Risk assessment and the use of personal protective equipment in an emergency department: Differing perspectives of emergency and infection control clinicians. A video-vignette survey.

BACKGROUND: The use of personal protective equipment (PPE) in emergency departments (EDs) is an important defense during infectious disease emergencies. However, what counts as appropriate PPE in EDs is contentious and inconsistently implemented in practice. METHODS: An online scenario-based video survey was distributed through purposive sampling, and completed by 270 ED and infection prevention and control clinicians in Australia. A descriptive content analysis was performed on the data, and differences between groups were tested using Fisher exact test. RESULTS: Participants agreed that most items were required in both scenarios. Eye protection, mask use, and hand hygiene frequency were more contentious. Physicians were more likely than nurses, and ED clinicians more likely than infection prevention and control clinicians, to regard items or actions as optional rather than essential. Many ED clinicians, particularly physicians, regarded sequences as too time-consuming to be practical in a busy ED. DISCUSSION: Our findings likely reflect differences in professional roles, competing priorities, and risks, and highlight important contextual characteristics of EDs, such as diagnostic uncertainty, equipment inaccessibility, and resource constraints. CONCLUSIONS: To be feasible, practicable, and thereby effective, PPE guidance in the ED must be designed collaboratively with frontline ED staff, and reflects the complexities of their practice.

Cost-benefit analysis of orientation and mobility programs for adults with vision disability: a contingent valuation study.

PURPOSE: The purpose of this study is to conduct a cost-benefit analysis of orientation and mobility (O&M) programs from three perspectives: the general public, the experienced, and the potential users of O&M programs. METHODS: Willingness-to-pay (WTP) for O&M programs was collected via a contingent valuation survey using a double-bound dichotomous choice approach. WTP was estimated using interval regression analyses, accounting for study arm, sex, occupation, income, and self-rated health. The cost data were estimated from a service provider's perspective. The net present value (NPV), variation if delivered by tele-O&M, was investigated. RESULTS: The adjusted mean NPV of O&M programs was $3857 (95% CI: $3760-$3954) per client, with highest NPV from the general public ($4289, 95% CI: $4185-$4392), followed by the experienced users ($3158, 95% CI: $2897-$3419) and the potential users ($2867, 95% CI: $2680-$3054). The NPV reached break-even for tele-O&M. CONCLUSIONS: There was strong community support for investment into O&M programs considering benefits for clients over and above the cost of providing the services.Implications for rehabilitationThis study demonstrates the feasibility of using cost-benefit analysis with a contingent valuation approach to economically assess a rehabilitation intervention, where its multi-dimensional benefits cannot be fully captured by a conventional appraisal technique such as cost-effectiveness analysis.The high willingness-to-pay (WTP) values amongst the general public suggests that Australians perceive government's investment in orientation and mobility (O&M) rehabilitation as value for money and that individuals would be prepared to contribute to its costs.The lower WTP for O&M partially delivered via tele-practice (tele-O&M) indicates a lower acceptance of this innovation in comparison with the traditional face-to-face O&M.The estimated net present values of O&M programs, positive for traditional O&M and break-even for tele-O&M, can be of assistance to service planning and investment decisions within the Australian context.

Scaling-up food policies in the Pacific Islands: protocol for policy engagement and mixed methods evaluation of intervention implementation.

