PTSD and Stigma in the Australian Army

This paper by John Bale and published by the Australian Army seeks to identify the nature of the stigma attached to Post-traumatic Stress Disorder (PTSD) and other mental health conditions in the Australian Army.  It also looks at the negative implications of such a stigma on the individual, the workplace and the Army as a whole.

PTSD needs to be identified and treated early but many people fear the negative judgements of people around them so do not receive early diagnosis.  Previous reports have found that stigma surrounding mental health issues is a considerable barrier in the Australian Defence Force and particularly in the Army.  PTSD and Stigma in the Australian Army analyses Canadian, British and US initiatives and provides key recommendations to the Australian Army on how to combat stigma.

Impacts of climate change on public health in Australia

This Deeble Institute Issues Brief looks at the immediate and longer-term impacts of climate change and how it may affect Australian health and social environments.  The authors call on Federal and State Governments and agencies within the Australian public health sector to heed the information, opinions and recommendations provided here and offer them guidelines for decision-making in responding to climate change impacts.

"A new approach, based on ecological principles, will be required to navigate through the complex and interrelating health causes. The public health sector must strengthen existing approaches for effective climate change adaptation strategies, including assessing regional health risks to identify vulnerable and resilient populations, collecting enhanced surveillance data and developing monitoring indicators."

Impacts of climate change on public health in Australia: Recommendations for new policies and practices for adaptation within the public health sector.  Walter T, Stevens P, Verhoeven A & Boxall A. Deeble Institute for Health Policy Research (2014). 

Call for more generalist doctors and specialist nurses

In an article recently published in The Conversation, Professor Don Campbell from Monash University explains Why hospitals need more generalist doctors and specialist nurses.  With an ageing population with complex needs making increasing demands on our hospitals, Campbell argues that "we need to redesign the workforce so hospitals are staffed by general physicians and nurses who take on more complex roles."

Because we are living longer we are likely to develop multiple chronic diseases so need a generalist to manage our care. Nurses however need to up-skill into more specialist roles.  Examples of hospital workforce reform along these lines is given from the UK, the US and New Zealand.

Obesity in health-care settings

 Obesity-related stigma can influence how obese people interact with health-care professionals and access health care. The aim of this article was to undertake a synthesis of studies examining the views and experiences of both obese people in relation to their health-care provision and health-care professionals in providing care to obese patients.

Thirty studies were identified with all reporting obesity impacting on health-care interactions. Key themes identified were experiences of stigma and feelings of powerlessness, treatment avoidance, psycho-emotional functioning, professional attitudes, confidence and training, variations in health contact time and finally, differences in treatment options and preventative measures.

Mold, Freda, Forbes, Angus.(2013). Patients' and professionals' experiences and perspectives of obesity in health-care settings: a synthesis of current research. Health Expectations, 16(2), 119-142

The power of consoling presence

This article in the journal BMC Nursing looks at the dying person and the experience of the hospice nurse. Many nurses feel unprepared to accompany people through the process of dying and feel they don't have the skills in psychosocial and spiritual care. This can cause high levels of moral distress, grief and burnout.

Tornoe, Kirsten A. [et al] (2014). The power of consoling presence - hospice nurses’ lived experience with spiritual and existential care for the dying. BMC Nursing, 13:25.  doi:10.1186/1472-6955-13-25

Preconception interventions

The journal Reproductive Health has published a series of articles on preconception care. The importance of public health interventions during the preconceptional period on maternal and child health is recognized. "The reviews highlight our current understanding (or lack thereof) regarding how both maternal and paternal preconception health and knowledge shapes the long-term health of not only children, but of families, communities, and nations."

The complete supplement is open access and free to download. You can also read the blog related to this supplement.

2014. Preconception interventions. Reproductive Health, 11(Supp 3)

Characteristics of people using mental health services and prescription medication, 2011

The Mental Health Services-Census Data Integration project brings together data from the 2011 Census with administrative information on people accessing subsidised mental health-related Medicare Benefits Schedule (MBS) services and Pharmaceutical Benefits Scheme (PBS) prescription medication.

The proportion of the population accessing PBS subsidised mental health-related prescription medications increased with age, with over one-third (34%) of all people aged 75 years and over accessing one or more of these drugs in 2011. By comparison, a higher proportion of people aged 15-64 years accessed MBS subsidised mental health-related services compared with people younger or older than this age group.

Published by the Australian Bureau of Statistics, the report is free to download.
4329.0 - Characteristics of people using mental health services and prescription medication, 2011  

Role of allied health professionals

In a comprehensive report from QualityWatch in the UK, researchers examined the role and quality of care of allied health professionals in the NHS.  Allied health professionals: Can we measure quality of care? looks at a diverse group of 12 professions who often work across mulidisciplinary teams and across sectors of care.  

