Research Flagships, Centres and Institutes

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An Aboriginal family and community healing program in metropolitan Adelaide: description and evaluation
(Australian Indigenous Health InfoNet, 2009) Kowanko, Ingeborg Christine; Stewart, Terry; Power, Charmaine; Fraser, Rosalie; Love, Ida; Bromley, Trevor
This paper describes and evaluates the process, impacts and outcomes of an Aboriginal Family and Community Healing (AFCH) Program based in metropolitan Adelaide, South Australia. The evaluation used participatory action oriented methodology, mixed methods and multiple data sources. The AFCH comprised complex and dynamic activities for Aboriginal men, women and youth built around community engagement, and hosted by the regional primary health care Aboriginal outreach service. The AFCH Program was designed to develop effective responses to family violence that took into account the complexities within Aboriginal families and communities. The evaluation identified strengths of the program including: evidence-based design, holistic approach, clinical focus, committed staff, intersectoral linkages, peer support, mentoring, Aboriginal cultural focus, strategic partnerships and creative use of resources. Clients and workers were unanimous in their enthusiastic support for the program; their stories highlight beneficial impacts on Aboriginal clients, families and community. Other services may be able to adapt strategies from this AFCH to address the needs of their Aboriginal communities.
Aboriginal premature mortality within South Australia 1999-2006: a cross-sectional analysis of small area results
(BioMed Central, 2011-05) Banham, David; Jury, Heather; Woollacott, Tony; McDermott, Robyn; Baum, Fran
Abstract Background: This paper initially describes premature mortality by Aboriginality in South Australia during 1999 to 2006. It then examines how these outcomes vary across area level socio-economic disadvantage and geographic remoteness. Methods: The retrospective, cross-sectional analysis uses estimated resident population by sex, age and small areas based on the 2006 Census, and Unit Record mortality data. Premature mortality outcomes are measured using years of life lost (YLL). Subsequent intrastate comparisons are based on indirect sex and age adjusted YLL results. A multivariate model uses area level socio-economic disadvantage rank, geographic remoteness, and an interaction between the two variables to predict premature mortality outcomes. Results: Aboriginal people experienced 1.1% of total deaths but 2.2% of YLL and Aboriginal premature mortality rates were 2.65 times greater than the South Australian average. Premature mortality for Aboriginal and non- Aboriginal people increased significantly as area disadvantage increased. Among Aboriginal people though, a significant main effect for area remoteness was also observed, together with an interaction between disadvantage and remoteness. The synergistic effect shows the social gradient between area disadvantage and premature mortality increased as remoteness increased. Conclusions: While confirming the gap in premature mortality rates between Aboriginal South Australians and the rest of the community, the study also found a heterogeneity of outcomes within the Aboriginal community underlie this difference. The results support the existence of relationship between area level socio-economic deprivation, remoteness and premature mortality in the midst of an affluent society. The study concludes that vertically equitable resourcing according to population need is an important response to the stark mortality gap and its exacerbation by area socio-economic position and remoteness.
An Aboriginal-driven program to prevent, control and manage nutrition-related 'lifestyle' diseases including diabetes
(2006) Gracey, Michael; Bridge, Ernie; Martin, David; Jones, Timothy; Spargo, Randolph M; Shephard, Mark Douglas; Davis, Elizabeth A
Accurate Imputation-Based Screening of Gln368Ter Myocilin Variant in Primary Open-Angle Glaucoma
(Association for Research in Vision and Ophthalmology, 2015-08) Gharahkhani, Puya; Burdon, Kathryn Penelope; Hewitt, Alex W; Law, Matthew H; Souzeau, Emmanuelle; Montgomery, Grant W; Radford-Smith, Graham; Mackey, David A; Craig, Jamie E; MacGregor, Stuart
PURPOSE: Myocilin (MYOC) is a well-established primary open-angle glaucoma (POAG) risk gene, with rare variants known to have high penetrance. The most common clinically relevant risk variant, Gln368Ter, has an allele frequency of 0.1% to 0.3% in populations of European ancestry. Detection of rare MYOC variants has traditionally been conducted using Sanger sequencing. Here we report the use of genotyping arrays and imputation to assess whether rare variants including Gln368Ter can be reliably detected. METHODS: A total of 1155 cases with advanced POAG and 1992 unscreened controls genotyped on common variant arrays participated in this study. Accuracy of imputation of Gln368Ter variants was compared with direct sequencing. A genome-wide association study was performed using additive model adjusted for sex and the first six principal components. RESULTS: We found that although the arrays we used were designed to tag common variants, we could reliably impute the Gln368Ter variant (rs74315329). When tested in 1155 POAG cases and 1992 controls, rs74315329 was strongly associated with risk (odds ratio = 15.53, P = 1.07 × 10-9). All POAG samples underwent full sequencing of the MYOC gene, and we found a sensitivity of 100%, specificity of 99.91%, positive predictive value of 95.65%, and negative predictive value of 100% between imputation and sequencing. Gln368Ter was also accurately imputed in a further set of 1801 individuals without POAG. Among the total set of 3793 (1992 + 1801) individuals without POAG, six were predicted (probability > 95%) to carry the risk variant. CONCLUSIONS: We demonstrate that some clinically important rare variants can be reliably detected using arrays and imputation. These results have important implications for the detection of clinically relevant incidental findings in ongoing and future studies using arrays.
