Geographical Access to Child and Family Healthcare Services and Hospitals for Africa-Born Migrants and Refugees in NSW, Australia; A Spatial Study.

Background: African-born migrants and refugees arriving from fragile states and countries with political and economic challenges have unique health needs requiring tailored healthcare services and support. However, there is little investigation into the distribution of this population and their spatial access to healthcare in Australia. This paper reports on research that aimed to map the spatial distribution of Africa-born migrants from low and lower-middle-income countries (LLMICs) and refugees in New South Wales (NSW) and access to universal child and family health (CFH) services and hospitals. Methods: We analysed the Australian Bureau of Statistics 2016 Census data and Department of Social Services 2018 Settlement data. Using a Geographic Information System mapping software (Caliper Corporation. Newton, MA, USA), we applied data visualisation techniques to map the distribution of Africa-born migrants and refugees relative to CFH services and their travel distance to the nearest service. Results: Results indicate a spatial distribution of 51,709 migrants from LLMICs in Africa and 13,661 refugees from Africa live in NSW, with more than 70% of the total population residing in Sydney. The Africa-born migrant and refugee population in Sydney appear to be well served by CFH services and hospitals. However, there is a marked disparity between local government areas. For example, the local government areas of Blacktown and Canterbury-Bankstown, where the largest number of Africa-born migrants and refugees reside, have more uneven and widely dispersed services than those in Sydney's inner suburbs. Conclusion: The place of residence and travel distance to services may present barriers to access to essential CFH services and hospitals for Africa-born refugees and migrants. Future analysis into spatial-access disadvantages is needed to identify how access to health services can be improved for refugees and migrants.

Prevalence of intellectual disability in New South Wales, Australia: a multi-year cross-sectional dataset by Local Government Area (LGA).

The presented dataset relates to a research project titled "My Home My Community" undertaken at University of Technology Sydney (UTS) which has been funded by the National Disability Insurance Agency (NDIA) Australia. The dataset reports estimated prevalence rates of Intellectual Disability in NSW by local government area (LGA) from 2010 - 2015. The dataset is a re-examination of a cohort of 92, 542 people with intellectual disability from a larger linked research dataset built by the Department of Developmental Disability Neuropsychiatry, School of Psychiatry, UNSW. The dataset in this paper is presented in a multi-year cross-sectional format. The cohort of people with Intellectual Disability was analysed to estimate, quantify and visualise where people with intellectual disability live in New South Wales (NSW). The cohort analysed in this dataset had been generated in an earlier project undertaken by the UNSW-based authors. This dataset was generated to share with local governments in Australia and has the potential to be more widely used in a range of health policy and planning research, and city and regional planning research environments. It represents one of the only datasets currently available in Australia on Intellectual Disability describing prevalence rates at a local government area level. This dataset allows for population comparisons in other Australian states and internationally and can be examined in combination with other social and economic datasets to continue to build evidence about disability, planning and geography.

A Spatial Dashboard for Alzheimer's Disease in New South Wales.

This paper illustrates a proof of concept scenario for the application of comprehensive data visualisation methods in the rapidly changing aged care sector. The scenario we explored is population ageing and the dementias with an emphasis on the spatial effects of change over time at the Statistical Area 2 (SA2) level for the state of New South Wales. We did this using a combination of methods, culminating in the use of the Tableau software environment to explore the intersections of demography, epidemiology and their formal cost of care implications. In addition, we briefly illustrate how key infrastructure data can be included in the same data management context by showing how service providers can be integrated and mapped in conjunction with other analyses. This is an innovative and practical approach to some of the complex issues already faced in the health and aged care sectors which can only become more pronounced as population ageing progresses.

A Virtual Earth Model of the Dementias in China.

This developmental project was undertaken to explore how applying spatial science analysis and visualisation methods might inform societies undergoing significant structural and demographic change. China is rapidly transitioning to an aged society. It already exceeds all other countries in its population aged 65 years and over. Dementia is closely correlated with ageing and intersects with a variety of physical and cognitive disabilities. Information dashboards are a growing part of health and social policy data environments. These visual data applications increasingly include mapping capabilities. In this paper, we explore the utility of a geographic modelling approach to exploring the complex nature of population ageing and the dementias in China.

Hospital autopsy: Endangered or extinct?

