Sampling approaches and geographic coverage in Mayi Kuwayu: the national study of Aboriginal and Torres Strait Islander wellbeing.

OBJECTIVE: The objective of this paper is to investigate the geographic distribution of participants in Mayi Kuwayu, the National Study of Aboriginal and Torres Strait Islander Wellbeing. The Mayi Kuwayu Study is the largest national longitudinal study of the health and wellbeing of Aboriginal and Torres Strait Islander adults (aged 16 years and over) in Australia. It is an Aboriginal-led and governed Study with embedded community engagement. The Study collects data through self-report questionnaires, using multiple sampling approaches: (1) a large-scale mail-out based on stratified random sampling; (2) convenience sampling; (3) snowball sampling; (4) voluntary sampling. A comparison of the geographic distribution of Mayi Kuwayu Study participants to that of the total Aboriginal and Torres Strait Islander population was also conducted. RESULTS: A total of 9,843 people participated in the Mayi Kuwayu Study baseline survey from 2018 to 2022. Participants resided in all Australian States and Territories. The geographic distribution of participants broadly matched the total population distribution, with participants generally located on the east and south-east coast of Australia. Apparent differences in the geographic distribution were identified by sex and age group.

Reducing the risk of surgical site infections.

Surgical site infections (SSIs) are commonly reported healthcare-acquired infections that can have a detrimental effect on patient outcomes and quality of life. SSIs are associated with longer periods of hospitalisation and increased patient morbidity and mortality. A rigorous approach is required to identify and manage the risk of infection across the preoperative, intraoperative and post-operative phases of care. This article describes the causes of, risk factors for development and signs and symptoms of SSIs. The author emphasises the importance of a collaborative, holistic and multidisciplinary approach to the prevention and management of SSIs, which involves the nurse and other healthcare professionals working in partnership with the patient.

Evaluation of a therapist-guided virtual psychological pain management program when provided as routine care: a prospective pragmatic cohort study.

INTRODUCTION: Numerous randomized controlled trials have evaluated the outcomes of internet-delivered psychological pain management programs (PMPs) as a way of increasing access to care for people with chronic pain. However, there are few reports of the effectiveness of these PMPs when provided as part of routine care. METHODS: The present study sought to report the clinical and demographic characteristics of users (n = 1367) and examine the effectiveness of an established internet-delivered psychological PMP program in improving several pain-related outcomes, when offered at a national digital mental health service over a 5-year period. It also sought to comprehensively explore predictors of treatment commencement, treatment completion, and clinical improvement. RESULTS: Evidence of clinical improvements (% improvement; Hedges g) were found for all outcomes, including pain interference (18.9%; 0.55), depression (26.1%; 0.50), anxiety (23.9%; 0.39), pain intensity (12.8%; 0.41), pain self-efficacy (-23.8%; -0.46) and pain-catastrophizing (26.3%; 0.56). A small proportion of users enrolled but did not commence treatment (13%), however high levels of treatment completion (whole treatment = 63%; majority of the treatment = 75%) and satisfaction (very satisfied = 45%; satisfied = 37%) were observed among those who commenced treatment. There were a number of demographic and clinical factors associated with commencement, completion and improvement, but no decisive or dominant predictors were observed. DISCUSSION: These findings highlight the effectiveness and acceptability of internet-delivered psychological PMPs in routine care and point to the need to consider how best to integrate these interventions into the pathways of care for people with chronic pain.

Assessment and management of fractures.

Fractures can have significant impact on function and quality of life, and an cause significant disruption to psychological and social wellbeing. A systematic approach is required for the assessment and management of fractures to ensure effective and timely recovery. Nurses play a key role in the care continuum to support the acute and rehabilitation phases of recovery. The use of Patient Reported Outcome Measures ensure a patient-centred approach to management, gauge progress and identify actions needed to optimise recovery. This article outlines the assessment and management of fractures, common concerns and potential complications.

The impact of obesity and overweight on response to internet-delivered cognitive behavioural therapy for adults with chronic health conditions.

