Higher dietary calcium intakes are associated with reduced risks of fractures, cardiovascular events, and mortality: a prospective cohort study of older men and women

The aim of this population-based, prospective cohort study was to investigate long-term associations between dietary calcium intake and fractures, non-fatal cardiovascular disease (CVD), and death from all causes. Participants were from the Melbourne Collaborative Cohort Study, which was established in 1990 to 1994. A total of 41,514 men and women (∼99% aged 40 to 69 years at baseline) were followed up for a mean (SD) of 12 (1.5) years. Primary outcome measures were time to death from all causes (n = 2855), CVD-related deaths (n = 557), cerebrovascular disease-related deaths (n = 139), incident non-fatal CVD (n = 1827), incident stroke events (n = 537), and incident fractures (n = 788). A total of 12,097 participants (aged ≥50 years) were eligible for fracture analysis and 34,468 for non-fatal CVD and mortality analyses. Mortality was ascertained by record linkage to registries. Fractures and CVD were ascertained from interview ∼13 years after baseline. Quartiles of baseline energy-adjusted calcium intake from food were estimated using a food-frequency questionnaire. Hazard ratios (HR) and odds ratios (OR) were calculated for quartiles of dietary calcium intake. Highest and lowest quartiles of energy-adjusted dietary calcium intakes represented unadjusted means (SD) of 1348 (316) mg/d and 473 (91) mg/d, respectively. Overall, there were 788 (10.3%) incident fractures, 1827 (9.0%) incident CVD, and 2855 people (8.6%) died. Comparing the highest with the lowest quartile of calcium intake, for all-cause mortality, the HR was 0.86 (95% confidence interval [CI] 0.76-0.98, ptrend  = 0.01); for non-fatal CVD and stroke, the OR was 0.84 (95% CI 0.70-0.99, ptrend  = 0.04) and 0.69 (95% CI 0.51-0.93, ptrend  = 0.02), respectively; and the OR for fracture was 0.70 (95% CI 0.54-0.92, ptrend  = 0.004). In summary, for older men and women, calcium intakes of up to 1348 (316) mg/d from food were associated with decreased risks for fracture, non-fatal CVD, stroke, and all-cause mortality.

Use of the My Health Record by people with communication disability in Australia: A review to inform the design and direction of future research

BACKGROUND: People with communication disability often struggle to convey their health information to multiple service providers and are at increased risk of adverse health outcomes related to the poor exchange of health information. OBJECTIVE: The purpose of this article was to (a) review the literature informing future research on the Australian personally controlled electronic health record, 'My Health Record' (MyHR), specifically to include people with communication disability and their family members or service providers, and (b) to propose a range of suitable methodologies that might be applied in research to inform training, policy and practice in relation to supporting people with communication disability and their representatives to engage in using MyHR. METHOD: The authors reviewed the literature and, with a cross-disciplinary perspective, considered ways to apply sociotechnical, health informatics, and inclusive methodologies to research on MyHR use by adults with communication disability. RESEARCH OUTCOMES: This article outlines a range of research methods suitable for investigating the use of MyHR by people who have communication disability associated with a range of acquired or lifelong health conditions, and their family members, and direct support workers. CONCLUSION: In planning the allocation of funds towards the health and well-being of adults with disabilities, both disability and health service providers must consider the supports needed for people with communication disability to use MyHR. There is an urgent need to focus research efforts on MyHR in populations with communication disability, who struggle to communicate their health information across multiple health and disability service providers. The design of studies and priorities for future research should be set in consultation with people with communication disability and their representatives.

First record of contourites from Lower Devonian Liptrap Formation in southeast Australia

Typical contourite deposits associated with submarine turbidite fan deposits are recognized for the first time from the Lower Devonian Liptrap Formation at Cape Liatrap, Victoria in southeast Australia. The contourites are well integrated within the turbidite fan deposits and are characterized by thin (5–8 cm), lenticular, well-sorted coarse-grained siltstones to fine-grained sandstones with current-ripples and cross beddings. The palaeocurrent directions of the turbidite fan and contourites are perpendicular to each other, with the former directed generally westward while the latter varying from 165° to 190° southward. In view of the facies types and architecture, we suggest that the turbidite fan was developed at the base of a westward inclined palaeo-slope, at the front of which the contourites were deposited as a result of southward flowing deep-sea contour (geostrophic) currents. The depositional setting interpreted for the Liptrap Formation thus may provide a provisional model for the Lower Devonian continental slope and abyssal basin environment in the southeastern part of the Melbourne Trough.

