19683 research outputs found
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Integrating Social Media with Traditional Data Sources for Data Driven Decisions in Public Enterprise
No full textA thesis submitted in total fulfilment of the requirements for the degree of Doctor of Philosophy to the La Trobe Business School, La Trobe University, Victoria, Australia.</p
Appropriateness of the EQ-HWB for Use in Residential Aged Care: A Proxy Perspective
No full textBackground and Objective: The EQ Health and Wellbeing (EQ-HWB) is a new generic quality-of-life measure for use in evaluating interventions in health, public health and social care. This study aimed to explore proxies’ views regarding the appropriateness of the EQ-HWB for measuring residents’ quality of life living in residential aged care facilities. Methods: Qualitative think-aloud and semi-structured interviews were conducted with family members and aged care staff across three facilities in Melbourne, Australia. Proxies completed the 25-item EQ-HWB proxy version 2 (i.e. proxy-person perspective) whilst talking through the reasons for choosing their response. All interviews were audio-recorded and transcribed verbatim. A thematic analysis was used for data analysis. Results: The sample included 29 proxies; nine family members and 20 aged care staff. The first theme summarised proxies’ ability to proxy report residents’ health and well-being using the EQ-HWB, which highlighted challenges with adherence to the proxy perspective, proxies’ limited knowledge about residents, disagreement with residents’ self-evaluation and use of heuristics. The second theme reflected feedback on the suitability of the EQ-HWB for use in residential aged care. Although proxies perceived that the EQ-HWB covered important domains, there were concerns about ambiguity, inappropriate examples, double-barrelled items and perceived repetition. Suggestions were made to improve the response options, comprehensiveness, recall period, layout and instructions of the questionnaire. Conclusions: While the EQ-HWB captures domains relevant to residential aged care, modifications to item wording and examples are necessary to improve its appropriateness. Use of the proxy-person perspective revealed some challenges that require further consideration.</p
Identifying potential dietary treatments for inherited metabolic disorders using Drosophila nutrigenomics.
No full textInherited metabolic disorders are a group of genetic conditions that can cause severe neurological impairment and child mortality. Uniquely, these disorders respond to dietary treatment; however, this option remains largely unexplored because of low disorder prevalence and the lack of a suitable paradigm for testing diets. Here, we screened 35 Drosophila amino acid disorder models for disease-diet interactions and found 26 with diet-altered development and/or survival. Using a targeted multi-nutrient array, we examine the interaction in a model of isolated sulfite oxidase deficiency, an infant-lethal disorder. We show that dietary cysteine depletion normalizes their metabolic profile and rescues development, neurophysiology, behavior, and lifelong fly survival, thus providing a basis for further study into the pathogenic mechanisms involved in this disorder. Our work highlights the diet-sensitive nature of metabolic disorders and establishes Drosophila as a valuable tool for nutrigenomic studies for informing potential dietary therapies
Lifetime Cost-Effectiveness of Structured Education and Exercise Therapy for Knee Osteoarthritis in Australia
No full textImportance: Structured education and exercise therapy programs have been proposed to reduce reliance on total knee replacement (TKR) surgery and improve health care sustainability. The long-term cost-effectiveness of these programs is unclear.
Objectives: To estimate the lifetime cost-effectiveness of implementing a national structured education and exercise therapy program for individuals with knee osteoarthritis with the option for future TKR compared with usual care (TKR for all). Design, Setting, and Participants: This economic evaluation used a life table model in combination with a Markov model to compare costs and health outcomes of a national education and exercise therapy program vs usual care in the Australian health care system. Subgroup, deterministic, and probabilistic sensitivity analyses were completed. A hypothetical cohort of adults aged 45 to 84 years who would undergo TKR was created.
Exposure: Structured education and exercise therapy intervention provided by physiotherapists. The comparator was usual care where all people undergo TKR without accessing the program in the first year.
Main Outcomes and Measures: Incremental net monetary benefit (INMB), with an incremental cost-effectiveness ratio threshold of 28 033 Australian dollars (A498 307 942 (US 7970 (US 4090 [-US 11 [US $8]). Results were robust to uncertainty around model inputs.
