Australia's health 1996 : the fifth biennial report of the Australian Institute of Health and Welfare

The fifth biennial report of the Australian Institute of Health and Welfare. This publication provides comprehensive information and the most recent data available on health and health services in Australia. It also details key sources of health information and statistics in this country, and directions for the future. Australia's Health 1996 is an important reference text and information source for all Australians with an interest in health, in addition to medical and paramedical personnel and students, health workers and those working in or studying health administration, policy, planning and management.

Effects of time since fire on birds : how informative are generalized fire response curves for conservation management?

Fire is both a widespread natural disturbance that affects the distribution of species and a tool that can be used to manage habitats for species. Knowledge of temporal changes in the occurrence of species after fire is essential for conservation management in fire-prone environments. Two key issues are: whether postfire responses of species are idiosyncratic or if multiple species show a limited number of similar responses; and whether such responses to time since fire can predict the occurrence of species across broad spatial scales. We examined the response of bird species to time since fire in semiarid shrubland in southeastern Australia using data from surveys at 499 sites representing a 100-year chronosequence. We used nonlinear regression to model the probability of occurrence of 30 species with time since fire in two vegetation types, and compared species' responses with generalized response shapes from the literature. The occurrence of 16 species was significantly influenced by time since fire: they displayed six main responses consistent with generalized response shapes. Of these 16 species, 15 occurred more frequently in mid- or later-successional vegetation (>20 years since fire), and only one species occurred more often in early succession (<5 years since fire). The models had reasonable predictive ability for eight species, some predictive ability for seven species, and were little better than random for one species. Bird species displayed a limited range of responses to time since fire; thus a small set of fire ages should allow the provision of habitat for most species. Postfire successional changes extend for decades and management of the age class distribution of vegetation will need to reflect this timescale. Response curves revealed important seral stages for species and highlighted the importance of mid- to late-successional vegetation (>20 years). Although time since fire clearly influences the distribution of numerous bird species, predictive models of the spatial distribution of species in fire-prone landscapes need to incorporate other factors in addition to time since fire.

Factor analysis of partners' commitment to risk management in public-private partnership projects

Purpose – The purpose of this paper is to investigate and uncover key determinants that could explain partners' commitment to risk management in public-private partnership projects so that partners' risk management commitment is taken into the consideration of optimal risk allocation strategies.

Design/methodology/approach – Based on an extensive literature review and an examination of the purchasing power parity (PPP) market, an industry-wide questionnaire survey was conducted to collect the data for a confirmatory factor analysis. Necessary statistical tests are conducted to ensure the validity of the analysis results.

Findings – The factor analysis results show that the procedure of confirmatory factor analysis is statistically appropriate and satisfactory. As a result, partners' organizational commitment to risk management in public-private partnerships can now be determined by a set of components, namely general attitude to a risk, perceived one's own ability to manage a risk, and the perceived reward for bearing a risk.

Practical implications – It is recommended, based on the empirical results shown in this paper, that, in addition to partners' risk management capability, decision-makers, both from public and private sectors, should also seriously consider partners' risk management commitment. Both factors influence the formation of optimal risk allocation strategies, either by their individual or interacting effects. Future research may therefore explore how to form optimal risk allocation strategies by integrating organizational capability and commitment, the determinants and measurement of which have been established in this study.

Originality/value – This paper makes an original contribution to the general body of knowledge on risk allocation in large-scale infrastructure projects in Australia adopting the procurement method of public-private partnership. In particular, this paper has innovatively established a measurement model of organisational commitment to risk management, which is crucial to determining optimal risk allocation strategies and in turn achieving project success. The score coefficients of all obtained components can be used to construct components by linear combination so that commitment to risk management can be measured. Previous research has barely focused on this topic.

Balanced efficacy, safety, and tolerability recommendations for the clinical management of bipolar disorder

Objective:  To provide practical and clinically meaningful treatment recommendations that amalgamate clinical experience and research findings for each phase of bipolar disorder.

