Happy Christmas from your health librarians!

Sally, Cathie and Adele would like to wish you all a very merry Christmas and a peaceful and prosperous new year.  We are taking a couple of weeks' break now and would like to take this opportunity to thank you for making our Blog so successful for another year.  We would really appreciate your feedback about these pages, and suggestions for posts are always very welcome.

Good health to you these holidays.

Christmas BMJ issue - always entertaining

Highly recommended reading at this time of year is BMJ's Christmas issue.  This year is no exception with some great tongue-in-cheek research studies on such topics as the survival time of chocolates in hospital wards, whether it is better to be right than happy, and the hypothesis that James Bond's drinks may have been shaken due to alcohol tremor.  Perhaps more serious is "Following celebrities' medical advice: meta-narrative analysis", which assesses how celebrities can be a useful force for health promotion in newspapers and magazines, but they can also provide poor information which is too readily taken up by some people.

BMJ, 21 Dec 2013 (Vol 347, Issue 7938).  Many articles are open access and others can be accessed via CIAP for NSW Health employees.

10 most popular health research publications

Another top ten list, this time from Australian Policy Online, they have listed the Top ten health research publications 2013.  Based on the number of page visits to the APO's health research site, the most popular research publication this year was "Making it work: a workforce guide for disability service providers", published in June by the Social Policy Research Centre. Reports on early childhood disease prevention, collaborative care in mental health and the costs of alcohol misuse are also included, with links to all publications.

10 fascinating health articles for 2013

The Monthly magazine has chosen their ten favourite health stories from publications around the world over the past year and provided links to each one.  Included in 10 fascinating articles on health, 2013 are stories on the vitamin myth, the importance of germs, the DSM, treatment for cholesterol and the history of childbirth deaths.

Latest issue of AIHW Access available

Access is a newsletter published by the Australian Institute of Health and Welfare, profiling the Institute's work and its people. The December 2013 issue is now available and topics include:

• Australia's Welfare 2013 - Aussies living and working longer, but some are doing it tough
• Accidents and lifestyle choices-the biggest health challenges facing Australia's males
• Stroke death rates drop 70% but thousands still affected
• Program screens over 3.6 million women for cervical cancer
• Dental care hitting Aussies' hip pockets
• Youngest offenders at high risk of returning to youth justice system
• Australian prisoners face many health challenges-but it's not all bad news
• Falls and transport accidents main causes of hospitalised injury
• Profiling homelessness services in Australia
• New information available on seclusion in mental health facilities

Program on the Global Demography of Aging - working papers

The purpose of the Working Paper Series on global demography and ageing is to share research prior to journal publication and stimulate debate and critical comments. Working papers also give an opportunity to authors to publish longer and more detailed material than can appear in a journal.  All papers go through a review process at the Harvard Center for Population and Development Studies. 

PGDA’s research focuses on six main themes:

• Measurement of the global patterns of disease, mortality, and morbidity in aging populations
• Social determinants of population health and aging
• Economics of health care provision for the elderly
• Economics of aging (macroeconomics, behavioral and experimental)
• Migration and aging
• Aging and HIV/AIDS

Endorsed ANZCA guidelines

The Australian and New Zealand College of Anaesthetists (ANZCA) has endorsed a selection of guidelines developed by other organisations. The include anaphylaxis, central line insertion, OSSIE Guide to Clinical Handover and patient blood management guidelines.

Use of pharmacologic interventions for breast cancer risk reduction

The American Society of Clinical Oncology has updated the guideline Use of pharmacologic interventions for breast cancer risk reduction: American Society of Clinical Oncology clinical practice guideline. It is freely available to download.

Indigenous Health Reports

A number of reports have been published by 'Closing the Gap Clearinghouse', a clearinghouse for research and evaluation evidence on what works to overcome Indigenous disadvantage.
These include:

What works? A review of actions addressing the social and economic determinants of Indigenous health

Improving the accessibility of health services in urban and regional settings for Indigenous people

Housing strategies that improve Indigenous health outcomes

Click here to download these and other related reports.

Improving the early life outcomes of Indigenous children

This paper outlines the wide gaps in early life outcomes for Indigenous people compared with non-Indigenous people, such as higher rates of poor health conditions, hospital admissions and poor nutrition among Indigenous children. It then discusses how localised early childhood development works to overcome these disadvantages through a range of interventions that are tailored to address the local determinants of early childhood development. 

Improving the early life outcomes of Indigenous children: implementing early childhood development at the local level.

Issues paper no. 6 produced for the Closing the Gap Clearinghouse. AIHW. Sarah Wise, December 2013

Is Fracking Good for Your Health? An Analysis of the Impacts of Unconventional Gas on Health and Climate

This report assesses existing research to address the question of whether unconventional gas should be endorsed as a major future energy source, based on its impacts on human health and the climate.It’s becoming increasingly clear that Australia needs to change the way it uses energy and many of those changes will be taking place over the next decade. Our current reliance on coal is unsustainable, while Australia’s considerable reserves of unconventional gas - tight, shale and coal seam gas (CSG) - are raising controversy after being flagged as part of a major expansion of the gas industry.
There is considerable lack of information and uncertainty around the health impacts of unconventional gas extraction. However, the potential health impacts associated with fracking chemicals used for extracting unconventional gas are serious. They include cancer, skin and eye irritation, respiratory problems, damage to the nervous system, cells and blood, endocrine disruption and reproductive problems. The effects of climate change are likely to exacerbate certain health risks and the vulnerability of certain groups including the elderly, rural and indigenous communities, as well as future generations. This report finds that unconventional gas should not be endorsed from an environmental and human health perspective and states that the current case against further expansion of the industry is overwhelming. Taking into account the evidence that exists for the health and climate impacts of unconventional gas, this does not represent the best option for Australia’s energy future, either as a stepping-stone or a final destination. (APO 27 November 2013)

Mental Health and the National Disability Insurance Scheme: Position Paper

The National Disability Insurance Scheme (NDIS) represents a major opportunity to deliver much-needed services and support for people with a range of disabilities. The Mental Health Council of Australia (MHCA) supports the NDIS, especially given the bi-partisan commitment to increasing funding to support people with significant ongoing disabilities over the next few years. It is absolutely appropriate that the scheme includes people with a psychosocial disability related to mental illness. However, the MHCA has strong concerns about the implications of the scheme for mental health consumers, carers and service providers. These concerns relate to the design of the NDIS, the status of existing services, and the likely impact on future mental health programs. This position paper outlines the current challenges and provides some suggestions on how to resolve them. (APO 15 November 2013)