BACKGROUND: There is growing evidence that internet-delivered cognitive behavioural therapy (iCBT) can improve functioning and reduce psychological distress in people with chronic health conditions. Obesity frequently co-occurs with chronic health conditions, yet its impact on response to psychological interventions in this population is not known. The current study examined associations between BMI and clinical outcomes (depression, anxiety, disability, and satisfaction with life) following a transdiagnostic iCBT program targeting adjustment to chronic illness. METHODS: Participants from a large randomised controlled trial, who provided information on height and weight, were included (N = 234; mean age= 48.32, SD = 13.80; mean BMI = 30.43, SD = 8.30, range 16.18-67.52; 86.8% female). The influence of baseline BMI range on treatment outcomes at post-treatment and 3-month follow-up was examined using generalized estimating equations. We also examined changes in BMI and in participants' perceived impact of weight on their health. RESULTS: Improvement in all outcomes occurred across BMI ranges; additionally, persons with obesity or overweight generally experienced greater symptom reductions than those within a healthy weight range. A greater proportion of participants with obesity achieved clinically significant change on key outcomes (e.g., depression: 32% [95% CI: 25%, 39%]) than participants with a healthy weight (21% [95% CI: 15%, 26%]) or overweight (24% [95% CI: 18%, 29%], p = 0.016). There were no significant changes in BMI from pre-treatment to 3-month follow-up, however there were significant reductions on the self-rated impact of weight on health. CONCLUSIONS: Persons with chronic health conditions and with obesity or overweight benefit at least as much as those with a healthy BMI from iCBT programs targeting psychological adjustment to chronic illness, even without changes in BMI. iCBT programs may be an important component in the self-management of this population, and may address barriers implicated in health behaviour change.

Predictors of functional impairment at assessment and functional improvement after treatment at a national digital mental health service.

Mental disorders are associated with impairment to daily functioning, which affects both the individual and society. Despite this, most research on treatment outcome only report symptom change. Self-reported days out of role (DOR) is a simple measure of functional impairment used in many population studies. The current study sought to report on the degree of functional impairment measured by DOR in a clinical sample at assessment, the factors associated with this impairment, the predictors of functional improvement after treatment and the relationship between symptomatic and functional change. Using a prospective uncontrolled observational cohort study design with a sample of 17,813 patients accessing a digital mental health service (DMHS), we examined self-reported demographic, psychosocial and clinical data. Using a series of univariate regression models and multivariate classification algorithms, we found that baseline DOR was associated with age, employment and relationship status, symptom severity, symptom chronicity and with the presence of several psychosocial difficulties. Baseline DOR was best predicted by older age, disability payments, higher symptom severity and increasing number of endorsed psychosocial difficulties (R2 = 32.7 %). Forty-one per cent of the sample experienced a >50 % or greater reduction in DOR following treatment. Those who were separated, unemployed or on disability payments, or with severe and chronic depression, experienced the greatest reductions in DOR after treatment. Changes in functioning were independent of changes in symptoms, highlighting the importance of functional impairment as a treatment outcome. This study found that many of the patients who access DMHS have significant levels of functional impairment, a large proportion obtain functional improvement after treatment, and improvement in function after treatment was independent of improvement in symptoms.

Implementing COVID-19 infection prevention and control measures in long-term care settings.

The coronavirus disease 2019 (COVID-19) pandemic has had far-reaching and significant effects worldwide. Many of those identified as most vulnerable to the disease reside in long-term care settings such as nursing and residential homes, so infection prevention and control is an essential area of practice. This article describes how COVID-19 is transmitted and discusses various measures that can be taken to reduce the spread of infection to protect residents, staff and visitors. Such measures include social distancing, routine screening, the use of personal protective equipment and cleaning.

Reflection on modern methods: statistical, policy and ethical implications of using age-standardized health indicators to quantify inequities.