BACKGROUND: There is a crisis of non-communicable diseases (NCDs) in the Pacific Islands, and poor diets are a major contributor. The COVID-19 pandemic and resulting economic crisis will likely further exacerbate the burden on food systems. Pacific Island leaders have adopted a range of food policies and regulations to improve diets. This includes taxes and regulations on compositional standards for salt and sugar in foods or school food policies. Despite increasing evidence for the effectiveness of such policies globally, there is a lack of local context-specific evidence about how to implement them effectively in the Pacific. METHODS: Our 5-year collaborative project will test the feasibility and effectiveness of policy interventions to reduce salt and sugar consumption in Fiji and Samoa, and examine factors that support sustained implementation. We will engage government agencies and civil society in Fiji and Samoa, to support the design, implementation and monitoring of evidence-informed interventions. Specific objectives are to: (1) conduct policy landscape analysis to understand potential opportunities and challenges to strengthen policies for prevention of diet-related NCDs in Fiji and Samoa; (2) conduct repeat cross sectional surveys to measure dietary intake, food sources and diet-related biomarkers; (3) use Systems Thinking in Community Knowledge Exchange (STICKE) to strengthen implementation of policies to reduce salt and sugar consumption; (4) evaluate the impact, process and cost effectiveness of implementing these policies. Quantitative and qualitative data on outcomes and process will be analysed to assess impact and support scale-up of future interventions. DISCUSSION: The project will provide new evidence to support policy making, as well as developing a low-cost, high-tech, sustainable, scalable system for monitoring food consumption, the food supply and health-related outcomes.

Developing economic measures for Aboriginal and Torres Strait Islander families on out-of-pocket healthcare expenditure.

Objective Out-of-pocket healthcare expenditure (OOPHE) has a significant impact on marginalised households. The purpose of this study was to modify a pre-existing OOPHE survey for Aboriginal and Torres Strait Islander households with children. Methods The OOPHE survey was derived through a scoping review, face and content validity, including judgement quantification with content experts. Exploratory factor analyses determined factor numbers for construct validity. Repeatability through test-retest processes and reliability was assessed through internal consistency. Results The OOPHE survey had 168 items and was piloted on 67 Aboriginal and Torres Strait Islander parents. Construct validity assessment generated a 62-item correlation matrix with a three-factor model. Across these factors, item loadings varied, 10 items with high correlations (>0.70) and 20 with low correlations (<0.40). OOPHE survey retest was conducted with 47 families, where 43 items reached slight to fair levels of agreement. Conclusion The low level of item loadings to factors in the OOPHE survey indicates interconnectedness across the three-factor model, and reliability results suggest systemic differences. Impeding factors may include cohort homogeneity and survey length. It is unknown how cultural and social nuances specific to Aboriginal and Torres Strait Islander households impacts on results. Further work is warranted. What is known about the topic? Out-of-pocket healthcare expenditure (OOPHE) are expenses not covered by universal taxpayer-funded health insurance. In elderly Australians or those with chronic conditions, OOPHE can cause substantial burden and financial hardship and, in the most extreme cases, induce bankruptcy. Despite higher hospital admissions and disease burden, little is known about how OOPHE impacts Aboriginal and Torres Strait Islander families. Additionally, in Australia, no OOPHE survey tools have been appropriately assessed; this includes for use with Aboriginal and Torres Strait Islander families. What does this paper add? This pilot study modified a pre-existing Australian OOPHE survey for use with Aboriginal and Torres Strait Islander households with children. Knowledge interface methodology was used to bring together Indigenous knowledges with quantitative survey methods. This was critical to ensuring Indigenous knowledges were central to the overall pilot study across item creation, participant focus, outcome contextualisation, interpretation, and resetting dominant norms. Outcomes have demonstrated pertinent points for future work in this area, such as the complexities in developing robust, culturally safe and specific surveys, which reach ideal psychometric levels of validity and reliability for Aboriginal and Torres Strait Islander communities. Certainly, it raises questions for current and future research using surveys in Aboriginal and Torres Strait Islander communities, which are generic and not purpose-built. What are the implications for practitioners? We recommend that OOPHE surveys should be developed with Aboriginal and Torres Strait Islander families from the outset, so they can include important contextual factors for Aboriginal and Torres Strait Islander households.

Socioeconomic status during youth and risk of car crash during adulthood. Findings from the DRIVE cohort study.