Methods:  A comprehensive search of the literature was undertaken using electronic database search engines (Medline, PubMed, Cochrane reviews) using key words (e.g., bipolar depression, mania, treatment). All relevant randomised controlled trials were examined, along with review papers, meta-analyses, and book chapters known to the authors. In addition, the recommendations from accompanying papers in this supplement have been distilled and captured in the form of summary boxes. The findings, in conjunction with the clinical experience of international researchers and clinicians who are practiced in treating mood disorders, formed the basis of the treatment recommendations within this paper.

Results:  Balancing clinical experience with evidence informed and lead to the development of practical clinical recommendations that emphasise the importance of safety and tolerability alongside efficacy in the clinical management of bipolar disorder.

Conclusions:  The current paper summarises the treatment recommendations relating to each phase of bipolar disorder while providing additional, evidence-based, practical insights. Medication-related side effects and monitoring strategies highlight the importance of safety and tolerability considerations, which, along with efficacy information, should be given equal merit.

The relationship between coronary heart disease (CHD) and major depressive disorder (MDD) : key mechanisms and the role of quality of life

Various trials have been conducted evaluating depression management programs for patients with Coronary Heart Disease (CHD). However, to date, the most effective way to manage this co-morbidity in the real world setting remains unclear. To better understand the past successes and failures of previous trials and subsequently develop suitable interventions that target key components of health related quality of life (HRQOL) such as mental, physical and vocational functioning, we first need to understand the mechanisms underpinning the relationship between the two conditions. This paper will draw on the key literature in this field as identified by psychiatric, medical and social sciences databases (Cochrane Central Register of Controlled Trials, PubMed, OVID, Medline) available up to January 2012, with the aim to conduct a narrative review which explores: the aetiological relationship between depression and CHD; its association with HRQOL; the relationship between CHD, depression and vocational functioning; and the impact of depression treatment on these outcomes. Key recommendations are made regarding the management of this prevalent co-morbidity in clinical settings.

Population genetic tools for pest management : a review

Population genetic tools have the potential to answer key questions in pest management including quantifying the number of genetically distinct populations represented in an invasion, the number of individuals present, whether populations are expanding or contracting, identifying the origin of invasive individuals, the number of separate introduction events that have occurred and in which order, and the rate that individuals are moving between populations. Genetic methods have only recently gained sufficient resolution to address these questions due to advances in laboratory techniques coupled with an increase in computational power. In combination, these methods may lead to a more comprehensive understanding of the dynamics of invasions. The expansion of the European starling (Sturnus vulgaris) into Western Australia is used as an applied example of how genetic methods can be integrated to provide vital information to improve pest-management strategies. Invasion events also may provide a unique opportunity to test some of these methodologies.

External knowledge and performance of offshore IT service providers in India : the mediating role of talent management

The global shortage of IT professionals has been identified as one of the most serious threats against the continued growth of offshore IT service providers (OSPs). As a result, talent management has become a key competitive strategy for OSPs. However, how talent management contributes towards the performance of OSPs remains poorly understood in relation to its interaction with knowledge. To examine this issue, we draw on a sample of 68 OSPs in India to test the effects of talent management and external knowledge on performance. The results confirm that both external knowledge and talent management are positively related to firm performance and that the latter has strong mediating effects on the relationship between external knowledge and firm performance. The results suggest that OSPs should consider talent management as a mechanism through which knowledge resources can be exploited to enhance firm performance. The managerial implications and limitations of the findings are also discussed.

Towards more integrated and participatory coastal management : insights from Victoria’s Estuary Entrance Management Support System.

Participation and integration are core elements of coastal management. A key argument is that involving stakeholders from the broader community in collaborative coastal management allows for a more reflexive approach to consideration of ecological science outputs. However the role of stakeholder participation is still problematic especially when the involvement is short term and limited in its knowledge co-production. We argue for the development of a participatory logic that includes five key elements: the institutionalization of the processes that derive from stakeholder co-production and co-management; the ability and capacity to make meaningful decisions about issues of importance in an on-going way; the inclusion of all stakeholders in the process; the flexibility of central policies that enable participation by stakeholders at local level; the allowance for pathways for the uptake of all knowledge systems. Using this approach we report in this paper on the Estuary Entrance Management Support System (EEMSS) and ask whether this is a model system for answering the following questions as part of participatory logic: What types of collaborative activities can be used to improve the management of coastal zones? Are these activities a sufficient pathway for integrating different knowledge forms including science into coastal management? How important is stakeholder participation to science uptake? How can stakeholder participation be institutionalized in coastal management?

