A breastfeeding study in a rural population in South Australia.
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INTRODUCTION: The benefits of breastfeeding for mothers and babies are well recognised; however, challenges to its establishment and maintenance exist in rural locations. METHOD: This study in a rural community aimed to: (1) collect rates of any breastfeeding at 6 weeks, 3 months and 6 months postpartum; and (2) seek women's postnatal breastfeeding needs and discern how they were met. Fifty-eight women, most of whom had planned to birth at one of two rural hospitals with fewer than 50 births a year were interviewed face-to-face or by telephone. Questions included whether they were still breastfeeding, reasons for stopping, and their breastfeeding support needs in hospital and after discharge on eight domains: establishment; attachment; engorgement; sore nipples; cracked nipples; ongoing support; supply and mastitis. RESULTS: The number breastfeeding at 3 months (55%) compared poorly with South Australia (62%) or nationally (63%). Midwives met most of the needs of the women in hospital while, at home, midwives and GPs remained the main sources of support. At home, small numbers contacted the Australian Breastfeeding Association, child and youth health service nurse; a midwife employed by a pharmacist and family members such as mothers and mothers-in-law for support. Overall, 25% of women who had an identified need did not seek help. Of those who did, 36% had the need met well and 28% poorly. After discharge, 52 (90%) would have welcomed a visit from a community midwife had it been available. In the regional town, facilities to breastfeed and change babies' nappies were rated poor or non-existent. CONCLUSION: Since this study, a part-time community midwife has been employed and a new project initiated that educates and assists older women volunteers to support and promote breastfeeding for isolated new mothers. (+info)
Improving surveillance for Barrett's oesophagus.
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PROBLEM: A retrospective audit of surveillance for Barrett's oesophagus 1996-2001 identified the need to improve adherence to guidelines for the endoscopic surveillance of patients with Barrett's oesophagus. DESIGN: Prospective audit of the effect of disseminating guidelines in 2002. Prospective audit of the effect of introducing local guidelines and Barrett's oesophagus surveillance officers, 2003-2005. SETTING: Two general hospitals in Australia, 2002-5. All adult patients diagnosed with Barrett's oesophagus were included. KEY MEASURES FOR IMPROVEMENT: Proportions of patients in a Barrett's oesophagus surveillance programme who had appropriate time intervals between follow-up endoscopies and who had appropriate numbers of biopsies collected at endoscopy. STRATEGIES FOR CHANGE: Local guidelines were laid down. Surveillance coordinators for Barrett's oesophagus were introduced to manage the process according to a clinical protocol designed for each patient. EFFECTS OF CHANGE: Disseminating guidelines had little effect on practice. Six months after surveillance coordinators were introduced, adherence to the planned surveillance interval increased from 17% to 92% and the number of endoscopies at which sufficient biopsies were collected increased from 45% to 83%. These changes have been maintained. LESSONS LEARNT: Disseminating guidelines and results of an audit on endoscopic surveillance in Barrett's oesophagus had no effect on practice. Introducing coordinators who proactively managed the process greatly improved adherence to guidelines. (+info)
A population view of mental illness in South Australia: broader issues than location.
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INTRODUCTION: There is growing evidence in Australia and elsewhere to indicate that prevalence rates of mental illness are no higher in rural and remote areas than in urban areas. However, it is generally perceived that people from rural and remote areas are at heightened risk of mental illness, because many psychosocial determinants of health are magnified by factors related to remoteness. In this study we attempt to unpack the factors guiding prevalence rates of mental illness to determine if remoteness per se is an important determinant of mental illness. METHODS: Analysis of data from a cross-sectional, population-based, computer-assisted telephone interview survey in 2000. Respondents included 2545 South Australian adults, aged 18 years or more. The mental illness measure was self-reported, medically confirmed depression, anxiety or stress related problems in the previous 12 months and receiving treatment. Remoteness was determined using the Accessibility and Remoteness Index of Australia (ARIA). Psychosocial measures consisted of major stressful life events, perceived control of life events, socio-demographic characteristics and lifestyle behaviours. RESULTS: Unadjusted odds of mental illness were lower among residents of accessible and remote/very remote areas than for those from highly accessible areas (OR [odds ratio] 0.67, 95% CI 0.50-0.91 and OR 0.73, 0.54-1.00). After controlling for the joint effects of stressful life events, perceived control of life events, socio-demographic characteristics and lifestyle behaviors, odds of mental illness did not vary by ARIA category (highly accessible [reference category]; accessible: OR 0.90 95% CI 0.60-1.31; moderately accessible: OR 0.80, 95% CI 0.45-1.43; remote/very remote: OR 0.70, 95% CI 0.44-1.03). The most important predictors of mental illness in the multivariate logistic model were female sex; smoking; low consumption of vegetables; low exercise; a physical condition; perceived lack of control with life in general, personal life, job security or health; and major stressful events such as family or domestic violence and the death of someone close. CONCLUSIONS: Remoteness per se was not associated with mental illness, either directly or indirectly, as an important confounder in stressful life event/mental illness associations. Psychosocial factors were more important determinants of mental illness. (+info)
Does using potting mix make you sick? Results from a Legionella longbeachae case-control study in South Australia.
