Far West Local Health District

Access is defined as the degree of fit between the user and the service; the better the fit, the better the access. Using the theory developed by Penchansky and Thomas, access is optimized by accounting for the different dimensions of access: accessibility; availability; acceptability; affordability; and adequacy in service design, implementation and evaluation. These dimensions are independent yet interconnected and each is important to assess the achievement of access. However, I argue that one dimension is missing - awareness. I propose that awareness is integral to access, that it should become a permanent part of the theory, and be applied whenever using the theory to develop, implement, or evaluate health care services and access more generally.

Iron deficiency anaemia (IDA) remains prevalent in Australia and worldwide, especially among high-risk groups. IDA may be effectively diagnosed in most cases by full blood examination and serum ferritin level. Serum iron levels should not be used to diagnose iron deficiency. Although iron deficiency may be due to physiological demands in growing children, adolescents and pregnant women, the underlying cause(s) should be sought. Patients without a clear physiological explanation for iron deficiency (especially men and postmenopausal women) should be evaluated by gastroscopy/colonoscopy to exclude a source of gastrointestinal bleeding, particularly a malignant lesion. Patients with IDA should be assessed for coeliac disease. Oral iron therapy, in appropriate doses and for a sufficient duration, is an effective first-line strategy for most patients. In selected patients for whom intravenous (IV) iron therapy is indicated, current formulations can be safely administered in outpatient treatment centres and are relatively inexpensive. Red cell transfusion is inappropriate therapy for IDA unless an immediate increase in oxygen delivery is required, such as when the patient is experiencing end-organ compromise (eg, angina pectoris or cardiac failure), or IDA is complicated by serious, acute ongoing bleeding. Consensus methods for administration of available IV iron products are needed to improve the utilisation of these formulations in Australia and reduce inappropriate transfusion. New-generation IV products, supported by high-quality evidence of safety and efficacy, may facilitate rapid administration of higher doses of iron, and may make it easier to integrate IV iron replacement into routine care.

Background: Social inclusion is a key priority of the Fourth National Mental Health Plan for Australia (2009–2014), with strong evidence for its protective impact on mental health. Social integration has been associated with enhanced well-being for people with mental illnesses such as psychosis. Objective: To explore the impact of psychosis on an individual’s social and community participation. Method: The second Australian national survey of psychosis was conducted across seven Australian sites. Semi-structured interviews with adults living with psychosis assessed mental health status, social and role functioning, life satisfaction and future goals. The cohort comprised 1825 adults with a psychotic illness (59.6% were male; 42.4% were aged 18–34 years; 31.5% had 12 years or more of education) of whom 32.7% had been employed in the past year. Results: Most adults indicated experiencing loneliness (80.1%) and a need for more friends (48.1%). Men were more likely to have never had a long-term relationship (59.4% M, 33.2% F). Even though women were more likely to experience anxiety in social situations [(χ 2 (1) = 8.95, p < 0.01)], they were more likely to have attended a social activity in the past year [χ 2 (2) = 11.84, p < 0.01]. Just over half of the survey participants (56.7%) reported having daily or nearly daily contact with family members. In the past year, 69% had not attended any social activity and 43% described stigma as a barrier. Although 63.2% showed significant impairment in social functioning, only 29.5% had received help for this in the last year. Social isolation and loneliness were rated as major challenges by 37.2% of the cohort. Conclusions: Social isolation and dysfunction experienced by people with psychosis have not decreased since the last Australian national survey of people with psychosis. Alongside education and employment, social functioning and participation must be addressed to improve social inclusion for people with psychosis. Programs targeting social opportunities (befriending, peer support), social anxiety and social functioning for all stages of psychosis are warranted.

