Oropharyngeal dysphagia in an elderly post-operative hip fracture population : a prospective cohort study

Background: normal ageing processes impact on oropharyngeal swallowing function placing older adults at risk of developing oropharyngeal dysphagia (OD). Anecdotal clinical experience has observed that older patients recovering from hip fracture surgery commonly develop OD post-operatively. Objective: to document the presence of OD following hip fracture surgery, and the factors associated with OD. Methods: one hundred and eighty-one patients with a mean age of 83 years (range: 65–103) admitted to a specialised orthogeriatric unit were assessed for OD post-surgery for hip fracture. Pre-admission, intra-operative and post-operative factors were examined to determine their relationship with the presence of OD. Results: OD was found to be present post-operatively in 34% (n = 61) of the current population. Multivariate logistic regression analyses revealed the presence of pre-existing neurological and respiratory medical co-morbidities, presence of post-operative delirium, age and living in a residential aged care facility prior to hospital admission to be associated with the post-operative OD. Conclusion: these results highlight that OD is present in a large number of the older hip fracture population. Early identification of OD has important implications for the provision of timely dysphagia management that may prevent secondary complications and potentially reduce the hospital length of stay.

Assessing the long term viability of leasehold rural land in Queensland

Rural land holdings in a number of states in Australia can be freehold or leasehold. The actual type and tenure of the leasehold varies according to each state, but the underlying principles of ownership, transferability and farming and grazing rights are reasonably similar. There are rural areas that are all leasehold title such as the western lands in NSW, while rural land in some states and areas can be a mix of both freehold and lease hold rural property. Over the years many rural farming areas that were originally developed or granted as leasehold land have been converted to freehold title. In many instances the cost of purchasing perpetual leasehold property is similar to the equivalent freehold property despite the fact that an additional rental charge is applied to this form of ownership. Many of the current leasehold rural holdings are located in the more arid regions of the state and the prevailing agricultural farming system is either cattle or sheep grazing.

Social enterprises in rural community development

Social enterprises are hybrid organizational forms that combine characteristics of for-profit businesses and community sector organizations. This article explores how rural communities may use social enterprises to progress local development agendas across both economic and social domains. Drawing on qualitative case studies of three social enterprises in rural North West Tasmania, this article explores the role of social enterprises in local development processes. The case study social enterprises, despite differences in size, structure, mission and age, are strongly embedded in their local places and local communities. As deeply contextualized development actors, these social enterprises mobilize multiple resources and assets to achieve a range of local development outcomes, including but not limited to social capital

Discussion paper and working paper series : Motivations, expectations and experiences of Australian rural and regional planners

Despite playing an extremely important role in shaping communities, the role and contribution of planners is not widely understood or acknowledged. At the same time, there is a shortage of planners in Australia, especially in non-urban areas. Thus, though an online survey of 185 rural and regional planners, this research explores their motivations, expectations and experiences. Most enjoyed and felt confident in their role, explaining that they valued the relaxed family orientated rural lifestyle and the varied nature of the planning work. Although they sometimes felt isolated, the non-urban location provided quicker progression to senior roles, the ability to engage directly with the community and to see the consequences of their decisions. Only half felt their education had prepared them well for their role, citing gaps in terms of computerised modelling, team leadership and conflict resolution skills. Their feedback centred on providing a more practical course, focussing more on regional planning, and encouraging urban and rural experience placements. As the first study to quantifiably explore rural and regional Australian planners perceptions of their role and challenges, the findings illustrate current experiences, key planning challenges, perceived educational gaps and future priorities.

