Evaluation of NHMRC data on the funding of dementia research in Australia

The aim of this report is to provide the evidence base for evaluating the level of expenditure by the National Health and Medical Research Council (NHMRC) on research funding (including research, people support and infrastructure) related to dementia, in comparison to research funding for other areas of chronic disease. The report was commissioned by Alzheimer’s Australia to support a submission to the McKeon Review of Health and Medical Research in Australia in March, 2012.  (APO 30/5/12)

National Guide to a Preventive Health Assessment for Aboriginal and Torres Strait Islander People

This second edition of the guide  prepared by the Royal Australian College of General Practitioners is an up-to-date, evidence-based national resource created to help all health professionals delivering primary health care to Indigenous people. The use of this guide may help to prevent disease, detect early and unrecognised disease, and promote health. It contains Indigenous-specific information on:

• lifestyle factors (including smoking, overweight/obesity, physical activity, and alcohol)
• health among specific populations (child health, adolescent health, and the health of older people)
• chronic conditions (cardiovascular health, rheumatic heart disease, respiratory health, kidney health, diabetes, and cancer)
• infections conditions (sexual health and bloodborne viruses)
• other health conditions (oral health, eye health, ear health, and mental health). (APO 18/5/12) 

Indigenous early childhood development. New directions: mothers and babies services

The Australian National Audit Office has conducted an audit which has examined the effectiveness of the Department of Health and Ageing’s administration of New Directions, a program aimed at improving child health and education in Indigenous communities.
The audit considered whether:

• planning processes were developed to support the program’s objectives and rationale;
• implementation arrangements were clearly defined and aligned to the objectives of the program; and
• robust performance management arrangements had been established and were in use by the department.                       (APO 29/5/12) 

Families with Multiple and Complex Needs

This report by the Department of Human Services is a Best interests case practice model - Specialist practice resource. People with complex needs may have to negotiate several issues in their life, such as physical or mental illness, substance abuse and disability. They may be living in deprived circumstances and lack access to suitable housing, employment or meaningful daily activities. Each individual with multiple and complex needs has unique concerns tied closely to the interaction between his/her social, economic and health care needs, and so requires an individualised response. Within child protection and family intervention work, the phrase ‘multiple and complex needs’ can be used to refer to families presenting with circumstances and behaviours that are having negative consequences for family members, particularly children. (APO 23/8/12)

A review of opioid prescribing in Tasmania: a blueprint for the future

This review of the evidence, by the National Drug & Alcohol Research Centre, on opioid medications in Tasmania, and also nationally and internationally, has brought up a number of important observations on the changing landscape in Schedule 8 (S8) opioid medication availability, prescribing, and the changes in the regulation of these potent medications that have occurred in Australian jurisdictions and internationally. In Section One, the review of the international and national literature identifies consistent and substantial increases in opioid analgesic prescribing across a range of developed nations since the early 1990s. Increases in prescribing have occurred in Tasmania since the late 1990s, with a six- to seven-fold increase in prescribing authorities for opioids over a 12-year period.

There is growing concern both internationally and locally about the harms associated with these drugs amongst chronic pain patients, and about extra medical use and diversion. These concerns are based on peer reviewed studies of opioid-related deaths and other harms amongst chronic pain patients and injecting drug users (IDU), primarily in the United States; are shared by a number of medical practitioners and other health professionals in Tasmania; and are borne out by the analysis of Tasmanian and Australian data in Section Two. (APO 25/7/12)

The role of supervisory neglect in childhood injury

This paper, from the Australian Institute of Family Studies, explores the theoretical understandings of supervisory neglect and how these understandings might assist in delivering practical responses using a public health approach to child protection. Children are vulnerable to different types of injury depending on their stage of growth and development. Children will also need varying degrees of supervision depending on their exposure to a range of risk and protective factors.
Key findings:

• There is no universally accepted, all encompassing definition of the concept of "neglect", and consideration of supervisory neglect suggests that there is no "one size fits all" definition.
• Supervision can be a complex, resource-intensive activity when undertaken at its maximum effectiveness - understanding and evaluating what comprises "good enough parenting" remains subjective and is difficult to evaluate.
• Identification of neglect should pay heed to parental competence and/or caregiver capability, cultural context, child personality and level of maturity, and environmental risk factors.
• The need to forecast where future harm may arise from a lack of appropriate supervision is paramount.
• Impoverished families living in "poor" neighbourhoods may be unable to provide adequate nutrition, medical care or education for their children not because of a lack of recognition of the child's needs or a want to do so, but because of a lack of access to resources.
• Exposure to one type of harm (such as neglect) increases the risk of exposure to other forms of harm (such as physical or sexual abuse). In a child protection context, if children suffer a number of injuries this may serve as a warning that there are other issues of a potentially neglectful nature.  (Authors: R. Franklin, D. Higgins, D.Scott) (APO 6/9/12)

Addressing fetal alcohol spectrum disorder in Australia

This report contains an overview of fetal alcohol spectrum disorder in Australia, including the health and social impacts of alcohol use during pregnancy.
The report also contains recommendations to address the condition, which include:

• implementing broad ranging social marketing campaigns to raise awareness of fetal alcohol spectrum disorder, and the risks to the fetus or baby if the mother consumes alcohol while pregnant and breastfeeding
• supporting health professionals and services through the development of national policy and clinical practice guidelines, as well as workforce development and training. (APO 6/6/12)

