Guideline for the non-surgical management of hip and knee osteoarthritis

Introduction: Chronic disease is a major public health burden on Australian society. An increasing proportion of the population has risk factors for, or at least one, chronic disease, leading to increasing public health costs. Health service policy and delivery must not only address acute conditions, it must also effectively respond to the wide range of health and public service requirements of people with chronic illness.^1,2 Strong primary health care policy is an important foundation for a successful national health delivery system and long term management of public health, and is linked to practical outcomes including lower mortality, decreased hospitalisation and improved health outcomes.¹ National strategic health policy has recently given increased recognition to the importance of chronic disease management, with the Australian Federal Government endorsement of a number of initiatives for the prevention (or delay in onset), early detection and evidence based management of chronic disease, including osteoarthritis.^1,3
Chronic musculoskeletal conditions, including arthritis, account for over 4% of the national disease burden in terms of disability adjusted life years. Over 6 million Australians (almost one-third of the population) are estimated to have a chronic musculoskeletal disease; chronic musculoskeletal disease represents the main cause of long term pain and physical disability. In Australia, osteoarthritis is self reported by more than 1.4 million people (7.3% of the population4) and is the tenth most commonly managed problem in general practice.5 This number is set to rise as the elderly population grows. Osteoarthritis exerts a significant burden on the individual and the community through reduction in quality of life, diminished employment capacity and an increase in health care costs. For further details, refer to the Evidence to support the National Action Plan for Osteoarthritis, Rheumatoid Arthritis and Osteoporosis: Opportunities to improve health-related quality of life and reduce the burden of disease and disability (2004).⁶
As such, federal government health policy has identified arthritis as a National Health Priority Area and adopted a number of initiatives aimed at decreasing the burden of chronic disease and disability; raising awareness of preventive disease factors; providing access to evidence based knowledge; and improving the overall management of arthritis within the community.4 In 2002, all Australian health ministers designated arthritis and musculoskeletal conditions as Australia’s seventh National Health Priority Area. In response, a National Action Plan was developed in 2004 by the National Arthritis and Musculoskeletal Conditions Advisory Group (NAMSCAG).6 The aim of this document was to provide a blueprint for national initiatives to improve the health related quality of life of people living with osteoarthritis, rheumatoid arthritis and osteoporosis; reduce the cost and prevalence of these conditions; and reduce the impact on individuals, their carers and their communities within Australia. The National Action Plan was developed to complement both the National Chronic Disease Strategy – which is broader – and the National Service Improvement Framework for Osteoarthritis, Rheumatoid Arthritis and Osteoporosis, in addition to other national and state/ territory structures.

Women's views of postnatal care in the context of the increasing pressure on postnatal beds in Australia

Background : Despite limited evidence evaluating early postnatal discharge, length of hospital stay has declined dramatically in Australia since the 1980s. The recent rising birth rate in Victoria, Australia has increased pressure on hospital beds, and many services have responded by discharging women earlier than planned, often with little preparation during pregnancy. We aimed to explore the views of women and their partners regarding a number of theoretical postnatal care ‘packages’ that could provide an alternative approach to early postnatal care.

Methods : Eight focus groups and four interviews were held in rural and metropolitan Victoria in 2006 with participants who had experienced a mix of public and private maternity care. These included 8 pregnant women, 42 recent mothers and 2 male partners. All were fluent in English. Focus groups explored participants’ experiences and/or expectations of early postnatal care in hospital and at home and their views of alternative packages of postnatal care where location of care shifted from hospital to home and/or hotel. This paper describes the packages and explores and describes what ‘value’ women placed on the various components of care.

Findings : Overall, women expressed a preference for what they had experienced or expected, which may be explained by the ‘what is must be best’ phenomenon where women place value on the status quo. They generally did not respond favourably towards the alternative postnatal care packages, with concerns about any shorter length of hospital stay, especially for first time mothers. Women were concerned about the safety and wellbeing of their new baby and reported that they lacked confidence in their ability to care for their baby. The physical presence and availability of professional support was seen to alleviate these concerns, especially for first time mothers. Participants did not believe that increased domiciliary visits compensated for forgoing the perceived security and value of staying in hospital. Women generally valued staying in hospital for the length of time they felt they needed above all other factors.

Key conclusions and implications for practice : Women were concerned about shortened postnatal length of hospital stay and these concerns must be considered when changes are planned in maternity service provision. Any moves towards shorter postnatal length of stay must be comprehensively evaluated with consideration given to exploring consumer views and satisfaction. There is also a need for flexibility in postnatal care that acknowledges women's individual needs.

Emotional intelligence and teaching : solving the puzzle

The emotional intelligence of educators has a major influence on how well they are able to help people to learn. Teachers with high levels of emotional intelligence always or usually adopt an appropriate emotionally intelligent response in both positive and negative situations. Teachers with low levels of emotional intelligence sometimes adopt an emotionally intelligent response in positive situations but seldom or never in negative situations. These differences have some significant implications. The authors' research shows that emotional intelligence and self-efficacy are different but related concepts. A teacher's level of emotional intelligence is linked to his or her sense of self-efficacy. A teacher with high levels of emotional intelligence is more likely to be able to work more effectively and persist longer because they have a belief in their own ability and feel that they are in control. The emotionally intelligent teacher is sensitive to his or her own emotions and the emotions of others and so is able to build positive relationships with colleagues and students. Beyond that, a teaching environment that is emotionally healthy and supportive will enhance the development of teachers' emotional intelligence.

