Early closing of hotels: Impacts on alcohol consumption, drunkenness, liver disease and injury mortality.

INTRODUCTION: Early (six o'clock) closing of hotels was introduced in 1916 in Australia to curb heavy drinking. It lasted between 21 and 51 years in four Australian states. The aim of this study is to assess the impact of early closing on alcohol consumption, liver disease mortality rates, drunkenness and various forms of injury. METHODS: Time series analysis was undertaken using an Autoregressive Integrated Moving Averages modelling technique. Relevant data were derived from annual publications of the Australian Bureau of Statistics and its predecessor organisations. RESULTS: Early closing had a substantial downward effect on alcohol consumption across 1901-2006. It had a substantial and beneficial effect on liver disease mortality. Drunkenness rates declined pre-World War II (WWII), though they increased post-WWII. Rates for homicide decreased substantially, and close to substantially for suicide and female homicide. Early closing impacts were more beneficial pre-WWII than post-WWII. DISCUSSION AND CONCLUSIONS: Early closing has not been favourably remembered in Australia in recent years. However, all pre-WWII impacts of early closing were beneficial including public drunkenness rates. Post-WWII, beneficial effects were less clear-cut and drunkenness increased. Resistance to early closing may also have arisen in the 1950s as families had more disposable income and ability to consume alcohol. While universal six o'clock closing is no longer feasible or desirable, opening hours and days for hotels are still part of the policy discussion in Australia. The experience of early closing pre-WWII gives confidence that the impacts of these can be beneficial.

Vision impairment and refractive errors in refugees presenting to community optometry clinics in Victoria, Australia.

BACKGROUND: There is a paucity of data relating to refugee eye health in Australia. This study aimed at investigating the spectrum of vision impairment and other ocular conditions in refugees utilising the Victorian Eyecare Service operated by the Australian College of Optometry. METHODS: A cross-sectional study of electronic clinical records of 518 individuals (adults and children) recognised as refugees by the Australian College of Optometry and treated between January 2013 and May 2014 were identified. Extracted data included presenting visual acuities, best-corrected visual acuities, and final refraction values (using spherical equivalents), for both eyes. Diagnoses of presenting ocular conditions were also extracted. RESULTS: Of all refugees examined, 129 (27.2 per cent) had some degree of vision impairment (≤ 6/9.5) based on presenting visual acuities in their better eye; five (1.0 per cent) being of a severe (≤ 6/60) or profound (≤ 6/120) nature. In contrast, 27 (6.3 per cent) refugees had some degree of vision impairment based on best-corrected visual acuities in their better eye; two (0.4 per cent) being of a severe or profound nature. The prevalence of myopia (≥ -0.50 D) in the better eye was 23.0 per cent (n = 114); 25 (5.0 per cent) being moderate (≥ -3.00 D) to high (≥ -6.00 D). The prevalence of hypermetropia (≥ +2.00 D) in the better eye was 3.2 per cent (n = 16); 12 (2.4 per cent) being moderate (≥ +2.25 D) to high (≥ +5.25 D). The most common ocular conditions diagnosed at initial presentation were refractive error (n = 104, 20.1 per cent) and dry eyes (n = 57, 11.0 per cent). CONCLUSION: Mild vision impairment and refractive error are significant issues for refugees attending the Australian College of Optometry, emphasising the need for optometry, particularly refractive, services in this population.

Evaluation of an integrated housing and recovery model for people with severe and persistent mental illnesses: the Doorway program.