Sustainable management of real estate : is it really sustainability?

This paper investigates from a management perspective exactly what building owners and managers of commercial real estate are actually doing in the guise of sustainability. This research investigates key owners of real estate portfolios in Australia and New Zealand, and examines what they perceive sustainability to mean to their commercial real estate portfolios and their level of implementation. The research uses a qualitative framework in order to gain an understanding of owners’ perceptions of sustainability. The findings reveal that owners perceive sustainability to be very important to the longevity of their portfolios. However, at present, sustainability factors are limited to resource efficiency measures in their real estate portfolios. Consequently, this research questions whether current interpretation and implementation of sustainability in commercial real estate is merely ‘changing the name’ of best practice management to ‘sustainability.’

Critiques and extensions of strategic international human resource management framework for dragon multinationals

This paper aims at critiquing several existing strategic international human resource management frameworks and discusses their inadequacy to apply directly to emerging multinational companies, especially those generated from Brazil, Russia, India, China and South Africa. To complement the existing strategic international human resource management frameworks, key variables relevant to emerging economies are identified and an extended model with reference to emerging multinational companies is developed with several research propositions. It is believed that the proposed model would better capture the current development of multinationals in transition, and alert emerging international managers to address several people management challenges in the global context.

Innovation for 21st century conservation

Most indicators of species and ecological health suggest that our current efforts are inadequate to stem species losses, especially in the face of increasing threats from invasive species and climate change. This has driven a commitment to seek integrated conservation management across many tenures to support our protected areas. To make this happen we need all sectors to break down silos and explore more effective partnerships to achieve conservation at scale, with many different land managers and communities.

This publication illustrates a rich variety of such innovation – new partnerships and models for the establishment, management, financing and governance of both protected areas and initiatives on other lands. Its key purpose is to illustrate that new approaches are possible and workable and to give impetus to these directions. However, the book also illustrates that the path to new approaches will not be without challenges and the occasional blockage. The period of production has seen major changes in government policies, funding cuts, change in personnel and questioning of the business models with some abandonment of the directions within this publication.

Stakeholder participation in estuary management: the development of Victoria's Estuary Entrance Management Support System

Stakeholder involvement in the management of estuaries is a necessary element of good environmental governance. In Victoria, Australia, a key challenge for estuary managers is whether or not estuaries should be artificially opened since many river mouths close ‘naturally’ from time to time. Estuary closure resulting in raised estuarine water levels leads to economic and social impacts on local communities. In the past these effects have been addressed by artificial river mouth openings, often without reference to associated environmental impacts. This article discusses the development and features of an Estuary Entrance Management Support System and considers its performance against principles of effective environmental management. It concludes that, in bringing together technical information with stakeholder input through a structured process, such a system makes a useful contribution to improving estuary entrance management.

Implementation of a quality care management system for patients with arthritis of the hip and knee

The Orthopaedic Unit of the Repatriation General Hospital (RGH) in Adelaide, South Australia has implemented a quality care management system for patients with arthritis of the hip and knee. The system not only optimises conservative management but ensures that joint replacement surgery is undertaken in an appropriate and timely manner. This new service model addresses identified barriers to service access and provides a comprehensive, coordinated strategy for patient management. Over 4 years the model has reduced waiting times for initial outpatient assessment from 8 to 3 months and surgery from 18 to 8 months, while decreasing length of stay from 6.3 to 5.3 days for hips and 5.8 to 5.3 days for knees. The service reforms have been accompanied by positive feedback from patients and referring general practitioners in relation to the improved coordination of care and enhanced efficiency in service delivery.

