Use of expert knowledge to elicit population trends for the koala (Phascolarctos cinereus)

Aim: The koala is a widely distributed Australian marsupial with regional populations that are in rapid decline, are stable or have increased in size. This study examined whether it is possible to use expert elicitation to estimate abundance and trends of populations of this species. Diverse opinions exist about estimates of abundance and, consequently, the status of populations. Location: Eastern and south-eastern Australia Methods: Using a structured, four-step question format, a panel of 15 experts estimated population sizes of koalas and changes in those sizes for bioregions within four states. They provided their lowest plausible estimate, highest plausible estimate, best estimate and their degree of confidence that the true values were contained within these upper and lower estimates. We derived estimates of the mean population size of koalas and associated uncertainties for each bioregion and state. Results: On the basis of estimates of mean population sizes for each bioregion and state, we estimated that the total number of koalas for Australia is 329,000 (range 144,000-605,000) with an estimated average decline of 24% over the past three generations and the next three generations. Estimated percentage of loss in Queensland, New South Wales, Victoria and South Australia was 53%, 26%, 14% and 3%, respectively. Main conclusions: It was not necessary to achieve high levels of certainty or consensus among experts before making informed estimates. A quantitative, scientific method for deriving estimates of koala populations and trends was possible, in the absence of empirical data on abundances.

HPV.edu study protocol: a cluster randomised controlled evaluation of education, decisional support and logistical strategies in school-based human papillomavirus (HPV) vaccination of adolescents

BACKGROUND: The National Human Papillomavirus (HPV) Vaccination Program in Australia commenced in 2007 for females and in 2013 for males, using the quadrivalent HPV vaccine (HPV 6,11,16,18). Thus far, we have demonstrated very substantial reductions in genital warts and in the prevalence of HPV among young Australian women, providing early evidence for the success of this public health initiative. Australia has a long history of school-based vaccination programs for adolescents, with comparatively high coverage. However, it is not clear what factors promote success in a school vaccination program. The HPV.edu study aims to examine: 1) student knowledge about HPV vaccination; 2) psycho-social outcomes and 3) vaccination uptake.

METHODS/DESIGN: HPV.edu is a cluster randomised trial of a complex intervention in schools aiming to recruit 40 schools with year-8 enrolments above 100 students (approximately 4400 students). The schools will be stratified by Government, Catholic, and Independent sectors and geographical location, with up to 20 schools recruited in each of two states, Western Australia (WA) and South Australia (SA), and randomly allocated to intervention or control (usual practice). Intervention schools will receive the complex intervention which includes an adolescent intervention (education and distraction); a decisional support tool for parents and adolescents and logistical strategies (consent form returns strategies, in-school mop-up vaccination and vaccination-day guidelines). Careful process evaluation including an embedded qualitative evaluation will be undertaken to explore in depth possible mechanisms for any observed effect of the intervention on primary and secondary outcomes.

DISCUSSION: This study is the first to evaluate the relative effectiveness of various strategies to promote best practice in school-based vaccination against HPV. The study aims to improve vaccination-related psychosocial outcomes, including adolescent knowledge and attitudes, decision-making involvement, self-efficacy, and to reduce fear and anxiety. The study also aims to improve school vaccination program logistics including reduction in time spent vaccinating adolescents and increased number of consent forms returned (regardless of decision). Less anxiety in adolescents will likely promote more efficient vaccination, which will be more acceptable to teachers, nurses and parents. Through these interventions, it is hoped that vaccination uptake will be increased.

Acceptability of videoconference technology for the delivery of continuing education to rural pharmacists

Aim: To investigate whether a rural continuing education (CE) program delivered by videoconference can enhance access to, and uptake of, CE among pharmacists and determine their satisfaction with videoconference for the delivery of CE. Method: A postal survey was sent to 33 registered pharmacists in south-west Victoria and south-east South Australia who had attended at least one videoconference CE session organised in that region. Results: Respondents worked in different areas of pharmacy, and 40% worked in more than one area of pharmacy. The use of videoconference facilities has increased access to and participation in CE generally, and most participants (88%) have found it to be an acceptable medium for delivery. Increased access to high-quality CE opportunities, and reduced travel time for CE were seen as the principal benefits of the medium. Negative aspects included technical glitches, organisational issues, and the time-lag in voice transmission. Overall, most participants were happy to receive a substantial proportion of their contact CE using this medium. Conclusions: Videoconference technology is a valuable tool for the delivery of carefully structured CE sessions in rural and remote areas with an appropriate information technology infrastructure.