Osteoporosis Costing all Australians: a New Burden of Disease Analysis – 2012 to 2022

This report, by Osteoporosis Australia, finds that little progress is being made in preventing and managing osteoporosis in Australia. It updates previous burden of disease analysis undertaken in 2001 and 2007, and shows little progress is being made in preventing and managing osteoporosis in Australia. With an ageing population, it is now critical that real steps are taken to address this silent and often underdiagnosed disease affecting women and men that is costing governments, the community and comes at a great personal cost to the individuals affected. The new information in this report on the current and future costs of osteoporosis in Australia will aid government policy makers, funding bodies, clinicians, researchers and health care organisations in assessing the importance of reducing osteoporosis and osteoporosis – related fractures, promoting bone health and in identifying future resource needs. It includes Key Findings and A Call to Action. (Authors: Jennifer J. Watts, Julie Abimanyi-Ochom, Kerrie M. Sanders)

Health System Expenditure on Cancer and Other Neoplasms in Australia 2008-09

Health system expenditure on cancer and other neoplasms inAustralia, 2008-09 presents an overview of cancer expenditure focusing on the six cancers with the highest health system expenditure in each of four life stages 0-14, 15-24, 25-64 and 65 years and over. Findings include:

 - Cancer and other neoplasms ranked sixth in terms of estimated health system expenditure on chronic diseases, accounting for 6.9% of total health system expenditure on all chronic diseases;

 - Expenditure on national population screening programs totalled $332 million;

 - From 2000-01 to 2008-09, total health system expenditure on cancer increased by 56% from $2,894 million to $4,526 million. 

Supporting Healthy Communities Through Sports and Recreation Programs

Healthy communities are communities in which people have the physical and mental health and wellbeing needed to conduct their daily lives. The purpose of this paper, released by the Australian Institute of Health and Welfare (AIHW) on 13 December 2013, is to review the available evidence of a range of sports and recreation programs in relation to their effects on supporting and building healthy communities. 

There is some evidence in the form of critical descriptions of programs and systematic reviews on the benefits to Aboriginal and Torres Strait Islander communities from participation in sport and recreational programs. These include some improvements in school retention, attitudes towards learning, social and cognitive skills, physical and mental health and wellbeing; increased social inclusion and cohesion; increased validation of and connection to culture; and some evidence of crime reduction.

Salt Reduction Program Reduces Heart Deaths

The United Kingdom program of voluntary salt reduction, in collaboration with the food industry, has reduced 24-hour urinary sodium levels by 15% and prevented an estimated 9,000 cardiovascular deaths each year since the program began in 2003-2004, according to this comprehensive analysis.

The article provides an analysis of the program with the aim of providing a simple step-by-step guide for development and implementation of a national salt reduction program that other countries have already followed.

UK population salt reduction: an experiment in public health. The Lancet, Volume 382, Supplement 3, Page S43, 29 November 2013 (register on the Lancet site to get free access to the article).

Cancer Forum focuses on Geriatric Oncology

The November 2013 issue of Cancer Forum has focused on geriatric oncology and the current state of the science. Both MNCLHD and NNSWLHD have free access to all the articles via their Library e-journal site.
Some of the articles included, cover such topics as polypharmacy, cognition, primary care and nutritional issues.
Cancer Forum November 2013 | Volume 37 | Number 3   

Australasian Clinical Indicator Report 2005 – 2012

The Australasian Clinical Indicator Report 2005 – 2012 (14th edition), published by the Australian Council on Healthcare Standards (ACHS), presents a detailed statistical analysis of clinical indicators for HCOs in the Australasian region. Over  342 public and 329 private HCOs reported, representing  almost 35,000 data submissions providing excellent statistical knowledge for an overview on how Australian health care is performing. It is one of the most comprehensive reports on the status of national clinical performance of 670 healthcare organisations over the last eight years.

Go to the ACHS website to freely download the report.

What does your pee say about your health?

The Cleveland Clinic in Ohio has drawn up a diagram showing all the possible shades of urine colour and what each one means;

• Colourless urine indicates a person is drinking too much water

• Healthy urine is considered pale straw coloured or transparent yellow

• Amber or honey coloured urine indicates an urgent need for water

• Brown ale coloured urine is a sign of liver disease or severe dehydration

• Red urine could have blood in it and this is a symptom of bladder cancer, kidney disease, prostate problems and infections, the doctors say       

Click here to open the diagram.

Amino Acid Explorer

This tool, provided by the  National Center for Biotechnology Information (NCBI), allows users to explore the characteristics of amino acids by comparing their structural and chemical properties, predicting protein sequence changes caused by mutations, viewing common substitutions, and browsing the functions of given residues.

Client-based Analyses for Reporting on Alcohol and Other Drug Treatment Services

Developing client based analysis for reporting on alcohol and other drug treatment services outlines the Australian Institute of Health and Welfare (AIHW) intended analysis techniques to:- estimate the number and rate of clients receiving alcohol and other drug treatment - explore patterns of drug use and pathways through treatment - explore the characteristics of different client groups, for example, those who return to treatment over many years with multiple drugs of concern or treatment types. Some analyses described either require, or would be improved by, future data development activities for this collection. Public consultation is open until 28 February 2014. (AIHW released 9th December 2013)

Nursing and Midwifery Workforce 2012

This report ,release by the Australian Institute of Health and Welfare on 29 November 2013, outlines the workforce characteristics of nurses and midwives in 2012. Between 2008 and 2012, the number of nurses and midwives employed in nursing or midwifery increased by 7.5%, from 269,909 to 290,144. During this period, nursing and midwifery supply increased by 0.5%, from 1,117.8 to 1,123.6 full-time equivalent nurses and midwives per 100,000 population. In 2012, the proportion of employed nurses and midwives aged 50 or older was 39.1%, an increase from 35.1% in 2008.

