Empowering and Building the Capabilities of Mid-Level Health Service Managers to Lead and Support the Health Workforce-A Study Protocol.

(1) Background: Mid-level managers in healthcare are central to improving safety and quality of care. Their ability in demonstrating leadership and management competency in their roles and supporting frontline managers and frontline staff has a direct effect on staff retention and turn-over. Yet, investment in their professional development and support for mid-level managers is often neither adequate nor effective, and high rates of staff turnover are evident. This study, set in northern Queensland, Australia, takes a strength-based approach to explore the role and strengths of mid-level managers and organisations' existing mechanisms in supporting managers. With broad involvement and contribution from managers at different management level and frontline staff, the project will identify strategies to address the challenges mid-level managers face while building on their capabilities. (2) Methods: Using co-design principles, a situation analysis approach will guide a mixed-methods, multiphase design. Qualitative data will be collected using transcripts of focus groups and quantitative data will be collected by surveys that include validated scales. (3) Results: Thematic analysis of the transcripts will be guided by the framework of Braun and Clarke. Quantitative data will employ descriptive and inferential analysis, including chi-squared, t-tests, and univariate analyses of variance. (4) Conclusions: This study will generate evidence to guide two partner organisations, and other similar organisations, to develop strategies to improve support for mid-level managers and build their capabilities to support and lead frontline managers and staff. Competent mid-level managers are critical to high-quality patient care and improve the outcomes of the population they serve.

The impact of extreme heat on mass-gathering sporting events: Implications for Australia and other countries.

OBJECTIVES: As temperatures increase across the globe due to climate change, human exposure to extreme heat is a public health challenge. During sporting events, athletes, officials, spectators, and staff are at risk of heat stress and resulting illness. The objective of this review was to explore the impact of heat on the health outcomes of these groups and the wider health system and discuss implications for outdoor mass-gathering sporting events in Australia. DESIGN: A systematic review was undertaken to identify literature published from 2010 to 2023. METHODS: Seven databases were searched: Web of Science, SportDiscus, Scopus, Medline, CINAHL, Emcare, and PsychInfo, for relevant key search terms such as heatwave, heat stress, extreme heat, stadium, arena, sports facilit*, sport, athletic, and Olympic. An inductive thematic analysis was undertaken. Articles were quality checked using Joanna Briggs Institute critical appraisal tools and data were extracted, tabulated, and synthesized. RESULTS: Forty papers were included in the final analysis: 17 quantitative, and 23 descriptive and qualitative (including reviews). Health outcomes explored across the literature included exertional heat illness, exertional heat stroke, hyperthermia, and general heat related illness. Six recommendation themes emerged: planning, mitigation strategies, medical, policy, research, and education. CONCLUSIONS: The impact of heat on health outcomes during sporting events is significant, and should be considered by individuals, coaches, officials, and organizers before, during, and after mass-gathering sporting events. These findings can inform evidence-based preparedness strategies to protect the health of those attending and competing in mass-gathering sporting events now and into the future.

Examining the relationship between heatwaves and fatal drowning: a case study from Queensland, Australia.

BACKGROUND: Globally, drowning is a leading cause of injury-related harm, which is heavily impacted by environmental conditions. In Australia, fatal unintentional drowning peaks in summer, yet the impact of prolonged periods of hot weather (heatwave) on fatal drowning has not previously been explored. METHODS: Using a case-crossover approach, we examined the difference in drowning risk between heatwave and non-heatwave days for the Australian state of Queensland from 2010 to 2019. Heatwave data, measured by the excess heat factor, were acquired from the Bureau of Meteorology. Incidence rate ratios (IRRs) were calculated by sex, age of drowning decedent, category of drowning incident (International Classification of Diseases-10 codes) and heatwave severity. Excess drowning mortality during heatwaves was also calculated. RESULTS: Analyses reveal increased fatal drowning risk during heatwave for males (IRR 1.22, 95% CI 0.92 to 1.61), people aged 65+ years (IRR 1.36, 95% CI 0.83 to 2.24), unintentional drowning (IRR 1.28, 95% CI 0.98 to 1.69) and during severe heatwaves (IRR 1.26, 95% CI0.88 to 1.82). There were 13 excess drowning deaths due to heatwave over the study period. DISCUSSION: The findings confirm an increased risk of fatal drowning during heatwaves. With increased likelihood and severity of heatwaves, this information should be used to inform drowning prevention, in particular the timing of public awareness campaigns and patrolling of supervised aquatic locations. CONCLUSIONS: Water safety and patrolling organisations, as well as first responders, need to prepare for more drowning deaths during heatwave conditions. In addition, drowning prevention education ahead of heatwaves is needed for recreational swimmers, and older people, particularly those with comorbidities which may be further exacerbated by a heatwave.