The rural school experiment : creating a Queensland yeoman

Using historical narrative and extensive archival research, this thesis portrays the story of the twentieth century Queensland Rural Schools. The initiative started at Nambour Primary School in 1917, and extended over the next four decades to encompass thirty primary schools that functioned as centralized institutions training children in agricultural science, domestic science, and manual trade training. The Rural Schools formed the foundation of a systemised approach to agricultural education intended to facilitate the State’s closer settlement ideology. The purpose of the Rural Schools was to mitigate urbanisation, circumvent foreign incursion and increase Queensland’s productivity by turning boys into farmers, or the tradesmen required to support them, and girls into the homemakers that these farmers needed as wives and mothers for the next generation. Effectively Queensland took rural boys and girls and created a new yeomanry to aid the State’s development.

The changing role of actors in the participatory project for rural craftspeople

This paper examines the role of actors in a participatory project, a case study of the glass-bead traditional craft industry in rural Indonesia. The project aimed to unite and empower rural craftspeople with regard to their unique potential. The problems of empowering rural craftspeople were complicated, due to the interrelated aspect of rural community life, cultural and educational backgrounds, as well as the local political situation. However, through a comprehensive understanding of the community prior to the project and by maintaining the communication, craftspeople were engaged actively in the project by promoting the craft industry to local buyers. The researcher, other facilitators and the community leader gave supportive roles at the middle and the end stage of the project.

Participatory approach to support community development of rural craftspeople

This paper presents a case study of the participatory project in the Jombang glass bead craft industry. Economic instability has brought significant business challenges in the community. The involvement of outsiders to collaborate with craftspeople in order to support business innovation as well as strengthen the social capital in the community is essential. However, facilitating a rural community to formulate and implement bottom-up planning needs an integrated approach. In this paper, we explain a participatory project in the rural craftspeople community that resulted in a collective action. The project aimed at uniting and empowering rural craftspeople focusing on the unique skills and knowledge of participants. There are some aspects influencing the success of collective action: the ability to understand the local political situation; the role of facilitators to respect and support the unique potential of craftspeople; and the economic benefit of the program.

Mortality and cost outcomes of elderly trauma patients admitted to intensive care and the general wards of an Australian tertiary referral hospital

Mortality and cost outcomes of elderly intensive care unit (ICU) trauma patients were characterised in a retrospective cohort study from an Australian tertiary ICU. Trauma patients admitted between January 2000 and December 2005 were grouped into three major age categories: aged ≥65 years admitted into ICU (n=272); aged ≥65 years admitted into general ward (n=610) and aged <65 years admitted into ICU (n=1617). Hospital mortality predictors were characterised as odds ratios (OR) using logistic regression. The impact of predictor variables on (log) total hospital-stay costs was determined using least squares regression. An alternate treatment-effects regression model estimated the mortality cost-effect as an endogenous variable. Mortality predictors (P ≤0.0001, comparator: ICU ≥65 years, ventilated) were: ICU <65 not-ventilated (OR 0.014); ICU <65 ventilated (OR 0.090); ICU age ≥65 not-ventilated (OR 0.061) and ward ≥65 (OR 0.086); increasing injury severity score and increased Charlson comorbidity index of 1 and 2, compared with zero (OR 2.21 [1.40 to 3.48] and OR 2.57 [1.45 to 4.55]). The raw mean daily ICU and hospital costs in A$ 2005 (US$) for age <65 and ≥65 to ICU, and ≥65 to the ward were; for year 2000: ICU, $2717 (1462) and $2777 (1494); hospital, $1837 (988) and $1590 (855); ward $933 (502); for year 2005: ICU, $3202 (2393) and $3086 (2307); hospital, $1938 (1449) and $1914 (1431); ward $1180 (882). Cost increments were predicted by age ≥65 and ICU admission, increasing injury severity score, mechanical ventilation, Charlson comorbidity index increments and hospital survival. Mortalitycost-effect was estimated at -63% by least squares regression and -82% by treatment-effects regression model. Patient demographic factors, injury severity and its consequences predict both cost and survival in trauma. The cost mortality effect was biased upwards by conventional least squares regression estimation.

