Self-management support and training for patients with chronic and complex conditions improves health-related behaviour and health outcomes

The Sharing Health Care SA chronic disease self-management (CDSM) project in rural South Australia was designed to assist patients with chronic and complex conditions (diabetes, cardiovascular disease and arthritis) to learn how to participate more effectively in the management of their condition and to improve their self-management skills. Participants with chronic and complex conditions were recruited into the Sharing Health Care SA program and offered a range of education and support options (including a 6-week peer-led chronic disease self-management program) as part of the Enhanced Primary Care care planning process. Patient self-reported data were collected at baseline and subsequent 6-month intervals using the Partners in Health (PIH) scale to assess self-management skill and ability for 175 patients across four data collection points. Health providers also scored patient knowledge and self-management skills using the same scale over the same intervals. Patients also completed a modified Stanford 2000 Health Survey for the same time intervals to assess service utilisation and health-related lifestyle factors. Results show that both mean patient self-reported PIH scores and mean health provider PIH scores for patients improved significantly over time, indicating that patients demonstrated improved understanding of their condition and improved their ability to manage and deal with their symptoms. These results suggest that involvement in peer-led self-management education programs has a positive effect on patient self-management skill, confidence and health-related behaviour.

Sustainable population health : a pressing priority for community wellbeing

Recent developments in primary health care, preventive care, early intervention programs, population health constructs and coordinated care trials in Australia have explored the idea of changing our emphasis in health care from responsive acute care to more integrated, whole population community wellbeing management. This idea accepts that much illness and even trauma experienced by individuals in our communities can be prevented, mitigated or managed in a more constructive and positive manner than has previously been the case. Much disabling illness need not occur at all and can be avoided through better community based management models, education programs, and lifestyle changes that contribute to more healthy communities. As in the wider business world, we are becoming more cognisant of the fact that prevention is not only an appealing idea in terms of health outcomes and quality of life, but that it is good for business also. It can moderate demand for costly health care, assist consumers to understand how to live healthier and fulfilling lives and overall help to sustain a much more dynamic community. This article, based on work in a rural health service in South Australia, points to some elements of sustainable primary care that appear to have potential to take us where we need to go. It asks whether we have the capacity and the will to make the necessary investment in sustainability to ensure our future or whether we are to remain bound in a reactionary model of health care rather than considering the impact of wider social and physical environments as part of the overall community health equation.

The Centre of Clinical Research Excellence in Aboriginal Health : an operational rationale and some reflections on progress so far

The Centre of Clinical Research Excellence (CCRE) in Aboriginal and Torres Strait Islander Health was established in late 2003 through a major National Health and Medical Research Council (NHMRC) grant involving collaboration between the Aboriginal Health Council of South Australia (AHCSA), Flinders University, and Aboriginal Health Services. Our foundation research communities are the Aboriginal communities served by these Aboriginal Health Services in the Spencer Gulf / Eyre Peninsula region. In recent years a number of collaborative research programs involving chronic illness management, self-management and coordinated care have been implemented in these communities and this work is the basis of the initial CCRE activities. Key objectives of the CCRE are to improve the health status of Indigenous people through conducting relevant and meaningful Aboriginal controlled health research, providing formal training for Indigenous health researchers and developing innovative approaches to health care that can be readily translated and applied to support communities. The inclusion, empowerment and engagement of Indigenous people in the process of managing community health represent tangible strategies for achieving more equitable health outcomes for Aboriginal people. This paper outlines the CCRE operational rationale and presents early activities and outcomes across the three strategic areas of CCRE operations: research, education and training, and translation. Some critical reflections are offered on the progress and experience of the CCRE thus far. A common obstacle this CCRE has encountered is that the limited (especially staff) resources available to the Aboriginal Health Services with which we are collaborating make it difficult for them to engage with and progress the projects we are pursuing.

