Understanding the contribution of general medical services to acute inpatient care in Victorian public hospitals

BACKGROUND

General medicine is an integral part of health services, yet there is little data highlighting their contribution to acute hospital care in Australia.

AIMS

To utilise the Victorian Department of Health's administrative dataset for hospital admissions to evaluate the relative contribution and trends over time of general medical services to acute multiday inpatient hospital separations in the Victorian public healthcare system.

METHODS

A retrospective time-series study of general medical activity compared to other major specialties using hospital-level data provided by the Department of Health: (i) extrapolation from diagnosis-related group (DRG) activity data (2011-2021) and, (ii) directly reported discharge unit-based activity (available from 2018). Acute multiday separations of all patients aged ≥18 years from all metropolitan and rural Victorian public hospitals were included.

RESULTS

Using the DRG-based data, general medicine ranked as the largest care provider of all specialties studied, accounting for 12.1% of separations. Despite the largest increase at a rate of 2831 separations/year (0.336%/year of total, P < 0.001) compared to others, mean length of stay declined by 0.08 days/year (P < 0.001). These findings were significant for metropolitan and rural hospitals. The use of directly reported discharge unit-based data also ranked general medicine as the largest care provider accounting for 32.9% of total separations, with rural hospital general medical services contributing nearly 50% of all multiday separations.

CONCLUSIONS

Both DRG-based data and discharge unit-based data indicate that general medicine is the largest provider of acute multiday inpatient care in Victorian hospitals. The estimate of contribution of general medicine differed between the two datasets as DRG data likely over-represents the role of other specialties possibly due to assumptions regarding specialty management of varying groups of diagnoses.

Assessing Residents' Perceptions of Their Relocation to Long-Term Care: Psychometric Validation of the View of Relocation Scale

OBJECTIVES

Relocation to long-term care is a major challenge for older people. The View of Relocation Scale (VRS) was developed to address the need for a brief instrument to assess residents' perceptions of the relocation.

DESIGN

Secondary analysis of data collected in a cluster randomized trial. The psychometric properties of the VRS examined in this study included factorial structure (using exploratory factor analysis), unidimensionality (Rasch modeling), internal consistency reliability (Kuder-Richardson Formula 20, squared multiple correlations, and item-total correlations), and known groups validity (analysis of variance). The results were used to identify the psychometrically most robust items for inclusion into the final version of the instrument.

SETTING AND PARTICIPANTS

Participants were 202 long-term care residents in Melbourne, Australia (mean age = 85.52 years, standard deviation = 7.33), who had relocated to the facility a mean of 4.4 weeks previously. Residents with moderately severe and severe dementia were excluded.

MEASURES

The VRS was developed following a review of the literature describing residents' views of relocation and was designed for administration shortly after their relocation.

RESULTS

There was support for a 2-factor, 10-item solution, with separate subscales assessing Perceived Control (degree of control in the decision making and planning for the relocation) and Perceived Need (perceived need for the relocation to long-term care). Participants who were admitted directly from hospital reported higher perceived need but lower perceived control than those admitted to the facility from home.

CONCLUSION AND IMPLICATIONS

The VRS can be used to understand the impact of older people's perceptions of relocation to long-term care on their subsequent adjustment and well-being, and to identify those who may benefit from tailored support.

The Path to Eldership: Results from a Contemporary Indigenous Australian Community

BACKGROUND AND OBJECTIVES

Traditionally, Elders have held a unique social position within Indigenous Australian communities. This study aimed to identify the characteristics of Indigenous Elders that distinguish them from other people in their community.

RESEARCH DESIGN AND METHODS

Using a community-based participatory research approach, the study was conducted in a regional Indigenous community in Southeast Queensland. The design and data collection methods were informed through a community forum, known as a 'Yarning Circle'. One-on-one semi-structured interviews and focus groups with community members were carried out by Indigenous researchers. Data were analysed in NVivo software, using thematic analysis (TA), with themes derived directly from data.

RESULTS

Fifty individuals participated in the study. The participants' median age was 45 years (range 18-76 years) and 31 (62%) were female. TA identified three overarching themes related to Elders' attributes: (1) distinguishing characteristics of Elders (sub-themes of respect, leadership, reciprocity, life experience, approachability, connection to traditional culture, transmitting knowledge through generations): (2) how one becomes an Elder (earnt eldership, permanency of eldership, mentors and role models, age); and (3) threats to Elders' influence (intergenerational gap, community disconnect, and cultural trauma).

DISCUSSION AND IMPLICATIONS

Our results build a greater understanding of the contemporary role of Indigenous Australian Elders, which will inform the development of future interventions directed at strengthening Elders' role in their communities.

How Important Are Choice, Autonomy, and Relationships in Predicting the Quality of Life of Nursing Home Residents?

Older people face major challenges when they move into nursing homes, particularly in relation to independence and their ability to influence their activities of daily living (ADLs). This study evaluated the contribution of resident choice, as well as the staff-resident relationship, to promoting resident quality of life (QoL). A total of 604 residents from 33 nursing homes in Australia completed measures of QoL, perceived levels of choice in various ADLs, and the staff-resident relationship. A hierarchical regression demonstrated that the predictor variables accounted for 25% of the variance in QoL. Two of the four predictor variables (resident choice over socializing and the staff-resident relationship) significantly contributed to resident QoL. These findings reinforce the important contribution of autonomy and social relationships to resident QoL. Nursing home staff have a key role to play in supporting resident autonomy as a means of building residents' chosen social connections, and thereby promoting QoL.

Prediction models and questionnaires developed to predict vitamin D status in adults: a systematic review

A systematic review of prediction models/questionnaires developed to identify people with deficient/insufficient vitamin D status shows the potential of self-reported information to estimate vitamin D status. The objective is to identify and compare existing screening tools, developed to identify vitamin D deficiency or insufficiency in adults. A systematic search of literature was conducted using MEDLINE, Scopus, Web of Science and CINAHL databases. Risk of bias and applicability concerns were assessed by quality assessment of diagnostic accuracy studies (QUADAS-2). Data were extracted on socio-demographic, anthropometric, risk factors, serum 25 hydroxyvitamin D [25(OH)D] levels, statistical methods and predictive ability. A total of 12 studies were considered for inclusion for this systematic review after screening of 4851 abstracts and 15 full-text articles. Ten of twelve studies developed prediction models and 2 studies developed questionnaires. The majority of studies had low risk of bias and applicability as assessed by QUADAS-2. All studies included only self-reported predictors of vitamin D status in their final models and development of scores. Sunlight exposure and related factors were important significant contributors to the predictive ability of the models and/or questionnaires. Sensitivity and specificity of the prediction models or questionnaires ranged from 55 to 91% and 35 to 84%, respectively. Six out of twelve studies converted final models to scores associated with vitamin D status. There was no evidence that any of these existing tools have been translated into clinical practice. The prediction models or questionnaires identified in this systematic review were moderately sensitive and specific for identifying people with vitamin D deficiency or insufficiency. The substantial contribution of sunlight exposure to the prediction of vitamin D status highlights the importance of including this information when developing vitamin D screening tools.