Diagnosing borderline personality disorder : examination of how clinical indicators are used by professionals in the health setting

This paper reviews the history of the recognition of borderline personality disorder as a clinical disorder, followed by a review of the contemporary practice of diagnosing borderline personality disorder in psychiatric settings. Many researchers have cautioned against the conflation of difficult patients with the diagnostic category of borderline personality disorder. The current study examines how clinical indicators used to screen for this complex disorder differ across service settings, professions, specialised training and years of clinical experience. A purpose-designed survey was administered to 108 mental and emergency medicine health practitioners across an Australian health service and a New Zealand health service to record the level of significance placed on different clinical indicators in the application of the diagnosis of borderline personality disorder. A heavy reliance was placed on observable behavioural symptoms, such as self-mutilation and impulsive behaviours that are self-damaging, in the screening of borderline personality disorder as a psychiatric diagnosis. Statistically significant differences were found between emergency medical staff and mental health clinicians in their use of diagnostic indicators of borderline personality disorder, χ²(4) = 17.248, p = .002. Implications of these findings for the screening, assessment and diagnosis of patients with borderline personality disorder are discussed.

Determining clinical pharmacy workload by patient disease classification in medical and surgical patients

Aim: To determine the time needed to provide clinical pharmacy services to individual patient episodes for medical and surgical patients and the effect of patient presentation and complexity on the clinical pharmacy workload. Method: During a 5-month period in 2006 at two general hospitals, pharmacists recorded a defined range of activities that they provided for patients, including the actual times required for these tasks. A customised database linked to the two hospitals' patient administration systems stored the data according to the specific patient episode number. The influence of patient presentation and complexity on the clinical pharmacy activities provided was also examined. Results: The average time required by pharmacists to undertake a medication history interview and medication reconciliation was 9.6 (SD 4.9) minutes. Interventions required 5.7 (SD 4.6) minutes, clinical review of the medical record 5.5 (SD 4.0) minutes and medication order review 3.5 (SD 2.0) minutes. For all of these activities, the time required for medical patients was greater than for surgical patients and greater for 'complicated' patients. The average time required to perform all clinical pharmacy activities for 1071 completed patient episodes was 14.4 (SD 10.9) minutes and was greater for medical and 'complicated' patients. Conclusion: The time needed to provide clinical pharmacy services was affected by whether the patients were medical or surgical. The existence of comorbidities or complications affected these times. The times required to perform clinical pharmacy activities may not be consistent with recently proposed staff ratios for the provision of a basic clinical pharmacy service.

What is a research track record?

The evaluation of academic research performance is a difficult question and can be evaluated in a number of different ways. In Australia and New Zealand there are formal governmental assessments of research quality, but them are of course also other forms of assessment, such as job interviews, grant assessment, etc, that occur as well. The objective of this commentary is to very briefly overview the issue assessing research quality. The issue of how to develop an effective portfolio of research is an issue that will be addressed by the other commentaries within this special section of AMJ. The materials presented here are based on the discussions at a special session of the 2006 ANZMAC conference and other materials in the literature. The issue of assessing research quality is an issue of concern for some governments, as they want to ensure that public money allocated to Universities are resulting in 'value' to the tax payer.