Impact of a Population-based HPV Vaccination Program on Cervical Abnormalities: a Data Linkage Study

Evidence that the human papillomavirus (HPV) vaccination program is preventing cervical pre-cancer lesions in young women has been published for the first time as part of a collaborative study between the Australian Institute of Health and Welfare (AIHW) and the Victorian Cytology Service (VCS). The findings, in an article written by Dorota M. Gertig et al and published in the medical journal BMC Medicine, are the first in the world to show that a population-based HPV vaccination program has resulted in a fall in cervical abnormalities within five years of implementation. (AIHW 27 November 2013)

Mental Health Services in Australia Website

The Australian Institute of Health and Welfare (AIHW) has released updated material on the: Mental health services in Australia website. The AIHW made national seclusion information (2008-09 to 2011-12) available for the first time in July 2013. This information extends the period of available data to 2012–13 and can be found in the ‘Admitted patient mental health-related care’ section under ‘Use of restrictive practices during admitted patient care’.  

The release of seclusion information by the AIHW will coincide with their public release at the 9th National Seclusion and Restraint Reduction Forum being held in Canberra on 28th November 2013. (AIHW 28 November 2013)

No Longer Just an Inner City Issue: Meeting the Demand for Needles, Syringes and Opioid Replacement Therapies (ORTs) Across Melbourne's Western Suburbs

Sufficient access to needles, syringes and opioid replacement therapies (ORTs) across the western suburbs of Melbourne, Victoria, is an important health issue for the people who require these services, the organisations that support their health and welfare and the communities they live in. This document, prepared by HealthWest Partnership, outlines current issues with access to these services in the western metropolitan region and makes recommendations for action. (APO 6 August 2013)

Gambling Problems Amongst the CALD Population of Australia: Hidden, Visible or Not a Problem?

There have been mixed research results when studying gambling problems in Culturally and Linguistically Diverse (CALD) communities in Australia and internationally. This study, published in the Asian Journal of Gambling Issues and Public Health, tests the feasibility of using nationally representative General Social Surveys for examining trends and patterns in gambling problems and other life stressors amongst the Australian CALD population. Two surveys were analysed to determine whether the CALD population experienced gambling problems and other life stressors at different levels to the non-CALD population, and to identify, using multivariable models, whether CALD related variables showed evidence of an association with reported gambling problems after adjustment for other covariates. There was no evidence that 2002 estimates of gambling problems were different in CALD and non-CALD populations. In 2006, there was evidence that gambling problems were lower in the CALD population compared with the non-CALD population (1.3% cf. 3.5%). In 2002 multivariable models there was no evidence of an association between CALD status or related variables with gambling problems, after adjustment for other variables. In 2006 multivariable models, there was evidence of an association between being the CALD population (protective), and being born in Oceania or New Zealand (risk) with gambling problems, after adjustment for other variables. The authors of this article are Matthew Stevens and Kate Golebiowska. (APO 20 Feb 2013)

Chronic Obstructive Pulmonary Disease (COPD) snapshot

Chronic obstructive pulmonary disease (COPD) limits airflow in the lungs. It includes emphysema and chronic bronchitis. This is a snapshot of the latest statistics on COPD in Australia, updated November 2013 by the Australian Institute of Health and Welfare (AIHW). It includes a link to information re: Death rate from COPD; Hospitalisation for COPD; Money spent on COPD in 2008-9.

National Performance Indicators to Support Neonatal Hearing Screening in Australia

Around half the children born with hearing impairment have no identified risk factor for the condition. It is widely acknowledged that delays in the identification and treatment of permanent childhood hearing impairment may profoundly affect quality of life in terms of language acquisition, social and emotional development, and education and employment prospects. All states and territories in Australia have universal neonatal hearing screening. This working paper, by the Australian Institute of Health and Welfare (AIHW), presents a set of performance indicators for monitoring neonatal hearing screening activity in Australia at a national level. National evaluation and monitoring provides a measure of how well neonatal hearing screening is achieving its aims and objectives and will enable strengthening of screening practices and administrative processes to further improve outcomes for Australian infants. (Report released by the AIHW on 25th November 2013)

Promoting Aboriginal Health Through the Arts: Overview of Supported Projects

This paper provides an overview of organisations and arts projects VicHealth supports and explores the role of arts in Aboriginal culture and the associated positive health impacts. Engagement with the arts can have powerful impacts on health, wellbeing and the strengthening of communities. For more than two decades VicHealth has been supporting the arts because of the great health promotion opportunities it provides. We know that access to the arts helps people connect socially and participate in their community’s cultural life. The role of the arts in exploring and communicating social concerns, giving voice to hidden issues and allowing self-expression is also a major contributor to health. (APO 19 September 2013)

NDIS Launch Sites: Projection of the Number of Young People in Residential Aged Care

The launch of the National Disability Insurance Scheme (NDIS) on 1 July 2013, heralded the start of a new era for people with disability in Australia. PricewaterhouseCoopers and the Summer Foundation have been collaborating to undertake a projection of people aged under 65 living in aged care nursing homes in the three NDIS launch sites that are targeting people in this group: Australian Capital Territory, the Hunter region of New South Wales and the Barwon region of Victoria. The Report estimates that although the NDIS will have been operational in the NDIS launch sites for three years, there will be an additional 40 young people living in nursing homes in these launch sites by June 2016. The report provides an estimate of the unmet needs and resources required for housing and support in the NDIS launch sites. (APO 2 October 2013)

Growing Older, Staying Well: Mental Health Care for Older Australians

This study, conducted by SANE Australia, finds that more support, services and education are needed to appropriately care for Australia's ageing population.
Recommendations:

• Stronger lobbying and advocacy giving the needs of older people living with mental illness more prominence in aged care and mental health
• Address social isolation in older adults living with mental illness as a central tenet of any policy reform and advocacy work in this area
• Consult with older adults when seeking to understand the experience of living with mental illness
• Mandatory mental health training for staff working in the aged care and community support sectors
• Provide clear and easily-accessible information for older adults, their families, friends and staff about mental illness in older age
• Encourage GPs and other primary health professionals to seek additional training and education in the treatment of coexisting physical and mental health problems      (APO 12 November 2013)

Monitoring Activities of the National Cervical Screening Program Safety Monitoring Committee

This report looks at the evidence collected and assessed by the Safety Monitoring Committee established to assess whether there were adverse outcomes following the introduction of new NHMRC guidelines on how women with a low-grade Pap test result or a treated high-grade cervical biopsy result should be managed. Acknowledging that new evidence may come to light in future which could affect this picture, the overarching message from the evidence currently available and the methods used to assess this evidence is that the new guidelines have not led to an increase in cervical cancer in the seven years since they were introduced. (Released by the Australian Institute of Health and Welfare (AIHW) 22 November 2013)

