Projecting the future: modelling Australian dialysis prevalence 2021-30.

Objectives To project the prevalence of people receiving dialysis in Australia for 2021-30 to inform service planning and health policy. Methods Estimates were based on data from 2011 to 2020 from the Australia & New Zealand Dialysis & Transplant (ANZDATA) Registry and the Australian Bureau of Statistics. We projected dialysis and functioning kidney transplant recipient populations for the years 2021-30. Discrete-time, non-homogenous Markov models were built on probabilities for transition between three mutually exclusive states (Dialysis, Functioning Transplant, Death), for five age groups. Two scenarios were employed - stable transplant rate vs a continued increase - to assess the impact of these scenarios on the projected prevalences. Results Models projected a 22.5-30.4% growth in the dialysis population from 14 554 in 2020 to 17 829 ('transplant growth') - 18 973 ('transplant stable') by 2030. An additional 4983-6484 kidney transplant recipients were also projected by 2030. Dialysis incidence per population increased and dialysis prevalence growth exceeded population ageing in 40-59 and 60-69 year age groups. The greatest dialysis prevalence growth was seen among those aged ≥70 years. Conclusion Modelling of the future prevalence of dialysis use highlights the increasing demand on services expected overall and especially by people aged ≥70 years. Appropriate funding and healthcare planning must meet this demand.

Hip Arthroplasty Outcomes in the Presence of Kidney Failure: A National Data Linkage Study.

BACKGROUND: Patients who have kidney failure are at higher risk of requiring total hip arthroplasty (THA) and are at higher risk of complications. This study compared the rate of revision surgery and mortality following THA between patients who have kidney failure receiving long term dialysis or who had a kidney transplant and those who did not have kidney failure. METHODS: A data linkage study was performed using data from 2 national registries: a registry of dialysis and kidney transplant patients and a registry of THA procedures. Both registries had coverage of almost all procedures or treatments in Australia. Data from September 1999 to December 2016 were used. Mortality and revision surgery were compared between patients receiving dialysis, those who had a functioning kidney transplant, and patients who did not have kidney failure using Cox and Fine-Gray (competing risk) regression models. A total of 383,478 primary THA procedures were identified as people receiving dialysis (n = 490), who had a functioning kidney transplant (n = 459), or who did not have kidney failure (n = 382,529). RESULTS: There was no significant difference in the overall rate of revision surgery between the groups (dialysis versus no kidney failure HR = 1.20; 95% CI 0.76, 1.88, transplant versus no kidney failure (hazard ratio) HR = 1.01; 95% (confidence interval) CI 0.66, 1.53). The risk for death after surgery was significantly higher in the dialysis group compared to both the functioning transplant group (HR = 3.44; 95%CI 1.58, 7.5), and in those without kidney failure (HR = 4.13; 95%CI 3.25, 5.25). CONCLUSION: The rate of mortality after THA in patients on dialysis is higher than in patients who have a functioning transplant or those who do not have kidney failure, but there is no early excess mortality to suggest a difference in this metric due to the surgery.

The Australian Youth Cancer Service: Developing and Monitoring the Activity of Nationally Coordinated Adolescent and Young Adult Cancer Care.

Adolescents and young adults (aged 15-25 years) diagnosed with cancer have unique medical and psychosocial experiences and care needs, distinct from those of paediatric and older adult patients. Since 2011, the Australian Youth Cancer Services have provided developmentally appropriate, multidisciplinary and comprehensive care to these young patients, facilitated by national service coordination and activity data collection and monitoring. This paper reports on how the Youth Cancer Services have conceptualised and delivered quality youth cancer care in four priority areas: clinical trial participation, oncofertility, psychosocial care and survivorship. National activity data collected by the Youth Cancer Services between 2016-17 and 2019-20 are used to illustrate how service monitoring processes have facilitated improvements in coordination and accountability across multiple indicators of quality youth cancer care, including clinical trial participation, access to fertility information and preservation, psychosocial screening and care and the transition from active treatment to survivorship. Accounts of both service delivery and monitoring and evaluation processes within the Australian Youth Cancer Services provide an exemplar of how coordinated initiatives may be employed to deliver, monitor and improve quality cancer care for adolescents and young adults.

Predictors for oral and general health outcomes and quality of life among older people attending general practice clinics in South Australia.

BACKGROUND: As the proportion and number of older people in Australia continue to grow, innovative means to tackle primary care and prevention are necessary to combat the individual, social and economic challenges of non-communicable diseases. OBJECTIVE: To assess risk factors (or predictors) for oral and general health outcomes and quality of life of older people (75+ years.) attending general practice (GP) clinics in South Australia. METHODS: Data were collected from older people attending 48 GP clinics in metropolitan South Australia. Age, sex, education, living arrangement, material standards, chronic conditions and nutrition were assessed as risk factors. Global self-rated oral and general health and quality of life (OHIP Severity and EQ-5D Utility) were included as outcome measures. RESULTS: A total of 459 participants completed the study; response rate was 78%. In the adjusted models, high satisfaction with material standards and good nutritional health were positively associated with all four oral and general health measures. Sex (ß = -0.08), age (ß = -0.09) and number of chronic conditions (ß = -0.12) were negatively associated with EQ-5D, while living arrangement (ß = 0.07) was positively associated. Further, having four or more chronic conditions (RR:1.47) was significantly associated with self-rated general health. CONCLUSION: Satisfaction with material standards and nutritional risk were consistent predictors for oral and general health outcomes and quality of life of older people visiting GP clinics.

