Self-reported access to and quality of healthcare for diabetes : Do the severely obese experience equal access?

Background: Given reported pejorative views that health professionals have about patients who are severely obese, we examined the self-reported views of the quality and availability of diabetes care from the perspective of adults with type 2 diabetes (T2DM), stratified by body mass index (BMI). Methods: 1795 respondents to the Diabetes MILES - Australia national survey had T2DM. Of these, 530 (30%) were severely obese (BMI ≥35 kg/m2) and these participants were matched with 530 controls (BMI <35 kg/m2). Data regarding participants' self-reported interactions with health practitioners and services were compared. Results: Over 70% of participants reported that their general practitioner was the professional they relied on most for diabetes care. There were no betweengroup differences in patient-reported availability of health services, quality of interaction with health practitioners, resources and support for selfmanagement, or access to almost all diabetes services. Discussion: Participants who were severely obese did not generally report greater difficulty in accessing diabetes care.

In-reach nursing services improve older patient outcomes and access to emergency care

Aims: To identify the impact of in-reach services providing specialist nursing care on outcomes for older people presenting to the emergency department from residential aged care. Methods: Retrospective cohort study compared clinical outcomes of 2278 presentations from 2009 with 2051 presentations from 2011 before and after the implementation of in-reach services. Results: Median emergency department length of stay decreased by 24 minutes (7.0 vs 6.6 hours, P<0.001) and admission rates decreased by 23% (68 vs 45%, P<0.001). The proportion of people with repeat emergency department visits within six months decreased by 12% (27 vs 15%). The proportion of admitted patients who were discharged with an end of life palliative care plan increased by 13% (8 vs 21%, P=0.007). Conclusions: There was a significant reduction in the median length of stay, fewer hospital admissions and fewer repeat visits for people from residential aged care following implementation of in-reach services.

Access to breast prostheses via a government-funded service in Victoria, Australia

For many women, the only alternative to breast reconstruction following a mastectomy is to use external prostheses, which need replacing regularly at a cost of up to $395 per prosthesis. Commonwealth and state governments across Australia have responded to this need by providing subsidies to assist in the purchase of breast prostheses. However, current arrangements have been highly variable and sometimes difficult to access. As part of a larger review of breast pros-thesis services in Victoria, Australia, the aim of this research was to evaluate client satisfaction among Victorian women who accessed funds through the State Government's Aids and Equipment Program, compare the responses of the program service providers with the experiences of clients accessing funding, and identify opportunities to improve service provision.

An analysis of computer-mediated marketing education : the relationship between access to WEBCT, tutorial attendance and student grades

One of the problems faced by Australian academics in the 21 st century is to facilitate learning with a changing profile of students, in bigger and bigger classes. As educators at tertiary institutions, our environment is undergoing major changes as increasingly marketing programs are offering courses either partially (Web enabled) or totally (Web exclusive) online. This study has developed a significant model allowing the prediction of students' overall results and indicates that a student's final grade is dependant, in part, on accessing the study materials and study tools available to them via WebCT and attending face-to-face tutorials.

Measuring food access in Melbourne: access to healthy and fast foods by car, bus and foot in an urban municipality in Melbourne

Access to healthy food can be an important determinant of a healthy diet. This paper describes the assessment of access to healthy and unhealthy foods using a GIS accessibility programme in a large outer municipality of Melbourne. Access to a major supermarket was used as a proxy for access to a healthy diet and fast food outlet as proxy for access to unhealthy food. Our results indicated that most (>80%) residents lived within an 8–10 min car journey of a major supermarket i.e. have good access to a healthy diet. However, more advantaged areas had closer access to supermarkets, conversely less advantaged areas had closer access to fast food outlets. These findings have application for urban planners, public health practitioners and policy makers.

Increasing access to mathematical thinking

This article is a contribution to understanding of teacher actions that can contribute to a successful mathematics learning experience, defined as one that engages all students, especially those who may sometimes feel alienated from mathematics and schooling, in productive and successful mathematical thinking and learning. We offer an example of a task that can form the basis of such a learning experience. The key elements are that the task is open-ended, that the teacher offers specific pedagogical prompts to support student leaning, that the teacher builds a sense of community by ensuring that there are some common experiences, and the teacher prepare prompts that can be used to support students who are experiencing difficulty, or to extend those students who complete the
basic task readily.

Improving access to evidence-based acute stroke services: development and evaluation of a health systems model to address equity of access issues

Level 1 evidence for management of patients with stroke in a dedicated Stroke Care Unit (SCU) demonstrates improved outcomes by about 20%. It has been estimated that 21% of Australian hospitals provide an SCU and that these SCUs are mainly located in either metropolitan sites and/or in hospitals with more than 300 beds. To address equity issues related to access to SCUs, the National Stroke Foundation and the Australian Government undertook the National Stroke Units Program. One program outcome was the development of a conceptual model of acute stroke service delivery. The development process and initial evaluation of the model are described. Use of the model to increase capacity within the health care system to treat stroke is discussed.

Increasing access to mathematical thinking

The authors describe their current project that examines ways to maximise learning opportunities for students in upper primary and lower secondary mathematics classes. There are two aspects to the project: the type of tasks posed, and particularly ways to assist students experiencing difficulty with those tasks; and the steps that teachers can take to overcome structural barriers to mathematical learning by being explicit about classroom processes.

Access to a healthy diet and fast foods in the City of Casey

It is known that the consumption of fast food is associated with obesity (Binkley 2000). Relative ease of access to fast foods compared with healthy foods may contribute to the increasing prevalence of obesity. The aim of this study was to determine and compare the access by car to fast foods and a healthy diet. The study was located in the City of Casey, a municipality in South East Melbourne with a population of 220,000. We have previously shown that ease of access to a large chain supermarket ensures access to a basket of healthy foods adequate to meet the nutritional needs of a family of 6 (Burns 2004). The City of Casey council provided location details for major fast food outlets and supermarkets. Fast food was defined as food sourced from an outlet without table service. We included only those major fast food chain outlets which had more than 10 franchises within Australia. We included the 3 major supermarket chains that account for 87% total food retailing in Victoria. Geographic details from the City of Casey were used to map the location of these outlets. Then using these locations and road network a basic cost distance model was created for either the supermarket chains or fast food chains outlets. The cost unit is (time), it was to calculate by giving the roads in the network an average travel speed depending in the type of road (minor, major or highway) and then calculating how long it would take to reach the closest outlet. Access to supermarket and fast food outlets were determined relative to population density.
Our results indicate that in the City of Casey most (> 80%) people live within an 8-10 minute car journey of a major supermarket and a fast food outlet. Fifty percent of the fast food outlets are co-located with a supermarket. We conclude that access to both healthy food and fast food in the City of Casey is good if you own a car. The increasing demand for fast food is easily met in this municipality. Obesity prevention strategies in Casey should concentrate on the food choices available at fast food outlets and town planning to ensure a mix of food outlets to maximize the likelihood of healthy food choices.

Building collaborative partnerships: a key to increasing Indigenous Victorian peoples' access to country

This article reports on a qualitative research study undertaken with Indigenous government employees to explore ways in which Indigenous communities can access programs involving caring for Country' (knowledge, responsibility and inherent right to protect the traditional natural landscape) on their traditional land and, in so doing. improve their health. Factors that optimise such nature-based projects are the capacity of their intention to build relationships, consultation. transparency, consistency, education and training between Indigenous communities. government and the general public. Government agencies need to develop strategies where partnership and collaboration are effective with Indigenous communities and within the agencies themselves, in order to resolve controversial issues surrounding access to Country.