Cancer in Victoria: Statistics and Trends 2012

This report, edited by Vicky Thursfield, Carolyn Staines, Graham Giles, and Helen Farrugia for the Cancer Council Victoria, is a compilation of the latest available Victorian cancer statistics. The report covers the following key areas: Incidence, Mortality, Most common cancers, Less common cancers, Aboriginal and/or Torres Strait Islander Victorians, Trends in cervix cancer, Survival, and Projections. (APO 11 October 2013)

Clinical ICT Systems in the Victorian Public Health Sector

This audit report, by the Victorian Auditor-General's Office, examined the clinical information and communications technology (ICT) systems of eight public health services in Victoria to see whether they were appropriately planned and implemented and whether expected outcomes and benefits are being realised. It examined the HealthSMART clinical ICT systems implemented at four health services and clinical ICT systems implemented at four other health services. The Department of Health (DH) failed to complete the expected implementation of clinical ICT systems across 19 Victorian health services due to poor planning and an inadequate understanding of system requirements. It significantly underestimated project scope, costs and time lines, as well as the required clinical workflow redesign and change management efforts. In contrast, non-HealthSMART sites have used their own internally generated funds and implemented clinical ICT systems at a fraction of the cost of implementing HealthSMART. This audit found evidence of a number of potential clinical risks at three of the HealthSMART sites. In the absence of appropriate controls and effective mitigations, these issues could pose serious patient safety risks. (APO 31 October 2013)

Managing Madness: Mental Health and Complexity in Public Policy

This paper, by Sebastian Rosenberg and Ian Hickle, explores the concept of collaborative care, particularly in relation to a range of new models of organisation and service that are emerging in response to one of the most problematic areas of public policy – mental health. These emerging models of coordinated mental health care are testing the limits of the evidence supporting coordinated care, and require critical evaluation. Myriad concepts of collaborative or coordinated care in health, including mental health, have created multiple definitions. Once definitional issues have been surmounted, however, the evidence for coordination of health care is reasonably strong. There is considerable research about which treatments and programs are best for people with a mental illness. There are few areas seemingly as complex as mental health, given that responsibility for policy and service lies across all three tiers of Australian government and across multiple jurisdictions. It also engages public, private and non-government sectors. Co-morbidities are commonplace, particularly drug and alcohol problems among younger people. Governments in Australia have traditionally taken responsibility for policy, programs and services, either as direct service providers or through contracting outputs from others. Yet the evidence indicates that for people with a mental illness, the best solutions are often not found in government but in the community and in organisations outside of government. New organisations and new structures are attempting more holistic management approaches, combining clinical care, community support, housing, employment and other services. This paper considers some of these new models in the light of existing evidence. The key challenge facing continued reform in mental health is not uncertainty regarding programs or services, but rather how to drive coordinated care for consumers across departments, governments and providers. This review will highlight the key changes that must be made for the benefit of the millions of Australians with a mental illness. Such changes need to empower users of care systems to choose options that actively support coordinated and efficient care delivery systems.

Monitoring Pulmonary Rehabilitation and Long Term Oxygen Therapy for People with Chronic Obstructive Pulmonary Disease (COPD)

Chronic obstructive pulmonary disease (COPD) is a major cause of death and disability in Australia. While pulmonary rehabilitation and long term oxygen therapy are recommended treatments for COPD, there is currently no national information about the supply and use of these therapies. This report, by the Australian Institute of Health and Welfare (AIHW), outlines a proposed approach to monitoring access to, and utilisation of, these therapies, by capitalising on existing data sources and identifying data development opportunities. (AIHW media release 20 November 2013)

A Problem Worth Solving: the Rising Cost of Musculoskeletal Conditions in Australia

This report details the rising cost of musculoskeletal conditions in Australia and makes a case for why there needs to be a proactive, strategic response.
Key findings include:

• $55.1 billion cost to the Australian economy, including direct health costs, lost productivity and reduced quality of life
• 6.1 million Australians already affected, of which 58% are of working age in peak income earning years (25-64 years)
• 43% growth in musculoskeletal cases projected over the next two decades, including a surge in older Australians living with the conditions

This report was produced by Arthritis Victoria and Osteoporosis Victoria based on analysis by Deloitte Access Economics (APO 17 October 2013)

Prostate Cancer in Australia

This is the first comprehensive national report on prostate cancer in Australia by the Australian Institute of Health and Welfare (AIHW). It presents an overview of the condition and analysis of key summary   measures including incidence, mortality and survival. Findings include: - Prostate cancer is the most commonly diagnosed cancer in Australia (excluding non-melanoma skin cancer), with 21,808 new diagnoses in 2009. - Prostate cancer is the fourth leading cause of mortality among Australian males, with 3,294 deaths from prostate cancer in 2011. - Around 9 in 10 (92%) males diagnosed with prostate cancer survive 5 years from diagnosis. This is higher than for all cancers (65%). (AIHW 14 November 2013)

Palliative Care Services in Australia 2013

Palliative care services in Australia 2013 is the second in a planned series of annual reports by the Australian Institute of Health and Welfare (AIHW) providing a detailed picture of the national response to the palliative care needs of Australians. Information from a range of data sources from 2011-12 and where indicated, 2010-11 are presented, as are changes over time. There were almost 54,500 palliative care-related separations reported in public and private hospitals in 2010-11. Almost $3.5 million in Medicare Benefits Schedule payments was paid for palliative medicine specialist services in 2011-12 (AIHW 15 November 2013)

Role of Traditional Medicine Practice in Primary Health Care within Aboriginal Australia

