National health and hospital network for Australia's future : Implications for emergency medicine

The proposals arising from the agreement reached between the Rudd government and the States and Territories (except Western Australia) in April 2010 represent the most fundamental realignment of health responsibilities since the creation of Medicare in 1984. They will change the health system, and the structures that will craft its future direction and design. These proposals will have a significant impact on Emergency Medicine; an impact from not only the system-wide effects of the proposals but also those that derive from the specific recommendations to create an activity-based funding mechanism for EDs, to implement the four hour rule and to develop a performance indicator framework for EDs. The present paper will examine the potential impact of the proposals on Emergency Medicine to inform those who work within the system and to help guide further developments. More work is required to better evaluate the proposals and to guide the design and development of specific reform instruments. Any such efforts should be based upon a proper analysis of the available evidence, and a structured approach to research and development so as to deliver on improved services to the community, and on improved quality and safety of emergency medical care.

Pandemic (H1N1) 2009 Influenza Outbreak in Australia: Impact on Emergency Departments.

Executive summary Objective: The aims of this study were to identify the impact of Pandemic (H1N1) 2009 Influenza on Australian Emergency Departments (EDs) and their staff, and to inform planning, preparedness, and response management arrangements for future pandemics, as well as managing infectious patients presenting to EDs in everyday practice. Methods This study involved three elements: 1. The first element of the study was an examination of published material including published statistics. Standard literature research methods were used to identify relevant published articles. In addition, data about ED demand was obtained from Australian Government Department of Health and Ageing (DoHA) publications, with several state health departments providing more detailed data. 2. The second element of the study was a survey of Directors of Emergency Medicine identified with the assistance of the Australasian College for Emergency Medicine (ACEM). This survey retrieved data about demand for ED services and elicited qualitative comments on the impact of the pandemic on ED management. 3. The third element of the study was a survey of ED staff. A questionnaire was emailed to members of three professional colleges—the ACEM; the Australian College of Emergency Nursing (ACEN); and the College of Emergency Nursing Australasia (CENA). The overall response rate for the survey was 18.4%, with 618 usable responses from 3355 distributed questionnaires. Topics covered by the survey included ED conditions during the (H1N1) 2009 influenza pandemic; information received about Pandemic (H1N1) 2009 Influenza; pandemic plans; the impact of the pandemic on ED staff with respect to stress; illness prevention measures; support received from others in work role; staff and others’ illness during the pandemic; other factors causing ED staff to miss work during the pandemic; and vaccination against Pandemic (H1N1) 2009 Influenza. Both qualitative and quantitative data were collected and analysed. Results: The results obtained from Directors of Emergency Medicine quantifying the impact of the pandemic were too limited for interpretation. Data sourced from health departments and published sources demonstrated an increase in influenza-like illness (ILI) presentations of between one and a half and three times the normal level of presentations of ILIs. Directors of Emergency Medicine reported a reasonable level of preparation for the pandemic, with most reporting the use of pandemic plans that translated into relatively effective operational infection control responses. Directors reported a highly significant impact on EDs and their staff from the pandemic. Growth in demand and related ED congestion were highly significant factors causing distress within the departments. Most (64%) respondents established a ‘flu clinic’ either as part of Pandemic (H1N1) 2009 Influenza Outbreak in Australia: Impact on Emergency Departments. the ED operations or external to it. They did not note a significantly higher rate of sick leave than usual. Responses relating to the impact on staff were proportional to the size of the colleges. Most respondents felt strongly that Pandemic (H1N1) 2009 Influenza had a significant impact on demand in their ED, with most patients having low levels of clinical urgency. Most respondents felt that the pandemic had a negative impact on the care of other patients, and 94% revealed some increase in stress due to lack of space for patients, increased demand, and filling staff deficits. Levels of concern about themselves or their family members contracting the illness were less significant than expected. Nurses displayed significantly higher levels of stress overall, particularly in relation to skill-mix requirements, lack of supplies and equipment, and patient and patients’ family aggression. More than one-third of respondents became ill with an ILI. Whilst respondents themselves reported taking low levels of sick leave, respondents cited difficulties with replacing absent staff. Ranked from highest to lowest, respondents gained useful support from ED colleagues, ED administration, their hospital occupational health department, hospital administration, professional colleges, state health department, and their unions. Respondents were generally positive about the information they received overall; however, the volume of information was considered excessive and sometimes inconsistent. The media was criticised as scaremongering and sensationalist and as being the cause of many unnecessary presentations to EDs. Of concern to the investigators was that a large proportion (43%) of respondents did not know whether a pandemic plan existed for their department or hospital. A small number of staff reported being redeployed from their usual workplace for personal risk factors or operational reasons. As at the time of survey (29 October –18 December 2009), 26% of ED staff reported being vaccinated against Pandemic (H1N1) 2009 Influenza. Of those not vaccinated, half indicated they would ‘definitely’ or ‘probably’ not get vaccinated, with the main reasons being the vaccine was ‘rushed into production’, ‘not properly tested’, ‘came out too late’, or not needed due to prior infection or exposure, or due to the mildness of the disease. Conclusion: Pandemic (H1N1) 2009 Influenza had a significant impact on Australian Emergency Departments. The pandemic exposed problems in existing plans, particularly a lack of guidelines, general information overload, and confusion due to the lack of a single authoritative information source. Of concern was the high proportion of respondents who did not know if their hospital or department had a pandemic plan. Nationally, the pandemic communication strategy needs a detailed review, with more engagement with media networks to encourage responsible and consistent reporting. Also of concern was the low level of immunisation, and the low level of intention to accept vaccination. This is a problem seen in many previous studies relating to seasonal influenza and health care workers. The design of EDs needs to be addressed to better manage infectious patients. Significant workforce issues were confronted in this pandemic, including maintaining appropriate staffing levels; staff exposure to illness; access to, and appropriate use of, personal protective equipment (PPE); and the difficulties associated with working in PPE for prolonged periods. An administrative issue of note was the reporting requirement, which created considerable additional stress for staff within EDs. Peer and local support strategies helped ensure staff felt their needs were provided for, creating resilience, dependability, and stability in the ED workforce. Policies regarding the establishment of flu clinics need to be reviewed. The ability to create surge capacity within EDs by considering staffing, equipment, physical space, and stores is of primary importance for future pandemics.