Methods for calculating health indicators profoundly influence understanding of and action on population health and inequities. Age-standardization can be useful and is commonly applied to account for differences in age structures when comparing health indicators across groups. Age-standardized rates have well-acknowledged limitations, including that they are relative indices for comparison, and not accurate measures of actual rates where the age structures of groups diverge. This paper explores these limitations, and demonstrates alternative approaches through a case study quantifying mortality rates within the Aboriginal and Torres Strait Islander (Indigenous) population of Australia and inequities compared with the non-Indigenous population, over 2001-16. Applying the Australian Standard Population, the Aboriginal and Torres Strait Islander age-standardized mortality rate was more than double the crude mortality rate in 2001 and 2016, inflated through high weighting of older age groups. Despite divergent population age structures, age-standardized mortality rates remain a key policy metric for measuring progress in reducing Indigenous-non-Indigenous inequities in Australia. Focusing on outcomes age-standardized to the total population can obscure inequities, and denies Aboriginal and Torres Strait Islander peoples and communities valid, actionable information about their health and well-being. Age-specific statistics convey the true magnitude of health risks and highlight high-risk subgroups. When requiring standardization, standardizing to a population-specific standard (here, an Indigenous standard) generates metrics centred around and reflective of reality for the population of focus, supporting communities' self-determination to identify priorities and informing resource allocation and service delivery. The principles outlined here apply across populations, including Indigenous and other populations internationally.

Ultrasonographic Validation for Needle Placement in the Tibialis Posterior Muscle.

BACKGROUND: The tibialis posterior (TP) muscle plays an important role in normal foot function. Safe, efficacious therapeutic approaches addressing this muscle are necessary; however, the location of the muscle in the deep posterior compartment can create challenges. PURPOSE: The purpose of this study was to assess the accuracy of needle placement in the TP muscle and determine the needle placement in relation to the neurovascular structures located within the deep compartment. DESIGN: Cross Sectional Study. METHODS: Needle placement and ultrasound imaging were performed on 20 healthy individuals. A 50 mm or 60 mm needle was inserted between 30 - 50% of the tibial length measured from the medial tibiofemoral joint. The needle was inserted in a medial to lateral direction into the right extremity with the patient in right side lying. Placement of the needle into the TP muscle was verified with ultrasound imaging, and the shortest distance from the needle to the posterior tibial artery and tibial nerve was measured. The depth from the skin to the superficial border of the TP muscle was also measured. RESULTS: Ultrasonography confirmed the needle filament was inserted into the TP muscle in all 20 individuals and did not penetrate the neurovascular bundle in any individual. The mean distance from the needle to the tibial nerve and posterior tibial artery was 10.0 + 4.7 mm and 10.2 + 4.7 mm respectively. The superficial border of the TP muscle from the skin was at a mean depth of 25.8 + 4.9 mm. CONCLUSION: This ultrasound imaging needle placement study supports placement of a solid filament needle into the TP muscle with avoidance of the neurovascular structures of the deep posterior compartment when placed from a medial to lateral direction at 30-50% of the tibial length. LEVEL OF EVIDENCE: 2b.

Risk of severe illness from COVID-19 among Aboriginal and Torres Strait Islander adults: the construct of 'vulnerable populations' obscures the root causes of health inequities.

OBJECTIVE: To quantify the prevalence of known health-related risk factors for severe COVID-19 illness among Aboriginal and Torres Strait Islander adults, and their relationship with social determinants. METHODS: Weighted cross-sectional analysis of the 2018-19 National Aboriginal and Torres Strait Islander Health Survey; Odds Ratios for cumulative risk count category (0, 1, or ≥2 health-related risk factors) by social factors calculated using ordered logistic regression. RESULTS: Of the adult population, 42.9%(95%CI:40.6,45.2) had none of the examined health-related risk factors; 38.9%(36.6,41.1) had 1, and 18.2%(16.7,19.7) had ≥2. Adults experiencing relative advantage across social indicators had significantly lower cumulative risk counts, with 30-70% lower odds of being in a higher risk category. CONCLUSIONS: Aboriginal and Torres Strait Islander peoples must continue to be recognised as a priority population in all stages of pandemic preparedness and response as they have disproportionate exposure to social factors associated with risk of severe COVID-19 illness. Indigeneity itself is not a 'risk' factor and must be viewed in the wider context of inequities that impact health Implications for public health: Multi-sectoral responses are required to improve health during and after the COVID-19 pandemic that: enable self-determination; improve incomes, safety, food security and culturally-safe healthcare; and address discrimination and trauma.

