Jonathan Newbury

Distress levels and self-reported treatment rates for medicine, law, psychology and mechanical engineering tertiary students: cross-sectional study

Objective: The aim of this research was to assess tertiary student distress levels with regards to (i) comparisons with normative population data, and (ii) the effects of discipline, year level, and student characteristics. Self-reported treatment rates and level of concern regarding perceived distress were also collected. Method: Students from all six years of an undergraduate medical course were compared with samples from Psychology, Law and Mechanical Engineering courses at the University of Adelaide, Australia. Students participated in one of three studies that were either web-based or paper-based. All studies included Kesslers Measure of Psychological Distress (K10), and questions pertaining to treatment for any mental health problems and concern regarding distress experienced. Results: Of the 955 tertiary students who completed the K10, 48% were psychologically distressed (a K10 score ≥ 22) which equated to a rate 4.4 times that of age-matched peers. The non-health disciplines were significantly more distressed than the health disciplines. Distress levels were statistically equivalent across all six years of the medical degree. Of tertiary students, 11% had been treated for a mental health problem. Levels of concern correlated with the K10 score. Conclusion: The results from this research suggest that high distress levels among the tertiary student body may be a phenomenon more widely spread than first thought. Low treatment rates suggest that traditional models of support may be inadequate or not appropriate for tertiary cohorts.

Adelaide Stroke Incidence Study Declining Stroke Rates but Many Preventable Cardioembolic Strokes

Background and Purpose— Stroke incidence rates are in flux worldwide because of evolving risk factor prevalence, risk factor control, and population aging. Adelaide Stroke Incidence Study was performed to determine the incidence of strokes and stroke subtypes in a relatively elderly population of 148 000 people in the Western suburbs of Adelaide. Methods— All suspected strokes were identified and assessed in a 12-month period from 2009 to 2010. Standard definitions for stroke and stroke fatality were used. Ischemic stroke pathogenesis was classified by the Trial of ORG 10172 in Acute Stroke Treatment criteria. Results— There were 318 stroke events recorded in 301 individuals; 238 (75%) were first-in-lifetime events. Crude incidence rates for first-ever strokes were 161 per 100 000 per year overall (95% confidence interval [CI], 141–183), 176 for men (95% CI, 147–201), and 146 for women (95% CI, 120–176). Adjusted to the world population rates were 76 overall (95% CI, 59–94), 91 for men (95% CI, 73–112), and 61 for women (95% CI, 47–78). The 28-day case fatality rate for first-ever stroke was 19% (95% CI, 14–24); the majority were ischemic (84% [95% CI, 78–88]). Intracerebral hemorrhage comprised 11% (8–16), subarachnoid hemorrhage 3% (1–6), and 3% (1–6) were undetermined. Of the 258 ischemic strokes, 42% (95% CI, 36–49) were of cardioembolic pathogenesis. Atrial fibrillation accounted for 36% of all ischemic strokes, of which 85% were inadequately anticoagulated. Conclusions— Stroke incidence in Adelaide has not increased compared with previous Australian studies, despite the aging population. Cardioembolic strokes are becoming a higher proportion of all ischemic strokes.

Knowledge translation within a population health study: how do you do it?

BackgroundDespite the considerable and growing body of knowledge translation (KT) literature, there are few methodologies sufficiently detailed to guide an integrated KT research approach for a population health study. This paper argues for a clearly articulated collaborative KT approach to be embedded within the research design from the outset.DiscussionPopulation health studies are complex in their own right, and strategies to engage the local community in adopting new interventions are often fraught with considerable challenges. In order to maximise the impact of population health research, more explicit KT strategies need to be developed from the outset. We present four propositions, arising from our work in developing a KT framework for a population health study. These cover the need for an explicit theory-informed conceptual framework; formalizing collaborative approaches within the design; making explicit the roles of both the stakeholders and the researchers; and clarifying what counts as evidence. From our deliberations on these propositions, our own co-creating (co-KT) Framework emerged in which KT is defined as both a theoretical and practical framework for actioning the intent of researchers and communities to co-create, refine, implement and evaluate the impact of new knowledge that is sensitive to the context (values, norms and tacit knowledge) where it is generated and used. The co-KT Framework has five steps. These include initial contact and framing the issue; refining and testing knowledge; interpreting, contextualising and adapting knowledge to the local context; implementing and evaluating; and finally, the embedding and translating of new knowledge into practice.SummaryAlthough descriptions of how to incorporate KT into research designs are increasing, current theoretical and operational frameworks do not generally span a holistic process from knowledge co-creation to knowledge application and implementation within one project. Population health studies may have greater health impact when KT is incorporated early and explicitly into the research design. This, we argue, will require that particular attention be paid to collaborative approaches, stakeholder identification and engagement, the nature and sources of evidence used, and the role of the research team working with the local study community.