Why we should stop performing vertebroplasties for osteoporotic spinal fractures

While vertebroplasty enjoys continued use in some settings, there is now high-moderate quality evidence based on systematic review that includes five placebo-controlled trials that it provides no benefits over placebo and these results do not differ according to pain duration (≤6 vs >6 weeks). A clinically important increased risk of incident symptomatic vertebral fractures or other serious adverse events cannot be excluded due to small event numbers. Serious harms including cord compression, ventricular perforation, pulmonary embolism, infection and death have been reported. This unfavourable risk-benefit ratio should be convincing doctors and patients to stop the use of vertebroplasty. At the very least, clinicians should fully inform their patients about the evidence including the likelihood of improving without vertebroplasty and the potential harms, so that patients can make evidence-informed decisions about their treatment. They should also warn patients about the pitfalls of relying on information sourced from the internet or from 'awareness raising' campaigns.

Consumer directed care in residential aged care: an evaluation of a staff training program

Objectives: The advent of Consumer-Directed Care (CDC, or individualized care) in Residential Aged Care Facilities (RACFs, or residential care) will require a paradigm shift in service delivery. This article evaluated the six-session Resident at the Centre of Care (RCC) staff training program designed to equip staff to implement a CDC model of care among residents.Method: There were two experimental conditions: RCC training program alone, RCC training program plus support, and a 'care as usual' condition. Outcome measures were resident quality of life (QoL) and resident working relationships with staff at 3-month follow-up. At Time 1, 92 residents from RACFs participated in the program. The RCC is six sessions that focus on the development of staff skills in communicating with residents, as well as the organizational change and transformational leadership that is needed for the implementation of CDC.Results: There were significant improvements in resident QoL. There was no major difference between the RCC Program plus support condition compared to the RCC Program alone condition, but both were associated with more positive changes in resident QoL than the 'care as usual' condition.Conclusion: This study demonstrates that training staff in strategies to implement CDC in RACFs can lead to an improvement in the wellbeing of many residents, and that additional support to assist staff to implement the strategies may not be required to produce such improvements. Longer term follow-up is necessary to determine if the improvements in resident QoL are sustained.

A cluster randomised trial of the program to enhance adjustment to residential living (PEARL): a novel psychological intervention to reduce depression in newly admitted aged care residents

Background

Depression rates are high in residential aged care (RAC) facilities, with newly admitted residents at particular risk. New approaches to address depression in this population are urgently required, particularly psychological interventions suitable for widespread use across the RAC sector. The Program to Enhance Adjustment to Residential Living (PEARL) is a brief intervention, designed to provide individually tailored care approaches to meet the psychological needs of newly admitted residents, delivered in collaboration with facility staff.

Methods

PEARL will be evaluated using a cluster randomised controlled design, comparing outcomes for residents who participate in the intervention with those residing in care as usual control facilities. Participants are RAC residents aged 60 years or above, with normal cognition or mild-moderate cognitive impairment, who relocated to the facility within the previous 4 weeks. The primary outcomes are depressive symptoms and disorders, with secondary outcomes including anxiety, stress, quality of life, adjustment to RAC, and functional dependence, analysed on an intention to treat basis using multilevel modelling.

Discussion

PEARL is an intervention based on self-determination theory, designed to reduce depression in newly admitted residents by tailoring day to day care to meet their psychological needs. This simple psychological approach offers an alternative care model to the current over-reliance of antidepressant medications.

Trial registration

ACTRN12616001726448; Registered 16 December 2016 with the Australian New Zealand Clinical Trials Registry.

Impact of a model of care for heart failure in-patients to reduce variation in care: a quality improvement project

BACKGROUND

We identified variation in delivery of guideline recommended care at our institution, and undertook a project to design a heart failure (HF) model of care.

AIM

To maximise time patients with HF spend well in the community by delivering best practice guidelines to reduce variation in care improving overall outcomes.

METHODS

This quality improvement project focused on reducing variation in process measures of care. The HF model of care included electronic HF care bundles, a patient education pack with staff training on delivering HF patient education, referral of all HF patients to the Hospital Admissions Risk Program for phone call within 72 h, and a nurse-pharmacist early follow-up clinic. Outcomes were assessed using interrupted time series analyses.

RESULTS

The pre-intervention group comprised 1585 patients, and post-intervention 1720 patients with a primary diagnosis of HF admitted under general cardiology and general medicine. Interrupted time series analysis indicated 30-day readmissions did not change in overall trend (-0.2% per month, P = 0.479) but a significant immediate step-down of 7.8% was seen (P = 0.018). For 90-day readmissions, a significant trend reduction over the time period was seen (-0.6% per month, P = 0.017) with a significant immediate step-down (-9.4%, P = 0.001). Emergency department representations, in-patient mortality and length of stay did not change significantly. Improvements in process measures were seen at audit.

CONCLUSION

This model of care resulted in overall trends of reductions in 30- and 90-day readmissions, without increasing emergency department representations, mortality and length of stay. This model will be adapted as the electronic medical record is introduced at our institution.

Male ageing is negatively associated with the chance of live birth in IVF/ICSI cycles for idiopathic infertility

STUDY QUESTION

Is male age associated with the clinical outcomes of IVF/ICSI cycles for idiopathic infertility after adjustment for female age?

SUMMARY ANSWER

Male ageing is negatively associated with clinical IVF/ICSI outcomes in couples with idiopathic infertility independent of female age.

WHAT IS KNOWN ALREADY

The effect of male age on the outcomes of infertility treatments is controversial and poorly explored. In contrast, fertility is known to decline significantly with female age beyond the mid-30s, and reduced oocyte quality plays an important role. The negative effect of male age on sperm quality is largely associated with an increasing susceptibility to sperm DNA damage. Although increasing maternal age has been linked with poorer oocyte quality, studies on the effect of male age have disregarded the need to control for female age making it difficult to define clearly the role of male age in infertile couples.

STUDY DESIGN, SIZE, DURATION

This retrospective cohort study analysed 2425 cycles of couples with idiopathic infertility selected from a total of 24 411 IVF/ICSI cycles performed at Monash IVF in Australia between 1992 and 2017. The primary outcome was live birth and secondary outcomes were clinical pregnancy and miscarriage.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Couples with primary/secondary infertility who underwent IVF/ICSI cycles with male partners classified as normozoospermic were selected (inclusion criteria). Couples in which the female partner had endometriosis, tubal factors, polycystic ovarian syndrome, ovarian hyperstimulation syndrome, poor responders (≤3 mature oocytes retrieved) and couples with more than 15 cumulus oocyte complexes retrieved or who used cryopreserved gametes were excluded. Binary logistic multilevel modelling was used to identify the effect of male age and female age on clinical outcomes after controlling for confounding factors. Male age and female age were examined as continuous and categorical (male age: &lt;40, 40–44, 45–49, 50–54, ≥55; female age:&lt;30, 30–34, 35–39, ≥40) predictors.

MAIN RESULTS AND THE ROLE OF CHANCE

There was a negative effect of male age and female age on live birth as odds ratios (OR) with 95% CI for each additional year of age (OR-male age: 0.96 [0.94–0.98]; OR-female age: 0.90 [0.88–0.93] P &lt; 0.001). Potential interactions with male age such as type of treatment (IVF/ICSI), embryo transfer day (Day 3/Day 5) and female age did not have significant associations with outcomes (P &gt; 0.05). Secondary outcomes showed a significant reduction in the odds of clinical pregnancy (OR-male age: 0.97 [0.96–0.99]; OR-female age: 0.92 [0.89–0.94] P &lt; 0.001) and an increase in the odds of miscarriage with older age: male age (OR: 1.05 [1.01–1.08]; P = 0.002); female age (OR: 1.11 [1.05–1.18]; P &lt; 0.001). Worse outcomes were associated with more cycles (clinical pregnancy-OR: 0.96 [0.93–0.99] P = 0.03; live birth-OR: 0.96 [0.92–0.99] P = 0.023) while more inseminated oocytes were associated with better outcomes (clinical pregnancy-OR: 1.06 [1.03–1.06] P &lt; 0.001; live birth-OR: 1.07 [1.04–1.11] P &lt; 0.001). Analyses for age categories showed a gradual worsening of clinical outcomes with increasing male age, with a significantly worse live birth and clinical pregnancy outcomes in males aged older than 50 years compared to males younger than 40 years (P &lt; 0.05).

