A comparison of Australian rural and metropolitan cardiovascular risk and mortality: the Greater Green Triangle and North West Adelaide population surveys

Objectives:
Cardiovascular (CVD) mortality disparities between rural/regional and urban-dwelling residents of Australia are persistent. Unavailability of biomedical CVD risk factor data has, until now, limited efforts to understand the causes of the disparity. This study aimed to further investigate such disparities.

Urbanisation and the ecology of powerful owls ninox strenua in outer Melbourne, Victoria

Historically, the Powerful Owl (Ninox strenua) has been seen as a southeastern Australian species restricted to, or most numerous in, dense gullies of tall open forests in hilly or mountainous areas of the coast and Great Divide. However, recent research has revealed that Powerful Owls may breed numerously and successfully in a wider range of habitats than previously believed, including the forests and woodlands within the metropolitan areas of some major cities.Here we report on the breeding of a number of pairs of Powerful Owls in the Yarra Valley, Victoria. Study sites ranged from relatively undisturbed, wet sclerophyll forest 80 km from central Melbourne, through dry sclerophyll, eucalypt-dominated open forest with some disturbance, to a highly disturbed urban parkland only 18 km from central Melbourne. We found that Powerful Owls breed successfully in some urban areas, but are limited in the amount of human disturbance they can tolerate near their nesting hollow. In the most heavily utilized section of the urban parkland, all breeding attempts were unsuccessful and in one year the young were apparently eaten by one of the parents. This followed construction of a timber boardwalk under the nest tree during the breeding season. The Powerful Owls subsequently moved to a more secluded nesting hollow and raised two young. Recommendations for management of Powerful Owls in urban areas are discussed in the context
of these results.

Undergraduate pre-registration nursing education in Australia: a longitudinal examination of enrolment and completion numbers with a focus on students from rural and remote campus locations

Introduction: There is much evidence to indicate a shortage of Registered Nurses (RNs) in Australia and to suggest that the shortage may be more pronounced in rural and remote locations. Attracting RNs to work in rural and remote areas may not be as simple as increasing the intake of students into university undergraduate pre-registration nursing courses. There is some evidence indicating that student nurses may be more likely to enter the nursing workforce in rural and remote locations if they have existing associations with rural and remote areas and/or their undergraduate education provides opportunities to undertake supported placements in rural and remote settings. Two important difficulties have been associated with measuring outcomes in relation to rural and remote pre-registration nursing students. One is defining what constitutes a rural or remote location and the other is suspect data on the number of nursing students enrolled in, and completing, nursing courses. The aims of this study were to provide a longitudinal profile of the number of domestic students studying and completing undergraduate pre-registration nursing courses in Australia, with a particular emphasis on identifying those at rural and remote university campuses, and to compare results across States and Territories.
Method: This study presents the combined findings from two investigative reports. Data on undergraduate pre-registration nursing student numbers were collected via electronic survey instruments completed by staff at all Australian educational institutions offering undergraduate pre-registration nursing education programs in 2001 and 2002. Australian domestic students were the focus of this study. Data included the total number of domestic students enrolled in undergraduate pre-registration nursing courses in 2001 and 2002, the number of domestic students who successfully completed courses in 1999, 2000 and 2001, and estimates for the number expected to complete in 2002. Surveys were sent to course coordinators or other staff nominated by heads of divisions of nursing at each institution.
Results: There was a 100% response rate. Twenty-four rural and remote campus locations were identified using an adjusted form of the Rural, Remote and Metropolitan Areas (RRMA) classification system. The Australian Capital Territory and the Northern Territory did not have any rural or remote campus locations. In contrast, undergraduate pre-registration nursing in Tasmania was offered at a rural campus only (for the first 2 years). From 2001 to 2002, there was an increase of just over 5% in the total number of domestic students enrolled in undergraduate pre-registration nursing courses in Australia (2002 total = 22 811 students). Rural and remote location students accounted for slightly more than 25% of these students in 2001, and almost 27% in 2002. The States Victoria, New South Wales and Queensland had the highest percentage of students enrolled at rural and remote campus locations, greater than the Australian average for both years. In contrast, South Australia and Western Australia had less than 11% of students enrolled at rural and remote campus locations for each year. Total undergraduate pre-registration course completions increased by approximately 16% across Australia between 1999 (n = 4868) and 2002 (n = 5667), although for 2002, the figure was projected. Of these total course completions, the percentage of students completing at rural and remote campus locations increased from almost 23% to nearly 28% during the same period. Of the States/Territories with both metropolitan and rural/remote campus locations, only Victoria and Queensland had more than 25% of their total student completions consisting of students enrolled at rural and remote campus locations for each year. In contrast, South Australia and Western Australia had approximately 6% of student completions consisting of students enrolled at rural and remote campus locations in 1999, increasing to approximately 12% projected for 2002.
Conclusion: In this study, the authors attempted to improve the accuracy of data collection in relation to the number of domestic undergraduate pre-registration nursing students in Australia, which is representative of the potentially new Australian domestic RN workforce. There was a trend towards an increasing number of students being enrolled in undergraduate pre-registration nursing courses, and also toward an increasing number of course completions. From the perspective of the rural and remote RN workforce, the percentage of students enrolled and completing courses at rural and remote campus locations was found to be increasing. However, there may be some areas of concern for education and workforce planners in States and Territories that are providing a smaller percentage of their undergraduate pre-registration nursing courses in rural and remote areas. Several study limitations are discussed and suggestions made for future research.

