Hospitalisations for mental health conditions

Healthy communities: hospitalisations for mental health conditions and intentional self-harm in 2013–14 has been published by the AIHW recently. It examines how many people in each community need hospital treatment for mental health conditions, in order to identify local areas that may require more services and support, focusing on the mental health of populations in small areas across Australia.

The report found that in that year, there were enormous inequities in the age-standardized rate of mental health hospitalisations between Primary Health Networks, with the rates being six times higher in some areas than others. The most common group of mental health conditions requiring hospitalisation was from drug and alcohol use. In 2013–14, there were 33,956 hospital admissions (including overnight and same-day) for intentional self-harm, which accounted for 184,332 bed days nationally.

Causes of illness and death in Aboriginal and Torres Strait Islander people 2011

The Australian Institute of Health & Welfare has published this Australian Burden of Disease Study which estimates the total, non-fatal and fatal burden of disease and injuries for the Aboriginal and Torres Strait Islander population for 2011 and 2003. It also provides estimates of the burden attributable to 29 risk factors, and estimates the gap in disease burden between Indigenous and non-Indigenous Australians.

The report indicates that Indigenous Australians experience a burden of disease that is 2.3 times the rate of non-Indigenous Australians and that two thirds of the burden is from chronic diseases.  Coronary heart disease, suicide and self-inflicted injuries, anxiety disorders, alcohol use disorders and diabetes were the leading specific diseases, together contributing 24% of the total burden and are also the main causes of the gap in disease burden.

The report indicates that around 37% of the burden of disease in Indigenous Australians was preventable by reducing exposure to the modifiable risk factors included in this study, notably tobacco and alcohol use, high body mass, physical inactivity, high blood pressure and high blood plasma glucose.

Australian Burden of Disease Study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2011 Australian Burden of Disease Study series no. 6. Cat. no. BOD 7. Canberra: AIHW

Egg and peanut allergies in infants reduced by early exposure

The Journal Of the American Medical Association (JAMA) has published the results of a study indicating that the early introduction to infants of egg (from four to six months) and peanuts (from four to 11 months) is linked to lower rates of egg and peanut allergy.

The authors of Timing of Allergenic Food Introduction to the Infant Diet and Risk of Allergic or Autoimmune Disease: A Systematic Review and Meta analysis found moderate certainty-evidence from various clinical trials to support their conclusions.  They also found high-certainty evidence that timing of gluten introduction was not associated with coeliac disease risk. 

You can read a good summary of the evidence from this study in an article published last week in The Conversation by Merryn Netting and Katie Allen.

Despo Ierodiakonou et al. JAMA. 2016;316(11):1181-1192. doi:10.1001/jama.2016.12623. (NSW Health Employees can access the full text via CIAP or contact your librarian).                    

Multimorbidity guideline

Multimorbidity: Clinical assessment and management is a new guideline from the National Institute for Health and Care Excellence (NICE) in the UK. It aims to optimize care for adults with multiple long-term conditions by reducing the treatment burden of polypharmacy and multiple appointments. It also promotes the importance of shared decisions between the client and the health practitioner in regard to treatments, health priorities, lifestyle and goals.

This guideline includes recommendations on tailoring an approach to care, identifying people who may benefit, assessing frailty and delivering the approach to care.

Suicide by health professionals

Suicide by health professionals: a retrospective mortality study in Australia, 2001–2012 has just been published in the Medical Journal of Australia and examines age-standardised rates and methods of suicide by health professionals, compared with suicide rates for other occupations.

The researchers looked at intentional self-harm cases recorded by the National Coronial Information System during the period 2001–2012 and found that suicide rates for female health professionals  were higher than for women in other occupations. For men, medical practitioners did not have a higher suicide rate than other professions, but male nurses and midwives did. The most frequent method of suicide used by health professionals was found to be self-poisoning. The authors concluded that that there was a need for a targeted prevention of suicide for health professionals.