Wet surface heat exchangers such as cooling towers and wet plate heat exchangers are important in air conditioning. A linear approximate model of wet surface heat exchangers is proposed. The equations of the model are rearranged, enabling solutions for wet bulb depression and wet bulb temperature to be obtained independently, by analogy from published solutions for dry bulb temperature in dry surface heat exchangers. Performance predictions by this method for a crossflow cooling tower are found to agree with those from a prevous finite difference solution. Published performance measurements for a crossflow wet plate heat exchanger are lower than predicted by the method possibly due to poor wetting or excessive water flow. Excellent performance is predicted for a proposed regenerative evaporative cooler using such an exchanger.

OBJECTIVE: This paper outlines the methods and baseline data from a multisite cohort study of the determinants and outcomes of mental health and well-being within rural and remote communities. METHODS: A stratified random sample of adults was drawn in non-metropolitan New South Wales using the Australian Electoral Roll, with the aim of recruiting all adult members of each household. Surveys assessed psychological symptoms, physical health and mental disorders, along with individual-, family/household- and community-level characteristics. A stratified subsample completed a telephone-administered World Mental Health-Composite International Diagnostic Interview (World Mental Health-3.0). Proxy measures of child health and well-being were obtained. Follow up of this sample will be undertaken at one, three and five years. RESULTS: A total of 2639 individuals were recruited (1879 households), with 28% from remote/very remote regions. A significant relationship was found between recent distress (Kessler-10 scores), age and remoteness, with a linear reduction of Kessler-10 scores with age and the lowest mean scores in remote regions. CONCLUSIONS: Existing rurality categories cannot address the diverse socio-cultural, economic and environmental characteristics of non-metropolitan regions. While it has limitations, the dataset will enable a fine-grained examination of geographic, household and community factors and provide a unique longitudinal dataset over a five-year period.

Abstract Sign reversals in the coincident-loop transient response can be produced by employing a Cole-Cole model in numerical TEM modeling of polarizable conductors. These reversals may be thought of in terms of a polarization current which changes sign during the transient, passing from a charging current at early times to a discharging current at late times. In a layered earth, the relative strength of this current compared to the normally induced vortex current dictates whether or not a reversal is seen. If the earth is conductive, the effects of the polarization current may never be seen. If, however, the earth is only moderately conductive, the polarization current may dominate.In the case of a 3-D polarizable conductor in a conductive host, the addition of a host response serves to delay the time of any sign reversal in the transient. Reducing the host rock response by increasing its resistivity enables the polarization current to dominate earlier. By bringing the conductor closer to the surface, the amplitude of the negative response can be made greater and hence the sign reversal brought earlier in time. In such cases, moderate polarization parameters may cause substantial negative responses.It is possible to interpret TEM anomalies exhibiting sign reversals. The location and geometry of a discrete polarizable conductor can be correctly assessed, and a valid but approximate TEM time constant can be measured, from the positive part of the transient before the sign reversal.

OBJECTIVE: To determine the percentage of research projects funded by the National Health and Medical Research Council in the period 2000-2014 that aimed specifically to deliver health benefits to Australians living in rural and remote areas and to estimate the proportion of total funding this represented in 2005-2014. DESIGN: This is a retrospective analysis of publicly available datasets. SETTING: National Health and Medical Research Council Rural and Remote Health Research 2000-2014. OUTCOME MEASURES: 'Australian Rural Health Research' was defined as: research that focussed on rural or remote Australia; that related to the National Health and Medical Research Council's research categories other than Basic Science; and aimed specifically to improve the health of Australians living in rural and remote areas. Grants meeting the inclusion criteria were grouped according to the National Health and Medical Research Council's categories and potential benefit. Funding totals were aggregated and compared to the total funding and Indigenous funding for the period 2005-2014. RESULTS: Of the 16 651 National Health and Medical Research Council-funded projects, 185 (1.1%) that commenced funding during the period 2000-2014 were defined as 'Australian Rural Health Research'. The funding for Australian Rural Health Research increased from 1.0% of the total in 2005 to 2.4% in 2014. A summary of the funding according to the National Health and Medical Research Council's research categories and potential benefit is presented. CONCLUSION: Addressing the health inequality experienced by rural and remote Australians is a stated aim of the Australian Government. While National Health and Medical Research Council funding for rural health research has increased over the past decade, at 2.4% by value, it appears very low given the extent of the health status and health service deficits faced by the 30% who live in rural Australia.

