Cardiac rehabilitation in rural and remote areas of North Queensland: How well are we doing?

OBJECTIVE: To address access to cardiac rehabilitation (CR) for people in R&R areas, this research aimed to investigate: (1) post discharge systems and support for people returning home from hospital following treatment for heart disease (HD). (2) propose changes to improve access to CR in R&R areas of NQ. SETTING: Four focus communities in R&R areas of NQ. PARTICIPANTS: Focus communities' health staff (resident/visiting) (57), community leaders (10) and community residents (44), discharged from hospital in past 5 years following treatment for heart disease (purposeful sampling). DESIGN: A qualitative descriptive case study, with data collection via semi-structured interviews. Inductive/deductive thematic analysis was used to identify primary and secondary themes. Health service audit of selected communities. RESULTS: Health services in the focus communities included multipurpose health services, and primary health care centres staffed by resident and visiting staff that included nurses, Aboriginal and Torres Strait Islander Health Workers, medical officers, and allied health professionals. Post-discharge health care for people with HD was predominantly clinical. Barriers to CR included low referrals to community-based health professions by discharging hospitals; poorly defined referral pathways; lack of guidelines; inadequate understanding of holistic, multidisciplinary CR by health staff, community participants and leaders; limited centre-based CR services; lack of awareness, or acceptance of telephone support services. CONCLUSION: To address barriers identified for CR in R&R areas, health care systems' revision, including development of referral pathways to local health professionals, CR guidelines and in-service education, is required to developing a model of care that focuses on self-management and education: Heart: Road to Health.

Treatment of the lung injury of drowning: a systematic review.

BACKGROUND: Drowning is a cause of significant global mortality. The mechanism of injury involves inhalation of water, lung injury and hypoxia. This systematic review addressed the following question: In drowning patients with lung injury, what is the evidence from primary studies regarding treatment strategies and subsequent patient outcomes? METHODS: The search strategy utilised PRISMA guidelines. Databases searched were MEDLINE, EMBASE, CINAHL, Web of Science and SCOPUS. There were no restrictions on publication date or age of participants. Quality of evidence was evaluated using GRADE methodology. RESULTS: Forty-one papers were included. The quality of evidence was very low. Seventeen papers addressed the lung injury of drowning in their research question and 24 had less specific research questions, however included relevant outcome data. There were 21 studies regarding extra-corporeal life support, 14 papers covering the theme of ventilation strategies, 14 addressed antibiotic use, seven papers addressed steroid use and five studies investigating diuretic use. There were no clinical trials. One retrospective comparison of therapeutic strategies was found. There was insufficient evidence to make recommendations as to best practice when supplemental oxygen alone is insufficient. Mechanical ventilation is associated with barotrauma in drowning patients, but the evidence predates the practice of lung protective ventilation. There was insufficient evidence to make recommendations regarding adjuvant therapies. CONCLUSIONS: Treating the lung injury of drowning has a limited evidentiary basis. There is an urgent need for comparative studies of therapeutic strategies in drowning.

Reducing inequities among adult female migrants at higher risk for drowning in Australia: The value of swimming and water safety programs.

ISSUE ADDRESSED: Drowning is a global public health challenge with a need to ensure equity to drowning prevention information and interventions. In Australia, people born overseas are identified as being at greater risk of drowning. This paper presents findings from a community-based qualitative evaluation of swimming and water safety (SWS) programs delivered to adults from migrant backgrounds in Sydney, Australia. METHODS: A qualitative study was conducted in November-December 2019 among 35 female participants of SWS programs targeted to adult migrants. While offered to all SWS program participants, no males took part in the study. Focus groups and interviews were recorded, transcribed and thematically analysed using a deductive approach. The domains of enquiry were guided by the health belief model and the theory of planned behaviour. RESULTS: Study participants were ≥25 years, first generation and most had lived in Australia for ≥10 years. Most were nonswimmers and were fearful of water prior to the program. Key themes were: direct SWS program outcomes, health and well-being; enablers and barriers to participation including: motivation, a program coordinator, fear and settlement priorities. CONCLUSION: Findings suggest that in order to increase SWS participation among migrant communities, the broader determinants of health need to be considered. Culturally appropriate strategies are required to enable both men and women equal opportunities to access SWS programs. SO WHAT: SWS programs provide multiple benefits for adult migrants; however, the impact on reducing inequities is limited, with broader multi-strategic health promotion approaches and policies required for inclusion and sustainability.

