Vårdpersonalens kunskapsläge i hjärtlungräddning samt följsamhet till det svenska hjärtlungräddningsregistret på ett länssjukhus i Mellansverige : En kvantitativ tvärsnittsstudie

Syfte: Att kartlägga vårdpersonalens kunskapsläge samt utbildningsfrekvens i hjärtlungräddning på ett länssjukhus i Mellansverige, samt beskriva följsamheten till att registrera behandlade hjärtstopp till det svenska hjärt-lungräddningsregistret. Metod: Enkätstudie med kvantitativ ansats bestående av 177 respondenter samt även som en retrospektiv observationsstudie. Huvudresultat: Enskilda personer svarade rätt på alla kunskapsfrågorna men som grupp fanns det brister i kunskapen i hjärtlungräddning. Då man jämförde vårdpersonalens kunskap påvisades att i fyra av sju kunskapsfrågor fanns en signifikant skillnad i kunskap mellan den vårdpersonal som har mer regelbunden utbildning, än den som har mindre. De som hade mer regelbunden utbildning hade flera rätt. En signifikant skillnad påvisades även beroende på när man hade haft sin senaste HLR-utbildning, där de som haft sin utbildning nyligen hade flera rätt. Följsamheten hos vårdpersonalen till att registrera patienter som behandlats för hjärtstopp på sjukhus till det svenska hjärt-lungräddningsregistret, kan sammanfattas med att det brister i rapporteringen. Konklusion: Det är viktigt att skapa förutsättningar för frekventa utbildningar till vårdpersonal för att öka kunskap och beredskap i hjärt- och lungräddning, vilket även kan ses som ett kvalitetssäkringsarbete. Ett förbättringsarbete är nödvändigt för att förbättra följsamheten till registreringen.

Nurses’ and patients’ communication in smoking cessation at nurse-led COPD clinics in primary health care

Background: Smokers with chronic obstructive pulmonary disease (COPD) have high nicotine dependence making it difficult to quit smoking. Motivational interviewing (MI) is a method that is used in stimulating motivation and behavioral changes. Objective: To describe smoking cessation communication between patients and registered nurses trained in MI in COPD nurse-led clinics in Swedish primary health care. Methods: A prospective observational study with structured quantitative content analyses of the communication between six nurses with basic education in MI and 13 patients in non-smoking consultations. Results: Only to a small extent did nurses’ evoke patients’ reasons for change, stimulate collaboration, and support patients’ autonomy. Nurses provided information, asked closed questions, and made simple reflections. Patients’ communicationwasmainly neutral and focusing on reasons for and against smoking. It was uncommon for patients to be committed and take steps toward smoking cessation. Conclusion: The nurses did not adhere to the principles of MI in smoking cessation, and the patients focused to a limited extent on how to quit smoking. Practice implications: To make patients more active, the nurses need more education and continuous training in motivational communication.

Internal validity of the Swedish Maternal Health Care Register

Background: The Swedish Maternal Health Care Register (MHCR) is a national quality register that has been collecting pregnancy, delivery, and postpartum data since 1999. A substantial revision of the MHCR resulted in a Web-based version of the register in 2010. Although MHCR provides data for health care services and research, the validity of the MHCR data has not been evaluated. This study investigated degree of coverage and internal validity of specific variables in the MHCR and identified possible systematic errors. Methods: This cross-sectional observational study compared pregnancy and delivery data in medical records with corresponding data in the MHCR. The medical record was considered the gold standard. The medical records from nine Swedish hospitals were selected for data extraction. This study compared data from 878 women registered in both medical records and in the MHCR. To evaluate the quality of the initial data extraction, a second data extraction of 150 medical records was performed. Statistical analyses were performed for degree of coverage, agreement and correlation of data, and sensitivity and specificity. Results: Degree of coverage of specified variables in the MHCR varied from 90.0% to 100%. Identical information in both medical records and the MHCR ranged from 71.4% to 99.7%. For more than half of the investigated variables, 95% or more of the information was identical. Sensitivity and specificity were analysed for binary variables. Probable systematic errors were identified for two variables. Conclusions: When comparing data from medical records and data registered in the MHCR, most variables in the MHCR demonstrated good to very good degree of coverage, agreement, and internal validity. Hence, data from the MHCR may be regarded as reliable for research as well as for evaluating, planning, and decision-making with respect to Swedish maternal health care services.