After European colonization, the ancestral remains of Indigenous people were often collected for scientific research or display in museum collections. For many decades, Indigenous people, including Native Americans and Aboriginal Australians, have fought for their return. However, many of these remains have no recorded provenance, making their repatriation very difficult or impossible. To determine whether DNA-based methods could resolve this important problem, we sequenced 10 nuclear genomes and 27 mitogenomes from ancient pre-European Aboriginal Australians (up to 1540 years before the present) of known provenance and compared them to 100 high-coverage contemporary Aboriginal Australian genomes, also of known provenance. We report substantial ancient population structure showing strong genetic affinities between ancient and contemporary Aboriginal Australian individuals from the same geographic location. Our findings demonstrate the feasibility of successfully identifying the origins of unprovenanced ancestral remains using genomic methods.

SUMMARY The effects of prolonged strenuous exercise on the plasma concentrations of sodium, potassium, calcium, chloride, bicarbonate, phosphate, albumin, cholesterol, glucose, creatinine, bilirubin, alkaline phosphatase, creatine phosphokinase, lactic dehydrogenase and aspartate amino transferase were studied in a group of 26 horses competing in an endurance ride. There were significant changes in most parameters, when control values were compared with those taken immediately after the ride. There was also a significant correlation between several biochemical parameters and heart rate taken 30 minutes after the ride. When faster and slower horses were compared, significant differences were found only in phosphate and glucose values. RÉSUMÉ Sur 26 chevaux soumis à une épreuve d'endurance, on étudie les modifications plasmatiques du sodium, du potassium, du calcium, des chlorures, bicarbonates, phosphates, de l'albumine, du cholesterol, du glucose, de la creatinine, de la bilirubine, des phosphatases alcalines, creatine phosphokinase, lacto déshydrogénase et aspartate amino transferase. Dans la plupart des paramètres des modifications significatives furent constatées entre les valeurs recueillies en fin d'effort et les valeurs de controle. Des corrections significatives furent également constatées entre certains paramètres et le rythme du coeur, trente minutes après l'épreuve. Des taux plasmatiques de phosphates et glucoses ont été différents de manière significative suivant la rapidité des chevaux. ZUSAMMENFASSUNG Die Auswirkungen einer längeren, grossen Anstrengung auf die Plasmakonzentrationen von Natrium, Kalium, Calcium, Chlorid, Bikarbonat, Phosphat, Albumin, Cholesterin, Glucose, Kreatinin, Bilirubin, alkalische Phosphatase, Kreatin‐Phosphokinase, Lactatdehydrogenase und Aspartat‐Amminotransferase wurden an einer Gruppe von 26 Pferden studiert, die an einem Distanzritt teilnahmen. Signifikante Veränderungen der meisten Parameter gegenüber den Ausgangswerten stellten sich nach der Ausdauerprüfung ein. Es bestand auch eine signifikante Korrelation zwischen mehreren biochemischen Parametern und der Herzschlagfrequenz 30 Minuten nach dem Ritt. Ein Vergleich von schnelleren und langsameren Pferden ergab nur für Phosphat und Glucose signifikante Unterschiede.

The survival of patients who were artificially ventilated in an intensive therapy unit (ITU) of a district general hospital was studied. The first 100 such patients admitted were followed up for at least four years. Of these, 67 survived treatment in the ITU, 47 were discharged from hospital, and 30 survived four years. (Survival in the ITU of patients who did not require ventilation was 89%.) The effects of age, duration of ventilation, and disease were studied, and a higher survival was found in children, in patients ventilated for under 24 hours, and in patients admitted with drug overdosage. Survival was poor in patients aged over 75 and in those who required ventilation after cardiac arrest or myocardial infarction or for chronic obstructive lung disease. The cost of a bed in an ITUs to be used to the greatest effect it is important to define those patients who are most likely to benefit from the facilities they offer.

