Maternal and neonatal health outcomes for First Nations Australian women and children: A retrospective cohort study in a Western Sydney metropolitan tertiary referral centre.

AIM: To analyse key pregnancy and birth outcomes for First Nations women and children at a Western Sydney metropolitan tertiary referral centre. METHODS: The birth and health-determining characteristics of 470 First Nations infants born at Nepean Hospital in 2018 and their mothers were included in a retrospective audit and compared with a contemporaneous control group of 470 infants and their mothers. RESULTS: Mothers of First Nations infants had significantly higher rates of socioeconomic disadvantage (P < 0.001), psychosocial vulnerability (P < 0.007), mental illness (P < 0.001), teenage pregnancy (P < 0.001), smoking (45.6% vs. 19.4%, P < 0.001) and drug and alcohol use than control mothers (P < 0.001, P < 0.048). First Nations peoples did not have increased rates of maternal morbidity, nor any difference in rates of Caesarean section, resuscitation at birth, NICU admission, preterm birth or low birth weight in multivariable analysis. However, multivariable analysis demonstrated significant associations between low birth weight and maternal smoking (P < 0.001), hypertension (P < 0.01) and drug use (P < 0.01). CONCLUSIONS: Despite challenges facing First Nations mothers and infants, our study found no significant difference in maternal morbidity nor adverse birth outcomes for First Nations infants. The study occurred in the context of culturally specific, First Nations-led antenatal and infant services. Future studies should further investigate relationships between participation in these services and health outcomes. This could identify strengths and areas for improvement in current services, with the goal of further improving outcomes for First Nations peoples through targeted health services that address their psychosocial vulnerabilities and support women to make healthy choices during pregnancy.

Emotional exhaustion among regional doctors in training and the application of international guidelines on sustainable employability management for organisations.

Objective The first objective of this study was to assess the associations between individual, community and hospital factors with emotional exhaustion (EE) among rural Australian doctors in training (DITs); the second objective was to apply criteria from an international standard that measures sustainable employability in organisations. Methods A cross-sectional study of 70 DITs was conducted. Odds ratios (ORs) with 95% confidence intervals (CIs) of EE across individual, community and organisational factors were calculated. Results DITs with poor or moderate ability to cope with mental work demands had higher odds of being emotionally exhausted (OR 8.273; 95% CI 1.693-40.423), as did DITs with sleep disturbance (OR 6.187; 95% CI 1.721-22.242). Higher psychological distress (OR 1.701; 95% CI 1.286-2.249), more hours worked on-call (OR 1.052; 95% CI 1.011-1.094) and increased presenteeism (OR 1.285; 95% CI 1.049-1.576) were associated with being emotionally exhausted. Those who felt ambivalent or unsatisfied with hospital support networks had threefold higher odds of EE (OR 3.323; 95%CI 1.191-9.273). All metrics associated with the International Organisation for Standardisation (ISO) sustainable employability guidelines were significantly associated with EE; DITs who thought the hospital did not promote physical (OR 5.489; 95%CI 1.494-20.162) or mental health behaviours (OR 4.750; 95%CI 1.228-18.406) and those who did not perceive DITs overall well-being to be prioritised had higher odds of EE (OR 8.800; 95% CI 1.920-40.336). Conclusions When DITs perceive the hospital promotes and prioritises well-being measures and provides a supportive environment, they are less likely to experience EE. This pilot study demonstrated the value of using an international standard to measure sustainable employability in hospitals. What is known about the topic? Doctors are an at-risk population with increased rates of suicide, depression and anxiety compared with other professions. Junior doctors and regional DITs experience a greater burden of psychological distress, burnout and compassion fatigue than non-training, urban-based doctors. Regional and rural communities are often characterised by fewer doctors per head of population and workforce shortage, with an identified need to optimise the mental well-being of rural doctors to retain the medical workforce and ensure they continue to meet the needs of these rural communities. What does this paper add? This paper adds to the evidence about the well-being of regional DITs. This pilot study is unique in its demonstration of the relationship between EE and sustainable employability factors within hospitals. The use of an international standard to measure elements of sustainable employability at the organisational level in relation to well-being can potentially be further tested and replicated across the whole organisation and in other healthcare organisations and professions. What are the implications for practitioners? Rural hospital administrators and policy makers can potentially use the results to guide hospital interventions aimed at alleviating EE in DITs. It appears that supportive hospital environments are key factors to consider when developing these interventions. The international standard guidelines on sustainable employability can be used by top management and human resource managers to develop sustainable employability metrics.