Development and evaluation of training in culturally specific screening and brief intervention for hospital patients with alcohol-related injuries

Objective To evaluate health practitioners’ confidence and knowledge of alcohol screening, brief intervention and referral after training in a culturally adapted intervention on alcohol misuse and well-being issues for trauma patients. Design Mixed methods, involving semi-structured interviews at baseline and a post-workshop questionnaire. Setting: Targeted acute care within a remote area major tertiary referral hospital. Participants Ten key informants and 69 questionnaire respondents from relevant community services and hospital-based health care professionals. Intervention Screening and brief intervention training workshops and resources for 59 hospital staff. Main outcome measures Self-reported staff knowledge of alcohol screening, brief intervention and referral, and satisfaction with workshop content and format. Results After training, 44% of participants reported being motivated to implement alcohol screening and intervention. Satisfaction with training was high, and most participants reported that their knowledge of screening and brief intervention was improved. Conclusion Targeted educational interventions can improve the knowledge and confidence of inpatient staff who manage patients at high risk of alcohol use disorder. Further research is needed to determine the duration of the effect and influence on practice behaviour. Ongoing integrated training, linked with systemic support and established quality improvement processes, is required to facilitate sustained change and widespread dissemination.

Effect of waiting time on health outcomes and service utilization : A prospective randomized study on patients admitted to hospital for hip or knee replacement

Although the principle of equal access to medically justified treatment has been promoted by official health policies in many Western health care systems, practices do not completely meet policy targets. Waiting times for elective surgery vary between patient groups and regions, and growing problems in the availability of services threaten equal access to treatment. Waiting times have come to the attention of decision-makers, and several policy initiatives have been introduced to ensure the availability of care within a reasonable time. In Finland, for example, the treatment guarantee came into force in 2005. However, no consensus exists on optimal waiting time for different patient groups. The purpose of this multi-centre randomized controlled trial was to analyse health-related quality of life, pain and physical function in total hip or knee replacement patients during the waiting time and to evaluate whether the waiting time is associated with patients health outcomes at admission. This study also assessed whether the length of waiting time is associated with social and health services utilization in patients awaiting total hip or knee replacement. In addition, patients health-related quality of life was compared with that of the general population. Consecutive patients with a need for a primary total hip or knee replacement due to osteoarthritis were placed on the waiting list between August 2002 and November 2003. Patients were randomly assigned to a short waiting time (maximum 3 months) or a non-fixed waiting time (waiting time not fixed in advance, instead the patient followed the hospitals routine practice). Patients health-related quality of life was measured upon being placed on the waiting list and again at hospital admission using the generic 15D instrument. Pain and physical function were evaluated using the self-report Harris Hip Score for hip patients and a scale modified from the Knee Society Clinical Rating System for knee patients. Utilization measures were the use of home health care, rehabilitation and social services, physician visits and inpatient care. Health and social services use was low in both waiting time groups. The most common services used while waiting were rehabilitation services and informal care, including unpaid care provided by relatives, neighbours and volunteers. Although patients suffered from clear restrictions in usual activities and physical functioning, they seemed primarily to lean on informal care and personal networks instead of professional care. While longer waiting time did not result in poorer health-related quality of life at admission and use of services during the waiting time was similar to that at the time of placement on the list, there is likely to be higher costs of waiting by people who wait longer simply because they are using services for a longer period. In economic terms, this would represent a negative impact of waiting. Only a few reports have been published of the health-related quality of life of patients awaiting total hip or knee replacement. These findings demonstrate that, in addition to physical dimensions of health, patients suffered from restrictions in psychological well-being such as depression, distress and reduced vitality. This raises the question of how to support patients who suffer from psychological distress during the waiting time and how to develop strategies to improve patients initiatives to reduce symptoms and the burden of waiting. Key words: waiting time, total hip replacement, total knee replacement, health-related quality of life, randomized controlled trial, outcome assessment, social service, utilization of health services

Qualitative study of patients' choice between public and private hospital emergency departments

Objective The aim of this study was to gather patients' perceptions regarding their choice between public and private hospital EDs for those who hold private health insurance. The findings of this study will contribute to knowledge regarding patients' decision-making processes and therefore may contribute to the development of evidence based public policies. Methods An in-depth semi-structured guide was used to interview participants at public and private hospital EDs. Questions sought to identify the issues that were considered by the participants to decide to attend that hospital ED, previous ED experience, expectations of ED services and perceived benefits and barriers to accessing services. Interviews were audio recorded, transcribed verbatim and analysed using content and thematic approaches. Results Four core themes emerged: prior good experience with the hospital, perceived quality of care, perceived waiting times and perceived costs that may explain patients' choice. Patients' choice between public and private EDs can be explained by the interaction of these core themes. The principal issues appear to be concern for gap payments at private hospital ED and waiting times at public hospital ED. Conclusions Patients who choose to attend public EDs appear to value financial concern over waiting time; those who choose to attend private EDs appear to value waiting time ahead of financial concerns.