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A case-control study was performed in South Australia to determine if L. longbeachae infection was associated with recent handling of commercial potting mix and to examine possible modes of transmission. Twenty-five laboratory-confirmed cases and 75 matched controls were enrolled between April 1997 and March 1999. Information on underlying illness, smoking, gardening exposures and behaviours was obtained by telephone interviews. Recent use of potting mix was associated with illness (OR 4.74, 95% CI 1.65-13.55, P=0.004) in bivariate analysis only. Better predictors of illness in multivariate analysis included poor hand-washing practices after gardening, long-term smoking and being near dripping hanging flower pots. Awareness of a possible health risk with potting mix protected against illness. Results are consistent with inhalation and ingestion as possible modes of transmission. Exposure to aerosolized organisms and poor gardening hygiene may be important predisposing factors to L. longbeachae infection. (+info)
Myeloid leukaemia treatment and survival--the South Australian experience, 1977 to 2002.
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OBJECTIVE: To evaluate trends in survival and treatment for myeloid leukaemia in South Australia during 1977-2002, using population-based survival data plus data on survival and treatment of patients at three teaching hospitals. METHODS: Population data were analysed using relative survival methods and hospital registry data using disease-specific survival. Univariate and multivariable analyses were undertaken. Multiple logistic regression analysis was used to investigate factors associated with first-line chemotherapy. RESULTS: South Australia recorded 1,572 new cases of acute myeloid leukaemia (AML) in 1977-2002, together with 536 cases of chronic myeloid leukaemia (CML). Of these cases, 42.6% were recorded in teaching hospital registries. The five-year survival for AML at the teaching hospitals of 14.5% was similar to the corresponding 12.0% for South Australia as a whole. The five-year survival for CML at these hospitals was higher, however, at 48.1% compared with 37.5% for all South Australian cases. Younger patients had higher survivals, both for AML and CML. An increase in survival was evident for more recently diagnosed cases for both leukaemia types, after adjusting for age. This increase in survival was accompanied by an increase over time in the proportion of patients at teaching hospitals having a primary course of chemotherapy. Cytarabine in combination with other agents was the most common induction therapy for AML. While hydroxyurea was the most common first-line treatment of CML, there were changes in clinical policies towards higher-dose treatments, plus trials of new agents and combination therapies. CONCLUSIONS: Secular gains in survival have occurred from AML and CML in association with an increased use of chemotherapy. (+info)
What makes for sustainable Healthy Cities initiatives?--A review of the evidence from Noarlunga, Australia after 18 years.
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This paper examines the factors that have enabled the Healthy Cities Noarlunga (HCN) initiative to be sustainable over 18 years (1987-2005). Sustainability related to the ability of the initiative to continue to operate continuously in a manner that indicated its existence was accorded value by the community and local service providers. The analysis is based on a narrative review of 29 documents related to HCN, including a number of evaluations. Nine factors emerged as important to ensuring sustainability: strong social health vision; inspirational leadership; a model that can adapt to local conditions; ability to juggle competing demands; strongly supported community involvement that represents genuine engagement; recognition by a broad range of players that Healthy Cities is a relatively neutral space in which to achieve goals; effective and sustainable links with a local university; an outward focus open to international links and outside perspectives; and, most crucial, the initiative makes the transition from a project to an approach and a way of working. These sustainability factors are likely to be relevant to a range of complex, community-based initiatives. (+info)
Mapping oral health related quality of life to generic health state values.
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BACKGROUND: A summary utility index is useful for deriving quality-adjusted life years (QALY) for cost analyses or disability weights for burden of disease studies. However, many quality of life instruments provide descriptive profiles rather than a single utility index. Transforming quality of life instruments to a utility index could extend the use of quality of life instruments to costs analyses and burden of disease studies. The aims of the study were to map a specific oral health measure, the Oral Health Impact Profile to a generic health state measure, the EuroQol, in order to enable the estimation of health state values based on OHIP data. METHODS: Data were collected from patients treated by a random sample of South Australian dentists in 2001-02 using mailed self-complete questionnaires. Dentists recorded the diagnosis of dental conditions and provided patients with self-complete questionnaires to record the nature, severity and duration of symptoms using the EuroQol (EQ-5D) and 14-item version of the Oral Health Impact Profile (OHIP-14) instruments. Data were available from 375 patients (response rate = 72%). A random two-thirds sample of patients was used in tobit regressions of EQ-5D health state values estimated using OHIP-14 in a model with categories of OHIP responses as indicator variables and in a model with OHIP responses as continuous variables. Age and sex were included as covariates in both models. The remaining one-third sample of patients was used to test the models. RESULTS: The OHIP item 'painful aching in mouth' was significantly related to health state values in both models while 'life less satisfying' was also significant in the continuous model. Mean forecast errors relative to the mean observed health state value were higher when fitted to the categorical model (17.4%) compared to the continuous model (15.2%) (P < 0.05). CONCLUSION: The findings enable health state values to be derived from OHIP-14 scores for populations where utility has not or cannot be measured directly. (+info)
When symptoms of disease overlap with symptoms of depression.
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BACKGROUND: The diagnosis of depression is often dependent on somatic symptoms which overlap with the symptoms of many medical illnesses. METHOD: We analysed tape recorded interviews of 46 out of 61 eligible community dwelling older adults with advanced disease and many somatic symptoms of depression. Participants answered an open question about feelings, and structured questions about symptoms of depression. RESULTS: Twenty-four (39%) patients met DSM-IV symptom criteria for depression when somatic symptoms were included, and only 1 (2%) when they were excluded. Of the 24, 22 (92%) reported two or more psychological symptoms of depression and 14 of the 17 (82%) for whom transcripts were available disclosed feelings of psychological distress. DISCUSSION: Although every older adult with advanced disease reported somatic symptoms of depression, most did not meet DSM-IV criteria of depression even when all somatic symptoms are included. Including somatic symptoms accurately identifies patients who warrant follow up when psychological distress in unstructured interviews is used as the gold standard. There is no need to exclude somatic symptoms when considering a diagnosis of major depression in medical patients. (+info)