Alzheimer's Disease - causes and predictors

ABC Radio National's Health Report this week focused on Alzheimer's Disease, and research from the University of California Los Angeles (UCLA).
The first interview was with Dr Gary Small, professor of psychiatry and director of the UCLA Longevity Centre.  He talked about a way of identifying people who are still healthy yet may be at increased risk of developing Alzheimer's disease in the future, and therefore who might benefit from some intensive dementia prevention.  There are a couple of chemical markers for Alzheimer's in the brain, one of which is tau tangles.  Small and his colleagues have been studying these for some time, and have followed a group over two years with various interventions and controls.  Read the transcript or listen to the interview here.
The other interview was with John Ringman, who has been researching people who develop Alzheimer's disease quite young due to a genetic mutation, and what this tells us about the disease.  Ringman and his fellow researchers have been investigating chemical messages which could help with treatment and prevention of the disease.  The transcript or audio can be found here. 

Systematic review of hand hygiene strategies

"A systematic review of hand hygiene improvement strategies: a behavioural approach", by Huis et al, has just been published in Implementation Science.  Available on open access as a provisional pdf, the review looked at behaviour change techniques for hand hygiene categorised by determinant.  For example, increasing memory, or the understanding of information related to a 'knowledge' determinant, and providing opportunities for social comparison related to 'social influence'. The authors reviewed 41 studies and found that the most successful improvement strategies addressed combinations of different determinants such as knowledge, awareness, action control, social influence and facilitation.  One or two determinants addressed in the strategy is not enough to change hand hygiene behaviour.  

Implementation Science 2012, 7:92 http://dx.doi.org/10.1186/1748-5908-7-92  

Guidelines - adults surviving child abuse

Adults Surviving Child Abuse (ASCA) has published their new Australian guidelines 'The last frontier: practice guidelines for treatment of complex trauma and trauma informed care and service delivery'.

Funded by the Department of Health and Ageing, the purpose of the guidelines is to inform health professionals, workers and organisations about new ways of responding to trauma, in clinical practice and in health and human service settings. The guidelines aim to influence, advise and educate on treatment of complex trauma and the implementation of trauma informed care and service. This is the first time clinical guidelines for the treatment of complex trauma have been published, and they collate the last 20 years of national and international research.

HealthEngine - GP directory

HealthEngine Australia is an online directory of GPs across Australia.  It has been operating since 2006, but this year has expanded to include a real time appointment facility and other medical specialists.  You search by town or postcode, then a list of practices and available appointments comes up, ready to book.  There are limitations, as there still aren't very many practices listed with appointment times (especially in rural areas), and there are few specialist doctors listed in the directory, but it has the potential for growth and is handy for GP listings, especially if you find yourself in unfamiliar territory.

Breast screening - lives saved outweigh overdiagnosis

A Europe-wide review of breast cancer screening has concluded that the benefits in lives saved outweigh the risks of overdiagnosis. Reported in the  BMJ by Nigel Hawkes, the study carried out by a working group from nine European countries, showed that for every 1000 women between the ages of 50 and 69 who are screened, between seven and nine lives are saved and four women are “overdiagnosed.” The conclusion contradicts that of critics of breast cancer screening, who have argued that the number of women damaged by false positive findings exceeds the number who benefit by having their cancers detected earlier.

The original report of the study can be found in the Journal of Medical Screening, Summary of the evidence of breast cancer service screening outcomes in Europe and first estimate of the benefit and harm balance sheet" by Eugenio Paci.  J Med Screen September 2012 vol. 19 no. suppl 1 .  

Contact your health library for the full text of these reports.

Dementia in Australia Report

Dementia in Australia has been released by the AIHW today. In 2011, there were an estimated 298,000 people with dementia, 62% of whom were women. This number is expected to increase markedly over time, with projections suggesting it will reach around 400,000 by 2020 and 900,000 by 2050. Dementia is a leading cause of death and burden of disease, accounting for 6% of all deaths in 2010, and for people over 65, being the second leading cause of overall burden of disease. The total direct health and aged care services expenditure on people with dementia was at least $4.9 billion in 2009-10, and it is estimated that there are around 200,000 informal carers of people with dementia living in the community.

Australian (illicit) drug policy timeline 1985-2012

This paper, from the National Drug & Alcohol Research Centre, provides a list of key events, policy and legislative changes that have occurred in Australia since 1985, when the National Campaign Against Drug Abuse was adopted, and methadone was nationally endorsed as an appropriate treatment intervention. Events are listed by jurisdiction, at the national and state/territory level. Illicit drugs refer to cannabis, heroin, cocaine, amphetamines, ecstasy, hallucinogens and other ‘designer’ drugs.  

Low health literacy concerns from report

Health Literacy : Implications for Australia is a report from Medibank Private, which explains how low health literacy in patients is leading to more deaths in older Australians and is causing significant cost to the healthcare industry.  The study, which mainly focussed on seniors, found that nearly 60% of Australians may be unable to understand, access and communicate health information, and this is associated with higher mortality, lack of medication adherence, lack of ability to interpret labels and health messages, increased hospitalisations and poorer overall health status in seniors.