Student empathy levels across 12 medical and health professions: an interventional study

Background
Empathy is a difficult characteristic to define, teach and assess; the ‘nebulous’ properties of empathic behaviour often means that educators fail to incorporate the explicit teaching and assessment of empathy within the curriculum. One solution suggested is that teaching empathy in an interprofessional education setting is an effective educational approach in developing empathic behaviours.

Method
Student participants from Monash University, Deakin University, University of South Australia, and Edith Cowan University completed a self-reporting survey package pre and post two-hour empathy workshop consisting of the Jefferson Scale of Empathy – Health Profession – Student version (JSE-HP-S).

Results
A total of 293 students from 12 different medical and health care professions participated in the empathy workshops. The majority of participants were from Monash University n = 230 (78 %), the nursing profession n = 59 (20 %), < 26 years of age n = 215 (73 %) and enrolled in first year studies n = 123 (42 %). Using a paired t-test repeated measure self-reported empathy levels improved at p < 0.0001, mean 114.34 vs. 120.32 (d = 0.22).

Conclusion
This project has shown that self-reported empathy levels have been shown to statistically improve following DVD simulation-based workshops.

Experiences and perceptions of problem gamblers on cognitive and exposure therapies when taking part in a randomised controlled trial: a qualitative study

In South Australia (SA) problem gambling is mainly a result of the widespread availability of electronic gaming machines. A key treatment provider in SA offers free cognitive and behavioural therapy (CBT) to help-seeking problem gamblers. The CBT program focuses on the treatment of clients' urge to gamble using exposure therapy (ET) and cognitive therapy (CT) to restructure erroneous gambling beliefs. The aim of this study was to explore treatment specific and non-specific effects for CT alone and ET alone using qualitative interviews. Interviewees were a sub-sample of participants from a randomised trial that investigated the relative efficacy of CT versus ET. Findings revealed that all interviewees gained benefit from their respective therapies and their comments did not appear to favour one therapy over another. Both treatment specific and treatment non-specific effects were well supported as playing a therapeutic role to recovery. Participants' comments in both therapy groups suggested that symptom reduction was experienced on a gambling related urge-cognition continuum. In addition to symptom improvement from therapy-specific mechanisms, ET participants described a general acquisition of "rational thought" from their program of therapy and CT participants had "taken-over" their gambling urges. The findings also highlighted areas for further improvement including therapy drop-out.

Predictors of relapse in problem gambling : a prospective cohort study

To explore the variation of predictors of relapse in treatment and support seeking gamblers. A prospective cohort study with 158 treatment and support seeking problem gamblers in South Australia. Key measures were selected using a consensus process with international experts in problem gambling and related addictions. The outcome measures were Victorian Gambling Screen (VGS) and behaviours related to gambling. Potential predictors were gambling related cognitions and urge, emotional disturbance, social support, sensation seeking traits, and levels of work and social functioning. Mean age of participants was 44 years (SD = 12.92 years) and 85 (54 %) were male. Median time for participants enrolment in the study was 8.38 months (IQR = 2.57 months). Patterns of completed measures for points in time included 116 (73.4 %) with at least a 3 month follow-up. Using generalised mixed-effects regression models we found gambling related urge was significantly associated with relapse in problem gambling as measured by VGS (OR 1.29; 95 % CI 1.12-1.49) and gambling behaviours (OR 1.16; 95 % CI 1.06-1.27). Gambling related cognitions were also significantly associated with VGS (OR 1.06; 95 % CI 1.01-1.12). There is consistent association between urge to gamble and relapse in problem gambling but estimates for other potential predictors may have been attenuated because of methodological limitations. This study also highlighted the challenges presented from a cohort study of treatment and support seeking problem gamblers.

