Past, present and the evolving future of public health and health promotion: Reflections on dismantling in Queensland Australia

Objective For more than ten years the public health and health promotion workforce in the Australian state of Queensland grew dramatically. This growth was most pronounced in the disciplines of Health Promotion and in Public Health Nutrition, both regionally and corporately. In 2012 political change led to an abrupt dismantling of its public and preventive health services across the state. Individual responsibility was declared. Method This presentation provides a qualitative narrative description of past achievements and activities, the current situation and provides a perspective towards the future. Findings Government reports over several years described the growing burden of chronic disease arising from conditions such as obesity, physical inactivity, and poor nutrition in Queensland. By 2008, obesity had overtaken smoking as the single greatest risk factor to the health of Queenslanders. In 2010, the Chief Health Officer called for an increased focus on prevention to address the continuing need for more beds in hospitals. However, with political change in 2012 resulted in the dismantling and dismissal of preventive health services across the state. The following year, despite outcry, sexual health services were also axed. At present, outbreaks of vaccine preventable diseases such as measles are occurring. The epidemics of chronic disease, obesity and physical inactivity continue to grow. Conclusion The evolution of public health is not necessarily progressive, but cyclic. Challenges include political change, health practice and the interplay of health policy. A lack of an embedded emphasis on systematic review translation is one potential contributor. Perhaps the warning of Lang & Rayner should be heeded: “public health proponents have allowed themselves to be corralled into the narrow language of individualism and choice”.

Depression in Working Adults: Comparing the Costs and Health Outcomes of Working When Ill

Objective Working through a depressive illness can improve mental health but also carries risks and costs from reduced concentration, fatigue, and poor on-the-job performance. However, evidence-based recommendations for managing work attendance decisions, which benefit individuals and employers, are lacking. Therefore, this study has compared the costs and health outcomes of short-term absenteeism versus working while ill (“presenteeism”) amongst employed Australians reporting lifetime major depression. Methods Cohort simulation using state-transition Markov models simulated movement of a hypothetical cohort of workers, reporting lifetime major depression, between health states over one- and five-years according to probabilities derived from a quality epidemiological data source and existing clinical literature. Model outcomes were health service and employment-related costs, and quality-adjusted-life-years (QALYs), captured for absenteeism relative to presenteeism, and stratified by occupation (blue versus white-collar). Results Per employee with depression, absenteeism produced higher mean costs than presenteeism over one- and five-years ($42,573/5-years for absenteeism, $37,791/5-years for presenteeism). However, overlapping confidence intervals rendered differences non-significant. Employment-related costs (lost productive time, job turnover), and antidepressant medication and service use costs of absenteeism and presenteeism were significantly higher for white-collar workers. Health outcomes differed for absenteeism versus presenteeism amongst white-collar workers only. Conclusions Costs and health outcomes for absenteeism and presenteeism were not significantly different; service use costs excepted. Significant variation by occupation type was identified. These findings provide the first occupation-specific cost evidence which can be used by clinicians, employees, and employers to review their management of depression-related work attendance, and may suggest encouraging employees to continue working is warranted.

Developing and evaluating approaches for utilising injury data to support product safety initiatives

With increasing concern about consumer product-related injuries in Australia, product safety regulators need evidence-based research to understand risks and patterns to inform their decision making. This study analysed paediatric injury data to identify and quantify product-related injuries in children to inform product safety prioritisation. This study provides information on novel techniques for interrogating health data to identify trends and patterns in product-related injuries to inform strategic directions in this growing area of concern.

PM348 Heart education assessment and rehabilitation toolkit: Heart online. A web resource for clinicians

Access to the right information at the right time is a challenge facing health professionals across the globe. HEART Online (www.heartonline.org.au) is a website designed to support the delivery of evidence based care for the prevention and rehabilitation of heart disease. It was developed by the Queensland Government and the National Heart Foundation of Australia and launched May 2013.

A matter of style? Driver attributional 'style' in accounting for the driving of others as protective or as predisposing drivers towards retaliatory aggressive driving

Driver cognitions about aggressive driving of others are potentially important to the development of evidence-based interventions. Previous research has suggested that perceptions that other drivers are intentionally aggressive may influence recipient driver anger and subsequent aggressive responses. Accordingly, recent research on aggressive driving has attempted to distinguish between intentional and unintentional motives in relation to problem driving behaviours. This study assessed driver cognitive responses to common potentially provocative hypothetical driving scenarios to explore the role of attributions in driver aggression. A convenience sample of 315 general drivers 16–64 yrs (M = 34) completed a survey measuring trait aggression (Aggression Questionnaire AQ), driving anger (Driving Anger Scale, DAS), and a proxy measure of aggressive driving behaviour (Australian Propensity for Angry Driving AusPADS). Purpose designed items asked for drivers’ ‘most likely’ thought in response to AusPADS scenarios. Response options were equivalent to causal attributions about the other driver. Patterns in endorsements of attribution responses to the scenarios suggested that drivers tended to adopt a particular perception of the driving of others regardless of the depicted circumstances: a driving attributional style. No gender or age differences were found for attributional style. Significant differences were detected between attributional styles for driving anger and endorsement of aggressive responses to driving situations. Drivers who attributed the on-road event to the other being an incompetent or dangerous driver had significantly higher driving anger scores and endorsed significantly more aggressive driving responses than those drivers who attributed other driver’s behaviour to mistakes. In contrast, drivers who gave others the ‘benefit of the doubt’ endorsed significantly less aggressive driving responses than either of these other two groups, suggesting that this style is protective.