This literature review by Stefanie Oliver, published in the Journal of Ethnobiology and Ethnomedicine, attempts to identify and examine, both qualitatively and quantitatively, traditional medicine practices within Aboriginal Australia today. The practice of traditional Aboriginal medicine within Australia is at risk of being lost due to the impact of colonisation. Displacement of people from traditional lands as well as changes in family structures affecting passing on of cultural knowledge are two major examples of this impact. Prior to colonisation traditional forms of healing, such as the use of traditional healers, healing songs and bush medicines were the only source of primary health care. It is unclear to what extent traditional medical practice remains in Australia in 2013 within the primary health care setting, and how this practice sits alongside the current biomedical health care model. An extensive literature search was performed from a wide range of literature sources in attempt to identify and examine both qualitatively and quantitatively traditional medicine practices within Aboriginal Australia today. Whilst there is a lack of academic literature and research on this subject the literature found suggests that traditional medicine practice in Aboriginal Australia still remains and the extent to which it is practiced varies widely amongst communities across Australia. This variation was found to depend on association with culture and beliefs about disease causation, type of illness presenting, success of biomedical treatment, and accessibility to traditional healers and bush medicines. Traditional medicine practices were found to be used sequentially, compartmentally and concurrently with biomedical healthcare. Understanding more clearly the role of traditional medicine practice, as well as looking to improve and support integrative and governance models for traditional medicine practice, could have a positive impact on primary health care outcomes for Aboriginal Australia. (APO 2 July 2013)

Health in Australia: a quick guide

Health in Australia: a quick guide has been published by Amanda Biggs of the Parliamentary Library as an overview of Australia's complex health system.  It looks at the role of the different tiers of government, private health insurance, how much we spend on health care, how our health outcomes compare with that of other nations and our health workforce.  It also includes useful links to further information and resources.

New US guidelines on cholesterol treatment

Following on from the recent Australian media debate over the use of statins, the major heart organisations in the USA have just released new guidelines, published in the Journal of the American College of Cardiology:  2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines [J Am Coll Cardiol. 2013;():. doi:10.1016/j.jacc.2013.11.005].

A useful summary of the changes in the US can be found in Tuesday's New York Times article, Experts reshape treatment guide for cholesterol, by Gina Kolata.  Doctors are encouraged to prescribe statins to high risk patients (those who have diabetes or have had a heart attack), and to those who have very high levels of LDL cholesterol.  Others should be considered for statin therapy if, using a new risk calculator their risk of a heart attack or stroke in the next 10 years is at least 7.5 percent.  There is less emphasis on lowering cholesterol by specific amounts, and as Kolata reports, "It is not clear whether more or fewer people will end up taking the drugs under the new guidelines, experts said. Many women and African-Americans, who have a higher-than-average risk of stroke, may find themselves candidates for treatment, but others taking statins only to lower LDL cholesterol to target levels may no longer need them."

Treatment needs of pregnant women who are alcohol dependent

It's time to have the conversation: understanding the treatment needs of women who are pregnant and alcohol dependent is a report by Lucy Burns and Courtney Breen from the National Drug and Alcohol Research Centre.  It presents a narrative literature review of treatments available to pregnant women who have alcohol use disorders and findings from interviews with key stakeholders regarding current treatment practices and areas requiring improvement.

The authors found very little evidence-based literature on this topic, but from their research they compiled gold standards for the treatment of alcohol dependence in pregnancy. These standards include the screening of all pregnant women on their alcohol use by health professionals.  Pregnant women who screen positively for alcohol-use disorders should be offered access to treatment and extended hospitalisation post-delivery and birth with help and support from a multidisciplinary team.

The State of the World's Children - UNICEF

The 2013 edition of The State of the World’s Children is dedicated to the situation of children with disabilities. This UNICEF report examines the barriers that deprive children with disabilities of their rights and keep them from participating fully in society, such as inaccessible buildings, dismissive attitudes, and invisibility in official statistics.  It also lays out some of the key elements of inclusive societies that respect and protect the rights of children with disabilities, adequately support them and their families, and nurture their abilities, so that they may take advantage of opportunities to flourish and make their contribution to the world.

Tattoo ink and cancer

Photo from the ABC

Is there a link between tattoo inks and cancer?  Last year, a literature review, Tattoos, inks, and cancer by Kluger and Koljonen was published in Lancet Oncology. The authors concluded that "The number of skin cancers arising in tattoos is seemingly low, and this association has to be considered thus far as coincidental." Recently the issue has been raised again in the media, with Ian Olver, Clinical Professor of Oncology at Cancer Council Australia, penning a piece in The Conversation, To dye for?  Jury still out on tattoo ink causing cancer.  Olver concludes that more research is needed to find out whether the pigments and metallic elements in some tattoo dyes are used in great enough quantities to cause cancer.  He says individuals must weigh the risk and benefits themselves.

ABC Radio's Background Briefing also recently featured a program on the toxicity of inks and the lack of health regulations surrounding tattooing. Epidemic of Ink reported that tattoo ink containing polyaromatic hydrocarbons (PAHs) at levels above European guidelines have been found in Australia in a preliminary study by the National Research Centre for Environmental Toxicology. You can read a summary of the program or download the one hour investigation from their website.

Significant gaps in stroke care - report

The increasing number of people surviving strokes is leading to a crisis in service provision as the health and community support systems struggle to keep pace with demand. A new report, The needs of stroke survivors in Australia was released recently by the National Stroke Foundation.  It shows Australians are struggling every day due to a lack of access to essential support – a situation that is set to worsen as the number of stroke survivors grows. The report shows services are fragmented and access is dependent on where survivors live.   

Pain management webpage

The Australian Medicare Local Alliance has launched a webpage dedicated to pain management education. It includes information about forthcoming online education programs, a webinar series for multidisciplinary care teams including GPs, nurses and allied health care professionals, and a symposia scheduled in capital cities early next year for nurses, physiotherapists, clinical psychologists and pharmacists.  

At present, there are useful links to pain resources, the National Pain Strategy, other education resources for health professionals, and consumer information.

Cholesterol and statins debate

The ABC recently aired a two-part program on Catalyst entitled The Heart of the Matter.  The first program, Dietary Villains, questioned the role of saturated fats in causing high cholesterol and cardiovascular disease, and the second program, Cholesterol Drug War, asked if statins really reduce your risk of heart disease.  The result has been consternation among some of Australia's medical community, with the ABC's own health specialist Norman Swan claiming that the Catalyst program could cause people to die if they gave up taking statins on the basis of this program (see the Sydney Morning Herald report on 4 November).

The ABC's Health Report (presented by Norman Swan) made an alternative case in their program this week, The Cholesterol and Statin Debate, which included an interview with Professor Peter Clifton.  Another interesting article which attempts to unravel the arguments and includes links to clinical trials and other evidence-based material was published this week in The Conversation by Justin Coleman from Griffith University - Viewing Catalyst's cholesterol programs through the sceptometer . Be sure to scroll down to the comments below where the conversation continues.