Objective: To carry out a pilot study surveying the spiritual attitudes and needs of patients with a psychiatric illness at the Centre of Excellence in Remote and Rural Psychological Medicine, Broken Hill Base Hospital, NSW. Method: A questionnaire consisting of 6 questions was completed by 79 patients. Results: It was found that 79% of the patients rated spirituality as very important and 82% thought their therapists should be aware of their spiritual beliefs and needs. Sixty-nine per cent of the patients reported that patients's; spiritual needs should be considered by the therapist in treating their psychological illness and 67% said that their spirituality helped them cope with their psychological pain. Conclusion: The majority of patients said spirituality was important to them and that they wanted their therapist to take their spiritual needs into consideration in the assessment and management of their illness.

Psoriasis is a common condition with recognised psychological comorbidity in specialist practice. The objective of this study was to investigate the psychological comorbidities in psoriasis in patients from general (family) practices and specialist dermatology practices, using a qualitative methodology. This was a qualitative study, utilising semi-structured interviews and thematic analysis. Twenty-nine patients with psoriasis were recruited from general practices and specialist dermatology practices in an Australian non-capital city. Respondents represented a broad range of ages and psoriasis severities. The principle study finding was that psychological morbidity in psoriasis is considerable. Though mood and anxiety symptoms were present in participants, and were occasionally severe, more prominent sequelae of psoriasis were embarrassment, shame, impaired self-image, low self-esteem, self-consciousness and stigmatisation. Psoriasis was associated with behavioural avoidance and effects on respondents' sexuality. The perception of psoriasis as an incurable disease beyond respondents' control, with consequent pessimism regarding prognosis and treatment efficacy, was a contributor to psychological morbidity. Some respondents reported psoriasis having permanently and adversely affected their personality - avoidant personality traits were ascribed to the experience of living with psoriasis. Our conclusion is that the psychological effects of psoriasis can be considerable and long-lasting and are evident across a broad range of psoriasis severities. Clinicians should be aware that psychological sequelae are complex and encompass a range of psychological morbidities beyond conventional psychiatric diagnoses.

PURPOSE OF REVIEW: The aim of this article is to provide a framework and analysis of a series of critical components to inform the future design, development, sustaining, and monitoring of community mental health services. RECENT FINDINGS: Many mental health services remain too hospital-centric, often without adequate outreach services. On the basis of outcome evidence, we need to shift the balance of mental health services from hospital-centered with community outreach when convenient for staff, to community-centered and mobile, with in-reach to hospital only when necessary. Too few training programs those with emphasize the macroskills of public advocacy, working with service users, families, social movements, and the media to improve mental health and wellbeing of regional and local communities. SUMMARY: We should adopt a health ecosystems approach to mental healthcare and training, encompassing nano to macrolevels of service in every region. Catchment mental health services should be rebuilt as community-centric mental health services, integrating all community and inpatient components, but led and integrated from community sites. Community psychiatrists and mental health professionals of the future will need to be well trained in the nano to macroskills required to take responsibility for the mental health and wellbeing of their catchment communities and to provide leadership in service-planning, management, and continuing revision on the basis of rigorous evaluation. These approaches should be the core of all training in psychiatry and all mental health professions prior to any subspecialization.