Canine Support Program: Student perceptions and preferences at a regional university and implications for health, well-being, and student support enhancements.

ISSUE ADDRESSED: Canine Support Programs (CSPs) are a potential solution to growing university student support demands. While current studies focus on the impacts of CSPs, there is limited understanding of the views and expectations of tertiary students about CSPs. This study explored the perceptions and preferences of students in an Australian regional university about CSPs. METHODS: A questionnaire with multiple choice and open-ended questions surveyed residential students' perspectives about CSP. Data were analysed using descriptive statistical tests and thematic analysis for open responses. RESULTS: Majority (98%) of participants (sample n = 48) would support a CSP on campus. Frequent, small-group interactions of ≥15 min involving physical contact were preferred. Dog disposition, welfare-trained handlers, and veterinary certification were important aspects of program safety. Participants strongly agreed a CSP would improve mental health and well-being, relieve stress, reduce feelings of homesickness, provide support, comfort, and enable social interactions. CONCLUSION: There is strong support among the study population for CSP to be established on campus. This study supports earlier research that CSP has benefit potential for new, stressed, and/or students who love dogs. The preferences of students should inform program design to enhance utility and impact. This aligns with Health Promoting Universities and College's Okanagan Charter principle of 'engaging student voices'. More institutional awareness and support for CSPs will be necessary for integration. SO WHAT?: This study reveals the need for tailored and creative student support beyond traditional offerings including those that focus on student well-being and social initiatives. CSPs can be utilised as an advocate, enabler, and medium for mental health promotion action and well-being support for tertiary students; thereby, contributing to the 'Health Promoting University' agenda in Australia. It also reinforces the need for a Health in All Policies approach to be incorporated into our tertiary education sector. Future actions should focus on improving institutional awareness, support, and sector implementation.

Connection Between Sleep and Psychological Well-Being in U.S. Army Soldiers.

INTRODUCTION: The goal of this exploratory study was to examine the relationships between sleep consistency and workplace resilience among soldiers stationed in a challenging Arctic environment. MATERIALS AND METHODS: A total of 862 soldiers (67 females) on an Army base in Anchorage, AK, were provided WHOOP 3.0, a validated sleep biometric capture device and were surveyed at onboarding and at the conclusion of the study. Soldiers joined the study from early January to early March 2021 and completed the study in July 2021 (650 soldiers completed the onboarding survey and 210 completed the exit survey, with 151 soldiers completing both). Three comparative analyses were conducted. First, soldiers' sleep and cardiac metrics were compared against the general WHOOP population and a WHOOP sample living in AK. Second, seasonal trends (summer versus winter) in soldiers' sleep metrics (time in bed, hours of sleep, wake duration during sleep, time of sleep onset/offset, and disturbances) were analyzed, and these seasonal trends were compared with the general WHOOP population and the WHOOP sample living in AK. Third, soldiers' exertion, sleep duration, and sleep consistency were correlated with their self-reported psychological functioning. All analyses were conducted with parametric and non-parametric statistics. This study was approved by The University of Queensland Human Research Ethics Committee (Brisbane, Australia) Institutional Review Board. RESULTS: Because of the exploratory nature of the study, the critical significance value was set at P < .001. Results revealed that: (1) Arctic soldiers had poorer sleep consistency and sleep duration than the general WHOOP sample and the Alaskan WHOOP sample, (2) Arctic soldiers showed a decrease in sleep consistency and sleep duration in the summer compared to that in the winter, (3) Arctic soldiers were less able to control their bedroom environment in the summer than in the winter, and (4) sleep consistency but not sleep duration correlated positively with self-report measures of workplace resilience and healthy social networks and negatively with homesickness. CONCLUSIONS: The study highlights the relationship between seasonality, sleep consistency, and psychological well-being. The results indicate the potential importance of sleep consistency in psychological functioning, suggesting that future work should manipulate factors known to increase sleep consistency to assess whether improved sleep consistency can enhance the well-being of soldiers. Such efforts would be of particular value in an Arctic environment, where seasonality effects are large and sleep consistency is difficult to maintain.

