio = 27·5, P < 0·001) in those with flow diversion. Conclusions Anterior cerebral artery flow diversion indicates effective leptomeningeal collateralization as measured by computed tomography angiography, and independently predicts acute infarct size and 90-day clinical outcome. Flow diversion appears to provide penumbral perfusion, offering some protection against infarct expansion. Acute bedside transcranial Doppler assessment of flow diversion aids prognostication and therapeutic decision making in anterior circulation stroke.
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Affiliation(s)
- Hossein Zareie
- Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia
- Callaghan Campus, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, John Hunter Hospital, Newcastle, NSW, Australia
| | - Debbie A. Quain
- Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia
- Callaghan Campus, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, John Hunter Hospital, Newcastle, NSW, Australia
| | - Mark Parsons
- Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia
- Callaghan Campus, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, John Hunter Hospital, Newcastle, NSW, Australia
| | - Kerry J. Inder
- Callaghan Campus, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, John Hunter Hospital, Newcastle, NSW, Australia
| | - Patrick McElduff
- Callaghan Campus, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, John Hunter Hospital, Newcastle, NSW, Australia
| | - Ferdinand Miteff
- Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia
| | - Neil J. Spratt
- Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia
- Callaghan Campus, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, John Hunter Hospital, Newcastle, NSW, Australia
| | - Christopher Levi
- Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia
- Callaghan Campus, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, John Hunter Hospital, Newcastle, NSW, Australia
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Robertson J, McElduff P, Pearson SA, Henry DA, Inder KJ, Attia JR. The health services burden of heart failure: an analysis using linked population health data-sets. BMC Health Serv Res 2012; 12:103. [PMID: 22533631 PMCID: PMC3413515 DOI: 10.1186/1472-6963-12-103] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 04/25/2012] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The burden of patients with heart failure on health care systems is widely recognised, although there have been few attempts to quantify individual patterns of care and differences in health service utilisation related to age, socio-economic factors and the presence of co-morbidities. The aim of this study was to assess the typical profile, trajectory and resource use of a cohort of Australian patients with heart failure using linked population-based, patient-level data. METHODS Using hospital separations (Admitted Patient Data Collection) with death registrations (Registry of Births, Deaths and Marriages) for the period 2000-2007 we estimated age- and gender-specific rates of index admissions and readmissions, risk factors for hospital readmission, mean length of stay (LOS), median survival and bed-days occupied by patients with heart failure in New South Wales, Australia. RESULTS We identified 29,161 index admissions for heart failure. Admission rates increased with age, and were higher for males than females for all age groups. Age-standardised rates decreased over time (256.7 to 237.7/100,000 for males and 235.3 to 217.1/100,000 for females from 2002-3 to 2006-7; p = 0.0073 adjusted for gender). Readmission rates (any cause) were 27% and 73% at 28-days and one year respectively; readmission rates for heart failure were 11% and 32% respectively. All cause mortality was 10% and 28% at 28 days and one year. Increasing age was associated with more heart failure readmissions, longer LOS and shorter median survival. Increasing age, increasing Charlson comorbidity score and male gender were risk factors for hospital readmission. Cohort members occupied 954,888 hospital bed-days during the study period (any cause); 383,646 bed-days were attributed to heart failure admissions. CONCLUSIONS The rates of index admissions for heart failure decreased significantly in both males and females over the study period. However, the impact on acute care hospital beds was substantial, with heart failure patients occupying almost 200,000 bed-days per year in NSW over the five year study period. The strong age-related trends highlight the importance of stabilising elderly patients before discharge and community-based outreach programs to better manage heart failure and reduce readmissions.
