The magic of numbers and the amazing disappearing act : the politics of counting youth homelessness

No-one wants to see young people who are no longer able to stay at home with their parents living in situations that are neither stable nor safe. Most Australians also appreciate that youth homelessness is typically a result of factors beyond the control of young people like poverty, lack of affordable housing, parental divorce or separation, family conflict and violence, sexual abuse, or mental health problems.1 Since the Burdekin Report of 1989 first put the issue on the national agenda, youth homelessness has been a point of some political sensitivity as the numbers of young homeless stayed stubbornly high through the 1990s and into the 2000s.

Language affects length of stay in emergency departments in Queensland public hospitals

BACKGROUND: A long length of stay (LOS) in the emergency department (ED) associated with overcrowding has been found to adversely affect the quality of ED care. The objective of this study is to determine whether patients who speak a language other than English at home have a longer LOS in EDs compared to those whose speak only English at home. METHODS: A secondary data analysis of a Queensland state-wide hospital EDs dataset (Emergency Department Information System) was conducted for the period, 1 January 2008 to 31 December 2010. RESULTS: The interpreter requirement was the highest among Vietnamese speakers (23.1%) followed by Chinese (19.8%) and Arabic speakers (18.7%). There were significant differences in the distributions of the departure statuses among the language groups (Chi-squared=3236.88, P<0.001). Compared with English speakers, the Beta coeffi cient for the LOS in the EDs measured in minutes was among Vietnamese, 26.3 (95%CI: 22.1–30.5); Arabic, 10.3 (95%CI: 7.3–13.2); Spanish, 9.4 (95%CI: 7.1–11.7); Chinese, 8.6 (95%CI: 2.6–14.6); Hindi, 4.0 (95%CI: 2.2–5.7); Italian, 3.5 (95%CI: 1.6–5.4); and German, 2.7 (95%CI: 1.0–4.4). The fi nal regression model explained 17% of the variability in LOS. CONCLUSION: There is a close relationship between the language spoken at home and the LOS at EDs, indicating that language could be an important predictor of prolonged LOS in EDs and improving language services might reduce LOS and ease overcrowding in EDs in Queensland's public hospitals.

Mobility and out-of-home activities of older people living in suburban environments : ‘Because I'm a driver, I don't have a problem'

Governments are challenged by the need to ensure that ageing populations stay active and engaged as they age. Therefore, it is critical to investigate the role of mobility in older people's engagement in out-of-home activities, and to identify the experiences they have within their communities. This research investigates the use of transportation by older people and its implications for their out-of-home activities within suburban environments. The qualitative, mixed-method approach employs data collection methods which include a daily travel diary (including a questionnaire), Global Positioning System (GPS) tracking and semi-structured interviews with older people living in suburban environments in Brisbane, Australia. Results show that older people are mobile throughout the city, and their car provides them with that opportunity to access desired destinations. This ability to drive allows older people to live independently and to assist others who do not drive, particularly where transport alternatives are not as accessible. The ability to transport goods and other people is a significant advantage of the private car over other transport options. People with no access to private transportation who live in low-density environments are disadvantaged when it comes to participation within the community. Further research is needed to better understand the relationship between transportation and participation within the community environment, to assist policy makers and city and transportation planners to develop strategies for age-friendly environments within the community.

Which mothers receive a postpartum home visit in Queensland, Australia? A cross-sectional retrospective study

Objective While home visiting in the early postpartum period appears to have increased, there are limited data defining which women receive a visit and none that include Queensland. We aimed to investigate patterns of postpartum home visiting in the public and private sectors in Queensland. Methods Data were collected via a retrospective cross-sectional survey of women birthing in Queensland between 1st February and 31st May 2010 at 4 months postpartum (N = 6948). Logistic regression was used to assess associations between receiving a home visit and sociodemographic, clinical and hospital variables. Analyses were stratified by public and private birthing sector because of significant differences between sectors. Results Public sector women were more likely to receive a visit from a nurse or midwife (from the hospital or child health sector) within 10 days of hospital discharge (67.2%) than private sector women (7.2%). Length of hospital stay was associated with home visiting in both sectors. Some vulnerable sub-populations in both sectors were more likely to be visited, while others were not. Conclusions Home visiting in Queensland varies markedly between the public and private sector and is less common in some vulnerable populations. Further consideration to improving the equity of community postpartum care in Queensland is needed.

Aaishah’s choice: Choosing home education in the Muslim community

In Australia, the decision to home educate is becoming increasingly popular (cf. Townsend, 2012). In spite of its increasing popularity, the reasons home education is chosen by Australian families is under-researched (cf. Jackson & Allan, 2010). In addition, the decision to home educate among minority groups, such as Australian Muslim families, is absent from the literature. This paper reports on an interview with one Muslim mother who chose to home educate her children. An in-depth, qualitative interview was conducted with Aaishah (pseudonym), a mother who lived in one of Australia’s most populated cities. Data were analysed using the Discourse Historical Approach to Critical Discourse Analysis. The analysis revealed that there were similarities between the discourses of Christian parents described in the literature, in terms of the reasons Aaishah had given for her decision to home educate. In particular, analysis reveals Aaishah’s fears about schools, their negative experiences on her children and her hopes for her children’s futures.