LIMITATIONS, REASONS FOR CAUTION

This study is limited to the information on confounding factors included. The study may also be limited in its generalizability to a wider population due the strict selection criteria. Age as a category could potentially result in residual confounding due to categorizing a continuous variable.

WIDER IMPLICATIONS OF THE FINDINGS

This study provides information for counselling of couples with idiopathic infertility.

STUDY FUNDING/COMPETING INTEREST(S)

Funded by the Education Program in Reproduction and Development, Department of Obstetrics and Gynaecology, Monash University. None of the authors has any conflict of interest to report.

TRIAL REGISTRATION NUMBER

N/A.

Mapping the Perceived Sexuality of Heterosexual Men and Women in Mid- and Later Life: A Mixed-Methods Study

Introduction

There is currently limited research that examines the meaning of sexuality at midlife and later life.

Aim

This study investigates how heterosexual men and women in mid- and later life perceive their sexuality and the factors that influence it.

Methods

Group concept mapping was used to produce a conceptual map of the experience of sexuality for heterosexual adults ages 45 years and above. Group concept mapping data were collected using 6 open-ended survey questions that asked about sexuality, intimacy, and desire. Thematic analysis was used to examine how participants perceived their sexuality to have changed as they aged. Thematic analysis data were collected using a single open-ended survey question.

Main Outcome Measure

Statements generated from 6 of the open-ended survey questions were rated by participants using a 5-point Likert scale for how important participants felt that each statement was to themselves personally. Participants responses to the seventh open-ended survey question were examined using thematic analysis to understand whether participants felt that their sexual experiences had changed over time and, if so, how they had changed.

Results

Eight themes were identified across the different phases of group concept mapping. These were, in order of importance, partner compatibility, intimacy and pleasure, determinants of sexual desire, sexual expression, determinants of sexual expression, barriers to intimacy, sexual urges, and barriers to sexual expression. Seven areas of change were identified in terms of perceived changes to sexuality with age. These included changes to perspective, relationship dynamics, environment, behavior, body/function, sexual interest/desire, and sexual enjoyment.

Conclusion

The results highlight the prioritization of interrelationship dynamics in mid- and later life sexuality over sexual functioning and sexual urges. These findings may facilitate the development of new perspectives on how sexuality is experienced in the later years and provide new avenues for intervention in situations where sexual problems arise.

Macleod A, Busija L, McCabe M. Mapping the Perceived Sexuality of Heterosexual Men and Women in Mid- and Later Life: A Mixed-Methods Study. Sex Med 2019; 8:84–99.

Trials with proxy-reported outcomes registered on the Australian New Zealand Clinical Trials Registry (ANZCTR)

AIMS

A proxy is someone other than a patient who reports a patient's outcomes as if they are the patient. Due to known discordance with patient reports, proxies are often not recommended in clinical trials; however, proxies may be needed in certain research contexts. We aimed to identify and describe trials registered on the Australian New Zealand Clinical Trials Registry (ANZCTR) with proxy-reported endpoints.

METHODS

ANZCTR was systematically searched from inception (2005) to 31 March 2017 for trials with proxy-reported endpoints. Primary and secondary endpoints for each trial retrieved by the search were individually coded (proxy-reported: yes/no), and trials with confirmed proxy-reported endpoints were included in the analysis.

RESULTS

Of 13,666 registered trials, 469 (3.4%) included a proxy-reported endpoint (867 individual proxy-reported endpoints in total: 62% family member proxy, 22% health professional). Proxy endpoint inclusion did not significantly increase over time (r = 0.18, p = 0.59). Mental health (11.5%), stroke (10.3%) and neurological (8.3%) trials had the highest proportion of trials using proxies. Of the 469 trials, 123 (26.2%) studies involved paediatric patients.

DISCUSSION

Proxy-reported endpoints are included in a small but notable number of studies, which may indicate other types of outcomes are used for patients unable to self-report, or that these patients are under-researched.

The Role of Elders in the Wellbeing of a Contemporary Australian Indigenous Community

Background and Objectives

Traditional Elders are integral to the social structure of Australian Indigenous communities. Due to progressive loss of traditional way of life, however, the role of Elders has been eroding. This study aims to develop a conceptual model of the role of Elders in an Australian Indigenous community, with the goal of attaining strategies to strengthen the role of Elders.

Research Design and Methods

The study, conducted in a regional Indigenous community in Australia, adopted a community-based participatory approach. Design and focus of the project were informed by a community forum (Yarning Circle). One-on-one semistructured interviews and focus groups with community members were conducted by Indigenous researchers. Group concept mapping (GCM) was applied to elicit major themes in qualitative data, from the point of view of community members, and to derive a conceptual model of the role of Elders.

Results

Fifty members of the Indigenous community took part in interviews and focus groups. The participants’ median age was 45 years (range 18–76 years); 31 (62%) were female. An additional 24 Indigenous community members took part in the data sorting task of GCM. GCM identified seven major aspects of the role of Elders, including Community relations, Passing down the knowledge, Dealing with racism and oppression, Building a better resourced community, Intergenerational connectedness, Safeguarding our identity, and Caring for our youth.

Discussion and Implications

Elders fulfill many important roles in contemporary Indigenous communities. Our results can be used to assist the community to codesign a program to increase community wellbeing.

A randomized controlled trial to evaluate the effectiveness of a staff training program to implement consumer directed care on resident quality of life in residential aged care

BACKGROUND

Residential Aged Care Facilities (RACFs) are moving towards a Consumer Directed Care (CDC) model of care. There are limited examples of CDC in ageing research, and no evaluation of a comprehensive CDC intervention in residential care was located. This study will implement and evaluate a staff training program, Resident at the Center of Care (RCC), designed to facilitate and drive CDC in residential care.

METHODS

The study will adopt a cluster randomized controlled design with 39 facilities randomly allocated to one of three conditions: delivery of the RCC program plus additional organizational support, delivery of the program without additional support, and care as usual. A total of 834 staff (22 in each facility, half senior, half general staff) as well as 744 residents (20 in each facility) will be recruited to participate in the study. The RCC program comprises five sessions spread over nine weeks: Session 1 clarifies CDC principles; Sessions 2 to 5 focus on skills to build and maintain working relationships with residents, as well as identifying organizational barriers and facilitators regarding the implementation of CDC. The primary outcome measure is resident quality of life. Secondary outcome measures are resident measures of choice and control, the working relationship between resident and staff; staff reports of transformational leadership, job satisfaction, intention to quit, experience of CDC, work role stress, organizational climate, and organizational readiness for change. All measures will be completed at four time points: pre-intervention, 3-months, 6-months, and 12-month follow-up. Primary analyses will be conducted on an intention to treat basis. Outcomes for the three conditions will be compared with multilevel linear regression modelling.

DISCUSSION

The RCC program is designed to improve the knowledge and skills of staff and encourage transformational leadership and organizational change that supports implementation of CDC. The overarching goal is to improve the quality of life and care of older people living in residential care.

TRIAL REGISTRATION

ACTRN12618000779279; Registered 9 May 2018 with the Australian and New Zealand Clinical Trials Registry (ANZCTR; http://www.anzctr.org.au/ ).