Allison J Milner, Humaira Maheen, Marie M Bismark, Matthew J Spittal. Medical Journal of Australia 19 September 2016

Coping with Violence in Mental Health Care Settings

Coping with and understanding violent and threatening behavior in mental health care settings is a challenging, but integral part of a caregiver's job, and if not handled well, such situations can result in staff and patient injuries. This multiple case study in Archives of Psychiatric Nursing, explores de-escalation processes in threatening and violent situations based on patients and staff members
perspectives.
Berring, L., Pedersen, L. & Buus, N. (2016). Coping with Violence in Mental Health Care Settings: Patient and Staff Member Perspectives on De-escalation Practices. Archives of Psychiatric Nursing, 30(5), 499-507 (Open Access)

When an Elder is the Abuser

Professionals face additional barriers when faced with domestic violence in older people. There may be a lower imperative to enquire about domestic violence owing to assumptions that an older partner lacks the ability to cause physical harm and because of the absence of dependent children at home. The physical signs of domestic violence may be all too easily explained in older people as the result of frailty or a fall.
This open access article in the Medical Journal of Australia raises the concern that intimate partner violence in older couples is under-recognised. Domestic violence perpetrated by an older person requires clinicians and families to consider a different narrative to that predominant in elder abuse, one where the elder is the aggressor and may have been so for decades.

Wijeratne, C. & Reutens, S. (2016). When an elder is the abuser. Medical Journal of Australia, 205(6), 246-247. 

Mentoring to Retain Newly Hired Nurses

Failure of the current transition experience from education to clinical practice is evident when nurses exhibit characteristics of burnout and role stress during their first year of employment. Often nurses become discouraged because their experience is stressful and often the environment is one of bullying. Mismanagement of the early professional experience leads to lack of motivation, low productivity and decreased quality of patient care, which should be a worry to all hospitals.
Supporting the professional socialization of nurses is critical because engaged nurses are satisfied with their careers and stay longer at their employing institutions, which in turn decreases staff turnover and improves patient outcomes satisfaction.
Mentoring is a low cost option and a positive mentoring relationship may be a career lifeline that eases the feelings of loneliness and stress that can stifle professional development.

Gazaway, S., Schumacher, A. and Anderson, L. (2016). Mentoring to retain newly hired nurses. Nursing Management, 47(8), 9-13. (Full text access via CIAP for NSW Health Staff. Otherwise check with your library staff)

Parkinson’s Disease Psychosis

Parkinson's Disease Psychosis (PD-P) remains a challenging clinical disorder for patients, caregivers, and treatment providers.

This virtual issue features 20 key and representative psychosis articles, authored by many leaders in the field of PD psychosis (PD-P), and published over the past decade in either Movement Disorders or Movement Disorders Clinical Practice. This collection spans the spectrum of key research that has occurred in this area, covering prevalence, course, psychiatric and cognitive comorbidity, and overlaps with related neurodegenerative diseases, neurobiology, and assessment instruments.

Parkinson's Disease Psychosis: Articles Collection   

Hip Fracture Care Standard

The Australian Commission on Safety and Quality in Health Care in collaboration with the Health Quality & Safety Commission New Zealand has released the Hip Fracture Care Clinical Care Standard. In Australia, an estimated 19,000 people over the age of 50 are hospitalised with a hip fracture each year, often after falls.
  
The Hip Fracture Care Clinical Care Standard aims to ensure that a patient with a hip fracture receives optimal treatment from presentation to hospital through to the completion of treatment in hospital.    

Nurse Empathy and the Care of People with Dementia

Although there is widespread acknowledgment that nurses require empathy to deliver quality care, the complexity of caring for people with dementia in hospital creates further challenges for both nurses and patients. This recent paper in the Australian Journal of Advanced Nursing details the relevant influences on the ability of nurses to care empathetically for people with dementia in hospital. Appropriate nurse-patient ratios which consider the additional workload attached to caring for people with dementia, clinical supervision and targeted nurse education must be considered to ensure health systems deliver appropriate person-centred care to people with dementia.

Digby, R., Lee, S. & Williams. (2016). Nurse empathy and the care of people with dementia. Australian Journal of Advanced Nursing, 34(1)

State of Telehealth

A review article on the State of Telehealth, has recently been published in the New England Journal of Medicine. The authors define telehealth as "the provision of health care remotely by means of a variety of telecommunication tools, including telephones, smartphones, and mobile wireless devices, with or without a video connection."