Cardiopulmonary resuscitation and first-aid training of river users in Australia: A strategy for reducing drowning.

ISSUE ADDRESSED: Rivers are a leading location for fatal drowning worldwide, often geographically isolated from timely medical assistance. Cardiopulmonary resuscitation (CPR) benefits drowning victims and those who suffer cardiac arrests. This study explored CPR and first-aid training of river users in Australia. METHODS: Adult river users (18+ years) were surveyed at four high-risk river drowning sites. Respondents were asked the last time they undertook CPR (responses converted into: "CPR ever undertaken"-yes/no; and "CPR training current"-yes/no (training undertaken ≤12 months ago). Responses were explored by demographics and social determinants of health. RESULTS: Of those surveyed (N = 688), 98.4% responded regarding CPR. Seventy-five percent (74.9%) had undertaken CPR training previously. Females and 35- to 44-year-olds were more likely to have undertaken training (P < 0.05). Males and older people (65+ years) were less likely to hold a current qualification (P < 0.05). Major city residents reported a longer mean time (5.4 years) since last trained than remote and very remote locations (2.0 years). People in low socio-economic areas had a shorter time since qualification current (5.8 years) than those in areas deemed high (7.2 years). CONCLUSION: Current CPR qualifications are important, particularly among those visiting high-risk river drowning locations. System-level, upstream strategies that should be explored include compulsory CPR training in secondary schools and linking CPR updates to motor vehicle licence renewals. SO WHAT?: Cardiopulmonary resuscitation is a vital component of multifaceted river drowning prevention. Social determinants of health, such as socio-economic disadvantage and geographical isolation, were not barriers to participation or currency of qualification.

Types and outcomes of pharmacist-managed travel health services: A systematic review.

BACKGROUND AND AIM: Pharmacists have an important role in providing travel health services and medications to travelers. However, given the limited literature on this topic, the aim of this study is to systematically review the types and outcomes of pharmacist-managed travel health services. METHODS: A comprehensive literature search was performed in four electronic databases, namely Scopus, Web of Science, PubMed and ProQuest to identify studies published in English from 1999 to July 2022. The inclusion criteria included the studies that reported an experience of providing dedicated travel health services by pharmacists and reported the outcomes and/or evaluation of these travel health services. RESULTS: Nine studies were identified from the literature and included in the review. The pharmacists have provided a wide range of general and specialized travel health services including pre-travel risk assessment, routine and travel-related vaccination service, prescribing or recommending medications for travel-related illnesses, counseling and travel health advice. Overall, 94-100% of the patients were satisfied or very satisfied with pharmacist-managed travel health services. In addition, a good acceptance rate of pharmacist recommendations for vaccines and travel-related mediations was reported with most studies reporting an overall acceptance rate of ≥75% (acceptance rate range: 48%-94.2%). In addition, high rates of acceptance of other nonpharmacological advices were noted. CONCLUSION: Pharmacists with training in travel medicine have successfully provided a wide range of general and specialized travel health services. Most travelers were highly satisfied with the pharmacy-based travel health services and accepted the pharmacist recommendations.

Pharmacies in the Airport Ecosystem and How They Serve Travelers' Health and Medicines Need: Findings and Implications for the Future.