Observation of pain assessment and management- the complexities of clinical practice

• Pain assessment and management are complex issues that embrace physiological, emotional, cognitive, and social dimensions.

• This observational study sought to investigate nurse–patient interactions associated with pain assessment and management in hospitalized postsurgical patients in clinical practice settings.

• Twelve field observations were carried out on Registered Nurses' activities relating to pain with their assigned patients. All nurses were involved in direct patient care in one surgical unit of a metropolitan teaching hospital in Melbourne, Australia. Six observation times were identified as key periods for activities relating to pain, which included change of shift and high activity periods. Each observation period lasted 2 hours and was examined on two occasions.

• Four major themes were identified as barriers to effective pain management: nurses' responses to interruptions of activities relating to pain, nurses' attentiveness to patient cues of pain, nurses' varying interpretations of pain, and nurses' attempts to address competing demands of nurses, doctors and patients.

• These findings provide some understanding of the complexities impacting on nurses' assessment and management of postoperative pain. Further research using this observational methodology is indicated to examine these influences in more depth. This knowledge may form the basis for developing and evaluating strategic intervention programmes that analyse nurses' management of postoperative pain and, in particular, their administration of opioid analgesics.

Dietary composition of pregnant women is related to size of the baby at birth

The fetal origins theory of adult disease suggests that term infants who are small for their gestational age have an increased susceptibility to chronic disease in adulthood as a consequence of physiologic adaptations to undernutrition during fetal life. Consistent evidence for an influence of women's dietary composition during pregnancy on growth of their babies is lacking, despite robust effects in animal experiments. We undertook a prospective observational study of 557 women aged 18-41 y, living in Adelaide, South Australia. Diet was assessed in early and late pregnancy using an FFQ. In early pregnancy, medians for energy intake, the proportion of energy derived from protein and from carbohydrate were 9.0 MJ, 17 and 48%, respectively. In late pregnancy the corresponding medians were 9.2 MJ, 16 and 49%. In early pregnancy, the percentage of energy derived from protein was positively associated with birth weight (P = 0.02) and placental weight (P = 0.07), independently of energy intake and weight gain during pregnancy, and after adjustment for potential confounders, including maternal age, parity, and smoking. Effects were stronger among women (n = 429) who had reliable data, based on prespecified criteria including the plausibility of dietary data when referenced against estimated energy expenditure. In addition, for this subgroup, the percentage of energy from carbohydrate in early and late pregnancy was negatively associated with ponderal index of the baby, and a specific effect of protein from dairy sources was identified. These data support the proposition that maternal dietary composition has an effect on fetal growth. Maternal diet in Western societies may therefore be important for the long-term health of the child.

Association between obesity and diabetes using nested linear models

A data source with 7260 cases from the prospective observational study was used. Cases included both sexes and age ranging between 20yr and 7Oyr. Chi-squared tests and linear models were used to examine the effects of age (linear and quadratic), sex, smoking habit (currently a smoker or non-smoker), presence or absence of type 2 diabetes on obesity as measured by body mass index (BMI) and waist to hip ratio (WHR). Both these measures of
obesity were significantly affected by age, sex and the presence of diabetes. Cases with diabetes were significantly more obese (10%) between the ages 40yr to 59yr compared to patients without diabetes. These results accentuate the need to further examine the association between age, diabetes and obesity and other risk factors with cardiovascular diseases.