The authors of this report express concern that the contribution AHPs make to overall healthcare is undervalued.  The different AHP groups include chiropodists, dieticians, music therapists, occupational therapists, orthoptists, paramedics, physiotherapists, radiologists and speech and language therapists.  They found that AHPs made up 6% of the NHS workforce in 2013.  "We suggest that a better understanding of both the levels of care and the quality of care provided by AHPs will be increasingly important in a financially constrained NHS."

Views of Australian paediatricians on asylum seeker children

In an article published in the Medical Journal of Australia recently, Elizabeth Corbett and her colleagues report on a survey sent to all Australian paediatricians registered with the Royal Australasian College of Physicians.  Over 80% of respondents (n139) agreed with the Australian Medical Association assertion that mandatory detention of children constitutes child abuse, and disagreed with offshore processing.  Their knowledge about practical issues such as current health screening practices and Medicare eligibility showed some significant gaps, and the authors concluded that education was needed in these areas.

The article is available through CIAP for NSW Health employees, or contact your librarian if you have trouble obtaining the full text.

Australia's treatment of refugee and asylum seeker children: the views of Australian paediatricians, Elizabeth J M Corbett, Hasantha Gunasekera, Alanna Maycock and David Isaacs.

Med J Aust 2014; 201 (7): 393-398.  doi: 10.5694/mja14.00279.  

Taking a New Look at Artificial Sweeteners

Diet sodas and other treats sweetened with artificial sweeteners are often viewed as guilt-free pleasures. Because such foods are usually lower in calories than those containing natural sugars, many have considered them a good option for people who are trying to lose weight or keep their blood glucose levels in check. But some surprising new research suggests that artificial sweeteners might actually do the opposite, by changing the microbes living in our intestines.  
Read the complete blog post here.

Reposted from the NIH Director's Blog.

Australian hospital statistics 2013-14: elective surgery waiting times

Waiting times for elective surgery in Australian public hospitals have remained relatively stable between 2012-13 and 2013-14, according to a report released by the Australian Institute of Health and Welfare (AIHW). The report, Australian hospital statistics 2013-14: elective surgery waiting times, shows that national admissions for elective surgery increased by 4.2% between 2012-13 and 2013-14.

In 2013-14  about 700,000 patients were admitted to Australian public hospitals from elective surgery waiting lists and 50% of patients were admitted for their surgery within 36 days of being placed on the waiting list and 90% were admitted within 262 days.

The State of Safety and Quality in Australian Health Care

A new report released by the Australian Commission on Safety and Quality in Health Care (ACSQHC) provides an overview of a series of key topics in relation to the safety and quality of Australia's health care system. Professor Villis Marshall, Chair of ACSQHC said  “Vital Signs 2014 is structured around 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?”  Each question is  considered in its own section using examples of key health issues in Australia and followed by two case studies.

Vital Signs 2014: The State of Safety andQuality in Australian Health Care.  Australian Commission on Safety and Quality in Health Care, Sydney: ACSQHC; 2014. 

Women With Disability After Breast Cancer - Insights from Yoga

A recent study in Canada looked at a newly developed Yoga Program for women with disability after breast cancer. Significant gaps remain in our understanding of pain, range of motion restrictions, and lymphoedema and their potentially disabling impact on women's everyday lives in relation to arm disability. Often lymphoedema is the main consideration for women, however through the course it was found that pain and range of motion restrictions are often more prevalent and continue to effect everyday life. It was also found that  the emotional burden of this illness is not only significant but also underexplored, particularly with respect to the development of supportive interventions.

Many of the women in the study felt that yoga had a positive influence on many dimensions of their lives and the study suggests that there is a need for multiple, holistic interventions such as yoga.

Insights From an Iyengar Yoga Program for Women With Disability After Breast Cancer. Holistic Nursing Practice; 28(6), 2014, p 353–361. Available on CIAP free to NSW Health Staff.              

Hip Fracture Care Clinical Guideline

The NHMRC-approved Australianand New Zealand Guideline for Hip Fracture Care - Improving Outcomes in HipFracture Management of Adults was released by the Australian and New Zealand Hip Fracture Registry (ANZHFR) Steering Group in September 2014.
This guideline is designed to help professionals providing care for people with a hip fracture to deliver consistent, effective and efficient care and is available through the Clinical Practice Guidelines Portal.