Camouflage using three-dimensional surface disruption.

Disruptive markings are common in animal patterns and can provide camouflage benefits by concealing the body's true edges and/or by breaking the surface of the body into multiple depth planes. Disruptive patterns that are accentuated by high contrast borders are most likely to provide false depth cues to enhance camouflage, but studies to date have used visual detection models or humans as predators. We presented three-dimensional-printed moth-like targets to wild bird predators to determine whether: (1) three-dimensional prey with disrupted body surfaces have higher survival than three-dimensional prey with continuous surfaces, (2) two-dimensional prey with disruptive patterns or enhanced edge markings have higher survival than non-patterned two-dimensional prey. We found a survival benefit for three-dimensional prey with disrupted surfaces, and a significant effect of mean wing luminance. There was no evidence that false depth cues provided the same protective benefits as physical surface disruption in three-dimensional prey, perhaps because our treatments did not mimic the complexity of patterns found in natural animal markings. Our findings indicate that disruption of surface continuity is an important strategy for concealing a three-dimensional body shape.

Determining the Impact of Heatwaves on Emergency Ambulance Calls in Queensland: A Retrospective Population-Based Study.

Heatwaves are a significant and growing threat to the health and well-being of the residents of Queensland, Australia. This threat is increasing due to climate change. Excess heat increases the demand for health services, including ambulance calls, and the purpose of this study was to explore this impact across Queensland. A state-wide retrospective analysis of heatwaves and emergency 'Triple Zero' (000) calls to Queensland Ambulance (QAS) from 2010-2019 was undertaken. Call data from the QAS and heatwave data from the Bureau of Meteorology were analysed using a case-crossover approach at the postcode level. Ambulance calls increased by 12.68% during heatwaves. The effect was greatest during low-severity heatwaves (22.16%), followed by severe (14.32%) and extreme heatwaves (1.16%). The impact varied by rurality, with those living in very remote areas and major cities most impacted, along with those of low and middle socioeconomic status during low and severe intensity heat events. Lag effects post-heatwave continued for at least 10 days. Heatwaves significantly increase ambulance call centre workload, so ambulance services must actively prepare resources and personnel to address increases in heatwave frequency, duration, and severity. Communities must be informed of the risks of heatwaves at all severities, particularly low severity, and the sustained risks in the days following a heat event.

Heatwaves and mortality in Queensland 2010-2019: implications for a homogenous state-wide approach.

Heatwaves are a significant cause of adverse health outcomes and mortality in Australia, worsening with climate change. In Queensland, the northeastern-most state, little is known about the impact of heatwaves outside of the capital city of Brisbane. This study aims to explore the impact of heatwaves on mortality across various demographic and environmental conditions within Queensland from 2010 to 2019. The Excess Heat Factor was used to indicate heatwave periods at the Statistical Area 2 (SA2) level. Registered deaths data from the Australian Bureau of Statistics and heatwave data from the Bureau of Meteorology were matched using a case-crossover approach. Relative risk and 95% confidence intervals were calculated across years, regions, age, sex, rurality, socioeconomic status, and cause of death. Heatwaves were associated with a 5% increase in all-cause mortality compared to deaths on non-heatwave days, with variability across the state. The risk of death on a heatwave day versus a non-heatwave day varied by heatwave severity. Individuals living in urban centers, the elderly, and those living in regions of lower socioeconomic status were most impacted by heatwave mortality. The relative risk of dying from neoplasms, nervous system conditions, respiratory conditions, and mental and behavioral conditions increased during heatwaves. As heatwaves increase in Queensland due to climate change, understanding the impact of heatwaves on mortality across Queensland is important to tailor public health messages. There is considerable variability across communities, demographic groups, and medical conditions, and as such messages need to be tailored to risk.

Systematic review of the impact of heatwaves on health service demand in Australia.