‘Universities are not the safe places we would like to think they are, but they are getting safer’: Indigenous women academics in higher education

This paper outlines some of the experiences of Indigenous women academics in higher education. The author offers these experiences, not to position Indigenous women academics as victims, but to expose the problematic nature of racism, systemic marginalisation, white race privilege and radicalised subjectivity played out within Australian higher education institutions. By utilising the experiences and examples she seeks to bring the theoretical into the everyday world of being Indigenous within academe. In analysing these examples, the author reveals the relationships between oppression, white race privilege, institutional privilege and the epistemology that maintains them. She argues that, in moving from a position of being silent to speaking about what she has witnessed and experienced, she is able to move from the position of object to subject and gain a form of liberated voice (hooks 1989: 9) for herself and other Indigenous women. She seeks to challenge the practices within universities that continue to subjugate Indigenous women academics.

Steering (towards a post apology Australia) without a rudder

After Kevin Rudd’s Apology to Indigenous Peoples after his election as Prime Minister in 2008 the climate was hopeful with many Aboriginal and Torres Strait Islander women (and non-Indigenous women, too) breathing a sigh of relief that the disastrous effects of White Australia’s government policies had at last been symbolically, publicly and officially acknowledged. There was also, though, skepticism about the ‘real’ change this Apology might have for Indigenous Australians. Many of us wondered if the Apology would make any difference at all in the ‘real’ world, where the gaps between non-Indigenous and Indigenous Australians is still so glaringly apparent in areas such as health, education, housing and employment.