Companion animals and the health of older people

The International Federation on Ageing has published Companion animals and the health of older persons as one response to the projected costs associated with caring for ageing populations.  A literature review examined the relationship of older people living both independently and in long-term care facilities, including dementia sufferers and people with a mental illness, with their pets. The study focused on the physical, mental, emotional and social health of these people, as well as the role of animals in their perceptions of inclusion in their community.  The economic impact of animals interacting with older people was also examined and some promising initiatives explored, including one in Victoria and one in NSW.  It was acknowledged that research on this topic has been very limited.

Coeliac disease: where are we in 2014?

Published recently in Australian Family Physician by Kristin Kenrick and Andrew S Day, Coeliac disease: where are we in 2014? seeks to summarise the current knowledge and management of this autoimmune disease which affects at least one in a hundred Australians.

Coeliac disease is characterised by chronic inflammation of the small-intestinal mucosa and triggered by eating gluten. Many people with the disease remain undiagnosed because of the varied manifestations of symptoms it can produce.   The article presents up-to-date information on CD as we now understand it, with recommendations on whom to test and how to test for it, and how to manage patients once they are diagnosed.

Australian Family Physician Volume 43, No.10, October 2014 Pages 674-678.

Women, work and the menopause

According to this report, 78% of women aged between 45 and 54 participate in the Australian workforce, representing over a million women potentially experiencing menopause while at work.
Women, work and the menopause: releasing the potential of older, professional women is a report from the Australian Research Centre in Sex Health and Society at La Trobe University and authored by Gavin Jack and colleagues.  It explores:

• Older women’s health and well-being
• The relationship between menopause-related symptoms and work outcomes  
• Actual and desired levels of organisational support for women experiencing menopause
• Work-related and organisational factors that exacerbate or ameliorate women’s experiences of menopause in the workplace
• Women’s first-hand experiences, beliefs and attitudes towards menopause at work

Mistakes made when interpreting research

Two researchers at the Australian National University have written a useful article in The Conversation, The 10 stuff-ups we all make when interpreting research.  Will J Butler and Rod Lamberts explain very simply some of the pitfalls we can easily fall into when trying to critically appraise a study.

Some of these "stuff-ups" include using the results of just one study to prove a point, confirmation bias (where we look for studies that confirm what we already believe), confusing the merits of qualitative and quantitative results and giving too much weight to significance and peer review.

Medication errors: an overview for clinicians

The Institute of Medicine in the US has estimated that medication errors cause one in 131 outpatient deaths and many more morbidities.  "Medication errors: an overview for clinicians" is an article recently published in Mayo Clinic Proceedings and its authors provide an overview of medical errors, including definitions, incidence, risk factors, avoidance strategies and legal consequences.

Medication errors can be precipitated by many factors, ranging from the confusion which may arise from the similar labeling or naming of different drugs to poor communication between health professionals.  Strategies that have been used to overcome these problems are discussed.

Wittich CM, Burkle CM, Lanier WL, Mayo Clinic proceedings.89(8):1116-25.  http://dx.doi.org/10.1016/j.mayocp.2014.05.007

Contact your health library for the full text.

Dying in America report

Continuing the theme of palliative care and dying, this consensus report has just been published by the US Institute of Medicine. Dying in America:  Improving quality and honoring individual preferences near the end of life argues that improving palliative care services not only enhances the quality of life of the patient, but could be more economically sustainable.

Recommendations from the report include health professionals communicating better to patients about their choices and advanced care planning, there should be more rigorous education for clinicians in the issues of palliative care and there should be greater financial incentives for people to die in their own homes.

Dying Well - Grattan report

The Grattan Institute has published Dying Well, a report by Hal Swerissen and Stephen Duckett about how we die in Australia. According to the report, 70% of Australians would like to die at home, but only 14% actually do so.  About 50% die in hospital and a third in residential care. Dying in Australia is more institutionalised than most other countries and this is linked to medical and community attitudes as well as a lack of funding for home-based care.

The report recommends more public discussion, including an education campaign, about the limits of health care as death approaches and the need to focus on end-of-life care.  It also proposes the widespread adoption of advance care plans that ensure people’s desires for the end of life are met.  “The baby boomers are growing old and in the next 25 years the number of Australians who die each year will double,” Professor Swerissen says. “We need the courage to promote a national discussion about a subject that we might dislike but cannot avoid.”

You can also read Swerisson and Duckett's article in The Conversation, A Good death:  Australians need support to die at home.  It's a good summary of their full report.