OBJECTIVES: Heatwaves have been linked to increased levels of health service demand in Australia. This systematic literature review aimed to explore health service demand during Australian heatwaves for hospital admissions, emergency department presentations, ambulance call-outs, and risk of mortality. STUDY DESIGN: A systematic review to explore peer-reviewed heatwave literature published from 2000 to 2020. DATA SOURCES: Articles were reviewed from six databases (MEDLINE, Scopus, Web of Science, PsychINFO, ProQuest, Science Direct). Search terms included: heatwave, extreme heat, ambulance, emergency department, and hospital. Studies were included if they explored heat for a period of two or more consecutive days. Studies were excluded if they did not define a threshold for extreme heat or if they explored data only from workers compensation claims and major events. DATA SYNTHESIS: This review was prospectively registered with PROSPERO (# CRD42021227395 ). Forty-five papers were included in the final review following full-text screening. Following a quality assessment using the GRADE approach, data were extracted to a spreadsheet and compared. Significant increases in mortality, as well as hospital, emergency, and ambulance demand, were found across Australia during heatwave periods. Admissions for cardiovascular, renal, respiratory, mental and behavioural conditions exhibited increases during heatwaves. The most vulnerable groups during heatwaves were children (< 18 years) and the elderly (60+). CONCLUSIONS: Heatwaves in Australia will continue to increase in duration and frequency due to the effects of climate change. Health planning is essential at the community, state, and federal levels to mitigate the impacts of heatwaves on health and health service delivery especially for vulnerable populations. However, understanding the true impact of heatwaves on health service demand is complicated by differing definitions and methodology in the literature. The Excess Heat Factor (EHF) is the preferred approach to defining heatwaves given its consideration of local climate variability and acclimatisation. Future research should explore evidence-based and spatially relevant heatwave prevention programs. An enhanced understanding of heatwave health impacts including service demand will inform the development of such programs which are necessary to promote population and health system resilience.

Aeromedical retrievals in Queensland: A five-year review.

OBJECTIVE: Aeromedical services are an essential part of the healthcare system. Centralised coordination of aeromedical retrieval tasking offers benefits for safety, timeliness and efficiency in service delivery. The aim of the present study is to review aeromedical retrievals in Queensland exploring patient demographics, temporal patterns and usage characteristics. METHODS: This is a retrospective cases series for the period 1 January 2010 to 31 December 2014 incorporating data from Retrieval Services Queensland and Queensland Newborn Emergency Transport Service. Ethics approval was obtained (JCU-HREC H6137 and Public Health Act #RD005673). Descriptive analysis of the de-identified data was undertaken included patient demographics, referral and receiving locations, retrieval platform and acuity of transport request. RESULTS: There were 73 042 aeromedical retrievals undertaken during the period, with an average of 40 cases per day (range 16-89). The majority (95%) of retrievals were for Queensland residents. Overall 23.1% of cases were cardiology-related and 12.7% were injury-related. Older adults aged 75-84 years had the highest rate of retrievals relative to the population with a crude rate of 942.4 per 100 000 per annum. Overall 14.9% of cases were Priority 1, which represents the tasking with the highest acuity but majority were Priority 4 (41.6%). One third (37.6%) of all patients were from inner regional locations. CONCLUSIONS: Potential investments in health service planning may alleviate the burden on aeromedical services, particularly related to cardiology services in inner and outer regional Queensland. Aeromedical services are pivotal in enabling all sick and injured residents' access to the highest quality of care regardless of the remoteness of their residence.

Exploring Australian residents cycling engagement - Differences in self-reported cycling behaviour between urban and rural dwelling Queenslanders.