Trials with patient-reported outcomes registered on the Australian New Zealand Clinical Trials Registry (ANZCTR)

AIMS

It is important to understand the number, types and regions of trials that include patient-reported outcomes (PROs) to appreciate how patient experiences have been considered in studies of health and interventions. Twenty-seven percent of trials registered with ClinicalTrials.gov (2007-2013) included PROs; however, a regional breakdown was not provided and no reviews have been conducted of the Australia New Zealand Clinical Trials Registry (ANZCTR). We aimed to identify trials registered with ANZCTR with PRO endpoints and describe their characteristics.

METHODS

ANZCTR was systematically searched from inception (2005) to 31 March 2017 for trials with PRO endpoints. Search terms included PRO measures listed in Patient-Reported Outcomes Quality of Life Instrument Database and Grid-Enabled Measures, as well as generic PRO terms (e.g. "quality of life" (QOL)). Trial endpoints were individually coded using an established framework to identify trials with PROs for the analysis.

RESULTS

Of 13,666 registered trials, 6168 (45.1%) included a PRO. The proportion of studies including PROs increased between 2006 and 2016 (r = 0.74, p = 0.009). Among the 6168 trials, there were 17,961 individual PRO endpoints, including symptoms/functional outcomes/condition-specific QOL (65.6%), generic QOL (13.2%), patient-reported experiences (9.9%), patient-reported behaviours (7.9%). Mental health was the most common category (99.8% included PROs), followed by physical medicine/rehabilitation (65.6%), musculoskeletal (63.5%), public health (63.1%), and cancer (54.2%).

DISCUSSION

Our findings suggest growing use of PROs in the assessment of health and interventions in ANZ. Our review identifies trial categories with limited patient-reported information and provides a basis for future work on the impact of PRO findings in clinical care.

Measuring cancer caregiver health literacy: Validation of the Health Literacy of Caregivers Scale-Cancer (HLCS-C) in an Australian population

Caregivers have been largely neglected in health literacy measurement. We assess the construct validity, and internal consistency of the Health Literacy of Caregivers Scale-Cancer (HLCS-C), and present a revised, psychometrically robust scale. Using data from 297 cancer caregivers (12.4% response rate) recruited from Melbourne, Australia between January-July 2014, confirmatory factor analysis (CFA) was conducted to evaluate the HLCS-C's proposed factor structure. Items were evaluated for: item difficulty, unidimensionality and overall item fit within their domain. Item-threshold-ordering was examined though one-parameter Item Response Theory models. Internal consistency was assessed using Raykov's reliability coefficient. CFA results identified 42 poorly performing/redundant items which were subsequently removed. A 10-factor model was fitted to 46 acceptable items with no correlated residuals or factor cross-loadings accepted. Adequate fit was revealed (χ²_WLSMV  = 1463.807[df = 944], p < .001, RMSEA = 0.043, CFI = 0.980, TLI = 0.978, WRMR = 1.00). Ten domains were identified: Proactivity and determination to seek information; Adequate information about cancer and cancer management; Supported by healthcare providers (HCP) to understand information; Social support; Cancer-related communication with the care recipient (CR); Understanding CR needs and preferences; Self-care; Understanding the healthcare system; Capacity to process health information; and Active engagement with HCP. Internal consistency was adequate across domains (0.78-0.92). The revised HLCS-C demonstrated good structural, convergent, and discriminant validity, and high internal consistency. The scale may be useful for the development and evaluation of caregiver interventions.

Omega-3 polyunsaturated fatty acid supplementation for improving peripheral nerve health: protocol for a systematic review

INTRODUCTION

Damage to peripheral nerves occurs in a variety of health conditions. Preserving nerve integrity, to prevent progressive nerve damage, remains a clinical challenge. Omega-3 polyunsaturated fatty acids (PUFAs) are implicated in the development and maintenance of healthy nerves and may be beneficial for promoting peripheral nerve health. The aim of this systematic review is to assess the effects of oral omega-3 PUFA supplementation on peripheral nerve integrity, including both subjective and objective measures of peripheral nerve structure and/or function.

METHODS AND ANALYSIS

A systematic review of randomised controlled trials that have evaluated the effects of omega-3 PUFA supplementation on peripheral nerve assessments will be conducted. Comprehensive electronic database searches will be performed in Ovid MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), US National Institutes of Health Clinical Trials Registry and the WHO International Clinical Trials Registry Platform. The title, abstract and keywords of identified articles will be assessed for eligibility by two reviewers. Full-text articles will be obtained for all studies judged as eligible or potentially eligible; these studies will be independently assessed by two reviewers to determine eligibility. Disagreements will be resolved by consensus. Risk of bias assessment will be performed using the Cochrane Collaboration risk of bias tool to appraise the quality of included studies. If clinically meaningful, and there are a sufficient number of eligible studies, a meta-analysis will be conducted and a summary of findings table will be provided.

ETHICS AND DISSEMINATION

This is a systematic review that will involve the analysis of previously published data, and therefore ethics approval is not required. A manuscript reporting the results of this systematic review will be published in a peer-reviewed journal and may also be presented at relevant scientific conferences.

PROSPERO REGISTRATION NUMBER

CRD42018086297.

Do active modes of transport cause lower body mass index? Findings from the HABITAT longitudinal study

Background

Few studies have examined the causal relationship between transport mode and body mass index (BMI).

Methods

We examined between-person differences and within-person changes in BMI by transport mode over four time points between 2007 and 2013. Data were from the How Areas in Brisbane Influence HealTh and AcTivity project, a population-representative study of persons aged 40–65 in 2007 (baseline) residing in 200 neighbourhoods in Brisbane, Australia. The analytic sample comprised 9931 respondents who reported on their main transport for all travel purposes (work-related and non-work-related). Transport mode was measured as private motor vehicle (PMV), public transport, walking and cycling. Self-reported height and weight were used to derive BMI. Sex-specific analyses were conducted using multilevel hybrid regression before and after adjustment for time-varying and time-invariant confounders.

Results

Independent of transport mode and after adjustment for confounders, average BMI increased significantly and linearly across the four time points for both men and women. Men and women who walked or cycled had a significantly lower BMI than their counterparts who used a PMV. BMI was nearly always lower during the time men and women walked or cycled than when they used a PMV; however, few statistically significant differences were observed. For women, BMI was significantly higher during the time they used public transport than when using a PMV.

Conclusion

The findings suggest a causal association between transport mode and BMI and support calls from health authorities to promote walking and cycling for transport as a way of incorporating physical activity into everyday life to reduce the risk of chronic disease.

Validation of the WHO-5 as a first-step screening instrument for depression in adults with diabetes: Results from Diabetes MILES - Australia

AIMS

Screening for depression is recommended internationally. The World Health Organization's 5-item Well-being Index (WHO-5) is used clinically to screen for depression but its empirical suitability for this purpose is not well documented. We investigated the psychometric properties of the WHO-5 and its suitability for identifying likely depression in Australian adults with diabetes.

METHODS

The Diabetes MILES - Australia study dataset provided a sample of N=3249 who completed the WHO-5 (positively-worded 5-item measure of emotional well-being) and the PHQ-9 (9-item measure of depressive symptoms). Analyses were conducted for the full sample, and separately by diabetes type and treatment (type 1, non-insulin-treated type 2, and insulin-treated type 2 diabetes). Construct (convergent and factorial) validity and reliability of the WHO-5 were examined. ROC analyses were used to examine the sensitivity and specificity of the WHO-5 as a depression screening instrument, comparing two commonly used WHO-5 cut-off values (≤7 and <13) with the PHQ-9.