Associations between the physical and social environment and depressive symptomology among Australian adolescents

Depression is a significant public health issue among Australian adolescents. A number of family, school and community level factors have been identified as important determinants of adolescent's health and well-being, including depression. This study examines associations between measures of the social and physical environment and adolescent mental health, specifically depressive symptomotology using data from the Healthy Neighbourhoods study, a large observational study carried out in 231 Australian schools stratified by socioeconomic quartiles and urban/non-urban geography, which focuses on adolescent health and well-being. Participants were 8256 year 6 and 8
students (48% male), aged 11-16 years (M = 11.6, SD = 0.8 years) from schools across Victoria,Queensland and Western Australia who completed a comprehensive on-line survey. Data collected included the Short Mood and Feeling Questionnaire (SMFQL a tool for assessing depressive symptomotology in adolescents. Results showed that the mean total depression score (possible range 0-26 with total scores;:: 8 used as the cutoff for depression symptomotology) was 6.4 (SD = 5.9), with scores for females (M = 6.8, SD = 6.3) higher than those for males (M = 5.9, SD = 5.5), and scores for year 8 students (M = 6.7,SD = 6.1) higher than those for year 6 students (M = 6.2, SD = 5.8) (p < .001). Greater access to sporting and play equipment, local parks, and more functional neighbourhoods for walking and jogging reduced the odds for depressive symptomotology (p < .05L while increased levels of abandoned homes, and higher levels of fighting within the neighbourhood, and fewer scout/guide clubs, local teams to play sport, and adults in the neighbourhood to talk with, as well as reduced neighbourhood safety increased the odds for depressive symptomotology (p < .05). These findings support the important role of physical and social environments in influencing adolescent health and well-being. Modifications to particular aspects of these environments at the community level may assist in providing adolescents some protection from depression.

Statphylococcus aureus bacteraemia : a major cause of mortaility in Australia and New Zealand

Objective : To document the types of, and mortality from, Staphylococcus aureus bacteraemia in Australia and New Zealand, and determine factors associated with mortality.

Design and setting : Prospective observational study in 27 independent or hospital pathology laboratories in Australia (24) and New Zealand (3), employing a web-based database to prospectively record demographic features, selected risk factors, principal antibiotic treatment and mortality data on all patients with positive blood cultures for S. aureus from June 2007 to May 2008.

Main outcome measure : 30-day all-cause mortality.

Results : 1994 episodes of S. aureus bacteraemia were identified, and complete 30-day follow-up data were available for 1865. Most episodes had their onset in the community (60.8%; 95% CI, 58.7%–63.0%). Methicillin-resistant S. aureus (MRSA) caused 450 episodes (24.1%; 95% CI, 22.2%–25.9%), and 123 of these (27.3%) had a susceptibility profile consistent with community-associated MRSA. All-cause mortality at 30 days was 20.6% (95% CI, 18.8%–22.5%). On univariate analysis, increased mortality was significantly associated with older age, European ethnicity, MRSA infection, infections not originating from a medical device, sepsis syndrome, pneumonia/empyema, and treatment with a glycopeptide or other non-β-lactam antibiotic. On multivariable analysis, independent predictors of mortality were age, sepsis syndrome, pneumonia/empyema, device-associated infection with a secondary focus, left-sided endocarditis, and treatment with a glycopeptide such as vancomycin, but not MRSA infection.

Conclusions : S. aureus bacteraemia is a common infection in both the community and hospitals in Australia and New Zealand, and is associated with appreciable mortality. Invasive MRSA infection may be more life-threatening, partly because of the inferior efficacy of the standard treatment, vancomycin. National web-based surveillance of S. aureus bacteraemia and its outcomes is not only important but also easily achievable.

Has the ban on smoking in New South Wales restaurants worked? A comparison of restaurants in Sydney and Melbourne

Objective: To evaluate compliance with a legislative ban on smoking inside restaurants by comparing smoking in Sydney restaurants (where it is legally banned) with smoking in Melbourne restaurants (not subject to a legal ban).

Design and participants: Unobtrusive observational study of restaurant patrons, and interviews with restaurant staff, carried out by 159 volunteers.

Setting: 78 Sydney restaurants with smoke-free indoor environments (as required by legislation) and 81 Melbourne restaurants not subject to legislation preventing smoking. The study took place from 20-31 October 2000.