ISSUE ADDRESSED: Cycling participation rates in Australia and Queensland remain low. Rural residents typically do not have distinct cycling infrastructure available for use. Investigating current cycling participation and barriers to cycling engagement will inform future work to promote cycling engagement. METHODS: Data were collected through the inclusion of cycling-related questions in the 2012 Queensland Social Survey. RESULTS: The majority of the sample had not cycled in the previous 12 months (66%; n = 831). Significantly more rural residents reported not cycling due to environmental concerns (P < 0.05) and preferring other modes of transport or exercise (P < 0.01). Rural cyclists (31.4%; n = 113) had higher levels of cycling engagement in the previous week (41.6% to 32.6% urban; χ2  = 7.83; n = 420; P < 0.05) but lower cycling durations than urban cyclists (41.6% rural residents cycling for 30+ minutes vs 57.4% urban residents; χ2  = 8.25; n = 418; P < 0.01). Rural cycling engagement was independently associated with being male (OR = 2.34; 95% CI = 1.40-3.91); sufficient physical activity engagement (OR = 1.86; 95% CI = 1.10-3.15); and having children at place of residence (1-2 children: OR = 3.21; 95% CI = 1.88-5.49; 3+ children: OR = 3.01; 95% CI = 1.17-7.75). CONCLUSIONS: One-third of all adults cycled in the previous 12 months irrespective of location; however reasons for not cycling varied by urban/rural location. Results indicate that environmental factors appear to be inhibiting cycling participation in rural areas. Advocating for government commitment for infrastructure development to support safe cycling across Queensland including outside of metropolitan areas is required. SO WHAT?: This research explores self-reported cycling engagement amongst a sample of urban and rural dwelling Queenslanders. Differences in cycling exposure and reasons for lack of engagement offer insights into what may encourage greater cycling participation.

A Systematic Review of Large Agriculture Vehicles Use and Crash Incidents on Public Roads.

Background: Agricultural vehicles are a common sight on rural public roads. However, due to their larger mass (height, width, length, and weight), there are concerns about safety. The aim of this paper is to explore crash incidents on public roads of agricultural vehicles to determine the size of the problem, risk factors, and potential prevention strategies.Methods: A systematic review using the PRISMA guidelines was undertaken of peer-reviewed literature from Medline, Agricola, Scopus, PsycInfo, Science Direct, Web of Science, and SafetyLit. Crash incident rates, risk factors, and prevention strategies were extracted from the articles, and a review of quality was undertaken using McMasters guidelines.Results: Included in the review were 30 articles, with the majority from the United States. Crash risk rates, where reported, were low relative to agricultural vehicle use and when compared to overall road crash numbers. Crash risk factors included weather and visibility, age, personal and driving characteristics, road conditions, and event characteristics. Prevention strategies proposed were targeted at drivers and operators, vehicles, road design, driving behavior, and surveillance, policy, and technology.Conclusions: Overall, reported crash numbers involving large agricultural vehicles were low. Currently, there is limited capacity to calculate exposure rates compounded by the difficulties in identifying road incidents that involve agriculture vehicles. Better surveillance systems are required to improve our understanding of exposure and crash incident rates. Future research into the multiplicity of interrelated factors involved in agriculture vehicle crashes on roads, exposure rates, and evidence for the effectiveness of the prevention strategies is required.

Review article: Primary aeromedical retrievals in Australia: An interrogation and search for context.

Primary aeromedical retrievals are a direct scene response to patients with a critical injury or illness using a medically equipped aircraft. They are often high-acuity taskings. In Australia, information on primary retrieval taskings is housed by service providers, of which there are many across the country. This exploratory literature review aims to explore the contemporary peer-reviewed literature on primary aeromedical retrievals in Australia. The focus is on adult primary aeromedical retrievals undertaken in Australia and clinical tools used in this pre-hospital setting. Included articles were reviewed for research theme (clinical and equipment, systems and/or outcomes), data coverage and appraisal of the evidence. Of the 37 articles included, majority explored helicopter retrievals (n = 32), retrieval systems (n = 21), compared outcomes within a service (n = 10) and explored retrievals in the state of New South Wales (n = 19). Major topics of focus included retrieval of trauma patients and airway management. Overall, the publications had a lower strength of evidence because of the preponderance of cross-sectional and case-study methodology. This review provides some preliminary but piecemeal insight into primary retrievals in Australia through a localised systems lens. However, there are several areas for research action and service outcome improvements suggested, all of which would be facilitated through the creation of a national pre-hospital and retrieval registry. The creation of a registry would enable consideration of the frequency and context of retrievals, comparison across services, more sophisticated data interrogation. Most importantly, it can lead to service and pre-hospital and retrieval system strengthening.

Influencing Safety in Australian Agriculture and Fisheries.