RESULTS

For the whole sample, the WHO-5 demonstrated satisfactory internal consistency reliability (α=0.90) and convergent validity with the PHQ-9 (r=-0.73, p<0.001). Confirmatory factor analysis partially supported factorial validity: Χ²(5)=834.94, p<0.001; RMSEA=0.23, 90% CI 0.21-0.24; CFI=0.98, TLI=0.96; factor loadings=0.78-0.92. The AUC was 0.87 (95% CI: 0.86-0.89, p<0.001). The sensitivity/specificity of the WHO-5 for detecting likely depression was 0.44/0.96 for the ≤7 cut-off, and 0.79/0.79 for the <13 cut-off, with similar findings by diabetes type and treatment.

CONCLUSIONS

These findings support use of a WHO-5 cut-point of <13 to identify likely depression in Australian adults with diabetes, regardless of type/treatment.

Diversity in fall characteristics hampers effective prevention: the precipitants, the environment, the fall and the injury

Falls among the elderly are common and characteristics may differ between injurious and non-injurious falls. Among 887 older Australian women followed for 1.6 years, 32% fell annually. Only 8.5% resulted in fracture and/or hospital admission. The characteristics of those falls are indistinguishable from those not coming to medical attention.

INTRODUCTION

The precipitants and environment of all falls occurring among a large cohort of older Caucasian women were categorised by injury status to determine if the characteristics differed between injurious and non-injurious falls.

METHODS

Among 887 Australian women (70+ years), falls were ascertained using monthly postcard calendars and a questionnaire was administered for each fall. Hospital admissions and fractures were independently confirmed.

RESULTS

All falls were reported for a mean observation time of 577 (IQR 546-607) days per participant, equating to a total 1400 person-years. Thirty-two percent fell at least once per year. The most common features of a fall were that the faller was walking (61%) at home (61%) during the day (88%) and lost balance (32%). Only 12% of all falls occurred at night. Despite no difference in the type of injury between day and night, the likelihood of being hospitalised from a fall at night was 4.5 times greater than that of a daytime fall with adjustment for injury type and participant age (OR 4.5, 95% CI 2.1, 9.5; p < 0.001). Of all falls, approximately one third were associated with no injury to the faller (31%), one third reported a single injury (37%) and one third reported more than one injury (32%). In 95% of falls, the faller was not admitted to hospital. Only 5% of falls resulted in fracture(s).

CONCLUSIONS

Our findings demonstrate the significant diversity of precipitants and environment where falls commonly occur among older community-dwelling women. Falls resulting in fracture and/or hospital admission collectively represent 8.5% of all falls and their characteristics are indistinguishable from falls not coming to medical attention and incurring no apparent cost to the health system.

Associations between illness duration and health-related quality of life in specified mental and physical chronic health conditions: results from a population-based survey

PURPOSE

We compared health-related quality of life (HRQOL) in incident (≤1 year since diagnosis), mid-term (>1-5 years since diagnosis), and long-term (>5 years since diagnosis) cases of mental and physical chronic illness with the general population and assessed the modifying effects of age and gender on the association between HRQOL and illness duration.

METHODS

Data from the 2007 Australian National Health and Mental Wellbeing Survey were used. HRQOL was captured by the Assessment of Quality of Life Scale 4D. Multivariable linear regression analyses compared HRQOL of individuals with different duration of illnesses with those who did not have the condition of interest.

RESULTS

The 8841 survey respondents were aged 16-85 years (median 43 years, 50.3% female). For the overall sample, worse HRQOL was associated with incident (P = 0.049) and mid-term (P = 0.036) stroke and long-term depression (P < 0.001) and anxiety (P = 0.001). Age had moderating effect on the associations between HRQOL and duration of asthma (P < 0.001), arthritis (P = 0.001), diabetes (P = 0.004), stroke (P = 0.009), depression (P < 0.001), bipolar disorder (P < 0.001), and anxiety (P < 0.001), but not heart disease (P = 0.102). In older ages, the greatest loss in HRQOL was associated with incident asthma, depression, and bipolar disorder. In younger ages, the greatest loss in HRQOL was associated with arthritis (any duration) and incident diabetes and anxiety. Additionally, gender moderated the association between HRQOL and arthritis, with worse HRQOL among men with incident arthritis (P = 0.047).

CONCLUSIONS

Loss of HRQOL associated with longer duration of chronic illness is most apparent in stroke and mental illness and differs between age groups.

Healthy me: A gender-specific program to address body image concerns and risk factors among preadolescents

This study evaluated a gender-specific, school-based program to promote positive body image and address risk factors for body dissatisfaction. In total, 652 children aged 8-10 years participated (335 intervention, 317 wait-list control). Children participated in four 60min sessions and a recap session at three months post-intervention. The broad content areas were body image, peer relationships, media awareness, healthy diet, and exercise. The activities and examples for each session were gender specific. The recap session was an overview of the four sessions. Assessment measures were completed at pre-intervention, post-intervention, and after the recap. Boys and girls in the intervention demonstrated higher muscle esteem and vegetable intake at post-intervention, compared to children in the control condition. Boys and girls demonstrated higher body esteem, muscle esteem and fruit and vegetable intake at the recap. Boys in the intervention demonstrated less investment in masculine gender norms at post-intervention and at recap.

A parent-based intervention to promote healthy eating and active behaviours in pre-school children: evaluation of the MEND 2-4 randomized controlled trial

BACKGROUND

There is a paucity of studies evaluating targeted obesity prevention interventions in pre-school children.

OBJECTIVES

We conducted a randomized controlled trial to evaluate the efficacy of a parent-based obesity prevention intervention for pre-schoolers - MEND (Mind, Exercise, Nutrition … Do It!) 2-4 on child diet, eating habits, physical activity/sedentary behaviours, and body mass index (BMI).

METHODS

Parent-child dyads attended 10 weekly 90-min workshops relating to nutrition, physical activity and behaviours, including guided active play and healthy snack time. Assessments were conducted at baseline, immediately post-intervention, and 6 and 12 months post-intervention; child intake of vegetables, fruit, beverages, processed snack foods, fussiness, satiety responsiveness, physical activity, sedentary behaviour and neophobia were assessed via parent proxy report. Parent and child height and weight were measured.

RESULTS

Two hundred one parent-child dyads were randomized to intervention (n = 104) and control (n = 97). Baseline mean child age was 2.7 (standard deviation [SD] 0.6) years, and child BMI-for-age z-score (World Health Organization) was 0.66 (SD 0.88). We found significant positive group effects for vegetable (P = 0.01) and snack food (P = 0.03) intake, and satiety responsiveness (P = 0.047) immediately post-intervention. At 12 months follow-up, intervention children exhibited less neophobia (P = 0.03) than controls.

CONCLUSION

Future research should focus on additional strategies to support parents to continue positive behaviour change. ACTRN12610000200088.

Psychometric Properties of a Tool to Measure Nurses' Attitudes to Single Checking Medications: SCAMS-II

BACKGROUND AND AIMS

Single checking medications has been increasingly adopted over the past decade by nurses in Australian healthcare services. However, attitudes toward the practice of only one nurse checking medications remain unclear. The aim of this article is to report on the development, reliability, and validity of a tool to measure nurses' attitudes to single checking medications in a health service in which single checking has been in place for over a decade.