Reliability, validity, and clinical utility of a culturally modified Kessler scale (MK-K5) in the Aboriginal and Torres Strait Islander population.

BACKGROUND: Aboriginal and Torres Strait Islander peoples are the first people of Australia. Consequences of historic and contemporary settler-colonialism including racism, trauma, grief and loss (of land, culture, spirituality, and freedoms) have led to substantial negative health and wellbeing impacts. The Kessler Psychological Distress Scales are population and individual-level tools designed to measure general psychological health status. There has been limited assessment of the psychometric properties and validity of the Kessler Psychological Distress Scale for use with the Aboriginal and Torres Strait Islander population in Australia, despite its widespread use. METHODS: A national sample of Aboriginal and Torres Strait Islander adults (n = 6988 ≥ 16 years) was used in the psychometric assessment of the MK-K5, which involved face validity, acceptability, internal consistency/reliability, construct validity, and convergent and divergent validity testing. Receiver Operator Characteristics (ROC) curves were produced to assess clinical utility for depression and anxiety screening. RESULTS: The MK-K5 demonstrated face validity for psychological distress in two focus groups, and had good acceptability, good internal consistency/reliability (α = 0.89), good construct validity (uni-dimensional; one underlying component explaining 70.1% of variance), and demonstrated convergent and divergent validity in the sample. The MK-K5 had good clinical utility at a cut-off score of 11 for detecting ever being diagnosed with depression or anxiety. CONCLUSIONS: The MK-K5 is a valid measure of psychological distress and has clinical utility in the Aboriginal and Torres Strait Islander population.

Developing and validating measures of self-reported everyday and healthcare discrimination for Aboriginal and Torres Strait Islander adults.

BACKGROUND: It is well established that racism is a fundamental contributor to poor health and inequities. There is consistent evidence of high exposure to discrimination among Aboriginal and Torres Strait Islander (Indigenous Australian) peoples, but impacts have not been fully quantified, in part due to limited measurement tools. We aim to validate instruments developed to measure interpersonal discrimination. METHODS: Instruments were discussed at five focus groups and with experts, and field tested in developing Mayi Kuwayu: The National Study of Aboriginal and Torres Strait Islander Wellbeing. Data from 7501 baseline survey participants were analysed. Acceptability was assessed according to extent of missingness, construct validity using exploratory and confirmatory factor analysis, and reliability using Cronbach's alpha. Associations between each instrument and outcomes conceptually understood to be closely (community-level racism) or less closely (family wellbeing) related were quantified to test convergent and discriminant validity. RESULTS: An 8-item instrument captures experiences of discrimination in everyday life and a 4-item instrument experiences in healthcare, each followed by a global attribution item. Item missingness was 2.2-3.7%. Half (55.4%) of participants reported experiencing any everyday discrimination, with 65.7% attributing the discrimination to Indigeneity; healthcare discrimination figures were 34.1% and 51.1%. Items were consistent with two distinct instruments, differentiating respondents with varying experiences of discrimination. Scales demonstrated very good reliability and convergent and divergent validity. CONCLUSION: These brief instruments demonstrate face validity and robust psychometric properties in measuring Aboriginal and Torres Strait Islander adults' experiences of interpersonal discrimination in everyday life and in healthcare. They can be used to quantify population-level experiences of discrimination, and associated wellbeing consequences, and monitor change.

Who responds? An examination of response rates to a national postal survey of Aboriginal and Torres Strait Islander adults, 2018-2019.

