Solar ultraviolet protection provided by human head hair

The solar erythemal UV irradiances through human hair and the protection from UV provided by human head hair have been investigated for a solar zenith angle (SZA) range of 17 to 51 degrees for the conditions of a head upright in full sun, a head upright in shade and a head in full sun tilted towards the sun. The two hair lengths investigated were 49.1+-7.1 mm for the short type and 109.5+-5.5 mm for the long type. For the head upright in full sun, the irradiances through the hair ranged from 0.75 to 1.4 SED/h for SZA less than 25 degrees and less than 0.6 SED/h in shade. The ultraviolet protection factor (UPF) ranged from approximately 5 to 17 in full sun, with the UPF increasing with higher SZA. The longer hair provided a lower UPF than the shorter hair and for the head oriented towards the sun, there was a marginally lower UPF than for the upright head. This research shows that the UV exposure limits to the scalp through hair can be exceeded within short timeframes and provides important information to assist employers to comply with Workplace Health and Safety legislation

Exploring staff diabetes medication knowledge and practices in regional residential care: triangulation study

Aims and objectives: This study is drawn from a larger project that aimed to identify the staffing and organisational factors influencing the quality of diabetes care for older people living in residential care in regional Victoria, Australia. The focus of the current study is on medication management for residents with diabetes. Background: With a continuous rise in diabetes in the population, there is an associated increase in the prevalence of diabetes in aged care residential settings. However, there is little specific guidance on how to manage diabetes in older people living in institutional settings who experience multiple concurrent chronic conditions. Design: A triangulation strategy consisting of three phases. Methods: A one-shot cross-sectional survey (n = 68) focus group interviews and a case file audit (n = 20). Data were collected between May 2009-January 2010. Findings: Staff knowledge of diabetes and its contemporary medication management was found to be suboptimal. Challenges to managing residents with diabetes included limited time, resident characteristics and communication systems. Additionally, the variability in medical support available to residents and a high level of polypharmacy added to the complexity of medication management of resident. Conclusions: The current study suggests administering medicine to residents in aged care settings is difficult and has potentially serious medical, professional and economic consequences. Limitations to staff knowledge of contemporary diabetes care and medications potentially place residents with diabetes at risk of receiving less than optimal diabetes care. Relevance to clinical practice: Providing evidence-based guidelines about diabetes care in residential care settings is essential to achieve acceptable outcomes and increase the quality of life for residents in public aged care. Continuing education programs in diabetes care specifically related to medication must be provided to all health professionals and encompass scope of practice. © 2013 John Wiley & Sons Ltd

Active adults recall their physical activity differently to less active adults: test-retest reliability and validity of a physical activity survey

Issue addressed: This paper determined the test-retest reliability and criterion validity of a modified version of the Active Australia Survey (AAS) and whether these properties varied across participants' activity levels

A preliminary analysis of the cost-effectiveness of the National Bowel Cancer Screening Program – demonstrating the potential value of comprehensive real world data

Background The complexity and cost of treating cancer patients is escalating rapidly and increasingly difficult decisions are being made regarding which interventions provide value for money. BioGrid Australia supports collection and analysis of comprehensive treatment and outcome data across multiple sites. Here we use preliminary data regarding the National Bowel Cancer Screening Program (NBCSP) and stage-specific treatment costs for colorectal cancer (CRC) to demonstrate the potential value of real world data for cost-effectiveness analyses (CEA).Methods Data regarding the impact of NBCSP on stage at diagnosis was combined with stage-specific CRC treatment costs and existing literature. An incremental CEA was undertaken from a government healthcare perspective, comparing NBCSP to no-screening. The 2008 invited population (n=681,915) was modelled in both scenarios. Effectiveness was expressed as CRC-related life years saved (LYS). Costs and benefits were discounted at 3% per annum.Results Over the lifetime and relative to no-screening, NBCSP was predicted to save 1,265 life-years, prevent 225 CRC cases and cost an additional $48.3 million, equivalent to a cost-effectiveness ratio of$38,217 per LYS. A scenario analysis assuming full participation improved this to $23,395.Conclusions This preliminary CEA based largely on contemporary real world data suggests population-based FOBT screening for CRC is attractive. Planned ongoing data collection will enable repeated analyses over time, using the same methodology in the same patient populations, permitting an accurate analysis of the impact of new therapies and changing practice. Similar CEA using real world data related to other disease types and interventions appears desirable.<br /

