Research

Fewer infants are being readmitted to New South Wales hospitals in the first year of life

Samantha J Lain PhD, MPH, BHlthSci(Hons) · Christine L Roberts MB BS, FAFPHM, DrPH · Jennifer R Bowen MB BS, MD, FRACP · Natasha Nassar PhD, MPH, BEc

Objectives: To examine experiences of racism in health settings and their impact on mental health among Aboriginal Australians. Design, setting and participants: A cross-sectional survey of experiences of racism and mental health was conducted in two metropolitan and two rural Victorian local government areas (LGAs) between 1 December 2010 and 31 October 2011. Participants included 755 Aboriginal Australians aged over 18 years who had resided in the relevant LGA for at least a year. The response rate across all LGAs was 99%. Main outcome measures: Being above or below the threshold for high or very high psychological distress on the Kessler Psychological Distress Scale. Results: 221 participants reported experiences of racism in health settings in the past 12 months. The results suggested that people experiencing racism in health settings (OR, 4.49; 95% CI, 2.28–8.86) and non-health settings (OR, 2.66; 95% CI, 1.39–5.08) were more likely than people who did not experience racism to be above the threshold for high or very high psychological distress. Conclusions: Experiencing interpersonal racism in health settings is associated with increased psychological distress over and above what would be expected in other settings. This finding supports the rationale for improving cultural competency and reducing racism as a means of closing the health gap between Aboriginal and other Australians. Capitalising on this investment will require explicitly evaluating the impact of these initiatives on reducing patient experiences of racism.

Margaret A Kelaher BSc, PhD · Angeline S Ferdinand BA, MPH · Yin Paradies PhD

The frequency and severity of adverse effects warrant experienced clinical supervision

Marliese Alexander BPharm(Hons), GradCertPharmPrac, MPH · James D Mellor MPharm(Hons) · Grant McArthur MB BS(Hons), PhD, FRACP · Damien Kee MB BS, FRACP

How does prescribing practice to prevent another stroke measure up against recommendations?

Janet K Sluggett BPharm(Hons), GDipClinEpid · Gillian E Caughey BSc(Hons), PhD · Michael B Ward BPharm(Hons), PhD · Andrew L Gilbert PhD, DipAppPsych, BPharm

Despite an increase in uptake of health assessments, delivery of Indigenous-specific follow-up care is lagging

Jodie Bailie BA, GradDipEd · Gill H Schierhout PhD · Margaret A Kelaher PhD · Alison F Laycock BFA, BEd · Nikki A Percival BSc, MPH · Lynette R O’Donoghue · Tracy L McNeair BA, MPH · Amal Chakraborty · Barbara D Beacham BSocSc, MCDM, CertBT · Ross S Bailie MB ChB, MPhil, MD

A 44% increase in funding is needed to provide optimal care for patients with type 2 diabetes and chronic kidney disease

Andrew P Gador-Whyte BMedSc · John Wakerman MB BS, MTH, HonDSc · David Campbell PostgradCertManagement, MSc, BSc · Sue Lenthall RN, BT, MPH · Janet Struber BPthy, GradCertHSM, MHSc · Alex Hope BA, MB ChB · Colin Watson RN, MTH, PhD

Strategies are needed to curb excessive screen time and soft drink consumption among Aboriginal children

Louise L Hardy MPH(Hons), PhD · Blythe J O’Hara MAppSc, PhD · Debra Hector PhD · Lina Engelen PhD · Sandra J Eades BMed, PhD

Objective: To evaluate the costs and health outcomes associated with primary care use by Indigenous people with diabetes in remote communities in the Northern Territory. Design, setting and participants: A population-based retrospective cohort study from 1 January 2002 to 31 December 2011 among Indigenous NT residents ≥ 15 years of age with diabetes who attended one of five hospitals or 54 remote clinics in the NT. Main outcome measures: Hospitalisations, potentially avoidable hospitalisations (PAH), mortality and years of life lost (YLL). Variables included disease stage (new, established or complicated cases) and primary care use (low, medium or high). Results: 14 184 patients were eligible for inclusion in the study. Compared with the low primary care use group, the medium-use group (patients who used primary care 2–11 times annually) had lower rates of hospitalisation, lower PAH, lower death rates and fewer YLL. Among complicated cases, this group showed a significantly lower mean annual hospitalisation rate (1.2 v 6.7 per person [P < 0.001]) and PAH rate (0.72 v 3.64 per person [P < 0.001]). Death rate and YLL were also significantly lower (1.25 v 3.77 per 100 population [P < 0.001] and 0.29 v 1.14 per person-year [P < 0.001], respectively). The cost of preventing one hospitalisation for diabetes was $248 for those in the medium-use group and $739 for those in the high-use group. This compares to $2915, the average cost of one hospitalisation. Conclusion: Improving access to primary care in remote communities for the management of diabetes results in net health benefits to patients and cost savings to government.