BACKGROUND: Young drivers of low socioeconomic status (SES) have a disproportionally high risk of crashing compared with their more affluent counterparts. Little is known if this risk persists into adulthood and if it differs between men and women. METHODS: We used data from a 2003/2004 Australian survey of young drivers (n=20 806), which included measures of drivers' demographics and established crash risk factors. These data were linked to police-reported crash, hospital and death data up to 2016. We used negative binomial regression models to estimate the association between participants' SES, with car crash. RESULTS: After adjusting for confounding, drivers of lowest SES had 1.30 (95% CI 1.20 to 1.42), 1.90 (95% CI 1.25 to 2.88), 3.09 (95% CI 2.41 to 3.95) and 2.28 (95% CI 1.85 to 2.82) times higher rate of crash, crash-related hospitalisation, crash in country areas and crash on streets with a speed limit of 80 km/hour or above compared with drivers of highest SES, respectively. For single-vehicle crashes, women in the lowest SES groups had 2.88 (95% CI 1.83 to 4.54) times higher rate of crash compared with those in the highest SES group, but no differences were observed for men from different SES groups. CONCLUSION: Young drivers who lived in areas of low SES at the time of the survey had a sustained increased risk of crash over the following 13 years compared with drivers from the most affluent areas. Our findings suggest that in addition to traditional measures, road transport injury prevention needs to consider the wider social determinants of health.

Factors influencing duration of compensation following road traffic crash injury in older vs younger adults.

OBJECTIVE: To identify factors independently associated with late claim closure, a proxy for recovery, in older (65+ years) compared to younger (17-64 years) adults following road traffic crash injury (RTI). METHODS: Multivariable analysis of statewide compensation data from New South Wales (NSW), Australia, for NSW residents aged ≥17 years injured in a non-catastrophic RTI between July 2010 and June 2013 with finalised claims (n = 16 687). RESULTS: Legal representation was the dominant factor independently associated with late claim closure in both age groups. However, the odds were doubly high for the younger group (younger: AOR 8.46, 95% CI 7.7-9.4; older: AOR 3.95, 95% CI 3.1-5.0). Median time to claim closure was shorter for older people. CONCLUSION: Older (and younger) claimants with legal representation are at increased risk of late claim closure and can be readily identified within routinely collected compensation data, enabling delivery of targeted strategies or supports early in the claims process.

Corrigendum to: Developing economic measures for Aboriginal and Torres Strait Islander families on out-of-pocket healthcare expenditure.

Objective Out-of-pocket healthcare expenditure (OOPHE) has a significant impact on marginalised households. The purpose of this study was to modify a pre-existing OOPHE survey for Aboriginal and Torres Strait Islander households with children. Methods The OOPHE survey was derived through a scoping review, face and content validity, including judgement quantification with content experts. Exploratory factor analyses determined factor numbers for construct validity. Repeatability through test-retest processes and reliability was assessed through internal consistency. Results The OOPHE survey had 168 items and was piloted on 67 Aboriginal and Torres Strait Islander parents. Construct validity assessment generated a 62-item correlation matrix with a three-factor model. Across these factors, item loadings varied, 10 items with high correlations (>0.70) and 20 with low correlations (Conclusion The low level of item loadings to factors in the OOPHE survey indicates interconnectedness across the three-factor model, and reliability results suggest systemic differences. Impeding factors may include cohort homogeneity and survey length. It is unknown how cultural and social nuances specific to Aboriginal and Torres Strait Islander households impacts on results. Further work is warranted. What is known about the topic? Out-of-pocket healthcare expenditure (OOPHE) are expenses not covered by universal taxpayer-funded health insurance. In elderly Australians or those with chronic conditions, OOPHE can cause substantial burden and financial hardship and, in the most extreme cases, induce bankruptcy. Despite higher hospital admissions and disease burden, little is known about how OOPHE impacts Aboriginal and Torres Strait Islander families. Additionally, in Australia, no OOPHE survey tools have been appropriately assessed; this includes for use with Aboriginal and Torres Strait Islander families. What does this paper add? This pilot study modified a pre-existing Australian OOPHE survey for use with Aboriginal and Torres Strait Islander households with children. Knowledge interface methodology was used to bring together Indigenous knowledges with quantitative survey methods. This was critical to ensuring Indigenous knowledges were central to the overall pilot study across item creation, participant focus, outcome contextualisation, interpretation, and resetting dominant norms. Outcomes have demonstrated pertinent points for future work in this area, such as the complexities in developing robust, culturally safe and specific surveys, which reach ideal psychometric levels of validity and reliability for Aboriginal and Torres Strait Islander communities. Certainly, it raises questions for current and future research using surveys in Aboriginal and Torres Strait Islander communities, which are generic and not purpose-built. What are the implications for practitioners? We recommend that OOPHE surveys should be developed with Aboriginal and Torres Strait Islander families from the outset, so they can include important contextual factors for Aboriginal and Torres Strait Islander households.

