Psittacosis contagion in 1930: an old story in a new era of zoonotic disease.

The SARS-CoV-2 pandemic has highlighted the importance of zoonotic diseases. Psittacosis, a human disease resulting from infection spill-over from Chlamydia psittaci-infected birds, is a lesser-known example of a zoonosis. Psittacosis was responsible for numerous outbreaks in the 1930s, characterised by significant human mortality and disruption to the global trade in parrots. This paper describes the epidemiological and clinical details of one family group impacted by the purchase of an infected, imported parrot. Findings are discussed in the context of a growing awareness of the health risks of global disease outbreaks, as well as social and economic impacts. Health information recorded for cases of psittacosis associated with the 1930 cluster was reviewed using contemporary knowledge of disease symptoms and epidemiology. Case details and autopsy reports were examined. Public health investigation deduced that the cluster of infections was chronologically and physically connected to the purchase and subsequent death of an imported parrot. Disease symptoms were consistent with C. psittaci infection. Epidemiological data supported the diagnoses and causes of death, despite the presenting symptoms sharing significant overlap with other common respiratory diseases. There is growing awareness of the risks of epidemiological bridges in transmitting animal diseases to humans. Historical cases are a strong reminder of the fundamental role of scientific and public health responses in the face of such contagion.

Evidence-Based Practice in Medical Education: Mapping a Research and Critical Analysis Program Against the Sicily Statement.

This paper describes how evidence-based practice (EBP) is taught through an integrated curriculum across a 4-year graduate MD program. Mapping of the curriculum to the domains of the Sicily Statement of EBP was an effective approach to evaluate integration of EBP into a graduate medical education program. The longitudinal integration of EBP engages students in multiple opportunities to learn, understand, and apply these concepts. The EBP program incorporates both traditional and innovative teaching approaches and can easily be adapted for other professional courses. This whole-course approach is graduating a new generation of doctors with a sound understanding of EBP.

The success of Australia's 'No Jab, No Pay' policy at a local level; retrospective clinical audit of a single medical practice assessing incidence of catch-up vaccinations.

Vaccination is a vital health care initiative to prevent individual and population infection. To increase vaccination rates the federal government implemented the 'No Jab, No Pay' policy, where eligibility for several government benefits required children to be fully vaccinated by removing 'conscientious objections' and expanding the age range of children whose families receive benefits. This study assesses the impact of this policy at a local area within a single medical practice community in NSW, Australia. A retrospective clinical audit was performed between 2012 and 2017 on a single general practice's vaccination records for children ≤19 years. Catch-up vaccinations were assessed based on age at vaccination. Incidence of catch-up vaccinations was assessed for each of four years before and two years after the implementation of the 'No Jab, No Pay' policy in January 2016, along with the age of children and vaccination(s) given. Catch-up vaccinations were assessed temporally either side of implementation of 'No Jab, No Pay'. Comparing the average annual vaccination catch-up incidence rate of 6.2% pre-implementation (2012-2015), there was an increase to 9.2% in 2016 (p < .001) and 7.8% in 2017 (p = .027). Secondary outcome measurement of catch-up vaccination incidence rates before (2012-2015) and after (2016-2017) 'No Jab, No Pay' implementation showed statistically significant increases for children aged 8-11 years (3.2%-5.6%, p = .038), 12-15 years (7.5%-14.7%, p < .001) and 16-19 years (3.3%-10.2%, p < .001) along with a statistically significant reduction in children aged 1-3 years (11.4%-6.2%, p = .015). Also, catch-up rates for DTPa significantly increased after program implementation. This study demonstrates that the Australian federal government vaccination policy 'No Jab, No Pay' was coincident with an increase in catch-up vaccinations within a rural NSW community served by one medical practice, especially for older children.

Educating Medical Students for Practice in a Changing Landscape: An Analysis of Public Health Topics within Current Indonesian Medical Programs.