Who makes the news : Australia : global media monitoring project 2010 national report

The Australian report for the Global Media Monitoring Project 2010 (GMMP 2010) involved a study of 374 stories that were sampled from 26 Australian newspapers, radio and television stations, and internet news services on 10 November 2009. This snapshot of reporting on that day suggests that women are under-represented in the Australian news media as both the sources and creators of news. Females made up only 24% of the 1012 news sources who were heard, read about or seen in the stories that were studied. Neglect of female sources was particularly noticeable in sports news. Women made up only 1% of the 142 sources who were talked about or quoted in sports stories. Female sources of news were disproportionately portrayed as celebrities and victims. Although women made up only 24% of sources overall, they comprised 44% of victims of crimes, accidents, war, health problems, or discrimination. Unsurprisingly, women made up 32% of sources in stories about violent crimes and 29% in stories about disasters, accidents or emergencies – usually in the role of victim. Females were commonly defined in terms of their status as a mother, daughter, wife, sister or other family relationship. Family status was mentioned for 33% of women quoted or discussed in the news stories compared to only 13% of male sources. Women also made up 75% of sources described as homemakers or parents. The Australian GMMP 2010 study also indicates a gender division among the journalists who wrote or presented the news. Only 32% of the stories were written or presented by female reporters and newsreaders. The gender inequality was again most evident in sports journalism. Findings from the Australian report also contributed to the GMMP 2010 Global Report and the Pacific GMMP 2010 Regional Report, which are available at http://whomakesthenews.org/gmmp/gmmp-reports/gmmp-2010-reports

Talkin' up sport and gender : Three Australian Aboriginal women speak

This paper presents the perspectives from three Aboriginal women on body image, sport and physical activity within Australian contemporary society. It draws on a range of literature along with artworks from visual artist Pamela Croft.

Profiling the offence patterns of disqualified drink drivers in Queensland, Australia.

While unlicensed driving does not play a direct causative role in road crashes, it represents a major problem for road safety. A particular subgroup of concern is those offenders who continue to drive after having their licence disqualified for drink driving. Surveys of disqualified drivers suggest that driving among this group is relatively common. Method This paper reports findings from an analysis of the driving records of over 545,000 Queensland drivers who experienced a licence sanction between January 2003 and December 2008. The sample included drivers who were disqualified by a court (e.g., for drink driving); those who licence had been suspended administratively (e.g., for accumulation of demerit points); and those who were placed on a restricted licence. Results Overall, 95,461 of the drivers in the sample were disqualified from driving for a drink driving offence. During the period, these drivers were issued with a total of 2,644,619 traffic infringements with approximately 12% (n = 8, 095) convicted of a further drink driving offence while disqualified. Other traffic offences detected during this period including unlicensed driving (18%), driving an unregistered vehicle (27%), speeding (21%), dangerous driving (36%), mobile phone use (35%), non-restraint use (32%), and other moving violation (23%). Offending behaviour was more common among men than women. Conclusions While licence disqualification has previously been shown to be a relatively effective sanction for managing the behaviour of drink driving offenders, the results of the current study highlight that it is a far from perfect tool since many offenders continue to commit both drink driving and other traffic offences while disqualified. As such, this study highlights the ongoing need to enhance the detection of disqualified and unlicensed driving in order to deter this behaviour.