The science of the COAG coordinated care trials

Objectives: To explicate the organisational change agenda of the COAG coordinated care trials within the Australian health system and to illuminate the role of science in this process. Methods and Results: This article briefly outlines the COAG coordinated care trial aims and the effect of the trial as a change initiative in rural South Australia. It is proposed that although the formal trial outcomes are still not clear, the trial had significant impact upon health service delivery in some sites. The trial involved standard research methods with control and intervention groups and with key hypotheses being tested to compare the costs and service utilization profile of intervention and control groups. Formal results indicate that costs were not significantly different between intervention and control groups across all sites, but that the trial, nonetheless, had a powerful impact on the attitude and behaviours of service providers in the rural trial on Eyre Peninsula in particular. Some of the key structural changes now in place are outlined. Conclusions: The COAG trial has had many and varied impacts upon those organisations and individual providers involved with it. It is argued here that since successive initiatives had been implemented before final evaluation results were published, other agendas were served by the trial apart from those of standard scientific research and hypothesis testing. That is, the main impact of the coordinated care trial in Eyre Region at least has been change by stealth, and not through scientific research and demonstration. Implications: The COAG trials have set in train a series of structural and procedural changes in the methods of delivery and management of primary health care systems; changes that are embodied in the Enhanced Primary Care packages (EPC) and other initiatives recently introduced by the Commonwealth Government. These changes have occurred and are occurring across the system without formal evidence as to their efficacy, suggesting that other financial motives are driving these new approaches apart from the goal of improving health outcomes for consumers. Also, if science is to be used in this way to drive policy and procedural change ahead of actual outcome evidence, it is important that we examine the more subtle agendas of such research projects in future if the integrity of the scientific method is to be maintained. The occurrence of such phenomena questions the very foundation of scientific endeavour and weakens the application of scientific principles in the arena of social and political science.

Construction labor productivity convergence: a conditional frontier approach

Purpose-Understanding and simulating construction activities is a vital issue from a macro-perspective, since construction is an important contributor in economic development. Although the construction labor productivity frontier has attracted much research effort, the temporal and regional characteristics have not yet been explored. The purpose of this paper is to investigate the long-run equilibrium and dynamics within construction development under a conditional frontier context. Design/methodology/approach-Analogous to the simplified production function, this research adopts the conditional frontier theory to investigate the convergence of construction labor productivity across regions and over time. Error correction models are implemented to identify the long-run equilibrium and dynamics of construction labor productivity against three types of convergence hypotheses, while a panel regression method is used to capture the regional heterogeneity. The developed models are applied to investigate and simulate the construction labor productivity in the Australian states and territories. Findings-The results suggest that construction labor productivity in Australia should converge to stable frontiers in a long-run perspective. The dynamics of the productivity are mainly caused by the technology utilization efficiency levels of the local construction industry, while the influences of changes in technology level and capital depending appear limited. Five regional clusters of the Australian construction labor productivity are suggested by the simulation results, including New South Wales; Australian Capital Territory; Northern Territory, Queensland, and Western Australia; South Australia; and Tasmania and Victoria. Originality/value-Three types of frontier of construction labor productivity is proposed. An econometric approach is developed to identify the convergence frontier of construction labor productivity across regions over time. The specified model can provides accurate predictions of the construction labor productivity.

Implementing the Flinders Model of self-management support with Aboriginal people who have diabetes : findings from a pilot study

A pilot program for Aboriginal people with diabetes on Eyre Peninsula, South Australia, aimed to test the acceptability and impact of using the Flinders model of self-management care planing to improve patient self-management. A community development approach was used to conduct a twelve-month demonstration project. Aboriginal health workers (AHWs) conducted patient-centred, self-management assessment and care planning. Impacts were measured by patient-completed diabetes self-management assessment tool, goal achievement, quality of life and clinical measures at baseline and 12 months. Impact and acceptability were also assessed by semi-structured interviews and focus groups of AHWs. Sixty Aboriginal people with type 2 diabetes stated their main problems as family and social dysfunction, access to services, nutrition and exercise. Problems improved by 12% and goals by 26%, while quality of life scores showed no significant change. Self-management scores improved in five of six domains. Mean HbA1c reduced from 8.74-8.09 and mean blood pressure was unchanged. AHWs found the process acceptable and appropriate for them and their patients. It was concluded that a diabetes self-management program provided by AHWs is acceptable, improves self-management and is seen to be useful by Aboriginal communities. Barriers include lack of preventative health services, social problems and time pressure on staff. Enablers include community concern regarding the prevalence and mortality associated with diabetes.

