Managing the health effects of temperature in response to climate change : challenges ahead

BACKGROUND: Although many studies have shown that high temperatures are associated with an increased risk of mortality and morbidity, there has been little research on managing the process of planned adaptation to alleviate the health effects of heat events and climate change. In particular, economic evaluation of public health adaptation strategies has been largely absent from both the scientific literature and public policy discussion. OBJECTIVES: his paper aims to discuss how public health organizations should implement adaptation strategies, and how to improve the evidence base for policies to protect health from heat events and climate change. DISCUSSION: Public health adaptation strategies to cope with heat events and climate change fall into two categories: reducing the heat exposure and managing the health risks. Strategies require a range of actions, including timely public health and medical advice, improvements to housing and urban planning, early warning systems, and the assurance that health care and social systems are ready to act. Some of these actions are costly, and the implementation should be based on the cost-effectiveness analysis given scarce financial resources. Therefore, research is required not only on the temperature-related health costs, but also on the costs and benefits of adaptation options. The scientific community must ensure that the health co-benefits of climate change policies are recognized, understood and quantified. CONCLUSIONS: The integration of climate change adaptation into current public health practice is needed to ensure they increase future resilience. The economic evaluation of temperature-related health costs and public health adaptation strategies are particularly important for policy decisions.

The exemplification of governance principles within state asset management laws and policies : the case of Indonesia

Efficient state asset management is crucial for governments as they facilitate the fulfillment of their public functions, which include the provision of essential services and other public administration support. In recent times economies internationally and particularly in South east Asia, have displayed increased recognition of the importance of efficiencies across state asset management law, policies and practice. This has been exemplified by a surge in notable instances of reform in state asset management. A prominent theme in this phenomenon is the consideration of governance principles within the re-conceptualization of state asset management law and related policy, with many countries recognizing variability in the quality of asset governance and opportunities for profit as being critical factors. This issue is very current in Indonesia where a major reform process in this area has been confirmed by the establishment of a new Directorate of State Asset Management. The incumbent Director-General of State Asset Management has confirmed a re-emphasis on adherence to governance principles within applicable state asset management law and policy reform. This paper reviews aspects of the challenge of reviewing and reforming Indonesian practice within state asset management law and policy specifically related to public housing, public buildings, parklands, and vacant land. A critical issue in beginning this review is how Indonesia currently conceptualizes the notion of asset governance and how this meaning is embodied in recent changes in law and policy and importantly in options for future change. This paper discusses the potential complexities uniquely Indonesian characteristics such as decentralisation and regional autonomy regime, political history, and bureaucratic culture.

Why stagnant? behind the scenes in Indonesia’s reformed state asset management policies

This study seeks to answer the question of “why is policy innovation in Indonesia, in particular reformed state asset management laws and regulations, stagnant?” through an empirical and qualitative approach, identifying and exploring potential impeding influences to the full and equal implementation of said laws and regulations. The policies and regulations governing the practice of state asset management has emerged as an urgent question among many countries worldwide (Conway, 2006; Dow, Gillies, Nichols, & Polen, 2006; Kaganova, McKellar, & Peterson, 2006; McKellar, 2006b) for there is heightened awareness of the complex and crucial role that state assets play in public service provision. Indonesia is an example of such country, introducing a ‘big-bang’ reform in state asset management laws, policies, regulations, and technical guidelines. Two main reasons propelled said policy innovation: a) world-wide common challenges in state asset management practices - such as incomplete information system, accountability, and governance adherence/conceptualisation (Kaganova, McKellar and Peterson 2006); and b) unfavourable state assets audit results in all regional governments across Indonesia. The latter reasoning is emphasised, as the Indonesian government admits to past neglect in ensuring efficiency and best practice in its state asset management practices. Prior to reform there was euphoria of building and developing state assets and public infrastructure to support government programs of the day. Although this euphoria resulted in high growth within Indonesia, there seems to be little attention paid to how state assets bought/built is managed. Up until 2003-2004 state asset management is considered to be minimal; inventory of assets is done manually, there is incomplete public sector accounting standards, and incomplete financial reporting standards (Hadiyanto 2009). During that time transparency, accountability, and maintenance state assets was not the main focus, be it by the government or the society itself (Hadiyanto 2009). Indonesia exemplified its enthusiasm in reforming state asset management policies and practices through the establishment of the Directorate General of State Assets in 2006. The Directorate General of State Assets have stressed the new direction that it is taking state asset management laws and policies through the introduction of Republic of Indonesia Law Number 38 Year 2008, which is an amended regulation overruling Republic of Indonesia Law Number 6 Year 2006 on Central/Regional Government State Asset Management (Hadiyanto, 2009c). Law number 38/2008 aims to further exemplify good governance principles and puts forward a ‘the highest and best use of assets’ principle in state asset management (Hadiyanto, 2009a). The methodology of this study is that of qualitative case study approach, with a triangulated data collection method of document analysis (all relevant state asset management laws, regulations, policies, technical guidelines, and external audit reports), semi-structured interviews, and on-site observation. Empirical data of this study involved a sample of four Indonesian regional governments and 70 interviews, performed during January-July 2010. The analytical approach of this study is that of thematic analysis, in an effort to identify common influences and/or challenges to policy innovation within Indonesia. Based on the empirical data of this study specific impeding influences to state asset management reform is explored, answering the question why innovative policy implementation is stagnant. An in-depth analysis of each influencing factors to state asset management reform, and the attached interviewee’s opinions for each factor, suggests the potential of an ‘excuse rhetoric’; whereby the influencing factors identified are a smoke-screen, or are myths that public policy makers and implementers believe in; as a means to explain innovative policy stagnancy. This study offers insights to Indonesian policy makers interested in ensuring the conceptualisation and full implementation of innovative policies, particularly, although not limited to, within the context of state asset management practices.