Swerissen, H and Duckett, S., 2014, Dying Well. Grattan Institute ISBN: 978-1-925015-61-

Palliative Care Services in Australia 2014

The Australian Institute of Health and Welfare has published this annual report about services available to Australians in palliative care, and changes over time.  There were over 57 600 palliative care related separations from public and private hospitals in 2011-12 and almost $4.7 million MBS payments were made for palliative medicine specialist services in 2012-13.

Detailed information is provided in the report about definitions of palliative care and who provides it.  Both GP and specialist encounters are explored, and data provided on the overall palliative workforce, medications and services and facilities.

Combating the Obesity Epidemic

A two-part program on Australia's obesity problems have recently aired on ABC Radio National's Health Report.  Combating the Obesity Epidemic Part 1 and Part 2 discuss the latest reports that almost two thirds of Australians are now overweight or obese, and how willpower, surgery and drugs are being used to tackle the problem.

Guests include Professor John Dixon from Baker IDI Heart and Diabetes Institute in Melbourne, Associate Professor Garett Smith, a surgeon from Royal North Shore Hospital and Guy Maddern, Professor of Surgery at the University of Adelaide.  In addition one man's battle with his weight is charted over time. You can read the transcripts or download the audio at the above links.

World Alzheimer Report 2014

Alzheimer's Disease International has published  World Alzheimer Report 2014, Dementia and Risk Reduction: An analysis of protective and modifiable factors, which examines the evidence for the existence of modifiable risk factors for dementia in four key domains: developmental, psychological and psychosocial, lifestyle and cardiovascular conditions. The report makes recommendations to drive public health campaigns and disease prevention strategies.

The report calls for dementia to be integrated into both global and national public health programs alongside other major non-communicable diseases. Among the many findings, the report reveals that diabetes can increase the risk of dementia by 50%, and with obesity and inactivity being risk factors for diabetes, they should be targeted.

Australia's health expenditure 2012-13

Expenditure on Australian health was estimated according to this AIHW report at $147.4 billion in 2012-13.  This was only 2.4% higher than the previous year and the lowest growth since 1990-91.  Health Expenditure Australia 2012-13 shows this to be largely a result of the Australian Government health funding falling by 1.9%, and a very low growth in state funding.  Non-government funding however was quite strong at 9.7%.

There was an analysis of this report on ABC Radio National's Health Report recently, when Norman Swan discussed the implications with the Director of the AIHW, David Kalisch.  You can see the transcript of the interview or listen to the audio here.

Dementia on ABC Big Ideas

Dementia was the topic on a recent episode of Big Ideas on ABC radio.  It is estimated that 332,000 Australians suffer from dementia, and this is likely to triple over the next forty ears unless a cure is found. The costs to our health system are enormous and much research is going into Alzheimer's Disease, but can we prevent or cure this disease?

Guests on this program include Professor Kaarin Anstey, Director of the Centre for Research on Ageing at ANU, Dr Zoe Terpening from the Brain and Mind Research Institute at the University of Sydney, Professor Henry Brodaty, Director of the Centre for Health Brain Ageing, UNSW and Ita Buttrose, Alzheimer's Australia ambassador.

You can listen or download the program here

Public health advocacy toolkit

The third edition of the Advocacy in Action Toolkit from the Public Health Advocacy Institute of Western Australia is now available for download.  It is a practical resource full of examples and case studies demonstrating how advocacy strategies can be applied across different issues. The toolkit addresses the challenges faced when advocating on an issue and provides practical solutions.  It also provides tips on working with the media. 

Effectiveness of Aboriginal Community Controlled Health Services

The Deeble Institute for Health Policy Research has compiled an evidence brief:  The relative effectiveness of Aboriginal Community Controlled Health Services compared with mainstream health service.  ACCHSs have been funded by the Australian Government to provide primary health care services to Aboriginal people.  The authors of this brief found a lack of evidence on the effectiveness of these health services.  "This means that it is impossible to make categorical statements, one way or the other, about the effectiveness of ACCHS.  That said, a range of studies have been conducted which, while mostly small-scale, indicate that the services provided by ACCHS are valued by their Aboriginal clients."

Prevalence of osteoporosis in Australia

Because osteoporosis has no obvious symptoms until a trauma fracture occurs, it is difficult to estimate the number of people living with this condition.  Estimating the prevalence of osteoporosis in Australia looks at both the epidemiology and the impact of osteoporisis in people over 50 years of age.  It is shown that it markedly increases with age and is more common in women than in men.

In 2011-12 the estimated prevalence of self-reported diagnosed osteoporosis among those aged 50 and over living in the community was 15% of women and 3% of men, according to the Australian Health Survey.  However, a recent study which measured bone density in a population sample estimated that 23% of women over 50 had osteoporosis and 6% of men.