Enhancing capacity for 'systematic' thinking in public health

The concept of being evidence based or evidence informed is widely acknowledged as an important component of decision-making. It is perhaps most universally referred to in medicine, however has extended into many other disciplines over the past decade, including public health. Evidence-based public health has been defined as the ‘conscientious, explicit and judicious use of current best evidence in making decisions about the care of communities and populations in the domain of health protection, disease prevention, health maintenance and improvement (health promotion)’.1 More recent literature favours the use of the term evidence informed over evidence based to acknowledge the varying influences on decisions in this complex field.2,3 Evidence-informed activities in any discipline require a specific set of skills in critical thinking. These skills include identifying the questions to be resolved, collecting relevant evidence, and assessing, synthesizing and distilling evidence in a way that can inform the set of activities to be undertaken as a result.

Self-assembled hyperbranched polymer - gold nanoparticle hybrids : understanding the effect of polymer coverage on assembly size and SERS performance

In the past few years, remarkable progress has been made in unveiling novel and unique optical properties of strongly coupled plasmonic nanostructures. However, application of such plasmonic nanostructures in biomedicine remains challenging due to the lack of facile and robust assembly methods for producing stable nanostructures. Previous attempts to achieve plasmonic nano-assemblies using molecular ligands were limited due to the lack of flexibility that could be exercised in forming them. Here, we report the utilization of tailor-made hyperbranched polymers (HBP) as linkers to assemble gold nanoparticles (NPs) into nano-assemblies. The ease and flexibility in tuning the particle size and number of branch ends of a HBP makes it an ideal candidate as a linker, as opposed to DNA, small organic molecules and linear or dendrimeric polymers. We report a strong correlation of polymer (HBP) concentration with the size of the hybrid nano-assemblies and “hot-spot” density. We have shown that such solutions of stable HBP-gold nano-assemblies can be barcoded with various Raman tags to provide improved surface-enhanced Raman scattering (SERS) compared with non-aggregated NP systems. These Raman barcoded hybrid nano-assemblies, with further optimization of NP shape, size and “hot-spot” density, may find application as diagnostic tools in nanomedicine.

Review of guidelines for children’s vision screenings

The aim of children's vision screenings is to detect visual problems that are common in this age category through valid and reliable tests. Nevertheless, the cost effectiveness of paediatric vision screenings, the nature of the tests included in the screening batteries and the ideal screening age has been the cause of much debate in Australia and worldwide. Therefore, the purpose of this review is to report on the current practice of children's vision screenings in Australia and other countries, as well as to evaluate the evidence for and against the provision of such screenings. This was undertaken through a detailed investigation of peer-reviewed publications on this topic. The current review demonstrates that there is no agreed vision screening protocol for children in Australia. This appears to be a result of the lack of strong evidence supporting the benefit of such screenings. While amblyopia, strabismus and, to a lesser extent refractive error, are targeted by many screening programs during pre-school and at school entry, there is less agreement regarding the value of screening for other visual conditions, such as binocular vision disorders, ocular health problems and refractive errors that are less likely to reduce distance visual acuity. In addition, in Australia, little agreement exists in the frequency and coverage of screening programs between states and territories and the screening programs that are offered are ad hoc and poorly documented. Australian children stand to benefit from improved cohesion and communication between jurisdictions and health professionals to enable an equitable provision of validated vision screening services that have the best chance of early detection and intervention for a range of paediatric visual problems.