Active ageing and employment in rural SA: a Health in All Policies project
(South Australian Community Health Research Unit, 2013-04-15) Osborne, Katy; Newman, Lareen Ann; Ramanathan, Rama; Williams, Carmel; Wildgoose, Deborah; Foote, Amy; Ludford, Isobel
The South Australian (SA) Health in All Policies (HiAP) initiative provides a framework and mandate for intersectoral policy work on the social determinants of health. Participation in decent and meaningful employment is a key social determinant of health, and is also an important strategy to promote ‘active ageing’ in the population. This paper reports on an intersectoral project undertaken by the Health In All Policies Unit and Country Health SA Local Health Network (CHSA LHN) in collaboration with Flinders University’s SA Community Health Research Unit and Southgate Institute for Health Society & Equity. The project Active Ageing and Employment in Regional South Australia aims to identify policy levers to increase the workforce retention and re-entry for rural people aged 45+. The project is designed to do this by building the capacity of the regional health workforce to address the social determinants of health in collaboration with agencies outside of the health system. The project partners have adopted a ‘learning by doing’ strategy with the focus on employment and ageing.
Acupuncture to improve live birth rates for women undergoing in vitro fertilization: a protocol for a randomized controlled trial
(BioMed Central Ltd., 2012-05-18) Smith, Caroline A; De Lacey, Sheryl Lynne; Chapman, Michael; Ratcliffe, Julie; Norman, Robert J; Johnson, Neil; Sacks, Gavin; Lyttleton, Jane; Boothroyd, Clare
IVF is a costly treatment option for women, their partners, and the public. Therefore new therapies that improve reproductive and health outcomes are highly desirable. There is a growing body of research evaluating the effect of acupuncture administered during IVF, and specifically on the day of embryo transfer (ET). Many trials are heterogeneous and results inconsistent. There remains insufficient evidence to determine if acupuncture can enhance live birth rates when used as an adjunct to IVF treatment. The study will determine the clinical effectiveness of acupuncture with improving the proportion of women undergoing IVF having live births. Other objectives include: determination of the cost effectiveness of IVF with acupuncture; and examination of the personal and social context of acupuncture in IVF patients, and examining the reasons why the acupuncture may or may not have worked.
Adapting, Pilot Testing and Evaluating the Kick.it App to Support Smoking Cessation for Smokers with Severe Mental Illness: A Study Protocol
(MDPI, 2018-02-03) Lawn, Sharon Joy; van Agteren, Joseph; Zabeen, Sara; Bertossa, Sue Ursula; Barton, Christopher Allan; Stewart, James
(1) Background: While the prevalence of tobacco smoking in the general population has declined, it remains exceptionally high for smokers with severe mental illness (SMI), despite significant public health measures. This project aims to adapt, pilot test and evaluate a novel e-health smoking cessation intervention to assist relapse prevention and encourage sustained smoking cessation for young adults (aged 18–29 years) with SMI. (2) Methods: Using co-design principles, the researchers will adapt the Kick.it smartphone App in collaboration with a small sample of current and ex-smokers with SMI. In-depth interviews with smokers with SMI who have attempted to quit in the past 12 months and ex-smokers (i.e., those having not smoked in the past seven days) will explore their perceptions of smoking cessation support options that have been of value to them. Focus group participants will then give their feedback on the existing Kick.it App and any adaptations needed. The adapted App will then be pilot-tested with a small sample of young adult smokers with SMI interested in attempting to cut down or quit smoking, measuring utility, feasibility, acceptability, and preliminary outcomes in supporting their quit efforts. (3) Conclusions: This pilot work will inform a larger definitive trial. Dependent on recruitment success, the project may extend to also include smokers with SMI who are aged 30 years or more.
