Lesley Russell

Brief cognitive screening and self concepts for children with low intellectual functioning

OBJECTIVES To evaluate the use of brief assessments for children with low intellectual functioning. METHODS Assessments used the SYSTEMS cognitive screening test and ASK-KIDS self-concept inventory. Participants were children recruited through the hospital and special education classes (N = 39). RESULTS Results showed that cognitive screening accurately classified children, and their scores correlated closely with full cognitive assessment and achievement. Most children could respond to the self-concept inventory, scales were internally consistent, and profiles were similar to those for children in the normative sample. CONCLUSIONS Findings support the use of brief assessments of cognitive functioning and self concepts, and suggest further studies with children in clinical settings.

Reports indicate that changes are needed to close the gap for Indigenous health

TO THE EDITOR: The summation by Russell that “the inescapable reality is that current primary care interventions are not working”1 overlooks evidence of signifi cant improvements in the Northern Territory. The latest “closing the gap” report indicates that the Indigenous mortality gap in the NT should close within a generation.2 Mortality among NT Indigenous adults has declined by a third since 2000.2 We attribute this positive outcome primarily to effective use of primary health care funding, which has been progressively increased and equitably distributed, since 2001. This money has funded universally adopted e-health solutions and NT key performance indicators, which drive continuous quality improvement initiatives. These are backed by common clinical guidelines, with increasing adherence rates, that are used in all Aboriginal primary health care clinics.3 The statement “ACCHOs [Aboriginal community controlled health organisations] have had little infl uence on the mainstream health system”1 neglects experience in the NT, where the ACCHO sector is a co-owner of the NT Medicare Local and remains a critical driver in the NT Aboriginal Health Forum (NTAHF). Now in its 15th year, the NTAHF has secured government support for community control as the preferred model for delivering Aboriginal primary health care. The ACCHO sector is also a leader in developing and using clinical guidelines, mental health services, e-health, and continuous quality improvement programs. National policy should support the expansion and enhancement of Aboriginal community controlled primary health care services. Pasqualina M Coffey Public Health Registrar1 Alex Hope Public Health Medical Officer1 John D Boffa Chief Medical Officer Public Health2 1 Public Health Unit, Aboriginal Medical Services Alliance Northern Territory, Darwin, NT.

Understanding affective and cognitive self-evaluations about the body for adolescent girls.

OBJECTIVE The aim of this study was to understand relations between cognitive and affective self-evaluations about the body for adolescent girls in the context of their diverse experiences of the body. METHOD The project involved adolescent girls (N = 141), including underweight to overweight schoolgirls, and hospitalized girls with anorexia nervosa (AN). Materials were brief, reliable inventories of self-concepts about body, movement and appearance, and feelings about the body. RESULTS Measurement models confirmed the related yet discrete self-concepts about the body, movement and appearance, and feeling OK, guilt, worry, disgust, and anger about the body. Self-concepts and feelings were not correlated with body weight, and were sensitive and specific for girls with AN versus low-weight schoolgirls. Relations among self-concepts and feelings about the body vary with the context. In particular, self-concepts and feelings about the body were incongruent for AN girls with acute experiences of making self-evaluations of their bodies. DISCUSSION It is clear that self-evaluations by adolescent girls do not necessarily reflect actual body weight. Findings suggest that associations between thoughts and feelings about the body vary with diverse experiences of the body. Results support brief, reliable, and valid indicators of self-concepts and feelings about the body that are vital in the design of prevention, intervention, and monitoring, and the evaluation of programmes for girls in clinical and educational settings.

Lessons for the Australian healthcare system from the Berwick report

There are common key recommendations in the raft of recent reports from inquiries into hospital quality and safety issues, both in Australia and in the United Kingdom. Prime among these is that governments, bureaucrats, clinicians and administrators must work together to place the quality and safety of patient care above all other aims in the healthcare system. Performance targets and enforcement, although needed, are not the route to improvement; what is required is a change in culture to drive a system of care that is open to learning, capable of identifying and admitting its problems and acting to correct them, and where the patients voice is always heard.

Patient safety in primary care: more data and more action needed.

Although most health care services are delivered in the community-based primary care sector, little is known about medical errors and near misses (here referred to as patient safety threats) and the consequent adverse events and harms (here referred to as patient safety incidents) in primary care. In Australia, research and data on patient safety comes almost exclusively from the hospital sector. The common assumption is that the problem is at least as common in primary care as in other areas of medical practice, but there is currently no mechanism to capture and analyse national data. A better understanding of patient safety threats and incidents in primary care is needed, along with resources to enable preventive action.

Australia's National Partnership Agreement on Preventive Health: Critical reflections from States and Territories

Abstract Issue addressed Australian efforts to tackle the burden from chronic diseases through prevention have included numerous strategies, committees, policies and programs. This research reflects on this changing landscape, with focus on the most recent, and most significant, investment and subsequent disinvestment in preventive health, the National Partnership Agreement on Preventive Health (NPAPH). The purpose is to better understand the place of the NPAPH in Australias prevention landscape, explore views from senior health department personnel on the NPAPH and identify lessons for the future. Methods Individual and small group semi‐structured interviews were undertaken with 19 senior public health managers and program implementation staff from State and Territory health departments across Australia. A grounded theory approach was used to generate themes relevant to the research. Results Participants reflected positively on the NPAPH, mostly that it established a strong platform for the national roll out of programs supporting healthy lifestyles, it created core infrastructure that elevated the rigour and sophistication of prevention activities and it was achieving or on the way to achieving its desired outputs. However, despite promising potential, governance arrangements over chronic disease prevention were not clearer either throughout or post the NPAPH. While partnerships between State and Territory governments, as well as with other sectors, were seen as a strength of the NPAPH, many viewed the role of the Commonwealth in the NPAPH as limited to funding. Conclusion Longer term investment in, and leadership for, chronic disease prevention is necessary. The NPAPH built on positive reforms at the time, creating opportunities for implementing programs at scale, building workforce capacity and improving evaluations. Early termination of the NPAPH meant potential return on investment was unrealised, new partnerships could not always be sustained and the prevention workforce was again under threat. Furthermore, responsibility for prevention, which was never clear, became even more opaque. So what? The NPAPH, as a national initiative for achieving improvements to the prevention of chronic disease, was a welcome investment. Disinvestment in the NPAPH, as well as other promising reforms of the time, led to a loss of credibility in outcomes focussed funding collaborations as well as missed opportunities for the future health and wellbeing of the Australian population. Australia needs a recommitment at all levels of government to investment and action in prevention and a restoration of funding in prevention commensurate with the size of the health burden.