eCommerce and the region : not necessarily an unequivocal good

eCommerce is generally assumed to be an unequivocal benefit for regional areas. Drawing upon the globalisation literature and the experience in Australia as a case study, this paper questions whether eCommerce is an unequivocal benefit and suggests that at least in some cases eCommerce may lead to the increased import of goods and service into non-metropolitan regions and the domination of these regions by large businesses based in urban areas. The impact of eCommerce in non-metropolitan areas needs to be systematically studied and a number of research avenues are suggested.

Housing price diffusion pattern of Australia's state capital cities

The ripple effect of house prices within metropolitan areas has recently been recognised by researchers. However, it is very difficult to formulate and measure this effect using conventional house price theories particularly in consideration of the spatial locations of cities. Based on econometrics principles of the cointegration test and the error correction model, this research develops an innovative approach to quantitatively examine the diffusion patterns of house prices in mega-cities of a country. Taking Australia's eight capital cities as an example, the proposed approach is validated in terms of an empirical study. The results show that a 1-1-2-4 diffusion pattern exists within these cities. Sydney is on the top tier with Melbourne in the second; Perth and Adelaide are in the third level and the other four cities lie on the bottom. This research may be applied to predict the regional housing market behavior in a country.

The impact of a police crackdown on a street drug scene : evidence from the street

This article documents the impact of a police crackdown on a street heroin market in a suburb of Melbourne, Australia, as perceived by individuals involved in the market. While our data suggest that ‘Operation Clean Heart’ achieved its objective of reducing the visible aspects of this street drug scene, they also imply that the drug market rapidly adapted to its new conditions and that the impact of the operation was essentially superficial and temporary. In addition, we contend that the operation had numerous (unintended) negative consequences, some of which are potentially harmful to public health. Negative outcomes implied by our data included the partial displacement of the drug scene to nearby metropolitan areas; the discouragement of safe injecting practice and safe needle and syringe disposal; and more frequent occurrences of violence and fraud. These outcomes may outweigh the perceived positive impacts, which were achieved at significant public expense. We conclude that police crackdowns are inappropriate responses to illicit drug problems; instead, in line with longstanding Australian policy, approaches which incorporate and balance demand reduction, supply reduction and harm reduction principles should be followed.

Rural sports and recreational injuries in Australia: what do we know?