Paramedics' perceptions of their role in palliative care : analysis of focus group transcripts

Paramedics play an important role in out-of-hospital health care. They provide unscheduled care, assisting both patients with minor injuries and those experiencing life-threatening emergencies. Increasingly, paramedics are called on to manage chronic and complex health needs, including symptom relief for patients at the end of life. However, paramedics may not be well prepared to offer palliative care, as practice guidelines and education tend to focus on the management of acute medical emergencies and major trauma. Emergency medical services that employ paramedics rarely have practice guidelines or protocols that deal specifically with palliative care.

Interventions for preventing abuse in the elderly (protocol)

This is the protocol for a review and there is no abstract. The objectives are as follows:The primary objective of the review is to assess the effectiveness of primary, secondary and tertiary intervention programmes utilised to reduce or prevent, or both, elderly abuse in organisational, institutional and community settings. We will also identify and report on adverse consequences or effects of the intervention/s in the review.The secondary objective is to investigate whether intervention?s effects are modified by types of abuse, types of participants, setting of intervention or cognitive status of the elderly.

Community interventions for physical activity : the role of a new Cochrane systematic review

Introduction: Systematic reviews are essential in summarising the results of a range of research studies on a specific topic into a single report. They serve as a key source of evidence-based information to support and develop policy and practice for healthy communities. This presentation will examine a new review of community-wide strategies to increase population levels of physical activity and compare it to an earlier Community Guide Review (CGR) of Community-wide campaigns to increase physical activity which recommended community wide interventions. Methods: We registered a Cochrane Systematic Review (CSR) title, published a protocol and recently completed the review of Community-wide interventions to increase physical activity. We compared the definitions, design and findings of the CSR to the CGR. Results: The two reviews differed remarkably in their conclusions with the CGR recommending “strong evidence exists that community-wide campaigns are effective in increasing levels of physical activity”, and the new CSR stating “The body of evidence in this review does not support the hypothesis that multi-component community wide interventions effectively increase population levels of physical activity”. We observed that both reviews examined multi-component interventions as a “combined package”. Possible explanations for the different conclusions may be due to the definition of community (CSR defined community as “comprising those persons residing in a geographically defined community, such as a village, town, or city”, excluding interventions which were whole of state or country, and CGR as “a group of individuals who share one or more characteristics. The CSR utilised a logic model at various stages of the review process and explicitly defined a combination of strategies encompassed within the intervention. The CSR included 25 and CGR 10 studies, respectively. Six of the 10 studies that were included in CGR were excluded from the CSR due to issues relating to study design, intervention definition or duration. The two reviews also differ in function as the CSR seeks to summarise global evidence and included 7 studies in low-income countries, where as the CGR contained only studies deemed relevant to the USA context. Discussion: Differences in the findings between older and newer reviews can be due to a variety of factors. For example, in updating a review the definition of an intervention can be changed. Further, differences may also be due to improvements in the standards and methodologies for systematic reviews as well as the inclusion of newer studies. These factors need to be understood whenever differences between newer and older reviews are considered.