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Affiliation(s)
- Jane Robertson
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
- Clinical Pharmacology, Calvary Mater Hospital, The University of Newcastle, Clinical Sciences Building, Waratah, NSW, 2298, Australia
| | - Patrick McElduff
- Hunter Medical Research Institute, The University of Newcastle, Newcastle, Australia
| | - Sallie-Anne Pearson
- UNSW Cancer Research Centre, University of New South Wales and Prince of Wales Clinical School, Sydney, Australia
| | - David A Henry
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
- Institute for Clinical Evaluative Sciences and Department of Medicine, University of Toronto, Toronto, Canada
| | - Kerry J Inder
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
| | - John R Attia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
- Hunter Medical Research Institute, The University of Newcastle, Newcastle, Australia
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Handley TE, Inder KJ, Kelly BJ, Attia JR, Kay-Lambkin FJ. Urban-rural influences on suicidality: gaps in the existing literature and recommendations for future research. Aust J Rural Health 2012; 19:279-83. [PMID: 22098210 DOI: 10.1111/j.1440-1584.2011.01235.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Suicide is a major public health issue of particular concern among rural populations, which experience a consistently higher suicide rate than urban areas. Although extensive research efforts have been directed towards understanding suicidality and related factors, there is a continued lack of clinically useful factors to target preventive measures, particularly among some regional and demographic groups. This suggests limitations in the conceptualisation of this important construct. A review of the literature was undertaken, using a snowballing and saturation approach. Literature was considered relevant if it addressed the research question 'what are the current limitations in research on urban/rural influences on suicidality?' Findings were used to develop a set of guidelines to inform future research. A number of gaps in existing research relevant to limitations in rural suicide research were identified: inconsistencies in terminology; a focus on high-end suicidal behaviours; a disproportionate focus on urban populations; a dominance of cross-sectional research; and a high use of clinical samples. These limitations are discussed in terms of their implications for rural suicidality, and are used to support the development of recommendations for future research, with a focus on encouraging consistency and standardisation. A number of limitations can be identified in existing research on suicide. Targeting these specific areas can be an important step in addressing the current gaps in knowledge relating to rural suicide prevention.
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Affiliation(s)
- Tonelle E Handley
- Centres for Brain and Mental Health Research, University of Newcastle, Callaghan, New South Wales, Australia.
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Abstract
This paper, presented at the 2010 rural health researchers' National Scientific Symposium on Rural and Remote Health, provides an overview of large Australian population mental health cohort studies which have a focus on climate-related and environmental adversity, social factors and mental health. These studies highlight the value of exploiting multiple exceptional datasets to better understand the drivers of rural health, including how to use population-level research to improve health resources in non-metropolitan areas. We show how the key characteristics of rural and remote mental health might be explored by exploiting the following cohort studies: Household, Income and Labour Dynamics in Australia Survey; Australian Rural Mental Health Study; Hunter Community Study; and Extending Treatments, Education and Networks in Depression study. Existing cohort studies that focus on significant rural and regional characteristics can be creatively analysed to better understand geographic variation in mental health. They have the potential to move understanding beyond simple prevalence to building knowledge about the trajectories of psychological distress and determinants of mental disorders and outcomes over time.
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Affiliation(s)
- Kerry J Inder
- Centre for Brain and Mental Health Research, Faculty of Health, University of Newcastle, Callaghan, Newcastle, New South Wales, Australia.
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Johnson NA, Inder KJ, Ewald BD, James EL, Bowe SJ. Association between Participation in Outpatient Cardiac Rehabilitation and Self-Reported Receipt of Lifestyle Advice from a Healthcare Provider: Results of a Population-Based Cross-Sectional Survey. Rehabil Res Pract 2010; 2010:541741. [PMID: 22110968 PMCID: PMC3200279 DOI: 10.1155/2010/541741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 10/01/2010] [Accepted: 11/05/2010] [Indexed: 11/18/2022] Open
Abstract
We test the hypothesis that the odds of self-reported receipt of lifestyle advice from a health care provider will be lower among outpatient cardiac rehabilitation (OCR) nonattendees and nonreferred patients compared to OCR attendees. Logistic regression was used to analyse cross-sectional data provided by 65% (4971/7678) of patients aged 20 to 84 years discharged from public hospitals with a diagnosis indicating eligibility for OCR between 2002 and 2007. Among respondents, 71% (3518) and 55% (2724) recalled advice regarding physical activity and diet, respectively, while 88% (592/674) of smokers recalled quit advice. OCR attendance was low: 36% (1764) of respondents reported attending OCR, 11% (552) did not attend following referral, and 45% (2217) did not recall being invited. The odds of recalling advice regarding physical activity and diet were significantly lower among OCR nonattendees compared to attendees (OR 0.34, 95% CI 0.21, 0.56 and OR 0.33, 95% CI 0.25, 0.44, resp.) and among nonreferred respondents compared to OCR attendees (OR 0.10, 95% CI 0.07, 0.15 and OR 0.17, 95% CI 0.14, 0.22, resp.). Patients hospitalised for coronary heart disease should be referred to OCR or a suitable alternative to improve recall of lifestyle advice that will reduce the risk of further coronary events.