Objective: It is widely recognised that individuals residing in regional or rural areas have poorer health outcomes than those from metropolitan areas. Factors associated with these poorer health outcomes include geographical isolation, population declines, limited health care provision and higher levels of inactivity compared to urban areas. The mental, social and physical health of individuals and communities in rural areas can be improved through active participation in sport and recreation activities. Unfortunately, participation in such activities can potentially lead to injury. There is a suggestion that there is an increased risk of sports injuries in rural areas due to the lack of health professionals and coaching personnel, fewer available volunteers to organise and deliver sport, and the general attitude towards injuries in rural settings.

Results: There is very limited information about the number and types of injuries sustained during participation in sports activities in rural and regional settings. This is largely related to a lack of formal sporting structures and support mechanisms including research funding and trained personnel.

Conclusion: A range of factors need to be implemented to improve safety for sporting and recreational participants in these areas. These include improved monitoring of injury occurrence, stronger promotion of safety initiatives and wider implementation of education strategies.

Housing price diffusion pattern of Australia's state capital cities

The ripple effect of house prices within metropolitan areas has recently been recognised by researchers. However, it is very difficult to formulate and measure this effect using conventional house price theories particularly in consideration of the spatial locations of cities. Based on econometrics principles of the cointegration test and the error correction model, this research develops an innovative approach to quantitatively examine the diffusion patterns of house prices in mega-cities of a country. Taking Australia's eight capital cities as an example, the proposed approach is validated in terms of an empirical study. The results show that a 1-1-2-4 diffusion pattern exists within these cities. Sydney is on the top tier with Melbourne in the second; Perth and Adelaide are in the third level and the other four cities lie on the bottom. This research may be applied to predict the regional housing market behavior in a country.

Conservation management and diets of Powerful Owls (Ninox strenua) in outer urban Melbourne, Australia

The Powerful Owl Ninox strenua is Australia’s largest owl, and is mainly found east of the Great Dividing Range on the mainland in tall-open forests. The species is considered rare, both nationally and in the State of Victoria; and threatened in the Greater Melbourne area. Recovery plans for the future conservation management of N. strenua are being prepared in 2 states.

Historically, Powerful Owls have been thought to require large homes ranges (about 1000 ha per pair) in suitable old-growth forest, which provides nest hollows for the owls and their arboreal marsupial prey. Recent research, however, has found N. strenua may be more numerous and breed more successfully in a wider range of habitats than previously believed. In particular, the birds have been found living in forests and woodlands within the greater metropolitan areas of cities. The most extreme case is where a nest tree has been found within 800m of urban settlement and 6km from the centre of Brisbane.

In this paper we report on the diet, habitat use, and conservation management by a number of breeding pairs of owls in outer urban Melbourne. Study sites range from a relatively undisturbed rainforest habitat 80km from central Melbourne, through dry sclerophyll, eucalyptus-dominated open forest with some disturbance to a site 8km from central Melbourne in highly disturbed urban parkland.

Diets of the families of owls were determined by analyzing remains in regurgitated pellets. The data confirm that arboreal marsupials constitute the major prey items, especially the Common Ringtail Possum Pseudocheirus peregrinus. There were differences in diets depending on the availability of prey species, which suggest a level of opportunism not previously suspected. Our study is also the first to confirm the owls capture adult Common Brushtail Possums Trichosurus vulpecula (15% of pellets containing the remains of this large opossum have bones of mature adults at 1 site) and thus take prey up to two and a half times their own weight. As well our data suggest Powerful Owls are not restricted to hollow-dwelling prey, as in some sites the marsupials rested during the day either in leafy nests called dreys (P. peregrinus) or in house roofs (T. vulpecula).

In the most heavily disturbed sites, breeding success has been reduced, and we have evidence that in one particular year the young were eaten by one of the parents. This followed construction of a bicycle track under the nest during the breeding season. Recommendations are made for the future conservation and habitat management of Powerful Owls in the Yarra Valley corridor.

Country practice : a case study of regional public relations practice

Research into public relations practice in all settings is vital given the extent and spread of its practice. However, despite the maturity of the public relations profession and the number of public relations practitioners who operate outside metropolitan areas, there has been little research to identify the distinctive nature of public relations practice in regional locations.