Susan L Thomas DrPH · Yuejen Zhao BM, MBiostat, PhD · Steven L Guthridge MB BS, MTH, FAFPHM · John Wakerman MB BS, MTH, FAFPHM

Men living outside major cities are still at a disadvantage compared with their urban brothers

Xue Qin Yu PhD, MPH · Qingwei Luo MAppStats, BSc · David P Smith PhD, MPH · Dianne L O’Connell PhD, BMaths(Hons) · Peter D Baade PhD, AStat

Admission rates reveal an increasing health burden that thwarts national aspirations to close the gap

Elisabeth K Janu MB BS · Bhavana I Annabattula MB BS · Saampavi Kumariah MB BS · Marta Zajaczkowska MB BS · John S Whitehall FRACP · Matthew J Edwards MD, FRACP, FACMG · Sanja Lujic BSc(Hons), MStats, MBiostats · Ian B Masters MB BS, FRACP, PhD

High, increasing chlamydia rates highlight need for better prevention and screening programs for Indigenous people

Catherine C O’Connor DrPH, FAChSHM, MB BS(Hons) · Hammad Ali MB BS, MPH · Rebecca J Guy BAppSc, MAppEpi, PhD · David J Templeton MB ChB, PhD, FAChSHM · Christopher K Fairley PhD, FRACP, FAChSHM · Marcus Y Chen MB BS, PHD, FAChSHM · Bridget M Dickson · Lewis J Marshall MB BS, FAChSHM, FAFPHM · Andrew E Grulich MB BS, PhD, MScEpid · Margaret E Hellard MB BS, FRACP, PHD · John M Kaldor PhD · Basil Donovan MB BS, MD, FAChSHM · James S Ward BA

People on a spleen registry are more likely to adhere to recommended antibiotic and vaccination guidelines

Julie Wang MB BS, BMedSci · Penelope Jones RN, GradDipEpi · Allen C Cheng MB BS, FRACP, PhD · Karin Leder MB BS, FRACP, PhD

Paediatric hospitals are making decisions about drugs based on poor evidence and incomplete documentation

Yashwant K Sinha MB BS(Hons), FRACP, PhD · Jonathan C Craig MB ChB, FRACP, PhD · Peter G Barclay BPharm, DipHospPharm · Hugh Miller BScPharm(Hons), DipHospPharm(Admin), GradCertMan · Sean C Turner BPharm, MSc, DipClinPharm · Joseph P Whitehouse BPharm(Hons) · Jo-anne E Brien BPharm, BS(Pharm), PharmD

Dementia occurs more often and at a younger age in the NT’s Indigenous population compared with the non-Indigenous

Shu Qin Li MD, MPHBN · Steven L Guthridge MB BS, MTH, FAFPHM · Padmasiri Eswara Aratchige MB BS, MSc, MD · Michael P Lowe BMed, FRACP · Zhiqiang Wang PhD · Yuejen Zhao BM, MBiostat, PhD · Vicki Krause MB BS, MPH, FAFPHM

Population density is independently associated with survival after out-of-hospital cardiac arrest

Ziad Nehme BEmergHlth(Hons) · Emily Andrew BBiomedSc · Peter A Cameron MB BS, MD · Janet E Bray RN, PhD · Stephen A Bernard MB BS, MD · Ian T Meredith BSc(Hons), MB BS, PhD · Karen Smith BSc(Hons), PhD

The high rate of injuries and fatalities among paramedics is a serious public health issue

Brian J Maguire DPH, MSAEMT-P · Peter F O’Meara BHA, MPP, PhD · Richard F Brightwell PhD, BSc(Hons), PGCertEd · Barbara J O’Neill BSNRN-OCN · Gerard J Fitzgerald MD, FACEM, FRACMA

Although good for patient safety, introducing a short-stay unit did not increase overall bed capacity

Patrick T Russell MD, FRACP · Paul Hakendorf BSc, MPH · Campbell H Thompson MD, DPhil, FRACP

Over 40% of GPs would like to reduce their working hours, but only about a quarter of these have managed to do so

Richard Norman PhD · Jane P Hall BA, PhD

Linking data improves monitoring of hospital performance and identification of patients at risk

Mikaela L Jorgensen BAppSc(SpPath)(Hons) · Jane M Young MB BS, PhD, FAFPHM · Timothy A Dobbins BMath, PhD · Michael J Solomon MB BCh, MSc(ClinEpi), FRACS

Relationship between hospital volume and outcomes supports the consolidation of oesophagogastric cancer surgery

Ross C Smith MB BS, MD, FRACS · Nicola Creighton MAppStats · Reginald V Lord MB BS, MD, FRACS · Neil D Merrett MB BS, FRACS · Gregory W Keogh MB BS, FRACS · Winston S Liauw MB BS, MMedSci, FRACP · David C Currow BMed, MPH, FRACP

Fewer women receive information and counselling about emergency contraception from their GP

Danielle Mazza MD, FRACGP · Christopher M Harrison BPsych(Hons), MSocHlth · Angela J Taft BA, MPH, PhD · Helena C Britt BA, PhD · Melissa Hobbs RN, MPH, PhD · Kay Stewart BPharm(Hons), PhD · Safeera Hussainy BPharm(Hons), PhD, GCHE · Bianca R Brijnath BA(Hons), PhD

Text message surveillance of vaccine safety has the capacity to complement passive reporting systems

Alan Leeb MB BCh, DCH, FRACGP · Annette K Regan MPH · Ian J Peters BA · Candice Leeb MB BS, DCH · Gregory Leeb · Paul V Effler MD, MPH, FAFPHM

Older patients are showing improved hospital survival without longer stays and with most returning home

Graeme J Duke MD, FCICM, FANZCA · Anna Barker MPthy(Geriatrics), PhD · Cameron I Knott FRACP, FCICM · John D Santamaria MD, FRACP, FCICM

MDR-TB remains uncommon in WA, but the challenges associated with managing it are being increasingly recognised

Joshua R Francis BAppSc(MedSc), MB BS, FRACP · Christopher C Blyth MB BS, FRACP, FRCPA · Sarah Colby MB BS · Joanna M Fagan MPH · Justin Waring MB BS, FRACP