Objective The Doorway program is a 3-year pilot integrated housing and recovery support program aimed at people with a severe and persistent mental illness who are 'at risk' or actually homeless. Participants source and choose properties through the open rental market, with appropriate rental subsidy and brokerage support. This arrangement is highly innovative, differing from widely favoured arrangements internationally involving congregate and scattered-site housing owned or managed by the support program. The aim of the present study was to determine the effects of the Doorway program on participants' health, housing, service utilisation and costs. Methods A pre-post study design was used with outcome measures consisting of a number of question inventories and their costs (where relevant). The principal inventories were the Behaviour and Symptom Identification Scale 32 (BASIS-32), a consumer-oriented, self-report measure of behavioural symptoms and distress, the Health of the Nation Outcome Scale (HoNOS), an interviewer-administered measurement tool designed to assess general health and social functioning of mentally ill people and the Outcomes Star (Homelessness) system which measures various aspects of the homelessness experience. Baseline measurements were performed routinely by staff at entry to the program and then at 6-monthly intervals across the evaluation period. Results For 55 of 59 participants, total mean BASIS-32 scores (including as well three of five subscale scores) improved significantly and with moderate effect size. Four of the 10 domain scores on the Outcome Star (Homelessness) inventory also improved significantly, with effect sizes ranging from small-medium (three domains) to large (one domain). Mean usage of bed-based mental health clinical services and general hospital admissions both significantly decreased (with overall net savings of A$3096 per participant per annum). Overall cost savings (including housing) to government ranged from A$1149 to A$19837 depending on the housing type comparator. Conclusion The Doorway program secured housing for this vulnerable group with additional benefits in client outcomes, including reduced use and cost of health services. These findings, if confirmed in larger studies, should have widespread applicability internationally. What is known about the topic? Beneficial effects of housing and recovery programs (Housing First) on people with severe and persistent mental illness and who are 'at risk', or actually homeless, are being demonstrated in Northern America. These effects include housing security, well being, health service utilisation and cost effects on government. However, these beneficial effects can only be regarded as settled for housing security. The highly innovative Doorway care model in which participants source and choose properties through the open rental market, with appropriate rental subsidy and brokerage support, has not been investigated previously. What does this paper add? This paper adds new data on the Doorway care models, it's effects and costs, particularly with regard to participant behavioural distress and social functioning. What are the implications for practitioners? The beneficial effects of this innovative model, if confirmed in larger studies, should have widespread applicability internationally.

Media reports on dementia: quality and type of messages in Australian media.

AIM: To analyse changes in the quantity and quality of media reporting about dementia in Australian media between two time periods. METHODS: A media retrieval service collected all news items related to dementia. Quality ratings based on previously developed criteria were made for a stratified random sample of items - 1129 items for 2000/2001 and 1606 for 2006/2007. Nine items of quality were assessed. A summary score for quality was constructed. The content of the sampled media items was also coded. RESULTS: Overall, the mean total quality score for dementia-related items significantly improved over the study period. There were very large improvements in quality of reporting of 'sensationalism', 'language' and 'provision of information about help services' and some small deterioration in quality for 'medical terminology' and 'illness versus person'. CONCLUSIONS: A very positive finding here is that generally the quality of reporting dementia has improved over the period studied.

Helping smokers with depression to quit smoking: collaborative care with Quitline.

OBJECTIVES: To report smokers' evaluations and uptake of Quitline-doctor comanagement of smoking cessation and depression, a key component of the Victorian Quitline's tailored call-back service for smokers with a history of depression and to explore its relationship to quitting success. DESIGN, PARTICIPANTS AND SETTING: Prospective study followed Quitline clients disclosing doctor-diagnosed depression (n = 227). Measures were taken at baseline (following initial Quitline call), posttreatment (2 months) and 6 months from recruitment (77% and 70% response rates, respectively). MAIN OUTCOME MEASURES: Uptake of comanagement (initiated by fax-referral to Quitline), making a quit attempt (quit for 24 hours), sustained cessation (> 4 months at 6-month follow-up). RESULTS: At 2-month follow-up, 83% thought it was a good idea to involve their doctor in their quit attempt, 74% had discussed quitting with their doctor, and 43% had received comanagement. In all, 72% made a quit attempt, 37% and 33% were abstinent posttreatment and at 6 months, respectively, and 20% achieved sustained cessation. Among participants who discussed quitting with their doctor, those receiving comanagement were more likely to make a quit attempt than those who did not receive comanagement (78% v 63%). Participants with comanagement also received more Quitline calls (mean 4.6 v 3.1) - a predictor of sustained cessation. Exacerbation of depression between baseline and 6 months was reported by 18% of participants but was not related to cessation outcome. CONCLUSION: Quitline-doctor comanagement of smoking cessation and depression is workable, is valued by smokers, and increases the probability of quit attempts. Smoking cessation did not increase the risk of exacerbation of depression.

A user assessment of a smaller hospital surveillance program.