The context, influences and challenges for undergraduate nurse clinical education: Continuing the dialogue

Introduction – Approaches to clinical education are highly diverse and becoming increasingly complex to sustain in complex milieu Objective – To identify the influences and challenges of providing nurse clinical education in the undergraduate setting and to illustrate emerging solutions. Method: A discursive exploration into the broad and varied body of evidence including peer reviewed and grey literature. Discussion - Internationally, enabling undergraduate clinical learning opportunities faces a range of challenges. These can be illustrated under two broad themes: (1) Legacies from the past and the inherent features of nurse education and (2) Challenges of the present, including, population changes, workforce changes, and the disconnection between the health and education sectors. Responses to these challenges are triggering the emergence of novel approaches, such as collaborative models. Conclusion(s) – Ongoing challenges in providing accessible, effective and quality clinical learning experiences are apparent

Study protocol: developing a decision system for inclusive housing: applying a systematic, mixed-method quasi-experimental design

Background Identifying the housing preferences of people with complex disabilities is a much needed, but under-developed area of practice and scholarship. Despite the recognition that housing is a social determinant of health and quality of life, there is an absence of empirical methodologies that can practically and systematically involve consumers in this complex service delivery and housing design market. A rigorous process for making effective and consistent development decisions is needed to ensure resources are used effectively and the needs of consumers with complex disability are properly met. Methods/Design This 3-year project aims to identify how the public and private housing market in Australia can better respond to the needs of people with complex disabilities whilst simultaneously achieving key corporate objectives. First, using the Customer Relationship Management framework, qualitative (Nominal Group Technique) and quantitative (Discrete Choice Experiment) methods will be used to quantify the housing preferences of consumers and their carers. A systematic mixed-method, quasi-experimental design will then be used to quantify the development priorities of other key stakeholders (e.g., architects, developers, Government housing services etc.) in relation to inclusive housing for people with complex disabilities. Stakeholders randomly assigned to Group 1 (experimental group) will participate in a series of focus groups employing Analytical Hierarchical Process (AHP) methodology. Stakeholders randomly assigned to Group 2 (control group) will participate in focus groups employing existing decision making processes to inclusive housing development (e.g., Risk, Opportunity, Cost, Benefit considerations). Using comparative stakeholder analysis, this research design will enable the AHP methodology (a proposed tool to guide inclusive housing development decisions) to be tested. Discussion It is anticipated that the findings of this study will enable stakeholders to incorporate consumer housing preferences into commercial decisions. Housing designers and developers will benefit from the creation of a parsimonious set of consumer-led housing preferences by which to make informed investments in future housing and contribute to future housing policy. The research design has not been applied in the Australian research context or elsewhere, and will provide a much needed blueprint for market investment to develop viable, consumer directed inclusive housing options for people with complex disability

Caries experience among publicly-funded dental patients in Australia, 1995-96: Type of care and geographic location

The document attached has been archived with permission from the Australian Dental Association. An external link to the publisher’s copy is included.Health card holders are a financially disadvantaged group and are the target population eligible for publicly-funded dental care. While their health status is generally worse compared with other Australians, there is also considerable variation among card holders. The aims of this study were to describe the oral health status of publicly-funded dental patients by type of care, geographic location and age, and to compare trends over time against other Australian studies. Patients were sampled randomly, based on date of birth, by State/Territory dental services in 1995-96. Dentists recorded oral health measures at the initial visit of a course of care using written instructions, but there was no formal calibration. The 6109 patients sampled were weighted in proportion to the numbers of publicly-funded dental patients for each State/Territory. Multiple linear regression analysis indicated that caries experience measured by the DMFT index increased across older age groups (p<0.05). For rural compared with urban patients, mean numbers of decayed and filled teeth tended to be higher. For emergency compared with non-emergency care, mean numbers of decayed and missing teeth were higher, and filled teeth lower. The findings of this monitoring survey document high levels of previous disease and treatment and indicate variation between subgroups of users of publicly-funded dental care. This included an uneven geographic distribution of oral health and disease, and variation in unmet treatment needs by type of course of care. Temporal comparisons indicate publicly-funded patients have experienced the population trend towards lower levels of tooth loss over time but have higher levels of untreated decayed teeth compared with the general population.D.S. Brennan, A.J. Spencer and G.D Slad