Factors contributing to longer length of stay in Aboriginal and Torres Strait Islander children hospitalised for burn injury.

BACKGROUND: Aboriginal and Torres Strait Islander children have higher incidence, severity and hospital length of stay for their acute burn injuries than other Australian children. We examined factors contributing to longer length of stay for Aboriginal and Torres Strait Islander children with an acute burn injury. METHODS: Burns Registry of Australia and New Zealand admissions of children < 16 years of age between October 2009 and July 2018 were analysed. Descriptive statistics explored patient and injury characteristics; Cox-regression models estimated characteristics associated with longer length of stay. Knowledge Interface methodology and Indigenous research methods were used throughout. RESULTS: A total of 723 children were identified as Aboriginal and Torres Strait Islander and 6257 as other Australian. The median hospital length of stay for Aboriginal and Torres Strait Islander children (5 days [CI 5-6]) was 4 days longer than other Australian children (1 day [CI 1-2]). Remoteness, flame burns, high percentage total body surface area (%TBSA) and full thickness burns were factors associated with longer length of stay for Aboriginal and Torres Strait Islander children. Similar prognostic factors were identified for other Australian children along with Streptococcus sp. and Staphylococcus sp. infection. CONCLUSION: Remoteness, flame burns, %TBSA, and full thickness burns are prognostic factors contributing to extended hospital length of stay for all Australian children. These factors are more prevalent in Aboriginal and Torres Strait Islander children, impacting length of stay. Treatment programs, clinical guidelines, and burns policies should engage with the unique circumstances of Aboriginal and Torres Strait Islander children to mitigate inequities in health.

No evidence of a legacy effect on survival following randomization to extended hours dialysis in the ACTIVE Dialysis trial.

AIM: Extended hours haemodialysis is associated with superior survival to standard hours. However, residual confounding limits the interpretation of this observation. We aimed to determine the effect of a period of extended hours dialysis on long-term survival among participants in the ACTIVE Dialysis trial. METHODS: Two-hundred maintenance haemodialysis recipients were randomized to extended hours dialysis (median 24 h/wk) or standard hours dialysis (median 12 h/wk) for 12 months. Further pre-specified observational follow up occurred at 24, 36 and 60 months. Vital status and modality of renal replacement therapy were ascertained. RESULTS: Over the 5 years, 38 participants died, 30 received a renal transplant, and 6 were lost to follow up. Total weekly dialysis hours did not differ between standard and extended groups during the follow-up period (14.1 hours [95%CI 13.4-14.8] vs 14.8 hours [95%CI 14.1-15.6]; P = .16). There was no difference in all-cause mortality (hazard ratio for extended hours 0.91 [95%CI 0.48-1.72]; P = .77). Similar results were obtained after censoring participants at transplantation, and after adjusting for potential confounding variables. Subgroup analysis did not reveal differences in treatment effect by region, dialysis setting or vintage (P-interaction .51, .54, .12, respectively). CONCLUSION: Twelve months of extended hours dialysis did not improve long-term survival nor affect dialysis hours after the intervention period. An urgent need remains to further define the optimal dialysis intensity across the broad range of dialysis recipients.

Effectiveness of child restraint legislation to reduce motor vehicle related serious injuries and fatalities: A national interrupted time series analysis.