The article explores the trends of telehealth, its costs and limitations (together with possible solutions) and where the technology could go in the future. "The growth of telehealth over the next decade and beyond will have profound implications for health care delivery and medicine. The provision of care at a distance could help address longstanding concerns about the distribution and number of physicians and provide greater flexibility to both patients and clinicians with respect to their location and availability."

E. Ray Dorsey, Eric Topol. (2016). The New England Journal of Medicine, 375, 154-161. doi:10.1056/NEJMra1601705.  Available via CIAP for NSW Health employees. 

Indigenous children and deadly conditions

A three part series on deadly conditions found in Indigenous Australian children that do not tend to affect non-Indigenous children has been published this week in The Conversation. Each article, on trachoma, otitis media and rheumatic heart disease, describes the condition and its epidemiology and looks at what we need to do to eliminate the problem.

Why is trachoma blinding Aboriginal children when mainstream Australia eliminated it 100 years ago? is by Hugh Taylor, Emma Stanford and Fiona Lange from the University of Melbourne.  According to their research, Indigenous people at the age of 40 three times the rate of vision loss and six times the rate of blindness than non-indigenous adults.  Trachoma is present in 4-5% of Indigenous children, yet it "disappeared from mainstream Australia more than 100 years ago with improved hygiene facilities, water infrastructure and living conditions."

Why are Aboriginal children still dying from rheumatic heart disease? is by Professor Jonathan Carapetis from the Telethon Kids Institute.  He provides figures that show that young Indigenous Australians in the Northern Territory are up to 122 times more likely to have rheumatic heart disease than their non-Indigenous counterparts.

Amanda Leach at the Menzies School of Health Research wrote the third article:  Bulging ear drums and hearing loss: Aboriginal kids have the highest otitis media rates in the world. "Tragically, almost all Aboriginal children (90%) in remote areas have some form of otitis media: 50% have glue ear, 30% have acute otitis media, and around 15% have runny ears."

Australia's Health 2016

The AIHW has this week released it's 15th biennial health report - Australia's health 2016. Several feature articles and statistical snapshots cover Australia's health expenditure, the major causes of ill health, health of Indigenous Australians, health system performance and many other current profiles. Overall we are living longer and generally consider ourselves to be healthy.  For each 100 people, 56 rate their health as excellent or very good.  However, 19% of Australians have a disability, 20% a mental health disorder and 50% at least one chronic disease.  For the first time, cancer is the biggest overall killer of Australians and accounts for the biggest burden.

The main publication is accompanied by a summary report, Australia's health 2016-in brief.

Australia's Health 2016 report card: experts respond has been published in The Conversation as a useful commentary from Stephen Duckett (Grattan Institute), Fran Baum (Flinders University) and Rob Moodie (University of Melbourne).

Older Australia at a Glance

In 2016, 15% of the Australian population is over 65 years of age and Australians are (perhaps unsurprisingly) living healthier and longer than previous generations. 

The Australian Institute of Health and Welfare has published a web report, Older Australia at a glance, which includes snapshots of  how these people are living, where they are living, how their health is, what services they are using and how they are changing.  New snapshots are  released annually with the series reflecting the complexity and diversity of the older Australian population. 

Rheumatic Heart Disease resources

Rheumatic Heart Disease Australia has some useful resources on RHD and Acute Rheumatic Fever (AFD) including:

• The Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (2nd edition) 
• Acute Rheumatic Fever & Rheumatic Heart Disease E-Learning Modules  providing a range of education for all health professionals on several topics ranging from an introduction to ARF through to the surgical management of RHD.  The modules are endorsed by the Australian College of Nursing and accredited by the Australian College of Rural and Remote Medicine.
• Free Acute Rheumatic Fever & Rheumatic Heart Disease Guidelines and Diagnosis App - Key information from the Guideline, as well as an acute rheumatic fever diagnosis calculator, is included in this app for both iPhone and Android devices. 