This research project begins a dissection of the nature of professional public relations practice in a non-metropolitan setting through the examination of public relations activity, workplaces and interactions in a regional locale. The project seeks to examine the specific nature of public relations practice in non-metropolitan Australia through a case study of two Victorian regional cities; Ballarat and Warrnambool. Analysis of these two sites provides the pilot stage for a larger future comparative examination of public relations practice in regional Australian centres with a variety of economic, demographic and geographic profiles.

Prediction of paediatric asthma hospitalisation using data mining techniques

Research into the prevalence of hospitalisation among childhood asthma cases is undertaken, using a data set local to the Barwon region of Victoria. Participants were the parents/guardians on behalf of children aged between 5-11 years. Various data mining techniques are used, including segmentation, association and classification to assist in predicting and exploring the instances of childhood hospitalisation due to asthma. Results from this study indicate that children in inner city and metropolitan areas may overutilise emergency department services. In addition, this study found that the prediction of hospitalisaion for asthma in children was greater for those with a written asthma management plan.

Vietnamese-born health professionals : negotiating work and life in rural Australia

Introduction: Australia is a culturally diverse nation due to migrants from a wide variety of countries creating a multicultural society. The health professions are highly valued by the younger generation of overseas-born migrants who have acculturated into Australian society; many have chosen health care as their profession in Australia. However, most migrants settle in metropolitan areas and young health professionals may find working in rural or remote Australia culturally and professionally highly challenging. The present study of migrant health professionals examined the life experiences and acculturation strategies of Vietnamese-born health professionals working and living in rural Australia. Objectives: The two main study objectives were to: (1) examine aspects of the acculturation of overseas-born and Australian-trained health professionals in the Australian health discourse; and (2) identify key coping strategies used by them when in working in the rural context.

Methods: Six overseas-born, Australian-trained health professionals were invited to participate in this qualitative study using a snowball sampling technique. The participants were all born in Vietnam and had experienced working in rural Australia. They included three medical doctors, a dentist, a physiotherapist and a nurse. The interviews were recorded and four participants also provided additional written responses to some of the open-ended interview questions. The interview data were transcribed and later coded for thematic analysis. Topics and themes that emerged focused on the issues and strategies of acculturation to the rural health context.

Results: The study showed that the acculturation process was affected by the participants’ views about and attitudes towards working in an Australian rural context. The study identified these essential strategies used by the participants in adapting to a new workplace: collaborating, distancing, adjusting, repairing, and accommodating.

Conclusion: The study provides insights into the lives of these health professionals in a rural context, and particularly their experience of cultural shock and the coping strategies they may use. A need is identified for a larger study to inform recruitment and retention of these health professionals to rural Australia, and to assist universities to prepare such students and their clinical supervisors for rural placements.

Event that never happened : the history and politics of decentralisation in Victoria and New South Wales 1885-1985

The thesis is an account of movements and policies for decentralisation of population and economic activity away from metropolitan to non-metropolitan areas in Victoria and N.S.W. in the period 1885-1985. It examines the pull from the country and the push from the capitals for decentralisation. Ballarat (Victoria) and Bathurst (N.S.W.) are used as case studies. Introductory chapters describe the historic pattern of population distribution in the two Colonies/States and discuss theories about the spatial distribution of population and industry. Chapters recounting and discussing the history and politics of decentralisation in Victoria and N.S.W. are organised in three periods: 1885-1940; 1940-1965; 1965-1985. A more decentralised distribution of population in Victoria and N.S.W. was almost always widely accepted as being in the public interest. Decentralisation rose and fell recurrently on the issue attention cycle. The pull from the country was fragmented and locally self-interested. The push from the capitals occurred only when life or its quality was perceived as threatened because of factors related to city size. Governments in both States introduced micro policies ostensibly to counter formidable centralising forces. In the 1970s there was an abortive attempt to implement a selective decentralisation policy in N.S.W. The thesis argues that decentralisation did not happen because: (1) there was not a consistent set of values and goals underlying the pull and push; (2) there was never a sustained, unified constituency for decentralisation, even in the country; (3) the power to influence, subvert or obstruct decentralisation policies was too widely diffused; (4) insufficient account was taken in decentralisation policymaking of the underlying economic, social and political dynamics.