A Survey-based Study of Knowledge of Alzheimer's Disease among Health Care Staff

Background Continued aging of the population is expected to be accompanied by substantial increases in the number of people with dementia and in the number of health care staff required to care for them. Adequate knowledge about dementia among health care staff is important to the quality of care delivered to this vulnerable population. The purpose of this study was to assess knowledge about dementia across a range of health care staff in a regional health service district. Methods Knowledge levels were investigated via the validated 30-item Alzheimer's Disease Knowledge Scale (ADKS). All health service district staff with e-mail access were invited to participate in an online survey. Knowledge levels were compared across demographic categories, professional groups, and by whether the respondent had any professional or personal experience caring for someone with dementia. The effect of dementia-specific training or education on knowledge level was also evaluated. Results A diverse staff group (N = 360), in terms of age, professional group (nursing, medicine, allied health, support staff) and work setting from a regional health service in Queensland, Australia responded. Overall knowledge about Alzheimer's disease was of a generally moderate level with significant differences being observed by professional group and whether the respondent had any professional or personal experience caring for someone with dementia. Knowledge was lower for some of the specific content domains of the ADKS, especially those that were more medically-oriented, such as 'risk factors' and 'course of the disease.' Knowledge was higher for those who had experienced dementia-specific training, such as attendance at a series of relevant workshops. Conclusions Specific deficits in dementia knowledge were identified among Australian health care staff, and the results suggest dementia-specific training might improve knowledge. As one piece of an overall plan to improve health care delivery to people with dementia, this research supports the role of introducing systematic dementia-specific education or training.

Predictive modelling : parents’ decision making to use online child health information to increase their understanding and/or diagnose or treat their child’s health

Abstract Background The quantum increases in home Internet access and available online health information with limited control over information quality highlight the necessity of exploring decision making processes in accessing and using online information, specifically in relation to children who do not make their health decisions. Objectives To understand the processes explaining parents’ decisions to use online health information for child health care. Methods Parents (N = 391) completed an initial questionnaire assessing the theory of planned behaviour constructs of attitude, subjective norm, and perceived behavioural control, as well as perceived risk, group norm, and additional demographic factors. Two months later, 187 parents completed a follow-up questionnaire assessing their decisions to use online information for their child’s health care, specifically to 1) diagnose and/or treat their child’s suspected medical condition/illness and 2) increase understanding about a diagnosis or treatment recommended by a health professional. Results Hierarchical multiple regression showed that, for both behaviours, attitude, subjective norm, perceived behavioural control, (less) perceived risk, group norm, and (non) medical background were the significant predictors of intention. For parents’ use of online child health information, for both behaviours, intention was the sole significant predictor of behaviour. The findings explain 77% of the variance in parents’ intention to treat/diagnose a child health problem and 74% of the variance in their intentions to increase their understanding about child health concerns. Conclusions Understanding parents’ socio-cognitive processes that guide their use of online information for child health care is important given the increase in Internet usage and the sometimes-questionable quality of health information provided online. Findings highlight parents’ thirst for information; there is an urgent need for health professionals to provide parents with evidence-based child health websites in addition to general population education on how to evaluate the quality of online health information.

School based youth health nurses and a true health promotion approach : the Ottawa what?

Aim: The purpose of this research is to examine School Based Youth Health Nurses experience of a true health promotion approach. Background: The School Based Youth Health Nurse Program is a state-wide school nursing initiative in Queensland, Australia. The program employs more than 120 fulltime and fractional school nurses who provide health services in state high schools. The role incorporates two primary components: individual health consultations and health promotion strategies. Design/Methods: This study is a retrospective inquiry generated from a larger qualitative research project about the experience of school based youth health nursing. The original methodology was phenomenography. In-depth interviews were conducted with sixteen school nurses recruited through purposeful and snowball sampling. This study accesses a specific set of raw data about School Based Youth Health Nurses experience of a true health promotion approach. The Ottawa Charter for Health Promotion (1986) is used as a framework for deductive analysis. Results: The findings indicate school nurses have neither an adverse or affirmative conceptual experience of a true health promotion approach and an adverse operational experience of a true health promotion approach based on the action areas of the Ottawa Charter. Conclusions: The findings of this research are important because they challenge the notion that school nurses are the most appropriate health professionals to undertake a true health promotion approach. If school nurses are the most appropriate health professionals to do a true health promotion approach, there are implications for recruitment and training and qualifications. If school nurses are not, who are the most appropriate health professionals to do school health promotion? Implications for Practice: These findings can be applied to other models of school nursing in Australia which emphasises a true health promotion approach because they relate specifically to school nurses’ experience of a true health promotion approach.