BACKGROUND: Evidence on the effectiveness of postal recruitment methods for Indigenous peoples is lacking. Mayi Kuwayu, the National Study of Aboriginal and Torres Strait Islander Wellbeing, uses multi-staged sampling. We aimed to test postal surveys as a primary recruitment method, analysing preliminary response rate data to inform the Study's ongoing sampling approach. METHODS: Twenty thousand adults aged ≥16 years were sampled from Aboriginal and Torres Strait Islander people enrolled in the Medicare Australia Enrolment Database. We calculated response rates at 4 and 15 weeks, overall and by age group, gender, state/territory and remoteness. RESULTS: The overall response rate was 2.3% (n = 456/20000). Highest response rates were observed among males and females ≥50 years from major cities (6.0, 95%CI 4.4-7.9 and 5.5%, 4.1-7.2, respectively) and regional areas (6.0%, 4.6-7.6 and 6.2%, 4.9-7.7, respectively). Younger age groups and remote areas had lower response rates; all remote age groups < 50 years had a response rate ≤ 0.6%. While most participants responded on the paper surveys, online responses were more common among younger age groups and, respondents with higher education levels and whose first language was not English. CONCLUSION: Using a postal survey, we observed response rates of ≥5.5% among older Aboriginal and Torres Strait Islander adults in major cities and regional areas; response rates were lower in other groups. A two-stage postal distribution approach provided an opportunity to adapt sampling approaches to different demographic groups. Based on initial response rates, the sampling strategy was revised to send postal surveys to groups with higher response rates groups and focus field recruitment strategies on low response groups.

Osteoporosis and fragility fractures: risk assessment, management and prevention.

Osteoporosis is a chronic skeletal condition characterised by low bone mass and microarchitectural deterioration of the bones that disproportionately affects older people. Older people with osteoporosis are at increased risk of sustaining fragility fractures, and this risk is compounded by factors such as falls and frailty. Fragility fractures can have several physical and psychological effects, potentially affecting an older person's quality of life and reducing their life expectancy. Therefore, it is important that nurses can identify individuals at risk of osteoporosis and recognise the factors that may predict fragility fractures. This article outlines the main risk factors for osteoporosis and details the assessment and management of patients with this condition. It also explains the pharmacological interventions and lifestyle changes that can reduce the risk of fragility fractures in older people with osteoporosis.

Primary care access for mental illness in Australia: Patterns of access to general practice from 2006 to 2016.

General practice has an important role within the Australian healthcare system to provide access to care and effective management of chronic health conditions. However, people with serious mental illness experience challenges associated with service access. The current paper seeks to examine drivers of access to general practice for people with common and serious mental disorders, compared with people who access care for type II diabetes, a common physical health problem managed in general practice. The Bettering the Evaluation and Care of Health (BEACH) programme provides the most comprehensive and objective measurement of general practitioner activity in Australia. Using BEACH data, this study compared general practice encounters for depression, anxiety, bipolar disorder, schizophrenia, and type II diabetes during a 10-year period between 2006 and 2016. Analysis revealed more frequent encounters for depression compared to anxiety, and a higher representation of women in encounters for bipolar disorder compared to men. The relationship between number of encounters and patient age was strongly associated with the life course and mortality characteristics associated with each disorder. The findings highlight specific challenges associated with access to primary care for people with serious mental illness, and suggest areas of focus to improve the ability of these patients to access and navigate the health system.

A longitudinal test of the predictions of the interpersonal-psychological theory of suicidal behaviour for passive and active suicidal ideation in a large community-based cohort.