Medical curricula need to prepare doctors for emerging health issues and increased public health roles. With medical schools spread over a vast geographical region of Indonesia, ensuring that all schools meet appropriate standards in the quality of subjects, course delivery, and performance is challenging. This paper explores the inclusion of public health subjects in medical education across the country. A search of all subjects (n = 388) who were taught in 28 representative medical schools was undertaken and categorized by geographical region, accreditation grade, and according to the Indonesian National Standard of Medical Competency. Basic biomedicine subjects had the highest representation in the curricula (49.2 ± 8.7%) and public health was generally well represented (14.3 ± 5.0%). All medical schools complied with the minimum of 144 credits required for the bachelor stage. No statistically significant difference was found between school accreditation grades, or when an overall comparison of programs in Eastern and Western regions was undertaken. The Indonesian medical schools included have relatively good curriculum transparency, and public health is an important feature in their curricula. Further research is critical to identify the materials taught, the relevance and the applicability of the specific public health content, and the assessment of public health competency of graduates.

Pandemics in New South Wales prisons: the more things change .

BACKGROUND: The current COVID-19 pandemic is not the first time New South Wales prisons have faced contagion. This paper examines the current responses in New South Wales prisons to the threat of COVID-19 to prisoner health, by contrasting contemporary activities with actions and policy developed during two historical epidemics: the influenza epidemic of 1860 and pandemic of 1919. METHOD: Epidemiological information relating to cases of disease in NSW prisons during the 1860 and 1919 influenza epidemics was obtained from the Comptroller-General's reports for the specific outbreak years and for the preceding and succeeding five-year periods. Additional archival sources such as digitised newspaper reports and articles available through the National Library of Australia were analysed for closer detail. The management of these outbreaks was compared to current strategies to mitigate against risk from the COVID-19 pandemic in the NSW prison system. RESULTS: Interesting similarities were discovered in relation to the management of the historic influenza outbreaks in NSW prisons and in the management of the current COVID-19 pandemic. An outbreak of influenza in mid-1860 impacted seven penal institutions in Sydney and Parramatta. Infection rates at these institutions were between 3.1% and 100%; the mean rate was 41.8%. The public health measures employed at the time included allowing 'air circulation freely night and day', and treatments that were 'tonical and stimulatory'. DISCUSSION: While the past 100 or more years have brought huge progress in scientific knowledge, public health approaches remain the mainstay of outbreak management in prisons; and, as in 1919, the opportunity for Australia to observe the rest of the world and plan for action has not been wasted. Prisons pose a potential risk for pandemic spread but they also present a unique opportunity for reducing disease risk by ironic virtue of the 'separate system' that was recognised even 100 years ago as characteristic of these institutions.

Recent history of psittacosis in Australia: expanding our understanding of the epidemiology of this important globally distributed zoonotic disease.

Psittacosis is a human systemic disease caused by infection with Chlamydia psittaci. Shortly after reports emerged of a global pandemic associated with contact with imported parrots, Australian researchers including Macfarlane Burnet and others demonstrated that C. psittaci was widespread in Australian parrots. Australian cases over the last two decades have revealed that environmental exposure and contact with infected horses are also risk factors in an increasingly complicated epidemiological picture for this zoonotic disease.

Representations of Young Cancer Survivorship: A Discourse Analysis of Online Presentations of Self.

BACKGROUND: More young people are surviving treatment for cancer than ever before. Survival can have an adverse impact on their transition to adulthood. Discourses of cancer are applied to cancer survivors of all ages, but they manifest differently for young people. OBJECTIVE: The aim of this study was to describe practices of self-representation in an online Web site that supports young Australian cancer survivors. METHOD: We conducted a discourse analysis of images and text produced by young cancer survivors (aged 18-35 years) on a public cancer charity Web site. RESULTS: The dominant subject position of participants published on this web site is one of empowered, beautiful cancer survivor. This applies to young people who have learned to embrace their cancer as providing a positive influence on their lives. However, this discourse can marginalize those whose cancer experience remains a source of distress or shame. CONCLUSION: Web based media can provide a valuable forum for some young people to celebrate their cancer survival and to affirm the constructive influence that their cancer experience has had on their lives. However, we ponder the apparent unsuitability of some forums for young cancer survivors who have not yet found cause for celebration. IMPLICATIONS FOR PRACTICE: Nurses have the opportunity to contribute to the development of supportive structures that meet the specific needs of different groups of young cancer survivors. This might mean assisting young cancer survivors who are struggling to find meaning in their cancer experience to negotiate the establishment of a new normal that they can embrace.

