Esther May

Being mobile: electric mobility-scooters and their use by older people

ABSTRACT There is increasing use of electric mobility-scooters by older people in South Australia, the fourth largest state in Australia. Although various issues about their use have been raised by users, carers, urban planners and legislators, to date they have received little research attention. The purpose of the study reported in this paper was to explore the factors that influence and impact upon older people who use mobility-scooters, particularly from their own perspectives. Data were collected through a survey of 67 current electric mobility-scooter older users, and through two focus groups with other older South Australian people who were users. The data showed that more than 71 per cent of the participants had owned their scooter for more than two years, most had purchased the scooter as new, and 80 per cent owned a four-wheel scooter. The scooter was used predominantly for getting to and from shops, visiting friends and family, and to go for rides. Most respondents used their scooters three to five times each week and travelled between two and five kilometres from their home. The key findings from the focus groups were categorised into three major themes of ‘obtaining a scooter’, ‘the meaning of mobility’ and ‘issues around sharing spaces’. Each is exemplified. The implications for environmental and building design, for the better training of users, and for public education are discussed.

Dementia severity and on-road assessment: Briefly revisited

Objective:  Drivers with dementia should cease driving if unsafe. This report aims to add to the evidence concerning use of global dementia severity as an indicator of driving performance.

Regional Primary Care Team to Deliver Best-Practice Diabetes Care: A needs-driven health workforce model reflecting a biopsychosocial construct of health

OBJECTIVE Best-practice diabetes care can reduce the burden of diabetes and associated health care costs. But this requires access to a multidisciplinary team with the right skill mix. We applied a needs-driven evidence-based health workforce model to describe the primary care team required to support best-practice diabetes care, paying particular attention to diverse clinic populations. RESEARCH DESIGN AND METHODS Care protocols, by number and duration of consultations, were derived for twenty distinct competencies based on clinical practice guidelines and structured input from a multidisciplinary clinical panel. This was combined with a previously estimated population profile of persons across 26 patient attributes (i.e., type of diabetes, complications, and threats to self-care) to estimate clinician contact hours by competency required to deliver best-practice care in the study region. RESULTS A primary care team of 22.1 full-time-equivalent (FTE) positions was needed to deliver best-practice primary care to a catchment of 1,000 persons with diabetes with the attributes of the Australian population. Competencies requiring greatest contact time were psychosocial issues and dietary advice at 3.5 and 3.3 FTE, respectively (1 FTE/∼300 persons); home (district) nursing at 3.2 FTE; and diabetes education at 2.8 FTE. The annual cost of delivering care was estimated at just over 2,000 Australian dollars (∼2,090 USD) (2012) per person with diabetes. CONCLUSIONS A needs-driven approach to primary care service planning identified a wider range of competencies in the diabetes primary and community care team than typically described. Access to psychosocial competences as well as medical management is required if clinical targets are to be met, especially in disadvantaged groups.

Musculoskeletal disorder prevalence and risk factors in ambulance officers.

This review explores the prevalence and determinants of musculoskeletal disorders in ambulance officers, and the limitations of the current epidemiological evidence to inform the development of interventions. Relevant studies were selected using defined word search terms and inclusion criteria. Existing research shows a high annual prevalence of back, neck and shoulder musculoskeletal disorders in ambulance officers and emergency medical technicians, whilst limited research has demonstrated significant associations between individual, physical and psychosocial demands, and musculoskeletal disorders of the low-back and neck-shoulder area. However, methodological issues will need to be addressed in future epidemiological research in order to inform the development of industry specific risk assessment tools that will assist in identifying the complex array of interactive risk factors involved in ambulance work. The accurate identification of risk factors will in turn, better inform the establishment of multifaceted interventions to reduce the prevalence of musculoskeletal disorders in ambulance officers.

The conundrum of detecting stable angina pectoris in the community setting

Individuals with undetected stable angina pectoris (SAP) as a consequence of undiagnosed coronary artery disease are at high risk of poor quality of life and a premature fatal event (for example, sudden cardiac death out of hospital). If the extent and distribution of SAP are accurately identified at the population level, clinical screening could potentially be targeted and evaluated to optimize the management and secondary prevention of underlying coronary artery disease. Common measures of SAP in populations have important limitations. Measures chosen to identify such cases should reflect their validity as measures of undiagnosed SAP, currently symptomatic angina or lifetime diagnosis of angina.

Notation analysis of skill expertise differences in netball

Notation analysis was used to assess decision making capability of expert and developmental athletes during 12 netball matches. Analysis of variance with repeated measures demonstrated experts produced a greater percentage of successful pass outcomes than the developmental athletes. High defensive pressure and higher decision making complexity negatively affected performance. These results suggest experts in comparison to their younger counterparts have developed the required skills to manage the defensive pressure and decision making complexity routinely experienced during game play, and as a result are able to more effectively select and execute the most appropriate passing option.