Predictors of sexually transmitted infection in Australian women : evidence from the Australian longitudinal study on women’s health

This longitudinal study examined characteristics of women diagnosed with sexually transmitted infections (STI) for the first time in their later 20s and early 30s. Participants were 6,840 women (born 1973–1978) from the Australian Longitudinal Study on Women’s Health. Women aged 18–23 years were surveyed in 1996 (S1), 2000 (S2), 2003 (S3), and 2006 (S4). There were 269 women reporting an STI for the first time at S3 or S4. Using two multivariable logistic regression analyses (examining 18 predictor variables), these 269 women were compared (1) with 306 women who reported an STI at S2 and (2) with 5,214 women who never reported an STI across the four surveys. Women who reported an STI for the first time at S3 or S4 were less likely to have been pregnant or had a recent Pap smear compared to women reporting an STI at S2.Women reporting a first STI at S3 or S4 were less likely to have been pregnant or had a recent Pap smear compared to women reporting an STI at S2. Women were more likely to report an STI for the first time at S3 or S4 compared to women not reporting an STI at any survey if they were younger, unpartnered, had a higher number of sexual partners, had never been pregnant, were recently divorced or separated, and reported poorer access to Women’s Health or Family Planning Centres at S2. These findings demonstrate the value of longitudinal studies of sexual health over the life course beyond adolescence.

Information support for health management in regional Sri Lanka : health managers’ perspectives

Good management, supported by accurate, timely and reliable health information, is vital for increasing the effectiveness of Health Information Systems (HIS). When it comes to managing the under resourced health systems of developing countries, information-based decision making is particularly important. This paper reports findings of a self-report survey that investigated perceptions of local health managers (HMs) of their own regional HIS in Sri Lanka. Data were collected through a validated, pre-tested postal questionnaire, and distributed among a selected group of HMs to elicit their perceptions of the current HIS in relation to information generation, acquisition and use, required reforms to the information system and application of information and communication technology (ICT). Results based on descriptive statistics indicated that the regional HIS was poorly organised and in need of reform; that management support for the system was unsatisfactory in terms of relevance, accuracy, timeliness and accessibility; that political pressure and community and donor requests took precedence over vital health information when management decisions were made; and use of ICT was unsatisfactory. HIS strengths included user-friendly paper formats, a centralised planning system and an efficient disease notification system; weaknesses were lack of comprehensiveness, inaccuracy, and lack of a feedback system. Responses of participants indicated that HIS would be improved by adopting an internationally accepted framework and introducing ICT applications. Perceived barriers to such improvements were high initial cost of educating staff to improve computer literacy, introduction of ICTs, and HIS restructure. We concluded that the regional HIS of Central Province, Sri Lanka had failed to provide much needed information support to HMs. These findings are consistent with similar research in other developing countries and reinforce the need for further research to verify causes of poor performance and to design strategic reforms to improve HIS in regional Sri Lanka.

Utilising Reliability and Condition Monitoring Data for Asset Health Prognosis

The ability to forecast machinery health is vital to reducing maintenance costs, operation downtime and safety hazards. Recent advances in condition monitoring technologies have given rise to a number of prognostic models which attempt to forecast machinery health based on condition data such as vibration measurements. This paper demonstrates how the population characteristics and condition monitoring data (both complete and suspended) of historical items can be integrated for training an intelligent agent to predict asset health multiple steps ahead. The model consists of a feed-forward neural network whose training targets are asset survival probabilities estimated using a variation of the Kaplan–Meier estimator and a degradation-based failure probability density function estimator. The trained network is capable of estimating the future survival probabilities when a series of asset condition readings are inputted. The output survival probabilities collectively form an estimated survival curve. Pump data from a pulp and paper mill were used for model validation and comparison. The results indicate that the proposed model can predict more accurately as well as further ahead than similar models which neglect population characteristics and suspended data. This work presents a compelling concept for longer-range fault prognosis utilising available information more fully and accurately.

Machine prognostics based on health state estimation using SVM

The ability to accurately predict the remaining useful life of machine components is critical for machine continuous operation, and can also improve productivity and enhance system safety. In condition-based maintenance (CBM), maintenance is performed based on information collected through condition monitoring and an assessment of the machine health. Effective diagnostics and prognostics are important aspects of CBM for maintenance engineers to schedule a repair and to acquire replacement components before the components actually fail. All machine components are subjected to degradation processes in real environments and they have certain failure characteristics which can be related to the operating conditions. This paper describes a technique for accurate assessment of the remnant life of machines based on health state probability estimation and involving historical knowledge embedded in the closed loop diagnostics and prognostics systems. The technique uses a Support Vector Machine (SVM) classifier as a tool for estimating health state probability of machine degradation, which can affect the accuracy of prediction. To validate the feasibility of the proposed model, real life historical data from bearings of High Pressure Liquefied Natural Gas (HP-LNG) pumps were analysed and used to obtain the optimal prediction of remaining useful life. The results obtained were very encouraging and showed that the proposed prognostic system based on health state probability estimation has the potential to be used as an estimation tool for remnant life prediction in industrial machinery.