Conclusions and Relevance: In this economic evaluation of structured education and exercise therapy compared with usual care, the intervention was not cost-effective over the lifetime for all patients but was for the first 9 years and for those with minimal pain. These findings point to opportunities to invest early cost savings in additional care or prevention, including targeted implementation to specific subgroups.</p
The effect of childhood maltreatment on adult survivors' parental reflective function, and attachment of their children: A systematic review
No full textBACKGROUND: Parental reflective function (PRF) is a candidate mechanism in the transmission of intergenerational trauma. This systematic review examined (1) the association between parental history of childhood maltreatment and PRF, (2) how PRF relates to attachment in children of parent survivors, and (3) whether PRF moderates the association between parental maltreatment history and child attachment. METHODS: Ten databases were searched (from inception to 10th November 2021). Inclusion criteria were primary study, quantitative, parent participants, measures of childhood maltreatment, and postnatal PRF. Exclusion criteria were qualitative, intervention follow-up, gray literature, or a review study. Risk of bias was assessed using recommended tools. Data were narratively synthesized. RESULTS: One-thousand-and-two articles were retrieved, of which eleven met inclusion criteria (N = 974 participants). Four studies found a significant association between parental childhood maltreatment and disrupted PRF, six did not, one found mixed results. One study reported the association between childhood maltreatment and attachment (nonsignificant results). DISCUSSION: There is no clear evidence PRF is routinely disrupted in parent survivors, though there is high heterogeneity in studies. Future research should standardize design to better understand whether PRF is a candidate mechanism in intergenerational trauma.</p
A Comparison of an Australian First Nations Primary Healthcare Data Specification with Potentially Preventable Hospitalisations
No full textPotentially Preventable Hospitalisations (PPH) is a widely used indicator of the effectiveness of non-hospital care. Specified using the International Classification of Diseases (ICD) coding, PPH comprises a suite of health conditions that could have potentially been prevented with appropriate care. The most recent edition of the National Guide to a Preventative Health Assessment for First Nations People documents the health conditions of interest to providers of primary care, many of which are not represented in PPH. Given the National Guide has been developed specifically with First Nations in mind, the aim of this research is twofold. The first aim is to formally posit the question of whether a summative measure of hospitalisations aligned diagnostically to the National Guide has value either as an alternative or complement to PPH in the context of First Nations primary health information. The second aim is to develop and present a prototype ICD-10 data specification for such a measure, referred to as the First Nations primary healthcare (FNPHC) data specification, and examine the age-standardised hospitalisation rates for FNPHC and PPH for correlations and/or differences. Age-standardised hospitalisation rates from 2016–17 to 2019–20 using both classifications were examined to assess the usefulness and relevance of summative measures of hospitalisations for informing primary care. Rates of FNPHC for principal diagnoses were between 1.5 and 2.5 times higher than those of PPH and approximately between 6 and 12 times higher for additional diagnoses. There was a strong correlation with PPH when rates were compared across all observations: jurisdictions with higher rates of PPH tended to have higher rates of hospitalisations according to the custom specification. Findings support its application as a summary measure for First Nations primary care providers. Given the policy landscape in Australia that aims to close the gap, it is imperative that measures of primary health take advantage of the concepts and application of First Nations data sovereignty and governance. The validity and cultural appropriateness of the First Nations primary health data specification needs to be further researched.</p
Unveiling the Exodus: A scoping review of attrition in allied health
No full textBackground: Efficient utilisation of allied health workforce may help address the predicted shortfall of 18 million health workers estimated by 2030. Knowledge about allied health professionals’ attrition, or intention to leave, and factors influencing attrition can assist in developing evidence-informed strategies to mitigate this issue. The review aimed to map attrition and attrition intention rates, and its attributing factors for allied health professions worldwide. Methods: Adhering to the PRISMA-ScR guidelines, a comprehensive search was conducted across academic databases (PsycINFO, MEDLINE, Embase, Emcare, CINAHL, Scopus, and the Cochrane Library database) and grey literature (Google, Google Scholar, organisational websites). Two reviewers independently undertook a two-stage screening process along with data extraction using customised data extraction forms. A narrative synthesis was used to synthesise the data. Results: Thirty-two