Perspectives of Indigenous people in the Pilbara about the delivery of healthcare services.

AIM: To identify Indigenous people's views about gaps and practical solutions for the delivery of healthcare services in the Pilbara. METHODS: A structured guide was used to interview three Indigenous language groups from the Pilbara region of Western Australia. The responses were analysed with the use of content analysis. In the first stage, codes were developed by assigning names to small sections of the interview transcripts. Next, the most salient incisive codes were identified and developed into themes that captured the most important issues. RESULTS: Many respondents said that there were insufficient health professionals near country, which was compounded by a lack of adequate transport to reach healthcare services. Moreover, respondents commonly indicated that they would be unable to secure adequate accommodation for themselves and any carer when needing to leave country to undergo medical care. The importance of secondary healthcare interventions was highlighted, particularly health promotion initiatives that improved diet and exercise levels and reduced substance abuse. Assuming responsibility for one's own health was seen as integral to improving the overall health of communities. The respondents saw role models as the most important influence in leading people to take responsibility for improving their own health. CONCLUSION: This study provides Indigenous perspectives about gaps and solutions in healthcare service delivery in the Pilbara region of Western Australia. Although initiatives have commenced to address the shortfall in health professionals and inadequate transport to healthcare, there are still gaps in service provision. Mobile health services were strongly supported as an integral measure to address these gaps. WHAT IS KNOWN ABOUT THIS TOPIC? About two out of every three Indigenous adults in the Pilbara experience a chronic health condition. Moreover, compared with non-Indigenous people in the region, Indigenous people experience a significantly higher mortality rate for numerous chronic health conditions. Although some information is available about the provision of health services for Indigenous people in the Pilbara, little is known about Indigenous people's perspectives about its adequacy or how it should be delivered. WHAT DOES THIS PAPER ADD? This study details three local language groups' views about the gaps and solutions to delivery of healthcare for Indigenous people in the Pilbara. It highlights the need for secondary healthcare interventions given difficulties around providing adequate primary care in remote settings. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? Health promotion initiatives need to be prioritised to improve the health of Australian Indigenous people in the Pilbara and the initiatives should be delivered with the involvement of the local communities. Innovative solutions are required to improve the continuity of healthcare in the Pilbara, including increased use of mobile services.

Health professionals' views on Indigenous Health and the delivery of healthcare services in the Pilbara.

PURPOSE: To explore health professionals' views about Australian Indigenous people's health and the delivery of healthcare to them in the Pilbara region of Western Australia. METHODS: An open-ended questionnaire was used to gather information from health professionals located across diverse regions in the Pilbara. The responses were analysed with the use of thematic analysis. In the first stage, codes were developed by assigning names to small sections of the interview transcripts. Next, the most salient incisive codes were identified and developed into themes that captured the most important issues. FINDINGS: Twenty-eight health professionals indicated that the most important health issues were chronic diseases, substance abuse and ear disease. These health issues were often attributed to a cycle of poor health perpetuated throughout generations. Educational initiatives were thought to be integral to intervening in this cycle. Of particular importance in improving the effectiveness of educational initiatives was facilitating the participation of Australian Indigenous peoples to determine the content of such initiatives. The other main issues the health professionals identified were lifting the standard of Australian Indigenous housing and implementing strategies to improve the continuity of healthcare. CONCLUSION: Educational initiatives need to be prioritised to improve the health of Australian Indigenous people in the Pilbara and the initiatives should be delivered with the involvement of the local community in order to increase the likelihood of sustained behavioural change. Innovative solutions are required to improve the continuity of healthcare in the Pilbara, including increased use of mobile services.

The health and environmental risks and rewards of modernity that shape scientific optimism.

Individuals in high-income countries increasingly express less scientific optimism than in lower-income societies. In this article, we utilize risk society theory to understand the complicated relationship between individual- and country-level factors, and optimism toward the role of science in society in "reflexively modern" societies. We use multilevel modeling with 16 high-income countries to determine the individual-level and country-level factors that shape scientific optimism. Next, we look at the individual characteristics that affect scientific optimism in each country individually. At the individual level, we find that older people, the more highly educated and higher earning, those farther to the Right on the political spectrum, and those with more materialist (rather than postmaterialist) attitudes have higher scientific optimism, while more religious people have lower optimism regarding science. At the country level, we make a corollary argument about materialism: societies that have higher measles immunization rates, generate more electricity from fossil fuels, and have a greater percentage of mobile phone subscriptions, have populaces that are more optimistic toward science.