Children that are unrestrained while travelling in a motor vehicle are more vulnerable to serious injury and death. The greatest levels of crash protection are achieved when children use the most age or size appropriate form of restraint. In this study, we aimed to examine the effectiveness of the introduction of age-appropriate child restraint legislation on serious and fatal injury in five Australian states and territories. For this interrupted time series analysis, we used a segmented regression method to assess the association between the implementation of child-restraint legislation and motor-vehicle related serious injuries and fatalities using data obtained from transport authorities in each jurisdiction. We estimated the change in annual rates after the implementation of legislation with the number of motor-vehicle accidents resulting in fatalities or serious injuries as the outcome, and the total number of injuries (minor, serious and fatal) as an offset in the model. We identified 10882 motor-vehicle related crashes resulting in fatalities (n = 188), serious injuries (n = 1730) and minor injuries (n = 8964). In NSW and VIC, the rate ratio was statistically significant and positive, indicating an increase in the rate of serious injuries and fatalities in the period post-legislation compared to the period prior to legislation. In all other states and territories, we did not find a statistically significant effect of legislation Road safety programs incorporating interventions targeted at increasing awareness of optimal restraint practices, strengthened enforcement and measures to improve the affordability of restraints are needed to support legislation.

Evaluation of a Collaborative Protocolized Approach by Community Pharmacists and General Medical Practitioners for an Australian Minor Ailments Scheme: Protocol for a Cluster Randomized Controlled Trial.

BACKGROUND: Internationally, governments have been investing in supporting pharmacists to take on an expanded role to support self-care for health system efficiency. There is consistent evidence that minor ailment schemes (MASs) promote efficiencies within the health care system. The cost savings and health outcomes demonstrated in the United Kingdom and Canada open up new opportunities for pharmacists to effect sustainable changes through MAS delivery in Australia. OBJECTIVE: This trial aims to evaluate the clinical, economic, and humanistic impact of an Australian Minor Ailments Service (AMAS) compared with usual pharmacy care in a cluster randomized controlled trial (cRCT) in Western Sydney, Australia. METHODS: The cRCT design has an intervention group and a control group, comparing individuals receiving a structured intervention (AMAS) with those receiving usual care for specific health ailments. Participants will be community pharmacies, general practices, and patients located in Western Sydney Primary Health Network (WSPHN) region. A total of 30 community pharmacies will be randomly assigned to either intervention or control group. Each will recruit 24 patients, aged 18 years or older, presenting to the pharmacy in person with a symptom-based or product-based request for one of the following ailments: reflux, cough, common cold, headache (tension or migraine), primary dysmenorrhea, or low back pain. Intervention pharmacists will deliver protocolized care to patients using clinical treatment pathways with agreed referral points and collaborative systems boosting clinician-pharmacist communication. Patients recruited in control pharmacies will receive usual care. The coprimary outcomes are rates of appropriate recommendation of nonprescription medicines and rates of appropriate medical referral. Secondary outcomes include self-reported symptom resolution, health services resource utilization, and EuroQoL Visual Analogue Scale. Differences in primary outcomes between groups will be analyzed at the individual patient level accounting for correlation within clusters with generalized estimating equations. The economic impact of the model will be evaluated by cost-utility and cost-effectiveness analysis compared with usual care. RESULTS: The study began in July 2018. Thirty community pharmacies were recruited. Pharmacists from the 15 intervention pharmacies were trained. A total of 27 general practices consented. Pharmacy patient recruitment began in August 2018 and was completed on March 31, 2019. CONCLUSIONS: This study may demonstrate the efficacy of a protocolized intervention to manage minor ailments in the community and will assess the clinical, economic, and humanistic impact of this intervention in Australian pharmacy practice. Pharmacists supporting patient self-care and appropriate self-medication may contribute to greater efficiency of health care resources and integration of self-care in the health system. The proposed model and developed educational content may form the basis of a national MAS service in Australia, using a robust framework for management and referral for common ailments. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618000286246; http://www.anzctr.org.au/ACTRN12618000286246.aspx. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/13973.

A Smartphone App to Assist Smoking Cessation Among Aboriginal Australians: Findings From a Pilot Randomized Controlled Trial.