Kangaroo–vehicle collisions are frequent on Australian highways. Despite high economic costs, detrimental effects on animal welfare, and potential impacts on population viability, little research has been done to investigate the impact of road mortality on kangaroo populations, where and why accidents occur, and how the collisions can be mitigated. We therefore collected data on species (Macropus rufus, M. giganteus, M. fuliginosus, M. robustus), sex and age of kangaroos killed on a 21.2-km bitumenised section of outback highway over 6 months in far western New South Wales, Australia. The spatial and temporal distribution of road-killed kangaroos was investigated in relation to the cover and quality of road-side vegetation, road characteristics, the density of kangaroos along the road, climatic variables and traffic volume. A total of 125 kangaroos were found killed on the road at a rate of 0.03 deaths km–1 day–1. Grey kangaroos of two species (M. giganteus, M. fuliginosus) were under-represented in the road-kill sample in comparison with their proportion in the source population estimated during the day. No bias towards either sex was found. The age structure of road-killed kangaroos was similar to age structures typical of source kangaroo populations. Road-kills mainly occurred in open plains country. In road sections with curves or stock races, road-kill frequencies were higher than expected. Greater cover and greenness of roadside vegetation at the verge probably attracted kangaroos to the road and variation in this vegetation affected the spatial distribution of road-kills. The temporal distribution of road-kills was positively correlated with the volume of night-time traffic. The probability of a kangaroo–vehicle collision increased exponentially with traffic volume. Results are discussed in relation to the potential for mitigation of kangaroo–vehicle collisions.

CONTEXT: Integrated longitudinal rural placements are designed to promote favourable student attitudes towards and facilitate return to rural practice upon graduation. We explored the impact of an integrated placement on medical students' attitudes towards rural practice. METHODS: Data were available from interviews with 10 medical students, 15 clinical supervisors and teachers, three community health staff, and focus groups made up of medical students. Socio-cognitive career theory gave insight into the personal, contextual and experiential factors, as well as the career barriers, that influence students' rural practice intentions. Framework analysis was used to develop a thematic framework illustrating the key findings. RESULTS: The longitudinal placement enabled students to achieve personal goals, and enhanced self-efficacy beliefs and orientation towards the complex personal and professional demands of rural practice. The informal curriculum, including multifaceted interactions with patients and their families, clinical teachers and other health care staff, was a vital experiential component. Students assimilated these rich experiences into their practice and evolving notions of professional identity as rural practitioners. Some students had little intention of practising rurally, partly as a result of contextual barriers such as geographic isolation, family and relationship needs, restricted postgraduate training opportunities and limited opportunities for specialist practice. CONCLUSIONS: The richness of the informal curriculum in a longitudinal rural placement powerfully influenced students' intentions to practise rurally. It provided an important context for learning and evolving notions of professionalism and rural professional identity. This richness could be reinforced by developing formal curricula using educational activities based around service-led and interprofessional learning. To overcome the contextual barriers, the rural workforce development model needs to focus on socialising medical students into rural and remote medicine. More generic issues include student selection, further expansion of structured vocational training pathways that vertically integrate with longitudinal rural placements and the maintenance of rurally focused support throughout postgraduate training.

Of 241 male smelter workers diagnosed as having lead poisoning during 1928 to 1959, 140 are known to have subsequently died. Their cause-of-death profile has been compared with that of 695 other male decedents (predominantly nonoffice production workers) from the same smelter and with that of the Australian male population. Age-standardized proportional mortality analysis shows a substantial excess in the numbers of deaths from chronic renal disease and cerebral hemorrhage, particularly prior to 1965. A moderate excess was also apparent for the other smelter workers. In recent years, these mortality excesses in lead-exposed workers have largely dissipated.