The Gambling Urge Scale : reliability and validity in a clinical population

The aim of this study was to establish reliability and validity of the Gambling Urge Scale (GUS) in a clinical population of problem gamblers. This cohort study was conducted in South Australia between March 2008 and March 2009. Participants were problem gamblers aged ≥18 years (n = 158) who were seeking treatment from a range of gambling help services. Measures included gambling urge, problem gambling screening, gambling behaviour and problems caused by gambling, such as personal health and relationships. The psychometric properties investigated were internal reliability, criterion-related validity, concurrent validity and construct validity. Results showed high internal consistency for GUS (α = 0.93) and significant item-rest correlations ranging from 0.72 to 0.86. For criterion-related validity, a GUS cut score of three correctly classified 81.13% of participants as problem gambling with sensitivity 84.75% and specificity 76.6%. Concurrent validity was significant with a number of gambling-related symptoms and problems including psychological disturbance, work and social functioning and gambling-related cognitions (p < 0.001). An insignificant correlation was found between gambling urge and sensation seeking traits (p = 0.663). When controlling for gender and age the instrument was shown to have significant predictive properties for different levels of gambling severity (p < 0.001). A principal component analysis for the one component showed an overall explained variance of 75.54%. These findings indicate that GUS is a valid and reliable instrument for problem gambling screening, to measure treatment outcomes and may predict relapse in problem gambling.

An investigation into health and safety risks associated with deconstruction

As a response to calls for making construction activities environmentally conscious, alternatives to mechanical demolition such as deconstruction, recycling and reuse for re-entering building materials and components back in to the supply chain have emerged. However, deconstruction has remained unexploited within the construction industry due to the adverse effects of barriers and challenges that make demolishing contractors shy away from implementing deconstruction in projects. On assessment of the barriers/challenges facing deconstruction it was revealed that deconstruction, like all construction activities, is fraught with various health and safety hazards. This study attempts to identify the role of health and safety risks in impeding the widespread implementation of deconstruction practices in construction projects. Afterwards, major health and safety risks associated with deconstruction activities are identified. Findings of the present study are based on the results acquired through conducting unstructured interviews with 6 demolition contractors in South Australia. The study contributes to the body of knowledge by further establishing the deconstruction field and providing a basis for future investigations into barriers of deconstruction. Further, presented discussions would provide professional implications by offering guidelines for managing deconstruction projects in a safer and more efficient environment.

'It is not all about sex': young people's views about sexuality and relationships education

The Engaging Young People in Sexuality Education (EYPSE) research project addresses two questions: 1. What are young people’s views on school-based sexuality and relationships education? 2. In what ways could sexuality and relationships education be improved? This report focuses on findings from the first stage of the research project, consisting of an online survey of over 2,000 students in 31 secondary schools in South Australia and Victoria. The research was conducted in government secondary schools in South Australia (14) and Victoria (17). A detailed online survey was constructed and administered to students aged 13 to 16+ years old. The survey used similar terminology and language to that used in sexuality and relationships education classes. A total of 2,325 students undertook the survey. Demographic information about the students includes: - Age – 13 years (18%), 14 years (40%), 15 years (32%), 16+ years (10%) - Location – Victoria (63%), South Australia (37%) - Gender – Female (49%), Male (50%), ‘Other’ (1%) - Sexual attraction – opposite sex (83.5%), same sex (1.4%), both sexes (5.5%), unsure (5.2%), preferred not to disclose (4.3%) - Socio-economic status of the school – low (25.8%), middle (41.9%), high (25.8%), not ranked (6.5%)

Outcomes of a randomised controlled trial of the application of cognitive and behaviour therapies for problematic gambling : implications for the Statewide Gambling Therapy Service treatment model

Through an ongoing research programme, the Statewide Gambling Therapy Service (SGTS) in South Australia has been systematically developing approaches to treatment and relapse prevention in order to include a wider range of clients in the treatment programme, help them recover from their gambling problems and support them to avoid relapse to problematic gambling post treatment.In a recent randomised controlled trial exploring the efficacy of cognitive versus behavioural therapy in the treatment of problematic gambling disorders in SGTS, no significant differences were found between clinical outcomes of the two treatment modalities. Both purely cognitive and purely bahavioural approaches to therapy had similar outcomes in terms of improvements in measures of health and wellbeing (Work and Social Adjustment Scale: WSAS), general depressioni (Kessler 10: K10) and problematic gambling (Victorian Gambling Screen: VGS). Further studies are planned to test more precisely whether both approaches are indeed equivalent in terms of outcomes achieved for clients. In the mean time, the fact that behavioural therapy (BT) tends to required less treatment sessions to achieve the same outcomes as cognitive therapy (CT) suggests that working to retaining clients in treatment using BT may be a more effective and parsimonious treatment option for people with gambling disorders . This current paper provides an overview of SGTS client engagement and management strategies following the completion of our recent RCT.