Health Libraries - Worth Every Cent and More

Health Libraries Inc in Victoria and Health Libraries Australia commissioned  SGS Economics and Planning to investigate the return on investment of health library and information services in Australia, and their report has just been published. Worth every cent and more: an independent assessment of the return on investment of health libraries in Australia used surveys and case-studies to indicate that health libraries return $9 for every $1 invested.

This is considered to be a conservative estimate of  libraries' real worth as, for example, it takes into account the time saved by medical practitioners in searching for answers, but it does not take into account the improved quality of the results supplied by trained information specialists. It looks at how much it would cost users to have to buy the information they gain for free from the library, but it does not assess the savings achieved by library staff negotiating advantageous prices with information suppliers.

Indigenous women's health portal

The new Indigenous women’s health portal, located on the Australian Indigenous HealthInfoNet website, and partnered with Jean Hailes for Women's Health, aims to provide the indigenous women's health workforce and related health workers with access to quality information. 

The content of this portal is relevant to the health and wellbeing of women at a range of different life stages. The topics were chosen with input from Aboriginal and Torres Strait Islander health workers and a range of health professionals working in the area of Indigenous women's health. At this stage there is a core of evidence based facts and publications on such topics as menopause, menstruation, pregnancy and polycystic ovary syndrome.

Diabetes and disability

Diabetes anddisability: impairments, activity limitations, participation restrictions andcomorbidities is an AIHW report using data from the Australian Bureau of Statistics' Survey of Disability, Ageing and Carers 2009. People with diabetes were twice as likely to have a disability (39% compared with 17%) and almost 3 times as likely to have a severe or profound limitation (14% compared with 5%) than people without diabetes. Among working-age people with diabetes and disability, 40% said they were permanently unable to work compared with 20% of people with a disability who did not have diabetes. People with diabetes reported higher rates of high blood pressure, high cholesterol, heart disease, stroke, depression, vision loss and kidney related disorders than people without diabetes.

The Third Healthcare Revolution - Sir Muir Gray

Sir Muir Gray recently presented a public lecture in Sydney focusing on health reform and medical practice variation.  He believes we are in the midst of a Third Healthcare Revolution driven by citizens, knowledge and the Internet.  Sir Muir argues that despite the significant clinical advances of the last 50 years, health services are faced with the same persistent problems: patient harm, waste, unwarranted variation, inequity, and failure to prevent the preventable. Health services are also faced with the new challenges of rising demand and resource constraints.

Visit the Australian Commission on Safety and Quality in Health Care site to download the video of the presentation, view the PowerPoint slides, and link to more detailed workshop presentations.

Cancer in Aboriginal and Torres Strait Islander peoples

Cancer in Aboriginal and Torres Strait Islander Peoples of Australia: an overview is a report from the AIHW which brings together the most up-to-date data available from a wide range of sources to present statistics on difference across age, sex and remoteness areas and highlight key issues.  In 2007-2011, the age-standardised cancer mortality rate was 252 per 100,000 for indigenous Australians, compared to 172 for non-indigenous Australians, with lung cancer being the leading cause of cancer death.  Indigenous Australians had a 40% chance of surviving a diagnosis of cancer for at least 5 years, while non-indigenous Australians had a 52% chance.

Mental health research and evaluation project report

Mental health research and evaluation in multicultural Australia: Developing a culture of inclusion has been prepared by Mental Health in Multicultural Australia (MHiMA) for the National Mental Health Commission. This independent report looks at what is known about the mental health of culturally and linguistically diverse (CALD) communities in Australia; whether our mental health research pays adequate attention to cultural and linguistic diversity; and whether national data collections support evidence-informed mental health policy, practice and reform. The authors make recommendations for policy makers, researchers and others.  

Review of Acute Rheumatic Fever and Rheumatic Heart Disease Among Indigenous Australians

This review , or as a pdf, of acute rheumatic fever and rheumatic heart disease among Indigenous Australians has been prepared by the Australian Indigenous HealthInfoNet as a part of our contributions to ‘closing the gap’ in health between Indigenous people and other Australians by making relevant, high quality knowledge and information easily accessible to policy makers, health service providers, program managers, clinicians, researchers and the general community. The main purpose of the review, which follows the model of narrative reviews/syntheses, is to provide an authoritative, up-to-date review of acute rheumatic fever and rheumatic heart disease among Indigenous people that: (1) is a valuable overview for people working in the area; and (2) assists in the development/refinement of policies, strategies and programs. (APO 10/10/13)

Overweight and Obesity Rates Across Australia, 2011-12

In 2011–12, 10.8 million adults were either overweight or obese, and of these 4.7 million were obese.
This report, from the National Health Performance Authority (NHPA), shows that the percentage of adults who were obese varied threefold across local areas, from 14% in Sydney North Shore and Beaches to 41% in Loddon-Mallee-Murray. In three-quarters or more of communities for which we have comparable data, one in four adults were obese in 2011–12. The percentage of adults who were overweight or obese increased with geographic remoteness and lower socioeconomic status. Yet still half of adults (54%) in the wealthiest urban areas were overweight or obese, and two in 10 (19%) were obese. Overweight and obesity rates are increasing rapidly across Australia. In 1989, 44% of adults were overweight or obese, rising to 63% in 2011–12. Health problems related to excess body weight impact the health care system, as well as individuals, families and the community. (APO 24/10/13)

Review of Ear Health and Hearing Among Indigenous Australians

This review of ear health and hearing among Indigenous Australians has been prepared by the Australian Indigenous HealthInfoNet as a part of our contributions to ‘closing the gap’ in health between Indigenous people and other Australians, or as a pdf. The aim is to make relevant, high quality knowledge and information easily accessible to policy makers, health service providers, program managers, clinicians, researchers and the general community. The main purpose of the review, which follows the model of narrative reviews/syntheses , is to provide an authoritative, up-to-date review of ear health and hearing of Indigenous people that (1) is a valuable overview for people working in the area; and (2) assists in the development/refinement of policies, strategies and programs.