A chain is as strong as its weakest link: assessing the consequences of habitat loss and degradation in a long-distance migratory shorebird

The conservation of migratory species represents a major challenge, as they use multiple sites, all contributing in varying degrees in sustaining high survival and reproductive success. There is particular concern for shorebirds of the East Asian-Australasian Flyway (EAAF), where declining numbers of migratory species have mostly been attributed to habitat loss along the East Asian coast. Using a stochastic dynamic programming migration model, we assessed the effect of habitat degradation scenarios along the EAAF on migration behaviour, survival and reproductive success of a long-distance migrating shorebird, the Ruddy Turnstone (Arenaria interpres). Following manipulation of habitat quality through changes in intake rate, we found that changes on the wintering (major non-breeding) ground in South Australia had the highest negative effect on reproductive success and survival. We also identified Taiwan and the Yellow Sea as sites with high importance for reproductive success. Although habitats along the East Asian coastline are currently most threatened from a range of global change processes, we highlight the importance of conserving high-quality shorebird wintering habitat in Australia. This may be of notable importance to trans-equatorial migratory shorebirds, which often make a long non-stop flight from their wintering grounds in order to skip low-latitude sites that typically provide little food.

Anti-müllerian hormone serum concentrations of women with germline BRCA1 or BRCA2 mutations

STUDY QUESTION Do women with BRCA1 or BRCA2 mutations have reduced ovarian reserve, as measured by circulating anti-Müllerian hormone (AMH) concentration?SUMMARY ANSWER Women with a germline mutation in BRCA1 have reduced ovarian reserve as measured by AMH.WHAT IS KNOWN ALREADY The DNA repair enzymes encoded by BRCA1 and BRCA2 are implicated in reproductive aging. Circulating AMH is a biomarker of ovarian reserve and hence reproductive lifespan.STUDY DESIGN, SIZE, DURATION This was a cross-sectional study of AMH concentrations of 693 women at the time of enrolment into the Kathleen Cuningham Foundation Consortium for research in the Familial Breast Cancer (kConFab) cohort study (recruitment from 19 August 1997 until 18 September 2012). AMH was measured on stored plasma samples between November 2014 and January 2015 using an electrochemiluminescence immunoassay platform.PARTICIPANTS/MATERIALS, SETTING, METHODS Eligible women were from families segregating BRCA1 or BRCA2 mutations and had known mutation status. Participants were aged 25–45 years, had no personal history of cancer, retained both ovaries and were not pregnant or breastfeeding at the time of plasma storage. Circulating AMH was measured for 172 carriers and 216 non-carriers from families carrying BRCA1 mutations, and 147 carriers and 158 non-carriers from families carrying BRCA2 mutations. Associations between plasma AMH concentration and carrier status were tested by linear regression, adjusted for age at plasma storage, oral contraceptive use, body mass index and cigarette smoking.MAIN RESULTS AND THE ROLE OF CHANCE Mean AMH concentration was negatively associated with age (P < 0.001). Mutation carriers were younger at blood draw than non-carriers (P ≤ 0.031). BRCA1 mutation carriers had, on average, 25% (95% CI: 5%–41%, P = 0.02) lower AMH concentrations than non-carriers and were more likely to have AMH concentrations in the lowest quartile for age (OR 1.84, 95% CI: 1.11–303, P = 0.02). There was no evidence of an association between AMH concentration and BRCA2 mutation status (P = 0.94).LIMITATIONS, REASONS FOR CAUTION AMH does not directly measure the primordial follicle pool. The clinical implications of the lower AMH concentrations seen in BRCA1 mutation carriers cannot be assessed by this study design.WIDER IMPLICATIONS OF THE FINDINGS Women with a germline mutation in BRCA1 may have reduced ovarian reserve. This is consistent with other smaller studies in the literature and has potential implications for fertility and reproductive lifespan.STUDY FUNDING/COMPETING INTEREST(S) kConFab is supported by a grant from the Australian National Breast Cancer Foundation, and previously by the National Health and Medical Research Council (NHMRC), the Queensland Cancer Fund, the Cancer Councils of New South Wales, Victoria, Tasmania and South Australia, and the Cancer Foundation of Western Australia. K.A.P. is an Australian National Breast Cancer Foundation Practitioner Fellow. J.L.H. is a NHMRC Senior Principal Research Fellow. M.H. is a NHMRC Practitioner Fellow. R.A.A. reports personal fees from Roche Diagnostics & Beckman Coulter outside the submitted work and C.S. reports other earnings from Melbourne IVF outside the submitted work. The remaining authors have nothing to declare and no conflicts of interest.