BACKGROUND: Mobile health (mHealth) apps have the potential to increase smoking cessation, but little research has been conducted with Aboriginal communities in Australia. OBJECTIVE: We conducted a pilot study to assess the feasibility and acceptability and explore the effectiveness of a novel mHealth app to assist Aboriginal people to quit smoking. METHODS: A pilot randomized controlled trial (RCT) and process evaluation comprising usage analytics data and in-depth interviews was conducted. Current Aboriginal smokers (>16 years old), who were willing to make a quit attempt in the next month, were recruited from Aboriginal Community Controlled Health Services and a government telephone coaching service. The intervention was a multifaceted Android or iOS app comprising a personalized profile and quit plan, text and in-app motivational messages, and a challenge feature allowing users to compete with others. The comparator was usual cessation support services. Outcome data collection and analysis were conducted blinded to treatment allocation. The primary outcome was self-reported continuous smoking abstinence verified by carbon monoxide breath testing at 6 months. Secondary outcomes included point prevalence of abstinence and use of smoking cessation therapies and services. RESULTS: A total of 49 participants were recruited. Competing service delivery priorities, the lack of resources for research, and lack of support for randomization to a control group were the major recruitment barriers. At baseline, 23/49 (47%) of participants had tried to quit in recent weeks. At 6-month follow-up, only 1 participant (intervention arm) was abstinent. The process evaluation highlighted low to moderate app usage (3-10 new users per month and 4-8 returning users per month), an average of 2.9 sessions per user per month and 6.3 min per session. Key themes from interviews with intervention participants (n=15) included the following: (1) the powerful influence of prevailing social norms around acceptability of smoking; (2) high usage of mobile devices for phone, text, and social media but very low use of other smartphone apps; (3) the role of family and social group support in supporting quit attempts; and (4) low awareness and utilization of smoking cessation support services. Despite the broad acceptability of the app, participants also recommended technical improvements to improve functionality, greater customization of text messages, integration with existing social media platforms, and gamification features. CONCLUSIONS: Smoking cessation apps need to be integrated with commonly used functions of mobile phones and draw on social networks to support their use. Although they have the potential to increase utilization of cessation support services and treatments, more research is needed to identify optimal implementation models. Robust evaluation is critical to determine their impact; however, an RCT design may not be feasible in this setting. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTRN12616001550493; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371792 (Archived by WebCite at http://www.webcitation.org/76TiV7HA6).

Sources of Dietary Salt in North and South India Estimated from 24 Hour Dietary Recall.

Recent data on salt intake levels in India show consumption is around 11 g per day, higher than the World Health Organization's (WHO) recommended intake of 5 g per day. However, high-quality data on sources of salt in diets to inform a salt reduction strategy are mostly absent. A cross-sectional survey of 1283 participants was undertaken in rural, urban, and slum areas in North (n = 526) and South (n = 757) India using an age-, area-, and sex-stratified sampling strategy. Data from two 24-h dietary recall surveys were transcribed into a purpose-built nutrient database. Weighted salt intake was estimated from the average of the two recall surveys, and major contributors to salt intake were identified. Added salt contributed the most to total salt intake, with proportions of 87.7% in South India and 83.5% in North India (p < 0.001). The main food sources of salt in the south were from meat, poultry, and eggs (6.3%), followed by dairy and dairy products (2.6%), and fish and seafood (1.6%). In the north, the main sources were dairy and dairy products (6.4%), followed by bread and bakery products (3.3%), and fruits and vegetables (2.1%). Salt intake in India is high, and this research confirms it comes mainly from added salt. Urgent action is needed to implement a program to achieve the WHO salt reduction target of a 30% reduction by 2025. The data here suggest the focus needs to be on changing consumer behavior combined with low sodium, salt substitution.

Assessment of a Salt Reduction Intervention on Adult Population Salt Intake in Fiji.