Overcoming Governance and Cost Challenges for Australian Public Hospitals

Australia will face problems funding its public hospital and other publicly funded health services if cost increases continue at the current rate in the context of ever-increasing use and an ageing population. The challenges of sustainably financing the cost of health will be exacerbated by inefficiencies in the public hospital sector—unless productivity improvements reduce the quantity of public resources consumed by public hospitals. This report, Overcoming Governance and Cost Challenges for Australian Public Hospitals: the Foundation Trust alternative, identifies and discusses some of the major governance issues that impede public hospital performance and that can be revised within the existing Medicare framework via state government-initiated reforms, principally by adopting quasi market-based initiatives. It was written by Peter Phelan and Jeremy Sammut of the Centre for Independent Studies. (APO 13/10/13)

Tobacco Smoking Rates Across Australia, 2011–12

This report by the National Health Performance Authority (NHPA) presents adult smoking rates at the local level across Australia. In 2011–12, 2.8 million adults smoked tobacco daily and smoking rates varied across local areas. This report shows that the percentage of adults who smoked daily varied four-fold across local areas, ranging from 6% in Sydney North Shore and Beaches to 28% in Grampians. In four local areas, one in 10 adults or fewer were daily smokers. Rates in some local areas were still relatively high as one-third of all local areas had smoking rates of at least 20% – equivalent to at least one in five people smoking daily. Smoking is a major risk factor for many chronic conditions including coronary heart disease, stroke and many cancers. Rates of smoking have been declining for many decades. Latest national data shows 16% of adults smoked daily in 2011–12. Smoking is still one of the largest single preventable causes of death and disease in Australia and this represents an enormous social and economic burden on individuals and the health system. (APO 24/10/13)

The rising cost of musculoskeletal conditions in Australia

A new report from Arthritis and Osteoporosis Victoria, A problem worth solving: the rising cost of musculoskeletal conditions in Australia,  makes a case for why there needs to be a proactive, strategic response.  In 2012 the study found that there had been 6.1 million Australians affected (26.9% of the population), including 2.9 million people with back problems, 1.9 million people with osteoarthritis, 0.8 million people with osteoporosis and 0.5 million people with rheumatoid arthritis.

The cost to the Australian economy of these conditions in 2012 was estimated at $55.1 billion, including direct health costs, lost productivity and reduced quality of life.  A 43% growth in cases was projected over the next 20 years, especially in people over 75.

Depression in residential aged care 2008-2012

This AIHW report explores the prevalence and characteristics of people with symptoms of depression in residential aged care. In 2012, 52% of all permanent residential aged care residents had symptoms of depression, which resulted in higher care needs.  Changes to routine, loss of independence and physical relocation to a new environment are cited as some of the reasons for the onset of depressive symptoms.

How social status affects health

Robert Douglas, Emeritus Professor in Epidemiology and Population Health at the Australian National University, has written a piece for The Conversation, It's good to be king: how social status affects health.  He summarises the latest thinking on this topic, stating that this growing area of research supports the a social view of disease and treatment - that lower social standing leads to lower mental, social and physical wellbeing.  Several studies are linked concerning the complex health consequences of poverty and the importance of social inclusiveness.

New Closing the Gap Clearinghouse resource sheets

Two new resources have been published by the AIHW's Closing the Gap Clearinghouse.

Engagement with indigenous communities in key sectors examines approaches to engagement with Aboriginal and Torres Strait Islander communities and what is and is not working.  It concentrates on early childhood services, environmental and natural resource management activities as well as health programs.

Engaging with Indigenous Australia: exploring the conditions for effective relationships with Aboriginal and Torres Strait Islander communities provides an overview of evidence-based research on this topic, what is most effective and how engagement can be enhanced - especially in regional areas.

Elective surgery waiting times 2012-13

In 2012-13 about 673,000 patients were admitted to Australian public hospitals from elective surgery Australian Hospital Statistics 2012-13: elective surgery waiting times also gives a breakdown of types of surgery, with one in four patients undergoing general surgery and one in seven orthopaedic surgery. Compared to the previous year, admissions for elective surgery increased by 1.8% across Australia.

Health impact of bushfire smoke

A topical item in The Conversation this week, "What you can do about the health impact of bushfire smoke" has been written by epidemiologists Martine Dennekamp from Monash University and Fay Johnstone from the University of Tasmania.  The authors express particular concern about the very small PM2.5 particles of smoke that can penetrate deep into the lungs and have been shown to have an effect on the respiratory and cardiovascular systems.  People particularly at risk, such as the elderly, pregnant women and those with a history of lung or heart disease, are advised to stay indoors with doors and windows sealed if they are near a fire area and cannot relocate.  

Children and needles: a pain solution

With a son who had a phobia of needles, Dr. Amy Baxter stumbled upon a solution: a high-frequency vibrating ice pack that helps disrupt pain signals on their way to the brain. She stuck a cute bee on the front, won a $1 million federal health grant, and the product now known as Buzzy was born.
(re-posted from NPR Weekly Innovation Blog series)

Vital signs 2013: the state of safety and quality in Australian health care

The Australian Commission on Safety and Quality in Health Care has released VitalSigns 2013: The State of Safety and Quality in Australian Health Care. This report provides an overview of a series of key topics in relation to the safety and quality of Australia’s health care system.

Professor Debora Picone, Chief Executive of the Commission noted “Vital Signs 2013 focuses on three important questions that members of the public may ask about their health care. Will my care be safe? Will I get the right care? Will I be a partner in my care?”

Sunscreen helps protect key gene that fights skin cancer

Two out of three Australians will be diagnosed with some form skin cancer before turning 70. Australian researchers have completed a "world-first" study that provides yet another reason to always wear sunscreen. Researchers at the University of Technology Queensland say slip, slop, slap helps protect a key gene that fights all three forms of skin cancer. 
Lead researcher Dr Elke Hacker said that sunscreen helps in eliminating the risk of skin cancers like BCC (basal cell carcinoma), SCC (squamous cell carcinoma) and malignant melanoma. She also added that sunscreen safeguarded a superhero gene called p53 that helps prevent cancer.
"As soon as our skin becomes sun damaged, the p53 gene goes to work repairing that damage and thereby preventing skin cancer occurring" Dr Hacker said.  The study has been reported in the journal Pigment Cell & Melanoma Research.

It's all about the culture

From the Hospitals in Pursuit of Excellence (HPOE) is this new case study which describes how a US health care system, Mountain States Health Alliance (MHSA) in Virginia USA, adopted Lean management and found that the transformation meant improved patient care, employee satisfaction and reduced costs as MSHA shifted its organisational culture.
Andrew Wampler, assistant vice president on the whole of Tenessee operations made this comment: “When we first began looking into Lean, we saw it as a cost cutting tool. After visiting the hospital sites and seeing Lean in action, we quickly learned it is much more than cost cutting and flowcharts—it is a cultural transformation across the entire health care organization that enables workers on the front lines to develop strategies to streamline processes and decrease waste. As a result, the hospitals we visited not only improved the bottom line; they made impactful changes that improve the quality of care.”
To read more about this case study on improving organisational culture, click here.