Years overweight or obese increases cancer risk

A huge longitudinal study in the US, involving almost 74,000 women, has found that the more time a woman spends being overweight or obese over her lifetime, the higher the risk of her developing several forms of cancer.  This supports other evidence of a high body mass index being a large health risk factor in high-income countries, and for the first time looks at the cumulative impact of overweight on cancer in particular. The authors recommend that health professionals recognize the role of obesity management in cancer prevention.

Melina Arnold et al. Duration of Adulthood Overweight, Obesity, and Cancer Risk in the Women’s Health Initiative: A Longitudinal Study from the United States PLoS Medicine. Published: August 16, 2016

Once again, The Conversation has published a useful summary and overview of this research.

The Paleo Diet and Diabetes

A report in the Medical Journal of Australia recently concluded that "Studies are inconclusive about the benefits of the Paleo diet in patients with type 2 diabetes".  Author Sofianos Andrikopoulos from the University of Melbourne reviewed some recent intervention studies and found their results unconvincing due to short trials, the lack of proper controls and small sample sizes.  He wrote "...clearly more randomised controlled studies with more patients and for a longer period of time are required to determine whether it has any beneficial effect over other dietary advice.

The Paleo Diet and Diabetes. Med J Aust 2016; 205 (4): 151-152 doi:10.5694/mja16.00347

Fair Australia: Social Justice and the Health Gap

The 2016 Boyer Lecture series, presented by the President of the World Medical Association, Professor Sir Michael Marmot, is underway.  The topic for the four lectures is Fair Australia: Social Justice and the Health Gap, with the first lecture last weekend being "Health inequalities and the causes of the causes."  You can listen to it (and the others as they are delivered) at the ABC Radio National Boyer Lectures site, and you can also read a transcript of this lecture at The Conversation.

In this first lecture, Professor Marmot discusses the correlation between high income and education and better health, in both the indigenous and non-indigenous population.  He explains how the conditions of where people are born, grow up, work and age lead to inequities in power, money and resources, which have a direct flow-on to health, crime and civil unrest.

The lectures to come over the next three weeks are "Give every child the best start", "Living and working" and "Social justice and health - making a difference".  Another Conversation article by Sharon Friel from ANU is useful as background to this topic: "Social determinants – how class and wealth affect our health"

The National Disability Insurance Scheme: a quick guide

The Parliamentary Library has published a new Research Paper on the National Disability Insurance Scheme. The main component of the NDIS is individualised packages of support to eligible people with disability. When the NDIS is fully implemented in 2019, it is expected that around 460,000 Australians will receive individualised supports.

The National Disability Insurance Scheme: a quick guide. Research Paper Series 2016-2017, September 2016.

Hospital Quarterly NSW

The Bureau of Health Information has just  released the latest issue of Hospital Quarterly which provides the most up-to-date snapshot of activity and performance in NSW public hospitals.

This latest report shows that in NSW during the April to June 2016 quarter there were record numbers of elective surgeries and hospital admissions. You can also find out how your local hospital is performing by reading the individual profiles of more than 80 public hospitals in NSW.

You can also access five years of detailed results for more than 80 public hospitals in NSW on the BHI website.

Nurse burnout - recent articles

A couple of reviews of studies have recently been published on aspects this topic - one on coping strategies and one on the effects of burnout on patient safety.

A Meta-Analysis of the Effects of Coping Strategies on Reducing Nurse Burnout was published in Applied Nursing Research and looked at English and Chinese studies particularly concerned with coping strategies. After an analysis of seven chosen studies, it was concluded by the authors that "coping strategies can reduce nurse burnout and maintain effectiveness between 6 months and 1 year."
Lee H-F, Kuo C-C, Chien T-W, Wang Y-R Applied Nursing Research. 2016;31:100-10. (Available via CIAP for NSW Health employees) 

Healthcare Staff Wellbeing, Burnout, and Patient Safety: A Systematic Review, published on open access in PLoS ONE, was more focused on the effect of healthcare workers' burnout and general wellbeing on the safety of patients.  "Poor wellbeing and moderate to high levels of burnout are associated, in the majority of studies reviewed, with poor patient safety outcomes such as medical errors."
Hall LH, Johnson J, Watt I, Tsipa A, O’Connor DB PLoS ONE. 2016;11(7):e0159015.