BACKGROUND: The Interpersonal-Psychological Theory of Suicide (IPTS) aims to elucidate the key antecedents of suicide deaths. Limited research has tested the IPTS in a community setting, and very little longitudinal research has been conducted. The current study longitudinally tested the predictions of the IPTS for suicidal ideation in a large population-based sample. METHODS: The PATH through Life study assesses three age cohorts (20's, 40's, 60's) every four years. Two interpersonal factors were estimated at the third wave of assessment: thwarted belongingness (TB) and perceived burdensomeness (PB). The roles of these factors in suicide ideation (active and passive) four years later were estimated using logistic regression models (n = 4545). RESULTS: A one SD increase in TB was associated with increased odds of 37% for passive ideation and 24% for active ideation. For PB, odds were increased 2.5-fold for passive ideation and 2.4-fold for active ideation. A significant negative PB × TB interaction was found for passive but not active ideation. Effects were not consistent by age group or gender. LIMITATIONS: Proxy measures were used to assess the constructs. The extended timeframe and low prevalence of suicidal ideation limited power to find effects within subgroups. CONCLUSIONS: Although TB and PB were individually associated with suicidal thoughts, little evidence was found for the key predictions of the IPTS longitudinally. Further investigation of the dynamic interplay between interpersonal factors over time is needed.

A web-based survey to identify current practice in skeletal pin site management.

Infections associated with percutaneous pins and wires are common complications which can have a significant impact on patient outcomes. A survey was undertaken to identify current practice and gain insight into variations of clinical practice. Invitations were sent by email to complete an electronic questionnaire using SurveyMonkey. The survey was left open for 100 days. The single largest group of respondents (37.4%, n = 120) cleansed pin sites daily, with significant differences identified between medical and nursing professions (P = 0.02), and country of practice (P < 0.001). Significant differences were also identified in the use of different cleansing solutions between medical and nursing professions (P < 0.001) and country (P < 0.001). The majority group preferences were saline 30% (n = 96) and alcoholic chlorhexidine 29.6% (n = 95). Pin site crusts were routinely removed by 57.9% (n = 186). Pin sites were left exposed by 50.3% (n = 160). Dry gauze was identified as the most common dressing used to dress pin sites, however, substantial variation was identified in the types of dressings used. Compression was not routinely applied to pin sites by 51.6% (n = 165). There remains considerable diversity of practice when caring for pin sites. Further research is required to identify the most effective methods in preventing pin site infection.

Help seeking for social anxiety: A pilot randomised controlled trial.

OBJECTIVE: Although social anxiety disorder is a persistent and debilitating condition, only a minority of people with social anxiety disorder seek help and little is known about methods for promoting help seeking for social anxiety disorder. This pilot trial explored the potential effectiveness of an online program designed to increase help-seeking intentions for social anxiety disorder. METHODS: Australian adults with symptoms of untreated social anxiety disorder were recruited online and randomised to either the Shyness Information Online intervention (n = 41) or an online attention control condition (n = 41). Each program together with a baseline and postintervention survey was delivered in one session. The primary outcome was intentions to seek help from a professional. Secondary measures included anxiety literacy, help-seeking attitudes, internalised stigma, and perceived need for treatment. The acceptability of the program content and feasibility of the recruitment method were also examined. RESULTS: Although they did not demonstrate a significantly greater increase in help-seeking intentions relative to the control group (p = 0.097), those receiving the intervention showed more favourable attitudes towards seeking psychological help (Hedges'g = 0.38; p = 0.025) and a higher level of perceived need for treatment (p ≤ 0.001). Participants also showed a greater knowledge about social anxiety disorder at post-intervention than the control participants (adjusted Hedges' g = 0.46, p < 0.001). Most respondents were satisfied with the intervention content; the recruitment strategy appeared feasible. CONCLUSIONS: Further investigation of the intervention is warranted to test its effectiveness, explore the relationships between factors that influence social anxiety disorder help-seeking behaviour and to further test the validity of the social anxiety disorder help-seeking model on which the intervention was based.

Fibromyalgia: clinical features, diagnosis and management.

Patients with fibromyalgia experience chronic widespread pain, with associated symptoms of fatigue, sleep disturbance and memory problems. There are many therapies which may be helpful in managing the symptoms of fibromyalgia; however, these often require a process of trial and error to establish optimum management using a combination of pharmacological and non-pharmacological approaches. Nurses can support patients with fibromyalgia using a biopsychosocial approach to symptom management. Understanding the nature of fibromyalgia and management options will enable nurses to deliver holistic patient-centred care.