Forty-five infection control nurses responded to a survey that assessed a smaller hospital (<100 acute care beds) surveillance program. Most respondents (96.6%) agreed that participation in the program was useful. Only a few program elements that need further development were identified. Approximately half (52.3%) of the respondents agreed that the surveillance reports were easy to understand. The most frequent (72.9%) use of these reports was to present information to accreditation organizations. Approximately half (46.2% and 50%, respectively) of the respondents disagreed that the Web-based education package or the workplace visits by "educators" were useful.

MRSA infections in smaller hospitals, Victoria, Australia.

BACKGROUND: Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) cause significant morbidity, mortality, and associated costs. METHODS: Trained infection control (IC) nurses in 84 smaller (<100 acute beds) hospitals during a 20-month period collected data on MRSA infections. RESULTS: The aggregate rate for all MRSA infections confirmed by the Victorian Hospital Acquired Infection Surveillance System Coordinating Centre IC nurse was 1.5 per 10,000 acute care occupied bed days (OBDs) (95% CI: 1.2-1.8). MRSA infections of 0.5 per 10,000 OBDs were detected >48 hours after admission (95% CI: 0.3-0.7). The aggregate rate for MRSA infections in sterile sites was 0.2 per 10,000 OBDs (95% CI: 0.0-0.4) and in nonsterile sites was 1.3 per 10,000 OBDs (95% CI: 1.0-1.6). CONCLUSION: The results suggested that serious MRSA infections in Victoria's smaller hospitals are an infrequent event. Most are "inherited" either from the community or other health care facilities.

Implementation of a pilot surveillance program for smaller acute care hospitals.

BACKGROUND: An infection control (IC) surveillance program for smaller (<100 acute beds) hospitals was piloted for 18 weeks in 14 hospitals. The aim of the pilot stage was to test a theoretical program in the context in which it was to be implemented. METHOD: An evaluation framework was developed, outlining the program's intended activities for data collection, management, analysis, reporting, and use. This framework was used as a reference to interview each of the 12 IC nurses participating in the pilot stage. RESULTS: The preferred case finding methodologies were not uniformly applied. Management, analysis, and reporting of data were delayed because of infrequent and irregular IC hours and laboratory reporting. Reports were not always distributed to key persons. Specific action was only taken in response to the process (and not outcome) module reports. CONCLUSION: Discrepancies between the theoretical and actual implementation of a surveillance program for smaller hospitals were highlighted. The program will need to be revised before it is rolled out to all 89 eligible hospitals across Victoria.

Quality of data reported to a smaller-hospital pilot surveillance program.

This data quality study assessed the accuracy of data collected as part of a pilot smaller-hospital surveillance program for methicillin-resistant Staphylococcus aureus (MRSA) infection and bloodstream infection (BSI). For reported MRSA infection, estimated values were as follows: sensitivity, 40%; specificity, 99.9%; and positive predictive value, 33.3%. For reported BSI, estimated values were as follows: sensitivity, 42.9%; specificity, 99.8%; and positive predictive value, 37.5%.

Surgical antibiotic prophylaxis in smaller hospitals.

BACKGROUND: In 2004, The Victorian Hospital Acquired Infection Surveillance System Coordinating Centre established a smaller hospital (<100 beds) surveillance programme that included an optional 'surgical antibiotic prophylaxis' (SAP) module. Appropriate SAP is believed to be one of the most effective strategies to reduce surgical site infections after certain surgical procedures. METHODS: Trained infection control nurses in the participating hospitals were asked to collect SAP data for the first 50 consecutive procedures that could be classified into 1 of 12 surgical groups. The choice, timing and duration of antibiotics were compared against the Australian Therapeutic Antibiotic version 12 Guidelines and the US National Surgical Infection Prevention Project Advisory Statement. RESULTS: Fifty-one of the 87 smaller hospitals that participated in the surveillance programme of The Victorian Hospital Acquired Infection Surveillance System Coordinating Centre carried out surgery. Over 20 months, 25 of these hospitals contributed data on 1872 procedures. Antibiotic choice, timing and duration were 52.6, 54.7 and 76.1%, respectively, concordant with published recommendations. For antibiotic choice in five surgical groups (appendectomy, colon surgery, gastric surgery and abdominal and vaginal hysterectomies), less than half of the procedures were concordant with the Australian Therapeutic Antibiotic Guidelines. CONCLUSIONS: Substantial opportunities exist in smaller hospitals to improve compliance with published SAP recommendations. Further studies are required to determine the reasons for poor compliance with these recommendations.