Perceptions of Heat-Susceptibility in Older Persons: Barriers to Adaptation

The increase in the frequency of very hot weather that is a predicted consequence of climate change poses an emerging threat to public health. Extreme heat can be harmful to the health of older persons who are known to be amongst the most vulnerable in the community. This study aimed to investigate factors influencing the ability of older persons to adapt to hot conditions, and barriers to adaptation. A qualitative study was conducted in Adelaide, Australia, involving focus groups and interviews with stakeholders including key personnel involved in aged care, community services, government sectors, emergency services and policy making. Findings revealed a broad range of factors that underpin the heat-susceptibility of the aged. These were categorized into four broad themes relating to: physiology and an age-related decline in health; socioeconomic factors, particularly those influencing air conditioning use; psychological issues including fears and anxieties about extreme heat; and adaptive strategies that could be identified as both enablers and barriers. As a consequence, the ability and willingness to undertake behavior change during heatwaves can therefore be affected in older persons. Additionally, understanding the control panels on modern air conditioners can present challenges for the aged. Improving heat-health knowledge and addressing the social and economic concerns of the older population will assist in minimizing heat-related morbidity and mortality in a warming climate.

Risk factors, health effects and behaviour in older people during extreme heat: a survey in South Australia.

Older people had a high incidence of hospitalisation during the 2009 heat wave in South Australia. We sought to explore resilience, behaviours, health risk factors and health outcomes during recent heat waves for a representative sample of independently living residents. A telephone survey of 499 people aged 65 years and over was conducted, and included both metropolitan and rural residences. A variety of adaptive strategies were reported, with 75% maintaining regular appointments and activities during the heat. However, 74% took medication for chronic disease and 25% assessed their health status to be fair to poor. In a multivariate model, factors associated with heat health outcomes included medication for mental health, heart failure, diabetes or respiratory health, reporting a reduced health status, use of mobility aids and being female. Compared with younger participants, those over 75 had more check-up calls and visits by family, friends and neighbours. However, confidence to call on support was associated with indicators of social isolation. The study indicates that older people are generally resilient, but interventions addressing multi-morbidity and medication interactions and social isolation should be developed.

A systematic review of the effectiveness of primary health education or intervention programs in improving rural women's knowledge of heart disease risk factors and changing lifestyle behaviours

BACKGROUND Cardiovascular disease is the leading cause of death and disability for women in Australia. Women living in rural areas are at greater risk of heart disease, because of limited access and availability of healthcare in rural areas. Lifestyle is a major determinant to the risk of heart disease. Risk factors such as smoking, hypertension, diet, physical activity and alcohol intake can be controlled or modified by lifestyle changes. As heart disease develops over many years, women need to be following healthy lifestyle practices and reduce their chance of a first or recurrent heart attack. AIM To determine the effectiveness of primary health education or intervention programs for cardiac risk reduction in healthy women living in rural areas. INCLUSION CRITERIA Types of participants. Women aged 16-65 years, living in rural areas, who participated in primary healthcare education programs. Types of interventions. Primary health education or intervention programs aimed at improving rural womens knowledge of their risk of heart disease, for example group work, videos, telephone, workshops, educational material and counselling. Types of outcomes. Primary outcomes included: • Knowledge level of heart disease risk factors. • Lifestyle modification, for example dietary improvements such as reduced daily salt intake, increased intake of fruit and vegetables and decreased intake of fat, increased frequency of exercise, decreased levels of smoking, alcohol intake within national guidelines. • Health assessment measures, for example blood pressure, body weight, cholesterol levels. Types of studies. Any randomised controlled trials, other experimental studies, as well as cohort, case-control and cross-sectional studies were considered for inclusion. Search strategy. A search for published and unpublished studies in the English language was undertaken. METHODOLOGICAL QUALITY Each study was appraised independently by two reviewers using the standard Joanna Briggs Institute instruments. DATA COLLECTION AND ANALYSIS Information was extracted from studies meeting quality criteria using the standard Joanna Briggs Institute tools. Although similar outcomes are explored in many of the studies, the variable outcome measures precluded the use of meta-analysis. Data are therefore summarised in tables or by using narrative analysis. RESULTS Nine trials were included in the review. Three trials compared the effects of interventions on physical activity, one on smoking and five on multiple risk factors. Studies following interventions targeting physical activity reported that womens physical activity can be increased and that these increases can be sustained at 12 months. While there were decreases in blood pressure at 6 months, studies with a 5-year follow up found no decreases for both systolic and diastolic blood pressure. Overall results of studies into dietary modification programs also did not sustain an effect over a longer period of time. CONCLUSION The results of this review suggest that in rural areas, lifestyle interventions delivered by primary care providers in primary care settings to patients at low risk appeared to be of marginal benefit. Resources and time in primary care might be better spent on patients at higher risk of cardiovascular disease, such as those with diabetes or existing heart disease.