Drugs in prisons: exploring use, control, treatment and policy

Drugs are an increasingly salient concern in many prisons around the world. Specific prison drug policies are made, drugs are illegally used and legally prescribed, drug use and drug sale is sanctioned, drug profits are generated, and drug use is an important public health and treatment priority in most prisons. A growing number of prisoners are using drugs and a large proportion of people who use drugs have been in prison. As a consequence of such developments, everyday life in many prisons is dictated by drug-related issues. The purpose of this Special Issue is to critically examine and advance research relating to the growth in use, control and treatment of drugs within the prison environ- ment as well as research on relevant governmental policies and practices. The articles highlight a diverse range of issues including the dynamic nature of the drugs problem in prison in relation to the substances being used, how they are administered, the meanings and motives associated with drug use and dealing and the way in which the drug market operates, but also the ways in which supply reduction, demand reduction and harm reduction responses have developed within different prison settings. The papers draw on a range of different quantitative and qualitative research designs and methodologies, highlighting the voices of the prisoners themselves as well as the practitioners and policy- makers who are tasked with dealing with the problem of drugs in prisons

Walking for recreation and transport by geographic remoteness in South Australian adults

Objective: To determine differences in walking for recreation and transport between Accessibility/Remoteness Index of Australia (ARIA) categories, in South Australian adults.  Design: Cross-sectional self-reported data from adult telephone survey respondents between April and May in 2012 and 2013.  Setting: Population of South Australia.  Participants: A total of 4004 adults (aged over 18 years) participated: n = 1956 men and n = 2048 women. Area of residence was categorised using ARIA (major city, inner regional, outer regional and remote/very remote).  Main outcome measure(s): Self-reported participation in walking for transport and recreation/exercise as the number of times and minutes per week. Data were analysed using Kruskal–Wallis test for median minutes and negative binomial regression for times walked with adjustment for socioeconomic status, age and body mass index.  Results: Average age was 47.8 ± 18.5 years, 51.1% were women, 70.9% lived in the major cities, 14.6% in inner regional, 10.8% in outer regional and 3.6% in remote/very remote areas. Relative to major city, times walked for recreation was lower for only remote/very remote residents (incidence rate ratio (IRR) 0.74 (95%CI 0.59–0.92), P = 0.008). This difference was only observed for men (IRR 0.54 (95%CI 0.39–0.73), P < 0.001). Relative to major city, times walked for transport was less for inner regional (IRR 0.74 (95%CI 0.67–0.85), P < 0.001) and outer regional (IRR 0.64 (95%CI 0.56–0.74), P < 0.001) only. This difference in transport walking was seen in both men and women.  Conclusion: Frequency of walking varied by purpose, level of remoteness and sex. As walking is the focus of population-level health promotion, more detailed understanding of the aetiology of regular walking is needed

Substance use outcomes following treatment : findings from the Australian Patient Pathways Study

Background and Aims: Our understanding of patient pathways through specialist Alcohol and Other Drug (AOD) treatment and broader health/welfare systems in Australia remains limited. This study examined how treatment outcomes are influenced by continuity in specialist AOD treatment, engagement with non-AOD community services, and mutual aid, as well as exploring differences between clients who present with a primary alcohol problem compared to those presenting with a primary drug issue. Method: In a prospective, multi-site treatment outcome study, 796 clients from 21 AOD services in Victoria and Western Australia completed a baseline interview between January 2012 and January 2013. 555 (70%) completed follow-up assessment of subsequent service use and AOD use outcomes 12-months later. Results: Just over half of the participants (52.0%) showed reliable reductions in use of, or abstinence from, their primary drug of concern. This was highest among clients who reported meth/amphetamine (66%) as their primary drug of concern and lowest among those who reported alcohol (47%), with 31% achieving abstinence from all drugs of concern. Continuity of specialist AOD care was associated with higher rates of abstinence than fragmented AOD care. Different predictors of treatment success emerged for clients with a primary drug problem as compared to those with a primary alcohol problem; mutual aid attendance (OR=2.5) and community service engagement (OR=2.0) for clients with alcohol as PDOC, and completion of the index treatment (OR=2.8) and continuity in AOD care (OR=1.8) for those with primary drug issues. Conclusion: This is the first multi-site Australian study to include treatment outcomes for alcohol and cannabis users, who represent 70% of treatment seekers in AOD services. The results suggest a substantial proportion of clients respond positively to treatment, but that clients with alcohol as their primary drug problem may require different treatment pathways, compared to those with illicit drug issues, to achieve desirable outcomes