BACKGROUND: Improving the health and safety of those working in Australian agriculture and fishery industries is a recognized priority area for preventative activities. With Australian agricultural industries being among the nation's most dangerous workplaces, there is a need for action. While there are currently known solutions, their implementation is limited. Influential agents, i.e., people who can influence others, are important for helping engender action to enact solutions into practice. OBJECTIVE: This study examines agents that influence safety behavior either negatively (barriers) or positively (facilitators), in the Australian agriculture and fishery industries. METHODS: Focus groups were conducted with producers and industry representatives. Thematic analysis identified barriers and facilitators to improve health and safety. These were assessed against the Socioecological Model, which considers the various, and often intersecting, human (intrapersonal, i.e. values and attitudes, peers, familial, and cultural) factors influencing safety behavior. RESULTS: Seven categories of human influences were identified: self, peers, family, intergenerational change, industry agents, government agents, and other. Peers (including direct managers) and family were seen to be direct influencers. Individuals signal to others that safety is valued and important. This is reinforced by experience, skill, attitudes, and behavior. Safety practice knowledge acquisition occurred via the family unit, specific training, industry, or knowledge transfer between industries. Government influence predominately focused on legislation and while the source of this influence is distant, it does influence behavior. CONCLUSIONS/RECOMMENDATIONS: There is a need to support comprehensive programs. These should include strengthening relationships via peer-to-peer networking, sharing information about safety initiatives, appropriate legislation, and enhancing leadership of all influencers with regard to safety.

Falls in rural and remote community dwelling older adults: a review of the literature.

OBJECTIVE: Falls in older adults represent a significant challenge in Australia; however, the focus is often on urban-dwelling older adults. The aim of this review was to explore the literature on falls epidemiology and falls prevention interventions (FPI). DESIGN: A literature review was conducted searching Medline, Scopus, Social Sciences Citation Index, Google Scholar, Google and the Australian Institute of Health and Welfare publication catalogue. SETTING: Rural and remote Australia. PARTICIPANTS: Rural and remote community dwelling Australians aged 50 years and older. INTERVENTION: Literature review. MAIN OUTCOME MEASURES: Falls epidemiology and effective falls prevention interventions. RESULTS: Twenty references were identified: 14 related to falls epidemiology and 7 to FPI. No significant differences were found between rural, remote and major cities residents in relation to falls hospitalisation, falls mortality or fall-related injuries sustained. There are a wide assortment of health professionals and non-health professionals who are involved in providing FPI in rural and remote Australia. However, there was limited information on the effectiveness of these interventions in influencing falls outcomes. CONCLUSION: Few studies explored falls and their prevention in rural and remote Australia. The limited literature on the topic suggests that a change in focus to one that utilises existing services and resources will be required to create sustainable outcomes. Four areas are proposed for concentrated effort to reduce the impact of fall-related injury in rural and remote Australia: integration and collaboration among health professionals, promotion of physical activity across the lifespan, community involvement and ownership of interventions, and evaluation and publication of findings.

A framework for the assessment of community exercise programmes: a tool to assist in modifying programmes to help reduce falls risk factors.

BACKGROUND: falls in older adults is a significant global public health challenge. Exercise interventions which incorporate the physiological components of balance and strength can reduce falls risk. However, the optimum qualities, such as type, duration and frequency of engagement in these exercise programmes, are yet to be established. OBJECTIVE: the overall research project aimed to develop and test a tool for the assessment of physiological criteria in community exercise programmes and to determine which community exercise programmes may be modified to help reduce falls risk factors. This initial phase of the research and the aim of this paper are to describe the development of the Community Exercise Program Assessment Matrix (the Matrix). METHODS: a review of the falls literature identified an existing classification system, which guided the development of the Matrix. An expert panel assisted in reviewing, testing and ongoing refinement of the Matrix. RESULTS: the Matrix contains a range of physiological and cognitive components as well as other items which capture non-physiological components. After testing some modifications were made to the Matrix to aid usage. CONCLUSION: this paper has outlined the development of the Matrix, which is intended to be used for the recording of physiological components (related to falls prevention) of an exercise programme in terms of type, duration and frequency. The next step is to use the Matrix in conjunction with pre- and post-physiological testing of participants to assess a range of exercise programmes and changes in participant physiological functioning.