Clinical tips: Food poisoning

Food poisoning is used to describe a range of illnesses caused by drinking or eating contaminated drink or food. Infectious pathogens include bacteria, viruses, parasites, or their toxins, though food poisoning can also be a result of eating poisonous plants e.g. some mushrooms, or animals e.g. puffer fish. Common symptoms include nausea, vomiting, watery diarrhoea, abdominal pain and cramps, and fevers, though these will vary depending on the causative pathogen or toxin. Symptoms can start within hours of eating contaminated food, or may begin days or weeks later. Most food poisoning is mild in nature, lasts for several hours to a few days, and generally resolves without treatment. However, some cases of food poisoning can also be extremely severe, with people requiring medical attention or admission to hospital...

Food-borne pathogens - a key issue for all food animal industries

The modern consumer has an attitude that food safety is non-negotiable issue – the consumer simply demands food to be safe. Yet, at the same time, the modern consumer has an expectation that the food safety is the responsibility of others – the primary producer, the processing company, the supermarket, commercial food handlers and so on. Given this environment, all food animal industries have little choice but to regard food safety as a key issue. As an example, the chicken meat industry, via the two main industry funding bodies – the Rural Industries Research and Development Corporation (Chicken Meat) and the Poultry CRC – has a comprehensive research program that seeks to focus on reducing the risks of food-borne diseases at all points of the food processing chain – from the farm to the processing plant. The scale of the issue for all industries can be illustrated by an analysis of the problem of campylobacterosis – a major food-borne disease. It has been estimated that there are around 230,000 cases of campylobacterosis per year. In 1995, it was estimated that each case of food-borne campylobacterosis in the USA was costing between $(US) 350-580. Hence, a reasonable conservative estimate is that each Australian case in 2010 would result in a cost of around $500 (this includes hospital, medication and lost productivity costs). Hence, this single food-borne agent could be costing Australian society around $115 million annually. In the light of these types of estimated costs for just one food-borne pathogen, it is easy to understand the importance that all food animal industries place on food safety.

Economic consideration for reducing hospital presentations among patients with decompensated cirrhosis: not all presentations avoided can be considered equal

Individuals with decompensated cirrhosis and ascites requiring paracentesis utilize exceptionally high levels of hospital resources. Consequently, potential modifications to existing models of healthcare to assist patients in the management of their liver disease and reduce the need for hospital encounters have potential to improve patients’ health and reduce demand on acute hospital services. However, there is a paucity of data examining how much healthcare resources could be re-directed to interventions that prevent hospitalizations without net annual budgetary disadvantage (from the hospital’s perspective). The purpose of this study was to probabilistically examine how much healthcare resourcing could be saved per hospital presentation avoided among this clinical population.

Hospital in the Nursing Home program reduces emergency department presentations and hospital admissions from residential aged care facilities in Queensland, Australia: A quasi-experimental study

Background There has been considerable publicity regarding population ageing and hospital emergency department (ED) overcrowding. Our study aims to investigate impact of one intervention piloted in Queensland Australia, the Hospital in the Nursing Home (HiNH) program, on reducing ED and hospital attendances from residential aged care facilities (RACFs). Methods A quasi-experimental study was conducted at an intervention hospital undertaking the program and a control hospital with normal practice. Routine Queensland health information system data were extracted for analysis. Results Significant reductions in the number of ED presentations per 1000 RACF beds (rate ratio (95 % CI): 0.78 (0.67–0.92); p = 0.002), number of hospital admissions per 1000 RACF beds (0.62 (0.50–0.76); p < 0.0001), and number of hospital admissions per 100 ED presentations (0.61 (0.43–0.85); p = 0.004) were noticed in the experimental hospital after the intervention; while there were no significant differences between intervention and control hospitals before the intervention. Pre-test and post-test comparison in the intervention hospital also presented significant decreases in ED presentation rate (0.75 (0.65–0.86); p < 0.0001) and hospital admission rate per RACF bed (0.66 (0.54–0.79); p < 0.0001), and a non-significant reduction in hospital admission rate per ED presentation (0.82 (0.61–1.11); p = 0.196). Conclusions Hospital in the Nursing Home program could be effective in reducing ED presentations and hospital admissions from RACF residents. Implementation of the program across a variety of settings is preferred to fully assess the ongoing benefits for patients and any possible cost-savings.