INTRODUCTION: Pharmacists at airport pharmacies could offer essential health services for air travelers. Consequently, this study aimed to explore the type of professional services, the types of medicines at airport pharmacies and the pharmacists' experiences and views regarding their practices. METHODS: A qualitative study was conducted with pharmacists practicing in airport pharmacies from June 2020 to December 2020. A validated Google form-based interview questionnaire was developed, and the electronic link was sent to the participants. Recruitment of participants was continued until data saturation was achieved. In total, 15 pharmacists working at different airport pharmacies in different countries were included. Thematic analysis was used in the data analysis. RESULTS: The study identified six major themes including type of professional services and medicines at airport pharmacies, pharmacists' experiences, challenges at the airport pharmacy, suggestions to improve airport pharmacy services, pandemics and the role of pharmacists, and business aspect of the airport pharmacies. The study showed that several professional services provided at airport pharmacies, including the provision of medicines, health products, general health services, travel health services, and counseling. Moreover, 46.7% of the participants reported having a dedicated travel health service. In addition, most of the participants described their experience at airport pharmacies as good and exciting as they met different people from different countries. The most common challenges that pharmacists face at airport pharmacies include language barriers, requests for different medicine brands by travelers, and financial issues. The participants indicated that there is a need for promotion of pharmacists' role in providing health care services at airport pharmacies. CONCLUSION: The study showed that pharmacists could play vital roles in providing medicines and health care services for air travelers. However, there is still further scope for improvement in this sector of the pharmacy profession to ensure a more active role in travel medicine.

Illness and injury to travellers on a premium expedition to Iceland.

BACKGROUND: Commercial expeditions provide an opportunity for travellers to undertake various specialised travel to more adventurous and extreme destinations in the relative security of an expeditionary group with medical cover provided by an expedition physician. Little is known about the illnesses and injuries occurring on premium expeditions. The present study was designed to investigate the prevalence of health problems suffered by travellers on a premium expedition to Iceland and the Arctic Circle. METHODS: In 2004, the expedition physician diagnosed and recorded all illnesses and injuries amongst 45 travellers on a premium expedition to Iceland. Information recorded included age, sex, number of days into the expedition, the nature of the presenting illness, the assessment of the condition and the treatment employed. The period of the expedition was for 18 days and travel was by chartered aircraft, cruise ship and bus. RESULTS: Thirty-one (69%) travellers sought medical advice at least once for a total of 54 consultations (mean=1.7). Fifty-six health presentations were reported and recorded amongst the travellers. Females presented on 70% occasions, with the average age of expeditioners presenting being 62 years. The types of primary illness diagnosed were largely those related to the following systems: respiratory 34%, gastrointestinal 30%, dermatological 14%, and musculoskeletal 9%, and other problems 13%. Of the gastrointestinal problems, seasickness was the most common single complaint on 27% of occasions, occurring between day 4 and 9, the cruise phase of the journey. In total, the cruise phase accounted for 43 medical presentations with the pre-cruise phase accounting for 11% of them and the post-cruise phase accounting for the remaining 46%. Presentations were highest on day 5. About one third of presentations (34%) were handled conservatively with 23% requiring antiemetics and 6% requiring antibiotics. There were no deaths or other major incidents requiring emergency evacuation or hospitalisation; although 6 accidents were reported. Interestingly, accidents were significantly more likely to occur earlier in the expedition (t-test; t=2.828, df=54, p=0.007). CONCLUSIONS: On this premium expedition, the health problems encountered were largely similar to those reported for other expeditions. The most common problems included respiratory, gastrointestinal, dermatological conditions and musculoskeletal conditions in descending order. As well as being part of the service provided to travellers, the inclusion of an expedition physician on this premium expedition increased the independence of the travellers on this journey, yet decreased the reliance on local health services, a source which is often scarce or absent on more remote location expeditions.

Qualitative analysis of the impact of a lymphatic filariasis elimination programme using mass drug administration on Misima Island, Papua New Guinea.