Exploring the usefulness of structural-functional approaches to systematically assess the functionality of governance arrangements for natural resource management planning in two Australian case studies

This research developed and applied an evaluative framework to analyse multiple scales of decision-making for environmental management planning. It is the first exploration of the sociological theory of structural-functionalism and its usefulness to support evidence based decision-making in a planning context. The framework was applied to analyse decision-making in Queensland's Cape York Peninsula and Wet Tropics regions.

Classification of activities of daily living of individual with limb loss

The monitoring of the actual activities of daily living of individuals with lower limb amputation is essential for an evidence-based fitting of the prosthesis, more particularly the choice of components (e.g., knees, ankles, feet)[1-4]. The purpose of this presentation was to give an overview of the categorization of the load regime data to assess the functional output and usage of the prosthesis of lower limb amputees has presented in several publications[5, 6]. The objectives were to present a categorization of load regime and to report the results for a case.

Biomechanical analyses of the performance of Paralympians: From foundation to elite level

Biomechanical analysis of sport performance provides an objective method of determining performance of a particular sporting technique. In particular, it aims to add to the understanding of the mechanisms influencing performance, characterization of athletes, and provide insights into injury predisposition. Whilst the performance in sport of able-bodied athletes is well recognised in the literature, less information and understanding is known on the complexity, constraints and demands placed on the body of an individual with a disability. This paper provides a dialogue that outlines scientific issues of performance analysis of multi-level athletes with a disability, including Paralympians. Four integrated themes are explored the first of which focuses on how biomechanics can contribute to the understanding of sport performance in athletes with a disability and how it may be used as an evidence-based tool. This latter point questions the potential for a possible cultural shift led by emergence of user-friendly instruments. The second theme briefly discusses the role of reliability of sport performance and addresses the debate of two-dimensional and three-dimensional analysis. The third theme address key biomechanical parameters and provides guidance to clinicians, and coaches on the approaches adopted using biomechanical/sport performance analysis for an athlete with a disability starting out, to the emerging and elite Paralympian. For completeness of this discourse, the final theme is based on the controversial issues on the role of assisted devices and the inclusion of Paralympians into able-bodied sport is also presented. All combined, this dialogue highlights the intricate relationship between biomechanics and training of individuals with a disability. Furthermore, it illustrates the complexity of modern training of athletes which can only lead to a better appreciation of the performances to be delivered in the London 2012 Paralympic Games

One step closer into the design of fall protective device for individuals fitted with a bone-anchored prosthesis

The consequences of falls are often dreadful for individuals with lower limb amputation using bone-anchored prosthesis.[1-5] Typically, the impact on the fixation is responsible for bending the intercutaneous piece that could lead to a complete breakage over time. .[3, 5-8] The surgical replacement of this piece is possible but complex and expensive. Clearly, there is a need for solid data enabling an evidence-based design of protective devices limiting impact forces and torsion applied during a fall. The impact on the fixation during an actual fall is obviously difficult to record during a scientific experiment.[6, 8-13] Consequently, Schwartze and colleagues opted for one of the next best options science has to offer: simulation with an able-bodied participant. They recorded body movements and knee impacts on the floor while mimicking several plausible falling scenarios. Then, they calculated the forces and moments that would be applied at four levels along the femur corresponding to amputation heights.[6, 8-11, 14-25] The overall forces applied during the falls were similar regardless of the amputation height indicating that the impact forces were simply translated along the femur. As expected, they showed that overall moments generally increased with amputation height due to changes in lever arm. This work demonstrates that devices preventing only against force overload do not require considering amputation height while those protecting against bending moments should. Another significant contribution is to provide, for the time, the magnitude of the impact load during different falls. This loading range is crucial to the overall design and, more precisely, the triggering threshold of protective devices. Unfortunately, the analysis of only a single able-bodied participant replicating falls limits greatly the generalisation of the findings. Nonetheless, this case study is an important milestone contributing to a better understanding of load impact during a fall. This new knowledge will improve the treatment, the safe ambulation and, ultimately, the quality of life of individuals fitted with bone-anchored prosthesis.

Oral liquid nutritional supplements for people with dementia in residential aged care facilities

AIM: This systematic review investigated the prescription, administration and effectiveness of oral liquid nutritional supplements (OLNS) for people with dementia in residential aged care facilities (RACF). METHODS: A comprehensive search of relevant databases, hand searching and cross-referencing found 15 relevant articles from a total of 2910 possible results. Articles which met the inclusion criteria were critically appraised by two independent reviewers using the relevant Joanna Briggs Institute (JBI) appraisal checklist. Data were extracted using the relevant JBI extraction instruments. No data synthesis was possible due to clinical and methodological heterogeneity. RESULTS: Included studies examined a range of strategies, issues and results related to OLNS for persons with dementia in RACFs; however there appear to be significant gaps in the current body of research, particularly in relation to examinations of effectiveness. CONCLUSIONS: This review was unable to produce a definitive finding regarding effectiveness. OLNS may improve the nutritional state of residents with dementia and help prevent weight loss, and there is some suggestion that it may slow the rate of cognitive decline. However, in order for OLNS to be effective, nursing and care staff need to ensure that sufficient attention is paid to the issues of prescription and administration.