Fighting with fire : how bushfire suppression can impact on fire fighters' health

Background: Each year bushfire threatens Australia’s rural, forest, and urban-rural areas. Australia’s rural fire fighters work to curtail this threat in hot, smoky conditions, often at risk to their physical health. General practitioners, especially in rural areas, can help preserve the health of fire fighters during the fire season by understanding the stressors they face on the fireground.

Objective: This article outlines how the key fireground stressors of work intensity and duration, heat (from the weather, the fire, and the fire fighter’s own exertion) and smoke impact on the health of fire fighters. Practical advice for GPs treating Australia’s rural fire fighters is also included.

Discussion: General practitioners can help preserve fire fighters' health during bushfire suppression in a number of ways, including: identifying fire fighters at risk of cardiac distress during physical labour and educating them about the early warning signs; advocating regular exercise; discouraging smoking; and promoting the benefits of maintaining fluid, carbohydrate, and electrolyte levels during a shift.

Cyber safety

Cyber violence is growing; it is a global problem for governments, educational authorities, teachers, parents and children alike, the author argues. Given the insidious nature and rapid rise in cyber violence, the paucity of empirical research on cyber violence and cyber safety, it is clear that we need a concerted effort on both the policy and practical level. Most importantly, we need substantial funding to investigate what remains an under-researched area so as to inform good policy and practice. The article discusses why cyber violence is happening; what the main issues are; how to improve cyber safety; and existing safety initiatives. The author concludes that current initiatives to address cyber violence and cyber safety are well intended but we need to make a more concerted and systematic effort, based on further research, if we are to tackle the problem through policy and practice on the national and global level.

Collaborative care : the role of practice nurses

Background
Comorbid depression can occur with diabetes and heart disease. This article reports on a feasibility study focusing on additional roles for practice nurses in detecting and monitoring depression with other chronic diseases.
Method
A convenience sample of six practices in southeast Australia was identified. Practice nurses received training via a workshop, which included training in the use of the Patient Health Questionnaire, to detect depression.
Results
The 332 patients who participated in the project each received a comprehensive health summary to assist with self management. Depression was identified in 34% of patients in this convenience sample. After 18 months implementation, practice nurses were strongly in favour of continuing the model of care. General
practitioners gave highly favourable ratings for effectiveness and willingness to continue this model of care.
Discussion
Practice nurses can include depression monitoring alongside systematic care of diabetes and heart disease. A randomised trial is currently underway to compare the clinical outcomes of this model with usual care.

Case studies of change : addressing family support needs of rural GPs

The National Rural Faculty of The Royal Australian College of General Practitioners received commonwealth funding between 2000–2002 to develop a rural medical family support project. There were three elements to this project:

* a counselling and communication skills or ‘mentoring’ workshop for rural GP spouses in each state
* the development of a resource kit of existing rural medical family support strategies, and
* the piloting of a range of strategies designed to address family support needs in collaboration with rural GPs, registrars and their families.

This article focusses on the last of these three elements.

Vertebroplasty : letter to the editor

In separate letters the authors debate whether the promotion of vertebroplasty in routine care is both premature and potentially dangerous as there are no completed RCTs.

Rural smokers : a prevention opportunity

Background: Smoking is the largest single cause of preventable death and disease in Australia. This study describes smoking prevalence and the characteristics of rural smokers to guide general practitioners in targeting particular groups.

Methods: Cross sectional surveys in the Greater Green Triangle region of southeast Australia using a random population sample (n=1563, participation rate 48.7%) aged 25–74 years. Smoking information was assessed by a self administered questionnaire.

Results: Complete smoking data were available for 1494 participants. Overall age adjusted current smoking prevalence was 14.9% (95% CI: 13.1–16.7). In both genders, current smoking prevalence decreased with age. Those aged 25–44 years were more likely to want to stop smoking and to have attempted cessation, but less likely to have received cessation advice than older smokers.

Discussion: This study provides baseline smoking data for rural health monitoring and identifies intervention opportunities. General practice is suited to implement interventions for smoking prevention and cessation at every patient encounter, particularly in younger individuals.

Homophobic bullying and human rights : non-deficit approaches in queer youth wellbeing policy and practice

This chapter is concerned with ways for improving the capacity of school communities to provide queer young people with stimulating educational experiences that productively engage with the realities of their lives and which promote and enhance their wellbeing. By "queer" or "LBGTI" I mean to refer to all of those young people who do not conform to prevailing expectations regarding gender and sexual identity and behaviours, those young people who may be lesbian,gay, bisexual, transgender or intersexual (lGBTI), as well as all of those young people who have an association with gender and sexual diversity (for example, the straight fey boy who gets called a poofta; the teenage girl with lesbian parents, etc.). Methodologically, this chapter draws on a tradition of Foucauldian cultural analysis which acknowledges that gender and sexual identities are not stable or fixed, but that they are generated by influential discourses (e.g. my identity as a "man" in Melbourne today is mediated by contemporary discourses of masculinity, of Australianness, of class and so on) (for example, see Foucault 1984, 1990, 1992 and 1998).

This chapter argues that conventional approaches to school improvement for queer students normally focus on strategies for reducing the victimisation of teenage homosexuals, and that such strategies rely on dominant discourses of safety and bullying. I examine a recent example of this policy approach and use it as a starting point for considering the benefits and the constraints of a victim-based approach to queer youth wellbeing policy. The chapter then moves into a discussion about the recent introduction of human rights legislation in Victoria and how this can assist a move in policy and practice towards a more positive and diffuse engagement with gender and sexual diversity.