Addressing health equity through action on the social determinants of health: a global review of policy outcome evaluation methods
(Kerman University of Medical Sciences, 2018-02-06) Lee, Janice; Schram, Ashley; Riley, Emily; Harris, Patrick; Baum, Fran; Fisher, Matthew; Freeman, Toby; Friel, Sharon
Background: Epidemiological evidence on the social determinants of health inequity is well-advanced, but considerably less attention has been given to evaluating the impact of public policies addressing those social determinants. Methodological challenges to produce evidence on policy outcomes present a significant barrier to mobilising policy actions for health equities. This review aims to examine methodological approaches to policy evaluation of health equity outcomes and identify promising approaches for future research. Methods: We conducted a systematic narrative review of literature critically evaluating policy impact on health equity, synthesizing information on the methodological approaches used. We searched and screened records from five electronic databases, using pre-defined protocols resulting in a total of 50 studies included for review. We coded the studies according to (1) type of policy analysed; (2) research design; (3) analytical techniques; (4) health outcomes; and (5) equity dimensions evaluated. Results: We found a growing number of a wide range of policies being evaluated for health equity outcomes using a variety of research designs. The majority of studies employed an observational research design, most of which were cross-sectional, however, other approaches included experimental designs, simulation modelling, and meta-analysis. Regression techniques dominated the analytical approaches, although a number of novel techniques were used which may offer advantages over traditional regression analysis for the study of distributional impacts of policy. Few studies made intra-national or cross-national comparisons or collected primary data. Despite longstanding challenges of attribution in policy outcome evaluation, the majority of the studies attributed change in physical or mental health outcomes to the policy being evaluated. Conclusion: Our review provides an overview of methodological approaches to health equity policy outcome evaluation, demonstrating what is most commonplace and opportunities from novel approaches. We found the number of studies evaluating the impacts of public policies on health equity are on the rise, but this area of policy evaluation still requires more attention given growing inequities.
Addressing Smoking in Supported Residential Facilities for People with Severe Mental Illness: Has Any Progress Been Achieved?
(MDPI, 2016-10-10) Lawn, Sharon Joy; Lucas, T
Background: Smoking rates for people with severe mental illness have remained high despite significant declines in smoking rates in the general population, particularly for residents of community supported residential facilities (SRFs) where smoking has been largely neglected and institutionalized. Methods: Two studies undertaken 10 years apart (2000 and 2010) with SRFs in Adelaide, Australia looked at historical trends to determine whether any progress has been made to address smoking for this population. The first study was ethnographic and involved narrative description and analysis of the social milieu of smoking following multiple observations of smoking behaviours in two SRFs. The second study involved an eight-week smoking cessation group program providing tailored support and free nicotine replacement therapy to residents across six SRFs. Changes in smoking behaviours were measured using pre and post surveys with residents, with outcomes verified by also seeking SRF staff and smoking cessation group facilitator qualitative feedback and reflection on their observations of residents and the setting. Results: The culture of smoking in mental health SRFs is a complex part of the social milieu of these settings. There appears to have been little change in smoking behaviours of residents and attitudes and support responses by staff of SRFs since 2000 despite smoking rates declining in the general community. Tailored smoking cessation group programs for this population were well received and did help SRF residents to quit or cut down their smoking. They did challenge staff negative attitudes to residents’ capacity to smoke less or quit. Conclusions: A more systematic approach that addresses SRF regulations, smoke-free policies, staff attitudes and training, and consistent smoking cessation support to residents is needed. View Full-Text
Addressing social determinants of health inequities through settings: a rapid review
(Oxford University Press, 2015) Newman, Lareen Ann; Baum, Fran; Javanparast, Sara; O'Rourke, Kerryn; Carlon, Leanne
Changing settings to be more supportive of health and healthy choices is an optimum way to improve population health and health inequities. This paper uses the World Health Organisation’s (1998) definition of settings approaches to health promotion as those focused on modifying settings' structure and nature. A rapid literature review was undertaken in the period June-August 2014, combining a systematically conducted search of two major databases with targeted searches. The review focused on identifying what works in settings approaches to address the social determinants of health inequities, using Fair Foundations: the VicHealth framework for health equity (VicHealth 2013). This depicts the social determinants of health inequities as three layers of influence, and entry points for action to promote health equity. The evidence review identified work in twelve settings (cities; communities and neighbourhoods; educational; healthcare; online; faith-based; sports; workplaces; prisons; and nightlife, green and temporary settings), and work at the socioeconomic, political and cultural context layer of the Fair Foundations framework (governance, legislation, regulation and policy). It located a relatively small amount of evidence that settings themselves are being changed in ways which address the social determinants of health inequities. Rather, many initiatives focus on individual behaviour change within settings. There is considerable potential for health promotion professionals to focus settings work more upstream and so replace or integrate individual approaches with those addressing daily living conditions and higher level structures, and a significant need for programs to be evaluated for differential equity impacts and published to provide a more solid evidence base.