studies published between 1990 and 2024 were included. Attrition rates ranged from 0.5% to 41% across allied health disciplines. Pharmacists demonstrated the lowest attrition rates, while audiologists reported the highest. Radiographers reported the lowest intent to leave at 7.6%, while occupational therapists showed highest intent to leave, ranging from 10.7% to 74.1%. The analysis revealed three recurring themes contributing to attrition: profession-centric factors (e.g., career progression, job satisfaction, support, and professional growth), systemic-centric factors (e.g., compensation, staffing challenges, clinical practices, patient care, workload), and individual-centric factors (e.g., recognition, the need for change, and burnout). Conclusion: Attrition in allied health remains a significant challenge. Addressing this issue requires a systemic, nuanced, and evidence-based approach, given the complex, interlinked, and multifaceted factors contributing to attrition. The younger workforce, characterized by changing generational values, necessitates innovative thinking, intersectoral collaboration, and the potential for co-created solutions with, for, and by the allied health workforce.</p
Barriers and enablers of women carers from culturally and linguistically diverse communities participating in physical activities
No full textIntroduction: This research article presents a phenomenological evaluation of an organization working within disability and with CALD communities of a project that was supporting women carers who are newly arrived to Australia to be happier and healthier. The initiative aimed to alleviate social isolation, enhance wellbeing, and boost confidence among women from Culturally and Linguistically Diverse (CALD) backgrounds in Metropolitan Melbourne, Victoria. Methods: Through a qualitative exploration of the lived experiences of participants, findings were categorized into enablers and barriers, shedding light on the outcomes of physical activity participation for these women. Results and discussion: Enablers included improvements in health, skill development, achievement, and enhanced social interaction and support, while barriers encompassed challenges related to access, socio-cultural factors, resource availability, interpersonal dynamics, and physiological constraints. Based on these findings, recommendations are proposed to empower CALD community members in the co-development and co-delivery of future programs, fostering sustainability and community-driven engagement.</p
Forensic Radiology and the Testimony of Shadows
No full textThis article examines how radiological images became accepted by courts as visual evidence of death in the 20th century. Initially conceived as a speciality of photography, X-rays confounded courts, eliciting a range of judicial responses, from outright refusal to consider the images as any kind of evidence, to mocking them as cheap parlour tricks for an unwitting public, to recognising them as more reliable than the testimony of the expert witness. The article contends that courts moved towards recognising X-rays as proof of death only by both affirming forensic radiology's promise of ‘mechanical objectivity’ while acknowledging its reliance on the fallibility of ‘human subjectivity’. We suggest that this history has broader implications in socio-legal studies for comprehending how the invention of novel optical techniques continues to problematise legal epistemologies of death in the 21st century.</p
Clinical care ratios for allied health practitioners: an update and implications for workforce planning
No full textObjective: Clinical care ratios are used to quantify and benchmark the activity of allied health professionals. This study aims to review previous recommendations and identify what variables may influence them. Method: Data was collected from the core allied health professions (audiology, nutrition and dietetics, occupational therapy, physiotherapy, podiatry, prosthetics and orthotics, psychology, social work and speech pathology) across eight Australian hospitals. Data for 113 staff who were casual or from smaller professions (audiology, podiatry, prosthetics and orthotics and psychology) were excluded due to insufficient numbers for analysis. The remaining data were analysed according to profession, seniority (tiers 1, 2 and 3) and employment status (permanent versus casual staff). A two-way ANOVA was performed to assess the association of clinical care ratios with tier, profession, employment status and gender. Results: Data from 1246 staff from the five larger professions at participating hospitals were analysed. There were no interactions between profession and gender (P=0.185) or employment status (P=0.412). The relationship between clinical care ratio and profession was modified by tier (interaction term, P=0.014), meaning that differences in clinical care ratios between professions depended on the tier. Conclusion: This research has confirmed that clinical care ratios are a useful tool in workload management and determining staffing levels for allied health professionals. The recommendations from this research provide a starting point that can be finessed with reference to profession, model of care, workforce structure, governance and training requirements. This will lead to increased staff wellbeing and improved patient outcomes.</p