Movement patterns of Sanderling (Calidris alba) in the East Asian-Australasian Flyway and a comparison of methods for identification of crucial areas for conservation

Worldwide, most populations of migratory shorebirds are in jeopardy, none more so than those of the East Asian-Australasian Flyway (EAAF). In order to preserve these highly mobile species a detailed understanding of their use of feeding and resting sites along the flyway is required. In this study we used light-level geolocators and new analytical tools to reveal individual breeding locations and migration routes of 13 Sanderlings (Calidris alba) that spend their non-breeding season in South Australia. We then used these individual migration routes to identify the timing and location of important stopping areas and compared this with assessments based on resightings of leg-flagged birds and count data. During both northward and southward migration, Sanderlings were found to make extensive use of five main areas of the Chinese coastline, the Yellow Sea and the northern end of the Sakhalin Peninsula. Insights gained from the individual migration routes highlight inherent biases in using only count and resighting data to identify important feeding and resting sites along the Flyway. These findings suggest that data on individual movements may be crucial to effective conservation planning of shorebirds in the EAAF and elsewhere in the world.

Why fly the extra mile? Using stress biomarkers to assess wintering habitat quality in migratory shorebirds

Migratory birds make decisions about how far to travel based on cost-benefit trade-offs. However, in many cases the net effect of these trade-offs is unclear. We sought to address this question by measuring feather corticosterone (CORTf), leucocyte profile, avian malaria parasite prevalence and estimating fueling rates in three spatially segregated wintering populations of the migratory shorebird ruddy turnstone Arenaria interpres during their stay in the winter habitat. These birds fly from the high-Arctic breeding ground to Australia, but differ in that some decide to end their migration early (Broome, Western Australia), whereas others travel further to either South Australia or Tasmania. We hypothesized that the extra costs in birds migrating greater distances and overwintering in colder climates would be offset by benefits when reaching their destination. This would be evidenced by lower stress biomarkers in populations that travel further, owing to the expected benefits of greater resources and improved vitality. We show that avian malaria prevalence and physiological stress levels were lower in birds flying to South Australia and Tasmania than those overwintering in Broome. Furthermore, our modeling predicts that birds in the southernmost locations enjoy higher fueling rates. Our data are consistent with the interpretation that birds occupying more costly wintering locations in terms of higher migratory flight and thermoregulatory costs are compensated by better feeding conditions and lower blood parasite infections, which facilitates timely and speedy migration back to the breeding ground. These data contribute to our understanding of cost-benefit trade-offs in the decision making underlying migratory behaviour.

Do cognitive, language, or physical impairments affect participation in a trial of self-management programs for stroke?

BACKGROUND: Research studies may have limited generalizability when survivors of stroke with physical, language, or cognitive impairments are excluded. AIMS: To assess whether presence of cognitive, language, or global impairments affects participation in self-management programs.

METHODS: Stroke survivors were recruited in South Australia from seven hospitals or via advertisements into a randomized controlled trial (1:1:1 ratio) of a Stroke Self-Management Program, the Stanford chronic condition self-management program, or standard care. Impairment status was measured using: Cognistat (cognition), Frenchay Aphasia assessment (language), modified Rankin Score (mRS; where score 3-5 = global disability).

PRIMARY OUTCOMES: participation (i.e. booked, accessed, and completed a program (defined as attending ≥ 50% of sessions)) and safety (i.e. adverse events). Outcomes were compared by impairment status. RESULTS: Among 315 people screened 143/149 eligible were randomized (median age 71 years; 41% male; with impairments: 62% cognitive, 34% language, 64% global disability). Participation did not differ by cognitive or language impairment status (cognitive 75%, no cognitive 68%, p = 0.54; language 78%, no language 69%, p = 0.42). However, participation did vary by global impairment status (global disability 61%, no disability 96%, p < 0.001). Participants with cognitive impairment experienced more adverse events (severe n = 9 versus no cognitive impairment n = 1).

CONCLUSION: Survivors of stroke with cognitive, language, or global impairments are able to participate in self-management programs and should be included in these types of research studies or programs. Reduced participation by those with global disability and the possibility of more adverse events in people with cognitive impairments needs to be considered.