Habituated objects : everyday tangibles that foster the independent living of an elderly woman

The boundaries between 'the digital' and our everyday physical world are dissolving as we develop more physical ways of interacting with computing. This forum presents some of the topics discussed in the colorful multidisciplinary field of tangible and embodied interaction

Racial/ethnic variations in violence against women : Urban, suburban and rural differences

A large literature shows that violence against women in intimate relationships varies across racial/ethnic groups. However, it is unclear whether such variations differ across urban, suburban, and rural areas. The main objective of this article is to examine this issue using 1992 to 2009 National Crime Victimization Survey data. We also test the hypothesis that racial/ethnic minority women living in rural areas are more likely to be assaulted by their current and former intimate partners than are their urban and suburban counterparts. Contrary to expectations, results indicated virtually no differences in the rates at which urban, suburban, and rural racial/ethnic minority females were victims of intimate violence. The results indicate the great need of additional research into this important topic.

Communication choices to engage participation of rural Indonesian craftspeople in development projects

In participatory design projects, maintaining effective communication between facilitator and participant is essential. This paper describes the consideration given to the choice of communication modes to engage participation of rural Indonesian craftspeople over the course of a significant 3 year project that aims to grow their self-determination, design and business skill. We demonstrate the variety and subtlety of oral and written forms of communication used by the facilitator during the project. The culture, the communication skill and the influence of tacit knowledge affect the effectiveness of some modes of communication over the others, as well as the available infrastructure. Considerations are specific to the case of rural Indonesian craftspeople, but general lessons can be drawn.

A study of post diagnosis breast cancer concerns for women living in rural and remote Queensland. Part I : Personal concerns

The findings presented in this paper are part of a research project designed to provide a preliminary indication of the support needs of postdiagnosis women with breast cancer in remote and isolated areas in Queensland. This discussion will present data that focuses on the women’s expressed personal concerns. For participants in this research a diagnosis of breast cancer involves a confrontation with their own mortality and the possibility of a reduced life span. This is a definite life crisis, creating shock and needing considerable adjustment. Along with these generic issues the participants also articulated significant issues in relation to their experience as women in a rural setting. These concerns centred around worries about how their partner and families cope during their absences for treatment, the additional burden on the family of having to cope with running the property or farm during the participant’s absence or illness, added financial strain brought about by the cost of travel for treatment, maintenance of properties during absences, and problems created by time off from properties or self-employment. These findings accord with other reports of health and welfare services for rural Australian and the generic literature on psycho-oncology studies of breast cancer.

A study of postdiagnosis breast cancer concerns for women living in rural and remote Queensland. Part II : support issues

This paper presents the recent findings from a study on the postdiagnosis support needs of women with breast cancer living in rural and remote Queensland. The findings presented in this discussion focus on support needs from the perspective of the women experiencing breast cancer as well as health service providers. The tyranny of distance imposes unique hardships, such as separation from family and friends, during a time of great vulnerability for treatment, the need to travel long distances for support and follow-up services, and extra financial burdens, which can combine to cause strains on the marital relationship and family cohesion. Positive indications are, however, that the rural communities operate on strong, informal networks of support. This network of family, friends and community can, and does, play an active role in the provision of emotional and practical support.

Pain : the views of elderly people living in long term residential care settings

While an individual's beliefs and attitudes have long been considered important factors in how people respond to pain, few studies have attempted to provide in-depth descriptions of the nature of such pain beliefs and attitudes The aim of this research was to investigate the views of pain and pain management practices held by elderly people living in long-term residential care settings Ten 60–90 minute focus group interviews, each involving around five elderly people, were conducted in four large, long-term residential care settings in Brisbane, Australia Categories of beliefs and attitudes regarding pain were identified following analysis of the verbatim transcripts of these interviews Findings suggest that many elderly people living in long-term residential care settings may have become resigned to pain, that they are ambivalent about the benefit of any action for their pain and that they may be reluctant to express their pain Implications of these beliefs and attitudes are discussed