Addressing the stigmatisation of social housing
(Australian Housing and Urban Research Institute, 2012-02) Jacobs, Keith; Arthurson, Kathy
The stigmatisation of social housing neighbourhoods in Australia can be traced to under-investment in social housing, which contributes to poor maintenance, and allocation of housing to the most disadvantaged and marginalised tenants. These policies have unintentionally reinforced a sense of social division and undermined subsequent efforts to improve the welfare of residents. Previous AHURI research has found that there is a need to address poor perceptions of social housing in the wider community, and that changes in such attitudes will not be brought about simply by reinvesting in public housing. In order to address these attitudes, it is necessary to understand how stigmatisation of social housing works. This Investigative Panel research project sought to develop understandings of the stigmatisation of social housing through targeted discussions and utilisation of social theory.
Adverse events in hospice and palliative care: a pilot study to determine feasibility of collection and baseline rates
(Mary Ann Liebert, Inc., 2011-01-19) Currow, David Christopher; Agar, Meera Ruth; To, Timothy H M; Rowett, Debra Sharon; Greene, Aine; Abernethy, Amy Pickar
Background: Continuous quality improvement is fundamental in all health care, including hospice and palliative care. Identifying and systematically reducing symptomatic adverse events is limited in hospice and palliative care because these events are mostly attributed to disease progression. Objectives: The aim of this study was to assess the feasibility of symptomatic adverse events in hospice and palliative care and assessing their incidence. Methods: A retrospective, consecutive cohort of notes from a specialist palliative care inpatient service was surveyed by a clinical nurse consultant for symptomatic adverse events: falls, confusion, decreased consciousness, hypo- and hyperglycaemia, urinary retention, and hypotension. Demographic and clinical factors were explored for people at higher risk. Results: Data were available on the most recent admissions of 65 people, generating >900 inpatient days. Fifty people (78%) had events precipitating admission, of whom 31 (62%) had at least one further event during admission. Eleven of 15 people who were admitted without an event experienced at least one during their admissions. Only 4 did not have an adverse event. During their stay, there were 0.13 (standard deviation [SD] = 0.19) events per patient per day. No drug-drug or drug-host events were noted. No clinical or demographic factors predicted groups at higher risk. Conclusions: This pilot highlights the feasibility of collecting, and ubiquity of, symptomatic adverse events, and forms a baseline against which future interventions to decrease the frequency or intensity can be measured. Given the frailty of hospice and palliative patients, any adverse event is likely to accelerate irreversibly their systemic decline.
After-hours primary care
(Primary Health Care Research & Information Service, 2012-07) Anikeeva, Olga
After-hours primary care has the potential to improve consumer access to services and reduce the burden on hospital emergency departments. This RESEARCH ROUNDup outlines the function of five models of after-hours service provision, discusses Australian examples of after-hours services and presents information regarding each model’s effectiveness and shortcomings.
Ageing well, ageing productively - the essential contribution of Australia’s ageing population to the social and economic prosperity of the nation
(eContent Management, 2009) Harvey, Peter William; Thurnwald, Ian P
This paper offers an alternative view of our ageing population, as well as highlighting some of the assets we have in our elderly populations, and providing suggestions as to an alternative view of the phenomenon of ageing that incorporates elements such as flexible working arrangements and the application of new, enabling technologies. This approach to our ageing population dilemma is predicated on a concept of lifelong learning and social participation along with better preventive and early intervention systems of health care.