METHODS

In a cross-sectional survey design, the Single Checking and Administration of Medications Scale (SCAMS-II) was used to measure the attitudes of 299 registered nurses (RNs) who were single checking medications in one metropolitan teaching hospital in Australia. Exploratory factor analysis was used to explore the dimensions that best represented the SCAMS-II. Cronbach's α was used to assess internal consistency of the identified subscales. To test the construct validity of the emergent questionnaire, Confirmatory Factor Analysis and Rasch analyses were performed.

RESULTS

The psychometric properties of the SCAMS-II revealed 12 items with three reliable subscales: a five-item accountability model; a four-item efficiency model; and a three-item knowledge model.

LINKING EVIDENCE TO ACTION

In settings where single checking is current practice, the SCAMS-II is recommended as a reliable tool to measure nurses' attitudes toward the single checking of medications. The findings from this study may assist healthcare organizations in the development of policy and procedure guidelines for the safe administration of medications.

Effectiveness of dual-task functional power training for preventing falls in older people: study protocol for a cluster randomised controlled trial

Background

Falls are a major public health concern with at least one third of people aged 65 years and over falling at least once per year, and half of these will fall repeatedly, which can lead to injury, pain, loss of function and independence, reduced quality of life and even death. Although the causes of falls are varied and complex, the age-related loss in muscle power has emerged as a useful predictor of disability and falls in older people. In this population, the requirements to produce explosive and rapid movements often occurs whilst simultaneously performing other attention-demanding cognitive or motor tasks, such as walking while talking or carrying an object. The primary aim of this study is to determine whether dual-task functional power training (DT-FPT) can reduce the rate of falls in community-dwelling older people.

Methods/Design

The study design is an 18-month cluster randomised controlled trial in which 280 adults aged ≥65 years residing in retirement villages, who are at increased risk of falling, will be randomly allocated to: 1) an exercise programme involving DT-FPT, or 2) a usual care control group. The intervention is divided into 3 distinct phases: 6 months of supervised DT-FPT, a 6-month ‘step down’ maintenance programme, and a 6-month follow-up. The primary outcome will be the number of falls after 6, 12 and 18 months. Secondary outcomes will include: lower extremity muscle power and strength, grip strength, functional assessments of gait, reaction time and dynamic balance under single- and dual-task conditions, activities of daily living, quality of life, cognitive function and falls-related self-efficacy. We will also evaluate the cost-effectiveness of the programme for preventing falls.

Discussion

The study offers a novel approach that may guide the development and implementation of future community-based falls prevention programmes that specifically focus on optimising muscle power and dual-task performance to reduce falls risk under ‘real life’ conditions in older adults. In addition, the ‘step down’ programme will provide new information about the efficacy of a less intensive maintenance programme for reducing the risk of falls over an extended period.

Trial registration

Australian New Zealand Clinical Trials Registry: ACTRN12613001161718. Date registered 23 October 2013.

'Wide-awake drunkenness'? Investigating the association between alcohol intoxication and stimulant use in the night-time economy

AIMS

We tested whether patrons of the night-time economy who had co-consumed energy drinks or illicit stimulants with alcohol had higher blood alcohol concentration (BAC) levels than patrons who had consumed only alcohol.

DESIGN

Street intercept surveys (n = 4227) were undertaken between 9 p.m. and 5 a.m. over a period of 7 months.

SETTING

Interviews were undertaken with patrons walking through entertainment precincts, queuing to enter venues or exiting venues in five Australian cities.

PARTICIPANTS

The response rate was 92.1%; more than half the study sample was male (60.2%) and the median age was 23 years (range 18-72).

MEASUREMENTS

Data were collected on demographics, length of drinking session, venue types visited, types and quantity of alcohol consumed and other substance use. A BAC reading was recorded and a subsample of participants was tested for other drug use.

FINDINGS

Compared with the total sample (0.068%), illicit stimulant consumers (0.080%; P = 0.004) and energy drink consumers (0.074%; P < 0.001) had a significantly higher median BAC reading, and were more likely to engage in pre-drinking (65.6, 82.1 and 77.6%, respectively, P < 0.001) and longer drinking sessions (4, 5 and 4.5 hours, respectively, P < 0.001). However, stimulant use was not associated independently with higher BAC in the final multivariable model (illicit stimulants P = 0.198; energy drinks P = 0.112). Interaction analyses showed that stimulant users had a higher BAC in the initial stages of the drinking session, but not after 4-6 hours.

CONCLUSIONS

While stimulant use does not predict BAC in and of itself, stimulants users are more likely to engage in prolonged sessions of heavy alcohol consumption and a range of risk-taking behaviours on a night out, which may explain higher levels of BAC among stimulants users, at least in the initial stages of the drinking session.

Sociocultural influences on strategies to lose weight, gain weight, and increase muscles among ten cultural groups

This study determined how sociocultural messages to change one's body are perceived by adolescents from different cultural groups. In total, 4904 adolescents, including Australian, Chilean, Chinese, Indo-Fijian, Indigenous Fijian, Greek, Malaysian, Chinese Malaysian, Tongans in New Zealand, and Tongans in Tonga, were surveyed about messages from family, peers, and the media to lose weight, gain weight, and increase muscles. Groups were best differentiated by family pressure to gain weight. Girls were more likely to receive the messages from multiple sociocultural sources whereas boys were more likely to receive the messages from the family. Some participants in a cultural group indicated higher, and others lower, levels of these sociocultural messages. These findings highlight the differences in sociocultural messages across cultural groups, but also that adolescents receive contrasting messages within a cultural group. These results demonstrate the difficulty in representing a particular message as being characteristic of each cultural group.

Optimizing prediction of binge eating episodes: a comparison approach to test alternative conceptualizations of the affect regulation model

BACKGROUND

Although a wealth of studies have tested the link between negative mood states and likelihood of a subsequent binge eating episode, the assumption that this relationship follows a typical linear dose-response pattern (i.e., that risk of a binge episode increases in proportion to level of negative mood) has not been challenged. The present study demonstrates the applicability of an alternative, non-linear conceptualization of this relationship, in which the strength of association between negative mood and probability of a binge episode increases above a threshold value for the mood variable relative to the slope below this threshold value (threshold dose response model).

METHODS

A sample of 93 women aged 18 to 40 completed an online survey at random intervals seven times per day for a period of one week. Participants self-reported their current mood state and whether they had recently engaged in an eating episode symptomatic of a binge.

RESULTS

As hypothesized, the threshold approach was a better predictor than the linear dose-response modeling of likelihood of a binge episode. The superiority of the threshold approach was found even at low levels of negative mood (3 out of 10, with higher scores reflecting more negative mood). Additionally, severity of negative mood beyond this threshold value appears to be useful for predicting time to onset of a binge episode.

CONCLUSIONS

Present findings suggest that simple dose-response formulations for the association between negative mood and onset of binge episodes miss vital aspects of this relationship. Most notably, the impact of mood on binge eating appears to depend on whether a threshold value of negative mood has been breached, and elevation in mood beyond this point may be useful for clinicians and researchers to identify time to onset.

Field-testing of the rapid assessment of disability questionnaire

BACKGROUND

The Rapid Assessment of Disability (RAD) questionnaire measures the magnitude and impact of disability and aims to inform the design of disability inclusive development programs. This paper reports the psychometric evaluation of the RAD.

METHODS

The initial version of the RAD comprised five sections: 1) demographics, 2) functioning, 3) rights awareness, 4) well-being, and 5) access to the community. Item functioning and construct validity were assessed in a population-based study in Bangladesh. Data were analysed using descriptive statistics (sections 2 and 5) and Rasch modelling (sections 3 and 4). A subsequent case-control study in Fiji tested the refined questionnaire in a cross-cultural setting and assessed the sensitivity and specificity of the RAD section 2 to identify people with disability.