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Affiliation(s)
- Natalie A. Johnson
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, Callaghan, Newcastle, NSW 2308, Australia
| | - Kerry J. Inder
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, Callaghan, Newcastle, NSW 2308, Australia
| | - Ben D. Ewald
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, Callaghan, Newcastle, NSW 2308, Australia
| | - Erica L. James
- Centre for Health Research & Psycho-oncology (CHeRP), The Cancer Council NSW, and Hunter Medical Research Institute, The University of Newcastle, Callaghan, Newcastle, NSW 2308, Australia
| | - Steven J. Bowe
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, Callaghan, Newcastle, NSW 2308, Australia
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Williams JAS, Byles JE, Inder KJ. Equity of access to cardiac rehabilitation: the role of system factors. Int J Equity Health 2010; 9:2. [PMID: 20205776 PMCID: PMC2823593 DOI: 10.1186/1475-9276-9-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Accepted: 01/21/2010] [Indexed: 11/25/2022] Open
Abstract
Background When patient selection processes determine who can and cannot use healthcare there can be inequalities and inequities in individuals' opportunities to benefit. This paper evaluates the influence of a hospital selection process on opportunities to access outpatient cardiac rehabilitation (CR). Methods A secondary data analysis was conducted on a cohort of inpatients (n = 2,375) who were all eligible for invitation to an Australian CR program. Eligibility was determined by hospital discharge diagnosis codes. Only invited patients could attend. Logistic regression analysis tested the extent to which individual patient characteristics were statistically significantly associated with the outcome 'invitation' after adjusting for cardiac disease and other factors. Results Less than half of the eligible patients were invited to the CR program. After allowing for known factors that may have justified not being selected, there was bias towards inviting males, younger patients, married patients, and patients who nominated English as their preferred language. Conclusions Health service managers typically monitor service utilisation patterns as indicators of access but often pay little attention to ways in which locally determined system factors influence access to care. The paper shows how a hospital selection process can unreasonably influence patients' opportunities to benefit from an evidence-based healthcare program.
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Ramli, Agho KE, Inder KJ, Bowe SJ, Jacobs J, Dibley MJ. Prevalence and risk factors for stunting and severe stunting among under-fives in North Maluku province of Indonesia. BMC Pediatr 2009; 9:64. [PMID: 19818167 PMCID: PMC2765943 DOI: 10.1186/1471-2431-9-64] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Accepted: 10/06/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adequate nutrition is needed to ensure optimum growth and development of infants and young children. Understanding of the risk factors for stunting and severe stunting among children aged less than five years in North Maluku province is important to guide Indonesian government public health planners to develop nutrition programs and interventions in a post conflict area. The purpose of the current study was to assess the prevalence of and the risk factors associated with stunting and severe stunting among children aged less than five years in North Maluku province of Indonesia. METHODS The health and nutritional status of children aged less than five years was assessed in North Maluku province of Indonesia in 2004 using a cross-sectional multi-stage survey conducted on 750 households from each of the four island groups in North Maluku province. A total of 2168 children aged 0-59 months were used in the analysis. RESULTS Prevalence of stunting and severe stunting were 29% (95%CI: 26.0-32.2) and 14.1% (95%CI: 11.7-17.0) for children aged 0-23 months and 38.4% (95%CI: 35.9-41.0) and 18.4% (95%CI: 16.1-20.9) for children aged 0-59 months, respectively. After controlling for potential confounders, multivariate analysis revealed that the risk factors for stunted children were child's age in months, male sex and number of family meals per day (<or=2 times), for children aged 0-23 months, and income (poorest and middle-class family), child's age in months and male sex for children aged 0-59 months. The risk factors for severe stunting in children aged 0-23 months were income (poorest family), male sex and child's age in months and for children aged 0-59 months were income (poorest family), father's occupation (not working), male sex and child's age in months. CONCLUSION Programmes aimed at improving stunting in North Maluku province of Indonesia should focus on children under two years of age, of male sex and from families of low socioeconomic status.
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Affiliation(s)
- Ramli
- Centre for Clinical Epidemiology and Biostatistics, the University of Newcastle, NSW, Australia.
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Johnson NA, Inder KJ, Nagle AL, Wiggers JH. Secondary prevention among cardiac patients not referred to cardiac rehabilitation. Med J Aust 2009; 190:161. [DOI: 10.5694/j.1326-5377.2009.tb02323.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Accepted: 09/10/2008] [Indexed: 11/17/2022]
Affiliation(s)
- Natalie A Johnson
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW
| | - Kerry J Inder
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW
| | - Amanda L Nagle
- National Heart Foundation of Australia, NSW Division, Sydney, NSW
| | - John H Wiggers
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW
- Hunter New England Population Health, Hunter New England Health Service, Newcastle, NSW
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