Albuminuria in a remote South Australian Aboriginal community: results of a community based screening program for renal disease
(2003) Vanajek, Anne; Paizis, K; Allen, G G; Shephard, Mark Douglas; Barbara, Jeffrey A J; Barratt, L J; Brown, Michael A; McLeod, G
Allied health integration: Collaborative care for arthritis and other musculoskeletal conditions
(Primary Health Care Research & Information Service, 2014) Raven, Melissa; Brown, Lynsey; Bywood, Petra Teresia
Musculoskeletal conditions, including rheumatoid arthritis, osteoarthritis and osteoporosis, are prevalent in the Australian population, and they impose a substantial burden on the health care system and the community, reflected by their status as a national health priority area. They are the main cause of impaired physical functioning globally. These conditions have high chronicity rates and often have a long term impact, leading to reduced mobility and dexterity, chronic pain, reduced capacity for employment, and negative impact on family and social life. Much of the care for these conditions is provided in primary health care (PHC) settings.
Allied health practitioners in Australian primary health care
(Primary Health Care Research & Information Service, 2014) Raven, Melissa
Allied health practitioners (AHPs) are a large and diverse group of health professionals who are integral to the healthcare system. Many work in primary health care, mainly in private practice. Utilisation of AHP services is higher among people with chronic diseases. AHPs are under-researched, and they often lack recognition for their contribution to health care. This RESEARCH ROUNDup provides an overview of AHPs in primary health care, particularly in Australia. There is a need for more research by and about AHPs, better integration into the health system, and more interprofessional education.
Allied health video consultation services
(Primary Health Care Research & Information Service, 2013) Melissa; Bywood, Petra Teresia
Many Australians have limited access to health care services due to a range of barriers including living a considerable distance from health services. Furthermore, there are significant shortages of healthcare workers in many rural and remote areas. Traditionally, many people have had to either travel long distances to access healthcare, or go without. Telehealth is an alternative approach, using telecommunications and information technology to supplement face-to-face delivery of healthcare services.
Ambivalence and its influence on participation and non-participation in screening for colorectal cancer
(SAGE, 2013-09) Oster, Candice; Zajac, Ian; Flight, Ingrid; Hart, Elizabeth; Turnbull, Deborah; Wilson, Carlene J; Young, Graeme Paul
Colorectal cancer (CRC) is one of the most prevalent cancers worldwide, and an ideal target for early detection and prevention through cancer screening. Unfortunately, rates of participation in screening are less than adequate. In this article we explore why people who were offered a fecal immunochemical test for CRC decided to participate or not, and for those who did participate, what influenced them to take action and complete the test. We conducted four focus groups and 30 telephone interviews with 63 people. The main reason people decided to screen was “wanting to know” their CRC status, which operated on a continuum ranging from wanting to know, through varying degrees of ambivalence, to not wanting to know. The majority of participants expressed ambivalence about CRC screening, and the main cue to action was the opportunity to screen without being too inconvenienced.
Ambulance Employees Association – Scoping Literature Reviews drawing on qualitative literature to address the physical, psychological, psychobiological, and psychosocial health of operational ambulance staff and interventions to address the impact of workplace stressors.
(Flinders University, 2019-04) Lawn, Sharon Joy; Willis, Eileen Mary; Roberts, Louise; Couzner, Leah; Mohammadi, Leila; Goble, Elizabeth
Paramedics have in many ways been ‘the forgotten profession’ within the healthcare system. This situation has arisen due to the tendency to traditionally ‘silo’ health professions into their specific disciplines. It is also a consequence of the physical separation of out-of-hospital care from hospital and other community clinical work that has tended to create a barrier to inter-professional understanding and collaboration, and to the fact that, in Australia, paramedics have often been in a portfolio other than health. The result has been that ambulance personnel and organisations are faced with the legacy of, and negative effects on, mental well-being that their role and the environments they work within create. The nature of the work, the uncontrolled and often unpredictable environments, the everyday experience of trauma, and the cumulative nature of that trauma all play a key role in the development and impact of mental distress and psychological injury. Organisational and occupational factors such as workload, work demands, shift work, limited time for debriefing or downtime, the hierarchical nature of supervision, and the lack of recognition are clearly shown to have effects on the well-being of ambulance personnel that are as significant as, if not greater than, the nature of the work itself. The following excerpt from a submission to the Senate Committee Inquiry into the Mental health and well-being of emergency first responders succinctly identifies the operational and organisational factors which influence mental health and well-being within the pre-hospital setting. This commissioned review brings together the available literature from both peer-reviewed articles, public sources, and senate submissions to outline the effect of emergency medical response work on the psychological, psychosocial, and physical health of paramedics, ambulance officers, ambulance volunteers, and call-takers.

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