What is known about the topic? Several important initiatives both overseas and within Australia have contributed significantly to the development of this model of care. These include the UK National Health Service ‘18 weeks’ Project, the Western Canada Waiting List Project, the New Zealand priority criteria project, the Queensland Health Orthopaedic Physiotherapy Screening Clinic, and most importantly the Melbourne Health–University of Melbourne Orthopaedic Waiting List Project where a wide range of models were explored across Victorian hospitals from 2005 and the Multi-Attribute Prioritisation Tool (MAPT) was developed, validated and tested. This project became the Osteoarthritis Hip and Knee Service (OAHKS) and was operationalised in the Victorian healthcare system from 2012. These initiatives examined and addressed various aspects of management systems for patients with arthritis of the hip and knee in their particular setting.

What does this paper add? The development of this system is an extension of what is already known and is the first to encompass a comprehensive and coordinated strategy across all stages of the care management pathway for this patient group. Their management extends from the initial referral to development and implementation of a management plan, including surgery if assessed as necessary and organisation of long-term post operative follow up as required. By detailing the elements, key processes and measurable outcomes of the service redesign this paper provides a model for other institutions to implement a similar initiative.

What are the implications for practitioners? An important aspect of the design process was practitioner acceptance and engagement and the ability to improve their capacity to deliver services within an efficient and effective model. Intrinsic to the model’s development was assessment of practitioner satisfaction. Data obtained including practitioner surveys indicated an increased level of both satisfaction with the redesigned management service, and confidence in it to deliver its intended improvements.

Pharmacological management of unipolar depression

Objective : To be used in conjunction with ‘Psychological management of unipolar depression’ [Lampe et al. Acta Psychiatr Scand 2013;127(Suppl. 443):24–37] and ‘Lifestyle management of unipolar depression’ [Berk et al. Acta Psychiatr Scand 2013;127(Suppl. 443):38–54]. To provide clinically relevant recommendations for the use of pharmacological treatments in depression derived from a literature review.

Method : Using our previous Clinical Practice Guidelines [Malhi et al. Clinical practice recommendations for bipolar disorder. Acta Psychiatr Scand 2009;119(Suppl. 439):27–46] as a foundation, these clinician guidelines target key practical considerations when prescribing pharmacotherapy. A comprehensive review of the literature was conducted using electronic database searches (PubMed, MEDLINE), and the findings have been synthesized and integrated alongside clinical experience.

Results : The pharmacotherapy of depression is an iterative process that often results in partial and non-response. Beyond the initiation of antidepressants, the options within widely used strategies, such as combining agents and switching between agents, are difficult to proscribe because of the paucity of pertinent research. However, there is some evidence for second-line strategies, and a non-prescriptive algorithm can be derived that is based broadly on principles rather than specific steps.

Conclusion : Depression is by its very nature a heterogeneous illness that is consequently difficult to treat. Invariably, situation-specific factors often play a significant role and must be considered, especially in the case of partial and non-response. Consulting with colleagues and trialling alternate treatment paradigms are essential strategies in the management of depression.

Using social network analysis to identify key child care center staff for obesity prevention interventions: a pilot study

Introduction. Interest has grown in how systems thinking could be used in obesity prevention. Relationships between key actors, represented by social networks, are an important focus for considering intervention in systems. Method. Two long day care centers were selected in which previous obesity prevention programs had been implemented. Measures showed ways in which physical activity and dietary policy are conversations and actions transacted through social networks (interrelationships) within centers, via an eight item closed-ended social network questionnaire. Questionnaire data were collected from (17/20; response rate 85%) long day care center staff. Social network density and centrality statistics were calculated, using UCINET social network software, to examine the role of networks in obesity prevention. Results. “Degree” (influence) and “betweeness” (gatekeeper) centrality measures of staff inter-relationships about physical activity, dietary, and policy information identified key players in each center. Network density was similar and high on some relationship networks in both centers but markedly different in others, suggesting that the network tool identified unique center social dynamics. These differences could potentially be the focus of future team capacity building. Conclusion. Social network analysis is a feasible and useful method to identify existing obesity prevention networks and key personnel in long day care centers.