BACKGROUND: Papua New Guinea is the only endemic country in the Western Pacific Region that has not yet introduced a countrywide programme to eliminate lymphatic filariasis. However, on Misima Island in Milne Bay Province, government and private sectors have collaborated to implement a pilot elimination programme. Although interim evaluation indicated that the programme has been parasitologically successful, an appreciation that sustainable health gains depend on understanding and accommodating local beliefs prompted this qualitative study. METHODS: We investigated Misima community members knowledge and attitudes about lymphatic filariasis and the elimination programme. A combination of focus groups and key informant interviews were used to explore participants perceptions of health; knowledge of the aetiology and symptoms of filariasis, elephantiasis and hydrocele; attitudes towards the disease and mass drug distribution; and the social structure and decision-making protocols within the villages. RESULTS: Focus group discussions proved inferior to key informant interviews for gathering rich data. Study participants did not consider lymphatic filariasis ("pom") a major health problem but were generally positive about mass drug administration campaigns. A variety of conditions were frequently and incorrectly attributed to filariasis. Participants expressed the belief that individuals infected with filariasis always had visible manifestations of disease. A common misconception was that taking drugs during campaigns provided long-term immunity against disease. The role of mosquito vectors in transmission was not generally appreciated and certain clinical presentations, particularly hydrocele, were associated with supernatural forces. Multiple adverse events were associated with mass drug administration campaigns and most study participants mentioned community members who did not participate in campaigns. CONCLUSION: Important issues requiring educational intervention and elimination activity modification in the Misima region were identified during this study. Research outcomes should assist Papua New Guinea in developing and implementing a national elimination strategy and inform discussions regarding the appropriateness of current elimination strategies.

Level of concern and sources of information of a group of Brisbane hostelers for personal safety and terrorism when traveling abroad.

BACKGROUND: Little is known about the level of concern and sources of information of hostelers concerning personal safety and terrorism. This study was designed to investigate these in the Australian context. METHODS: In 2006, self-administered questionnaires were distributed to hostelers attending a travelers' information evening in Brisbane. RESULTS: Forty questionnaires (60.8%) were returned. Over two thirds of attendees were women (71.4%). About two thirds of the hostelers attending the travelers' information evening reported being aged 29 years or younger (64.2%). Anticipated main destinations were Europe (68.3%), Asia (14.3%), and North America (11.9%). Nearly two thirds (63.4%) intended to travel in more than 8 weeks time or were not sure. Of those departing within 8 weeks, only 40% had sought travel health advice from their general practitioner and/or travel clinic. Nonmedical sources of information on travel health included travel books and guides (40.5%), Internet (35.7%), and travel agents (19.0%). On a five-point rating scale (1 being not concerned to 5 being extremely concerned), median ratings of hostelers' concern for personal safety (4.0) was significantly higher than for terrorism (2.5), with the range being 1 to 5 in each case (p < 0.001). Nearly three quarters (73.8%) of hostelers would seek personal safety advice from multiple sources, and sources of information included the Internet (69.0%, 29), travel books and guides (59.5%), physicians (57.1%), and travel agents (45.2%). Only three (7.1%) nominated the physician as their only source of personal safety advice. CONCLUSIONS: Hostelers attending a travelers' information night in Australia expressed more concern for their personal safety when traveling than for terrorism. Since this group of travelers uses multiple sources of information with the Internet most commonly used, Web sites that provide accurate and relevant information in an acceptable format could play an important role in supporting this group. It is important that policies being promoted by travel health advocacy groups in Australia continue to advocate that travelers seek travel health advice from a qualified source early, preferably around 6 to 8 weeks before travel, and that personal safety be discussed as part of the travel health consultation.

Professional organisation profile: Travel Health Advisory Group, Australia.

The Australian Travel Health Advisory Group was established in 1997 and its membership has been active in several areas, including networking, policy development, research and education in Australia. Information is given on purpose, membership and the various activities of the group.

Assessment of febrile illness in the returned traveller.

BACKGROUND: Fever is among the most frequently reported problems in returning travellers. OBJECTIVE: This article provides an overview of the general approach to fever in the returned traveller, including identification of common causes and management. DISCUSSION: The returned traveller may present with fever and it is important to exclude life threatening conditions such as malaria that may be related to the travel. A complete risk assessment should be undertaken, including a complete travel history, examination and further investigations, to help to narrow the differential diagnosis. Common tropical diseases found include malaria, dengue, enteric fever, rickettsial infections and respiratory infections. General practitioners should be alert to the public health implications of travel related diseases.