Oxygen delivery to patients after cardiac surgery : a medical record audit

OBJECTIVE: To describe how intensive care nurses manage the administration of supplemental oxygen to patients during the first 24 hours after cardiac surgery.
METHODS: A retrospective audit was conducted of the medical records of 245 adult patients who underwent cardiac surgery between 1 January 2005 and 31 May 2008 in an Australian metropolitan hospital. Physiological data (oxygen saturation measured by pulse oximetry and respiratory rate) and intensive care unit management data (oxygen delivery device, oxygen flow rate and duration of mechanical ventilation) were collected at hourly intervals over the first 24 hours of ICU care.
RESULTS: Of the 245 patients whose records were audited, 185 were male; mean age was 70 years (SD, 10), and mean APACHE II score was 17.5 (SD, 5.14). Almost half the patients (122, 49.8%) were extubated within 8 hours of ICU admission. The most common oxygen delivery device used immediately after extubation was the simple face mask (214 patients, 87%). Following extubation, patients received supplemental oxygen via, on average, two different delivery devices (range, 1-3), and had the delivery device changed an average of 1.38 times (range, 0-6) during the 24 hours studied. Twenty-two patients (9%) received non-invasive ventilation or high-flow oxygen therapy, and 16 (7%) experienced one or more episode of hypoxaemia during mechanical ventilation. A total of 148 patients (60%) experienced one or more episodes of low oxygenation or abnormal respiratory rate during the first 24 hours of ICU care despite receiving supplemental oxygen.
CONCLUSION: These findings suggest that the ICU environment does not protect cardiac surgical patients from suboptimal oxygen delivery, and highlights the need for strategies to prompt the early initiation of interventions aimed at optimising blood oxygen levels in cardiac surgical patients in the ICU.

Importance of the contribution of Australians to the penetration of China by the China Inland Mission in the period 1888-1953, with particular reference to the work of Australian women missionaries

Australians, in the main, are unaware of the role which Australia played in the evangelization of China in the late nineteenth and the first half of the twentieth century. Most would never have heard of the China Inland Mission (CIM), the largest of the Protestant bodies which penetrated the Middle Kingdom, and few would know of the contribution that its Australian contingent, which consistently comprised about a tenth of the CIM's numbers, made towards the Christianization of that vast country. This thesis aims to raise the level of awareness in this area. Academic researchers have not totally neglected to examine the proselytization of China, and historians of the stature of Latourette have not let it escape their attention. However, most of the studies which have not merely fleetingly focused on the subject while viewing a larger canvas, have been North American, singling out the efforts of United States and Canadian bodies in introducing Christianity to the Chinese. Here, authors like Amerding, Bacon, Creighton, Gates, Hawkes, Ho, Ko, Mensendiek, Michell and Quale have left their mark. In the case of the present thesis, the outlook from which events played out in China are viewed is firmly based in Australia rather than North America. Earlier Australian research has been scarce, and is dominated by Loane and Dixon. Loane, evidently primarily working from Australasian Council minutes, mainly concentrates on the efforts of the CIM's Home Council, examining its endeavours decade by decade against a backdrop of contemporaneous events in China, and briefly referring to aspects of the lives of a cross-section of Australasian missionaries, without providing much idea about what they actually did in the field or what they achieved there. Because of its preoccupation with the Home Council, which never admitted women into its ranks, Loane's treatise is systemically biased towards men, though the more prominent of the women, like Mary Reed and Susie Garland, are given due recognition. The current thesis looks in detail at what Australians did in the field, the level of success they achieved, and at the particular contribution of Australian women towards the evangelization of China. Dixon took upon herself the formidable task of examining the endeavours of all missions in China which contained Australian missionaries. Because of the magnitude of her task, she could not focus to any great extent on particular missions, nor pursue in any detail the work of individual Australian missionaries. Like Loane, she was unable to explore what they actually did in the field or what they achieved there. Neither could she delve to any depth into the work of Australian women missionaries, though on the basis of the information she had accumulated, she drew the conclusion that Australian women had largely only brought about some unintended feminist consequences amongst Chinese women. This sweeping generalization failed to take into account the other very real social changes for Chinese women the Australian female missionaries quite purposely helped to bring about, and this thesis makes good that omission. This thesis studies aspects of the Australian missionary endeavour which both Loane and Dixon have neglected, thereby breaking new ground, and sets out to correct erroneous impressions which Dixon's dissertation has left on the historical record. One of these impressions concerned the longevity of the effect of the Australian effort in China. She had the View, writing in 1978, that the Chinese Church was moribund (a view shared by Varg and Lacy) , and that therefore the effects attributable to the endeavours of any nationality had proved fruitless, whereas the author is able to show, using modern-day sources, that the church has burgeoned in recent years thanks to earlier missionary endeavours and later neo-evangelistic efforts like Gospel radio, and now has a complement of perhaps 50 million adherents, making it second only to the United States in the size of its Protestant evangelical population. Another impression she left was that the Australian input into the evangelization of China can be largely dismissed because no totally Australian organization emerged, leaving the direction of Australia's effort in other hands. Contrary to that impression, the author shows that the Australian impact in China was significant and that Australians enjoyed more power than Dixon ever imagined. The author also shows that Australians were accepted as the equal of other nationalities in the CIM once they had acquired the necessary field expertise, a factor which doubtless also applied in respect of other missions with Australian components in China. Marchant has suggested that it is a fiction perpetuated by mission periodicals that Christianity spread and progressed in a determined manner in China. This thesis establishes that within the CIM's bailiwick, though there was some patchiness, Christianity progressed steadily and inexorably. One mission alone, the CIM, is concentrated upon, firstly in order to render the data manageable, secondly because it was the largest mission in China and had a sizeable Australian (including female) contingent, and thirdly because it exemplified many of the problems which would have been faced by missions in that country and their Australian components. The methodology employed is multifaceted. The written testimony of the missionaries themselves, contained in CIM periodicals, Field Bulletins, Monthly Notes, Annual Reports, autobiographies, personal files, diaries and letters is used to illustrate various aspects of the CIM's work in which Australians were engaged. This approach is augmented by other sources such as China and Australasian Home Council Minutes, missionary conference reports, Candidates' Books, biographies, and other selected material from archival holdings in Australia, Singapore, the United Kingdom, America and Canada. Statistics, especially ratio analyses and growth rate comparisons are used to demonstrate the relative success of different missions, missionaries and genders. Also employed are reminiscences of missionaries and descendants obtained by personal interview, and these are aggregated to provide some general conclusions. Data from these various sources have been synthesized to serve the central objective of demonstrating the importance of the contribution of Australians to the penetration of China by the CIM in the period 1888-1953 with particular reference to the work of Australian women missionaries.