OBJECTIVE: Access to services and workforce shortages are major challenges in rural areas worldwide. In order to improve access to mental health care, it is imperative to understand what services are available, what their capacity is and where existing funds might be spent to increase availability and accessibility. The aim of this study is to investigate mental health service provision in a selection of rural and remote areas across Australia by analysing service availability, placement capacity and diversity. METHOD: This research studies the health regions of Western New South Wales and Country Western Australia and their nine health areas. Service provision was analysed using the DESDE-LTC system for long-term care service description and classification that allows international comparison. Rates per 100,000 inhabitants were calculated to compare the care availability and placement capacity for children and adolescents, adults and older adults. RESULTS: The lowest diversity was found in northern Western Australia. Overall, Western New South Wales had a higher availability of non-acute outpatient services for adults, but hardly any acute outpatient services. In Country Western Australia, substantially fewer non-acute outpatient services were found, while acute services were much more common. Acute inpatient care services were more common in Western New South Wales, while sub-acute inpatient services and non-acute day care services were only found in Western New South Wales. CONCLUSION: The number and span of services in the two regions showed discrepancies both within and between regions, raising issues on the equity of access to mental health care in Australia. The standard description of the local pattern of rural mental health care and its comparison across jurisdictions is critical for evidence-informed policy planning and resource allocation.

This review article reports on the contribution of university Departments of Rural Health and Rural Clinical Schools to the development of rural health and the rural health workforce and is set at the Australian Government's university Departments of Rural Health and Rural Clinical Training and Support Programs. The main outcome measures include educational infrastructure, clinical academic workforce, student numbers, community engagement, research outputs, rural health and workforce outcomes. As a result, university Departments of Rural Health and Rural Clinical Schools have established a substantial geographical footprint covering most of the rural and remote populations and regions across Australia. They have a large distributed rural clinical academic workforce that exceeds 1300. Medical student numbers on long-term placements have increased threefold from inception to 1200 annually. Allied health and nursing numbers doubled over 10 years to 4000 in 2013 and are projected to double again by 2018. In 2013, they published 363 peer-reviewed papers - half of which specifically addressed rural and/or remote health issues. High levels of intention to practise rurally and uptake of rural and remote practice following exposure to rural training have been reported, especially for medicine. Thus, university Departments of Rural Health and Rural Clinical Schools constitute a national network of academic units that deliver academically enriched clinical education and training for medical, nursing and allied health students and fulfil an essential academic role for the health system in rural and remote Australia. Community engagement and accountability to region are hallmarks of the program. Early evidence of the uptake of rural and remote practice following exposure to rural training has set expectations for the Rural Health Multidisciplinary Training Program.

BACKGROUND: Community-based rural education opportunities have expanded in Australia, attracting more medical students to placements in rural and remote settings. AIM: To identify the factors in an integrated, community-engaged rural placement that may contribute to preparedness for practice (P4P) from the perspective of students and clinicians. METHOD: Forty-two semi-structured interviews with medical students, supervisors and clinicians analysed thematically. RESULTS: Opportunities for clinical learning, personal and professional development and cultural awareness were reported by students and clinicians as key factors that contribute to P4P. Potential barriers in rural and remote settings included geographical and academic isolation, perceived educational risk and differing degrees of program engagement. CONCLUSIONS: A longitudinal clinical placement in a rural setting may enable development of enhanced competencies leading to P4P. A rural setting can provide a unique experience through hands-on learning, enhanced personal and professional development opportunities and observation of the cultural and contextual impact on health.

OBJECTIVES: The objective of this study is to develop a framework to measure the impact of primary health care research, describe how it could be used and propose a method for its validation. DESIGN: Literature review and critical appraisal of existing models of research impact, and integration of three into a comprehensive impact framework. SETTING: Centre of Research Excellence focusing on access to primary health care services in Australia. PARTICIPANTS: Not applicable. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The Health Services Research Impact Framework, integrating the strengths of three existing models of research impact. CONCLUSION: In order to ensure relevance to policy and practice and to provide accountability for funding, it is essential that the impact of health services research is measured and monitored over time. Our framework draws upon previously published literature regarding specific measures of research impact. We organise this information according to the main area of impact (i.e. research related, policy, service and societal) and whether the impact originated with the researcher (i.e. producer push) or the end-user (i.e. user pull). We propose to test the utility of the framework by recording and monitoring the impact of our own research and that of other groups of primary health care researchers.