Reducing population salt intake is a global public health priority due to the potential to save lives and reduce the burden on the healthcare system through decreased blood pressure. This implementation science research project set out to measure salt consumption patterns and to assess the impact of a complex, multi-faceted intervention to reduce population salt intake in Fiji between 2012 and 2016. The intervention combined initiatives to engage food businesses to reduce salt in foods and meals with targeted consumer behavior change programs. There were 169 participants at baseline (response rate 28.2%) and 272 at 20 months (response rate 22.4%). The mean salt intake from 24-h urine samples was estimated to be 11.7 grams per day (g/d) at baseline and 10.3 g/d after 20 months (difference: -1.4 g/day, 95% CI -3.1 to 0.3, p = 0.115). Sub-analysis showed a statistically significant reduction in female salt intake in the Central Division but no differential impact in relation to age or ethnicity. Whilst the low response rate means it is not possible to draw firm conclusions about these changes, the population salt intake in Fiji, at 10.3 g/day, is still twice the World Health Organization's (WHO) recommended maximum intake. This project also assessed iodine intake levels in women of child-bearing age and found that they were within recommended guidelines. Existing policies and programs to reduce salt intake and prevent iodine deficiency need to be maintained or strengthened. Monitoring to assess changes in salt intake and to ensure that iodine levels remain adequate should be built into future surveys.

Implementation of a driver licensing support program in three Aboriginal communities: a brief report from a pilot program.

Issue addressed: Aboriginal people face significant barriers to accessing the driver licensing system in New South Wales (NSW). Low rates of licence participation contribute to transport disadvantage and impede access to employment, education and essential health services. The Driving Change program has been piloted in three communities to increase licensing rates for young Aboriginal people. This brief report reviews implementation to determine whether Driving Change is being delivered as intended to the target population.Methods: Descriptive analysis of routinely collected program data collected between April 2013 and October 2014 to monitor client demographics (n = 194) and program-specific outcomes.Results: The target population is being reached with the majority of clients aged 16-24 years (76%) and being unemployed (53%). Licensing outcomes are being achieved at all pilot sites (learner licence 19%; provisional or unrestricted licence 16%). There is variation in program delivery across the three pilot sites demonstrating the intended flexibility of the program.Conclusions: Driving Change is delivering all aspects of the program as intended at the three pilot sites. The program is reaching the target population and providing a sufficiently flexible program that responds to community and client identified need.So what?: Reviewing implementation of community pilot programs is critical to ensure that the intervention is being delivered as intended to the target population. This brief report indicates that Driving Change is assisting young Aboriginal people to access licensing services in NSW. This review of program implementation will assist the subsequent expansion of the program to a further nine communities in NSW.

Active travel to work in NSW: trends over time and the effect of social advantage.

ISSUES ADDRESSED: Active travel can increase population levels of physical activity, but should be promoted equitably. Socio-economic advantage, housing location and/or car ownership influence walking and cycling (active travel) for transport. We examined active commuting over time in the Sydney Greater Metropolitan Region, and associations between active commuting and socioeconomic advantage, urban/rural location and car ownership at a Local Government Area (LGA) level across New South Wales (NSW). METHODS: Journey to work data from the 2001, 2006 and 2011 Australian Census were examined. Associations between levels of active commuting in each LGA in NSW and the Socio-Economic Index for Areas (SEIFA), Accessibility/Remoteness Index of Australia (ARIA) and car ownership were examined using negative binomial regression modelling. RESULTS: Between 2001 and 2011, active commuting increased in inner Sydney (relative increase of 24%), decreased slightly in outer Sydney (declined 5.1%) and declined in the Greater Metropolitan Region (down 15%). Overall, active commuting increased slightly (6.8% relative increase). After adjusting for the LGA age and sex profile and all other LGA variables, people living in NSW LGAs with high socioeconomic status, more rural areas and low car ownership were more likely to cycle or walk to work. CONCLUSIONS: More needs to be done in NSW to increase levels of active commuting consistently across regions and socio-demographic groups. SO WHAT?: Despite small increases in active travel in the Sydney region, active travel patterns are not evenly distributed across locations or populations.

Revisiting lifestyle risk index assessment in a large Australian sample: should sedentary behavior and sleep be included as additional risk factors?

