Role of general practice in the utilisation of the NSW Get Healthy Information and Coaching Service.

A lifestyle-modification telephone-based service is delivered in New South Wales (NSW; the Get Healthy Information and Coaching Service (GHS)) as an important obesity-prevention, population-wide program. The present study examined referrals from general practitioners (GP) versus self-referral to the GHS in terms of risk profile and effectiveness of outcomes. The study used a pre-post test design to assess changes in outcomes within the setting of a telephone-based lifestyle-support service available to NSW adults (18+ years) who self-referred or were referred by their health practitioner and/or GP, and registered for the GHS between February 2009 and August 2013 (n = 22 183). The GHS has two service components: (1) the provision of an information kit (one off contact) on healthy eating, being physically active and achieving and/or maintaining a healthy weight; and (2) a 6-month coaching program that includes 10 telephone calls aimed at achieving and maintaining lifestyle-related goals. Sociodemographic characteristics, referral source and self-reported anthropometric (height, waist and waist circumference (WC)) and behavioural risk factor (physical activity and nutrition-related behaviours) data were collected at baseline and at 6 months. Analysis revealed that GPs effectively recruited hard-to-reach subtargets, as well as adults who are obese and have an increased WC risk. Participants in the GHS coaching program, irrespective of GHS referral source, reported a mean weight loss of -3.8 kg, a decrease in WC of -5.0 cm and increases in both fruit and vegetable consumption and physical activity. In conclusion, GPs have an important role in GHS uptake (through proactive referral or as an adjunct to practice-based interventions) because they can recruit those most at need and facilitate improvements in their patients' risk factor profiles.

An outbreak of enterovirus 71 in metropolitan Sydney: enhanced surveillance and lessons learnt.

OBJECTIVE: To report the findings of the enhanced surveillance set up in New South Wales in response to the recent outbreak of human enterovirus 71 (EV71) infection. DESIGN AND SETTING: A two-armed enhanced public health surveillance system including statewide emergency department surveillance and clinical surveillance at the Sydney Children's Hospitals Network. PARTICIPANTS: Children aged less than 10 years with suspected or confirmed enterovirus infection. MAIN OUTCOME MEASURES: Epidemiology of the outbreak, including weekly case counts, demographic information, geographic spread of the outbreak, and clinical presentation and progression. RESULTS: Statewide weekly case counts indicate that an epidemic of EV71 infection occurred in NSW from December 2012 until May 2013. Around 119 children were reported with disease severe enough to warrant admission to a tertiary Sydney children's hospital. Cases were spread throughout the Sydney metropolitan area and there is some evidence of geographic migration of the outbreak. Presenting features included fever, lethargy, myoclonus and skin rash. Only 24% of cases presented with classical hand, foot and mouth disease. CONCLUSIONS: EV71 infection is likely to continue to be a public health problem in Australia. Surveillance of routinely collected emergency department data can provide a useful indication of its activity in the community.

Active travel to work in NSW: trends over time and the effect of social advantage.

ISSUES ADDRESSED: Active travel can increase population levels of physical activity, but should be promoted equitably. Socio-economic advantage, housing location and/or car ownership influence walking and cycling (active travel) for transport. We examined active commuting over time in the Sydney Greater Metropolitan Region, and associations between active commuting and socioeconomic advantage, urban/rural location and car ownership at a Local Government Area (LGA) level across New South Wales (NSW). METHODS: Journey to work data from the 2001, 2006 and 2011 Australian Census were examined. Associations between levels of active commuting in each LGA in NSW and the Socio-Economic Index for Areas (SEIFA), Accessibility/Remoteness Index of Australia (ARIA) and car ownership were examined using negative binomial regression modelling. RESULTS: Between 2001 and 2011, active commuting increased in inner Sydney (relative increase of 24%), decreased slightly in outer Sydney (declined 5.1%) and declined in the Greater Metropolitan Region (down 15%). Overall, active commuting increased slightly (6.8% relative increase). After adjusting for the LGA age and sex profile and all other LGA variables, people living in NSW LGAs with high socioeconomic status, more rural areas and low car ownership were more likely to cycle or walk to work. CONCLUSIONS: More needs to be done in NSW to increase levels of active commuting consistently across regions and socio-demographic groups. SO WHAT?: Despite small increases in active travel in the Sydney region, active travel patterns are not evenly distributed across locations or populations.

Risk factors for dental caries in small rural and regional Australian communities.