Cross-sectional study of area-level disadvantage and glycaemic-related risk in community health service users in the Southern.IML Research (SIMLR) cohort.

Objectives The aim of the present study was to determine the association between area-level socioeconomic disadvantage and glycaemic-related risk in health service users in the Illawarra-Shoalhaven region of New South Wales, Australia. Methods HbA1c values recorded between 2010 and 2012 for non-pregnant individuals aged ≥18 years were extracted from the Southern.IML Research (SIMLR) database. Individuals were assigned quintiles of the Socioeconomic Indices for Australia (SEIFA) Index of Relative Socioeconomic Disadvantage (IRSD) according to their Statistical Area 1 of residence. Glycaemic risk categories were defined as HbA1c 5.0-5.99% (lowest risk), 6.0-7.49% (intermediate risk) and ≥7.5% (highest risk). Logistic regression models were fit with glycaemic risk category as the outcome variable and IRSD as the study variable, adjusting for age and sex. Results Data from 29064 individuals were analysed. Higher disadvantage was associated with belonging to a higher glycaemic risk category in the fully adjusted model (most disadvantaged vs least disadvantaged quintile; odds ratio 1.74, 95% confidence interval 1.58, 1.93; P<0.001). Conclusion In this geocoded clinical dataset, area-level socioeconomic disadvantage was a significant correlate of increased glycaemic-related risk. Geocoded clinical data can inform more targeted use of health service resources, with the potential for improved health care equity and cost-effectiveness. What is known about the topic? The rapid increase in the prevalence of Type 2 diabetes (T2D), both globally and nationally within Australia, is a major concern for the community and public health agencies. Individual socioeconomic disadvantage is a known risk factor for abnormal glucose metabolism (AGM), including T2D. Although small-area-level socioeconomic disadvantage is a known correlate of AGM in Australia, less is known of the association of area-level disadvantage and glycaemic-related risk in individuals with AGM. What does this paper add? This study demonstrates a robust association between small-area-level socioeconomic disadvantage and glycaemic-related risk in regional New South Wales. The study demonstrates that it is feasible to use geocoded, routinely collected clinical data to identify communities at increased health risk. What are the implications for practitioners? The identification of at-risk populations is an essential step towards targeted public health policy and programs aimed at reducing the burden of AGM, its complications and the associated economic costs. Collaboration between primary care and public health in the collection and use of data described in the present study has the potential to enhance the effectiveness of both sectors.

Enhancing hospital care of patients with cognitive impairment.

Purpose The patient-centred management of people with cognitive impairment admitted to acute health care facilities can be challenging. The TOP5 intervention utilises carers' expert biographical and social knowledge of the patient to facilitate personalised care. The purpose of this paper is to explore whether involvement of carers in the TOP5 initiative could improve patient care and healthcare delivery. Design/methodology/approach A small-scale longitudinal study was undertaken in two wards of one acute teaching hospital. The wards admitted patients with cognitive impairment, aged 70 years and over, under geriatrician care. Data for patient falls, allocation of one-on-one nurses ("specials"), and length-of-stay (LOS) over 38 months, including baseline, pilot, and establishment phases, were analysed. Surveys of carers and nursing staff were undertaken. Findings There was a significant reduction in number of falls and number of patients allocated "specials" over the study period, but no statistically significant reduction in LOS. A downward trend in complaints related to communication issues was identified. All carers ( n=43) completing the feedback survey were satisfied or very satisfied that staff supported their role as information provider. Most carers (90 per cent) felt that the initiative had a positive impact and 80 per cent felt that their loved one benefitted. Six months after implementation of the initiative, 80 per cent of nurses agreed or strongly agreed that it was now easier to relate to carers of patients with cognitive impairment. At nine-ten months, this increased to 100 per cent. Originality/value Actively engaging carers in management of people with cognitive impairment may improve the patient, staff, and carer journeys, and may improve outcomes for patient care and service delivery.