On-road driving assessment and route design for drivers with dementia

Introduction Dementia causes the progressive loss of cognitive capacities and thus impairs social and daily living skills. Dementia, to varying degrees, influences driver performance and safety. Eventually drivers affected by dementia must stop driving so they do not harm themselves or others. However, having to stop driving can result in loss of mobility and social connections. Therefore, assessing drivers with dementia is important. Driving assessment is susceptible to possible biases, including unreliable driving performance measures or driving routes that are inconsistent in the levels of difficulty of the driving tasks and manoeuvres. The aim of the study was to determine what measures of driving performance could optimally be applied to occupational therapy on-road driving assessments. Method All drivers with dementia underwent a 60 minute, set route on-road driving assessment that consisted of 110 pre-programmed observation points. Results The study identified 80 sufficiently challenging driving tasks and described the relationship of driving error to that task, for example, critical errors at unguided intersections. Conclusion The results of the task-demand by error type analysis identified a list of task items that can be applied to assessment route design to increase consistency of on-road assessment for people with dementia.

Self-Reported Physical Activity Using the International Physical Activity Questionnaire (IPAQ) in Australian Adults with Type 2 Diabetes, with and Without Peripheral Neuropathy

OBJECTIVES The aim of this study was to survey the level of self-reported physical activity in people with type 2 diabetes, with and without peripheral neuropathy. METHODS A sample of South Australian adults (n=481) 33 to 88 years of age who had type 2 diabetes, including 55 people with peripheral neuropathy, completed the International Physical Activity Questionnaire (IPAQ). Levels of self-reported physical activity were compared between those with and without peripheral neuropathy. RESULTS People with type 2 diabetes and peripheral neuropathy (median [Mdn]=1433; interquartile range [IQR]=495 to 3390 metabolic equivalent minutes per week [MET-min/wk]) were less physically active than those without peripheral neuropathy (Mdn=2106; IQR=876 to 4380 MET-min/wk) (p=0.04). A total of 49% of people with type 2 diabetes and peripheral neuropathy met physical activity recommendations of 150 minutes of at least moderate activity per week, compared to 57% of people with type 2 diabetes alone. CONCLUSIONS These findings demonstrate that people with type 2 diabetes and peripheral neuropathy reported being significantly less active than people with type 2 diabetes alone. People with type 2 diabetes and peripheral neuropathy need to be encouraged to perform higher levels of physical activity for biologic, physical and psychological benefits. Further studies using objective measures of physical activity are required to support these results.

Sport for development (S4D) as ‘core university business’? Modelling university participation in sport-based social development

ABSTRACT Among the recognised strengths of the ‘Sport for Development’ (S4D) framework there is the capacity of sport to contribute to positive community networks, education and community participation. However, its relevance to tertiary education institutions is often under-appreciated. In this framework, the Football United® program was recently piloted in South Australia with an innovative approach offering significant opportunities for integration with university activities, including academic, extra-curricular and skill acquisition programs, as well as for community outreach. This approach is based around four key strategic areas of community engagement, student engagement, research and aspirations towards education. It aims to encourage university leadership and participation and it has a focus on awareness and aspirations towards tertiary education in educationally disadvantaged communities. While it is important to address considerations about the meaning of development and the role that sport can play to facilitate it, this paper argues that there is scope for universities to become increasingly involved with the delivery of sport-based social development programs.

Pre-employment risk factors for back, neck and shoulder musculoskeletal injuries and claims in ambulance officers

This study aims to determine whether pre-employment medical, physical or psychological assessments can predict future back, neck and shoulder musculoskeletal injuries and claims in an Australian ambulance service. This was a retrospective observational study based on linked datasets. Poisson regression analysis was undertaken to determine which pre-employment personality traits, using the Fifteen Factor Questionnaire and 36 medical and functional capacity evaluation variables, predicted the number of injuries and claims in ambulance officers. Ambulance officers who at pre-employment assessment demonstrated more conceptual, intuitive and anxious personality traits, and those ambulance officers who had hypermobile joints, self-limited weights lifted, played less sport or exercised less, were more likely to sustain future back, neck or shoulder musculoskeletal injuries or submit workers compensation claims. Individual pre-employment risk factors were found to predict musculoskeletal injuries and claims in a cohort of ambulance officers. Anxious as opposed to stable personality types and conceptual rather than practical personality types appear to be at greater risk of an injury or submitting a claim, as were recruits with hypermobile joints. Identification of individual risk factors at recruitment may assist in the selection of suitable applicants into the ambulance service as well as providing a focus for career counseling where relevant.