AIM: To determine the hospital autopsy rate for the UK in 2013. METHODS: A study of data from a 'Freedom of Information' request to all (n=186) acute NHS Trusts within England (n=160), NHS Boards in Scotland (n=14) and Wales (n=7) and Social Care Trusts in Northern Ireland (n=5). Hospital autopsy rates were calculated from the number of hospital autopsies performed in 2013 as a percentage of total inpatient deaths in the Trust that year. RESULTS: The UK response rate was 99% (n=184), yielding a mean autopsy rate of 0.69%. The mean rates were 0.51% (England), 2.13% (Scotland), 0.65% (Wales) and 0.46% (Northern Ireland). 23% (n=38) of all included respondents had a rate of 0% and 86% (n=143) a rate less than 1%. CONCLUSIONS: The decline in hospital autopsy has continued relentlessly and, for better or for worse, the practice is on the verge of extinction in the UK. The study highlights to health professionals and policy makers the magnitude of this decline. Further research should investigate the impact of this on patient safety, clinical audit, public health and medical education.

A virtual aged care system: when health informatics and spatial science intersect.

Healthcare systems are increasingly adapting to address the issues associated with population ageing. The shift to chronic diseases and a rise in neuroepidemiological conditions, associated with rising life expectancies, means that continued change and accommodation will be required of our health and social support systems. Current social policy environments developed out of early approaches to state-supported health and welfare service provision, most now a century or more old. A feature of these systems has often been a formal separation between them, into silos, that does not and cannot effectively address the issues raised by a growing population of older people. This is especially true in the context of community-based care where the majority of older people currently live and where governments hope to keep more elderly people living into the future. This objective will require a far more sophisticated and responsive approach to the health information environment than is currently the case. One strategy for improving this scenario is the development of augmented and virtual environments that collect and analyse real-time data on which health professionals and support staff can act in a timely manner. In this paper we explore some aspects of a virtualised aged care system and provide some examples of how this would enhance our current strategies for aged care.

Globalising health informatics: the role of GIScience.

Health systems globally are undergoing significant changes. New systems are emerging in developing countries where there were previously limited healthcare options, existing systems in emerging and developed economies are under significant resource pressures and population dynamics are creating significant pressures for change. As health systems expand and intensify, information quality and timeliness will be central to their sustainability and continuity. Information collection and transfer across diverse systems and international borders already presents a significant challenge for health system operations and logistics. Geographic information science (giscience) has the potential to support and enhance health informatics in the coming decades as health information transfers become increasingly important. In this article we propose a spatially enabled approach to support and increasingly globalised health informatics environment. In a world where populations are ageing and urbanising and health systems are linked to economic and social policy shifts, knowing where patients, diseases, health care workers and facilities are located becomes central to those systems operational capacities. In this globalising environment, health informatics needs to be spatially enabled informatics.

A spatial informatics for aged care.

Population ageing is the demographic process that characterises the first half of the twenty-first century. Australia's population is already ageing and the states and territories are ageing at different rates. Our understanding of the dementias remains limited and diagnosis in primary care settings is poor. Locating where older people with dementia are and how they are coping is an emerging need in health information management. In this paper we discuss how a spatially informed health information management system could support population ageing and the disconnected systems that address ageing. We illustrate this with examples from our work to show how spatial informatics can advance our understanding of and response to the implications of population ageing.

Dead in the water--are we killing the hospital autopsy with poor consent practices?

It is now a recognized fact that the practice of conducting a consent (or hospital) post-mortem examination is in decline. There have been many reasons put forth to explain this demise, but the quality of the consenting process is frequently cited as having a high impact. This article focuses on consent practices for post-mortem examinations in England and Wales, and considers if our consent techniques are adversely affecting post-mortem examination uptake. We examine the regulatory compliance of trusts with their statutory obligations by analyzing the Human Tissue Authority's compliance and inspection reports. We further analyze 21 publicly available NHS Trust policies on post-mortem examination consent procedures, and consider whether these are fit for the purpose of meeting the dual needs of clinicians and the bereaved. Despite more Human Tissue Authority inspections, there is a disproportionate rise in enforcement actions, with up to 48% of sampled Trusts exhibiting shortcomings in their legal duties. Additionally, only 52.4% of sampled trusts follow the Human Tissue Authority best-practice model, with 23.8% having no documented procedures. Despite the well founded evidence base for best-practice models, consent practices for post-mortem examinations remains poor and is likely to have a gross adverse effect on the rate of post-mortem examinations. We recommend that NHS Trusts rigorously review their protocols and introduce a team-approach between clinicians and trained bereavement staff in core-consent teams, as the Human Tissue Authority suggests, whilst at the same time placing a strong emphasis on education for junior and senior colleagues alike.