Methodological challenges in conducting a systematic review of community wide interventions to increase physical activity

Introduction: Evaluating the effectiveness of interventions designed to increase the physical activity in communities is often a difficult and complex task, requiring considerable expertise and investment, and often constrained by methodological limitations. These limitations, in turn, create additional challenges when these studies are used in systematic reviews as they hinder the confidence, precision and interpretation of results. The objective of this paper is to summarise the methodological challenges posed in conducting a systematic review of community-wide physical activity interventions to help inform those conducting future primary research and systematic reviews. Methods: We conducted a Cochrane systematic review of community-wide interventions to increase physical activity. We assessed the methodological quality of the included studies. We will investigate these in greater detail, particularly in relation to the potential impact on measures of effect, confidence in results, generalizability of results and general interpretation. Results: The systematic review was conducted and has been published in the Cochrane Library. A logic model was helpful in defining and interpreting the studies. Many studies of unsuitable study design were excluded; however several important methodological limitations of the primary studies evaluating community-wide physical activity interventions emerged. These included: - the failure to use validated tools to measure physical activity; - issues associated with pre and post test designs; - inadequate sampling of populations; - poor control groups; and - intervention and measurement protocols of inadequate duration. Although it is challenging to undertake rigorous evaluations of complex interventions, these issues result in significant uncertainty over the effectiveness of these interventions, and the possible factors required for a community-wide intervention to be successful. In particular, the combination of several of these limitations (e.g. un-validated tools, inadequate sampling, and short duration) is that studies may lack the sensitivity to detect any meaningful change. Multiple publications of findings for the same study also made interpretation difficult; however, interventions with parallel qualitative publications were helpful. Discussion: Evaluating community wide interventions to increase physical activity in a rigorous way is incredibly challenging. These findings reflect these challenges but have important ramifications for researchers conducting primary studies to determine the efficacy of such interventions, as well as for researchers conducting systematic reviews. This new review shows that the inadequacies of design and evaluation are continuing. It is hoped that the adoption of such suggestions may aid in the development of systematic reviews, but more importantly, in enabling translation of such findings into policy and practice.

Assessment of applicability and transferability of evidence-based antenatal interventions to the Australian indigenous setting

There is a need for public health interventions to be based on the best available evidence. Unfortunately, well-conducted studies from settings similar to that in which an intervention is to be implemented are often not available. Therefore, health practitioners are forced to make judgements about proven effective interventions in one setting and their suitability to make a difference in their own setting. The framework of Wang et al. has been proposed to help with this process. This paper provides a case study on the application of the framework to a decision-making process regarding antenatal care in Aboriginal and Torres Strait Islander communities in Queensland. This method involved undertaking a systematic search of the current available evidence, then conducting a second literature search to determine factors that may affect the applicability and transferability of these interventions into these communities. Finally, in consideration of these factors, clinical judgement decisions on the applicability and transferability of these interventions were made. This method identified several interventions or strategies for which there was evidence of improving antenatal care or outcomes. By using the framework, we concluded that several of these effective interventions would be feasible in Aboriginal and Torres Strait Islander communities within Queensland.

Wife abuse : are we detecting it?

Our objective was to measure the prevalence of wife abuse in an urban teaching hospital family practice unit and compare this to the frequency of documentation by family physicians. A modified Conflicts Tactics Scale Questionnaire was administered to all female patients either married or common-law older than 16 years during the study period. The respective patients' charts were reviewed for documentation of wife abuse. Three hundred eighty-three charts were reviewed, and 275 surveys were completed (72% response rate). Physical and mental abuse were reported in 8% and 23%, respectively, of the respondents. Four percent of respondents had considered suicide. One percent of the charts had wife assault documented (p = 0.0001). Wife abuse is reported in at least 8% of our patients. There appear to be significant health risks to these women, including homicide, suicide, and rape. Family physician documentation of wife abuse was poor.

What are the health needs, familial and social problems of Thai migrants in a local community in Australia? A focus group study

This study explored the health needs, familial and social problems of Thai migrants in a local community in Brisbane, Australia. Five focus groups with Thai migrants were conducted. The qualitative data were examined using thematic content analysis that is specifically designed for focus group analysis. Four themes were identified: (1) positive experiences in Australia, (2) physical health problems, (3) mental health problems, and (4) familial and social health problems. This study revealed key health needs related to chronic disease and mental health, major barriers to health service use, such as language skills, and facilitating factors, such as the Thai Temple. We concluded that because the health needs, familial and social problems of Thai migrants were complex and culture bound, the development of health and community services for Thai migrants needs to take account of the ways in which Thai culture both negatively impacts health and offer positive solutions to problems.