Intervention: Legislation to ban smoking in indoor areas of restaurants was introduced in New South Wales in September 2000 (about six weeks before our study).

Outcomes: Observed incidents of smoking inside restaurants; staff attitudes to the ban; customer satisfaction as indicated by comments to staff; staff perceptions of restaurant patronage.

Results: No restaurant patrons were seen smoking in 78 Sydney restaurants during 156 hours of observation of 2646 diners, compared with 176 smokers among 3014 Melbourne diners over 154 hours of observation. Thirty-one per cent (24/78) of Sydney restaurants had experienced smokers attempting to smoke indoors after the legislation was introduced; 6% (5/78) reported instances of smokers refusing to stop smoking when asked; 79% (62/78) of restaurants had received favourable comments from patrons about the smoke-free law; 81% (63/78) of restaurant staff interviewed either supported or strongly supported the law. Since introduction of the legislation, 76% of restaurants reported normal trade, 14% increased trade, and 9% reduced trade.

Conclusions: Smoke-free restaurants do not require "smoking police" to enforce bans, present few ongoing difficulties for staff, attract many more favourable than unfavourable comments from patrons, and do not adversely affect trade.

Investigation of the effects of microcomputers on the work of professional accountants

Information technology research over the past two decades suggests that the installation and use of computers fundamentally affects the structure and function of organisations and, m particular, the workers in these organizations. Following the release of the IBM Personal Computer in 1982, microcomputers have become an integral part of most work environments. The accounting services industry, in particular, has felt the impact of this ‘microcomputer revolution’. In Big Six accounting firms, there is almost one microcomputer for each professional accountant employed, Notwithstanding this, little research has been done on the effect of microcomputers on the work outcomes of professional accountants working in these firms. This study addresses this issue. It assesses, in an organisational setting, how accountant’ perceptions of ease of use and usefulness of microcomputers act on their computer anxieties, microcomputer attitudes and use to affect their job satisfaction and job performance. The research also examines how different types of human-computer interfaces affect the relationships between accountants' beliefs about microcomputer utility and ease of use, computer anxiety, microcomputer attitudes and microcomputer use. To attain this research objective, a conceptual model was first developed, The model indicates that work outcomes (job satisfaction and job performance) of professional accountants using microcomputers are influenced by users' perceptions of ease of use and usefulness of microcomputers via paths through (a) the level of computer anxiety experienced by users, (b) the general attitude of users toward using microcomputers, and (c) the extent to which microcomputers are used by individuals. Empirically testable propositions were derived from the model to test the postulated relationships between these constructs. The study also tested whether or not users of different human-computer interfaces reacted differently to the perceptions and anxieties they hold about microcomputers and their use in the workplace. It was argued that users of graphical interfaces, because of the characteristics of those interfaces, react differently to their perceptions and anxieties about microcomputers compared with users of command-line (or textual-based) interfaces. A passive-observational study in a field setting was used to test the model and the research propositions. Data was collected from 164 professional accountants working in a Big Six accounting firm in a metropolitan city in Australia. Structural equation modelling techniques were used to test the, hypothesised causal relationships between the components comprising the general research model. Path analysis and ordinary least squares regression was used to estimate the parameters of the model and analyse the data obtained. Multisample analysis (or stacked model analysis) using EQS was used to test the fit of the model to the data of the different human-computer interface groups and to estimate the parameters for the paths in those different groups. The results show that the research model is a good description of the data. The job satisfaction of professional accountants is directly affected by their attitude toward using microcomputers and by microcomputer use itself. However, job performance appears to be only directly affected by microcomputer attitudes. Microcomputer use does not directly affect job performance. Along with perceived ease of use and perceived usefulness, computer anxiety is shown to be an important determinant of attitudes toward using microcomputers - higher levels of computer anxiety negatively affect attitudes toward using microcomputers. Conversely, higher levels of perceived ease of use and perceived usefulness heighten individuals' positive attitudes toward using microcomputers. Perceived ease of use and perceived usefulness also indirectly affect microcomputer attitudes through their effect on computer anxiety. The results show that higher levels of perceived ease of use and perceived usefulness result in lower levels of computer anxiety. A surprising result from the study is that while perceived ease of use is shown to directly affect the level of microcomputer usage, perceived usefulness and attitude toward using microcomputers does not. The results of the multisample analysis confirm that the research model fits the stacked model and that the stacked model is a significantly better fit if specific parameters are allowed to vary between the two human-computer interface user groups. In general, these results confirm that an interaction exists between the type of human-computer interface (the variable providing the grouping) and the other variables in the model The results show a clear difference between the two groups in the way in which perceived ease of use and perceived usefulness affect microcomputer attitude. In the case of users of command-line interfaces, these variables appear to affect microcomputer attitude via an intervening variable, computer anxiety, whereas in the graphical interface user group the effect occurs directly. Related to this, the results show that perceived ease of use and perceived usefulness have a significant direct effect on computer anxiety in command-line interface users, but no effect at all for graphical interface users. Of the two exogenous variables only perceived ease of use, and that in the case of the command-line interface users, has a direct significant effect on extent of use of microcomputers. In summary, the research has contributed to the development of a theory of individual adjustment to information technology in the workplace. It identifies certain perceptions, anxieties and attitudes about microcomputers and shows how they may affect work outcomes such as job satisfaction and job performance. It also shows that microcomputer-interface types have a differential effect on some of the hypothesised relationships represented in the general model. Future replication studies could sample a broader cross-section of the microcomputer user community. Finally, the results should help Big Six accounting firms to maximise the benefits of microcomputer use by making them aware of how working with microcomputers affects job satisfaction and job performance.