A behavioural therapy approach to self-management: the Flinders Program

Chronic diseases, including diabetes, represent the most prevalent problem in healthcare today. They are the most common cause of disability and consume the largest part of health expenditures internationally. Most diabetes care is provided by people with diabetes and their family or supporters. Therefore, understanding how to enhance diabetes self-management is of primary importance in addressing this growing burden. The effective self-management of type 2 diabetes is closely linked to environmental factors and a person’s lifestyle. In this article, the authors describe the Flinders Chronic Condition Self-Management Program, which highlights the person’s perspective, and provide an example of its practical application in an Aboriginal population in South Australia.

Chronic disease self-management in Aboriginal communities : towards a sustainable program of care in rural communities

The Chronic Disease Self-Management (CDSM) strategy for Aboriginal patients on Eyre Peninsula, South Australia, was designed to develop and trial new program tools and processes for goal setting, behaviour change and self-management for Aboriginal people with diabetes. The project was established as a one-year demonstration project to test and trial a range of CDSM processes and procedures within Aboriginal communities and not as a formal research project. Over a one-year period, 60 Aboriginal people with type-2 diabetes in two remote regional centres participated in the pilot program. This represents around 25% of the known Aboriginal diabetic population in these sites. The project included training for four Aboriginal Health Workers in goal setting and self-management strategies in preparation for them to run the program. Patients completed a Diabetes Assessment Tool, a Quality of Life Questionnaire (SF12), the Work and Social Adjustment Scale (WASAS) at 0, 6 and 12 months. The evaluation tools were assessed and revised by consumers and health professionals during the trial to determine the most functional and acceptable processes for Aboriginal patients. Some limited biomedical data were also recorded although this was not the principal purpose of the project. Initial results from the COAG coordinated care trial in Eyre suggest that goal setting and monitoring processes, when modified to be culturally inclusive of Aboriginal people, can be effective strategies for improving self-management skills and health-related behaviours of patients with chronic illness. The CDSM pilot study in Aboriginal communities has led to further refinement of the tools and processes used in chronic illness self-management programs for Aboriginal people and to greater acceptance of these processes in the communities involved. Participation in a diabetes self-management program run by Aboriginal Health Workers assists patients to identify and understand their health problems and develop condition management goals and patient-centred solutions that can lead to improved health and wellbeing for participants. While the development of self-management tools and strategies led to some early indications of improvements in patient participation and resultant health outcomes, the pilot program and the refinement of new assessment tools used to assist this process has been the significant outcome of the project. The CDSM process described here is a valuable strategy for educating and supporting people with chronic conditions and in gaining their participation in programs designed to improve the way they manage their illness. Such work, and the subsequent health outcome research planned for rural regions, will contribute to the development of more comprehensive CDSM programs for Aboriginal communities generally.

Rural health systems change

Much effort has been expended in recent years attempting to reform the Australian health system in order to deliver more efficient and effective systems of care for an ageing and increasingly chronically ill population. Rural health care systems in particular have been a focus of reform programs, and new initiatives such as University Departments of Rural Health, Regional Health Service structures and Commonwealth primary care initiatives have been designed to improve service provision and health status for rural people. However, with these attempts to reform the way rural communities understand and manage their health care, surprisingly little has changed in the day-to-day business of health care in rural and regional areas. Paradoxically, while rural communities have moved to embrace new farming technologies and environmental perspectives along with modern land management practices, revegetation and sustainable production systems, the same enthusiasm for change does not appear to have been kindled in relation to health system reforms. Rural communities, in terms of health care, are still using the equivalent of outmoded farming practices and other environmentally and economically unsustainable approaches to managing their affairs. Why might this be and what can be done to improve the current state of health reform in our rural and regional areas? The paper explores systems change in relation to health reform in rural communities and highlights several strategies for bringing about a functional synthesis of research and health service practice to create a more effective health care system in rural South Australia.