Assessment, incidence and factors associated with urinary incontinence in older Aboriginal Australians.

BACKGROUND: Little is known about urinary incontinence in older Aboriginal Australians. AIM: To describe urinary incontinence assessment, prevalence, incidence and associated conditions in older Aboriginal Australians. METHODS: Wave 1 consisted of 363 Aboriginal participants aged ≥45 years from Western Australia; 289 participants participated in Wave 2, with 184 included at both time points. Urinary incontinence was assessed by self-report, family report and the modified International Consultation on Incontinence Questionnaire (ICIQ). We investigated factors associated with incontinence with binary logistic regression. Sensitivity and specificity analyses of incontinence measures were undertaken using the ICIQ score ≥2 as the reference standard. RESULTS: Participant mean age was 61.2 ± 11.2 years. Prevalence of incontinence at Wave 2 (n = 289) using self-report was 24.6%; using ICIQ ≥2 was 22.5%; and family report 14.2%. Incidence after follow-up of 6.7 years was 33 (23.6%), higher than estimates of 5-20% in other populations. Cross-sectional associations with incontinence include female sex (odds ratio (OR) = 6.82; 95% confidence interval (CI) 2.98-15.57), stroke (OR = 3.55; 95% CI 1.43-8.77), head injury (OR = 3.15; 95% CI 1.54-6.45) and depressive symptoms (OR = 1.07; 95% CI 1.01-1.14). Longitudinal associations were age (OR = 1.05; 95% CI 1.01-1.09) and female sex (OR = 2.37; 95% CI 0.99-5.67). Sensitivity (81.5%) and specificity (93.5%) of self-report were high. CONCLUSION: The prevalence and incidence of urinary incontinence in Aboriginal Australians is high with risk factors of older age and female sex. The modified ICIQ and self-report appear to be appropriate incontinence screens. Further research to understand causes and treatments within this population is urgently required.

Dietetics students' construction of competence through assessment and placement experiences.

AIM: Competency standards are widely adopted as a framework to describe standards of performance required in the workplace. Little is known, however, about how students construct competence. This qualitative study aimed to explore how dietetics students ready to graduate construct the concept of competence and the role of assessment in developing professional competence. METHODS: A qualitative description was used to gather data from a convenience sample of students ready to graduate from universities with accredited dietetics programs across Australia (10 out of 15 at the time of the study). A total of 11 focus groups were conducted to explore perspectives of competence and experiences of 'competency-based' assessment. Data were audio-recorded, transcribed and analysed using a thematic analysis approach. RESULTS: A total of 81 (n = 81) participants across 10 universities representing 22% of total students participated in the focus groups. Themes revealed that: (i) there is no shared understanding of competence; (ii) current work placement experiences may not reflect current standards or workforce needs; (iii) assessment approaches may not fully support the development of competence; and (iv) the competent performance of supervising dietitians/clinical educators in the workplace influences the construction of competence. CONCLUSIONS: There is a need to work towards a shared understanding of dietetic entry-level competence in the profession. 'Work-based' learning experiences may need to be modified to ensure students meet current competency standards. Practitioners involved in student supervision need to acknowledge the influential role they have in the development of the future workforce.

Reducing health disparities for low decile children and families: a nurse-led response.

BACKGROUND AND CONTEXT: Reducing health disparities for children living in deprived areas has been difficult to achieve. This paper describes the implementation of a nurse-led, child-specific clinic within a general practice setting to improve health outcomes for high needs Maori/Pacific Island and NZDep96 quintile groups 4 and 5 children and their whanau/families. ASSESSMENT OF PROBLEM: The medical centre that implemented the clinic had a high number of enrolled children with chronic and recurrent morbidities. Children frequently did not attend clinic appointments, and there was high use of after-hours services. RESULTS: An outcome audit after 18 months demonstrated a significant (>30%) reduction in eczema severity, daily irritability, and daily occurrence of pain. Post-intervention fewer children were hospitalised and there was a 50% reduction in antibiotic use. STRATEGIES FOR IMPROVEMENT: The aim of the nurse-led clinic was to improve health gains, facilitate morbidity control of chronic conditions, and to offer prevention strategies to promote wellness for the target population. The reduction of morbidity severity by 10% was measured with specific morbidity scoring systems for eczema, constipation and nocturnal enuresis. Other outcome indicators measured vomiting/reflux, wheezing/coughing, constipation/soiling, irritability, sleep disturbances, hospital admissions, and antibiotic use. LESSONS: Nurse-led clinics facilitated by nurses with advanced skills can reduce health disparities for the target population. The amount of time the nurse is able to spend with the child and whanau/family, and the provision of opportunistic assessments as required, has effected positive change in those children most in need.