General health, wellbeing and oral health of patients older than 75 years attending health assessments.

Annual health assessments by general practices for community-dwelling people aged 75 years and over are important for the early intervention and monitoring of chronic health conditions, including oral disease. Uptake of the health assessment to date has been poor, and little is known of the general and oral health profile of patients. Older patients attending health assessments at general practices in South Australia were sampled for this study. Data on demographic and socioeconomic characteristics, and patients' general and oral health, were collected by mailed questionnaire from 459 respondents. By comparison with national estimates, patients attending health assessments fared worse in many of the measures, such as self-rated general health, quality of life and the prevalence of most chronic conditions, as well as their socioeconomic circumstances. Also identified were a high degree of nutritional risk and clear need for oral health treatment, with poor self-rated oral health being three-fold higher than the national age-eligible population. Patients attending health assessments would likely benefit from nutritional screening (by a validated tool) and specific assessment of their oral health and dentition, supported by appropriate referral or intervention.

General health and well-being among primary care patients aged 75+ years: Associations with living conditions, oral health and dependency.

OBJECTIVE: Our aim was to examine the associations between general health and well-being with living conditions, oral health and degree of dependency. METHODS: We surveyed people from a primary care service and collected data on sociodemographic characteristics, general health, health utility, well-being, activities, living conditions and oral health impact. RESULTS: Overall, 459 participated (78% response rate). Poor general health was associated with decreased instrumental activities of daily living scores (18% of those with poor general health were independent vs 60% with good general health). Greater oral health impact was also related to poor general health. Health utility was lower for some dependency, for renting and oral health impact. Well-being was also lower for some dependency, for renting, not speaking English and oral health impact. CONCLUSION: In addition to the well-known association of poor general health with dependency, our results also illustrate the potential importance of living conditions and oral health.

Oral health-related quality of life improves in employees with disabilities following a workplace dental intervention.

This pilot study evaluated a dental intervention for employees with disabilities by measuring changes in self-rated oral health, dental behaviours and oral health-related quality of life (OHRQol). Consenting employees with disabilities (≥18years) at two worksites in South Australia underwent dental examinations at baseline, three and six months. Referrals were arranged as needed to public dental clinics. At one and two months a dental hygienist provided group oral health education to the employees. Employees' demographics, self-rated oral health, dental behaviours and OHRQol were collected via face-to-face interviews. Of the 39 referred employees, 28 (72%) of them completed the recommended treatment. Self-rated oral health improved and there were significant reductions in the prevalence of oral health impact on quality of life (percentage of employees reporting 1+ items fairly/very often) from 27% to 11% (McNemar's test, p<0.05); the extent of impact (mean number of items reported fairly/very often) from 1.3 to 0.6 and the severity of impact (mean of summed OHIP item scores) from 3.6 to 1.8 (paired t-tests, p<0.01). As this pilot study indicates that enabling urgent referral for treatment and regular oral health education can improve OHRQol and self-rated oral health among employees with disabilities, a larger study with a control group should be undertaken.

Pre- and post-training evaluation of dental efficacy and activation measures in carers of adults with disabilities in South Australia - a pilot study.

The aim of this pilot study was to train carers to provide oral care for adults with disabilities and to evaluate the training programme. Forty-one carers of 103 care recipients from three disability organisations in South Australia were trained in providing oral care for adults with disabilities (April 2013-April 2014). The training included an oral presentation and practical session by a special needs dentist on completing oral health assessments (OHA), developing oral healthcare plans, providing oral hygiene care and assessing the need for dental referral. Continued support was provided via home visits by dental hygienists for the first 2 months and a dentist visit at 3 months. At 6 months, agreement on OHAs between the dentist and trained carers was assessed. Pre- and post-training questionnaires (at 6 months) collected information on dental behaviours of carers and psychosocial factors: carer activation measure-knowledge (CAM-Knowledge), carer activation measure-skills (CAM-Skills), carer activation measure-confidence (CAM-Confidence) and carer dental efficacy (CDE) items (carer diligence, self-efficacy and priority). Post-training (among 16 retained carers), there were significant increases in the mean scores of CAM-Knowledge and CAM-Confidence, but not for CAM-Skills (paired-samples t-tests, α = 0.05). Per cent agreement of CDE items varied little between questionnaires. Carer-dentist agreement on OHAs was generally high with kappa values ranging from 0.63 for the assessment of gums to 1.0 for the assessment of tongue, roof of mouth, denture and dental pain. Further, carers were able to assess the need for referral of their care recipients' oral health similar to the dentist. These findings suggest that with combined theoretical and practical training and continued support, non-dental professionals like carers can improve their knowledge and confidence in providing oral care for adults with disabilities. However, the findings of this pilot study need to be confirmed by further research in a larger study.