The Culture of Older Women’s Drinking in Australia

The purpose of this investigation was to undertake pilot research to develop an understanding of the current culture of older Australian women’s (35-50 years) drinking behaviour from a uniquely female perspective. Methods Two separate focus group interviews were undertaken with women (N = 11) aged between 35 and 50 years living in South-East Queensland, Australia. Women were asked to openly discuss how and why they drink alcohol (ie., their regular drinking behaviour), how this has changed over time, and the attitudes and values that influence their behaviour. Results Participants reported that their consumption of alcohol was more regulated and controlled and although some women drank more frequently, the quantity consumed at each drinking occasion had decreased significantly. Occasional consumption of large amounts of alcohol tended to be the result of ‘incidental drinking’ as opposed to ‘determined drinking’. The reasons for alcohol consumption were found to be internal as well as social. Internal reasons included stress relief, increased relaxation and self reward. Further, alcohol was used as a social lubricant. This cohort also reported being influenced by the drinking patterns of their partners. Social group matching was however found to have a negative impact on alcohol consumption as social groups most commonly endorsed lesser levels of intoxication. Further, the women reported that they were of an age in which they felt excessive drinking to be ‘undignified’. Personal reasons such as vocational and family responsibilities further modified the levels of consumption for individual women. Finally, it was reported that perceived health risks that can result from excessive and/or repetitive drinking led to a decreased in consumption. Conclusion It is proposed that the findings of this investigation could be used to improve current knowledge regarding more mature women’s drinking culture, associated risks and risk prevention strategies.

Design and implementation of the Exercise for Health trial – a pragmatic exercise intervention for women with breast cancer

Background Exercise for Health was a pragmatic, randomised, controlled trial comparing the effect of an eight-month exercise intervention on function, treatment-related side effects and quality of life following breast cancer, compared with usual care. The intervention commenced six weeks post-surgery, and two modes of delivering the same intervention was compared with usual care. The purpose of this paper is to describe the study design, along with outcomes related to recruitment, retention and representativeness, and intervention participation. Methods: Women newly diagnosed with breast cancer and residing in a major metropolitan city of Queensland, Australia, were eligible to participate. Consenting women were randomised to a face-to-face-delivered exercise group (FtF, n=67), telephone-delivered exercise group (Tel, n=67) or usual care group (UC, n=60) and were assessed pre-intervention (5-weeks post-surgery), mid-intervention (6 months post-surgery) and 10 weeks post-intervention (12 months post-surgery). Each intervention arm entailed 16 sessions with an Exercise Physiologist. Results: Of 318 potentially eligible women, 63% (n=200) agreed to participate, with a 12-month retention rate of 93%. Participants were similar to the Queensland breast cancer population with respect to disease characteristics, and the randomisation procedure was mostly successful at attaining group balance, with the few minor imbalances observed unlikely to influence intervention effects given balance in other related characteristics. Median participation was 14 (min, max: 0, 16) and 13 (min, max: 3, 16) intervention sessions for the FtF and Tel, respectively, with 68% of those in Tel and 82% in FtF participating in at least 75% of sessions. Discussion: Participation in both intervention arms during and following treatment for breast cancer was feasible and acceptable to women. Future work, designed to inform translation into practice, will evaluate the quality of life, clinical, psychosocial and behavioural outcomes associated with each mode of delivery.

The Australian story : catalysts and inhibitors in the achievement of new women professors

Women are substantially under-represented in the professoriate in Australia with a ratio of one female professor to every three male professors. This gender imbalance has been an ongoing concern with various affirmative action programs implemented in universities but to limited effect. Hence, there is a need to investigate the catalysts for and inhibitors to women’s ascent to the professoriate. This investigation focussed on women appointed to the professoriate between 2005, when a research quality assessment was first proposed, and 2008. Henceforth, these women are referred to as “New Women Professors”. The catalysts and inhibitors in these women’s careers were investigated through an electronic survey and focus group interviews. The survey was administered to new women professors (n=255) and new men professors (n=240) to enable a comparison of responses. However, only women participated in focus group discussions (n=21). An analysis of the survey and interview data revealed that the most critical catalysts for women’s advancement to the professoriate were equal employment opportunities and mentoring. Equal opportunity initiatives provided women with access to traditionally male-dominated forums. Mentoring gave women an insider perspective on the complexity of academia and the politics of the academy. The key inhibitors to women’s career advancement were negative discrimination, the culture of the boys’ club, the tension between personal and professional life, and isolation. Negative discrimination and the boys’ club are problematic because they favour men and marginalise women. The tension between personal and professional life is a particular concern for women who bear children and typically assume the major role in a family for child rearing. Isolation was a concern for both women and men with isolation appearing to increase after ascent to the professoriate. Knowledge of the significant catalysts and inhibitors provides a pragmatic way to orient universities towards redressing the gender balance in the professoriate.