Health behind bars: can exploring the history of prison health systems impact future policy?

The value of history is, indeed, not scientific but moral … it prepares us to live more humanely in the present, and to meet rather than to foretell, the future - Carl Becker. Becker's quote reminds us of the importance of revealing and understanding historical practices in order to influence actions in the future. There are compelling reasons for uncovering this history, in particular to better inform government policy makers and health advocates, and to address the impacts of growing community expectations to 'make the punishment fit the crime'.

'Involve Me and I Learn': Development of an Assessment Program for Research and Critical Analysis.

Evidence-based medical practice is best achieved by developing research understanding in medical practitioners. To this end, medical councils worldwide increasingly recognise the importance of medical schools graduating students with well-developed research skills and research capacity. To meet this need, the principles of programmatic assessment were implemented in designing a research and critical analysis curriculum and assessment program that aimed to enhance the research and critical analysis skills of medical students. The program was developed by mapping assessment tasks to a research capabilities framework that was in turn scaffolded to different levels of Miler's pyramid. The curriculum and assessments were integrated with the science, clinical, and professional aspects of the medical course. The progressive longitudinal development of research skills, with feedback and academic mentoring, culminated in the students' capacity to undertake an independent research project. Designing an assessment program for learning encouraged students to develop their research capacity by involving them in their learning.

Consumer knowledge about over-the-counter NSAIDs: they don't know what they don't know.

OBJECTIVE: To investigate consumers' knowledge about commonly purchased over-the-counter (OTC) products containing ibuprofen. METHODS: Customers buying two popular OTC ibuprofen-containing products (Nurofen™ or Nurofen Plus™ ) were asked to complete a short survey assessing their knowledge about the products. RESULTS: The survey was completed by 262 respondents, most of whom were older than 50 years of age; female; well-educated; with adequate functional health literacy. The majority correctly identified ibuprofen as an active ingredient and knew the correct intervals between doses. However, almost a third couldn't correctly identify the maximum daily dose and were unaware of some contraindications. Furthermore, fewer than half recognised potential side effects. Those who hadn't completed high school were significantly less likely to seek medical advice (when required) and significantly less likely to know when it was safe to take these products. CONCLUSIONS: The gaps in consumer knowledge, especially about the maximum daily dose, contraindications and potential side effects may be placing consumers at risk of experiencing ibuprofen-related adverse events. Implications for public health: Improving consumer knowledge to address these gaps in their understanding about the safe use of popular OTC ibuprofen-containing products is an important public health concern.

When a LIC came to town: the impact of longitudinal integrated clerkships on a rural community of healthcare practice.

INTRODUCTION: Two small rural towns in Australia, where medical practitioners provide primary care to the population, including emergency, anaesthetic and obstetric services, were early adopters of an innovative year-long integrated clerkship (clinical placement) designed to foster medical student skill attainment and a commitment to underserved rural communities. Primary care vocational trainees had previously trained in the region. Engaging with the university to participate in the clerkship initiative for undergraduate medical education offered the local healthcare service an opportunity to really integrate education with service. This study sought perspectives from a multidisciplinary group of stakeholders on the impact of the longitudinal integrated clerkship (LIC) on the healthcare community. METHOD: Three analysts independently analysed the transcripts arising from semi-structured interviews with a range of health care clinicians and managers (N=23). Themes were identified using inductive content analysis methodology. RESULTS: Four major themes emerged from the perspectives of a multi-professional group of participants from both towns: transforming a community of practice, realising the potential of the health service, investment in rural return, and sustainability. CONCLUSIONS: There was significant clinical exposure, skill and teaching capacity in these previously unrecognised rural placements but realising the potential of the health service needs careful management to sustain this resource. Early engagement and initial enthusiasm have produced many positive outcomes for the healthcare community, but this alone is not sufficient to sustain an increasing role for rural primary care in medical education. The study identified issues that need addressing for sustainability, namely validation, time and costs. Strategies to address these are key to continuation of LICs in small rural communities.