A qualitative study of the interactions among the psychosocial work environment and family, community and services for workers with low mental health.

BACKGROUND: The psychosocial work environment can benefit and harm mental health. Poor psychosocial work environments and high level work-family conflict are both associated with poor mental health, yet little is known about how people with poor mental health manage the interactions among multiple life domains. This study explores the interfaces among paid work, family, community and support services and their combined effects on mental health. METHODS: We conducted 21 in-depth semi-structured interviews with people identified as having poor mental health to examine their experiences of paid employment and mental health and wellbeing in the context of their daily lives. RESULTS: The employment-related psychosocial work environment, particularly workplace relationships, employment security and degree of control over hours, strongly affected participants' mental health. The interfaces among the life domains of family, community and access to support services suggest that effects on mental health differ according to: time spent in each domain, the social, psychological and physical spaces where domain activities take place, life stage and the power available to participants in their multiple domains. This paper is based on a framework analysis of all the interviews, and vignettes of four cases. Cases were selected to represent different types of relationships among the domains and how interactions among them either mitigated and/or exacerbated mental health effects of psychosocial work environments. CONCLUSIONS: Examining domain interactions provides greater explanatory capacity for understanding how people with low mental health manage their lives than restricting the research to the separate impacts of the psychosocial work environment or work-family conflict. The extent to which people can change the conditions under which they engage in paid work and participate in family and social life is significantly affected by the extent to which their employment position affords them latitude. Policies that provide psychosocial protections to workers that enable them to make changes or complaints without detrimental repercussions (such as vilification or job loss) and increase access to welfare benefits and support services could improve mental health among people with paid work. These policies would have particularly important effects for those in lower socioeconomic status positions.

Deliberately casual? Workers' agency, health, and nonstandard employment relations in Australia.

OBJECTIVE: We explored Australian workers' experiences of nonstandard employment, how it related to health and well-being, and the role that Bourdieu's forms of capital (cultural, economic, and social resources) played in underpinning workers' agency. METHODS: Qualitative data from semistructured interviews with 32 causal workers were analyzed on the basis of framework analysis. RESULTS: Most participants were "deliberate casuals" who had chosen casual over permanent employment, with half of that group naming improved health and well-being as motivation. Those with greater access to capital felt more able to exercise choice, whereas those with fewer capital resources felt constrained to be casual. Gendered structures and labor market dynamics were also significant in shaping agency. CONCLUSIONS: Access to capital and a buoyant labor market underpinned workers' agency in Australia, enabling some to gain health and well-being benefits from nonstandard employment.

Precarious employment, psychosocial working conditions, and health: Cross-sectional associations in a population-based sample of working Australians.

BACKGROUND: Precarious employment has been associated with poor health, but the potential mechanisms are unclear. We examined the relationships between precarious employment and health, and investigated psychosocial working conditions as potential mediators. METHODS: A cross-sectional population-based survey was conducted in South Australia in 2009 (N = 1,016 employed). SF-12 measures of mental and physical health were modeled using logistic regression in relation to employment arrangement, controlling for socio-demographics, years in job and psychosocial working conditions. RESULTS: There was no association between casual full-time or part-time employment and poor mental health in multivariate analyses. Conversely, there was a significant association between casual full-time employment and poor physical health (compared to permanent full-time workers, OR = 3.14, 95% CI 1.26-7.85). The association with physical health was unaffected by adjustment for psychosocial working conditions. CONCLUSIONS: Casual full-time employment was strongly associated with poor physical health but not with poor mental health. This association was not mediated by the psychosocial working conditions measured in this study, but may be related to other (unmeasured) working conditions.

Workplace bullying a risk for permanent employees.

OBJECTIVE: We tested the hypothesis that the risk of experiencing workplace bullying was greater for those employed on casual contracts compared to permanent or ongoing employees. METHODS: A cross-sectional population-based telephone survey was conducted in South Australia in 2009. Employment arrangements were classified by self-report into four categories: permanent, casual, fixed-term and self-employed. Self-report of workplace bullying was modelled using multiple logistic regression in relation to employment arrangement, controlling for sex, age, working hours, years in job, occupational skill level, marital status and a proxy for socioeconomic status. RESULTS: Workplace bullying was reported by 174 respondents (15.2%). Risk of workplace bullying was higher for being in a professional occupation, having a university education and being separated, divorced or widowed, but did not vary significantly by sex, age or job tenure. In adjusted multivariate logistic regression models, casual workers were significantly less likely than workers on permanent or fixed-term contracts to report bullying. Those separated, divorced or widowed had higher odds of reporting bullying than married, de facto or never-married workers. CONCLUSIONS: Contrary to expectation, workplace bullying was more often reported by permanent than casual employees. It may represent an exposure pathway not previously linked with the more idealised permanent employment arrangement. IMPLICATIONS: A finer understanding of psycho-social hazards across all employment arrangements is needed, with equal attention to the hazards associated with permanent as well as casual employment.