Documenting and treating acute pain in children.

Pain management for children in emergency departments is often inconsistent or inadequate due to a lack of appropriate protocols. This article discusses the development of such a protocol in an ED in Sydney, Australia, and how its implementation led to a huge improvement in documentation of pain scores and in the appropriateness of pain relief given.

The redesign of consumer cost sharing for specialty drugs at the California Health Insurance Exchange.

This paper describes the redesign of health benefits at Covered California-the nation's largest health insurance exchange, which covers 1.3 million individuals, and its benefit designs extending to hundreds of thousands more enrollees through insurance products sold outside the exchange-with respect to specialty drugs for the 2016 enrollment year. The catalyst for benefit redesign came from advocacy organizations representing patients suffering from HIV, multiple sclerosis, epilepsy, hepatitis C, and other chronic conditions. The first component of the benefit redesign creates a separate deductible for pharmaceutical expenditures, with a commensurate reduction in the deductible for other (medical) expenditures. The second component requires health plans to assign at least 1 specialty drug for each therapeutic class to a nonspecialty tier, offering patients a treatment option for which they are not exposed to coinsurance. The third component imposes a monthly payment limit of $250 for each specialty drug prescription, thereby buffering patients using these drugs against the $6250 individual, or $13,500 family, annual medical payment limit. The pharmacy deductible and monthly out-of-pocket payment limit are substantially lower for low-income enrollees in the subsidized silver-tier products. The Covered California redesign indicates that patients can be shielded from the most onerous cost-sharing burdens while keeping premiums affordable for the entire enrolled population; however, sustainable access to care requires reductions in the underlying cost of new clinical technologies.

Primary care nurse practitioners and the interface with secondary care: a qualitative study of referral practice.

In the United Kingdom nurse practitioners are assuming responsibilities traditionally considered to be within the domain of general practitioners. Important amongst these is the referral of patients to medical consultants in secondary care, a responsibility commonly associated with the general practitioner's role as 'gatekeeper' to health care. This paper describes a study designed to identify issues raised by the challenge that a developing nursing role presents to interprofessional working at the interface between primary and secondary care. When invited to comment, study participants (nurse practitioners, nurse educators, medical consultants and general practice registrars) related nursing referrals to issues associated with professional boundary changes, namely: teamwork, regulation of practice, communication, professional conflict and professional relationships. This paper discusses the views of primary and secondary care practitioners about who should take responsibility for the referral of patients in the light of concerns raised about professional competence and accountability. Individual nurse practitioners and their colleagues have found pragmatic ways to manage their work however, although UK government policy supports development of advanced clinical nursing, there remains much work to be done to provide the professional and legal infrastructure to support the role.

Early events of target deprivation/axotomy-induced neuronal apoptosis in vivo: oxidative stress, DNA damage, p53 phosphorylation and subcellular redistribution of death proteins.

The mechanisms of injury- and disease-associated apoptosis of neurons within the CNS are not understood. We used a model of cortical injury in rat and mouse to induce retrograde neuronal apoptosis in thalamus. In this animal model, unilateral ablation of the occipital cortex induces apoptosis of corticopetal projection neurons in the dorsal lateral geniculate nucleus (LGN), by 7 days post-lesion, that is p53 modulated and Bax dependent. We tested the hypothesis that this degenerative process is initiated by oxidative stress and early formation of DNA damage and is accompanied by changes in the levels of pro-apoptotic mediators of cell death. Immunoblotting revealed that the protein profiles of Bax, Bak and Bad were different during the progression of neuronal apoptosis in the LGN. Bax underwent a subcellular redistribution by 1 day post-lesion, while Bak increased later. Bad showed an early sustained increase. Cleaved caspase-3 was elevated maximally at 5 and 6 days. Active caspase-3 underwent a subcellular translocation to the nucleus. A dramatic phosphorylation of p53 was detected at 4 days post-lesion. DNA damage was assessed immunocytochemically as hydroxyl radical adducts (8-hydroxy-2-deoxyguanosine) and single-stranded DNA. Both forms of DNA damage accumulated early in target-deprived LGN neurons. Transgenic overexpression of superoxide dismutase-1 provided significant protection against the apoptosis but antioxidant pharmacotreatments with trolox and ascorbate were ineffective. We conclude that overlapping and sequential signaling pathways are involved in the apoptosis of adult brain neurons and that DNA damage generated by superoxide derivatives is an upstream mechanism for p53-regulated, Bax-dependent apoptosis of target-deprived neurons.