INTRODUCTION: Dental decay (caries) can cause pain, infection and tooth loss, negatively affecting eating, speaking and general health. People living in rural and regional Australian communities have more caries, more severe caries and more untreated caries than those in the city. The unique environmental conditions and population groups in these communities may contribute to the higher caries burden. In particular, some towns lack community water fluoridation, and some have a high proportion of Aboriginal people, who have significantly worse oral health than their non-Aboriginal counterparts. Because of these and other unique circumstances, mainstream research on caries risk factors may not apply in these settings. This study aimed to gather contemporary oral health data from small rural or regional Australian communities, and investigate caries risk factors in these communities. METHODS: A cross-sectional survey consisting of a standardized dental examination and questionnaire was used to measure the oral health of 434 children (32% Aboriginal) aged 3-12 years in three small rural or regional areas. Oral health was determined as the deciduous and permanent decayed, missing and filled teeth (dmft/DMFT), and the proportion of children without caries. Risk factors were investigated by logistic regression. RESULTS: The dmft/DMFT for children in this study was 1.5 for 5-6 year olds and 1.0 for 11-12 year olds (index groups reported). Independent predictors of having caries (Yes/No) were age group, holding a concession card (OR=2.45, 95%CI=1.58-3.80) and tooth-brushing less than twice per day (OR=2.11, 95% CI=1.34-3.34). Aboriginal status also became a significant variable under sensitivity analyses (OR 1.9, CI 1.12-3.24) when the tooth-brushing variable was removed. Gender, water fluoridation and parental education were not significant predictors of caries in these communities. CONCLUSIONS: The rural/remote children in this study had worse oral health than either state or national average in both the 5-6 year old and 11-12 year age group. Socioeconomic status, tooth-brushing and Aboriginal status were significantly associated with caries in these communities. To close the substantial gap in oral health outcomes between rural and metropolitan residents, approaches that target rural areas, Aboriginal people and those from low socioeconomic backgrounds are needed.

Joy, exercise, enjoyment, getting out: a qualitative study of older people's experience of cycling in Sydney, Australia.

INTRODUCTION: Cycling can be an enjoyable way to meet physical activity recommendations and is suitable for older people; however cycling participation by older Australians is low. This qualitative study explored motivators, enablers, and barriers to cycling among older people through an age-targeted cycling promotion program. METHODS: Seventeen adults who aged 50-75 years participated in a 12-week cycling promotion program which included a cycling skills course, mentor, and resource pack. Semistructured interviews at the beginning and end of the program explored motivators, enablers, and barriers to cycling. RESULTS: Fitness and recreation were the primary motivators for cycling. The biggest barrier was fear of cars and traffic, and the cycling skills course was the most important enabler for improving participants' confidence. Reported outcomes from cycling included improved quality of life (better mental health, social benefit, and empowerment) and improved physical health. CONCLUSIONS: A simple cycling program increased cycling participation among older people. This work confirms the importance of improving confidence in this age group through a skills course, mentors, and maps and highlights additional strategies for promoting cycling, such as ongoing improvement to infrastructure and advertising.

Changes in travel-related carbon emissions associated with modernization of services for patients with acute myocardial infarction: a case study.

BACKGROUND: Little attention has been paid on the carbon footprint of different healthcare service models. We examined this question for service models for patients with acute ST elevation myocardial infarction (STEMI). METHODS: We estimated carbon emissions associated with ambulance (patient) transport under a primary percutaneous coronary intervention (pPCI) care model based in tertiary centres, compared with historical emissions under a thrombolysis model based in general hospitals. We used geographical information on 41,449 hospitalizations, and published UK government fuel to carbon emissions conversion factors. RESULTS: The average ambulance journey required for transporting a STEMI patient to its closest care point was 13.0 km under the thrombolysis model and 42.2 km under the pPCI model, producing 3.46 and 11.2 kg of CO(2) emissions, respectively. Thus, introducing pPCI will more than triple ambulance journey associated carbon emissions (by a factor of 3.24). This ratio was robust to sensitivity analysis varying assumptions on conversion factor values; and the number of patients treated. CONCLUSIONS: Introducing pPCI to manage STEMI patients results in substantial carbon emissions increase. Environmental profiling of service modernization projects could motivate carbon control strategies, and care pathways design that will reduce patient transport need. Healthcare planners should consider the environmental legacy of quality improvement initiatives.