OBJECTIVE: Most studies on multiple health behaviors include physical inactivity, alcohol, diet, and smoking (PADS), with few including emerging lifestyle risks such as sleep or sitting. We examined whether adding sitting and sleep to a conventional lifestyle risk index improves the prediction of cross-sectional health outcomes (self-rated health, quality of life, psychological distress, and physical function). We also explored the demographic characteristics of adults with these multiple risk behaviors. METHODS: We used baseline data of an Australian cohort study (n=191,853) conducted in 2006-2008 in New South Wales. Lifestyle risk index was operationalized as 1) PADS, 2) PADS+sitting, 3) PADS+sleep, and 4) PADS+sitting+sleep. We estimated receiver operating characteristic curve for self-reported binary health outcomes and calculated the area under the curve to illustrate how well each index classified the outcome. We used multiple logistic regression to determine the demographic characteristics of adults with multiple lifestyle risks. RESULTS: Adding sleep duration but not sitting time to the PADS index significantly improved the classification of all health outcomes. Men, those aged 45-54years, those with 10 years of education or less, and those living in regional/remote areas had higher odds of multiple risk behaviors. CONCLUSIONS: Future research on multiple health behaviors might benefit from including sleep as an additional behavior. In Australia, unhealthy lifestyles tend to cluster in adults with certain demographic characteristics.

Adverse selection? A multi-dimensional profile of people dispensed opioid analgesics for persistent non-cancer pain.

OBJECTIVES: This study investigates utilisation patterns for prescription opioid analgesics in the Australian community and how these are associated with a framework of individual-level factors related to healthcare use. METHODS: Self-reported demographic and health information from participants in the 45 and Up Study cohort were linked to pharmaceutical claims from 2006-2009. Participants comprised 19,816 people with ≥1 opioid analgesic dispensing in the 12-months after recruitment to the cohort and 79,882 people not dispensed opioid analgesics. All participants were aged ≥45 years, were social security pharmaceutical beneficiaries, with no history of cancer. People dispensed opioid analgesics were classified as having acute (dispensing period <90 days), episodic (≥90 days and <3 'authority' prescriptions for increased quantity supply) or long-term treatment (≥90 days and ≥3 authority prescriptions). RESULTS: Of participants dispensed opioid analgesic 52% received acute treatment, 25% episodic treatment and 23% long-term treatment. People dispensed opioid analgesics long-term had an average of 14.9 opioid analgesic prescriptions/year from 2.0 doctors compared with 1.5 prescriptions from 1.1 doctors for people receiving acute treatment. People dispensed opioid analgesics reported more need-related factors such as poorer physical functioning and higher psychological distress. Long-term users were more likely to have access-related factors such as low-income and living outside major cities. After simultaneous adjustment, association with predisposing health factors and access diminished, but indicators of need such as osteoarthritis treatment, paracetamol use, and poor physical function were the strongest predictors for all opioid analgesic users. CONCLUSIONS: People dispensed opioid analgesics were in poorer health, reported higher levels of distress and poorer functioning than people not receiving opioid analgesics. Varying dispensing profiles were evident among people dispensed opioid analgesics for persistent pain, with those receiving episodic and long-term treatment dispensed the strongest opioid analgesics. The findings highlight the broad range of factors associated with longer term opioid analgesics use.

Quantifying under-reporting of pathology tests in Medical Benefits Schedule claims data.

OBJECTIVE: We investigated the completeness of recording of pathology tests in Australian Medical Benefits Schedule (MBS) claims data, using the example of the prostate-specific antigen (PSA) test. With some exceptions, MBS claims data records only the three most expensive pathology items in an episode of care, and this practice ('episode coning') means that pathology tests can be under-recorded. METHODS: The analysis used MBS data for male participants in the 45 and Up Study. The number and cost of items in each episode of care were used to determine whether an episode contained a PSA screening test (Item 66655), or could have lacked a record of this item because of episode coning. RESULTS: MBS data for 1070392 episodes involving a request for a pathology test for 118074 men were analysed. Of these episodes, 11% contained a request for a PSA test; a further 7.5% may have been missing a PSA request that was not recorded because of episode coning. CONCLUSIONS: It is important to consider under-reporting of pathology tests as a result of episode coning when interpreting MBS claims data. Episode coning creates uncertainty about whether a person has received any given pathology test. The extent of this uncertainty can be estimated by determining the proportion of episodes in which the test may have been performed but was not recorded due to episode coning.