Discrimination experienced by HIV/AIDS infected persons and its associations with mental health in an Indian sample

Purpose The purpose of this study was to investigate the nature and prevalence of discrimination against people living with HIV/AIDS in West Bengal, India, and how discrimination is associated with depression, suicidal ideation and suicidal attempts. Method Semi-structured interviews and the Beck Depression Inventory were administered to 105 HIV infected persons recruited by incidental sampling, at an Integrated Counseling and Testing Center (ICTC) and through Networks of People Living with HIV/AIDS, in the West Bengal area. Results Findings showed that 40.8% of the sample has experienced discrimination at least in one social setting – such as family (29.1%), health centers (18.4%), community (17.5%) and workplace (6.8%). About two-fifths (40.8%) reported experiencing discrimination in multiple social settings. Demographic factors associated with discrimination were gender, age, occupation, education, and current residence. More than half of the sample was suffering from severe depression while 8.7% had attempted suicide. Discrimination in most areas was significantly associated with suicidal ideation and suicidal attempts. Conclusions Prevalence of discrimination associated with HIV/AIDS is high in our sample from West Bengal. While discrimination was not associated with depressive symptomatology, discrimination was associated with suicidal ideation and attempts. These findings suggest that there is an urgent need for interventions to reduce discrimination of HIV/AIDS in the West Bengal region.

Ask : a health advocacy program for adolescents with an intellectual disability : a cluster randomised controlled trial

Background Adolescents with intellectual disability often have poor health and healthcare. This is partly as a consequence of poor communication and recall difficulties, and the possible loss of specialised paediatric services. Methods/Design A cluster randomised trial was conducted with adolescents with intellectual disability to investigate a health intervention package to enhance interactions among adolescents with intellectual disability, their parents/carers, and general practitioners (GPs). The trial took place in Queensland, Australia, between February 2007 and September 2010. The intervention package was designed to improve communication with health professionals and families’ organisation of health information, and to increase clinical activities beneficial to improved health outcomes. It consisted of the Comprehensive Health Assessment Program (CHAP), a one-off health check, and the Ask Health Diary, designed for on-going use. Participants were drawn from Special Education Schools and Special Education Units. The education component of the intervention was delivered as part of the school curriculum. Educators were surveyed at baseline and followed-up four months later. Carers were surveyed at baseline and after 26 months. Evidence of health promotion, disease prevention and case-finding activities were extracted from GPs clinical records. Qualitative interviews of educators occurred after completion of the educational component of the intervention and with adolescents and carers after the CHAP. Discussion Adolescents with intellectual disability have difficulty obtaining many health services and often find it difficult to become empowered to improve and protect their health. The health intervention package proposed may aid them by augmenting communication, improving documentation of health encounters, and improving access to, and quality of, GP care. Recruitment strategies to consider for future studies in this population include ensuring potential participants can identify themselves with the individuals used in promotional study material, making direct contact with their families at the start of the study, and closely monitoring the implementation of the educational intervention.

Spatial modelling of population health screening : the role of accessibility in predicting expected patient flows

This paper describes a generalised linear mixed model (GLMM) approach for understanding spatial patterns of participation in population health screening, in the presence of multiple screening facilities. The models presented have dual focus, namely the prediction of expected patient flows from regions to services and relative rates of participation by region- service combination, with both outputs having meaningful implications for the monitoring of current service uptake and provision. The novelty of this paper lies with the former focus, and an approach for distributing expected participation by region based on proximity to services is proposed. The modelling of relative rates of participation is achieved through the combination of different random effects, as a means of assigning excess participation to different sources. The methodology is applied to participation data collected from a government-funded mammography program in Brisbane, Australia.