RESULTS

2,057 adults took part in the study (1,855 in Bangladesh and 202 in Fiji). The prevalence of disability estimated using RAD section 2 in Bangladesh was 10.5% (95% CI 8.8-12.2), with satisfactory sensitivity and specificity (62.4% and 81.2%, respectively). Section 3 exhibited multidimensionality and poor differentiation between levels of rights awareness in both Bangladesh (person separation index [PSI] = 0.71) and Fiji (PSI = 0.0), and was unable to distinguish between people with and without disability (Bangladesh p = 0.786, Fiji p = 0.43). This section was subsequently removed from the questionnaire pending re-development. Section 4 had good ability to differentiate between levels of well-being (PSI = 0.82). In both countries, people with disability had significantly worse well-being scores than people without disability (p < 0.001) and also access to all sectors of community except legal assistance, drinking water and toilets (p < 0.001).

CONCLUSIONS

Filed-testing in Bangladesh and Fiji confirmed the psychometric robustness of functioning, well-being, and community access sections of the RAD. Information from the questionnaire can be used to inform and evaluate disability inclusive development programs.

Observable essential fatty acid deficiency markers and autism spectrum disorder

Autism Spectrum Disorder (ASD) has been associated with essential fatty acid (EFA) deficiencies, with some researchers theorising that dysregulation of phospholipid metabolism may form part of the biological basis for ASD. This pilot study compared observable signs of fatty acid status of 19 children with an ASD diagnosis to 23 of their typically developing siblings. A pregnancy, birth and breastfeeding history was also obtained from their parents, which included a measure of infant intake of fatty acid rich colostrum immediately post-partum. When considered within their family group, those infants not breastfed (with colostrum) within the first hour of life and who had a history of fatty acid deficiency symptoms were more likely to have an ASD diagnosis. Other variables such as formula use, duration of breastfeeding, gestational age and Apgar scores were not associated with group membership. The results of this study are consistent with previous research showing a relationship between fatty acid metabolism, breastfeeding and ASD such that early infant feeding practices and the influence this has on the fatty acid metabolism of the child may be a risk factor for ASD.

Cost-Effectiveness of Thrombolysis Within 4.5 Hours of Acute Ischemic Stroke

Background and Purpose—

Previous economic studies outside Australia have demonstrated that patients treated with tissue-type plasminogen activator (tPA) within 4.5 hours of stroke onset have lower healthcare costs than those not. We aim to perform cost-effectiveness analysis of intravenous tPA in an Australian setting.

Methods—

Data on clinical outcomes and costs were derived for 378 patients who received intravenous tPA within 4.5 hours of stroke onset at Royal Melbourne Hospital (Australia) between January 2003 and December 2011. To simulate clinical outcomes and costs for a hypothetical control group assumed not to have received tPA, we applied efficacy data from a meta-analysis of randomized trials to outcomes observed in the tPA group. During a 1-year time-horizon, net costs, years of life lived, and quality-adjusted life-years were compared and incremental cost-effectiveness ratios derived for tPA versus no tPA.

Results—

In the study population, mean (SD) age was 68.2 (13.5) years and 206 (54.5%) were men. Median National Institutes of Health Stroke Scale score (interquartile range) at presentation was 12.5 (8–18). Compared with no tPA, we estimated that tPA would result in 0.02 life-years and 0.04 quality-adjusted life-years saved per person >1 year. The net cost of tPA was AUD $55.61 per patient. The incremental cost-effectiveness ratios were AUD $2377 per life-year saved and AUD $1478 per quality-adjusted life-years saved. Because the costs of tPA are incurred only once, the incremental cost-effectiveness ratios would decrease with increasing time-horizon. Uncertainty analyses indicated the results to be robust.

Conclusions—

Intravenous tPA within 4.5 hours represents a cost-effective intervention for acute ischemic stroke.

A grounded patient-centered approach generated the personal and societal burden of osteoarthritis model

OBJECTIVE

To develop a conceptual model to describe the burden of osteoarthritis in individuals with this condition and on the broader community.

STUDY DESIGN AND SETTING

Six concept mapping workshops were undertaken: three with patients (n = 26) and three with health professionals (n = 27) in Australia and Sweden. The participants were asked to generate statements describing how osteoarthritis affects individuals with this condition and those around them. The results were used to construct an integrated theoretical model of the personal burden of osteoarthritis (PBO) and its extended version, the personal and societal burden of osteoarthritis (PSBO) model.

RESULTS

We identified eight potentially independent aspects of PBO, including physical distress, fatigue, physical limitations, psychosocial distress, physical deconditioning, financial hardship, sleep disturbances, and lost productivity. Physical distress and impaired physical function combined to produce psychosocial problems, reduced work productivity, financial difficulties, and loss of physical fitness at the individual level, and increased health and welfare cost at the societal level.

CONCLUSION

The PBO and PSBO models were developed directly from the views of patients and clinicians and provide new insights for managing the individual and societal burden of osteoarthritis.

Do patients who take part in stroke research differ from non-participants? Implications for generalizability of results

BACKGROUND

Stroke is one of the most disabling neurological conditions. Clinical research is vital for expanding knowledge of treatment effectiveness among stroke patients. However, evidence begins to accumulate that stroke patients who take part in research represent only a small proportion of all stroke patients. Research participants may also differ from the broader patient population in ways that could potentially distort treatment effects reported in therapeutic trials. The aims of this study were to estimate the proportion of stroke patients who take part in clinical research studies and to compare demographic and clinical profiles of research participants and non-participants.

METHODS

5,235 consecutive patients admitted to the Stroke Care Unit of the Royal Melbourne Hospital, Melbourne, Australia, for stroke or transient ischaemic attack between January 2004 and December 2011 were studied. The study used cross-sectional design. Information was collected on patients' demographic and socio-economic characteristics, risk factors, and comorbidities. Associations between research participation and patient characteristics were initially assessed using χ(2) or Mann-Whitney tests, followed by a multivariable logistic regression analysis. The logistic regression analysis was carried out using generalised estimating equations approach, to account for patient readmissions during the study period.

RESULTS

558 Stroke Care Unit patients (10.7%) took part in at least one of the 33 clinical research studies during the study period. Transfer from another hospital (OR = 0.35, 95% CI 0.22-0.55), worse premorbid function (OR = 0.61, 95% CI 0.54-0.70), being single (OR = 0.61, 95% CI 0.44-0.84) or widowed (OR = 0.77, 95% CI 0.60-0.99), non-English language (OR = 0.67, 95% CI 0.53-0.85), high socio-economic status (OR = 0.74, 95% CI 0.59-0.93), residence outside Melbourne (OR = 0.75, 95% CI 0.60-0.95), weekend admission (OR = 0.78, 95% CI 0.64-0.94), and a history of atrial fibrillation (OR = 0.79, 95% CI 0.63-0.99) were associated with lower odds of research participation. A history of hypertension (OR = 1.50, 95% CI 1.08-2.07) and current smoking (OR = 1.23, 95% CI 1.01-1.50) on the other hand were associated with higher odds of research participation.