No health without mental health: the link between chronic disease and mental illness

Many physical health conditions increase the risk of mental illness, while poor mental health is known to increase the risk of diseases such as heart disease, stroke and cancer.To address the issue of unacceptably poorer health outcomes of people with chronic disease and the associated mental illnesses, nurses and midwives need to have the knowledge and skills to identify manage and refer their patients.

As such, the Australian College of Mental Health Nurses has released a series of online resources aimed at improving the knowledge and skills of nurses to identify and manage mental health conditions associated with chronic disease.

These free online resources attract continuing professional development points and focus on four chronic disease areas: cancer, cardiovascular disease, diabetes and respiratory disease. You will need to register to access these free resources which will be made available October 22, 2013.

For further information, and to access these resources, go to www.acmhn.org/chronic-disease-elearning 

Chronic kidney disease: regional variation in Australia

This report on chronic kidney disease shows that people from remote and very remote areas were 2.2 times more likely to die from chronic kidney disease than people from major cities. People from very remote areas were at least 4 times more likely to start kidney replacement therapy (dialysis or kidney transplant) than people from non-remote areas.  

Chronic kidney disease is a common and serious problem in Australia and its management can be resource intensive, particularly for the most severe form of the disease: end-stage kidney disease. 
Download this AIHW report here.

An Introduction to social media for scientists

This open access article describes the exploding popularity and rapid expansion of online tools and the increasing number of science-based professionals taking advantage of them. Many researchers still feel overwhelmed and hesitant toward getting started with social media and the aim of this paper is to familiarise researchers with existing internet resources by discussing: prospective benefits that can stem from online science conversations; explaining how scientists can efficiently and effectively harness online resources; and providing an overview of popular online tools. Access the article in full here.

Bik HM, Goldstein MC (2013) An Introduction to Social Media for Scientists. PLoS Biol 11(4): e1001535. doi:10.1371/journal.pbio.1001535

Projection of the number of young people in residential aged care

The National Disability Insurance Scheme was launched in July 2013 and this report from the Summer Foundation provides an estimate of the unmet needs and resources required for housing and support in the three designated NDIS launch sites over the next three years.

National Disability Insurance Scheme launch sites: projection of the number of young people in Residential Aged Care indicates that at present there are 6192 people under the age of 65 in residential aged care, and 592 under the age of 50. This is not desirable and the problem needs to be addressed by the provision of affordable and appropriate housing.

Making Health Care Safer

Making Health Care Safer II: An Updated Critical Analysisof the Evidence for Patient Safety Practices (AHRQ Evidence Report No. 211) updates the 2001 report from the US Agency for Healthcare Research and Quality. It analyses a growing body of patient safety research using an evidence-based approach. 

After analyzing 41 patient safety practices, an international panel of patient safety experts identified 22 strategies that are ready for adoption.  Ten of these practices are "strongly encouraged" for adoption based on the strength and quality of evidence.

  

Movement between hospital and residential aged care 2008-09

This report from the Australian Institute of Health and Welfare examines movements between hospital and residential aged care by people aged 65 and over in 2008-09. Overall, almost 10% of 1.1 million hospitalisations for older people were for people already living in residential aged care. A further 3% of hospitalisations for older people ended with the patient being newly admitted into residential care. The report also describes the characteristics of people moving between the two sectors, and short-term outcomes for people going into residential care.

COPD best practice

The latest edition of the Australian Health Review includes an article by Teresa Burgess et al, Best-practice care for people with advanced chronic obstructive pulmonary disease: the potential role of a chronic obstructive pulmonary disease care co-ordinator.  This qualitative study found that people with this condition often have trouble navigating the many different services they may require, and that the lack of communication between these services can also be a problem.  A dedicated care coordinator with advanced nursing skills could ensure that people with COPD have streamlined care which is appropriate and accessible.

Australian Health Review 34 (4) 2013 : 474-81.  Available though CIAP or contact your health librarian.

A Review of Sexual Health Services for Gay, Bisexual and Other Men who have sex with men in Western Australia: survey report July 2013

The aim of this review was to describe the characteristics of men who have sex with men (MSM) accessing both hospital and community-based sexual health services in the Perth metropolitan area and assess the acceptability of these services to the MSM who access them. The majority of new HIV diagnoses in Australia are in gay, bisexual, and other (MSM). Providing accessible, appropriate and acceptable sexual health services is essential as a significant proportion of MSM are not testing for HIV and sexually transmitted infections (STIs) at the recommended frequency (at least once per year for sexually active MSM, and more often for higher risk men). Recognised barriers to testing include not having enough time to test and difficulty getting an appointment.

In July 2010, a new community-based clinical service employing peer workers targeting gay and bisexual men opened in West Perth. M Clinic, managed by the Western Australian AIDS Council (WAAC), complements traditional hospital-based sexual health services already operating in Perth and Fremantle. Until this project, no external evaluation of acceptability among MSM clients involving all of these services had been undertaken. The report was authored by Damian Conway, Martin Holt, Michael Atkinson, Lewis Marshall, Jenny McCloskey, Patricia Langdon, Denton Callander and Rebecca Guy of the Kirby Institute. (APO 30/7/13)

A Unified Approach for the Evaluation of Telehealth Implementations in Australia

This paper provides a conceptual framework for the evaluation of telehealth implementations in Australia, and also provides an evidence base that illustrates the current state of telehealth evaluation on an international scale. It was produced as part of a one year study, funded by the University of Melbourne interdisciplinary seed grant. This paper will firstly provide a conceptual framework that incorporates the key dimensions, criteria and measures that need to be considered in the evaluation of telehealth implementations in Australia.

The paper is divided into three sections. Section 1 provides an overview of the literature, method and proposed framework. Section 2 provides the proposed framework for telehealth evaluation. Section 3 describes the results of grouping the various criteria and measures mentioned in the literature. This paper also has two Appendices. Appendix A should be used to support the reading of Section 3. Appendix B provides an annotated bibliography of the papers reviewed, as well as further information on the literature.