Health advice obtained by tourists travelling to Magnetic Island: a risk area for 'Irukandji' jellyfish in North Queensland, Australia.

BACKGROUND: Little is known about the travel health advice obtained by tourists travelling to Magnetic Island, which is a known risk area for the potentially fatal 'Irukandji' jellyfish on the Great Barrier Reef coast of north Queensland, Australia. METHODS: Structured interviews were conducted with 208 ferry passengers (93% response) travelling between Townsville (Latitude 19 degrees S) and Magnetic Island. RESULTS: Less than half of the international tourists (21, 46%) had obtained travel health advice before coming to north Queensland, although they were significantly more likely to have done so than domestic tourists (p<0.001). Travel health advice obtained by international tourists was sourced mainly from their general practitioner (8, 50%) or from a guidebook (6, 38%). Eighty-eight percent of north Queensland residents, 70% of domestic tourists, and 34% of international tourists knew what an Irukandji jellyfish was (p<0.001), although this was not associated with having obtained travel health advice. For those passengers returning from the Island, 8 (44%) domestic tourists and 4 (35%) international tourists recalled seeing some information on the Island that improved their knowledge about Irukandji jellyfish. Most of the international tourists travelled to north Queensland by bus (30, 65%), while most domestic tourists arrived by private car (12, 40%) or plane (10, 33%). CONCLUSIONS: Only a small proportion of international tourists knew about Irukandji jellyfish and most tourists had not received travel health advice. The majority of tourists had not received further information about Irukandji jellyfish risk whilst on the island. All travellers to popular north Queensland tourist areas need travel health advice, which includes advice on avoiding contact with Irukandji and Chironex box jellyfish. Health promotion campaigns directed at providing this advice need to be aware that most tourists to north Queensland arrive by bus or car and the only 'shared' vehicle, at least to Magnetic Island, is the passenger ferry.

Alcohol and tobacco consumption among police officers.

Police occupy an important position within the community as both enforcers of the law and as role models for appropriate behavior. Despite this interesting juxtaposition, research has shown that they may consume alcohol and tobacco at rates higher than the general population. A significant causal factor is occupational stress, and the fact that police are regularly exposed to stressors beyond the range of normal human experiences. Given this ongoing and unavoidable relationship, the recognition and control of stress is paramount within law enforcement. Because police stressors are usually multi-faceted, health promotion interventions should focus on stress-reduction at both the institutional and individual level. Examples of health promotion strategies may include reducing overtime, carefully organizing shift rosters, streamlining administrative processes and allowing rest breaks for those on the night-shift. Interventions which focus on the individual are also important, because excess alcohol and tobacco consumption levels often relate to individual stress-coping mechanisms. Programs to help recognize and prevent excess alcohol and tobacco consumption may be worthwhile, as too, counseling, interpersonal support and critical incident debriefing. Promoting non-drinking and non-smoking stress-reduction activities where police can socialize and de-brief with their colleagues may be beneficial. Encouraging social events at sports clubs and gymnasiums has also been suggested. In order to achieve these goals however, governments will need to place a greater emphasis on the occupational health of police officers and the law enforcement agencies in which they work.

Trends in malaria chemoprophylaxis prescription in South Africa 1994 to 2000.

The World Health Organization estimates that more than 300 million cases of malaria exist worldwide each year, resulting in more than 3 million deaths, with more than 1 million deaths of children in sub-Saharan Africa alone. Malaria is also a reemerging disease in some parts of Africa, including South Africa. Malaria prevention is multi-faceted with no single precaution offering complete protection. Taking chemoprophylaxis decreases the severity and frequency of death from malaria due to Plasmodium falciparum when compared with taking no chemoprophylaxis.

Toxicity of cyanoacrylate adhesives and their occupational impacts for dental staff.