CONCLUSIONS

The results of this study indicate that stroke patients who take part in clinical research do not represent 'typical' patient admitted to a stroke unit. The imbalance of prognostic factors between stroke participants and non-participants has serious implications for interpretation of research findings reported in stroke literature. This study provides insights into clinical, demographic, and socio-economic characteristics of stroke patients that could potentially be targeted to enhance generalizability of stroke research studies. Given the imbalance of prognostic factors between research participants and non-participants, future studies need to examine differences in stroke outcomes of these groups of patients.

In-home monitoring of older adults with vision impairment: exploring patients', caregivers' and professionals' views

OBJECTIVE

To develop a conceptual framework for the design of an in-home monitoring system (IMS) based on the requirements of older adults with vision impairment (VI), informal caregivers and eye-care rehabilitation professionals.

MATERIALS AND METHODS

Concept mapping, a mixed-methods statistical research tool, was used in the construction of the framework. Overall, 40 participants brainstormed or sorted and rated 83 statements concerning an IMS for older adults with VI. Multidimensional scaling and hierarchical cluster analysis were employed to construct the framework. A questionnaire yielded further insights into the views of a wider sample of older adults with VI (n=78) and caregivers (n=25) regarding IMS.

RESULTS

Concept mapping revealed a nine-cluster model of IMS-related aspects including affordability, awareness of system capabilities, simplicity of installation, operation and maintenance, system integrity and reliability, fall detection and safe movement, user customization, user preferences regarding information delivery, and safety alerts for patients and caregivers. From the questionnaire, independence, safety and fall detection were the most commonly reported reasons for older adults and caregivers to accept an IMS. Concerns included cost, privacy, security of the information obtained through monitoring, system accuracy, and ease of use.

DISCUSSION

Older adults with VI, caregivers and professionals are receptive to in-home monitoring, mainly for fall detection and safety monitoring, but have concerns that must be addressed when developing an IMS.

CONCLUSION

Our study provides a novel conceptual framework for the design of an IMS that will be maximally acceptable and beneficial to our ageing and vision-impaired population.

The health literacy management scale (HeLMS): a measure of an individual's capacity to seek, understand and use health information within the healthcare setting

OBJECTIVE

Health literacy refers to an individual's ability to seek, understand, and use health information. This paper describes the development and psychometric testing of the health literacy management scale (HeLMS).

METHODS

Content areas were identified from a conceptual framework derived from interviews and concept mapping. Items were generated from statements from concept mapping participants. Construction (N=333) and replication (N=350) samples were participants in chronic disease self-management programs and emergency department attendees. Factor analysis was used to refine constructs and define psychometric properties.

RESULTS

Consultations generated 8 scales each with 4-5 items: Understanding health information, Accessing GP healthcare services, Communication with health professionals, Being proactive and Using health information, Patient attitudes towards their health, Social support, and Socioeconomic considerations. Confirmatory factor analyses indicated good fit of the data with the model (RMSEA=0.07, SRMR=0.05, CFI=0.97) and all domains had high internal consistency (Cronbach alpha>0.82).

CONCLUSION

The HeLMS has acceptable psychometric properties and assesses a range of health literacy constructs important to patients when seeking, understanding and using health information within the healthcare system.

PRACTICE IMPLICATIONS

The HeLMS presents a new approach to assessing health literacy in healthcare settings.

Younger siblings, C-reactive protein, and risk of age-related macular degeneration

In this study, we examined the relationship between exposure to siblings and 1) the risk of age-related macular degeneration (AMD) and 2) C-reactive protein levels. We retrospectively analyzed pooled cross-sectional data from 2 studies: the Cardiovascular Health and Age-Related Maculopathy Study (2001-2002) and the Age-Related Maculopathy Statin Study (2004-2006). Associations between number of siblings and AMD were assessed by using multinomial logistic regression. Associations between number of siblings and C-reactive protein levels were examined by using a generalized linear model for γ distribution. A higher number of younger siblings was associated with significantly lower odds of early AMD in those with a family history of AMD (odds ratio = 0.2, 95% confidence interval: 0.1, 0.8) (P = 0.022) but was unrelated to AMD for those who had no family history of the disease (odds ratio = 1.0, 95% confidence interval: 0.9, 1.2) (P = 0.874). A higher number of younger siblings correlated with lower C-reactive protein levels (β = -0.19, 95% confidence interval: -0.38, -0.01) (P = 0.036). This supports the theory that immune modulation contributes to AMD pathogenesis and suggests that exposure to younger siblings might be protective when there is a family history of AMD.

Abstract TP384: Recovery Trajectories in Acute Non-fatal Stroke

Introduction: Traditional approaches to the study of post stroke recovery assume that recovery follows a homogenous path, with deviations from the average explained in terms of socio-demographic and clinical differences. Latent class analysis (LCA) provides a powerful tool to investigate potential heterogeneity in post-stroke recovery pathways.

Aims: We aimed to 1) explore recovery trajectories in acute stroke over 3 months using LCA and 2) identify predictors of poor recovery.

Methods: Data from 202 patients admitted to Stroke Care Unit at the Royal Melbourne Hospital (Australia) between January and June 2011 were analyzed. The main outcome was disability (modified Rankin Score) pre-stroke, at discharge, and 3 months post stroke. Predictors of poor recovery were assessed using logistic regression analysis.

Results: Patients’ mean (SD) age was 68.6 (14.1), 58% were males and 82% had ischemic strokes. LCA identified 6 mutually exclusive recovery trajectories (see Figure 1), including: 1) No disability at onset, no impact from stroke (n=43); 2) Substantial disability, no impact from stroke (n=20); 3) Some disability, mild impact, full recovery (n=36); 4) No disability, mild impact, partial recovery (n=26); 5) No disability, high impact, partial recovery (n=50); 6) No disability, high impact, no recovery (n=27). Compared with those who made at least partial recovery (trajectories 1-5), those who made no recovery at 3 months were significantly younger (OR 0.97 95%CI 0.95,0.99) and more likely to be smokers (OR 2.48 95%CI 1.04,5.90). History of atrial fibrillation, ischemic heart disease, previous stroke, and stroke type were not associated with poor recovery (p≥0.103).

Conclusions: This study identifies stroke recovery pathways, providing a potentially useful tool for identifying individuals at risk of poor recovery and in need of targeted intervention.

The Impact of Knowledge and Attitudes on Access to Eye-Care Services in Cambodia

PURPOSE

To investigate how knowledge and attitudes influence the access to eye-care services in Takeo Province, Cambodia.

DESIGN

A cross-sectional survey (n=600).

METHODS

30 villages were randomly selected. Groups included: >50 years, 30-49 years, and parents with children <5 years. A newly developed Knowledge, Attitude and Practice in Eye Health (KAP-EH) questionnaire about knowledge and treatment of eye diseases, practices and attitudes to accessing services was used to interview respondents. Descriptive analysis, including Chi square and logistic regression tested for associations with sub-groups of gender, age group, education and self-reported type of disability.

RESULTS

The proportion of respondents who reported having knowledge of specific eye conditions ranged from 97% for eye injury, to 8% for diabetic eye disease. While 509 (85%) people reported knowledge of cataract, 47% did not know how cataract was treated and only 19% listed surgery. The older group (66.5%) were least informed about cataract (p= 0.001) compared to other groups, and were least likely to believe that some blindness could be prevented (p < 0.001). Women (55%) were more likely than men (46%) (p=0 .003) to report that a child with blindness could attend school, as did people without a disability compared to those with a disability (58% vs 34%) (p < 0.001).

CONCLUSIONS

The knowledge about cataract and refractive error and what to do to resolve the problems was low among this population and this study suggests that poor knowledge of eye diseases might contribute to the occurrence of un-operated cataract and uncorrected refractive error.