Area-Level Socioeconomic Gradients in Overweight and Obesity in a Community-Derived Cohort of Health Service Users - A Cross-Sectional Study.

BACKGROUND: Overweight and obesity lead to higher probability of individuals accessing primary care but adiposity estimates are rarely available at regional levels to inform health service planning. This paper analyses a large, community-derived clinical database of objectively measured body mass index (BMI) to explore relationships with area-level socioeconomic disadvantage for informing regional level planning activities. MATERIALS AND METHODS: The study included 91776 adults who had BMI objectively measured between 1 July 2009 and 30 June 2011 by a single pathology provider. Demographic data and BMI were extracted and matched to 2006 national census socioeconomic data using geocoding. Adjusted odds-ratios for overweight and obesity were calculated using sex-stratified logistic regression models with socioeconomic disadvantage of census collection district of residence as the independent variable. RESULTS: The prevalence of overweight or obesity was 79.2% (males) and 65.8% (females); increased with age to 74 years; and was higher in rural (74%) versus urban areas (71.4%) (p<0.001). Increasing socioeconomic disadvantage was associated with increasing prevalence of overweight (p<0.0001), obesity (p<0.0001) and overweight or obesity (p<0.0001) in women and obesity (p<0.0001) in men. Socioeconomic disadvantage was unrelated to overweight (p = 0.2024) and overweight or obesity (p = 0.4896) in males. CONCLUSION: It is feasible to link routinely-collected clinical data, representative of a discrete population, with geographic distribution of disadvantage, and to obtain meaningful area-level information useful for targeting interventions to improve population health. Our results demonstrate novel area-level socioeconomic gradients in overweight and obesity relevant to regional health service planning.

Using a framework to implement large-scale innovation in medical education with the intent of achieving sustainability.

BACKGROUND: Particularly when undertaken on a large scale, implementing innovation in higher education poses many challenges. Sustaining the innovation requires early adoption of a coherent implementation strategy. Using an example from clinical education, this article describes a process used to implement a large-scale innovation with the intent of achieving sustainability. Desire to improve the effectiveness of undergraduate medical education has led to growing support for a longitudinal integrated clerkship (LIC) model. This involves a move away from the traditional clerkship of 'block rotations' with frequent changes in disciplines, to a focus upon clerkships with longer duration and opportunity for students to build sustained relationships with supervisors, mentors, colleagues and patients. A growing number of medical schools have adopted the LIC model for a small percentage of their students. At a time when increasing medical school numbers and class sizes are leading to competition for clinical supervisors it is however a daunting challenge to provide a longitudinal clerkship for an entire medical school class. This challenge is presented to illustrate the strategy used to implement sustainable large scale innovation. WHAT WAS DONE: A strategy to implement and build a sustainable longitudinal integrated community-based clerkship experience for all students was derived from a framework arising from Roberto and Levesque's research in business. The framework's four core processes: chartering, learning, mobilising and realigning, provided guidance in preparing and rolling out the 'whole of class' innovation. DISCUSSION: Roberto and Levesque's framework proved useful for identifying the foundations of the implementation strategy, with special emphasis on the relationship building required to implement such an ambitious initiative. Although this was innovation in a new School it required change within the school, wider university and health community. Challenges encountered included some resistance to moving away from traditional hospital-centred education, initial student concern, resource limitations, workforce shortage and potential burnout of the innovators. Large-scale innovations in medical education may productively draw upon research from other disciplines for guidance on how to lay the foundations for successfully achieving sustainability.

Investigating the impact of a research-based integrated curriculum on self-perceived research experiences of medical students in community placements: a pre- and post-test analysis of three student cohorts.