Patient perspectives of factors contributing to inadequate dietary intake in acute care patients in hospital

Up to 30% of acute care patients consume less than half of the food provided in hospital. Inadequate dietary intake can have adverse clinical outcomes, including a higher risk of in-hospital mortality. This study aimed to investigate the reasons for poor intake among acute care patients in hospital. Patients with an observed intake of ≤50% of the food provided at lunch were approached to participate in the study. Thirty-two patients participated in semi-structured interviews over a three week period, to provide their perspective of food and mealtimes in hospital and discuss the reasons and factors influencing inadequate intake. Responses were coded and analysed thematically using the framework method. Patients reported both individual and organisational factors contribute to their inadequate intake. Half the patients reported the size of the meals were too large, with some patients reporting that large meal sizes puts them off their food and reduced their intake. ‘Not important to eat all the food provided’, and ‘do not need to eat much food in hospital’ were common attitudes among the patients. Half the patients reported that nurses did not observe their intake and were not concerned if all the food was not eaten. Identifying the reasons for poor intake can assist with the development of suitable interventions to improve dietary intake and reduce the risk of adverse clinical outcomes. Further investigation of suitable interventions to reduce portion sizes and improve both staff and patient perceptions of the importance of food in hospital is recommended.

A definition of food literacy and its components

This chapter defines food literacy and its components using the empirical data collected in two studies undertaken in 2010 and 2011 as part of the author’s PhD thesis. The first was a Delphi study of Australian food experts and the second was a study of young adults across a spectrum of disadvantage. Defining food literacy and identifying its components was an iterative process. At different times throughout the research, each study informed the other. This chapter will describe the components of food literacy, the data used to identify them and how they combined to produce a definition of food literacy.

Hospital social work in Australia: Emerging trends or more of the same?

Social work in health care has been established for more than 100 years and is one of the largest areas of practice for social workers. Over time, demographic changes and growth in the aging population, increased longevity rates, an explosion in rates of chronic illness together with rapidly increasing cost of health care have created serious challenges for acute hospitals and health social workers. This article reviews the Australian health care system and policies with particular emphasis on the public hospital system. It then examines current hospital social work roles, including the continued role in discharge planning and expanding responsibility for emerging client problems, such as patient complexity, legal, and carer issues. The article concludes with a discussion of evolving issues and challenges facing health social work to ensure that social work remain relevant within this practice context.

From environmental concerns towards sustainable food provisioning. : Material flow and food consumption scenario studies on sustainability of agri-food systems

Agriculture is an economic activity that heavily relies on the availability of natural resources. Through its role in food production agriculture is a major factor affecting public welfare and health, and its indirect contribution to gross domestic product and employment is significant. Agriculture also contributes to numerous ecosystem services through management of rural areas. However, the environmental impact of agriculture is considerable and reaches far beyond the agroecosystems. The questions related to farming for food production are, thus, manifold and of great public concern. Improving environmental performance of agriculture and sustainability of food production, sustainabilizing food production, calls for application of wide range of expertise knowledge. This study falls within the field of agro-ecology, with interphases to food systems and sustainability research and exploits the methods typical of industrial ecology. The research in these fields extends from multidisciplinary to interdisciplinary and transdisciplinary, a holistic approach being the key tenet. The methods of industrial ecology have been applied extensively to explore the interaction between human economic activity and resource use. Specifically, the material flow approach (MFA) has established its position through application of systematic environmental and economic accounting statistics. However, very few studies have applied MFA specifically to agriculture. The MFA approach was used in this thesis in such a context in Finland. The focus of this study is the ecological sustainability of primary production. The aim was to explore the possibilities of assessing ecological sustainability of agriculture by using two different approaches. In the first approach the MFA-methods from industrial ecology were applied to agriculture, whereas the other is based on the food consumption scenarios. The two approaches were used in order to capture some of the impacts of dietary changes and of changes in production mode on the environment. The methods were applied at levels ranging from national to sector and local levels. Through the supply-demand approach, the viewpoint changed between that of food production to that of food consumption. The main data sources were official statistics complemented with published research results and expertise appraisals. MFA approach was used to define the system boundaries, to quantify the material flows and to construct eco-efficiency indicators for agriculture. The results were further elaborated for an input-output model that was used to analyse the food flux in Finland and to determine its relationship to the economy-wide physical and monetary flows. The methods based on food consumption scenarios were applied at regional and local level for assessing feasibility and environmental impacts of relocalising food production. The approach was also used for quantification and source allocation of greenhouse gas (GHG) emissions of primary production. GHG assessment provided, thus, a means of crosschecking the results obtained by using the two different approaches. MFA data as such or expressed as eco-efficiency indicators, are useful in describing the overall development. However, the data are not sufficiently detailed for identifying the hot spots of environmental sustainability. Eco-efficiency indicators should not be bluntly used in environmental assessment: the carrying capacity of the nature, the potential exhaustion of non-renewable natural resources and the possible rebound effect need also to be accounted for when striving towards improved eco-efficiency. The input-output model is suitable for nationwide economy analyses and it shows the distribution of monetary and material flows among the various sectors. Environmental impact can be captured only at a very general level in terms of total material requirement, gaseous emissions, energy consumption and agricultural land use. Improving environmental performance of food production requires more detailed and more local information. The approach based on food consumption scenarios can be applied at regional or local scales. Based on various diet options the method accounts for the feasibility of re-localising food production and environmental impacts of such re-localisation in terms of nutrient balances, gaseous emissions, agricultural energy consumption, agricultural land use and diversity of crop cultivation. The approach is applicable anywhere, but the calculation parameters need to be adjusted so as to comply with the specific circumstances. The food consumption scenario approach, thus, pays attention to the variability of production circumstances, and may provide some environmental information that is locally relevant. The approaches based on the input-output model and on food consumption scenarios represent small steps towards more holistic systemic thinking. However, neither one alone nor the two together provide sufficient information for sustainabilizing food production. Environmental performance of food production should be assessed together with the other criteria of sustainable food provisioning. This requires evaluation and integration of research results from many different disciplines in the context of a specified geographic area. Foodshed area that comprises both the rural hinterlands of food production and the population centres of food consumption is suggested to represent a suitable areal extent for such research. Finding a balance between the various aspects of sustainability is a matter of optimal trade-off. The balance cannot be universally determined, but the assessment methods and the actual measures depend on what the bottlenecks of sustainability are in the area concerned. These have to be agreed upon among the actors of the area