The TrueBlue study : is practice nurse-led collaborative care effective in the management of depression for patients with heart disease or diabetes?

Background: In the presence of type 2 diabetes (T2DM) or coronary heart disease (CHD), depression is under diagnosed and under treated despite being associated with worse clinical outcomes. Our earlier pilot study demonstrated that it was feasible, acceptable and affordable for practice nurses to extend their role to include screening for and monitoring of depression alongside biological and lifestyle risk factors. The current study will compare the clinical outcomes of our model of practice nurse-led collaborative care with usual care for patients with depression and T2DM or CHD.

Methods: This is a cluster-randomised intervention trial. Eighteen general practices from regional and metropolitan areas agreed to join this study, and were allocated randomly to an intervention or control group. We aim to recruit 50 patients with co-morbid depression and diabetes or heart disease from each of these practices. In the intervention group, practice nurses (PNs) will be trained for their enhanced roles in this nurse-led collaborative care study. Patients will be invited to attend a practice nurse consultation every 3 months prior to seeing their usual general practitioner. The PN will assess psychological, physiological and lifestyle parameters then work with the patient to set management goals. The outcome of this assessment will form the basis of a GP Management Plan document. In the control group, the patients will continue to receive their usual care for the first six months of the study before the PNs undergo the training and switch to the intervention protocol. The primary clinical outcome will be a reduction in the depression score. The study will also measure the impact on physiological measures, quality of life and on patient attitude to health care delivered by practice nurses.

Conclusion: The strength of this programme is that it provides a sustainable model of chronic disease management with monitoring and self-management assistance for physiological, lifestyle and psychological risk factors for high-risk patients with co-morbid depression, diabetes or heart disease. The study will demonstrate whether nurse-led collaborative care achieves better outcomes than usual care.

Diabetes MILES - Australia (Management and Impact for Long-Term Empowerment and Success) : methods and sample characteristics of a national survey of the psychological aspects of living with type 1 or type 2 diabetes in Australian adults

Background Successful management of diabetes requires attention to the behavioural, psychological and social aspects of this progressive condition. The Diabetes MILES (Management and Impact for Long-term Empowerment and Success) Study is an international collaborative. Diabetes MILES-Australia, the first Diabetes MILES initiative to be undertaken, was a national survey of adults living with type 1 or type 2 diabetes in Australia. The aim of this study was to gather data that will provide insights into how Australians manage their diabetes, the support they receive and the impact of diabetes on their lives, as well as to use the data to validate new diabetes outcome measures.

Methods The survey was designed to include a core set of self-report measures, as well as modules specific to diabetes type or management regimens. Other measures or items were included in only half of the surveys. Cognitive debriefing interviews with 20 participants ensured the survey content was relevant and easily understood. In July 2011, the survey was posted to 15,000 adults (aged 18-70 years) with type 1 or type 2 diabetes selected randomly from the National Diabetes Services Scheme (NDSS) database. An online version of the survey was advertised nationally. A total of 3,338 eligible Australians took part; most (70.4%) completed the postal survey. Respondents of both diabetes types and genders, and of all ages, were adequately represented in both the postal and online survey sub-samples. More people with type 2 diabetes than type 1 diabetes took part in Diabetes MILES-Australia (58.8% versus 41.2%). Most respondents spoke English as their main language, were married/in a de facto relationship, had at least a high school education, were occupied in paid work, had an annual household income > $AUS40,000, and lived in metropolitan areas.

Discussion A potential limitation of the study is the under-representation of respondents from culturally and linguistically diverse backgrounds (including Aboriginal and Torres Strait Islander origin). Diabetes MILES-Australia represents a major achievement in the study of diabetes in Australia, where for the first time, the focus is on psychosocial and behavioural aspects of this condition at a national level.