Drivers for adopting reverse logistics in the construction industry : a qualitative study

Purpose - The purpose of this paper is to investigate and analyse the perceptions of South Australian construction practitioners on drivers affecting the implementation of reverse logistics (RL). In this context, RL is defined as the process of moving goods from their typical final destination for the purpose of capturing value or ensuring proper disposal.

Design/methodology/approach - Semi-structured interviews were conducted with eight practitioners to collect data and the interview transcripts were analysed using the NVivo (version 10) package. Cluster analysis was used to cross-validate the findings and provide an in-depth insight into the findings.

Findings - The findings indicate that most of the drivers identified in earlier research are relevant for the construction industry. In addition, the study identified some new drivers that are categorised as "targeted demands by an exclusive clientele". These drivers were found to be complementary to the economic, environmental and social drivers as previously conceptualised. In addition, a set of factors affecting the strength of drivers that had been overlooked in previous studies emanated from the interview analysis. These include the type of project and the attributes of clients, both of which strongly affect the drivers of RL implementation in construction.

Research limitations/implications - The major limitations are the relatively small size of the sample of interviewees and having interviewees from one geographic area with specific socio-economic characteristics.

Practical implications - The identified drivers and the clustering of RL themes could be used by practitioners as a "road map" for the development of appropriate solutions to successfully promote RL within the construction industry. Organisational energies could thus be channelled towards the drivers that need the most improvement.

Originality/value - The study contributes to this research sphere by employing cluster analysis to customise and contextualise the drivers that were previously identified. The study goes beyond the extant literature by discovering the prominent effects of these drivers on the impact of targeted demands by an exclusive clientele. This could be of great value in terms of creating avenues for future investigations on the topic.

Stakeholder perceptions of a coastal marine protected area

Marine protected areas (MPAs) are an increasingly utilised marine and coastal management tool, designation rising steeply over the last twenty years. MPAs are most commonly designated for conservation objectives and the management is thus focused primarily on meeting conservation associated monitoring programs gathering data on a narrow suite of biological indicators. However, a wide range of potential social and economic impacts and the ability to meet the goals of an influenced by the often unmonitored perceptions and buy-in of local stakeholders. Here we examine stakeholder perceptions concerning a coastal MPA in South Australia. We conducted semi-structured interviews individuals engaged in the MPA' s planning and designation process, as well as those involved with management. We explored their understanding of the purpose of the MPA, whether they thought successful and the future management challenges the MPA might face. In particular, we focused on stakeholders indicators they thought should be used to monitor the ongoing performance of the MPA. varied between stakeholder groups, however, the majority of respondents highlighted the importance economic factors in the ongoing performance of the MPA. The vast majority of them suggested both biological socio-economic indicators that should be incorporated into monitoring programs. Our findings highlight MPA planning and management, when defining goals and developing monitoring programs, to incorporate social and economic, as well as, biological indicators.

Incorporating historical data into aquaculture planning

Marine historical research has made progress in bridging the gap between science and policy, but examples in which it has been effectively applied remain few. In particular, its application to aquaculture remains unexplored. Using actual examples of natural resource management in the state of South Australia, we illustrate how historical data of varying resolution can be incorporated into aquaculture planning. Historical fisheries records were reviewed to identify data on the now extinct native oyster Ostrea angasi fishery throughout the 1800 and early-1900s. Records of catch, number of boats fishing, and catch per unit effort (cpue) were used to test fishing rates and estimate the total quantity of oysters taken from select locations across periods of time. Catch quantities enabled calculation of the minimum number of oysters per hectare for two locations. These data were presented to government scientists, managers, and industry. As a result, interest in growing O. angasi increased and new areas for oyster aquaculture were included in regulatory zoning (spatial planning). Records of introductions of the non-native oyster Saccostrea glomerata, Sydney rock oysters, from 1866 through 1959, were also identified and used to evaluate the biosecurity risk of aquaculture for this species through semi-quantitative risk assessment. Although applications to culture S. glomerata in South Australia had previously been declined, the inclusion of historical data in risk assessment led to the conclusion that applications to culture this species would be accepted. The examples presented here have been effectively incorporated into management processes and represent an important opportunity for the aquaculture industry in South Australia to diversify. This demonstrates that historical data can be used to inform planning and support industry, government, and societies in addressing challenges associated with aquaculture, as well as natural resource management more broadly.