Dietary patterns, assessed from a weighed food record, and survival among elderly participants from the United Kingdom

Background/Objectives: There is variability in the association between dietary intake and health outcomes across different countries, especially among the elderly. We used the gold standard dietary assessment method, a weighed food record, to examine the association between dietary pattern and mortality in a representative sample of community dwelling participants from Great Britain aged 65 years and older.

Subjects/Methods: Dietary intake was recorded at baseline in 1017 elderly participants (520 men, 497 women, mean age 76.3±7.4 years). Exploratory factor analysis was performed to examine dietary patterns and participants were followed up over an average of 9.2 years for mortality.

Results: The factor analysis revealed four interpretable principal components accounting for approximately 9.8% of the total variance, with similar patterns across sex. A ‘Mediterranean-style’ dietary pattern explained the greatest proportion of the variance (3.7%), followed by ‘health-aware’ (2.2%), ‘traditional’ (2.0%) and ‘sweet and fat’ (1.9%) factors. There were a total of 683 deaths through follow-up. After adjustment for potential confounders, only the Mediterranean-style dietary pattern remained associated with mortality (highest vs lowest tertile; hazard ratio¼0.82, 95% CI, 0.68–1.00). The benefits of the Mediterranean-style diet were only observed among women (hazard ratio¼0.71, 95% CI 0.52–0.96) although in men the traditional diet was a risk factor for mortality (hazard ratio¼1.30, 95% CI 1.00–1.71).

Conclusions: Using a gold standard approach, our results confirm previous evidence that dietary patterns are important in longevity among the elderly.