A critical assessment of the Australian OHS accreditation system's "Body of Knowledge (BoK)"

In response to an increasing perception of poor OHS consultancy quality amongst the Australian public, regulator and OHS professionals, the Safety Institute Australia (SIA) was tasked by the Victorian government to establish an accreditation process for OHS professionals. The OHS accreditation board decided to base its accreditation on a core "body of knowledge" (BoK), against which applicants are assesssed. While the foundation and structure of the BoK is unclear, the BoK consists of a collection of essays from a variety of invited authors. The BoK comprises about 811 pages in 34 chapters, with significant redundancy and considerable subjective components. The SIA BoK is benchmarked against two international best-practices, the German "Core Definition, Object Catalog and Research Domains of Labour Science (Ergonomics)" (Luzcak, Volpert, Raeithel & Schwier, 1989)(100 pages) and the American "Core Competency Model" for the "Master's Degree in Public Health" (Association of Schools of Public Health, 2006) (21 pages). Both "core definition" and "core competency model" are on a comparative level to the BoK. While the German expert panel consisted of 14 eminent professors, the American panel consisted of 135 members, organized in 6 groups chaired by discipline leading academics. The Australian approach employed a broad approach, where 137 professionals, consultants, emerging academics and academics contributed to 8 workshops. Both the German and the American panels maintained an open communication amongst members and with the discipline community throughout the process, whereas SIA applied an open and directed peer-review process. Moreover, the German process involved an analysis of all congress content and journal publications in the scientific domain in a set timeframe, which were then systematically clustered. These results were further expanded by structured interviews with 38 professors in the discpline, grasping their research and teaching practice. The American workgroup however assumed core scientific areas, underlying the domain. Based upon the a-priori assumption, they then established well defined competencies across all areas using a modified Delphi process. Although the BoK attempts to explore the knowledge in the OHS domain without an imposed structure in a bottom-up approach, it does not result in a structured systematic of the science. We conclude that the outcome of the German, rigorous academic approach, and the US American democratic approach under unambiguous academic leadership both outperform the Australian advocacy group approach. This product was determined for both structure and content of the taxonomy delivered through the processes.

Nurses’ role in caring for people with a comorbidity of mental illness and intellectual disability : A literature review

This article examines literature on the role of the nurse caring for people with a dual disability (DD) of intellectual disability and mental illness. A search of the literature between 2000 and 2010 resulted in a total of 21 articles that met the inclusion criteria. Seven key categories of the role of the nurse were identified: (i) advocacy/health promotion (including working with family); (ii) assessment/case management; (iii) behavioural interventions; (iv) communication; (v) leadership and the nurse’s role within the multidisciplinary team; (vi) functions regarding medication administration; and (vii) safety/risk management. There is a paucity of research about the role of nurses working with people with DD, although a number of opinion-based articles exist. This article identifies a need for the role of the nurse working in DD to be more clearly articulated and for the development of evidence to guide best practice.

Correct procedures and cutting corners: a qualitative study of women's occupational health and safety in a beauty therapy industry

Objective: To examine the context of occupational health and safety related to blood-borne communicable diseases practice. Methods: A case study approach using qualitative semi-structured interviews with five key informants who represented different sectors of the beauty therapy industry in South Australia. Results: Four main themes were identified: (i) exposure to blood and blood-borne communicable diseases; (ii) prevention in practice; (iii) OH&S problems; and (iv) industry needs. Conclusion: Key OH&S issues in the beauty therapy industry include: power relationships between employers and employees, equipment costs, the need for more continuing education, and monitoring of practitioners. Implications: Economic constraints, continuing education, and government regulation of the beauty therapy industry are highlighted as significant areas for further consideration in addressing the OH&S needs of practitioners and their clients.

Public health psychology : a conceptual and practical framework

Increasingly, the development of public health infrastructures requires psychology to reevaluate its contribution to public health at local, national and global levels. Already familiar to some psychologists, particularly those in community psychology and health promotion, the expansion of public health has implications for psychology in terms of knowledge/practice and working differently in multidisciplinary settings. In this article, I provide a critical overview of the implications of the historical and international development of health psychology and the changing nature of public health to strengthen the establishment of public health psychology. A conceptual and practical framework is proposed in which public health psychology theory, methods and practice are considered as well as its relevance to the health social sciences more generally.