How much land-based greenhouse gas mitigation can be achieved without compromising food security and environmental goals?

Feeding 9-10billion people by 2050 and preventing dangerous climate change are two of the greatest challenges facing humanity. Both challenges must be met while reducing the impact of land management on ecosystem services that deliver vital goods and services, and support human health and well-being. Few studies to date have considered the interactions between these challenges. In this study we briefly outline the challenges, review the supply- and demand-side climate mitigation potential available in the Agriculture, Forestry and Other Land Use AFOLU sector and options for delivering food security. We briefly outline some of the synergies and trade-offs afforded by mitigation practices, before presenting an assessment of the mitigation potential possible in the AFOLU sector under possible future scenarios in which demand-side measures codeliver to aid food security. We conclude that while supply-side mitigation measures, such as changes in land management, might either enhance or negatively impact food security, demand-side mitigation measures, such as reduced waste or demand for livestock products, should benefit both food security and greenhouse gas (GHG) mitigation. Demand-side measures offer a greater potential (1.5-15.6Gt CO2-eq. yr(-1)) in meeting both challenges than do supply-side measures (1.5-4.3Gt CO2-eq. yr(-1) at carbon prices between 20 and 100US$ tCO(2)-eq. yr(-1)), but given the enormity of challenges, all options need to be considered. Supply-side measures should be implemented immediately, focussing on those that allow the production of more agricultural product per unit of input. For demand-side measures, given the difficulties in their implementation and lag in their effectiveness, policy should be introduced quickly, and should aim to codeliver to other policy agenda, such as improving environmental quality or improving dietary health. These problems facing humanity in the 21st Century are extremely challenging, and policy that addresses multiple objectives is required now more than ever.

A study of women's participation in fish food security and poverty alleviation in Lagos and Ogun States

Women, all over the world have contributed in various ways to the social, political and economic development of the Society. In fact, the World Resource Institute recognizes that "women have profound and preserve effect onn the well-being of their families, communities and local ecosystems" (Gamble and Well 1997:211). Women constitute more than 50 percent of the Agricultural (Fisheries being a sub sector), labour force. A study on Women in Fisheries showed that they participate in all aspects of the sector (capture, culture, processing, marketing research, training and Extension services). This paper reports the result of the study on women's contributions in the development of the Fisheries Industry particularly their roles in Fish Food Security, Poverty Alleviation and high rates of women's adoption of Fisheries technologies. The Case-study research methodology is used to study the "How" and "Why" Women's Contribution in Fish Food Security and Poverty Alleviation is at the index level recorded for the gender. The study made use of "Case Study" Research Instrument; documents, interview, artefacts, direct observation and archival records. The sampling techniques were purposive for research audiences and simple random for fisher-folks in the chosen locations. Analysed data showed among others that in Fisheries Research women occupy very important positions as Heads of Division/Section, Fisheries Liasion/Extension Officers and Fisheries Laboratory Chiefs etc. The paper also gave results of women production, processing, marketing and other services statistics; it also discusses the "whys" of women's low capacity in fisheries development of the nation and finally suggested ways in improving women's optimal capacity utilization in fisheries development