Improve construction knowledge management system by using the soft system methodology

The construction industry has a poor record in the management of its knowledge and results into huge wastage of resources and detrimental effect to quality. Research has shown that data and information management system plus knowledge management are a critical part of today's project management practice for construction projects. Few people will deny that 'quality information' and 'useful knowledge' are extremely important to any decision-making. However, the current processes of handling information and knowledge in the construction industry and increasingly costly. One of the major reasons is the nature of this industry is not conducive to good knowledge management and the traditional data/information systems used in the industry has long been critisized. It is very common that information is often duplicated, inconsistent and not current. In turn, making knowledge becomes difficult to manage properly. Project managers have in the past found it very difficult to source and analyse data in order to make sound decisions. This paper is part of a doctoral research project which summarizes three exploratory surveys; namely ERP system, Partnering strategy and Leadership impact of a knowledge management system in a construction company. Those findings are described by using the Soft Systems Methodology (SSM) which later becomes the basis for actions research. SSM is useful to reveal complexities of the knowledge management situations that occur in construction industry. The first stage was to conduct interviews of the different practices in knowledge and reporting process. Then, the SSM rich picture was developed to present the problematic areas including difficulties in inputting data to enable the knowledge platform in place. The research then develops root definition and CATWOE, and a conceptual model was formed. Interviewees were conducted with structured questions to identify prioritized actions and activities that can be undertaken to improve and manage the knowledge platform.

Validation of de-identified record linkage to ascertain hospital admissions in a cohort study

Background Cohort studies can provide valuable evidence of cause and effect relationships but are subject to loss of participants over time, limiting the validity of findings. Computerised record linkage offers a passive and ongoing method of obtaining health outcomes from existing routinely collected data sources. However, the quality of record linkage is reliant upon the availability and accuracy of common identifying variables. We sought to develop and validate a method for linking a cohort study to a state-wide hospital admissions dataset with limited availability of unique identifying variables.

Methods A sample of 2000 participants from a cohort study (n = 41 514) was linked to a state-wide hospitalisations dataset in Victoria, Australia using the national health insurance (Medicare) number and demographic data as identifying variables. Availability of the health insurance number was limited in both datasets; therefore linkage was undertaken both with and without use of this number and agreement tested between both algorithms. Sensitivity was calculated for a sub-sample of 101 participants with a hospital admission confirmed by medical record review.

Results Of the 2000 study participants, 85% were found to have a record in the hospitalisations dataset when the national health insurance number and sex were used as linkage variables and 92% when demographic details only were used. When agreement between the two methods was tested the disagreement fraction was 9%, mainly due to "false positive" links when demographic details only were used. A final algorithm that used multiple combinations of identifying variables resulted in a match proportion of 87%. Sensitivity of this final linkage was 95%.

Conclusions High quality record linkage of cohort data with a hospitalisations dataset that has limited identifiers can be achieved using combinations of a national health insurance number and demographic data as identifying variables.

Unfair punishment : when criminal record checks lead to discrimination

Applying for a job is stressful enough, but if you have a criminal record, even if it’s not relevant to the job you’re applying for, it can be a nightmare.

Employers in Australia regularly discriminate on the grounds that a person has an irrelevant criminal record and checking criminal records is on the increase. The number of criminal record checks undertaken in Victoria have risen by almost 6,000% since 1993.

It is concerning then that the few laws that prohibit discrimination on the basis of irrelevant criminal record lack real teeth.

Implementing scanned medical record systems in Australia : a structured case study on envisioned changes to elective admissions process in a Victorian hospital

In recent years, influenced by the pervasive power of technology, standards and mandates, Australian hospitals have begun exploring digital forms of keeping this record. The main rationale is the ease of accessing different data sources at the same time by varied staff members. The initial step in this transition was implementation of scanned medical record systems, which converts the paper based records to digitised form, which required process flow redesign and changes to existing modes of work. For maximising the benefits of scanning implementation and to better prepare for the changes, Austin Hospital in the State of Victoria commissioned this research focused on elective admissions area. This structured case study redesigned existing processes that constituted the flow of external patient forms and recommended a set of best practices at the same time highlighting the significance of user participation in maximising the potential benefits anticipated. In the absence of published academic studies focused on Victorian hospitals, this study has become a conduit for other departments in the hospital as well as other hospitals in the incursion.