A pilot study to evaluate Australian predictive equations for the impulse oscillometry system

Background and objective:  Impulse oscillometry (IOS) measures respiratory function during normal breathing by transmitting mixed frequency rectangular pressure impulses down the airways and measuring the resultant pressure and flow relationships, which describe the mechanical parameters of the lungs. Respiratory impedance and its components, airways resistance and reactance, at a range of frequencies from 0.1 to 150 Hz are calculated by computer analysis. The IOS software generates predictive normal values for each of the parameters measured, including total airway resistance (R5), proximal airway resistance (R20) and peripheral capacitive reactance (X5). However, these values are based on German data and no other Caucasian data or Australian normative data exist.

Determining the Number of Ischemic Strokes Potentially Eligible for Endovascular Thrombectomy: A Population-Based Study

Background and Purpose— Endovascular thrombectomy (ET) is standard-of-care for ischemic stroke patients with large vessel occlusion, but estimates of potentially eligible patients from population-based studies have not been published. Such data are urgently needed to rationally plan hyperacute services. Retrospective analysis determined the incidence of ET-eligible ischemic strokes in a comprehensive population-based stroke study (Adelaide, Australia 2009–2010). Methods— Stroke patients were stratified via a prespecified eligibility algorithm derived from recent ET trials comprising stroke subtype, pathogenesis, severity, premorbid modified Rankin Score, presentation delay, large vessel occlusion, and target mismatch penumbra. Recognizing centers may interpret recent ET trials either loosely or rigidly; 2 eligibility algorithms were applied: restrictive (key criteria modified Rankin Scale score 0–1, presentation delay <3.5 hours, and target mismatch penumbra) and permissive (modified Rankin Scale score 0–3 and presentation delay <5 hours). Results— In a population of 148 027 people, 318 strokes occurred in the 1-year study period (crude attack rate 215 [192–240] per 100 000 person-years). The number of ischemic strokes eligible by restrictive criteria was 17/258 (7%; 95% confidence intervals 4%–10%) and by permissive criteria, an additional 16 were identified, total 33/258 (13%; 95% confidence intervals 9%–18%). Two of 17 patients (and 6/33 permissive patients) had thrombolysis contraindications. Using the restrictive algorithm, there were 11 (95% confidence intervals 4–18) potential ET cases per 100 000 person-years or 22 (95% confidence intervals 13–31) using the permissive algorithm. Conclusions— In this cohort, ≈7% of ischemic strokes were potentially eligible for ET (13% with permissive criteria). In similar populations, the permissive criteria predict that ⩽22 strokes per 100 000 person-years may be eligible for ET.

Preventive home visits to elderly people in the community. Visits are most useful for people aged >/= 75.

Editor—The systematic review by van Haastregt et al of trials of preventive home visits for people aged 65 or over reported that “no clear evidence was found in favour” of such visits.1 Some of the trials reviewed showed favourable effects in some of the five main outcome measures (physical functioning, psychosocial functioning, falls, admissions to institutions, and mortality), but most found no effect. However, the review shows that favourable outcomes were more prevalent in studies conducted in older subjects (⩾75), although it does not comment on this. The table is constructed from the analysis they report. Outcomes of physical functioning are the exception, with only one of the five favourable studies being in people aged 75 and over. This is not unexpected. It may be easier to improve physical functioning in the group aged 65 or over generally than in the group aged 75 or over specifically. General practitioners in Australia have recently been funded for “75+ health assessments.” We have just concluded a randomised controlled trial of these assessments. A nurse visited 100 elderly people who were living in the community on two occasions, one year apart (50 control, 50 intervention). No interval assessment nor reminder was included in the protocol.2 Initial analysis found: Fewer people reported falls in the intervention group in the study year (12 v 22, P=0.055) Fewer people died in the intervention group (1 v 5, P=0.2) Physical functioning did not change (measured using Barthel index of activities of daily living) Psychosocial functioning improved (geriatric depression scale 15, Wilcoxon scores (rank sums) P=0.09). Our study is consistent with the other published trials, showing modest improvement in the measured outcomes in the group aged 75 or over. Van Haastregt et al call for either improved effectiveness of preventive home visits or their discontinuation. Their data, and our initial results, indicate that annual preventive home visits are most useful in the group aged 75 or over. An editorial in the BMJ 12 years ago also made the point that 65 year olds are too young to receive preventive home visits.3 Evaluation of the Australian 75+ health assessments will establish whether they have a beneficial effect on outcome.

Exploring the need to update lung age equations

AIMS A renewed interest in lung age is evidenced by recent smoking cessation publications. This research compares the original Morris lung age equations (1985) with contemporary Australian lung age equations. METHODS Both lung age equations were applied to the spirometry results of two sub-groups (never-smokers n=340, and current smokers n=50) from an independent dataset. Means of both lung age estimates were compared to the mean of the chronological age of each group by paired Students t-test. RESULTS The Morris lung age estimates were paradoxically lower (younger) than chronological age in both groups. The new Australian equation produced lung age estimates that were equivalent to chronological age in the never-smoker group and significantly higher (older) than chronological age in the current smoker group. CONCLUSIONS These results strongly suggest that the Morris lung age equations are in need of review. The use of contemporary lung age equations may translate into greater success for smoking cessation programs. The new Australian equations seem to possess internal validity.