Interrelations between ceruloplasmin and Fe status during human pregnancy

It is well established that Fe and ceruloplasmin interact in animals and in in vitro models. However, Fe-mediated regulation of ceruloplasmin has never been investigated in humans. In an observational study, 53 pregnant women aged 19-39 yr (29.8±0.7 yr, mean ± SEM) were recruited at the Aberdeen Antenatal Clinic, Aberdeen Maternity Hospital, UK. All requirements for local ethical committees were followed. Venous blood samples were taken from each woman at 34 wk gestation for measurement of Fe status and ceruloplasmin. Various parameters were used to test for Fe status. The most sensitive one appeared to be soluble transferrin receptor, which increased with parity. In the population studied, there was no relationship between hemoglobin or ferritin and serum ceruloplasmin. However, using soluble transferrin receptor (sTfR) levels, we were able to demonstrate an inverse linear relationship (r=0.37, p=0.021, n=41) between Fe status and ceruloplasmin. Fe supplementation, number of previous pregnancies, and smoking habits did not affect this relationship. Our data support in vitro results showing regulation of ceruloplasmin by Fe and also suggest that the interactions between Fe and ceruloplasmin should be considered when Fe supplementation is given.

Intention to claim a Medicare rebate among women receiving private Victorian pregnancy termination service

Objectives: To determine the proportion of women who have pregnancy terminations as private patients in Victoria who do not intend to claim a procedure fee rebate from Medicare, to compare characteristics of women who intend to submit a Medicare claim with those who do not and to compare the findings to the results from a similar study conducted in NSW in 1992.

Design, setting and participants: This was a cross-sectional observational study over a 12-week period. Women having a pregnancy termination service in eight large Victorian private clinics were invited to complete a brief written questionnaire.

Outcome measurer: The proportion of women who did not have a Medicare card or who had a Medicare card but did not intend to use it to claim from Medicare.

Results: Of the 1,329 women who responded, 13.1% either did not have a Medicare card or did not intend to use their card to claim a Medicare rebate. A further 20.7% of respondents were not sure about whether they would submit a claim. Women who intended to claim a Medicare rebate were different from women who did not according to age, language spoken at home, residency, citizenship and distance travelled to the service. These results are very similar to the findings from the 1992 NSW study.