Increased traffic exposure and negative birth outcomes : a prospective cohort in Australia

Background: Pregnant women exposed to traffic pollution have an increased risk of negative birth outcomes. We aimed to investigate the size of this risk using a prospective cohort of 970 mothers and newborns in Logan, Queensland. ----- ----- Methods: We examined two measures of traffic: distance to nearest road and number of roads around the home. To examine the effect of distance we used the number of roads around the home in radii from 50 to 500 metres. We examined three road types: freeways, highways and main roads.----- ----- Results: There were no associations with distance to road. A greater number of freeways and main roads around the home were associated with a shorter gestation time. There were no negative impacts on birth weight, birth length or head circumference after adjusting for gestation. The negative effects on gestation were largely due to main roads within 400 metres of the home. For every 10 extra main roads within 400 metres of the home, gestation time was reduced by 1.1% (95% CI: -1.7, -0.5; p-value = 0.001).----- ----- Conclusions: Our results add weight to the association between exposure to traffic and reduced gestation time. This effect may be due to the chemical toxins in traffic pollutants, or because of disturbed sleep due to traffic noise.

Communicating friendships : a case study of women in an Australian 'seachange' town

This thesis proposes =friendworks‘ as an important sub-group of social networks, comprised of networks of friends. It investigates friendworks of a particular group of adult Australian women as a way of understanding neglected aspects of social networking practices. Friendworks are contextualised to highlight two main themes of interest: population mobility and communication practices. The impact of relocation on individuals, local communities and the wider society is explored through a case study of female friendworks in a seachange community. Research findings point to the importance of friendworks in building and cohering social and emotional support, well-being, belonging and senses of place and community. Different types of communication methods were used by research participants for mediating different kinds of social ties within the friendworks considered here. Communication patterns were influenced by geographical proximity to friends, and the type of social support required of them (emotional, instrumental or companionship). Most findings were consistent with broader social patterns of communication. For example, face-to-face interactions were the dominant and most favoured communication method between local friends, regardless of whether they were weak or strong ties. The fixed-telephone and the internet were commonly in use to maintain old and geographically distant social ties, while mobile phones were used the least among friends in comparison with other communication methods. The key finding of this thesis is that friendworks are an extremely important solid network in contemporary society, providing mooring relations in a mobile world. Paradoxically, however, for women in this study, the mobile phone, which is popularly perceived as a flexible, multi-purpose communication technology for people on the move, was the least versatile of all technologies for maintaining friendworks. The cost of services was the main inhibitor here. The internet was found to be the most versatile communication technology and was used to support various types of social ties: strong, weak, local and distant. This thesis also highlights the value of the concept of friendworks as well as networks for communication research and policy investigating individuals‘ motivations and practices.

The artistic partnership of two women

This brief paper details the artistic working relationship between Bronwyn Fredericks and Pamela Croft within the Keppel Sands / Rockhampton region.

Understanding speeding in school zones in Malaysia and Australia using an extended Theory of Planned Behaviour : the potential role of mindfulness

Speeding in school zones is a problem in both Malaysia and Australia. While there are differences between the countries in terms of school zone treatments and more generally, these differences do not explain why people choose to speed in school zones. Because speeding is usually an intentional behaviour, the Theory of Planned Behaviour (TPB) has been used to understand speeding and develop interventions, however it has limitations which can be addressed by extending the model to incorporate other constructs. One promising construct is mindfulness, which can improve the explanatory value of the TPB by taking into account unintentional speeding attributable to a lack of focus on important elements of the driving environment. We explain what mindfulness is (and is not), how it can assist in providing a better understanding of speeding in school zones, and how it can contribute to the development of interventions. We then outline a program of research which has been commenced, investigating the contribution of mindfulness to an understanding of speed choice in school zones in two different settings (Australia and Malaysia) using the TPB.