Alterations of the global water cycle and their effects on river structure, function and services

River structure and functioning are governed naturally by geography and climate but are vulnerable to natural and human-related disturbances, ranging from channel engineering to pollution and biological invasions. Biological communities in river ecosystems are able to respond to disturbances faster than those in most other aquatic systems. However, some extremely strong or lasting disturbances constrain the responses of river organisms and jeopardise their extraordinary resilience. Among these, the artificial alteration of river drainage structure and the intense use of water resources by humans may irreversibly influence these systems. The increased canalisation and damming of river courses interferes with sediment transport, alters biogeochemical cycles and leads to a decrease in biodiversity, both at local and global scales. Furthermore, water abstraction can especially affect the functioning of arid and semi-arid rivers. In particular, interception and assimilation of inorganic nutrients can be detrimental under hydrologically abnormal conditions. Among other effects, abstraction and increased nutrient loading might cause a shift from heterotrophy to autotrophy, through direct effects on primary producers and indirect effects through food webs, even in low-light river systems. The simultaneous desires to conserve and to provide ecosystem services present several challenges, both in research and management.

Gerenciamento de resíduos químicos em ambientes hospitalares: necessidades e dificuldades - estudo de caso: Hospital Universitário Federal localizado no Estado do Rio de Janeiro.

O tema do presente estudo é o gerenciamento de resíduos químicos em ambientes hospitalares. Os resíduos químicos são gerados nas atividades auxiliares dos estabelecimentos prestadores de serviços de saúde, tais como hospitais, laboratórios, serviços de diagnóstico e tratamento, centros de saúde, clínicas, institutos de medicina legal e outros. Dentre todos, os hospitais, por suas características de atendimento, são, sem dúvida, os maiores geradores deste tipo de resíduo. Controlar e diminuir os riscos inerentes a este tipo de resíduos, além de ser uma exigência legal, passa a ser uma necessidade ambiental e um desafio a ser enfrentado pelos administradores de estabelecimentos assistenciais à saúde. O objetivo geral desta pesquisa passa então por avaliar o gerenciamento dos resíduos químicos gerados nos hospitais públicos da região metropolitana do Estado do Rio de Janeiro, abordando às necessidades e dificuldades enfrentadas por estes geradores que incluí aspectos políticos, administrativos, econômicos e em alguns casos físico-estruturais. Para atingir tal objetivo o método empregado foi dividido em duas etapas: I) Pesquisa Aplicada, onde foram visitados alguns hospitais públicos do Estado e utilizou-se um questionário para avaliar as questões relacionadas com o gerenciamento de resíduos químicos e II) Estudo de Caso, onde se considerou, através de observações e entrevistas, o gerenciamento de resíduos químicos de um hospital universitário de grande porte de maneira efetiva. Foram utilizadas como fontes secundárias informações obtidas em seminários relacionados ao tema, reportagens de jornais e entrevistas publicadas em fontes especializadas. Os resultados obtidos mostram que as dificuldades enfrentadas no gerenciamento de RSS, inclusos neste grupo os resíduos químicos, é uma realidade para a maioria dos hospitais da rede pública. Conclusão: o maior problema a ser enfrentado por estas instituições está diretamente ligado à conscientização, ou melhor, a falta de conscientização, de funcionários, médicos e gerência dos hospitais, quanto à importância da correta segregação, armazenagem e manuseio destes resíduos. Além disso, a falta de recursos financeiros e, em alguns casos, até de espaço físico também dificulta o efetivo gerenciamento deste tipo de resíduos. Problemas secundários relacionam-se com a falta de fiscalização dos órgãos sanitário-ambientais competentes e o descaso da própria população que não atenta para os problemas ambientais e de saúde e segurança, decorrentes de um incorreto gerenciamento não só dos resíduos químicos, mas de todos os resíduos de serviço de saúde. Como recomendação, pode-se dizer que se faz necessária uma maior mobilização por parte dos estabelecimentos hospitalares para a discussão e atendimento das legislações aplicáveis e também, o desenvolvimento de uma estrutura gerencial com responsabilidades definidas e ações planejadas, compatíveis com a realidade do serviço público, e que possam levar a alcançar os objetivos e metas de um gerenciamento dos resíduos de serviço de saúde.