Conclusion: Between 13.1% and 33.8% of private Victorian pregnancy terminations were estimated to not be recorded at the Health Insurance Commission. Health Insurance Commission records of Medicare rebate claims for pregnancy terminations are an incomplete and somewhat biased record of the services that are provided and are likely to have been so for some time.

Travel undertaken by women accessing private Victorian pregnancy termination services

Objective: To investigate the extent and cost of travel undertaken by women accessing Victorian termination of pregnancy services.

Design, setting and participants: This was a multi-centre, cross-sectional observational study of women receiving privately funded pregnancy termination services, conducted between November 2002 and June 2003 at eight major pregnancy termination service providers in Victoria.

Main outcome measures: Distance travelled, money and time expended undertaking travel, and reasons women chose particular clinics.

Results: Of the 1,244 Australian resident respondents who resided in Victoria, 9.3% travelled more than 100 km to access services. Teenagers were 2.5 times more likely than other respondents to travel further than 100 kilometres (km) (18.2% compared with 7.8%, OR=2.5, 95% CI 1.5-4.2, p<0.001). Women originated from all Australian States and Territories except South Australia and 13.7% were from Statistical Divisions other than Melbourne. More than one-third of respondents (41.3%) chose their clinic because they were referred by a doctor or general practitioner.

Conclusion: Many pregnancy termination patients face substantial and immediate costs beyond the service fee, as well as the diffculties associated with poor continuity of care and signifcant time away from home. Patients and service providers should be consulted further to determine appropriate clinical services, support services and subsidy schemes for the sizeable proportion of patients who undertake long-distance travel to access pregnancy termination services.

Gender differences in personal, social and environmental influences on active travel to and from school for Australian adolescents

Active travel (walking or cycling for transport) is an important contributor to adolescents overall physical activity (PA). This study examines associations between personal, social and environmental variables and active travel to and from school using data from a large observational study to examine active travel in 2961 year 6 and 8 students (48.7% male), aged 10–14 years (M = 11.4, SD = 0.8 yrs) from 231 schools. Participants completed an on-line survey and all reported living within 2 km of school. Data collected included mode of travel to and from school, self-reported health, and PA variables. Social environmental variables included having playgrounds, parks or gyms close by, feeling safe to walk alone, barriers to walking in the neighbourhood (e.g. traffic, no footpaths), peer and family support for PA, existence of sports teams/scout groups, community disorder and perceived neighbourhood safety. Results showed that while more girls (44.3%) than boys (37.4%) walked to school, lower proportions rode bikes (8.3% vs 22.4%) and hence fewer were active travellers overall. Logistic regression models, adjusted for age, location and socio-economic status were conducted for active travel to/from school, separately for boys and girls. Predictors for boys and girls being ‘active travellers’ to/from school included recreational facilities close to home, higher perceived safety of the neighbourhood and higher community disorder. For boys, social support from friends, scout groups available and higher enjoyment of physical activity was also important. These findings suggest areas for future research and may be used to guide strategies to increase active travel to and from school.

The prevalence of work-related deaths associated with alcohol and drugs in Victoria, Australia, 2001 - 6

To describe the presence of alcohol, cannabis and amphetamines in work-related injury deaths in Victoria, 2001–6, an observational study of work-related deaths reported to the State Coroner's Office, Victoria, Australia was conducted. Case and postmortem forensic toxicology data were obtained from the National Coroner's Information System for work-related injury deaths with positive toxicology screens. Over 6 years there were 43 worker deaths in a total of 355 unintentional work-related injury deaths. The coroner mentioned the presence of alcohol/drugs in 22 of the 43 worker deaths with positive toxicology screens. Toxicology screens were positive for alcohol and/or drugs in 79 work-related deaths overall. Overall, alcohol was present in 26 (7%) work-related deaths and cannabis or amphetamines in 20 (6%). Incidents were mainly transport related. Alcohol and/or drugs were present in a significant portion of work-related deaths. Research is needed to determine the relative contribution of alcohol and drugs compared with other contributing factors to work-related deaths.