Cyanoacrylate (CA) and its homologues have a variety of medical, dental and commercial applications as adhesives. The increasing use of CA in dentistry, particularly as an adhesive and sealing glue, has raised concerns regarding its potential toxicity in humans. Reported toxicity of CA is uncommon in the dental workplace, but may manifest as conditions such as urticaria, contact dermatitis and other dermatoses. Dental staff using CA adhesives should avoid direct contact with CA and use appropriate personal protective measures. Maintaining higher levels of humidity, optimizing room ventilation and using special air conditioning filters in the working environment may be useful in minimising the toxicity of volatile CA adhesives.

Health advice given by general practitioners for travellers from Australia.

OBJECTIVES: To investigate the prevalence of travel health advice and written documentation reported to be given by general practitioners to travellers from Australia. DESIGN AND SETTING: A postal questionnaire was sent to general practitioners (GPs). PARTICIPANTS: 433 GPs were randomly selected from the register of the Medical Directory of Australia from the areas of western Sydney and Townville. RESULTS: Two hundred and thirteen questionnaires (49.2%) were returned. Approximately two-thirds of the sample was male (133/207,64.3%) and one-third female (74/207,35.7%). The mean age of the GPs was 46.7 (SD+/-12.1) years. The GPs reportedly saw an average of 3.9 (SD+/-11.8) travellers per week. Most GPs (160/202,79.2%) reported that they spent between 5-25 min for pre-travel consultations. GPs generally reported giving advice to travellers on travel vaccines, malaria prophylaxis, personal protective measures against insect bites, geographic diseases, clothing, and sexually transmitted infections. The majority of GPs did not routinely give information on travel insurance, unsafe sex, barotrauma, in-flight exercise, jet lag or first aid knowledge. Most GPs reported not routinely giving written documentation in the form of written travel health advice, a doctor's letter or a travellers' vaccination record. CONCLUSIONS: GPs report seeking core information needed for formulating travel health advice. GPs also provided travellers with health advice on most of the areas, which need to be covered in the pre-travel consultation. More GPs may wish to consider advising travellers about the importance of travel insurance and managing common maladies of travellers, such as motion sickness, barotrauma, and jet lag. With limited time in general practice to advise travellers, more GPs should consider providing written advice and documentation for travel, including a travellers' vaccination record.

Referral of travellers from Australia by general practitioners for travel health advice.

Background. General practitioners (GPs) may refer travellers to practice staff and to outside agencies to assist in the provision of travel health advice and preventive measures. In Australia, little is known about the referral patterns of travellers for travel health advice by GPs in the Australian context. This study was designed to investigate how frequently GPs' practice staff became involved in providing basic travel health advice and travel vaccination and to identify referral sources and how frequently GPs referred travellers to these sources for travel health advice. Method. In 2000, 433 GPs from western Sydney and Townsville were randomly selected from the register of the Australian Medical Association's Medical Directory of Australia database and sent self-administered questionnaires. Two reminders were sent. Results. Two hundred and thirteen questionnaires (43%) were returned. Approximately two thirds of the sample were male (133/207, 64.3%) and one third female (74/207, 35.7%). The mean age of the GPs was 46.7 (SD+/-12.1) years. About one tenth of GPs reported having a Yellow Fever Licence (11.3%, 23/203). The majority of GPs did not use their practice staff for giving travel health advice (60.7%, 122/201) or giving travel vaccinations (55.7%, 112/201). More than three quarters of GPs would never refer their patients for travel health advice to GPs with a special interest in travel medicine (76.4%, 152/199), specialists (76.8%, 152/198), or other agencies (77.8%, 63/81). Almost half of GPs stated that they would refer to travel clinics at least sometimes (46.6%, 95/204). Conclusions. GPs do sometimes refer travellers to specialised practices for travel health advice, especially to travel clinics, but also to other agencies, possibly for specialised services, such as yellow fever vaccination. Further studies may be needed on capacity of general practice staff to contribute to the travel health consultation and also the reasons and the appropriateness of the referral to outside agencies, where this occurs. Practices may need to consider further training of their auxiliary health staff in travel medicine, so that they can become more involved in the provision of travel health advice and immunization, where possible.