Calling Home

Through the exhibition implicit conceptions of home held by the participating artists and those viewing the exhibition were externalized. Represented as images, the conceptions conveyed different as well as shared understandings categorized as physical, cognitive, emotional, instrumental and existential. Unlike written papers on the meaning of home, the exhibition enabled access to a richer understanding of home as facilitating a way of being-in-the-world.

Not like my mother : truth and the author in creative nonfiction

This exegesis examines how a writer can effectively negotiate the relationship between author, character, fact and truth, in a work of Creative Nonfiction. It was found that individual truths, in a work of Creative Nonfiction, are not necessarily universal truths due to individual, cultural, historical and religious circumstances. What was also identified, through the examination of published Creative Nonfiction, is a necessity to ensure there are clear demarcation lines between authorial truth and fiction. The Creative Nonfiction works examined, which established this framework for the reader, ensured an ethical relationship between author and audience. These strategies and frameworks were then applied to my own Creative Nonfiction.

Using videotelephony to support paediatric oncology-related palliative care in the home : from abandoned RCT to acceptability study

Videotelephony (real-time audio-visual communication) has been used successfully in adult palliative home care. This paper describes two attempts to complete an RCT (both of which were abandoned following difficulties with family recruitment), designed to investigate the use of videotelephony with families receiving palliative care from a tertiary paediatric oncology service in Brisbane, Australia. To investigate whether providing videotelephone-based support was acceptable to these families, a 12-month non-randomised acceptability trial was completed. Seventeen palliative care families were offered access to a videotelephone support service in addition to the 24 hours ‘on-call’ service already offered. A 92% participation rate in this study provided some reassurance that the use of videotelephones themselves was not a factor in poor RCT participation rates. The next phase of research is to investigate the integration of videotelephone-based support from the time of diagnosis, through outpatient care and support, and for palliative care rather than for palliative care in isolation

Staff perspectives of a cardiology short stay unit

Objective To evaluate staff perceptions about working environment, efficiency and the clinical safety of a cardiovascular intervention short stay unit (SSU) during the first year of operation. Design Postal questionnaire. Setting Cardiac catheterisation laboratory (CCL), coronary care unit (CCU), general cardiology ward (GCW) and the short stay unit (SSU) of a tertiary referral hospital situated in the mid coastal region of NSW. Subjects Cardiologists (including visiting medical officers [VMO]), cardiology fellows, cardiology advanced trainees and nurses. Results Responses on the working environment of the SSU and the discharge process were statistically significant. A substantial proportion of both nurses and doctors had concerns about patient safety, even though no adverse events were formally recorded in the database. Conclusions Though the participants of the survey agree on the efficiency of the SSU in providing beds to the hospital, they disagree on aspects that are important in the functioning of the SSU, including the working environment, patient selection and clinical safety. The results highlight potential issues that could be improved or addressed and are relevant to the rollout of SSUs across NSW.

Using Trauma Injury Severity Score (TRISS) variables to predict length of hospital stay following trauma in New Zealand

Aim – To develop and assess the predictive capabilities of a statistical model that relates routinely collected Trauma Injury Severity Score (TRISS) variables to length of hospital stay (LOS) in survivors of traumatic injury. Method – Retrospective cohort study of adults who sustained a serious traumatic injury, and who survived until discharge from Auckland City, Middlemore, Waikato, or North Shore Hospitals between 2002 and 2006. Cubic-root transformed LOS was analysed using two-level mixed-effects regression models. Results – 1498 eligible patients were identified, 1446 (97%) injured from a blunt mechanism and 52 (3%) from a penetrating mechanism. For blunt mechanism trauma, 1096 (76%) were male, average age was 37 years (range: 15-94 years), and LOS and TRISS score information was available for 1362 patients. Spearman’s correlation and the median absolute prediction error between LOS and the original TRISS model was ρ=0.31 and 10.8 days, respectively, and between LOS and the final multivariable two-level mixed-effects regression model was ρ=0.38 and 6.0 days, respectively. Insufficient data were available for the analysis of penetrating mechanism models. Conclusions – Neither the original TRISS model nor the refined model has sufficient ability to accurately or reliably predict LOS. Additional predictor variables for LOS and other indicators for morbidity need to be considered.

Using a longitudinal model to estimate the effect of methicillin-resistant staphylococcus aureus infection on length of stay in an intensive care unit

Healthcare-associated methicillin-resistant Staphylococcus aureus(MRSA) infection may cause increased hospital stay or, sometimes, death. Quantifying this effect is complicated because it is a time-dependent exposure: infection may prolong hospital stay, while longer stays increase the risk of infection. We overcome these problems by using a multinomial longitudinal model for estimating the daily probability of death and discharge. We then extend the basic model to estimate how the effect of MRSA infection varies over time, and to quantify the number of excess ICU days due to infection. We find that infection decreases the relative risk of discharge (relative risk ratio = 0.68, 95% credible interval: 0.54, 0.82), but is only indirectly associated with increased mortality. An infection on the first day of admission resulted in a mean extra stay of 0.3 days (95% CI: 0.1, 0.5) for a patient with an APACHE II score of 10, and 1.2 days (95% CI: 0.5, 2.0) for a patient with an APACHE II score of 30. The decrease in the relative risk of discharge remained fairly constant with day of MRSA infection, but was slightly stronger closer to the start of infection. These results confirm the importance of MRSA infection in increasing ICU stay, but suggest that previous work may have systematically overestimated the effect size.