BACKGROUND: To build research capacity among graduating medical students, the teaching of research and critical analysis was integrated into the University of Wollongong (UoW) new, graduate-entry medical curriculum. This study examined whether the self-perceived research experiences of medical students, and consequent research capability, were influenced by exposure to this innovative research and critical analysis curriculum, which incorporated a 12-month community-based research project, and associated assessment tasks. METHODS: The first three medical students cohorts (N = 221) completed a self-assessment of their research experiences in ten areas of research activity. Their responses were collected: before and after they undertook an individual community-based research project within a 12-month regional/rural clinical placement. The research areas investigated by the self-assessment tool were: (i) defining a research question/idea; (ii) writing a research protocol; (iii) finding relevant literature; (iv) critically reviewing the literature; (v) using quantitative research methods; (vi) using qualitative research methods; (vii) analysing and interpreting results; (viii) writing and presenting a research report; (ix) publishing results; and (x) applying for research funding. RESULTS: Participation rates of 94% (207/221) pre-placement and 99% (219/221) post-placement were achieved from the three student cohorts. Following the successful completion of the research projects and their assessment tasks, the median responses were significantly higher (p < 0.05) in nine of the ten research areas. The only area of research for which there was no increase recorded for any one of the three cohorts, or overall, was (x) applying for research funding. This activity was not a component of the UoW research and critical analysis curriculum and the item was included as a test of internal validity. Significant gains were also seen between cohorts in some key research areas. CONCLUSIONS: Improved research capability among medical students was evidenced by increased scores in various areas of research experience in the context of successful completion of relevant assessment tasks. The results suggest that research capability of medical students can be positively influenced by the provision of a research-based integrated medical curriculum and further consolidated by authentic learning experiences, gained through conducting 'hands-on' research projects, under the supervision and mentoring of research-qualified academics.

Clinical scholarship among preceptors supervising longitudinal integrated medical clerkships in regional and rural communities of practice.

OBJECTIVE: All senior medical students at the University of Wollongong undertake a longitudinal integrated community-based clerkship, supervised by experienced general practitioners in a regional or rural community. This study investigates the influence of the longitudinal integrated clerkship model of medical education on scholarship among preceptors in these practice communities. DESIGN: General practitioner preceptors were interviewed after the first student cohort had completed their 38-week placements. Analysis of transcripts identified themes supporting clinical scholarship among preceptors. The entire transcript for each preceptor was analysed, permitting a quantitative determination of each theme. Quotations supporting the themes were selected. SETTING: The setting was the primary health care practices supervising the longitudinal integrated clerkship medical students. PARTICIPANTS: Twenty-six preceptors who supervised longitudinal integrated clerkship medical students in rural and regional New South Wales participated. None had previously been involved in this model of medical education. MAIN OUTCOME MEASURE: The study looked for evidence of clinical scholarship among preceptors supervising students in the longitudinal medical student clerkship. RESULTS: Thematic analysis of interview transcripts revealed evidence of clinical scholarship in regional/rural clinical medicine. The 'practice' was validated as a place where scholarship occurs, an 'academy of learning' and part of the university. About half of the preceptors believed the longitudinal integrated clerkship gave students a deeper link with the community. Two thirds of participants perceived an improved quality of care in their practice. CONCLUSION: Longitudinal integrated clerkships in teaching communities of practice provide the opportunity for emergence of clinical scholarship among preceptors supporting the learning needs of medical students.

Impacts of a measles outbreak in Western Sydney on public health resources.

During February and March 2011, an outbreak of 26 confirmed cases of measles was reported to the Parramatta Public Health Unit (PHU) in western Sydney. This paper describes the impact of the outbreak on PHU resources. A retrospective review of information obtained from case notification forms and associated contact tracing records was carried out for each of the confirmed cases. Seven cases (27%) required hospital admission for more than 1 day and 10 (38%) cases required management within a hospital emergency department. There were no cases of encephalitis or death. The number of contacts was determined for each case as well as the number who required post-exposure prophylaxis. In total, 1,395 contacts were identified in this outbreak. Of these, 79 (5.7%) required normal human immunoglobulin and 90 (6.5%) were recommended to receive the measles-mumps-rubella vaccine. A case study detailing the PHU costs associated with the contact management of a hospitalised measles case with 75 identified contacts is also included and the estimated total cost to the PHU of containing this particular case of measles was A$2,433, with staff time comprising the major cost component. Considerable effort and resources are required to manage measles outbreaks. The total cost of this outbreak to the PHU alone is likely to have exceeded A$48,000.